RCN competences · RCN COMPETENCES: AN EDUCATION AND RAINING RAMEWORK OR AURAL CARE NURSING AND REATMEN PROVISION 2 RCN Legal Disclaimer This publication contains information, advice

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RCN competences:an education and training framework for aural care nursing and treatment provisionUpdate 2018

RCN COMPETENCES: AN EDUCATION AND TRAINING FRAMEWORK FOR AURAL CARE NURSING AND TREATMENT PROVISION

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RCN Legal Disclaimer

This publication contains information, advice and guidance to help members of the RCN. It is intended for use within the UK but readers are advised that practices may vary in each country and outside the UK.

The information in this booklet has been compiled from professional sources, but its accuracy is not guaranteed. Whilst every effort has been made to ensure the RCN provides accurate and expert information and guidance, it is impossible to predict all the circumstances in which it may be used. Accordingly, the RCN shall not be liable to any person or entity with respect to any loss or damage caused or alleged to be caused directly or indirectly by what is contained in or left out of this website information and guidance.

Published by the Royal College of Nursing, 20 Cavendish Square, London, W1G 0RN

© 2018 Royal College of Nursing. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording or otherwise, without prior permission of the Publishers. This publication may not be lent, resold, hired out or otherwise disposed of by ways of trade in any form of binding or cover other than that in which it is published, without the prior consent of the Publishers.

AcknowledgementsSpecific thanks to the following:The Royal College of Nursing (RCN) would like to thank the following committee members of the RCN ENT/Maxillofacial Nursing Forum for their work in rewriting, revising and proof reading this document and the production of supporting evidence in keeping with current practice: Andrew Hill, ENT Advanced Nurse Practitioner, University Hospitals NHS Foundational Trust Bristol Angela Griggs, Quality and Safety Manager, The Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Foundation Trust and Lecturer Practitioner ENT Nursing at City University of London. Kathryn Markham, Advanced Nurse Practitioner ENT. University Hospitals Birmingham NHS Foundation Trust, Heartlands HospitalJudith Muir, Matron Head & Neck and Ophthalmology, Gloucestershire Hospitals NHS TrustMichelle Tait, Advanced Nurse Practitioner, North Cumbria University Hospitals, NHS Trust Cumberland Infirmary, Carlisle

We would also like to acknowledge the original forum committee and working group from 2012 for formulating the competences and how this integrates with potential training needsStaff within the RCN who helped get this document to publication. The ENT/Maxillofacial Nursing forum for the efforts and collaborative working. Finally to the ENT/Maxillofacial Nursing forum network which has provided informed comment that means the document is relevant to current clinical practice.

ROYAL COLLEGE OF NURSING

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1 Purpose and scope of this document 3

2 Aural treatment: clarification of roles 6

3 Aural treatment nursing competences 7

Practice and service development 7

Teaching and education 9

4 Aural treatment nursing competences:

Specialist psychological/psychosocial/physical interventions 10

Counselling 10

Assessment, investigation and treatment 12

Lifestyle 16

Management of deterioration in pre-existing ear conditions 17

Teaching self care skills 19

Specialist clinical interventions – topical/systemic treatments 20

Skills for health competences and references 21

5 Useful organisations and their websites 23

Contents


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1. Purpose and scope of this document Competence can be defined as: “The state of having the knowledge, judgement, skills, energy, experience and motivation required to respond adequately to the demands of one’s professional responsibilities” (Roach, 1992).

IntroductionAural care is a common and frequently practiced skill in both primary and secondary care. The provision of such a service provides management of chronic conditions preventing hospital admission with acute exacerbations as well as treatment of acute ear conditions. Aural care essentially provides optimisation of ear conditions and decreasing aural symptoms that may otherwise hinder daily life, for example diminished hearing, otalgia or ottorrhoea. The goal for managing patients with these disorders is for them to live a life as free as possible from clinical and psychological complications. It is vital that aural care services continue to be seen as essential as the population demographic become older and the need for hearing aid use increases (DWP 2017). It is estimated that 11 million people have hearing loss and will increase to 15.6 million by 2035 (Action on hearing loss 2015). This in turn is likely to increase the need for aural care services both in the NHS and private sectors.

