RCN competencies

Competences:An integrated career and competence

framework for nurses working in the field oflong-term follow-up and late effects care of

children and young people after cancer

RCN CompetencesRCN Competences

RCN Late effects comp 15/9/11 22:31

AcknowledgementsWe would like to thank: the Sheffield Children andYoungPeople’s Survivorship Test Site Nurse Competence ProjectTeam; the Sheffield Children andYoung People’sSurvivorship Test Site Steering Group; the North TrentCancer Network (NTCN) Survivorship Executive Group;the National Cancer Survivorship Initiative (NCSI)Children andYoung People’s (CYP) Clinical ReferenceGroup; the 80 senior managers and clinicians whocompleted and returned the Phase 1 survey into the scopeof the nurse’s role in late effects care; the 36 nurses inexisting long-term follow-up roles who completed andreturned the Phase 2 survey on the scope of the nurse’srole in late effects care; and Tanya Urquhart and the teamof children’s nurses who initiated this work.

Key contributorsJan Siddall, Teenage Cancer Trust Lead Nurse, SheffieldTeaching Hospitals NHS Foundation Trust

ClareWarnock, Practice Development Nurse, SheffieldTeaching Hospitals NHS Foundation Trust

DianaGreenfield,Macmillan Consultant Nurse, SheffieldTeaching Hospitals NHS Foundation Trust

SusanMehta, Clinical Nurse Specialist, Great OrmondStreet Hospital for Children NHS Trust

The project teamJan Siddall, Project Lead, Sheffield

ClareWarnock, Deputy Project Lead, Sheffield

DianaGreenfield, NCSI CYP Test Site Lead, Sheffield

MaxineAstley-Pepper, Development Manager,MacmillanCancer Support

Denise Friend, Project Manager and Service ImprovementFacilitator,North Trent Cancer Network

FaithGibson, Chair,NCSI CYP Steering Group

BevHorne and SusanMehta, Nurse Representatives,NCSICYP Steering Group

Alison Pass, Service User

Gail Peacock, Project Support,North Trent Cancer Network

Judi Tapp, National Improvement Lead,NHS Improvement

TanyaUrquhart,Macmillan Clinical Nurse Specialist,Sheffield, Children’s Hospital NHS Foundation Trust

RCN Legal Disclaimer

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

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

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

© 2011 Royal College of Nursing. This publication may not be lent,resold, hired out or otherwise disposed of by ways of trade in any formof binding or cover other than that in which it is published,without theprior consent of the Publishers.

Thanks are also due toDara de Burca, Director of Services,CLIC Sargent and Philomena Scott, Lead Nurse, ChildrenandYoung People, Sheffield Teaching Hospitals NHSFoundation Trust for reading and commenting on thedraft of this document.

Funding and SupportThis project was commissioned as part of a programme ofwork undertaken by the National Cancer SurvivorshipInitiative’s Children andYoung People Workstream, fundedby the Department of Health (DH) in partnership withNHS Improvement and Macmillan Cancer Support. It wasco-ordinated at Sheffield Teaching Hospitals NHSFoundation Trust in partnership with Sheffield Children’sHospital NHS Foundation Trust and supported by theNorth Trent Cancer Network and theYorkshire and theHumber Specialised Commissioning Group (SCG). Thefoundation of this work builds on our efforts to implementthe recommendations of the National Institute for Healthand Clinical Excellence’s guidance Improving outcomesin children and young people with cancer: the manual(NICE, 2005).

FeedbackThis framework will be reviewed in September 2013. Toprovide feedback on this competence framework, or onyour experience in using it, please contact:DrDianaGreenfield,Macmillan Consultant Nurse, 6th Floor,WestonPark Hospital,Whitham Road, Sheffield, S10 2SJ

Email: [email protected]: 0114 226 5592

RCN Late effects comp 15/9/11 22:31

R O Y A L C O L L E G E O F N U R S I N G

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Competences:an integrated career and competence framework for nurses working inthe field of long-term follow-up and late effects care of children andyoung people after cancer

Foreword 2

Introduction 3

Purpose of a competence framework 3

Context of this competence framework 3

How these competences were derived 4

Scope of the competences 5

How to produce evidence to demonstratecompetence 5

Headline competences 6

Model of nursing in this specialty 6

Benefits of the framework 6

References 7

Nursing competences: long-term follow-upand late effects care of children andyoung people after cancer: 9

1 Using and applying experience and clinicalknowledge of cancer and treatment to overseeand co-ordinate services, personalise thecancer pathway for individual patients, andto meet the complex information andsupport needs of children and young peopleand their families 10

1a Technical knowledge of cancer and itstreatment in relation to late effects care forchildren and young people 10

1b Applying technical knowledge to tests andinvestigations 10

1c Assessment 11

1d Care plans and treatment summaries 11

1e Medication 12

2. Acting as the key accessible professional forthe multidisciplinary team, undertakingproactive case management and using clinicalacumen to reduce the risks to patients fromdisease or treatment 12

2a Self-management 12

2b Transitional care 13

2c Multidisciplinary team working 13

3. Using empathy, knowledge and experienceto assess and alleviate the psychosocialsuffering of cancer, including referring toother agencies or disciplines 14

3a Information and support 14

3b Psychosocial care 14

4. Using experience, clinical knowledge andinsight from patient experience to leadservice redesign in order to implementimprovements and make service responsiveto patient need 15

4a Research, audit and service evaluation 15

4b Service development 15

4c Education 15

Contents

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R C N C O M P E T E N C E S – L A T E E F F E C T S A F T E R C A N C E R

Foreword

NHS Improvement is delighted to be working inpartnership with the Royal College of Nursing to producethis publication.

