South Tees Hospitals NHS Foundation Trust. Excellence in dementia care across general hospital and community settings. Competency framework

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1 South Tees Hospitals NHS Foundation Trust Excellence in dementia care across general hospital and community settings. Competency framework Written and compiled by Helen Robinson-Clinical Educator Dementia Approved by the skilled and effective workforce work stream Review date July

2 Contents Page 3 Page 4-8 Page 9 Page Page Page Introduction Structure of the framework The W.A.S.P. competency framework explained Level 1 dementia care. Essential practice level. Level 2 dementia care. Skilled practice level including W.A.S.P. competency framework. Level 3 dementia care. Enhanced practice level including W.A.S.P. competency framework Written and compiled by Helen Robinson-Clinical Educator Dementia Approved by the skilled and effective workforce work stream Review date July

3 Introduction At South Tees Hospitals Foundation Trust (STHFT) we strive to consistently deliver high quality care that meets the needs of our patients and their families in our hospitals and community services. Our organisational values place the patient central to everything we do and for those with dementia we recognise that care is often complex and admissions to hospital can be life changing. It is therefore vital that we all become dementia aware. For those who have clinical contact with patients with dementia it is essential that they have the right skills and knowledge to care competently and compassionately while promoting the individuals personhood. The principles of good dementia care should maximise each individual s person rights, choices and health and wellbeing. South Tees Hospitals NHS Foundation Trust Excellence in dementia care across general hospital and community settings competency framework applies to all health staff that have contact with, and or provide support, care, treatment and services for people who have dementia, and their families and carers. Our framework is an amalgam of the Scottish Government s Promoting excellence: a framework for all health and social services staff working with people with dementia, their families and carers (1) and the South West dementia partnership dementia competency framework (2). Embedded within this framework is the common core principles for supporting people with dementia: A guide for training the social care and health workforce (3). The development of the framework was informed by: Evidence, best practice guidance and literature reviews; Reviews of existing competency frameworks; Links being made with wider UK dementia work programmes; and Listening to what people with dementia, their friends, families and carers have said locally and nationally. (1) Scottish Government (2011) Promoting Excellence: A Framework For All Health And Social Services Staff Working With People With dementia, Their Families And Carers. Scottish Government. (You may re-use this information (excluding logos and images) free of charge in any format or medium, under the terms of the Open Government Licence). (2) South West dementia Partnership (2011) dementia Competency Framework. South West dementia Partnership. Employers can use this framework for; Identifying training needs, Developing job descriptions, Commissioning, designing and delivering training, Informing supervision and appraisal, Informing service redesign, Demonstrating skill mix and competence within a performance framework, Demonstrating competence and competence levels in practice. (3) DOH (2011) Common Core Principles For Supporting People With dementia: A Guide For Training The Social Care And Health Workforce. London. HMSO. Copies of this work may be made for non-commercial distribution to aid social care workforce development Written and compiled by Helen Robinson-Clinical Educator Dementia Approved by the skilled and effective workforce work stream Review date July

4 The structure of the framework. The dementia competency framework is an incremental 1, 2, 3 approach; moving from essential skills through enhanced skills, to specialist skills in dementia care. You must be proficient in Level 1 dementia care before you can move onto level 2. Again, you must be proficient in level 1 and level 2 dementia care before you can move onto level 3. Level 1 dementia care. Essential practice level - This looks at the basic awareness and training required in all areas of health and social care. Level 2 dementia care. Skilled practice level- This builds on the knowledge gained from the level 1 essential practice level. The focus of this level is the competencies required for staff working regularly with people with dementia, their relatives and carers. Level 3 dementia care. Enhanced practice level- This level builds on the knowledge gained from the level 1 essential practice level and the level 2 skilled practice level. The level 3 enhanced practice level is relevant to staff working more intensely with people with dementia, their relatives and carers. These levels are based on the knowledge and skills specific to the worker s role, rather than to their position within an organisation or profession, in relation to dementia. Level 1 dementia care is, as the name suggests, essential to all staff within South Tees NHS Foundation Trust. With Level 2 and Level 3 dementia care, it is up to the individual staff member and their employer to ensure they cover the competencies and training required for their own role in relation to working with people with dementia, their families and carers. Written and compiled by Helen Robinson-Clinical Educator Dementia Approved by the skilled and effective workforce work stream Review date July