Since the release of this document in 2012 nurse education and clinical service provision has moved forward but equally has become increasingly divergent with minor differences in health care ideologies between the 4 countries of the UK. As NHS services modernise and have to find more effective ways of working many ENT and aural care services have become squeezed. It is therefore vital that such services have a robust framework of service provision, training, education as well as the maintenance of standards regardless of the grade of nurse providing that service.

With the advent of Revalidation (NMC 2016) our knowledge, skills, care and treatment provision are more formally considered. This crystallises and portrays the importance of what we do and that public safety is all our concern. The NMC standards for competence for registered nurses

(2104) apply in all fields of nursing and are set out four main areas.

• Professional values

• Communication

• Nurse practice and decision making

• Leadership

Within these areas we are professionally obligated to demonstrate knowledge and competence; it is the aim of this document to endorse this position.

Many adults will be cared for in primary care, through out of hours services, walk-in clinics and GP surgeries. A significant number of patients will be referred on to secondary care settings either for ongoing management or access to specific equipment and skills. Health care professionals in both these settings must be able to demonstrate relevant knowledge, competence, skills and experience in the provision of aural care.

The importance in recognising this need and acknowledging the scope of the aural care practitioner is essential. Aural care and ENT nurses from across the UK have developed this RCN competency framework.

The framework aims to establish explicit, nationally-agreed role profiles for adult aural care nursing roles, in order to:

• Support practitioners in career planning and personal development

• Guide further role development and educational preparation

• Inform future pay negotiations

• Support managers in workforce planning and in developing role requirements/job descriptions for specific posts.

Advancing practice in our field leads to increasing autonomous practice. It is therefore import to pathways of education, training and maintenance of competence not only for the place of work but to be truly interchangeable and recognised by other Trusts. This will ensure mobility within the workforce


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Roaches (1992) original definition is further endorsed by Casey et al (2017) position of putting competency into practice.

“Competence incorporates knowledge, skills, attitudes, professionalism, application of evidence and translating learning into practice. It is specific to the nurse’s/midwife’s role, organizational needs, patient’s needs and the individual nurse’s/midwife’s learning needs. Competencies develop over time and change as nurses and midwives work in different practice areas. Thus, role-specific competence is linked to recent engagement in practice” (Casey et al 2017)

The Health Safety Executive for the UK (2017) also sees competence in terms of application:

Competence can be described as: the combination of training, skills, experience and knowledge that a person has and their ability to apply them to perform a task safely. (HSE 2017)

What is a competence framework? A nurse is competent when she or he possesses the skills and abilities required for lawful, safe and effective professional practice without direct supervision. Competences can be thought of as underlying characteristics of individuals, which result in effective performance. These are described as a combination of knowledge, skills, motives and personal traits. Competence in this sense is generally seen in the way someone behaves.

A competence framework is a collection of competences that are thought to be central to effective performance. The aim of this competence document is to draw upon core issues and principles central to develop and maintain high standards of competence as well as professional integrity in the ENT and aural care nursing specialty.

The role framework The RCN framework draws upon previous competence developments and role definitions and in particular, builds on generic nursing role and knowledge and skills framework. It is therefore important to note that the Nursing and Midwifery Council (NMC) The Code: Professional standards of Practice and Behaviour for nurses and midwifes (2015) has public protection as its primary concern.

The role of the framework will allow the ENT and aural care nurse to provide a good foundation to deliver best possible practice using evidenced based approaches and provide a focus for the central process of keeping up to date.

In addition, The Standards of Medicine Management (NMC 2007) document make it clear the proficiency and standards needed for safe medicine management and specifically the relevant knowledge, competence, skills and experience in using patient group directives (PGDs) and patient specific direction (PSD).

The NMC recognises that safe, effective and appropriate adult nursing involves more than just the application of theory to practice.

Core role descriptors and competences The primary sources for the core role descriptors and competences were the Agenda for change knowledge and Skills framework and skills for health competences. References to these are given in the tables below.

The use of this as a framework focuses on the core skills and competences to underpin the role as an holistic aural care provider. Other descriptors may need to be added or revised when considering your specific job and service provision need. The levels within novice to expert (level 5 to 7) are not indicative of pay banding.


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2. Aural nursing care: clarification of roles

Level 5 Competent nurse

Aural care Nurse

Uses clinical judgement and individual decision-making in relation to the specialist nursing care and management of patients.