NHS Improvement’s strength and expertise lie in practicalservice improvement. It has over a decade of experience inclinical patient pathway redesign in cancer, diagnostics,heart, lung and stroke and demonstrates some of the mostleading edge improvement work in England whichsupports improved patient experience and outcomes. Formore information, visit the NHS Improvement website atwww.improvement.nhs.uk

NHS Improvement has worked in partnership with theDepartment of Health and Macmillan UK to support thedelivery of the National Cancer Survivorship Initiative(NCSI). This initiative is designed to test, develop andrecommend the provision of appropriate after care to eachand every cancer patient ‘living with and beyond cancer’ tomeet their individual holistic needs.

The Children andYoung People (CYP) workstream is oneof two workstreams that NHS Improvement has activelysupported during the past three years. The initial testingphase involved 10 centres in England, and NHSImprovement is now working with four sites to prototypealternative models of after care.

Significant progress has already been made in terms ofdefining patient pathways, testing alternative models ofcare, and capturing the evidence to demonstrate thebenefits to both patients and the wider NHS if suchmodels were commissioned in the future.

A fundamental element of this work is to ensure that anychange to service can be delivered by a skilled andappropriately trained workforce – nursing skills andcompetences are the cornerstone of after care services tochildren and young people living with and beyond cancer.

The partnership working between the CYP workstream ofNHS Improvement and the Royal College of Nursing hasmade it possible to produce such an important publication– a set of nurse competences endorsed by the principalnursing organisation in the country.

NHS Improvement has valued this working partnershipimmensely.Without the advice and expertise of the RoyalCollege of Nursing it would not have been able to completethis work with the same degree of credibility and authorityat a national level.

We give our thanks to the Royal College of Nursing for itssupport in enabling this publication to be produced withinambitious time scales. It has been a pleasure to be involvedin this venture with them.

On behalf of the NCSI CYP workstream and NHSImprovement

PatriciaMorris, NHS Improvement Director – Cancer

Judi Tapp, NHS Improvement National ImprovementLead – Cancer



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This is the first competence framework for nurses in theUnited Kingdom involved in the long-term follow-up careof children and young people after cancer. It builds uponthe recommendations of the National Institute for Healthand Clinical Excellence (NICE) children and youngpeople’s (CYP) improving outcomes guidance (IOG)(NICE, 2005). The NICE CYP IOG addresses the care ofchildren and young people diagnosed with cancer up tothe age of 25 years. This spans the care of children andyoung people across children’s, adolescent, and adulthealth care services.

This competence framework addresses issues related tolong-term follow-up care (including late effects care andsurvivorship) for survivors of childhood, adolescent andyoung people’s cancer.However,with the exception ofthose competences which deal with the physical andemotional developmental stages in children and youngpeople, these competences may also be useful to nursesworking across the wider cancer population.

Purpose of a competenceframework

A competence framework describes the range ofknowledge, skills and performance levels required ofnurses working in a specialty, to help them achieve safe,effective and accountable practice. Competence can bedefined as“the state of having the knowledge, judgment,skills, energy, experience and motivation required torespond adequately to the demands of one’s professionalresponsibilities” (Roach, 1992). The Nursing andMidwifery Council (NMC) uses competence to describeskills and ability to practise safely and effectively withoutthe need for supervision (Dolan, 2003).

Context of this competenceframework

Many of the cancer treatment regimens delivered toachieve excellent survival rates in children and youngpeople include multi-agent chemotherapy in combinationwith surgery and/or radiotherapy.However, there is anincreasing recognition of the long-term consequences ofcancer treatment, often referred to as ‘late effects’. The late

effects of cancer treatment may vary in their impact,withsome being sub-clinical and others resulting in potentiallylife-threatening or debilitating conditions (Oeffinger et al.,2006). These may include, for example, effects on growth(in children), or on endocrine, cardiac or renal function,and an increased risk of developing future malignancies(Oeffinger et al., 2006; Chesterfield, 1999;Wallace et al.,2001).

There are a number of factors that influence anindividual’s risk of developing late effects. These includethe type of cancer, the cancer treatments received, age atdiagnosis, gender, time lapsed since treatment, individualpsychosocial responses to diagnosis and treatment inaddition to psychological, social and environmentalinfluences (Stein et al., 2008). Long-term follow-up care isdesigned to match a patient’s personal journey throughcancer; how they have coped with their treatment against acalculated risk stratification associated with their cancertreatments (Wallace et al., 2001; UKCCSG Late EffectsGroup, 2005).

Late effects can occur at any time following treatment, andit is important to consider approaches to monitoring,supporting and clinically managing this group of patients.Evidence suggests that patients may require monitoringfor many years – and some may require specialist care forthe rest of their lives.Others may need support to reach adegree of self-monitoring and responsibility for their ownhealth needs.

Cancers that occur in children and young people present aunique set of challenges for the patient, their family andhealth care providers. The transition from childhood toadulthood is a time when self identity, independence andnew work and social roles are being forged. Cancer and itstreatment,with the attendant frequent hospitalisation andconsequences of late effects, can interfere with thisprocess, resulting in long-term detrimental effects oneducational achievement, employment, social roles andrelationships (Greenfield et al., 2003).

This document will term all types of follow-up care after acancer treatment as long-term follow-up care (LTFU);LTFU care encompasses patients who have had anytreatment for any cancer that has, or may have, a physicalor psychological impact on their health.