5 The dementia competency framework. The framework should be used at a personal, service provider and organisational level in a number of ways, and for a range of purposes: By all staff members who are required to have a basic knowledge of dementia and the impact it has on the lives of those living with dementia, their family and carers. This would allow them to fulfil their responsibilities in delivering excellence in dementia care; By individual staff members, alongside their managers or supervisors, to identify strengths and areas from improvement required by staff working regularly with people with dementia, their relatives and carers. By wards and department managers, to ensure their staff have the correct level of dementia awareness and training to meet the needs of the people they serve, their family and carers. The South Tees Hospitals NHS Foundation Trust Excellence in dementia care across general hospital and community settings competency framework uses seven outcomes to cover the fundamental areas of dementia care. These are supported with evidence from a vast range of sources, as shown below: Outcome one- The person with dementia feels empowered and has personal choice and control over decisions about them; maintaining their dignity and respect. People with dementia feel empowered and enabled to exercise rights and choice, maintain their identity and to be treated with dignity and equality (1). Objective 12: Improved end of life care for people with dementia (7). Objective 13: An informed and effective workplace for people with dementia (7). Recommendation 9. Begin to change the approach to care for people with dementia to one of dignity and respect (9). I have personal choice and control or influence over decisions about me (10). Statement 5. People with dementia, while they have capacity, have the opportunity to discuss and make decisions, together with their carer/s, about the use of advance statements, advance decisions to refuse treatment, lasting power of attorney, and preferred priorities of care (11). G13. Consent to examination and treatment policy (12). G34i. Covert medication (adults) policy (12). G56. Advance decisions (living wills policy) (12). G62. Safeguarding vulnerable adults policy (12). G112. Privacy and dignity policy (12). (1) Scottish Government (2011) Promoting Excellence: A Framework For All Health And Social Services Staff Working With People With dementia, Their Families And Carers. Scottish Government. (You may re-use this information (excluding logos and images) free of charge in any format or medium, under the terms of the Open Government Licence). (7) DOH (2009) Living Well With dementia: The National dementia Strategy. (9) Alzheimer s Society (2009) Counting the cost. Caring for people with dementia on hospital wards. (10) DOH (2010) Quality Outcomes for people with dementia: Building On The Work Of The National dementia Strategy. (11) NICE (2010) Dementia Quality Standard (12) South Tees NHS Foundation Trust. Various Policies. Written and compiled by Helen Robinson-Clinical Educator Dementia Approved by the skilled and effective workforce work stream Review date July

6 Outcome Two- The person with dementia has access to good quality early diagnosis and intervention. People with dementia have access to a timely and accurate diagnosis of dementia (1). Objective 2: Good-quality early diagnosis and intervention for all (7). Principle 1 Know the early signs of dementia (2). Principle 2 Early diagnosis of dementia helps people receive information, support and treatment at the earliest possible stage (2). I live in an enabling and supportive environment where I feel valued and understood (10). Statement 2. People with suspected dementia are referred to a memory assessment service specialising in the diagnosis and initial management of dementia (11). Statement 3. People newly diagnosed with dementia and/or their carers receive written and verbal information about their condition, treatment and the support options in their local area (11). Outcome Three- The person with dementia maintains their best level of physical, mental, social, emotional and spiritual wellbeing. People with dementia maintain their best level of physical, mental, social and emotional wellbeing (1). Principle 3 Communicate sensitively to support meaningful interaction (2). Principle 4 Promote independence and encourage activity (2). Principle 5 Recognise the signs of distress resulting from confusion and respond by diffusing a person s anxiety and supporting their understanding of the events they experience (2). Recommendation 8. Make sure that people with dementia have enough to eat and drink (9). Statement 7. People with dementia who develop non-cognitive symptoms that cause them significant distress, or who develop behaviour that challenges, are offered an assessment at an early opportunity to establish generating and aggravating factors. Interventions to improve such behaviour or distress should be recorded in their care plan (11). G61. Mental capacity act 2005 and deprivation of liberty safeguards policy (12). G62. Safeguarding vulnerable adults policy (12). G65. Protected mealtimes policy and guidance for assisted feeding (12). G102. Pain management in inpatient adults policy (12). G141. Mental health act (12). (1) Scottish Government (2011) Promoting Excellence: A Framework For All Health And Social Services Staff Working With People With dementia, Their Families And Carers. Scottish Government. (You may re-use this information (excluding logos and images) free of charge in any format or medium, under the terms of the Open Government Licence). (2) Common Core Principles For Supporting People With dementia: A Guide For Training The Social Care And Health Workforce (DOH, 2011). Copies of this work may be made for non-commercial distribution to aid social care workforce development (7) DOH (2009) Living Well With dementia: The National dementia Strategy. (9) Alzheimer s Society (2009) Counting the cost. Caring for people with dementia on hospital wards. (10) DOH (2010) Quality Outcomes for people with dementia: Building On The Work Of The National dementia Strategy. (11) NICE (2010) Dementia Quality Standard Written and compiled by Helen Robinson-Clinical Educator Dementia Approved by the skilled and effective workforce work stream Review date July