Undertakes a range of specialist clinical action without supervision or direction.

Level 6 Experienced nurse

Senior aural care Nurse

Uses clinical judgement and autonomous decision-making in relation to the specialist nursing care and management of patients.

Undertakes a range of specialist clinical actions within a specific setting after assessing patient need and care.

Level 7 Senior Practitioner/Expert Nurse

Specialist Aural care Nurse

Uses clinical judgement and autonomous decision-making in relation to the specialist nursing care and management of patients.

Undertakes a range of specialist clinical actions across a variety of settings after assessment of patient need and care.

When working at higher levels of practice (level 7) it is expected that the user meets all the lower criteria levels (5 and 6).


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3. Aural nursing care competences

Level Competence KSF Performance criteriaKnowledge and understanding

Attitudes and behaviours

Contextual factors

5 Promotes adherence to policy, standards and care delivery strategies related to the care and management of Adults with a range of ear conditions.Implements and participates in the evaluation of innovations in the Care of adults With earconditions.

Core 4 Level 2

Consistently adheres to all relevant policy, standards and care delivery strategies. Assertively challenges members of the care team where policies, standards and care delivery strategies are not adhered to. Raises concerns with senior members of the care team.Documentation clearly shows accurate and authentic records of interventions undertaken related to the Innovations in care. Provides accurate information to senior team members regarding the effects of treatment and progress made.

All related policies, standards and care delivery strategies used within own area of practice.

Aural treatment regimes applicable to adults in their care.

Assertive. Role modelling adherence to organisational policy, standards and care delivery strategies.

NICE guidelines in relation ENT conditionsNMC Record keeping guidance. NMC A-Z advice sheets. Legislation relating to consent. Skills for Health Competences Local policies and guidelines.NMC guide to record keeping (The Code)

6 Contributes to policy, standards development and care delivery strategies related to the care and management of adults with aural conditions.

Core 4 level 2

Policies and standards used within the clinical area are up to date and relevant to Current practice. Minutes of meetings show clear record of constructively Identifying issues with policies, standards, protocols and care delivery strategies that drive practice.

Constructive suggestions made to inform and review development of polices.Assist in the development of policies/standards.

Policy development. Standards development. Care delivery strategies. Aural treatment regimes and research applicable to aural care nursing and adults with ear conditions.

Innovations and research development in aural care.

Ensures knowledge and practice is current and reflects best practice.

Skills for Health PHP35, PHP40, Gen79

Practice and service development Indicative Key Stage Framework (KSF) dimension – Core 4 Service improvement


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Contextual factors

7 Formulates policy, standards and care delivery strategies related to the care and management of adults with aural conditions.

Core 4 Level 3

All policies and standards used in service delivery are current and valid.

Policy development. Standards development. Partnership working. Research/innovations in aural care and its applicability adults.

Actively develops and influences local and national aural care practice.

External agency working

Professionalism, role modelling and advancing practice

Skills for Health CompetencesPHP35, BA3, PHP40

Commissioning groups

Up holding NMC Code

NMC (2017) standards in professional practice

Core 4 Level 4

Accurate and comprehensive documentation pertinent to innovations implemented and evaluated within the practice setting.

Evaluation processes. Critical analysis. Audit processes. All available information and processes applicable to the innovations adopted within the practice setting.


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Contextual factors

5 Participates in education of adults, carers and junior nursing staff in the management of ear conditions.

Core 2 Level 3

Patient documentation clearly states the education provided to the adult and carer. Information file contains current information in relation to the management of ear conditions.

Teaching and assessing adults. Anatomy and physiology of normal ear nose, throat, head and neck. Pathophysiology of ear conditions, their care and management.

Empathetic. Effective communicator. Seeks advice and guidance. Checks understanding. Good practical demonstrator.

Patient support networks for ENT/aural conditions e.g.NMC (2008) standards to support learning and assessment in practice. ENT RCN network to discuss best practice.Skills for Health Competences, CHS56, CHS58, GEN18, GEN84, HSC23, PE6, PE7, LADD10.LADD13PE8, HSC23

6 Leads/provides group education and training of adults, carers, nursing staff and other professionals in the management of aural conditions.