Introduction


How these competences werederived

Structured questionnaires were used to collect views onthe scope of the nurses’ role in a two-part data collectionprocess. The Phase 1 questionnaire asked thoseresponsible for late effects services to select the roles theyfelt were appropriate for nurses involved in late effectscare. This resulted in 80 completed responses from healthservice managers and clinicians. The Phase 2questionnaire asked nurses involved in late effects servicesto identify the roles they currently carried out and thosethey would like to develop in the future, and captured theperspectives of 36 nurses in existing roles.Questionnaireswere distributed via children’s, teenage and young adultprincipal treatment centres across the United Kingdom.The project was registered with the Clinical Effectivenessand Audit Department of Sheffield Teaching Hospital NHSFoundation Trust. It was conducted in line with the trust’sethical procedures.

The content of the questionnaires was based on itemsidentified following a literature review, a review of localand national competence frameworks and consultationwith clinical nurse specialists and health care professionalsinvolved in providing late effects care for patientsfollowing cancer (including services for children, teenagersand young adults). This process (see Figure 1) identifiedcore nursing roles that were potentially important to thenurse working in late effects care.Results from the surveyswere collated and the competences produced using theNursing career framework (DH, 2004) as describedoverleaf.A full report of the survey,The clinical skills andtraining needs required by nurses to meet the needs ofpatients living with and beyond cancer, for patientsdiagnosed under the age of 25: a 3 phase exercise, isavailable from the Sheffield Teaching Hospitals NHSFoundation Trust Project Team (Warnock et al).

The competences went through an iterative process withinvolvement from key stakeholders including the originalnurses from Phase 2 of the survey.

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Figure 1: How the framework was derived

Creation of a basic framework for CYP late effects care fromliterature search, consultation and project team

Pilot the framework with existing clinical nurse specialists inlate effects care

Request managers’ and clinicians’ views on ideal CYP late effectsnurse skills and roles

Request views of existing late effects nurses on their current andideal skills and roles

Collation of results and creation of CYP late effects competenceframework

Feedback frommanagers, clinicians and nurses for furthercomments and corrections

User’s views of the competence framework

Final changes

NHS Improvement authorisation

Royal College of Nursing endorsement


Scope of the competences

The knowledge, skill and performance levels in thisdocument reflect the comments from the project team andthe diverse group of LTFU nurses who contributed to thesurvey. The work concentrates on the Department ofHealth’s career framework supporting long-term care (DH,2006). The intention of the competence framework is tomeet the learning needs that reflect the range of skills andknowledge required by qualified nurses working in lateeffects care. The competences in this document are notdesigned to meet the learning needs of health careassistants or associates on levels 1, 2, 3, and 4 of the Careerframework for health, and the Department of Health’sNursing careers framework (DH, 2009).

This document does not set out to determine grades forspecific roles. Some roles may require the nurse to work atcompetent level in some aspects of their work whileworking at expert level in others. It is also anticipated thatnurses working at experienced/proficient level would holdthe skills identified at competent level and the expertnurse would hold many of the skills of the competent andproficient nurse (see the section entitled ‘How to produceevidence to demonstrate competence’which follows).

Matching this document against the Knowledge and skillsframework (KSF) has been considered.However, as not allhealth institutions use the KSF, the consensus was not tolink these competences to the KSF. Information about theKSF,which can be used as a supporting tool, can be foundon the Department of Health website (Skills for Health) atwww.dh.gov.uk.

A wide variety of role names are associated with nursesworking in this specialty; for example, clinical nursespecialist, and advanced nurse practitioner. To saveconfusion, the term‘nurse’will be used throughout thisdocument.We acknowledge that nurses working in LTFUcancer care may either work exclusively in this specialty, oras part of a wider nursing role. This will depend on theservice needs and evolving care locally.

Late effects services are provided across the developmentalrange including childhood, adolescence and adulthood.Asa consequence, the term‘children and young people’ hasbeen used to provide consistency of terms within thisdocument. The term‘carer’ has been used to describe thosewith significant caring responsibility such as a parent,guardian or partner.

How to produce evidence todemonstrate competence

You are responsible for developing your own portfolios ofevidence for each competence statement in order todemonstrate that you have achieved it at theidentified/desired level. Forms of evidence that you canuse include case histories, self appraisal via a reflectivediary, 360-degree feedback, verification of practice, andstructured observation of practice.

When you gather evidence it is important to consider thefollowing:

� ensure you understand what the competence statementis asking of you

� review any existing work that could be used

� identify whether the existing evidence is appropriate.

For example, if you attended a study day to prepare toperform a particular intervention but you have notpracticed the skill in a clinical setting, your certificate ofattendance is not evidence of competence.You will have toconsider making arrangements for supervised practice.However, if you have undergone training and haveevidence of supervised practice and perform the caretreatment on a regular basis the evidence should beenough.

You may also wish to:

� consider what else you may need to do in developingevidence such as feedback on your practice; if you havefurther developmental needs, are these recorded in apersonal development plan?

� think about using evidence that covers severalcompetences; one case study may demonstrate thatyou have used a variety of knowledge and skills incaring for a person.


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Headline competences� Assess actual and potential late effects problems.

� Develop individualised treatment summaries and careplans.

� Provide information, support and advice to children,young people and their families.

� Encourage self care and support self monitoring.

� Liaise with members of the multidisciplinary team tooptimise holistic care.

� Demonstrate knowledge of the impact of cancer andits treatment on the psychosocial development ofchildren and young people.

