2. DELEGATING CARE WITH CONFIDENCE CHILD & FAMILY CENTRED COMPETENCY SYSTEM

3. 2001 Increasing numbers and complexity of children.Increasing numbers and complexity of children. All care delivered by qualified nurses from agencies.All care delivered by qualified nurses from agencies. Trust staff reluctant to or barred from giving training to non-NHS staff.Trust staff reluctant to or barred from giving training to non-NHS staff. NHS role provision rather than training.NHS role provision rather than training. Major difficulties with recruitment and retention.Major difficulties with recruitment and retention. Inconsistency of approach, ‘many ways to crack an egg’!Inconsistency of approach, ‘many ways to crack an egg’! Lack of a child centred approachLack of a child centred approach High cost - £1 million plus!High cost - £1 million plus!

4. THE QUALITY OF BEING COMPETENT OR WELL EXPERIENCED, PRACTICALLY & A SOUND KNOWLEDGE BASE.

5. CHILDREN’SNSF EVERY CHILD MATTERSCLINICALGOVERNANCE N.M.C. POLICYAGENDA

6. Holistic Link with Bench-marking Based on alearningtheory Test the assessed & theassessor AideMulti-agencyworking Universal & Multi level Safe Child & FamilyCentred What did we want to achieve

7. THE EXPERIENTIAL TAXONOMY Steinaker & Bell 1979 Exposure First you discover it Participation Practice under supervision Identification Know what to do & why you are doing it Internalisation Like riding a bike Disseminator You can teach it

8. Basic anatomy & physiology Psychological implications Demonstration of skill Complications and trouble shooting Safety Record keeping Privacy & dignity

9. GASTROSTOMY BUTTON FEEDING COMPETENCY E – Initial training P – Practical Training I(a) – Competent to practice (b) – Competent and experienced (b) – Competent and experienced D – Competent to teach This competency is for Patient _____________________________ only. THIS COMPETENCY EXPIRES ON___________________________ This competency certifies Carer ___________________________ only. AREA OF CONCERN REQUIRED SKILLS AND KNOWLEDGE LEVEL REACHED EPI(a)I(b)D 1) Carer to understand reason for Enteral feeding tube. Carer demonstrates an awareness of:  Anatomy & physiology of the gastrointestinal tract and relative position of enteral tubes. Q  The indications for an enteral feeding tube. Q  Any additional problems the child may have that may complicate feeding - reflux. Q  The ability to identify whether the child can take oral food / fluids. Q 2) Carer to understand psychological aspects of feeding child enterally.  Age appropriate preparation of child. P  Carer to be aware of the importance of oral stimulation and prevention of food aversion. Q (Delete if inappropriate)  Use of finger foods and different textures if appropriate. Q (Delete if inappropriate)  Importance of oral hygiene. Q  Encouragement of normal interaction at family mealtimes. Q  Use of dummy when being fed. Q (Delete if inappropriate)  Encouragement of mouth games i.e. blowing bubbles or kisses, sticking tongue out etc. Q

10. IS IT SAFE TO TEACH & DELEGATE CARE TASKS TO NON NHS STAFF?

11. Some sources consider it inappropriate for C.C.Ns to assume responsibility for the training of non-nursing support workers as “in doing so jeopardise their professional position”. Murphy (2001) cited in The Textbook of Community Children’s Nursing (2005) The Health Select Committee’s first report into children & young people was published in 1997.

12. The Nursing and Midwifery Council (NMC) state: “you may be expected to delegate care delivery to others who are not registered nurses or midwives. Such delegation must not compromise existing care but must be directed to meeting the needs of and serving the interests of patients and clients. You remain accountable for the appropriateness of the delegation and for ensuring the person who does the work is able to do it and that adequate supervision and support is provided”. (NMC 2002)

