HELEN SNELL and MARINA LAMBERT showcase the national nursing diabetes and respiratory frameworks and what they can offer nurses.
Respiratory symptoms account for 40 per cent of presentations to general practice teams, and by 2020, chronic obstructive pulmonary disease (COPD) is predicted to be the fourth leading cause of death worldwide.
All nurses are likely to have contact with people with long-term conditions, including diabetes and respiratory disease.
The number of people with diabetes in New Zealand is approximately 235,000, and this is estimated to increase over 50 per cent by 2021 without effective prevention programmes. Respiratory symptoms account for 40 per cent of presentations to general practice teams, and by 2020, chronic obstructive pulmonary disease (COPD) is predicted to be the fourth leading cause of death worldwide.
The morbidity associated with these conditions impacts on quality of life and escalating health costs. Thus, it makes sense for the registered nursing workforce across the care continuum to be prepared to provide competent care based on agreed knowledge and skills.
In 2009, the Diabetes Nurse Specialist Section of NZNO, The College of Nurses Aotearoa, and the New Zealand Society for the Study of Diabetes endorsed the National Diabetes Nursing Knowledge and Skills Framework. In 2011, the recently formed National Nursing Consortium endorsed the National Adult Respiratory Knowledge and Skills Framework.
The framework levels are also linked to the Nursing Council of New Zealand registration competencies, so nurses undertaking learning activities to meet the frameworks’ knowledge and skills’ levels can provide evidence of professional development hours for both their ongoing competency requirements and their professional development and recognition programme (PDRP) portfolio. It is important to note that frameworks are not a programme of learning in themselves, but rather, they are a toolkit to guide the professional development of nurses working with people with diabetes or respiratory conditions as shown in the table below left.
Specifically, the frameworks provide the following:
• Specific knowledge and skills a nurse requires to deliver care within a particular specialty area of practice.
• An outline of what knowledge and skills all nurses require, what many nurses who work predominately with a specific condition require, and what some expert nurses require to be a specialist in the speciality.
• Identification of best practice guidelines, continuing education resources, websites for general information, and suggestions for practice, service, clinical, and health outcome measurement.
Implementation
Three tertiary education providers – UCOL (Universal College of Learning), WINTEC (Waikato Institute of Technology), and CPIT (Christchurch Polytechnic Institute of Technology) – have used the national diabetes nursing knowledge and skills frameworks to inform their respective Level 7 post-registration papers on nursing the person with diabetes, thus providing a consistent curriculum of learning. WINTEC also offer a Level 8 postgraduate diabetes paper with the curriculum based on the framework.
From a clinical service delivery perspective, many diabetes specialist services have used the diabetes knowledge and skills framework to inform nursing education programmes, their orientation programmes for nurses new to the specialty, professional development planning, and progress assessments.
At MidCentral Health District Health Board, the frameworks have been used to support the development of the diabetes and respiratory primary health nurses practising at a proficient level through a preceptored programme facilitated by the respective specialist nursing services. Counties Manukau DHB has also used the framework in the orientation of new staff into the respiratory area.
Feedback from nurses using the framework has been positive, for example: “I have learnt a lot and now have a clear idea of what I have to learn”; “more formal plan and knowledge of expectations is excellent”; “the workbook is excellent and very well written”.
Specialist nurses providing preceptorship have also made positive comments: “having a structured plan/workbook was imperative”; “the required knowledge and skills are clear, structured, and build on levels”; “has provided direction in terms of learning and helped to identify areas in which to focus”.
In summary, the national nursing knowledge and skills frameworks for diabetes and respiratory respectively:
• Assist in the development of a range of transferable clinical skills, which can be used in care delivery throughout one’s career.
• Provide evidence for professional development and recognition programme portfolio.
• Seek to minimise risk by ensuring all staff know the standard of care required in the speciality and are competent to provide that care.
• Provide guidance to employers about expectations of competency at different levels of nursing practice.
• Inform orientation programmes and professional development planning.
• Provide a reference point for curricula.
• Provide a mechanism for outcome measurement.
The frameworks, therefore, encapsulate and provide clarity on the nursing knowledge and skills required for these two common long-term conditions and are among the many resources available to support the development and maintenance of a competent, capable, and confident nursing workforce.
For further information contact the authors Dr Helen Snell (Diabetes NP) and Marina Lambert (Respiratory NP)
Inputs
Knowledge and skills framework
Guidelines
Protocols
Patient population
Service infrastructure
Library
Clinical mentorship
Processes
Service delivery
Clinical practice
Clinical mentorship
Case review
Quality assurance
Quality improvement
Assessment of competence
Output
Service quality Portfolio:
• PDRP
• Accreditation
• Evaluation
Confidence
Competence
Outcomes
Confidence
Competence
“The combination of skills, knowledge, attitudes, values & attributes that underpin effective performance as a nurse”
– Nursing Council of New Zealand (2011)