� Support the smooth transition of care either fromchildren’s to adult services, or from adolescent to adultservices.

� Create services that can work in conjunction with, orlink with, primary care.

� Initiate or co-operate in research, audit and serviceevaluation.

� Facilitate the development of evidence-based practicethrough service developments.

� Participate in educational programmes in late effectscare.

Model of nursing in thisspecialty

The model that most suits the responses gained fromcolleagues working in LTFU care is that contained in therecently published Excellence in cancer care: thecontribution of the clinical nurse specialist (CNS) (NationalCancer Action Team,2010),which follows the framework ofthe four main functions of the CNS in cancer care:

1. Using and applying technical knowledge of cancer andtreatment to oversee and co-ordinate services,personalise ‘the cancer pathway’ for individualpatients, and to meet the complex information andsupport needs of patients and their families.

2. Acting as the key accessible professional for themultidisciplinary team, undertaking proactive casemanagement and using clinical acumen to reduce therisks to patients from disease or treatments.

3. Using empathy, knowledge and experience to assessand alleviate the psychosocial suffering of cancer,

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including referring to other agencies or disciplines asappropriate.

4. Using technical knowledge and insight from patientexperience to lead service redesign in order toimplement improvements and make servicesresponsive to patient need.

Whilst we are not advocating that all nurses in thisspecialty should work at the level of the CNS, thisframework most suits the model currently practised byexisting nurses in this specialty and reflects the extent ofthe skills and experience nurses need to deliver this care.These are potentially highly skilled roles due to the complexnature of the long-term follow-up sequelae (that is, theabnormal conditions resulting from a previous disease).

This framework has been devised to be used alongsidegeneric competences developed by Skills for Health (SFH)and the Royal College of Nursing (RCN),where these areappropriate, for particular aspects of the role. For example,the Skills for Health competency CS30: provide advice andinformation to children and young people and thoseinvolved in their care on how to manage their owncondition (SFH, 2010) may be a useful supplementarygeneric competency alongside the self-managementcompetency contained in this framework.

The NICE IOG (NICE, 2005) recommends a key worker,and for this framework we have interpreted the key workerin LTFU to be a nurse (with the scope of theirresponsibilities dependant on their grade).

Benefits of the framework

The competence framework will not only provide benefitsfor nurses, but also their employers, especially where thereis currently a gap in services that needs addressing.

Using the framework will help you, as a nurse, to:

� deliver consistently high standards of care

� identify your level of practice and plan your career in amore structured way

� pinpoint education and development needs to help yourealise your potential more effectively

� work towards excellence in practice during the annualperformance and development review

� seize opportunities to influence the direction ofnursing in this relatively new field of clinical care

� foster and improve professional relationships withmedical colleagues and allied health professionals


through a greater understanding of skills andresponsibilities.

The framework will give employers and managers:

� a tool to develop, plan and implement LTFU servicesmore effectively, including job descriptions

� a model to ensure consistently high standards of care

� a tool with which to ensure children’s, teenage andyoung adult aftercare pathways are met

� a clearer insight into the expertise and competence ofnursing staff in this field

� a benchmark to assist with professional development.

The patient and public will benefit from the framework asit will:

� ensure acknowledgement of the nursing care needs ofthis group of patients

� ensure consistently high standards of care

� ensure increased effectiveness of service provision

� facilitate early identification of late effects

� promote timely intervention for late effects

� assist patients with the transition from children’s toadult LTFU care as needed

� provide a model of follow-up care that supports thepatient throughout their lifespan

� promote healthy lifestyles

� promote self-monitoring of health after cancertreatment.


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References

Chesterfield P (1999) ‘Late effects of chemotherapy’, inGibson F and Evans M (editors) Paediatric oncology: acutenursing care, London:Whurr Publishers, pp.142-153.

Children’s Oncology Group (2010) Long-term follow-upguidelines for survivors of childhood, adolescent, andyoung adult cancers (version 3).Available fromwww.survivorshipguidelines.org

Department of Health (2004) The knowledge and skillsframework and the development review process, London:DH.Available from www.dh.gov.uk

Department of Health (2006) Supporting people withlong-term condition to self care, London: DH.Availablefrom www.dh.gov.uk

Department of Health (2009) Nursing careers framework.Available from www.dh.gov.uk

Dolan G (2003) Assessing student competency: will weever get it right?, Journal of Clinical Nursing, 12, pp.132-141.

Greenfield DM,Absolom K,Davies H,Ross R and Eiser C(2003) Childhood cancer survivors: transition frompediatric to adult care,Current Medical Literature- GH andGrowth Factors, 18, pp.83-91.

National Cancer Action Team (2010) Excellence in cancercare: the contribution of the clinical nurse specialist,London: NHS.

National Institute for Health and Clinical Excellence(2005) Improving outcomes in children and young peoplewith cancer: the guide, London: NICE.Available fromwww.nice.org.uk

Oeffinger KC,Mertens AC, Sklar CA,Kawashima T,HudsonMM,Meadows AT, Friedman DL,Marina N,Hobbie W,Kadan-Lottick NS, Schwartz CL, Leisenring W andRobison LL (2006) Chronic health conditions in adultsurvivors of childhood cancer,New England Journal ofMedicine, 355(15), pp.1572-1582.

Roach S (1992) The human act of caring: a blueprint forhealth professions (revised edition), Ontario: CanadianHospital Association Press.