7 Outcome Four- The person with dementia has a sense of belonging by being empowered to maintain valued relationships and networks, and has the opportunity to develop new ones; both personal and professional, and can participate in community life and valued activities. People with dementia are able to maintain valued relationships and networks, and have the opportunity to develop new ones both personal and professional (1). Objective 1: Improving public and professional awareness and understanding of dementia (7). Objective 13: An informed and effective workplace for people with dementia (7). I have a sense of belonging and of being a valued part of family, community and civic life (10). Outcome Five- The person with dementia has access to quality services that are designed around their needs and the needs of their family and carers. People with dementia, their families, friends and carers, have access to the information, education and support that enhances the wellbeing of the person with dementia and those that support them (1). People with dementia have access to quality services and can continue to participate in community life and valued activities (1). Principle 8 Work as part of a multi-agency team to support the person with dementia (2). Objective 6: Improved community personal support services (7). Objective 13: An informed and effective workplace for people with dementia (7). Recommendation 5. Ensure that there is an informed and effective acute care workforce in hospitals for people with dementia (9). I know that services are designed around me and my needs (10). G130. Clinical handover of care policy (12). (1) Scottish Government (2011) Promoting Excellence: A Framework For All Health And Social Services Staff Working With People With dementia, Their Families And Carers. Scottish Government. (You may re-use this information (excluding logos and images) free of charge in any format or medium, under the terms of the Open Government Licence). (2) Common Core Principles For Supporting People With dementia: A Guide For Training The Social Care And Health Workforce (DOH, 2011). Copies of this work may be made for non-commercial distribution to aid social care workforce development (7) DOH (2009) Living Well With dementia: The National dementia Strategy. (9) Alzheimer s Society (2009) Counting the cost. Caring for people with dementia on hospital wards. (10) DOH (2010) Quality Outcomes for people with dementia: Building On The Work Of The National dementia Strategy. (12) South Tees NHS Foundation Trust. Various Policies. Written and compiled by Helen Robinson-Clinical Educator Dementia Approved by the skilled and effective workforce work stream Review date July

8 Outcome Six- The person with dementia feels safe, in a supportive environment, and is enabled to be to be as independent as possible. People with dementia feel safe and secure and are able to be as independent as possible (1). Principle 4 Promote independence and encourage activity (2). Objective 8: Improved quality of care for people with dementia in general hospitals (7). Objective 9: Improved intermediate care for people with dementia (7). Objective 10: Considering the potential for housing support, housing-related services and telecare to support people with dementia and their carers (7). Objective 11: Living well with dementia in care homes (7). Recommendation 7. Involve people with dementia, carers, family and friends in the care of people with dementia to improve person-centred care (9). I live in an enabling and supportive environment where I feel valued and understood (10). G30. Clinical falls prevention and management policy (12). Outcome Seven- The person with dementia, their families, friends and carers are supported to live how they wish and have the knowledge to get what they need. People with dementia, their families, friends and carers, have access to the information, education and support that enhances the wellbeing of the person with dementia and those that support them (1). Principle 6 Family members and other carers are valued, respected and supported just like those they care for and are helped to gain access to dementia care advice (2). Objective 3: Good-quality information for those with diagnosed dementia and their carers (7). Objective 4: Enabling easy access to care, support and advice following diagnosis (7). Objective 7: Implementing the Carer s Strategy (7). Recommendation 7. Involve people with dementia, carers, family and friends in the care of people with dementia to improve person-centred care (9). I have support that helps me live my life (10). I have the knowledge and know-how to get what I need (10). Statement 6. Carers of people with dementia are offered an assessment of emotional, psychological and social needs and, if accepted, receive tailored interventions identified by a care plan to address those needs (11). Statement 10. Carers of people with dementia have access to a comprehensive range of respite/short-break services that meet the needs of both the carer and the person with dementia (11). (1) Scottish Government (2011) Promoting Excellence: A Framework For All Health And Social Services Staff Working With People With dementia, Their Families And Carers. Scottish Government. (You may re-use this information (excluding logos and images) free of charge in any format or medium, under the terms of the Open Government Licence). (2) Common Core Principles For Supporting People With dementia: A Guide For Training The Social Care And Health Workforce (DOH, 2011). Copies of this work may be made for non-commercial distribution to aid social care workforce development (7) DOH (2009) Living Well With dementia: The National dementia Strategy. (9) Alzheimer s Society (2009) Counting the cost. Caring for people with dementia on hospital wards. (10) DOH (2010) Quality Outcomes for people with dementia: Building On The Work Of The National dementia Strategy. (11) NICE (2010) Dementia Quality Standard (12) South Tees NHS Foundation Trust. Various Policies. Written and compiled by Helen Robinson-Clinical Educator Dementia Approved by the skilled and effective workforce work stream Review date July

9 W.A.S.P. framework structure In order to assist in the assessment of skills, the W.A.S.P. (Witnessed, Assimilated, Supervised, and Proficient) framework will be used. The W.A.S.P. Framework is divided into four sections; i) action, ii) rationale, iii) W.A.S.P. assessment and iv) comments and progress record. The W.A.S.P. assessment (see table below) is used for each competency and contains a scoring process which is used to assess progress. W Witnessed Observe or witness the competency. It is considered good practice that the learner will have had the opportunity to observe an assessment prior to being supervised. A Assimilated Understand the elements of the competency. Three essential elements, theory, practice and professional approach. Demonstrate sound knowledge base for the competency element, including relevant Trust Policies, and Professional and Legal issues relating to it. Assimilation of knowledge can be assessed through observation of practice, or through questioning/discussion/simulation of situations relating to the competency element if these particular situations have not arisen. S Supervised Practice under supervision to demonstrate understanding. Score as follows: 1 needs further practice; 2 shows aptitude; 2 proficient. P Proficient Competent in knowledge and skill elements of the competency. Written and compiled by Helen Robinson-Clinical Educator Dementia Approved by the skilled and effective workforce work stream Review date July

10 Level 1 dementia care. Essential practice level Written and compiled by Helen Robinson-Clinical Educator Dementia Approved by the skilled and effective workforce work stream Review date July

