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October2013www.nhivna.org iNationalHIVNursingCompetenciesOctober2013 NHIVNACOMPETENCIESiiNationalHIVNursesAssociationNationalHIVNursingCompetenciesSSSSSSCopyrightNationalHIVNursesAssociation2013Thisdocumentisavailabletodownloadatwww.nhivna.orgFirstpublishedJune2007PublishedbyMediscriptLtd1MountviewCourt310FriernBarnetLaneLondonN200LDUK NHIVNACOMPETENCIESContentsiiiPreface.........................................................................................................................................................................................................................ivIntroductionfromFirstEditionofCompetenciesAimsandobjectives.....................................................................................................................................................................1UsingtheHIVnursingcompetenciesframework..................................................2Structureofthecompetencies..........................................................................................................................3GenericHIVnursingcompetenciesG1Assessinghealthandwell-being...................................................................................................................5G2Managementofantiretroviraltherapy...........................................................................................8G3Healthpromotion..............................................................................................................................................................................10G4Workinginpartnershipsincludingclinicalnetworksandmultidisciplinaryworking...............................................................................................................................................13SpecialistHIVnursingcompetenciesS1HIVoutpatients.......................................................................................................................................................................................15S2HIVinpatients.............................................................................................................................................................................................18S3Clinicaltrials..................................................................................................................................................................................................21S4Paediatric...............................................................................................................................................................................................................23AppendicesGlossaryandfurtherresources.........................................................................................................................29Acknowledgements........................................................................................................................................................................30 NHIVNACOMPETENCIESPrefaceivTheNationalHIVNursingCompetenciesweredevelopedthroughawideconsultationprocessandwerelaunchedatthe9thAnnualConferenceoftheNationalHIVNursesAssociationon28June2007inLondon.ThepreparationandoriginalproductionofthecompetencieswasfundedthroughagrantfromtheDepartmentofHealth.TheExecutiveCommitteeCompetencyWorkingPartycontinuallyevaluatesthedocumentandthiscurrentversionwascomprehensivelyupdatedinspring2013.TheCompetencieshavebeenre-launchedasane-bookandarealsoavailableasaWorddocumentwithanassessmentframeworktoenableyoutoeasilycopyandpasteacompetencydocumentappropriatetoyourjobandindividualdevelopmentplan.ThenewdocumentincludescompetenciesforuntrainedstaffworkinginHealthCareAssistant-typeroles.Forcommunity-basednurseswehaveincorporatedcompetenciesthroughoutallsectionswhichareappropriateforthecommunitysettingandwhichcanbepulledouttoadaptapersonalisedframework.WeappreciateyoursupportincontinuingtoimplementtheseNationalHIVNursingCompetencieslocallyacrossyourclinicalareaswhereHIVpatientsarecaredfor.ThistoolisintendedtoAssessandguidenursingcompetenceinthefieldofHIVcareintheUKandbeutilisedinthemappingandplanningofHIVnursingcareers.IndicatethespecificknowledgeandskillsrequiredbyindividualnursescaringforpeoplelivingwithHIVAIDStherebyimprovingequityandqualityofpatientcare.Complementandbeusedalongsidenationalandorlocalskillsandperformanceappraisalframeworks.Beusedatnationalnetworkserviceandindividuallevels.ThestructureofthecompetenciesisasfollowsGenericCoreCompetenciesPageG1Assessinghealthandwell-being5G2Managementofantiretroviraltherapy8G3Healthpromotion10G4Workinginpartnershipsincludingclinicalnetworksandmultidisciplinaryworking13SpecialistHIVCompetenciesPageS1HIVoutpatients15S2HIVinpatients18S3Clinicaltrials21S4Paediatric23NathanielAultChairNHIVNA References1.RoyalCollegeofNursing.SexualHealthCompetenciesAnIntegratedCareerandCompetencyFrameworkforSexualandReproductiveHealthNursing.LondonRoyalCollegeofNursing2004.2.DepartmentofHealth.TheNationalStrategyforSexualHealthandHIV.LondonDepartmentofHealth2001.3.MedicalFoundationforAIDSandSexualHealth.RecommendedStandardsforNHSHIVServices.LondonMedicalFoundationforAIDSandSexualHealth2003.4.DepartmentofHealth.TheNationalStrategyforSexualHealthandHIVImplementationActionPlan.LondonDepartmentofHealth2002.5.BritishHIVAssociationRoyalCollegeofPhysiciansBritishAssociationforSexualHealthandHIVBritishInfectionSociety.StandardsforHIVClinicalCare.LondonBHIVA2007.6.DepartmentofHealth.TheNHSKnowledgeandSkillsFrameworkNHSKSFandtheDevelopmentReviewProcess.LondonDepartmentofHealth2004.7.DepartmentofHealth.ModernisingNursingCareersSettingtheDirection.LondonDepartmentofHealth2006.NHIVNACOMPETENCIESIntroductionfromFirstEditionofCompetenciesAimsandobjectives1PurposeThedevelopmentoftheNHIVNANationalHIVNursingCompetencieshasbeenanincrementalprojectthathastakenplaceoverthepast3yearswithconsiderableconsultationwithnursesworkingintheHIVfield.ThedocumentisdesignedasatooltoassessandguidenursingcompetenceincaringforpeoplewithHIVAIDSintheUKandcanbeutilisedformappingskillsdevelopmentforcareerprogression.ScopeofthecompetencyframeworkThecompetencyframeworkisaimedattrainednursesworkingwithpeoplewithHIVAIDSintheUKirrespectiveofsizeofHIVcohortorgeographicallocation.Therevisedcompetencydocumentnowincludeshealthcareassistantsupportworkercompetencies.SincethefirsteditiontherolesofhealthcareassistantshasexpandedwithinHIVservicesandthereforecompetenciesarenowwithinthescopeofthisdocument.BackgroundTheRoyalCollegeofNursingsSexualHealthCompetencies1werelaunchedin2004andwerethefirstnationalcompetencyframeworkinthefieldofsexualhealthnursing.ThisframeworkprovidedaclearcareeroutlineforsexualhealthnursesandassistedinvalidatingtheknowledgeandskillsrequiredtodevelopsexualhealthnursingroleswithinthecontextoftheNationalStrategyforSexualHealthandHIV2.Priortothisin2003andwithspecificreferencetoHIVtheMedicalFoundationforAIDSandSexualHealthMedFASHpublishedtheRecommendedStandardsforNHSHIVServiceswhichfeatures12standardsbasedonapatientjourney3.TheunderpinningprincipleofthisdocumentisthedeliveryofthesestandardsthroughmanagedservicenetworksasadvisedintheImplementationActionPlanfortheNationalStrategyforSexualHealthandHIV4.MorerecentlyStandardsforHIVClinicalCarehasspecifiedthestructureofHIVmanagedservicenetworksbyclassifyinghowroutineandcomplexHIVcareshouldbeprovided5.TheessenceofthesebenchmarkdocumentshasprovidedthefoundationfortheNationalHIVNursingCompetenciesandthebasisfordefiningtheskillsandknowledgetodeliverviablenursingcaretoHIVpatientsatdifferentpointsacrossservicenetworks.ThepublicationoftheKnowledgeandSkillsFrameworkKSF6hasenabledtheNationalHIVNursingCompetenciestodevelopwithinanationalcompetencystructurethatwillhopefullyeasetheintegrationofthesespecialistcompetenciesintoappraisalandperformancedevelopment.ThefutureofnursingintheUKasoutlinedintheChiefNursingOfficerspaperonModernisingNursingCareers7hassetthesceneforamoreflexibleinfluentialandcontemporarynursingworkforce.ItisanticipatedthattheappropriateapplicationoftheNationalHIVNursingCompetencieswillmakeavalidcontributiontothedeliveryofkeyhealthpolicygoals. References8.TheRoyalCollegeofNursingsCoreCompetenciescanbefoundatwww.rcn.org.ukresourcescorecompetences9.ForfurtherinformationabouttheNationalOccupationalStandardsseewww.topssengland.netNHIVNACOMPETENCIESIntroductionfromFirstEditionofCompetenciesUsingtheHIVnursingcompetenciesframework2TheNationalHIVNursingCompetenciesaredesignedforusealongsidetheKnowledgeandSkillsFrameworkKSF6.ThesecompetenciescaneitherbeincorporatedintoanindividualKSFpostoutlineorcanbeusedasanaddendumtoamoregenericKSFoutline.ForareaswheretheKSFisnotinusethecompetenciescanbeusedasastand-alonedocumentforallnurseswholookafterHIVpatientswhetheraspartoftheirjoborinanHIVspecialistcapacityTable1.ThecompetenciesfoundinthisdocumentareintendedasspecialistHIVnursingcompetenciesthatwillcomplementothercompetencyframeworkssuchastheRoyalCollegeofNursingsCoreCompetencies8andtheNationalOccupationalStandards9.AssessingcompetenciesTheprincipleforassessingcompetentpracticeistoadoptamultifacetedapproachthatcanrangefromdirectobservationofpracticethroughreflectivediariestoimplementingchangeinpractice.SincetheintroductionofKSFmanynurseswillbefamiliarwiththerequirementtoprovideevidenceofcompetenceaspartoftheirpersonaldevelopmentplan.ThereisatpresentnonationaltoolforassessingcompetenceinrelationtoHIVnursinghoweverwewouldencouragenurseassessorstodeveloptheirownassessmentframeworksbasedontheHIVnursingcompetencies.Table1SuggesteduseoftheHIVnursingcompetenciesIAtnationalandnetworklevelProvisionofnationalstandardsforHIVnursingSupportrecruitmentandcareerpathwaysImprovequalityandequityofpatientcareInformeducationalprogrammesInformsector-widecommissioningIServicelevelEnablestandardisationofjobdescriptionsInformKSFandperformancereviewEnsurequalityofcaredeliveryInformnurse-ledservicesandmodernisationIIndividuallevelProvidecareerstructurePersonalandprofessionaldevelopmentEnhanceretentionofstaffProviderecognitionofindividualspecialistskills NHIVNACOMPETENCIESIntroductionfromFirstEditionofCompetenciesStructureofthecompetencies3TheNationalHIVNursingCompetenciescomprisefourgenericcompetenciesandfourspecialistcompetenciesseeFigure1.ThegenericHIVcompetenciesareapplicabletoallnursesworkinginHIVcareirrespectiveofwheretheyareclinicallybasedandareasfollows1.Assessinghealthandwell-being2.Managementofantiretroviraltherapy3.Healthpromotion4.WorkinginpartnershipsincludingclinicalnetworksandmultidisciplinaryworkingThespecialistcompetenciesapplytonursesworkinginHIVoutpatientclinicsHIVinpatientunitsclinicaltrialcentresorHIVpaediatricunitsornurseswhoseroleinvolveslookingafterpatientsinanyoftheseareasaspartoftheirclinicalcaseloadandareasfollows5.HIVoutpatientsTriageandminorillnesssupportManagementandsupportofwellstablepatientsManagementandsupportofpatientswithco-infectionandco-morbiditySupportandmanagementofpeopletakingpost-exposureprophylaxis6.HIVinpatients7.Clinicaltrials8.PaediatriccareCompetencylevelsThelevelsofcompetencedefinedintheNationalHIVNursingCompetenciesreflectthenursingcareerstructuredescribedintheDepartmentofHealthdocumentMakingaDifference10.TheyarealsoinformedbytheleveldescriptorswithintheNHSKSF6.ClinicaltrialsOutpatientsManagementofARTAssessinghealthandwell-beingMultidisciplinaryworkingHealthpromotionInpatientsPaediatricsFigure1.GenericandspecialistHIVnursingcompetencies NHIVNACOMPETENCIESIntroductionfromFirstEditionofCompetenciesStructureofthecompetencies4ThecompetencylevelsrelatenotonlytojobbandingandjobspecificationbutalsotothelevelofspecialistHIVcarethatisrequiredwithinanursesrole.Forexampleadistrictnursewhoworksatlevel3withherhisgeneralcaseloadmayonlyrequirelevel2competencetoprovidecaretoasmallcaseloadofHIVpatientsinthecommunity.WhereasanHIVclinicalnursespecialistmayfunctionatlevel4inexpertpracticewithantiretroviralcarebutatlevel3insettinguppathwaysforantiretroviralcareacrossamanagedservicenetwork.Thekeytoutilisingthesecompetencieseffectivelyistointerpretandadaptthemtolocalcircumstances.ForexamplesomeservicesmayspecifythatnursesneedtobecompetentinHIVtriageskillsbeforeundertakingnurse-ledclinics.Level2RegisteredpractitionerThisleveldefinestheentrypointforregisterednursesworkinginaspecialistHIVarea.HoweveritalsoappliestoregisterednursesatanygradeworkingwithHIVpatientsaspartofanon-specialistroleorinanon-HIVspecialistarea.Level3SeniorregisteredpractitionerLevel3competencyappliestoexperiencedHIVpractitionersworkinginaspecialistHIVrolesuchasteamleaderchargenurseorclinicalnursespecialist.Level4ConsultantpractitionerThislevelofpracticereflectstheroleofexpertHIVpractitionersworkinginadvancedpracticerolessuchasnurseconsultantseniorclinicalpractitionerorseniornursemanager.ScopeofpracticeAswithallnursingpracticeanyself-assessmentofcompetencemustincluderecognitionoflimitationsandskillsinkeepingwiththeNursingandMidwiferyCouncilguidelines11.References10.DepartmentofHealth.MakingaDifferenceStrengtheningtheNursingMidwiferyandHealthVisitingContributiontoHealthandHealthcare.LondonDepartmentofHealth1999.11.NursingandMidwiferyCouncilNMC.TheNMCCodeofProfessionalConductStandardsforConductPerformanceandEthics.LondonNursingandMidwiferyCouncil2004.Seewww.nmc-uk.org