Skills for Health (2010) Career frameworks CS30, London:SfH.Available from www.skillsforhealth.org.uk

Stein KD, Syrjala KL and Andrykowski MA (2008) Physicaland psychological long-term and late effects of cancer,Cancer, 112, pp.2577-2592.


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United Kingdom Children’s Cancer Study Group - LateEffects Group (2005) Therapy based long-term follow up:practice statement (2nd edition), Skinner R,Wallace WHBand Levitt G A (editors), Leicester: UKCCSG. Available atwww.cclg.org.uk

Wallace WHB,Blacklay A, Eiser C,Davis HA,Hawkins MM,Levitt GA and Jenney MEM (2001) Developing strategiesfor long-term follow up of survivors of childhood cancer,British Medical Journal, 323, pp.271-274.

Warnock C, Siddall J, Freeman J and Greenfield D(manuscript in progress) Beyond treatment: emergingnursing roles for the care of children and young peopleafter cancer.



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Nursing competences: long-term follow-upand late effects care of children and youngpeople after cancer

In the following pages, the competence framework isdivided into sub roles taken from the Department ofHealth Nurse career framework (DH, 2009). These includethat of clinician,manager, educator and researcher and arelisted as:

i. using and applying technical1 knowledge of cancer andtreatment to oversee and co-ordinate services,personalise the cancer pathway for individual patients,and to meet the complex information and supportneeds of patients and their families

ii. acting as the key accessible professional for themultidisciplinary team, undertaking proactive casemanagement, and using clinical acumen to reduce therisks to patients from disease or treatment

iii. using empathy, knowledge and experience to assessand alleviate the psychosocial suffering of cancer,including referring to other agencies or disciplines asappropriate

iv. using technical1 knowledge and insight from patientexperience to lead service redesign in order toimplement improvements and make service responsiveto patient need.

Further subheadings are given for domains of competenceunder which competences are categorised by level ofskill/knowledge, that is, that of competent nurse,experienced/proficient nurse, or expert nurse.

The flow from left to right assumes a gain in knowledgeand skills, in other words the movement from‘competent’to ‘experienced/proficient’ and from‘experienced/proficient’ to ‘expert’.

By the time a nurse is functioning as ‘expert’ thecompetences listed in ‘competent’ and ‘experienced’ areassumed and so not repeated. It is likely any one individualmay function at different levels in a number of domains.

1 A consultation process with key nurse stakeholders resulted inthe amendments of wording in the subheadings so that the term‘technical knowledge’ has been exchanged for the term‘experience and clinical knowledge’.


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Competent Experienced/proficient Expert nurse

• Has a basic knowledge ofpathophysiological principles relating tocancer

• Has a basic knowledge of cancertreatments and their potential long-termeffects

• Recognises and is able to describe lateeffects complications common to own areaof practice

• Demonstrates knowledge of potentialinterventions and outcomes in relation tocommon late effects complications

• Demonstrates understanding of the normalphysical developmental patterns of growthand puberty on the transition fromadolescent to adult

• Demonstrates knowledge of the principlesof symptommanagement in relation tocommon late effects complications

• Has a basic understanding of children andyoung people’s (CYP) psychosocial care.

• Has comprehensive knowledge of cancer andits treatment and potential late effectscomplications

• Has a comprehensive understanding oftreatment sequelae appropriate to ownspecialty area for example, endocrine,skeletal, developmental effects

• Has a comprehensive knowledge of potentialinterventions and outcomes in relation tocommon late effects complications

• Demonstrates a clear understanding of thepotential physical, psychological and socialcurrent and long-term consequences of cancerand its treatment on children and young adults

• Demonstrates knowledge of the widerphysical, psychological and social factors thatcan affect children and young adults treatedwith cancer

• Has comprehensive understanding ofoncology-related CYP care.

• Has expert knowledge of:• the late effects complications

associated with cancer and itstreatment

• oncology-related CYP care• Uses this knowledge to:

• create and promote innovativesolutions to health problems

• develop services that meet theneeds of patients requiring lateeffects care.

1a Technical knowledge of cancer and its treatment in relation to late effects care forchildren and young people


• Demonstrates knowledge of tests andinvestigations commonly used in own areaincluding rationale for use and normalranges of results

• Carries out basic investigations appropriateto own area of practice

• Organises tests and investigationsrequested by senior colleagues

• Assists clinicians carrying outinvestigations used within late effects careand provides appropriate support to theclinician and child or young person

• Makes appropriate decisions in seekinghelp in relation to findings of tests andinvestigations

• Is able to provide simple descriptive andprocedural information about tests andinvestigations

• Demonstrates a good working knowledgeof the legal framework and guidelinesrelating to the consent process for childrenand young people

• Provides support and further explanation tothe child or young person after the clinicianhas discussed test results.

• Independently initiates a wide range ofinvestigations used within late effects care aspart of agreed guidelines and protocols(UKCCSG Late Effects Group, 2005), (Children'sOncology Group, 2010)

• Accurately interprets the findings of tests andinvestigations used within late effects care

• Makes appropriate changes to the plan of carein the light of findings, in conjunction withclinicians or within protocols and guidelines

• Provides detailed information to the youngperson and their family about tests andinvestigations; identifies new support orinformation needs arising from findings ofresults

• Uses complex strategies to deal withchallenging issues relating to consent

• Uses expertise to relay difficult news tochildren and young people at a level of theirown understanding.

• Uses expertise to prescribe, initiate,interpret and monitor diagnostic testsand investigations utilised within lateeffects care independently andwithout supervision, according to thechild or young person’s clinical need

• Acts as an expert resource for otherhealth care professionals (HCPs)when dealing with complex orchallenging situations relating toconsent

• Plays a leading role in developingprotocols and clinical guidelinesrelating to tests and investigationsused within late effects care.