11 Level 1 dementia care. Essential practice level Level 1 dementia care. Essential practice level Basic/fundamental awareness and training required in all areas of the Trust. Level 1 dementia care. Essential practice level is basic knowledge about dementia and the impact it has on the lives of those living with dementia, their family and carers. Content includes the signs and symptoms of dementia and their effects on the person, person-centred care, communication issues, environmental issues, awareness of relevant legislation and support for the person with dementia, their families and carers. Outcome One- The person with dementia feels empowered and has personal choice and control over decisions about them; maintaining their dignity and respect. Quality of life; Person-centeredness; Choice and control; Supporting strengths; Understanding about the risk of neglect, harm and abuse. Outcome Two- The person with dementia has access to good quality early diagnosis and intervention. How to access information and services; Common signs and symptoms; Communication methods. Outcome Three- The person with dementia maintains their best level of physical, mental, social, emotional and spiritual wellbeing. Hazards; Effects of symptoms; Responding to distress. Outcome Four. The person with dementia has a sense of belonging by being empowered to maintain valued relationships and networks, and has the opportunity to develop new ones; both personal and professional, and can participate in community life and valued activities Support; Engagement in activities; Spiritual and cultural needs; Environment. Outcome Five- The person with dementia has access to quality services that are designed around their needs and the needs of their family and carers. Not applicable at Level 1. Outcome Six- The person with dementia feels safe, in a supportive environment, and is enabled to be as independent as possible. Stigma; Social Isolation. Written and compiled by Helen Robinson-Clinical Educator Dementia Approved by the skilled and effective workforce work stream Review date July

12 Outcome Seven- The person with dementia, their families, friends and carers are supported to live how they wish and have the knowledge to get what they need. Not applicable at Level 1. **At present Level 1 dementia care. Essential practice level is an interactive taught session with the Clinical Educators and is not included within a W.A.S.P. framework** Written and compiled by Helen Robinson-Clinical Educator Dementia Approved by the skilled and effective workforce work stream Review date July

13 Level 2 dementia care. Skilled practice level Written and compiled by Helen Robinson-Clinical Educator Dementia Approved by the skilled and effective workforce work stream Review date July

14 Level 2 dementia care. Skilled practice level Level 2 dementia care. Skilled practice level Builds on the knowledge gained from the level 1 dementia care. Essential practice level. The focus of this level is on the competencies required for staff working regularly with people with dementia, their relatives and carers. This could be on the ward, in outpatient areas, in the community, and even in people s own homes. It is expected than anyone undertaking level 2 dementia care. Skilled practice level will have already undertaken level 1 dementia care. Essential practice level, as this level builds on the knowledge already obtained from this. Content includes key legislation, risk assessment, health and wellbeing and anticipatory care planning. Outcome One- The person with dementia feels empowered and has personal choice and control over decisions about them; maintaining their dignity and respect. Health behaviours; Key legislation. Outcome Two- The person with dementia has access to good quality early diagnosis and intervention. No expansion from skills and knowledge gained in level 1 dementia care. Essential practice level. Outcome Three- The person with dementia maintains their best level of physical, mental, social, emotional and spiritual wellbeing. Life story; Specific health conditions associated with dementia; Interventions that can support good nutrition, skin care continence and pain management; Distress caused by changes in routine; Communication. Outcome Four- The person with dementia has a sense of belonging by being empowered to maintain valued relationships and networks, and has the opportunity to develop new ones; both personal and professional, and can participate in community life and valued activities. Engagement in activities; Current networks and introduction to third sector agencies for peer and group support; Independence; Spiritual and cultural needs; Environment; Need for involvement; Capacity; Challenges faced by the person with dementia, their family and carers. Outcome Five- The person with dementia has access to quality services that are designed around their needs and the needs of their family and carers. Types of dementia; Community based support; Voluntary services. Written and compiled by Helen Robinson-Clinical Educator Dementia Approved by the skilled and effective workforce work stream Review date July

15 Outcome Six- The person with dementia feels safe, in a supportive environment, and is enabled to be as independent as possible. Services available to the person with dementia, their family and carers; Assistive technology; Aids and adaptations used; Stigma and social isolation; Care approaches used. Outcome Seven. The person with dementia, their families, friends and carers are supported to live how they wish and have the knowledge to get what they need. Safety and wellbeing; Early diagnosis and its importance; Stages of the dementia journey; Cognitive stimulation. Written and compiled by Helen Robinson-Clinical Educator Dementia Approved by the skilled and effective workforce work stream Review date July