16. I certify that the person named, as carer on this document is competent to carry out the procedure detailed above and that I have current N.M.C. registration. Overall competency: -________________________________ ___________________________ Date _______ I the above named carer certify that I am happy to carry out the above procedure within the competencies detailed above. I understand the scope of these competencies. I will only use this training in respect of the child specifically named on the front of this form and I will not carry out procedures, which are contrary to or not covered by this training. I will seek further training if I have any concerns about my competency and in any event six weeks before the expiry date on the front of this form renew my training. Upon the date of expiry of this competency, if my training has not been renewed, or if I have concerns about my competency, I will discontinue undertaking the procedure detailed in this document and seek appropriate advice from a suitably qualified clinician and or my employer. In all other respects I will seek all necessary advice guidance and further training needed from time to time in order for me to continue to to operate within these competencies. to operate within these competencies. NAME _____________________________ SIGNATURE _______________________________________ DATE _________ EMPLOYERS OF NON-NHS TRAINEES. We will use our best endeavours to ensure that our employee /staff member delivers care to the person named within the boundaries of this competency as outlined above. NAME _________________________________DESIGNATION __________________________________________ SIGNATURE _____________________________________________ DATE ___________ COMPETENCY DISCLAIMER

17. LEGALSAFETY PICK UP TEACHINGREQUIREMENTS INDIVIDUALKNOWLEDGE AUDIT QUESTIONNAIIRE QUESTIONNAIRES

18. CONTINUING CARE ASSESSMENT -COMPETENCIES -COSTING TRAINING / ASSESSING PARENTS / CHILD TRAINING / ASSESSING MULTI AGENCY PARTNERS TRAINING / ASSESSING RESPITE VOLUNTARY SECTOR

19. WHERE ARE WE NOW? Distributed to 94 PCTs Published in Including Me CCN Textbook 21 Competencies with Questionnaires & Model answers. All child centred Used in:- -3 acute units - 3 acute units - across our 4 PCTs - Education - Social Services - Voluntary Sector - Private Sector - Parents & informal carers carers AUDIT. Child & family feedback. Audit Forms – time to give & receive training. Commissioning services. Skill mix. Single consistent Approach: - 1 way to crack an egg! Confident!Safe!Integrated! Multidisciplinary - chest physiotherapist Council for Social Care Inspection Integration with pre registration nursing curriculum Integration with Inter agency systems: – Warwickshire Health Directory Continuing Care Multi use / pooling of carers Consistent teaching standards

20. Areas Where The Competency CD-ROM Have Been Circulated To.

22. Teaching & Assessing Off the shelf packs will ensure equity of teaching.Off the shelf packs will ensure equity of teaching. Each child’s named nurse can deliver the package safe in the knowledge that all points are coveredEach child’s named nurse can deliver the package safe in the knowledge that all points are covered The Trust is sure all the points are coveredThe Trust is sure all the points are covered Quality of teachingQuality of teaching Personalised carePersonalised care Supports Nurse Teaching roleSupports Nurse Teaching role PrivacyPrivacy Effective use of timeEffective use of time

23. Off the Shelf Teaching Packs We have been successful in a £10,000 bid to complete this project. We have been successful in a £10,000 bid to complete this project. The teaching packs will include : The teaching packs will include : PowerPoint presentations, Teaching plans, Teaching Aids Handouts, Demonstration & playtimes. Underpinned by:- Focus Groups, Questionnaires and Research

24. FOCUS GROUP AND FUN TIME

25. NATIONAL USER AUDIT 12 out of 52 returned!12 out of 52 returned! 75% using them / adapting them75% using them / adapting them Medication competencies requestedMedication competencies requested Tracheostomy, gastrostomy and rectal diazepam are the most commonly used competenciesTracheostomy, gastrostomy and rectal diazepam are the most commonly used competencies All comments have been positive so far.All comments have been positive so far.

26. ONGOING USER INVOVMENT RESEARCH FUTURE COMPLETE OFF THE SHELF SYSTEM EXPERT CHILD, EXPERT PARENT, REVIEWERS

27. David Widdas. Consultant Nurse for Children with Complex Care Needs. Warwickshire PCT & Coventry PCT david.widdas@warkpct.nhs.uk Liz Herd. Education Facilitator. Coventry PCT. liz.herd@coventrypct.nhs.uk liz.herd@coventrypct.nhs.uk