1b Applying technical knowledge to tests and investigations

Nursing competences:

Using and applying experience and clinical knowledge of cancer and treatment tooversee and co-ordinate services, personalise the cancer pathway for individual

patients, and to meet the complex information and support needs of children and youngpeople and their families

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• Is able to carry out a structured nursingassessment for children and young peopledeveloped for the nursing service

• Recognises actual and potential late effectscare problems that might require attention,and reports concerns to appropriatecolleagues

• Makes appropriate decisions in seekinghelp in relation to findings followingassessment whilst also recognising ownlimitations

• Is able to prepare the child or young personundergoing clinical examination, ensuringthat privacy and dignity, health and safetyand consent issues are met

• Is able to assist the clinician in carrying outclinical assessments for children and youngpeople

• Provides appropriate explanation andsupport to the child or young personundergoing clinical assessments in lateeffects care

• Ensures assessments meet legalframework and guidelines relating tochildren and young people and consent;liaises with senior colleagues when issuesaround consent arise

• Has an understanding of the holistic needsassessment process, and its implicationsfor practice.

• Uses skills in history-taking and evaluation ofdiagnostic tests to carry out an assessmentwithin protocols and guidelines and/or inconjunction with senior nursing or medicalclinician

• Recognises signs and symptoms of healthproblems associated with late effects carerequiring urgent review by senior colleagues

• Uses specialist knowledge to recognisedeviations in expected childhood andadolescent development

• Is able to assess the impact of cancerdiagnosis and treatment on lifestyle and futureeducation and employment needs

• Uses specialist knowledge and skills to assessthe emotional and psychological wellbeing ofchildren and young people and carers receivinglate effects care

• Uses complex strategies to deal withchallenging issues relating to consent

• Ensures that assessments reflect current bestpractice and are evidence-based.

• Is able to work autonomouslymanaging the care of children andyoung people in the service

• Uses clinical examination skills todevelop late effects plans of careindependently

• Independently reviews and assesseschildren and young people

• Acts as an expert resource for otherHCPs when dealing with complex orchallenging situations relating toconsent

• Acts as an expert resource for othercolleagues in relation to issues andconcerns arising from outcomes ofassessments

• Plays a leading role in developingassessment tools and clinicalguidelines for late effects care.

1c Assessment


• Documents clear and accurate informationabout children and young people

• Provides accurate and appropriateinformation when assisting others withdeveloping care plans and treatmentsummaries for individual children andyoung people

• Provides information and explanation topatients and carers in relation to the lateeffects care plan

• Demonstrates awareness of confidentialityissues relating to the age and self-responsibility of the young person.

• Uses specialist knowledge to create age-appropriate care plans for children and youngpeople according to agreed protocols andguidelines

• Uses a range of clinical data to facilitate timelyand effective interventions for children andyoung people

• Is able to identify and prioritise children andyoung people requiring urgent interventionand referral

• Uses specialist knowledge to recognise andreport deviations from the expected progressof an individual child or young person

• Within protocols and guidelines, createstreatment summaries for children and youngpeople using case notes

• Co-ordinates late effects care whereappropriate to ensure prompt and appropriatereferral to specialist services

• Ensures late effects care plans are evidence-based and reflect current best practice.

• Uses expert knowledge toindependently assess, evaluate,select and implement appropriatelate effects care plans according topatients’ clinical needs

• Acts as an expert resource for otherHCPs when dealing with challengingsituations arising from the late effectscare plan for example, differentperspectives on treatment decisionsbetween children and young peopleand their family

• Designs, develops and implementscare pathways to guide practicewithin the late effects service.

1d Care plans and treatment summaries – personalising the cancer pathway for individualpatients


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• Demonstrates a basic knowledge ofmedications commonly used in own areaof practice in relation to late effects careincluding indication, mode of action, andadverse effects

• Administers appropriate medication asprescribed in accordance with professionaland organisational standards

• Provides advice and explanation to patientson medication used within late effects care.

• Provides medication for late effects patientsaccording to protocol and guidelines (forexample, patient group directions (PGDs))

• Evaluates effectiveness and outcomes ofmedication, and consults with clinicianregarding changes

• Uses specialist knowledge to provideindividualised information about medicationused within late effects care to enableinformed consent and self- management.

• Prescribes medicine as a non-medicalprescriber (independent and/orsupplementary prescriber) within thelate effects service

• Works with the multidisciplinary team(MDT) to develop protocols andguidelines for medications for usewithin the late effects service forexample, PGDs treatment pathways.

1e Medication

Acting as the key accessible professional for the multidisciplinary team, undertakingproactive case management and using clinical acumen to reduce the risks to patients

from disease or treatment


• Assesses the ability and motivation of thechild or young person to manage self care

• Identifies risk and age-related behavioursin relation to adherence with careinstructions or advice

• Teaches the child or young person to carryout self-monitoring and self-care on singleissues in focused consultation

• Supports the child or young person inhealthy living choices that may have beenaffected by cancer and its treatment

• Recognises the importance of primary careservices in providing local services forchildren and young people.