NHIVNACOMPETENCIESGenericHIVnursingcompetenciesG1Assessinghealthandwell-being5HealthCareAssistantCompetenciesHasbasicknowledgeandunderstandingofHIVsignsandsymptomsofinfectionanditsimpactonhealthandwell-being.IsawareoftheimpactofstigmaonpeoplelivingwithHIVandtherelevantstatutoryandvoluntaryagenciesthatprovidesocialcareandsupportforpatientswithHIVinfection.DemonstratesanawarenessandunderstandingofthepsychologicalandemotionalimpactoflivingwithHIVandhowthatmayvaryfordifferentindividuals.Hasanunderstandingoftheimpactofhealthbeliefsontheself-managementofHIVincludingadherencetomedicationandonwardtransmissionrisketc.IsawareofthedifferingspiritualneedsofpatientswithHIVandensuresanindividualsbeliefsandwishesarerespected.NurseCompetenciesForallnurseslookingafterHIVpatientsirrespectiveofwheretheyareclinicallybased.aPhysicalContributestoassessingthehealthandwell-beingneedsofanHIV-positivepatientandplanshowtomeetthoseneedsDemonstratesaknowledgeandunderstandingofandcanidentifythemajorpresentingsignsandsymptomsofacuteandchronicHIV-relatedconditionsandrisksofillnessassociatedwithrelevantCD4countsAccessesevidence-basedlocalnationalclinicalguidelinesonthecareandmanagementofHIV-relatedconditionsco-infectionsandco-morbidities1214DemonstratesanunderstandingoftheassessmentofapatientpresentingwithpalliativecareneedsIsawareoftheassessmentneedsofapatientwhorequiresterminalcareandtheevidence-basedtoolsavailableIdentifiesappropriatemethodsandequipmentneededtocarryoutassessmentandpreparesappropriatelytakingintoconsiderationanyrisk.Completesthenursingassessmentofthepatientsphysicalwell-beingandreportsrelevantfindingstothecareteamAssesseshealthandwell-beingneedsofanHIV-positivepatientanddevelopsmonitorsandreviewsplansofcaretomeetspecificneedsObtainsclearandconciseinformationonthepresentingphysicalsignsandsymptomsofHIV-relatedconditionsandco-morbiditiesRecognisessignsandsymptomsofcomplexandunstablehealthproblemsrequiringreviewbyseniorcolleaguesMakesacomprehensiveassessmentofapatientspalliativecareneedsFullyassessesthephysicalneedsofapatientwhorequiresterminalcareInterpretsallclinicalinformationavailableincludingthatdocumentedbycolleaguesAssessescomplexhealthandwell-beingneedsofHIV-positivepatientsanddevelopsmonitorsandreviewsplansofcaretomeetthoseneedsWorksautonomouslytoobtainaclinicalhistoryfromidentifiedpatientswithcomplexphysicalneedsasdefinedbylocalpolicynationalguidelinesProvidesadviceandsupporttocolleaguesandstudentsintheuseofdifferentmethodsofassessinganHIV-positivepatientshealthandwell-being.WorkswitheducationproviderstomeetstaffeducationneedsforpatientassessmentinHIVcareInitiatesandcontributestoresearchpartnershipstodevelopthepatientassessmentevidencebaseinHIVLEVEL2LEVEL3LEVEL4 NHIVNACOMPETENCIESGenericHIVnursingcompetenciesG1Assessinghealthandwell-being6bSocialcPsychologicalemotionalRecordsandreportsnewinformationrelatedtoclinicalassessmentinatimelymannerParticipatesinthedevelopmentofaplanofcaretomeettheidentifiedneeds.FacilitatespatientparticipationintheassessmentprocessParticipatesintheassessmentofclinicallystablepatientsonandofftherapyaspartofroutinefollow-upcarewithintheoutpatientorcommunitysettingCompletesanaccuratenursingassessmentofthesocialcareneedsofapatientwithHIVIsawareoftherelevantagenciesbothstatutoryandvoluntaryprovidingsocialcareandsupportforpatientswithHIVUnderstandstheimportanceofsensitivelyassessingthefamilyandsocialsupportnetworkforindividualpatientsUnderstandsthepotentialimpactofdrugandalcoholuseandwheretoreferpatientsshouldthisbeidentifiedasaproblemUnderstandsrelevantdiversitiesinthesocialculturalandsexuallifestylesofpatientsandthepotentialimpactonhealthandwell-beingDemonstratesanawarenessandunderstandingofthepsychologicalimpactofanHIVdiagnosisstartingorswitchingtherapyanacuteillnessdiagnosisofachronicconditiondiagnosisofaco-morbidityreachingaterminalstageindiseaseprogression16Demonstratesanunderstandingoftheimpactofhealthbeliefsontheself-managementofHIVincludingadherencetomedicationProvidesanenvironmentandopportunitiesthatenablepatientswithHIVtoexpresstheiremotionalandpsychologicalneedsRecognisesownlimitationsandseeksadvicefromseniorcolleaguesandrefersappropriatelyDevelopsaplanofcareworkingwiththepatientandensuresongoingmonitoringandevaluationofthecarewithintheteamAssessesacaseloadofpatientswithnon-complexcareneedsonoroffARTonanongoingbasisComprehensivelyassessessocialcareneedsanddevelopsacareplantomeettheneedsidentifiedinpartnershipwiththepatientAssistsandenablesthepatienttoaccesstheappropriatesocialcarepackageandmakestherelevantreferraltothesupportagenciesEnsuresthesocialcareprovisioniscoordinatedmonitoredandevaluatedAssessespsychologicalandemotionalbarrierstoeffectivehealthmaintenanceespeciallyatvulnerabletimesfromnewdiagnosisandthroughoutdiseaseprogressionLiaiseswithcolleaguesandreferspatientsforpsychologicalassessmentandsupportwhereappropriateDevelopsanappropriateplanofcaretomeetcomplexneedsandimplementsamonitoringandevaluationprocessWorksautonomouslyinpartnershipwiththeMDTtoassessacaseloadofclinicallystablepatientswithcomplexcareneedsonoroffARTonanongoingbasisIdentifiescomplexsocialcareneedsandcoordinatesapackageofcareActsasapointofreferralforpatientswithmorecomplexsocialcareneedsCoordinatesthedeliveryofcareplansfeedinginrelevantinformationtosupportwiderserviceplanningImprovescoordinationbetweenhealthandsocialcareprovisiontoenhancejointassessmentofpatientsWorkswithintheorganisationandacrossnetworkstoidentifylonger-termplanningaroundsocialneedswhichreflectsthediversityofthepatientcaseloadWorksautonomouslytocomprehensivelyassesscomplexpsychologicalandemotionalneedsfromnewdiagnosisandthroughoutdiseaseprogressionDevelopsservicelinksandmultidisciplinaryworkingwithpsychologicalpsychiatricservicestoenhancecase-by-caseassessmentLEVEL2LEVEL3LEVEL4 