In 1999, a sub-group of NATVNS members agreed tolead the production of the framework, with their statedaims being:1. To define tissue viability speciaLst nursing2. To provide a framework for TVNSs to work within3. To form a basis for clinical supervision and mentorship4. To inform curricula for tissue viability education.Midway through the project, the National Associationwas balloted in order to elicit opinion on theappropriateness of the frameworks and support for its'development. Over the last 2 years, the group, with achanging and evolving membership, has worked to listaspects of practice that are undertaken by TVNS, using amodified Delphi technique to enable achievement ofconsensus.

ResultsUsing a combination of models, a framework has evolvedthat clearly defines the multifaceted nature of the role. Theframework lists competencies, which are further brokendown into specific role elements, matched with measurableperformance criteria for the TVNS.

The competencies were piloted by a representativesample (30%) ofTVNSs from across Scotland. 1ncluded inthis pilot group were TVNSs who were either newlyappointed or experienced, and with responsibility forpaediatrics, acute, community, combined acute andcommunity NHS trust, and private sector. Following thepilot, some minor modifications were made to theformative document.

The competency statements that are provided withinthe publication describe the attitude, knowledge and skill,which are of equal importance, required to fulfill theTVNS role. The statements included are assessable andmeasurable. Examples of how to achieve each competencyare given and evidence must be provided for three areas:knowledge, attitude and skills.

The framework is first a definition of practice but mayalso be used to allow peer review. It will provide aminimum standard for benchmarking, and may form abasis for clinical supervision and curriculum development.Although unlikely to be descriptive of the work of everyTVNS it does form a structure that may be used to writejob descriptions, to support mentorship and clinicalsupervision, within a format that will allow all TVNSs todevelop. It is not intended to be a restrictive document,rather a framework on which to build excellence inpractice.

ConclusionThe document entitled 'An Enhanced Route toCompetence for Tissue Viability Nurse Specialists'l waspublished in June 2002, under the NES Quality AssuringContinual Professional Development banner.

The Scottish Executive has committed to explore andimplement competency-based education through 'Caring

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for Scotland', the nursing and midwifery strategy. Thisinitiative meets the national need for definition ofspecialist practice and provides a standard by which thepublic can be assured of quality care from TVNS inScotland.

NHS Education for Scotland. An Enhanced Route toCompetence for Tissue Viability Nurse Specialists. Edinburgh:NHS Education for Scotland, 2002.

Panel debate: Pressure area careequipment - Whose responsibility is it interms of selection, provision,maintenance and staff education?This panel discussion opened with a presentation fromeach of the four panel members. Their abstracts arereproduced below in the order in which each panelmember presented.

Brough H, NHS Purchasing & Supplies Agency

The NHS PurchaSing and Supply Agency (NHS PASA)exist to provide a national procurement service to you. Theauthor will to focus on what NHS PASA offers ion terms ofassisting you on each aspect of selection, provision,maintenance and staff education of pressure area careequipment and ask 'Can we do morel'

SelectionThe national framework agreement for pressure area careequipment offers a full range of quality products, alongwith price discount structures from vetted suppliers, givingyou an informed choice to assist in your deCiSion-makingprocess. Does it meet your needs or is it a benchmarkingtool?

ProvisionEquipment can be provided through purchase, lease, rentalor a bed facilities management route. 1s one best or do theyall have a place?

MaintenanceMaintenance is conducted in the main at trust levelthrough suppliers_ Could PASA add value at a nationallevel?

Staff educationPASA is presenting and raising awareness of the servicesoffered to you to assist you in the procurement process.How else might PASA add value?

Knowles C, Royal Devon & Exeter NHS Trust

This presentation will consider the ideal, and focus onpossible ways to ensure that a patient's identified need forpressure relief is met within a limited resource. The

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TISSUE VIABILITY SOCIETY CONFERENCE ABSTRACTS

registered nurse's responsibility for assessment, careplanning and evaluation will be reviewed. Discussion onthe benefit of a specialist overview will be considered.The special needs nursing scheme will be used toillustrate how it is possible to manage equipmentselection, provision, maintenance and staff education.Discussion points will be included on the perceivedprivate sector's responsibility for these issues combinedwith the NHS's duty of care.

Rush A, Berkshire Community EquipmentServices, Wokingham Primary Care Trust

Changes in health-care technology and clinical practicemeans that there has been a considerable increase invariety and number of support surfaces of vastly differingprices. This author asks the question 'who is legallyresponsible?' for a number of different aspects ofequipment provision.

Is the selection of equipment the responsibility of the:

• Manufacturer• Provider• Professional/carer• Individual named person• Research and development groupor all of these, or others7

Is the provision of equipment the responsibility of the:

• Manufacturer• Provider• Professional/carer• End user/relativesor all of these, or others?

Is the maintenance of the equipment the responsibilityof the:

• Manufacturer

• Provider• Professional/carer• End user/relativesor all of these, or others7

Is education the responsibility of the:

• Manufacturer

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• Provider• Organisation• Professional/careror all of these, or others?

Tetlow S, Park House Healthcare Ltd

As part of the debate on pressure care equipment thissection will be on behalf of the manufacturer/supplier. Thissection of the debate will look at:

Selection• Are assessment tools overused or misused in selecting

pressure care equipment7

Provision• Do we cater for 24-hour care7 If so does the prescriber

have the knowledge and competency to prescribeappropriately?

Maintenance• Do the prescribers and end users of the equipment treat

the equipment as though it was their own?• Do manufacturers offer appropriate traInIng,

information and after sales back-up to enable theprescriber to troubleshoot and use the equipmentappropriately?

Staff education• Do manufacturers, organisations and prescribers work

together to ensure competency through training andeducation as identified in the NICE pressure ulcerprevention guideline I, and are these realisticguidelines?

These comments are intended to be thought provoking.

National Institute for Clinical Excellence. Pressure ulcerprevention: Pressure ulcer risk assessment and prevention,including the use of pressure relieving devices (beds, mattressesand overlays) for the prevention of pressure ulcers in primaryand secondary care. London: National Institute of ClinicalExcellence, 2003.

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