• Responds to changes in the child or youngperson’s age and ability to understand theimplications of self care throughout their lateeffects care pathway

• Responds to identified risk behaviours andtakes appropriate action to minimise theirimpact on adherence to care instructions andadvice

• Teaches children and young people to carry outself-monitoring and self-care and mentorsthem in the process

• Continues contact with the child or youngperson and family to assess progress, provideencouragement, and advise on difficulties withself- management

• Uses communication skills to encourage thechild or young person to becomemoreresponsible for their own health

• Creates care plans with late effects patients toencourage self-care and self- reporting of anysignificant symptoms

• Liaises with primary care as appropriate.

• Acts as a resource to other staff insupporting children and youngpeople with complex needs in relationto adherence with care instructionsand advice

• Works with other agencies to developclear pathways for referral to supportand information services within thelate effects service

• Proactively engages in promoting theself care principle at local, nationaland international forums

• Creates services that can work inconjunction with, or link with primarycare services.

2a Self-management

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• Has an understanding of the phases of thetransition process and ensures youngpeople receive services appropriate to theirage and individual needs

• Provides support and information toenable young people to take moreresponsibility for their own care

• Guides young people in the use of andupdating of their care plan

• Provides practical and emotional support toencourage young people to develop theirconfidence in taking an active role incommunicating with health professionalsas appropriate

• Provides information to ensure youngpeople and parents are aware of thechanges in care and service provisionassociated with the transition process

• Respects the privacy and confidentialityissues of young people as they move intoadulthood and assume responsibility fortheir own health care

• Demonstrates an awareness of other keydevelopments and milestones at this age.

• Provides information and support to ensurechildren and young people and parents feelfully involved in the changes in care associatedwith the transition process

• Assesses the emotional and psychologicalreadiness of the young person to take moreresponsibility for their own care, and developsappropriate individualised interventions tosupport them to do so

• Supports the young person to develop theskills and confidence required to enable themto negotiate transition from parentalresponsibility to self-care

• Supports carers in allowing, and supporting,the young person to take more control of theirown care

• Provides information to ensure young peoplehave a good understanding of their diagnosisand associated late effects or risk fordeveloping late effects to enable them to takean active role in their future care

• Develops treatment summaries and care plansto provide information to support the transferof young people as they move from children’sto young adult and adult health care services

• Participates in educational programmesincluding health education to support staffinvolved in transitional care.

• Takes a leading role in developingand implementing services to supporttransitional care from children’s toyoung adult services and to adulthealth care in primary, secondary andtertiary care

• Works with other agencies to developclear pathways and guidelines for thetransfer of long-term follow-up carebetween services

• Acts as a specialist resource for localhealth and social care servicesregarding transitional care

• Develops educational programmes toenable young people to develop theknowledge, confidence and skills totake more responsibility for self-management and self-care and makehealthy lifestyle choices

• Develop approaches to monitoringtransition arrangements and servicesto ensure they meet the needs ofyoung people and their families.

2b Transitional care – supporting patients as they move from child/adolescent-centred toadult-orientated health care systems


• Liaises between patients and family andother members of the MDT involved in lateeffects services to optimise care

• Makes appropriate referrals to othermembers of the MDT involved in lateeffects services

• Attends MDTmeetings in late effects asappropriate

• Recognises the potential holistic careneeds of children and young people andthe contributions of other health and socialcare professionals in meeting these needs– for example youth support, educationaland emotional support.

• Uses communication and supportive skills toencourage the child or young person tobecomemore involved in consultations withthe MDT

• Is able to co-ordinate MDT interventionsincluding complex discharge or treatmentplans for children and young people

• Liaises with health care professionals in thecommunity and sign-posts to other health careteams as appropriate

• Liaises with agencies outside the late effectsservice in relation to current and anticipatedfuture needs of individual patients forexample, education and employment services

• Communicates effectively with the MDT using awide range of strategies to promote the patientexperience and quality of care within the lateeffects service

• Actively contributes to the development of thelate effects service within the MDT

• As a core member, presents patients at lateeffects MDTmeetings.

• Promotes inter-professional workingto ensure effective communicationand develop the MDT approach topatient care delivery within the lateeffects service

• Works with the MDT to ensurechildren and young people pathwaysare robust, feasible and promotequality care

• Provides expert advice to othermembers of the MDT across the lateeffects service

• Builds partnerships with health,social, voluntary and independentsectors to develop the late effectsservice

• Plays a leading role in developing lateeffects MDT operational policy andactivities of the MDTmeeting

• Plays a leading role in local andnetwork audits within the late effectsservice MDT.

2c Multidisciplinary team working


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Using empathy, knowledge and experience to assess and alleviate the psychosocialsuffering of cancer including referring to other agencies or disciplines


• Is able to direct children and young peopleand other family members to appropriateagencies and information sources withinthe late effects service

• Is able to provide written, online and verbalinformation to children and young peopleand carers about their condition andtreatment

• Evaluates children and young people andcarer understanding of information andcommunicates effectively to correctmisunderstandings and give furtherinformation when required

• Is able to provide simple advice andinformation relating to late effects care overthe phone

• Explains complex medical terminology inlay terms

• Participates in children and young peoplesupport groups for late effects care

• Demonstrates clear documentation ofpatient contact within the late effectsservice.

• Provides information about late effects carethat requires advanced specialist knowledge

• Supports the children and young people inevaluating information in relation to theirindividual needs and preferences

• Accesses information from a range ofresources and uses it to meet the individualneeds of children and young people

• Critically assesses writteninformation/websites prior to recommendingthese to the child or young person or carer

• Uses specialist knowledge to providetelephone consultations autonomously tochildren and young people

• Contributes to the development and evaluationof patient information resources within the lateeffects service

• Uses specialist knowledge to assess thesupportive needs of children and young peopleand their carers

• Assists in the provision of planned educationprogrammes for children and young peopleand carers

• Facilitates support groups for children andyoung people and carers.