NHIVNACOMPETENCIESGenericHIVnursingcompetenciesG1Assessinghealthandwell-being7dSpiritualIsawareoftherequirementtoassesscapacitytomakedecisionswithinthetermsoftheMentalCapacityAct17UnderstandsthereferralprocesstolocalstatutoryandvoluntaryprofessionalsandagenciesthatprovidepsychologicalsupportandreferswithinthelimitsoflocalprotocolDemonstratesanunderstandingofdifferingspiritualneedsofpatientswithHIVandtheirfamiliesandfriendsEnsuresanindividualpatientsbeliefsarerespectedandtheirwishesunderstoodatalltimesthroughouttheassessmentprocessCompletesanursingassessmentoftheseneedspromptlyandappropriatelyReferspatienttorelevantspiritualsupportasappropriateAssessesapatientsspiritualneedsandincorporatestheseintotheplanofcareAssessestheimpactofspiritualbeliefsthatmayimpactonthehealthandwell-beingofthepatientEnsurestheassessmentofspiritualneedsandincorporatestheseincludingthoseofapatientssignificantotherswhereappropriateandparticularlyregardingdisclosureandinend-of-lifecareBuildseffectivenetworkswithfaith-basedanddifferentculturalorganisationswhererelevantLEVEL2LEVEL3LEVEL4References12.Nelsonetal.BritishHIVAssociationandBritishInfectionAssociationguidelinesforthetreatmentofopportunisticinfectioninHIV-seropositiveindividuals2011HIVMed201112Suppl.215.13.Pozniaketal.BritishHIVAssociationguidelinesforthetreatmentofTBHIVcoinfection2011HIVMed201112517524.14.Brooketal.BritishHIVAssociationguidelinesforthemanagementofcoinfectionwithHIV-1andhepatitisBorCvirus2010HIVMed20101113015.Notethisreferencehasbeenremoved.16.BritishPsychologicalSocietyBritishHIVAssociationMedicalFoundationforAIDSSexualHealth2011StandardsforpsychologicalsupportforadultslivingwithHIV.Seewww.medfash.org17.MentalCapacityAct2005.ElizabethII.Chapter9.LondonTheStationeryOffice.Seewww.opsi.gov.uk NHIVNACOMPETENCIESGenericHIVnursingcompetenciesG2ManagementofantiretroviraltherapyART8HealthCareAssistantCompetenciesDemonstratesawarenessoftherationaleforstartingantiretroviraltherapyandtheimportanceofadherencetoprescribedregimens.Isawareofsomeofthecommonside-effectsofARTandthepotentialimpactonapatientswell-being.DemonstratesanawarenessofpotentialproblemswithadherenceandreportsappropriatelytothenurseinchargeifthereareanydifficultieswithARTadministration.DemonstratesawarenessofcommonlyusedprophylaxismedicationsusedforthepreventionofopportunisticdiseasesandcommontestsandinvestigationsusedintheearlydetectionofHIV-relatedcomplications.IsawareoftheuseofAdvancedDirectivesandtheirroleinHIVcare.NurseCompetenciesForallnurseslookingafterHIVpatientsirrespectiveofwheretheyareclinicallybased.ContributestocareplanninganddeliveryandmonitoringofART-relatedinterventionsDemonstratesanunderstandingofhowARTworksandisadministeredandofrelevantlocalandnationalguidelinesandpoliciesDemonstratesawarenessoftheriskofdruginteractionsandwheretoaccessadviceonthisDemonstratesanawarenessofART-relatedtestsandinvestigationsaccordingtonationalandlocalprotocolsDemonstrateshowtoobtainhelpandadviceonHIVtreatmentsandrelatedissues.AbletoexplainthebasicsofARTtreatmenttopatientsinarelevantmannerRecognisessituationswhichmaybedetrimentaltoanindividualsabilitytotaketreatmentasprescribedandalertstheMDTtothisFacilitatescorrectadministrationofARTinbothspecialistandnon-specialistsettingsPlansanddeliverscareandevaluatesART-relatedinterventionsDemonstratesanin-depthandup-to-dateknowledgeofARTincludingcommonlyusedcombinationsmechanismsofdifferentclassesofantiretroviraldrugsanddrugresistanceDemonstratesknowledgeofkeydruginteractionsDemonstratesabilitytoorderandinterpretappropriatetestsforsurrogatemarkersART-relatedtoxicitiesandroutinemonitoringtestsAssessespatientinformationneedsanddevelopsanappropriateplanofcaretoaddressthesewithaviewtofacilitatingselfmanagementwithinthepatientsabilityDescribesthenursesroleinassessingandpromotingadherenceandisproactiveindeliveringthisaspectofcareCorrectlyadministersandoradvisespatientsandotherMDTmembersontheadministrationofARTAnticipatesanythreatstoARTadministrationinterveningtofacilitateoptimaladherenceEstablishessystemstoplananddelivercareandevaluateARTwherecomplexclinicalsituationsexistDemonstratesadvancedexpertiseinmanagingpatientsonARTinlinewithlocalpoliciesandnationalpolicies1821andwithanholisticpatient-centredapproachDemonstratesin-depthknowledgeofdruginteractionsadvisespatientsaccordinglyindiscussionwithMDTEstablishesandleadsclinicsformonitoringandsupportingclinicallystablepatientsontherapyworkingbothautonomouslyandinpartnershipwiththeMDTasappropriateAbletoassesscomplexadherencebehavioursandapplyin-depthknowledgeandevidence-basedstrategiestofacilitatebehaviourchangeEstablishesandmonitorssystemstoensurecorrectARTadministrationforpatientsacrossdisciplinesservicesandsettingsEstablishesandevaluatessystemsforadherenceassessmentandsupportinconjunctionwithMDTLEVEL2LEVEL3LEVEL4 NHIVNACOMPETENCIESGenericHIVnursingcompetenciesG2ManagementofantiretroviraltherapyART9KeyAsperlocalguidelinespolicyShowsabilityinperformingbasicassessmentofindividualstreatmentadherenceDemonstratesanunderstandingofthephysicalandpsychologicalneedsofpatientspresentingwithART-relatedside-effectsandreferspatientsontoMDTasappropriateDemonstratestheabilitytorecognisethemostcommonlyoccurringside-effectsofARTDemonstratesawarenessofcurrentclinicaltrialsinARTandhowpatientscanaccessthesewithinaservicenetworkAssessesindividualsadherencein-depthusingskilledquestioningAbletoassessthephysicalandpsychologicalneedsofpatientspresentingwithARTside-effectsandformulateaplanofcaretoaddressthoseneedsAimstomaximisepreventionofside-effectsthroughproactiveassessmentandmonitoringwherepossibleandappropriateincorporatingthisintonurse-ledclinicsandpatientgroupdirectionsRefersforandoradministerstherapeuticinterventionswherecompetentSupportspatientswhoareconsideringclinicaltrialsandactsasanadvocateliaisingwithclinicaltrialteamsasrequiredEstablishesclearpatientreferralpathwaysforfurtheradherencesupporttoalliedhealthprofessionalsrelevantdepartmentsandcommunity-basedorganisationsEnsuresappropriatepathwaysareinplaceforreferraltoalliedspecialistswithregardtoARTside-effectsEstablishessystemsforproactiveassessmentmonitoringandtreatmentofside-effectsaslistedwithinnurse-ledservicesasagreedlocallyEstablishessystemsforpreventionandtreatmentofside-effectswherepossibleandwithincomplexsituationswhereco-infectionsandco-morbiditiesexistEnsuressystemspoliciesandproceduresareinplacetodelivertherapeuticinterventionsundernon-medicalprescribingPGDorotherappropriateguidelineswhereappropriateRefersinterestedandsuitablepatientstotheclinicaltrialteamLEVEL2LEVEL3LEVEL4References18.Williamsetal.BritishHIVAssociationguidelinesforthetreatmentofHIV-1-positiveadultswithantiretroviraltherapy2012HIVMed201213Suppl.218.19.Asboeetal.BritishHIVAssociationguidelinesfortheroutineinvestigationandmonitoringofadultHIV-1-infectedindividuals2011HIVMed201213144.20.Gilleeceetal.BritishHIVAssociationguidelinesforantiretroviraltreatmentofHIV-2-positiveindividuals2010HIVMed20101161161921.BritishHIVAssociationStandardsofcareforpeoplelivingwithHIVin2013.Seewww.bhiva.orgstandards-of-care-2013.aspx