G1 Level 3

Record of training plans, evaluation forms and handouts in addition to the requirements for Level 5.

Alert to individual learning needs within groups. Tailors education delivery to the needs of the individual.

7 Leads and develops specific education and training programmes for Adults, carers, nursing staff and other professionals across all care sectors, including teachers, peers and lay carers in the management of aural conditions.

G1 Level 4

Evidence of contribution to local and national programme/guideline development as a contributor.

ENT/Aural care Educational Programme Development. Training needs assessment.

Actively utilises all opportunities to educate others.

LADD03LADD05

Teaching and educationIndicative KSF dimension: G1 Learning and development


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4. Aural nursing care competencesSpecialist psychological/psychosocial/physical interventions

Counselling and consultationIndicative KSF dimension: HWB5 provision of care to meet health and wellbeing needs, HWB7 assessment and treatment planning.



Contextual factors

5 Identify adults within their care who may require additional support to manage long term health outcomes.

Core 1 Level 3 HWB2 Level 3

Patient records identify actual and potential needs and referral process initiated and recording of discharge planning.

Demonstrate effective communication with patients with hearing loss

Basic counselling and communication skills. Potential psychosocial impact of chronic ENT conditions. Roles and responsibilities of members of the multi-disciplinary team. Referral pathways available to area of practice. Knowledge of primary health care services.Understand how to communication aids can be used and the common types of hearing aids used.

Empathetic. Listens effectively. Recognises the impact of the patient’s condition on individuals. Approachable.

Recognise the need for openness and honesty regarding treatment options and side-effects.

Common assessment framework consent.Skills for health PE8 Skills for Health Competences CHS76 CHS98 Skills for Health Competences CHS98, CHS56

Action on hearing loss advice and fact sheet leaflets

ENT UK patient leaflets.

DVLA leaflets driving with medical conditions

Local Trust information leaflets

NHS choices information


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Contextual factors

6 Counsels adults about long term health outcomes on a proactive basis, liaising with other members of the multidisciplinary team.

HWB7 Level 3

Patient records demonstrate a clear plan of action implemented to address actual and potential needs and all communication with Records further referral to other professionals applicable to the person’s needs. Initiates and implements the need for ongoing care or discharge planning to primary care.

Long term health outcomes applicable to the ear conditions present with within your area of practice. Such Mastoid cavity management and chronic tympanic membrane perforation.Information available and its applicability/relevance explaining ongoing access to a service.

Provision of written leaflets and patient education.Know where to guide patient for further information.Simple resolution of hearing aid issues.

Communicates effectively. Actively engages relevant individuals. Actively seeks out relevant information.

Common assessment framework consent.Skills for health PE8 Skills for Health Competences CHS76 CHS98 Skills for Health Competences CHS98, CHS56

Action on hearing loss advice and fact sheet leaflets

ENT UK patient leaflets.

DVLA leaflets driving with medical conditions

Local Trust information leaflets

NHS choices information

7 Develops, implements and evaluates a variety of counselling and supportive members of the multidisciplinary team.

HWB7 Level 4

Patient records clearly identify need, action implemented, Patient records identify where expert psychological input is indicated and requested. Facilitates discharge planning and referral to other agencies. Information available and applicability/relevance to age group and level of understanding of child/young person. Care pathway applicable to patient.

Counselling and supportive strategies available and their strategies.Ability to access hearing therapy, tinnitus rehab and other audiology services as needed Refer for hearing assessments and reassessments

Questioning. Critical appraiser.


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Assessment, investigation and treatmentIndicative KSF dimension: HWB6 Assessment and treatment planning and HWB7 Interventions and treatments.



Contextual factors

5 Assesses adults inrelation to the management of their ear condition.

HWB6 Level 3

Accurate and comprehensively completed assessment of the adult recorded in the patient’s records.

Clear documentation of any ear condition that deviates from normal.

Follow lines of reporting and seeking advice.

Anatomy and physiology of normal ear, nose and throat. And how to record this. Understand whom to report identified deviations from normal and seek advice.

Be aware of simple ear treatments and the use of patient group directives in the treatment of ear conditions.

Recognition of own limitations. Adhering to the NMC Code of Professional Conduct. Prompt referral of problems to senior colleague or specialist.