16 Level 2 dementia care. Skilled practice level. Outcome One. Competency Standard Statement The person with dementia feels empowered and has personal choice and control over decisions about them; maintaining their dignity and respect. W WITNESSED Observe or witness the competency it is considered good practice that the healthcare professional will have had the opportunity to observe the procedure prior to being supervised. A ASSIMILATED Understands the underpinning knowledge associated with each element of the competency 1 = DEMONSTRATES FUNDAMENTAL KNOWLEDGE AND UNDERSTANDING 2 = DEMONSTRATES BROAD KNOWLEDGE AND UNDERSTANDING 3 = DEMONSTRATES IN DEPTH KNOWLEDGE AND UNDERSTANDING S SUPERVISED Practice under supervision to demonstrate understanding: score as follows: 1 = NEEDS FURTHER PRACTICE 2 = SHOWS APTITUDE 3 = DEMONSTRATES SKILLED AND PROFESSIONAL PRACTICE P PROFICIENT Competent in both knowledge and skill elements of the Competency. ACTION RATIONALE W A (Score) S (Score) P Demonstrate knowledge of health behaviours that may affect the person with dementia. Work in a way which promotes choice, well-being and protection of all individuals. Be aware of the key provisions of: Mental Health Act (1983); The Human Rights Act (1998); Mental Capacity Act (2005); and The Equalities Act (2010). To enable individuals with dementia to make informed choices concerning their health and wellbeing. To support the person with dementia. To assess risk in relation to capacity. To allow previously expressed wishes to be taken into account. Written and compiled by Helen Robinson-Clinical Educator Dementia Approved by the skilled and effective workforce work stream Review date July

17 Be aware of how to contact the local Safeguarding Team (South Tees Hospitals NHS Foundation Trust Policy G62. Safeguarding Vulnerable Adults Policy). Involve the person with dementia in all decisions and respect the decisions that they make. Consider the need for an advocate or independent mental capacity advocate in various stages of the dementia journey. To contribute to the assessment of people at risk of abuse. To support the person with dementia and to aid them in exercising their rights and choices. Staff Member (Signature) Trainer (Signature) Competency Achieved Yes/No Date Written and compiled by Helen Robinson-Clinical Educator Dementia Approved by the skilled and effective workforce work stream Review date July

18 Reflection on learning in practice. Describe the learning activity? How many hours was the session? What have you learnt? How will this influence your practice? What further learning needs has this identified? Written and compiled by Helen Robinson-Clinical Educator Dementia Approved by the skilled and effective workforce work stream Review date July

19 Level 2 dementia care. Skilled practice level. Outcome Two. Competency Standard Statement The person with dementia has access to good quality early diagnosis and intervention. *** No expansion from skills and knowledge gained in Level 1 dementia care. Essential Practice Level *** Written and compiled by Helen Robinson-Clinical Educator Dementia Approved by the skilled and effective workforce work stream Review date July

20 Level 2 dementia care. Skilled practice level. Outcome Three. Competency Standard Statement The person with dementia maintains their best level of physical, mental, social, emotional and spiritual wellbeing. W WITNESSED Observe or witness the competency it is considered good practice that the healthcare professional will have had the opportunity to observe the procedure prior to being supervised. A ASSIMILATED Understands the underpinning knowledge associated with each element of the competency 1 = DEMONSTRATES FUNDAMENTAL KNOWLEDGE AND UNDERSTANDING 2 = DEMONSTRATES BROAD KNOWLEDGE AND UNDERSTANDING 3 = DEMONSTRATES IN DEPTH KNOWLEDGE AND UNDERSTANDING S SUPERVISED Practice under supervision to demonstrate understanding: score as follows: 1 = NEEDS FURTHER PRACTICE 2 = SHOWS APTITUDE 3 = DEMONSTRATES SKILLED AND PROFESSIONAL PRACTICE P PROFICIENT Competent in both knowledge and skill elements of the Competency. ACTION RATIONALE W A (Score) S (Score) P Recognise and respect the spiritual, cultural and personal beliefs of the person with dementia. To enable support of the spiritual, cultural and personal wellbeing of individuals. Provide information or signpost to services. Assist with maintaining the physical comfort of the person with dementia. Assist the patient with dementia to mobilise (within the learner s professional responsibility). Manage the person with dementia s physical, mental, social and emotional needs (within the learner s professional responsibility). Support individuals during activities to improve To allow for physical comfort. To allow for maintenance of mobility. To maintain their best level of physical, mental, social and emotional wellbeing. Written and compiled by Helen Robinson-Clinical Educator Dementia Approved by the skilled and effective workforce work stream Review date July

21 their physical health and wellbeing. Support individuals during activities to improve their social wellbeing. Understand the need to assess mental, alongside physical, wellbeing. Use life story and patient passports to support meaningful engagement of the patient with dementia. To understand the person with dementia s history and support their individuality. Understand that the person with dementia may not be able communicate physical illness, pain or mental distress. To ensure that the person with dementia is cared for holistically, taking into account their own ability to communicate need. Contribute, as appropriate to your role, to the palliative and end of life care of the person with dementia. To allow for the maintenance of dignity and to enable the person with dementia to have a good death. Staff Member (Signature) Trainer (Signature) Competency Achieved Yes/No Date Written and compiled by Helen Robinson-Clinical Educator Dementia Approved by the skilled and effective workforce work stream Review date July

22 Reflection on learning in practice. Describe the learning activity? How many hours was the session? What have you learnt? How will this influence your practice? What further learning needs has this identified? Written and compiled by Helen Robinson-Clinical Educator Dementia Approved by the skilled and effective workforce work stream Review date July