NHIVNACOMPETENCIESGenericHIVnursingcompetenciesG3Healthpromotion10HealthCareAssistantCompetenciesDemonstratesanawarenessoftheimportanceofmaintainingahealthylifestyleforHIVpatients.DemonstratesanawarenessofHIVSTItransmissionriskandtheresourcesavailableforpreventione.g.freecondomsleafletspost-exposureprophylaxis.DemonstratesawarenessofissuesaroundconfidentialityanddisclosureofHIVstatustosexualpartnerspost-exposureprophylaxisandthepotentialcriminalisationofHIVtransmission.DemonstratesanawarenessoftheexistenceofexternalsupportorganisationssuchasLivingWellprogrammesandthevoluntarysector.Isawarehowtoaccessup-to-dateandrelevantinformationonHIVandtodirectpatientstosuchresourcesincludingthoseofsupportservices.NurseCompetenciesForallnurseslookingafterHIVpatientsirrespectiveofwheretheyareclinicallybased.InformationandeducationPlansdevelopsandimplementsapproachestopromotehealthandwell-beingDemonstratesknowledgeofthetransmissiondynamicsofHIVDemonstratesanunderstandingofmaintainingahealthylifestyleandhowthisrelatestoHIVAccessesup-to-dateinformationandclinicalguidelinesforthecareandmanagementofHIVDemonstratesknowledgeoflocalreferralpathwaystospecialistHIVservicese.g.counsellingcommunitycarepalliativecareandoutpatientservicesRecognisesindividualneedsinrelationtohowhealthpromotioninformationandeducationisprovidedtoclientspartnersfamilyandfriendsDemonstratesanawarenessofownroleinsupportingthelearningenvironmentforpatientsstaffcarersintheworkplaceReflectsonandevaluatestheeffectivenessofownhealthpromotionactivityMakesappropriatereferralswhenthelimitsofownhealthpromotionknowledgearereachedPlansdevelopsandimplementsprogrammestopromotehealthandwell-beingandpreventadverseeffectsonhealthandwell-beingPossessesanin-depthknowledgeoflevelsofriskforonwardstransmissionandmultiplemethodsofpreventionincludingTreatmentasPreventionPrEPandPEPIdentifieshealthpromotionneedsforgroupsofpatients.DevelopsandreviewsstrategiestomeettheseneedsInvolvespeoplewithHIVindevelopinghealthpromotioninitiativeswritteninformationandservicedevelopmentProvidesinformationeducationandpreventionadvicetoindividualsandorgroupsaccordingtolocalneedanddefinedrolePromoteshealthandwell-beingandpreventsadverseeffectsonhealthandwell-beingbycontributingtothedevelopmentimplementationandevaluationofrelatedguidanceandpoliciesEvaluateshealthpromotionactivitystrategiesacrossaserviceclinicalnetworkUndertakestrainingneedsanalysisandplansinterventionstoenablenursingstaffacrossservicestoimplementhealthpromotionstrategiesLEVEL2LEVEL3LEVEL4 NHIVNACOMPETENCIESGenericHIVnursingcompetenciesG3Healthpromotion11PreventionandriskreductionsupportDemonstratesanawarenessofthehealthscreeningneedsofpeoplewithHIVandensurespatientsareawareoftheneedandrationaleforhealthscreeningDemonstratesanawarenessofthesexualhealthandreproductiveneedsofpeoplewithHIVandunderstandstheindividualsrighttosexualandreproductivefulfilmentandtherelevantguidelinesPresentsanon-judgementalattitudetoissuesaroundsexandpatientssexualandreproductivehealthAssistsintheassessmentandtreatmentofthesexualhealthneedsofpatientslivingwithHIVUndertakesnursingassessmentinrelationtomaintainingahealthylifestyleDemonstratesawarenessofissuesarounddisclosureofHIVstatustosexualpartnerspost-exposureprophylaxisandthepotentialcriminalisationoftransmissionUtiliseseffectivecommunicationskillsforthedeliveryofriskreductionmessagesandchangebehaviourpatternsRefersindividualstoappropriatehealthcareworkersforspecifichealthpromotioninterventionsandriskmanagementIdentifiespsychosocialfactorsthatmayaffecttheabilityofindividualstoadoptmaintainahealthylifestyleandreportsfindingstocareteamforfurthermanagementandonwardreferralDevelopsstrategiestomeetthehealthscreeningneedsofindividualsandorgroupsaccordingtolocalneedanddefinedroleDemonstratesanunderstandingofcomplexityofissuesrelatingtothesexualhealthneedsofpeoplelivingwithHIVaandisabletoarticulatethemtotherestoftheMDTasappropriateDemonstratesanunderstandingofthenationalandlocalpoliciesandguidelinesrelatedtothemanagementofsexuallytransmittedinfectionsandthesexualhealthneedsofHIV-positiveadultsProactivelydiscussessexualhealthwithpatientsandencouragesregularhealthchecksscreeningaspartoftheirselfmanagementUndertakessexualhealthriskassessmentaspartofroutineassessmentofpatientswithHIVDescribestreatmentoptionsforsexuallytransmittedinfectionsinHIVaccordingtonationalprotocolsandguidelinesUsingidentifiedhealthpromotiontechniquesenablespatientstomakeinformedhealthylifestylechoicesrelatingtotheirsexualhealthandwell-beinge.g.2224Undertakesdetailedhealth-relatedriskassessmentDevelopscareplananddiscussesselfmanagementandmakesonwardreferralsbasedontheassessmentDiscussesissuesarounddisclosureofHIVstatustosexualpartnerspost-exposureprophylaxisandthepotentialcriminalisationofHIVtransmissionDiscussesindividualattitudesbeliefsmotivationsandperceptionstowardsbehaviouralchangestoimprovehealthUsesrecognisedevidence-basedstrategiesforfacilitatingsuchdiscussionsasappropriateandincorporatesintocareplanDevelopsstrategiestomeetthehealthscreeningneedsacrossaserviceorclinicalnetworkDevelopsimplementsandmonitorspathwaysprotocolsandreferralroutesthatallowaccesstotheassessmentandmanagementofpatientspresentingwithsexualhealthissuesbothlocallyandacrossaclinicalnetwork.ToincludeserviceuserrepresentationifappropriateEnsurestheincorporationofsexualhealthissuesintotheroutineprovisionofHIVnursingservicesWorkswithkeyservicesandworkerstoprovideappropriateriskreductionservicesacrossstatutoryandnon-statutoryservicesDevelopscarepathwayswithothermultidisciplinaryteamstoensurethatpartnernotificationissuesofcriminalisationandpostexposureprophylaxisaremanagedacrossaserviceorHIVclinicalnetworkLEVEL2LEVEL3LEVEL4 