NMC Code of Professional Conduct. Tools to support documentation of assessment.

Skills for health:CHS20, CHS168

Provides information.

Clear documentation of the Provision of accurate information specific to the needs the adult. With evidence of checking understanding and seeking further advice as required.

Information available. How to access and use information relevant to the needs of the adult and carers. This can be at local and national level

Ensures knowledge and practice is current and reflects best practice.

Skills for HealthCHS56 Competences ENT UK patient informationAction on hearing loss website

Skills for HealthCHS56 Competences ENT UK patient informationAction on hearing loss website

HWB7 Level 3

Effectively engages with the adult, reducing their anxiety and addressing any concerns identified. Refers to more experienced specialist nurse as required ensures theperson undergoes the required investigations safely.

Relevant ear investigations, their relevance and how they are undertaken. Actual and potential risks/complications associated with the required investigations. The role and responsibilities of the nurse in assisting with the investigation. How to prepare the patient for the investigation.

Listening and responding promptly to requests for specific equipment etc. Pre-empting needs.

Protocols and policies related to specific investigations.


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Contextual factors

5 Undertake simple ear treatments

HWB7 Level 3

Be able to remove wax safely /aural toilet and understand the limitations and risks of using the irrigation and microsuctionSafely undertake aural treatments with the aid of optical devices such as microscopes or ‘loops’Demonstrate skill and safe use of equipment needed.Refer to more experienced specialist nurse as required.Ability to carry out treatments and monitor progress of condition

Full understanding of anatomy and physiology of the earDemonstrate competent use of instruments and equipment.Knowledge and understanding of common topical aural preparationsDemonstrate clear documentation so a pathway of treatment can be seen.

Recognition of own limitations.Work within the scope of professional practice

NMC scope of professional practice. Protocols and policies related to the specific interventions.Skills for healthCHS20ENTUK.org

ENT Cochrane reviewEar drops for the removal of wax. (2016)


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Assessment, investigation and treatmentIndicative KSF dimension: HWB6 Assessment and treatment planning and HWB7 Interventions and treatments.



Contextual factors

6 Undertakes nurse-led assessment diagnoses and treatment of simple and intermediate ear conditions.

HWB6HWB7 Level 3-4

Documentation clearly shows an accurate and comprehensively completed assessment of the adult and their ear. Identification of the impact of the condition on the adult. Record a clear plan of treatment against a working diagnosis Records show relevant investigations implemented.

Able to assess, diagnose and treat simple and intermediate ear conditions and be able to consider long term management of chronic ear conditions.

Follow the guidance of patient group directives (PGDs).

Anatomy and physiology of normal ear nose and throatDemonstrate knowledge of pathophysiology of common more complex ear conditions. Understand and consider other ear investigations (e.g. audiograms and microbiology) and how they are undertaken.

Where, and how, to access support and advice.

Knowledge and understanding of the use of a range of ear treatments.

Use Patient Group Directives as appropriate

Self direction for learningReflection and evaluation of learning

NMC Code of Professional Conduct. Tools to support documentation of assessment.

Use of revalidation logs and reflection NMC (2016)

Skills for health:CHS20, CHS56, PE4, CHS152, CHS167

Formulates implements and evaluates a plan of care in conjunction with other aural care professionals or the multi-disciplinary team (MDT) if needed.

HWB6 Level 3

Patient documentation clearly shows the involvement of all relevant practitioners and their contribution to the plan of care. The plan of care clearly relates to all actual and potential needs identified in the nurse-led assessment. Patient records demonstrate clear implementation and ongoing evaluation and reassessment.

The roles and responsibilities of the MDT members and their individual contribution. Referral mechanisms and pathways available and how to use them.

Assertiveness. Inclusiveness. Advocacy.

Local service providers, e.g. social services, education, etc. Common assessment framework. Skills for Health Competences CHS41, CHS47, CHS56


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Contextual factors

7 Undertakes full independent nurse-led assessment and treatment management clinics and able to manage a full range of ear conditions.