23 Level 2 dementia care. Skilled practice level. Outcome Four. Competency Standard Statement The person with dementia has a sense of belonging by being empowered to maintain valued relationships and networks, and has the opportunity to develop new ones; both personal and professional, and can participate in community life and valued activities. W WITNESSED Observe or witness the competency it is considered good practice that the healthcare professional will have had the opportunity to observe the procedure prior to being supervised. A ASSIMILATED Understands the underpinning knowledge associated with each element of the competency 1 = DEMONSTRATES FUNDAMENTAL KNOWLEDGE AND UNDERSTANDING 2 = DEMONSTRATES BROAD KNOWLEDGE AND UNDERSTANDING 3 = DEMONSTRATES IN DEPTH KNOWLEDGE AND UNDERSTANDING S SUPERVISED Practice under supervision to demonstrate understanding: score as follows: 1 = NEEDS FURTHER PRACTICE 2 = SHOWS APTITUDE 3 = DEMONSTRATES SKILLED AND PROFESSIONAL PRACTICE P PROFICIENT Competent in both knowledge and skill elements of the Competency. ACTION RATIONALE W A (Score) S (Score) P Establish a therapeutic relationship with the person with dementia, their family and carers. Maintain a therapeutic relationship for the required duration and appropriately disengage from the therapeutic relationship as appropriate. To allow for a sense of belonging and empowerment. Support the person with dementia to develop and maintain relationships with others. Understand that it is important for the person with dementia, their family and carers to have the opportunity to be a valued part of the local community. To allow for a sense of belonging. To allow for a sense of belonging, empowerment and independence. Written and compiled by Helen Robinson-Clinical Educator Dementia Approved by the skilled and effective workforce work stream Review date July

24 Understand that the person with dementia must be encouraged to continue with their work, chosen activities, social and community life, as appropriate to the individual. Assist the person with dementia and their family and carers to contact local support. Understand that environmental adjustments may be required to help the person with dementia maintain valued relationships and networks. Understand that there may be challenges to maintaining valued relationships and networks as the dementia progresses. To allow for a sense of belonging, empowerment and independence. To allow for a sense of empowerment. To aid access and to allow participation in all stages of the dementia journey. To allow for a sense of belonging, empowerment and independence. Understand the person with dementia, their friends and family may need additional support at various stages, including counselling and psychological therapies, and know how to access or to signpost to these. Staff Member (Signature) Trainer (Signature) Competency Achieved Yes/No Date Written and compiled by Helen Robinson-Clinical Educator Dementia Approved by the skilled and effective workforce work stream Review date July

25 Reflection on learning in practice. Describe the learning activity? How many hours was the session? What have you learnt? How will this influence your practice? What further learning needs has this identified? Written and compiled by Helen Robinson-Clinical Educator Dementia Approved by the skilled and effective workforce work stream Review date July

26 Level 2 dementia care. Skilled practice level. Outcome Five. Competency Standard Statement The person with dementia has access to quality services that are designed around their needs and the needs of their family and carers. W WITNESSED Observe or witness the competency it is considered good practice that the healthcare professional will have had the opportunity to observe the procedure prior to being supervised. A ASSIMILATED Understands the underpinning knowledge associated with each element of the competency 1 = DEMONSTRATES FUNDAMENTAL KNOWLEDGE AND UNDERSTANDING 2 = DEMONSTRATES BROAD KNOWLEDGE AND UNDERSTANDING 3 = DEMONSTRATES IN DEPTH KNOWLEDGE AND UNDERSTANDING S SUPERVISED Practice under supervision to demonstrate understanding: score as follows: 1 = NEEDS FURTHER PRACTICE 2 = SHOWS APTITUDE 3 = DEMONSTRATES SKILLED AND PROFESSIONAL PRACTICE P PROFICIENT Competent in both knowledge and skill elements of the Competency. ACTION RATIONALE W A (Score) S (Score) P Have knowledge of the four main types of dementia: Alzheimer s Disease; Vascular dementia; Front temporal dementia; and Dementia with Lewy bodies. Be aware of local specialist memory services available. To allow an awareness of the range of challenges encountered by the person with each type of dementia. To support the person with memory impairment to access appropriate services. Written and compiled by Helen Robinson-Clinical Educator Dementia Approved by the skilled and effective workforce work stream Review date July

27 Have knowledge of support services available (such as professional, specialist and voluntary services) for the person with dementia, their family and carers. Assist in the movement of the patient between services (such as community, social, hospital, and specialist) and support as appropriate. Contribute to effective multidisciplinary team working. To refer or signpost the person with dementia, their family and carers; To empower the person with dementia and to allow them to maintain their independence. To refer or signpost the person with dementia, their family and carers. To ensure services are used appropriately; with the individual at the centre of the decision making. Staff Member (Signature) Trainer (Signature) Competency Achieved Yes/No Date Written and compiled by Helen Robinson-Clinical Educator Dementia Approved by the skilled and effective workforce work stream Review date July

28 Reflection on learning in practice. Describe the learning activity? How many hours was the session? What have you learnt? How will this influence your practice? What further learning needs has this identified? Written and compiled by Helen Robinson-Clinical Educator Dementia Approved by the skilled and effective workforce work stream Review date July