• Works with agencies outside of thelate effects service to developappropriate information and support

• Leads on the development, audit andevaluation of patient informationresources

• Organises and plans support groupsfor children and young people andcarers

• Develops strategies and guidelinesfor managing issues raised duringtelephone contact.


• Demonstrates knowledge of thepsychological effects of cancer on childrenand young people and their family andfriends

• Is able to communicate effectively andappropriately with children and youngpeople along the developmental continuum

• Has knowledge of the impact of cancer andits treatment on psychosocial developmentin children and young people and thetransition to adulthood

• Provides information and support tochildren and young people and carers onlate effects care issues, treatment andservices

• Uses local pathways to refer children andyoung people with psychosocial supportneeds to appropriate services.

• Has a comprehensive understanding of thepotential psychosocial consequences of lateeffects on the children and young people,carer, family members and friends

• Uses specialist knowledge to foster thedevelopment of coping strategies that areeffective for children and young people andtheir carers

• Provides advice and support to enable childrenand young people to manage the impact ofdiagnosis and treatment on their relationshipswith those important to them - carers, siblings,friends

• Uses complex strategies to deal withcommunication issues such as breaking badnews about relapse and development of newlate effects

• Uses knowledge and experience of the needsof children and young people to providepsychological support on a wide range ofdiverse issues

• Provides advice and support about work andnew roles to ensure the child or young personis not inappropriately disadvantaged by theconsequences of their diagnosis andtreatment.

• Uses expert knowledge to effectivelycommunicate with CYP and families inchallenging situations

• Works with families and otheragencies to ensure children’smaximum individual potential isachieved

• Acts as an expert resource for otherHCPs when dealing with complex andchallenging communication issues

• Demonstrates advancedcommunication skills e.g. counsellingand motivational interviewingtechniques

• Works with other agencies to developclear pathways for complexpsychosocial support needs relatingto late effects care.

3a Information and support

3b Psychosocial care

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• Collects data required for serviceevaluation, audit or research within the lateeffects service

• Demonstrates an understanding of theprinciples of clinical research and canexplain to patients the meaning of commonterms and concepts (for example, placebo,randomisation, qualitative research,patient reported outcomes, informedconsent).

• Carries out service evaluation and audit of keyaspects of own practice within the late effectsservice for example, patient satisfaction, localservice standards

• Writes for publication on own specialty e.g.article in journal aimed at nurses on specificaspect of late effects care

• Presents posters/papers at conferences onown specialty or service review

• Contributes to the development andcompletion of service review, audit and localresearch in late effects care.

• Identifies problems experienced byCYP that can be the focus of research

• Leads in the design and completion ofresearch projects within the lateeffects service

• Leads in the design and completion ofservice review and audit projects ofthe late effects service

• Writes for publication on ownresearch relating to late effects care

• Develops relationships with otheragencies to promote research andenterprise partnerships within lateeffects care and services.

Using experience, clinical knowledge and insight from patient experience to leadservice redesign in order to implement improvements and make service responsive to

patient need

4a Research, audit and service evaluation

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• Supports more junior staff in theimplementation of specialist late effectscare

• Contributes to the development of the lateeffects service by identifying concerns orgaps in the service and sharing them withsenior colleagues

• Demonstrates awareness that the views ofservice users are important to influencechange in practice

• Is responsive to change to improve clinicalservices.

• Teaches and supervises staff inlate effects care in a range ofsettings

• Uses specialist knowledge tocontribute to the developmentof evidence-based policies andprocedures for late effects care

• Represents the late effectsservice or own discipline withinthe late effects service at localstrategic meetings

• Contributes to the developmentof service reports within lateeffects care.

• Uses expert knowledge to inform the developmentand delivery of local late effects services

• Develops evidence-based protocols and guidelinesfor the late effects service

• Actively engages late effects service users to obtaintheir views of service delivery and improvement

• Monitors and evaluates late effects protocols andpolicies

• Represents the late effects service or own disciplinewithin the late effects service at network andnational meetings

• Plays a leading role in the development of businesscases and service reports within the late effectsservice

• Influences late effects care policy at local andnational level

• Identifies service deficits and develops strategicplans for the late effects service.

4b Service development


• Teaches other HCPs in their own late effectsservice on a one-to-one basis on issuesrelating to late effects care

• Supports more junior staff in theimplementation of specialist late effectcare.

• Teaches groups of HCPs on late effects care inthe local service in a range of settings

• Provides formal taught sessions on lateeffects care on local study days

• Teaches on externally run educationalprogrammes in late effects care for example,on undergraduate and postgraduate trainingprogrammes

• Participates in creating and delivering localand national programmes of education onlate effects care for example, study days andconferences.

• Creates local and network educationalprogrammes for other HCPs in lateeffects care

• Creates educational programmes onlate effects care for academic credit inliaison with university

• Creates national programmes ofeducation in late effects care forexample, study days and conferences.

4c Education


The RCN represents nurses and nursing,promotes excellence in practice and shapeshealth policies

September 2011

RCN Onlinewww.rcn.org.uk

RCN Directwww.rcn.org.uk/direct0345 772 6100

Published by the Royal College of Nursing20 Cavendish SquareLondonW1G 0RN

020 7409 3333

Publication code 004 172

ISBN 978-1-906633-85-1


RCN competencies

Health & Medicine

Transcript of RCN competencies