Be available to support less experienced nurses in assessment

HWB6HWB7 Level 4

Ability to competently assess ear nose and throat recognising deviation from the norm and formulation of diagnosis and treatment plan for ear conditions

Ability to follow treatment plan through to conclusion or develop a long term management plan

Appropriately refers to other members of the ENT team. For example consultant otologist for cases outside the realm of ear treatment clinics

Use PGDs or be independent non medical prescriber

Anatomy and physiology of normal ear nose and throat. Pathophysiology of common ENT conditions. Knowledge common ENT treatments and predicted outcomes of their use.

Full understanding of aural pathophysiology the impact of care and treatment decisions.

Awareness of more rare ear presentations

Understand how other ENT conditions and treatments impact on aural care.

Be able to request audiological testing

Understand and interrupt audiological tests and act accordingly

Understand results of microbiology tests in order to direct treatment.Understand the significance and pharmacology of topical ear treatments.

Leadership.Decision making. Awareness. Team and collegiate support and guidance.

Local and national protocols. Skills for Health Competences as above and CHS47, CHS83, PE1, CHS225, CHS40, CHS41British society of audiology

Changing medical treatments and equipment

NMC prescribing standards


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LifestyleIndicative KSF dimension: HWB1, HWB4 Enablement to address health and wellbeing needs.



Contextual factors

5 Provides support and information. Advise adults in lifestyle changes, referring to aural care/ ENT team as appropriate.

Core1HWB1 Level 1

Document the constraints the ear condition may have on lifestyle.

Consider patient occupation. Recognise of aural condition for the patient work place.

Anatomy and physiology of the ear nose and throat. Normal ear nose and throat function.

Understand how lifestyle and daily activity can affected by ear conditionsRecognise potential stressors on ability to manage aural conditions. Strategies to address any deviation.

Have a breadth of knowledge to advise and guide patients with ear conditions in order promote heath and prevent further ear problems

Enabling. Empowering. Supportive. Empathetic.

Advise.

Patient support networks – see appendix. DH guidelines re education. Skills for Health Competences. CHS56GEN98, PE1ENTUK.orgAction on hearing loss leaflet

6 Provides support, information and detailed advice on lifestyle changes and long-term implications of ear conditions referring to other members of the ear team as appropriate.

HWB1 Level 3 HWB4 Level 3

Documentation shows effective liaison with relevant personnel and appropriate advice given.

Local educational policy in relation to health needs. Skills for health competences PE8

7 Addresses requirements to, developing the care pathway in conjunction with the MDT.Evidence based approaches.

HWB4 Level 4

Documentation shows effective liaison with education and social personnel, and identifies difficulties and resultant action taken.

Referral pathways for psychosocial interventions.

Hearing therapy, Tinnitus rehabilitation, balance retraining.

Impact for patient occupation

Referral pathways for psychosocial interventions.

Hearing therapy, Tinnitus rehabilitation, balance retraining.

Impact for patient occupation


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Management of deterioration in pre-existing aural conditions Indicative KSF dimension: HWB7 Interventions and treatments



Contextual factors

5 Recognises signs of deterioration of ear conditions and implications for management.

HWB6 Level 3

Patient documentation clearly demonstrates recognition of signs of deterioration and referral to specialist ENT team or otologist.

ENT conditions. Recognise deviation from the norm. Signs and symptoms of exacerbation ear conditions and related implications.

Observant. Promptly reports and records any concerns. Seek help advice and clinical support

Firm understanding and recognition of the normal ear anatomy and appearances of the altered surgical ear.

Skills for Health Competences. CHS47

Ear atlaswww.earatlas.co.uk

ENTUKCHS20

6 Instigates investigations and treatment applicable to the nature of deterioration. Adjusts treatment according to local protocols, as appropriate.

HWB7 Level 3

Patient documentation clearly records the instigation of the correct investigations and treatment according to local policies/ procedures/ protocols. Patient documentation clearly demonstrates adherence to local protocols.

How to recognise the adverse effects of bacteria, virus, fungus, medications, environmental and other triggers on ear conditions. Understand and request relevant investigations. Understand and use treatment regimes available. Indications for the instigation of treatment. Side-effects and complications with identified treatments (actual and potential). Local protocols relating to the adjustment of treatment regimes.

Ensures appropriate actions implemented in response to concerns reported.

Local protocols. Skills for Health Competences CHS47. Awareness of EC11K.