29 Level 2 dementia care. Skilled practice level. Outcome Six. Competency Standard Statement The person with dementia feels safe, in a supportive environment, and is enabled to be as independent as possible. W WITNESSED Observe or witness the competency it is considered good practice that the healthcare professional will have had the opportunity to observe the procedure prior to being supervised. A ASSIMILATED Understands the underpinning knowledge associated with each element of the competency 1 = DEMONSTRATES FUNDAMENTAL KNOWLEDGE AND UNDERSTANDING 2 = DEMONSTRATES BROAD KNOWLEDGE AND UNDERSTANDING 3 = DEMONSTRATES IN DEPTH KNOWLEDGE AND UNDERSTANDING S SUPERVISED Practice under supervision to demonstrate understanding: score as follows: 1 = NEEDS FURTHER PRACTICE 2 = SHOWS APTITUDE 3 = DEMONSTRATES SKILLED AND PROFESSIONAL PRACTICE P PROFICIENT Competent in both knowledge and skill elements of the Competency. ACTION RATIONALE W A (Score) S (Score) P Recognise that environmental factors can affect the person with dementia and, wherever possible, be aware of adaptations that can be made. Monitor any changes in physical and mental health and ensure these are addressed, as appropriate to your role. To support the person with dementia to be as independent as possible. Work with other members of the multidisciplinary team to ensure the person with dementia has a full assessment of their home environment, allowing for adaptations to be made, as appropriate. To allow the person with dementia to feel safe and secure. Written and compiled by Helen Robinson-Clinical Educator Dementia Approved by the skilled and effective workforce work stream Review date July

30 Provide information and signposting to services for risk enablement, such as telecare. Provide support and encouragement, with activities of daily living, appropriate to your role. Have knowledge of some of the equipment available to aid with diet, fluids and continence, appropriate to your role. Recognise when the person with dementia is at risk of falls and react appropriately; To ensure the maintenance of independence for as long as possible. To support the person with dementia to maintain good physical health. To allow the person with dementia to remain independent and to maintain their dignity at all times. To maintain the safety and dignity of the person with dementia. Understand the impact of visual and auditory problems on the risk of falls. Understand that admission to hospital can have a dramatic detrimental effect on the person with dementia. To promote the use of anticipatory and preventative measures that can be put in place to prevent admission, or readmission, to the acute setting. Staff Member (Signature) Trainer (Signature) Competency Achieved Yes/No Date Written and compiled by Helen Robinson-Clinical Educator Dementia Approved by the skilled and effective workforce work stream Review date July

31 Reflection on learning in practice. Describe the learning activity? How many hours was the session? What have you learnt? How will this influence your practice? What further learning needs has this identified? 31

32 Level 2 dementia care. Skilled practice level. Outcome Seven. Competency Standard Statement The person with dementia, their families, friends and carers are supported to live how they wish and have the knowledge to get what they need. W WITNESSED Observe or witness the competency it is considered good practice that the healthcare professional will have had the opportunity to observe the procedure prior to being supervised. A ASSIMILATED Understands the underpinning knowledge associated with each element of the competency 1 = DEMONSTRATES FUNDAMENTAL KNOWLEDGE AND UNDERSTANDING 2 = DEMONSTRATES BROAD KNOWLEDGE AND UNDERSTANDING 3 = DEMONSTRATES IN DEPTH KNOWLEDGE AND UNDERSTANDING S SUPERVISED Practice under supervision to demonstrate understanding: score as follows: 1 = NEEDS FURTHER PRACTICE 2 = SHOWS APTITUDE 3 = DEMONSTRATES SKILLED AND PROFESSIONAL PRACTICE P PROFICIENT Competent in both knowledge and skill elements of the Competency. ACTION RATIONALE W A (Score) S (Score) P Respond with compassion to the person with dementia, and their families and carers, when they show signs of frustration and distress. Be aware of the needs of families and carers and enable a Carer s Assessment to take place. Build a therapeutic relationship with the person with dementia, their family and carers. Be able to give information on or signpost to Carer s Associations, specialist services, benefits advice and support agencies. To enable a sense of empowerment and independence. To ensure the health and wellbeing of those close to the person with dementia. To ensure that the needs of the person with dementia are at the centre of all decision making. To ensure the person with dementia, their families and carers have the knowledge and support they need. 32

33 Include families and carers, where appropriate, in honest discussions about the progression of dementia and the terminal nature of the disease. To enable the person with dementia, their family and carer to make informed choices about their own care. Staff Member (Signature) Trainer (Signature) Competency Achieved Yes/No Date 33

34 Reflection on learning in practice. Describe the learning activity? How many hours was the session? What have you learnt? How will this influence your practice? What further learning needs has this identified? 34