ENT Cochrane reviewEar drops for the removal of wax. (2016)

Interventions for acute otitis externa (2010)


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Contextual factors

7 Provides advice on unusual/difficult cases with rare or multiple pathology/ear conditions. Locally and nationally recognised expert in aural conditions.

HWB7 Level 4 Core 1 Level 4

A recognised expert and used as a resource in identification ear conditions.

In-depth knowledge of ear conditions and knowledge of common ENT conditions.

Approachable. Guides others. Effective Communicator. Confident. Decisive. Instils confidence in others. Self aware.Consultant liason.

EC11K


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Teaching self care skillsIndicative KSF dimension: HWB4 Enablement to address health and wellbeing needs



Contextual factors

5 Supports the adult and carers in managing the condition.

HWB4 Level 2

Patient records demonstrate appropriate information, advice and support provided to the adult to address their needs in managing their ear condition, including seeking advice/support from expert Specialist practitioner.

Basic technical and theoretical knowledge of ear conditions, their management and treatment.

Approachable. Supportive. Good practical demonstrator. Good communicator. Enabling.

Patient support networks. Skills for Health Competences PE4.

ENT UK patient leaflets

NHS choices

Action on hearing loss leaflets (2017)Eg wax management. Ear care when flying.

6 Facilitates adults empowerment by assessing and teaching them, technical knowledge and theoretical understanding of management of ear conditions.

HWB4 Level 3

How to assess the adults and their family’s training needs. Treatments. Technical and theoretical management ear conditions.

Effective communicator. Empowering. Knowledgeable.

7 Facilitates adults empowerment by assessing and teaching them and basic and more complex knowledge and theoretical understanding of self management, including recognition of exacerbations and infections.

HWB4 Level 4

Used as a resource to empower the adult carers in the self management of their ongoing condition.

Assessment of the adults training needs to enable self management.

Autonomously have an in-depth knowledge aural condition and surgeries to provide best evidential advice


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Specialist clinical interventionsTopical/systemic treatments – Indicative KSF dimension: HWB7 Interventions and Treatments



Contextual factors

5 Applies topical treatments as per prescription.

HWB5/ HWB4 Level 3

Correctly applies the topical treatment. Correct completion of the prescription documentation. Patient records clearly demonstrate evaluation of the medication.

Understand the role and how to monitor the effect of systemic treatments. Who to contact for specialist advice/support.

Good communicator. Supports the adult to ensure that the treatment is applied correctly. Practical.

Skills for Health Competences. PHARM 29, GEN135

NMC (2006 up date 2011) standards in prescribing

6 Assess adjusts treatments according to adults individual needs, adhering to local protocols/ PGDS.


Patient documentation clearly demonstrates adherence to local protocols.

Knowledge of local protocols and procedures covering sphere of practice. Knowledge of systemic treatments used to inform clinical judgements.

Observant. Knowledgeable. Confident.

7 Assesses and adjusts topical treatments using PGD’s or as an independent non- medical prescriber.


Patient documentation clearly demonstrates correct assessment of the adults condition and the resultant appropriate adjustment to the treatment regime.

Knowledge of systemic treatments to make informed clinical judgements.

Decisive. Safe.Timely.


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5. Skills for Health Competences and referencesAction on Hearing Loss (2017) Patient leaflets www.actiononhearingloss.org.uk/how-we-help/information-and-resources/publications/hearing-health/

Action on Hearing Loss (2015), Hearing Matters, Action on Hearing Loss, London www.actiononhearingloss.org.uk/supporting-you/policy-research-andinfluencing/research/hearing-matters.aspx

Burton M, Aaron , Warner L. (2016) Ear drops for the removal of wax. The Cochrane collaboration. John Wiley and son Ltd

Casey M, Cooney A et al (2017) Nurses’, midwives’ and key stakeholders’ experiences and perceptions on requirements to demonstrate the maintenance of professional competence. Journal of Advanced Nursing; vol. 73 (no. 3); p. 653-664.

DH (2004) The NHS Knowledge and skills framework (NHS KSF) and the development review process. HMSO.

Department of Work and Pensions (2017) Market review of British Sign Language and communications provision for people who are deaf or have hearing loss. HMSO.

Health and Safety Executive (2017) www.hse.gov.uk/competence/what-is-competence.htm

Kaushik V. et al (2010) Interventions for acute otitis externa. The Cochrane collaboration. John Wiley and son Ltd.

Nursing Midwifery Council (2017) Enabling Professionalism in nursing and midwifery practice, London NMC www.nmc.org.uk/globalassets/sitedocuments/other-publications/enabling-professionalism.pdf

Nursing Midwifery Council (2016) http://revalidation.nmc.org.uk/welcome-to-revalidation

Nursing Midwifery Council (2015) The code: Professional standards of Practice and behaviour for nurses and midwives, London: NMC.

Nursing Midwifery Council (2014) Standards for competence for registered nurses, London: NMC

Nursing Midwifery Council (2007) Standards for medicine management, London: NMC

Nursing Midwifery Council (2006) update 2011 Standards of proficiency for nurse and midwife prescribers, London: NMC.

Roach S (1992) The human act of caring: a blueprint for the health profession (revised edition), Ottawa: Canadian Hospital Association Press.


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All Skills for Health Competences referred to in this document are available from: www.skillsforhealth.org.uk. These are found within the National occupational standards tab.

Those referred to are:

SfH code Competence title

BA3 Contribute to the development of organisational policy and practice.

CHS20 Undertake examination of the external ear.

CHS38 Plan assessment of an individual’s health status.

CHS40 Establish a diagnosis of an individual’s health condition.

CHS41 Determine a treatment plan for an individual.

CHS44 Plan activities, interventions and treatments to achieve specific health goals.

CHS47 Monitor and assess patients following treatment.

CHS56 Provide clinical information to individuals.

CHS83 Interpret the findings of healthcare investigations.

CHS89 Evaluate treatment plan with individuals and those involved in the care.

CHS98 Arrange services and support with other healthcare providers.

CHS152 Assess an individuals communication skills and abilities.

CHS167 Obtain valid consent or authorisation.

CHS168 Obtain a patient/client history.

CHS225 Implement a treatment plan.

EC11K Investigate and diagnose an individual presenting for emergency assistance with ear nose or throat problems.

GEN79 Coordinates the progress of individuals through care pathway

GEN98 Promote effective communication in a healthcare environment.

GEN135 Support individuals to take their medications as prescribed.

LADD03 Evaluate and improve learning development provision.

LADD04 Plan and prepare specific learning and development opportunities.

LADD05 Develop and prepare resources for learning and development.

LADD10 Reflect on, develop and maintain own skills and practice in learning and development.

LADD13 Plan and prepare learning and development programmes.

PE1 Enable individuals to make informed healthcare choices and decisions.

PE4 Agree a plan to enable individuals to manage their health condition.

PE6 Identifying the learning needs of patients and carers to enable management of a defined condition.

PE7 Develop learning tools and methods for individuals and groups with a defined health condition.

PE8 Enable individuals to manage their defined health condition.

PHARM29 Take a medication history.

PHP35 Advise how health improvement can be promoted in policy development.

PHP40 Evaluate and recommend changes to policies to improve health and wellbeing.

SC0023 Developing your knowledge and practice.


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(All accessed checked Nov 2017)

Useful organisations and their websites

Action on hearing loss www.actiononhearingloss.org.uk/

British Association of Otorhinolaryngology head and neck Surgery. www.ENTUK.org.uk

British Society of audiology www.thebsa.org.uk

Department of Health National Service Framework: www.dh.gov.uk/en/Healthcare/NationalServiceFramework

DVLA driving with medical conditions www.gov.uk/browse/driving/disability-health-condition

Ear Atlas www.earatlas.co.uk

ENT UK www.ENTUK.org

National Eczema Society: www.eczema.org

National Institute for Health and Clinical Excellence (NICE) www.nice.org.uk

NHS choices www.NHS.uk

Nursing Midwifery Council www.nmc.org.uk

Patient UK (health information): www.patient.co.uk

Royal College of Nursing: www.rcn.org.uk

Skills for Health www.skillsforhealth.org.uk

The Cochrane library www.thecochranelibrary.com/view/0/index.html

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April 2018Publication code 006 855

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RCN competences · RCN COMPETENCES: AN EDUCATION AND RAINING RAMEWORK OR AURAL CARE NURSING AND REATMEN PROVISION 2 RCN Legal Disclaimer This publication contains information, advice