35 Level 3 dementia care. Enhanced practice level. 35

36 Level 3 dementia care. Enhanced practice level. Level 3 dementia care. Enhanced practice level. Builds on the knowledge gained from the level 1 dementia care. Essential practice level and the level 2 dementia care. Skilled practice level. The enhanced practice level is relevant to staff working more intensely with people with dementia, their relatives and carers. This could be within dementia clinics, memory clinics, dementia advisory services, and EMI care homes. It is expected than anyone undertaking Level 3 dementia care. Enhanced practice level will have already undertaken level 1 and level 2 dementia care, as this level builds on the knowledge already obtained from these. Content includes a much more in-depth overview of dementia; how this affects the person, their family, friends and carers, using an evidence-based approach. Outcome One- The person with dementia feels empowered and has personal choice and control over decisions about them; maintaining their dignity and respect. Human and legal rights; Safeguarding; Knowledge of principles and key provision of legislation; Future planning and the potential for distress; Creating a life story; Complexity of disease progression; Keeping family and carers informed; Advocacy; Remaining up to date with dementia care. Outcome Two- The person with dementia has access to good quality early diagnosis and intervention. Evidence based health behaviours; Detailed knowledge of dementia and the need for support; Evidence based screening tools; Delirium, depression and dementia and knowing how to differentiate. Outcome Three- The person with dementia maintains their best level of physical, mental, social, emotional and spiritual wellbeing. Health promotion; Causes and signs of distress; Sensitive approach to the person with dementia through all stages in their dementia journey; Specialist services; Self-management and self-help; Quality of life; Carer s assessments; Understanding pain, nutritional needs, physical wellbeing and cultural and spiritual support services available at end of life; Psychological and emotional effects of dying affecting the person with dementia, family and carers; Bereavement support; Physical conditions associated with different types of dementia. 36

37 Outcome Four- The person with dementia has a sense of belonging by being empowered to maintain valued relationships and networks, and has the opportunity to develop new ones; both personal and professional, and can participate in community life and valued activities Local services offering assessment and advice on memory problems; Impact of diagnosis; Younger onset dementia; Personalisation of care; Enablement; Social inclusion and quality of life; Understanding behaviours shown in distress; Balancing dependence and interdependence; and Helping the person with dementia to communicate their decisions. Outcome Five -The person with dementia has access to quality services that are designed around their needs and the needs of their family and carers. Problem solving with regard to what the person with dementia perceives as important; Pharmacological interventions; Guidance in the use of medication for people with dementia; Supporting the person with dementia, their family and carers in times of distress; Range of interventions that can support good nutrition, skin care, continence and pain management; Specialist services available. Outcome Six- The person with dementia feels safe, in a supportive environment, and is enabled to be as independent as possible. Quality of life; Independent living; Risk enablement; Respite and short breaks for the patient and their carer; Neglect and abuse; Informed consent, confidentiality and advance planning and the implications of such; Communication. Outcome Seven- The person with dementia, their families, friends and carers are supported to live how they wish and have the knowledge to get what they need. The role of families, friends and carers and their rights; Determining capacity; Communication and tools available. 37

38 Level 3 dementia care. Skilled practice level. Outcome One. Competency Standard Statement The person with dementia feels empowered and has personal choice and control over decisions about them; maintaining their dignity and respect. W WITNESSED Observe or witness the competency it is considered good practice that the healthcare professional will have had the opportunity to observe the procedure prior to being supervised. A ASSIMILATED Understands the underpinning knowledge associated with each element of the competency 1 = DEMONSTRATES FUNDAMENTAL KNOWLEDGE AND UNDERSTANDING 2 = DEMONSTRATES BROAD KNOWLEDGE AND UNDERSTANDING 3 = DEMONSTRATES IN DEPTH KNOWLEDGE AND UNDERSTANDING S SUPERVISED Practice under supervision to demonstrate understanding: score as follows: 1 = NEEDS FURTHER PRACTICE 2 = SHOWS APTITUDE 3 = DEMONSTRATES SKILLED AND PROFESSIONAL PRACTICE P PROFICIENT Competent in both knowledge and skill elements of the Competency. ACTION RATIONALE W A (Score) S (Score) P Have a detailed knowledge of the key provisions of: The Mental Health Act (1983); The Human Rights Act (1998); Mental Capacity Act (2005); The Equalities Act (2010). To support the person with dementia. To assess risk in relation to capacity. To empower the person with dementia and to allow previously expressed wishes to be taken into account. Be able to provide clinical information on dementia to the person with dementia, their family and carers. Have an in-depth understanding of person centred care. Be aware of the signs and symptoms of elder abuse. To enable the person with dementia to make well informed choices concerning their health and wellbeing. To empower the person with dementia. To contribute to the assessment of people at risk of abuse. 38

39 Be aware of how and when to make an Adult Safeguarding Referral (South Tees Hospitals NHS Foundation Trust Policy G62. Safeguarding Vulnerable Adults Policy) and encourage others to do the same. Involve the person with dementia in all decisions and respect the decisions that they make. Be aware of how and when to refer the person with dementia to an advocate or independent mental capacity advocate in various stages of the dementia journey. Be aware of risk taking and enable to person with dementia to take risks in the context of their own lives. Enable the person with dementia, their family and carers to discuss sensitive areas such as Advanced Planning, Power Of Attorney, Advance Directives and progression of the disease. To support the person with dementia and to aid them in exercising their rights and choices. To empower the person with dementia. To enable the person with dementia to make well informed choices concerning their health and wellbeing, and to aid them in exercising their rights and choices. Sensitively and empathetically support the person with dementia to make plans and identify their priorities for the future. Be aware when Advanced Planning has taken place, whether or not this has been recorded, and whether this knowledge has been used to deliver patient centred care. If no Advanced Planning is in place, work with family, carers or patient advocates, to ensure the choices of the person with dementia are met to the best possible knowledge. To support the person with dementia and to aid them in exercising their rights and choices. 39

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