NHIVNACOMPETENCIESGenericHIVnursingcompetenciesG3Healthpromotion12amayincludeculturalandbeliefissuesconfidentialityroutinescreeningwomensandmenshealthissuespreconceptionadvicehealthpromotion.SkillsbuildingEnablespeopletolearnanddevelopskillswitheducationalinformationDemonstratesanunderstandingofthecommunicationnegotiationassertivenessskillsandcopingstrategiesrequiredforindividualstoself-managealong-termconditionDemonstratesanawarenessoflocalreferralpathwaysforindividualsneedingskillsbuildingsupporte.g.22232425Integratesindividualbehaviouralphysicalsocialandenvironmentalrisk-modifyingfactorsintohealthpromotionactivitiesEngagesinone-to-oneandgroupskillsbuildingtrainingandusesevidence-basedmethodsforencouragingbehaviouralchangeDesignsimplementsandevaluatesskillsbuildingprogrammesforchronicdiseasemanagementacrossaserviceorclinicalnetworkLEVEL2LEVEL3LEVEL4References22.LivingWelloffersawiderangeofhealthrelatedservicesaimedatprovidingpeoplewiththeskillstheyneedtogetthemostoutoflife.www.livingwellcic.comforLondonboroughsonly.23.www.myhiv.org.ukonlineadviceonselfmanagingHIV.24.www.aidsmap.comSharinginformationonHIV.25.Clutterbucketal.UKNationalGuidelinesonSaferSexAdviceClinicaleffectivenessGroupBASHHandBHIVAJuly2012. NHIVNACOMPETENCIESGenericHIVnursingcompetenciesG4Workinginpartnershipsincludingclinicalnetworksandmultidisciplinaryworking13HealthCareAssistantCompetenciesDemonstratesanawarenessofthelocalHIVspecialistsandunderstandsroleoftheMDTandtheirrolewithinit.Actsasanadvocateforthepatientasrequired.Identifiesownroleassupportingtheassessmentofpatientspresentingasunwellorwithdeteriorationintheircondition.Demonstratesanawarenessofcommonco-infectionsandco-morbiditiesandhealthylifestylechoices.IsawareofPostExposureProphylaxisprovisionandwheretoaccessthis.NurseCompetenciesForallnurseslookingafterHIVpatientsirrespectiveofwheretheyareclinicallybased.aMultidisciplinaryteamMDTworkingandintegratedhealthandsocialcareatdepartmentalandnetworklevelsContributestomultidisciplinaryworkingUnderstandsconceptofworkingacrossamanagedservicenetworkandhasawarenessoftherelevantspecialistpolicydocuments26UnderstandsroleoftheMDTandownrolewithinitUnderstandslinkbetweenhealthandsocialcareandtheneedtopromoteintegratedcareIdentifieskeyHIVspecialistpersonnelacrossnetworkinrelationtoownareaofworkContactsappropriateHIVspecialistpersonnelforadviceandinformationaboutclinicalissuesEnsurespatientaccesstotherelevantmembersoftheMDTAwareofthenationalstandardsonintegratedhealthandsocialcareinHIVe.g.2729CoordinatesjointsocialandhealthcareworkingDevelopskeyworkingrelationshipsacrossnetworkwithpeersandkeynetworkpersonnelCoordinatesMDTworkingandfacilitatesMDTsandcaseconferencesAttendsnetworkorsubgroupmeetingstoparticipateinidentifyingnursingpathwaysacrosssectorsEnsuresdischargeplansarebasedonpatientneedMonitorsreferralpathwaysinpracticeandliaisesdirectlywithnetworkleaderswhencarepathwaysarenotseamlessIdentifiesthosepatientswithincreasedneedswhowouldbenefitfromjointcarecoordinationandreferspatientsappropriatelytotheMDTandacrossserviceswithinthenetwork.MonitorseffectivenessandidentifiesgapsTakesaleadininformationsharingandwhentoreferconcernsfurthere.g.insafeguardingvulnerableadultsPromotesanddevelopsintegratedsocialandhealthcareworkingacrossboundariesIdentifiesnursingreferralpathwaysacrossnetworkforallaspectsofHIVcareprovisionLeadsandparticipatesintheculturalchangesrequiredforjointworkingofhealthandsocialcareDesignssystemsforpatientaccesstoHIVnetworktoincludeserviceusergroupswherepossibleAssistsinthedevelopmentofjointworkingarrangementsforhealthandsocialcarewithlinksintovoluntaryagenciesWorkswithnursingleadersacrossnetworktheCRGforHIVandtheNationalCommissioningBoardtorefineprovisionofsharedservicesContributestothedevelopmentofalocalmulti-agencyplanninggrouptoevaluatejointworkinge.g.CCGsandindividualGeneralPractitioners28DevelopsconsistentnursingpoliciesandstandardsacrossthenetworkincludinginfectioncontrolandputssystemsinplacetoauditandmonitortheseLEVEL2LEVEL3LEVEL4 NHIVNACOMPETENCIESGenericHIVnursingcompetenciesG4Workinginpartnershipsincludingclinicalnetworksandmultidisciplinaryworking14bConfidentialityUtilisesreferralpathwaysforinpatientandoutpatientcareinlinewithlocalcarepathwaysParticipatesinMDTmeetingsanddiscussionsofpatientcareActsasanadvocateforthepatientasrequiredUnderstandstheissuesaroundconfidentialityaffectingpeoplewithHIVandisabletoapplythistopracticeacrossanumberofclinicalsettingsRecognisestheimpactofHIVstigmaonthepatientlivingwithHIVIdentifieswhenpatientdisclosureofHIVdiagnosiscanbedifficultandengagestheMDTtoassistpatientswithdisclosureissuesRecognisesdifficultyindisclosingHIVdiagnosisafterdeathandactsasapatientadvocatewhenthisarisesActivelypromotesappropriatepracticewithregardtoconfidentialityProactivelysupportspatientswherestigmahasanimpactontheirhealthandwell-beingAssistspatientswithdisclosureofdiagnosiswhererequiredandreferontootherappropriateservicese.g.counsellingmentalhealthpsychologicaltherapies26EnsuresthatthepatientswishesondisclosureofdiagnosisafterdeathareknowntotheMDTandthatthepatientswishesarerespectedwherepossibleParticipatesinnetworksteeringgroupataseniornursinglevelandinformssector-widecommissioningofnursingandotherclinicalservicesEstablishessystemsandguidelinestoappropriatelyprotectconfidentialityacrossHIVservicesWorkswiththeMDTacrossstatutoryandnon-statutoryservicestotacklestigmaanddiscriminationacrosstheservicenetworkWorkswiththewiderMDTtodeveloprobustsystemstoprotectpatientsconfidentialityindefinitelyLEVEL2LEVEL3LEVEL4References26.BritishPsychologicalSocietyBritishHIVAssociationMedicalFoundationforAIDSSexualHealth2011StandardsforpsychologicalsupportforadultslivingwithHIV.Seewww.medfash.org27.NationalHealthServiceAct2006Elizabeth11.Chapter41.LondonTheStationaryOffice.Seealsowww.medfash.org.uk28.HIVinPrimaryCarewww.medfash.org.uk29.BritishHIVAssociationStandardsofcareforpeoplelivingwithHIVin2013.Seewww.bhiva.orgstandards-of-care-2013.aspx NHIVNACOMPETENCIESSpecialistHIVnursingcompetenciesS1HIVOutpatients15TriageandminorillnesssupportandmanagementContributestothetriageandassessmentofpatientspresentingasunwellUnderstandsownrolewithintheassessmentandtriageofpatientspresentingasunwellIdentifiessignsandsymptomsofHIVormedication-relatedconditionsandunderstandsthetriageprioritysystemConductsanursingassessmentandreportsfindingstotheappropriateseniorteammemberinatimelyfashionIsabletodiscussthewell-beingneedsandwishesofthepatientandpotentialtreatmentoptionsMaintainsappropriatemonitoringofpatientsandreportssignificantchangesTriagesandassessesminorillnessanddeliverstreatmentplansaccordingtolocalpolicyUnderstandsownrolewithintheoverallassessmentofunwellpatientsthroughtelephonetriageorperson-to-personassessmentAssessestheurgencyofthepresentingproblemsincludingmedicalemergenciesHIVormedicationrelatedandrefersappropriatelyEvaluatesandrecordsassessmentfindingsasperprotocolEstablishessystemsforthetriageandassessmentofminorillnesswheretherearecomplexhealthneedsandautonomouslydevelopsandevaluatestreatmentplansDevelopsandimplementssystemsandpathwaysfornurse-ledassessmentandmanagementofpatientspresentingwithminorillnessDemonstratesadvancedknowledgeofandadvisesonthecomplexissuesofHIVtriageCarriesoutacomprehensivephysicalassessmentofunwellpatientsinlinewithevidence-basedpracticeprotocolspoliciesandlegislationOrdersrelevantinvestigationsinterpretsresultsandmonitorsindividualsduringtheassessmentMakesadifferentialdiagnosisandexplainsoutcomestothepatientMonitorsandevaluatestheimplementationoftreatmentplansandmakesappropriatechangesLEVEL2LEVEL3LEVEL4ManagementandsupportofclinicallystablepatientsonorofftherapyContributestothemanagementofclinicallystablepatientsDescribesownroleinthemanagementofclinicallystablepatientsUnderstandsthedefinitionofstablepatientAdvisespatientsofaccesstothenurse-ledclinicswhereappropriateIsawareoftherequiredroutinebloodtestandinvestigationsforstablepatientsManagesandsupportsowncaseloadofclinicallystablepatientsUnderstandsownroleintheprovisionofstablepatientclinicsandwhentorefertoothermembersoftheMDTIdentifiesandimplementsessentialaspectsofmanagingstablepatientssuchasadherencetoxicitymanagementsocialpsychologicalandsexualhealthInterpretsandexplainsHIVsurrogatemarkersandroutinetestresultstothepatientEstablishessystemsforthenurse-ledmanagementofclinicallystablepatientsandmanagesandsupportsowncaseloadofstableHIVpatientswithothercomplexhealthneedsDevelopsandauditspathwaysincorporatingnurse-ledstablepatientclinicsManagesandprescribesforowncaseloadofstablepatientsDemonstratesskillsinrelationtophysicalexaminationincludinghistorytakinginvestigationorderingandinterpretationLEVEL2LEVEL3LEVEL4 NHIVNACOMPETENCIESSpecialistHIVnursingcompetenciesS1HIVOutpatients16UnderstandstheneedsofpatientslivingwithalongtermconditionandtheNationalServiceFrameworkforLong-termConditions1214UsessupervisioneffectivelyinmanagingowncaseloadofstablewellpatientsAbletointerpretinvestigationsforstablepatientswithcomplexhealthneedsandactonthemappropriatelyProvidesadviceandsupervisiontojuniorstafflookingafterstablepatientsandusesupervisionappropriatelyforownclinicalcaseloadLEVEL2LEVEL3LEVEL4Supportandmanagementofpatientswithco-morbiditiesandco-infectionContributestothesupportandmanagementofpatientswithco-infectionUnderstandsownroleinmanagingthesepatientsandtherelevantpoliciesandprotocolsIsabletoadvisepatientsaboutcommonco-infectionsandco-morbiditiesandhealthylifestylechoicesUnderstandsandcanadviseonthetreatmentoptionsSupportsandmanagespatientswithco-infectionandco-morbiditiesaccordingtolocalpolicyUnderstandsscreeningandmonitoringfortheseconditionsandinterpretsrelevantinvestigationsAdvisesandsupervisesthepatientontheself-administrationside-effectsandrisksassociatedwithtreatmentoftheseconditionsEstablishessystemsforthemanagementofpatientswithco-infectionco-morbiditieswherecomplexhealthneedsexistMaintainsanin-depthunderstandingofthecomplexitiesoftheseconditionsDevelopspathwaysandproceduresfortheimplementationofnurse-ledmanagementoftheseconditionsDevelopseducationontheseconditionsforthenursingandMDteamDemonstratesexpertpractitionerskillsinthemanagementandsupportofHIVpatientswiththeseconditionsincludingassessmentdiagnosismanagementuseofantiretroviraltherapiesandnon-medicalprescribingLEVEL2LEVEL3LEVEL4Supportandmanagementofpeopletakingpost-exposureprophylaxisPEPforHIV3031ContributestothesupportandmanagementofpatientsaccessingPEPUnderstandslocalprovisionforthesetreatmentsandcandescribepathwayaccordingtolocalnetworkpolicyIsawareofnationalpoliciesandguidelinesonaccessandsupportUnderstandsownroleinthesupportandmanagementofpeopleaccessingthesetreatmentsSupportsandmanagespatientsaccessingPEPaccordingtolocalguidelinesandpoliciesUnderstandsthenationalpoliciesonprovisionforthistreatmentandaccessintheUKUndertakesariskassessmentDiscussestherisksandpossibleside-effectsassociatedwithtreatmentandprovidesclinicalorandpsychologicalsupportasnecessaryEstablishessystemsforthenurse-ledmanagementofpatientsaccessingPEPandsupportsandmanagespatientswherecomplexhealthneedsapplyDevelopspathwaysfornurse-ledmanagementofPEPprovisionProvidesexpertsupportforthemanagementofthisserviceespeciallywhencomplexhealthissuesapplyLEVEL2LEVEL3LEVEL4 References121314.SeereferencesinG1onassessmentforCoinfectionandOpportunisticInfections30.Bennetal.UKGuidelinefortheuseofpostexposureprophylaxisforHIVfollowingsexualexposure2011.IJSA201122695708.31.Fidleretal.PositionstatementontheuseofantiretroviraltherapytoreduceHIVtransmissionJanuary2013.TheBritishHIVAssociationBHIVAandtheExpertAdvisoryGrouponAIDSEAGA.Seewww.bhiva.orgNHIVNACOMPETENCIESSpecialistHIVnursingcompetenciesS1HIVOutpatients17OutlineswhatbloodtestsneedtobetakenandwhenIsawareofhowstaffandpatientscanaccessPEPona24-hourbasisacrosslocalandnetworkedservicesProvidescontinuingsupportandmanagementincludingtheprovisionofmedicationstomanageside-effectsDevelopsPGDsandorsupportsnon-medicalprescribingforthenurseledsupportEstablishesandorclarifiespathwaysacrossdepartmentsorganisationsandlocalcommunityservicesensuringprovisionfor24-houraccessProvidesandsupportseducationinrelationtothistopicacrossstakeholdersandpatientgroupsLEVEL2LEVEL3LEVEL4 NHIVNACOMPETENCIESSpecialistHIVnursingcompetenciesS2HIVInpatients18ThemanagementofpatientswithHIV-relatedconditionsintheinpatientsetting3233ContributestothemanagementofpatientswithHIV-relatedconditionsintheinpatientsettingUnderstandsownroleinrelationtothemanagementofinpatientswithHIV-relatedconditionsDemonstratesaknowledgeandunderstandingofthemainHIV-relatedconditionsandtherelevantlocalpoliciesandprotocolsfortreatmentandmanagementintheinpatientsettingAssistsinthemanagementofthecriticallyillpatientIsawareofthepotentialrapidityofdeteriorationofpatientswithanHIV-relatedconditionUnderstandsandundertakestheobservationsrequiredforearlydetectionofchangesandreportsanydeteriorationpromptlytotheappropriatemembersofthecareteamExplainstothepatientthepurposeofregularassessmentoftheirconditionandencouragesself-reportingIsawareofthepotentialneedsofapatientreceivinganHIV-positivediagnosisasaninpatientIsawareofthepotentialimpactforpatientsinthetransitionfromchronicHIVinfectiontoanacuteillnessIsawareoftheconditionssignsandsymptomsthatrequiresourceorprotectiveisolationIsawareofthepotentialriskstowell-beinginthosewhorequireisolationIsawareofthepotentialeffectofrepeatadmissionsonapatientswell-beingManagesthecareofpatientswithHIV-relatedconditionsintheinpatientsettingSupportsandassiststhepatienttounderstandthenatureoftheirconditionanditsimpactonhealthandwell-beingSupportsandinvolvespatientsintheplanningoftheircareUndersupervisionprovidesone-to-onecareofthecriticallyillpatientPlanstheappropriatelevelofassessmentandobservationinconjunctionwiththemedicalteamtoensureearlydetectionofanychangesInterpretsclinicalfindingsandreportstoappropriateteammembersEnsuresadequatesocialpsychologicalandspiritualsupportforpatientsfacingacuteillnessandoranewHIV-positivediagnosisAssessestheneedforisolationonalladmissionsasperlocalprotocolAssessesandmitigatestheriskofcaringforpatientsinisolationProvidespracticalandpsychologicalsupportforthepatienttoself-managetheexperienceofisolationManagesthepotentialeffectsofrepeatadmissionsonthepatientswell-beingandensurescontinuityofcareManagesandoverseesthecareofpatientswithHIV-relatedconditionsintheinpatientsettingEnsuresthereisappropriateeducationandmentoringintheprinciplesofmanaginginpatientswithHIV-relatedconditionsContributestothedevelopmentofguidelinesandcompetenciesforthenursemanagementofHIV-relatedconditionsSupportsandsupervisesjuniorstaffincludingmedicalstafftomanagethecriticallyillpatientSupportsstaffinassessingacutelysickpatientsLeadsonthedevelopmentofamultidisciplinaryapproachtothemanagementandsupportofthenewlydiagnosedHIVpatientsadmittedwithanacuteHIV-relatedconditionDevelopscross-workingwithinfectioncontrolonthemanagementofHIV-relatedconditionsEnsuresthepoliciesforisolationareunderstoodandimplementedbystaffpatientsandvisitorDevelopssystemsofcaredeliverytoensurecontinuityofcareforpatientsonsubsequentadmissionse.g.primaryteamnursingcaseloadmanagementLEVEL2LEVEL3LEVEL4 NHIVNACOMPETENCIESSpecialistHIVnursingcompetenciesS2HIVInpatients19UnderstandsthedischargeprocesspoliciesguidelinesandassessmenttoolstoaiddischargeplanningincludingcaseconferencesandhomevisitsIsawareoftherehabilitationandsupportservicesstatutoryandvoluntaryavailabletopatientsondischargefromhospitalDocumentsandreportstotheMDTanychangesthatmayaffectdischargeplansAssiststhepatienttoarticulatetheirneedsondischargeUnderstandstherationaleforthechangefromacuteinterventiontopalliationasdirectedbythecareteaminpartnershipwiththepatientandorsignificantothersIsawareofadvanceddirectivesandtheirroleinHIVcareEnsuresdischargeplanningcommencesonadmissionsettinganexpecteddateofdischargeinconjunctionwiththemedicalteamAssessesplansandevaluatesinpartnershipwiththepatienttheirsignificantothersandtheMDTasappropriateacomprehensivedischargepackageAssessesthesafetyissuespriortodischargeofthechronicallyilldisabledpatientSupportspatientswithinthecaseconferenceactingastheiradvocateasrequiredSupportsapatientinthetransitionfromacutetopalliativecareDiscussesend-of-lifedecisionswithpatientsandtheirsignificantothersDevelopsMDTstructurestoensurecollaborationbetweenprimaryacuteandrehabilitationcaretoplansafedischargeLEVEL2LEVEL3LEVEL4ThemanagementofsymptomsininpatientswithHIVHIV-relatedconditionsandonARTContributestothemanagementofHIV-relatedsymptomsUnderstandstheprinciplesofsymptomcontrolIsawareofthemainsymptomswhichmayaffectthoseintheendstagesoflifeorthosetakingARTAssistsintheassessmentreportingmanagementandevaluationofsymptomsandeffectivenessoftreatmentusingevidence-basedassessmenttoolsSupportsandencouragesthepatienttodescribeandreportsymptomsandself-recordSupportsthemanagementofHIV-relatedsymptomsUnderstandstheaetiologymanifestationmanagementandtreatmentofthemainsymptomsinHIVdiseaseAssessesplansandevaluatessymptommanagementinpartnershipwiththepatientandrefersappropriatelySupportspatientspsychologicalwell-beingduringtheperiodoftreatmentinductionforsymptomcontrolManagespatientsexperiencingHIV-relatedsymptomsDevelopseducationtoassistnursestodeveloptheplanningassessmentandevaluationskillsinsymptomcontrolCollaborateswiththeMDTtodevelopandorevaluatetoolsandprotocolsforthemanagementofsymptomsDevelopssymptomcontrolinformationtailoredtotheneedsofthepatientMaintainsanin-depthknowledgeofdevelopmentsinsymptomcontrolLEVEL2LEVEL3LEVEL4 NHIVNACOMPETENCIESSpecialistHIVnursingcompetenciesS2HIVInpatients20ThemanagementofinpatientswithHIV-relatedproblemsinthecontextoftheirsignificantothersContributestothecareandsupportofpatientsandtheirsignificantothersUnderstandstheimpactofstigmainHIVontheissueofconfidentialityAssessesandrecordsthepatientssocialnetworklevelofdisclosureandpotentialoractualissuesregardingthenominatednextofkinandinformstheMDTAssistssignificantotherstounderstandconfidentialityIsawareofpatientchoiceanditsimplicationsfortheroleofthecareteamorsignificantothersinprovisionofcareUnderstandstheirroleasanadvocateUnderstandstheirroleinreportinganyadultsafeguardingissuesManagesandsupportsthecareofpatientsandtheirsignificantothersSupportspatientsinmakinginformeddecisionsregardingdisclosureandrefersappropriatelySupportsthepatientssignificantotherstounderstandpatientchoiceandactsasadvocatetoensurethatthepatientswishesareupheldProvidesappropriatesupportandinformationforpatientssignificantothersManagesandsupportscomplexissuesinthecareofpatientsandtheirsignificantothersEnsurestherearepoliciesandproceduresinplacetoprotectconfidentialityinallareasofactivityinthewardenvironmentManagescomplexissuesrelatedtodisclosureandorproblemswithinthepatientssocialnetworkEnsurestheteamunderstandsthepotentialrisksforpatientsinthecontextoftheirsignificantotherse.g.SafeguardingAdultsatRiskofAbuse3435DevelopsstructurestoenablesupportofsignificantothersLEVEL2LEVEL3LEVEL4References32.Standard5BritishHIVAssociationStandardsofcareforpeoplelivingwithHIVin2013.Seewww.bhiva.orgstandards-of-care-2013.aspx33.Nelsonetal.BritishHIVAssociationandBritishInfectionAssociationguidelinesforthetreatmentofopportunisticinfectioninHIV-seropositiveindividuals2011HIVMed201112Suppl.215.34.NoSecretsguidanceondevelopingandimplementingmulti-agencypoliciesandprocedurestoprotectvulnerableadultfromabuse.DepartmentofHealthandHomeOfficeMarch2000.Seewww.gov.ukgovernmentpublicationsno-secrets-guidance-on-protecting-vulnerable-adults-in-care35.StatementofGovernmentPolicyonAdultSafeguardingReport.DepartmentofHealthMay2011.Seewww.gov.ukgovernmentpublicationsadult-safeguarding-statement-of-government-policy NHIVNACOMPETENCIESSpecialistHIVnursingcompetenciesS3ClinicalTrials21aReportingandmanagementofclinicaltrialinvestigationsbTakingandprocessingofclinicaltrialsamplesandotherinvestigationsLEVEL3LEVEL4PlansundertakesevaluatesandreportsbiomedicalinvestigationsandorinterventionsChecksandconfirmsappropriatekitsareavailabletoundertakestudyvisits.EnsuresalltestsarecarriedoutinaccordancewiththeprotocolIdentifiesanymissingtestsnotundertakeninaccordancewiththeprotocolandreportsonanabnormalityHasanunderstandingoftheprotocolanddepartmentrequirementstomanagetreatment-relatedtoxicitiesIdentifieswhentestsneedrepeatinginaccordancewiththeprotocolPlansapatientsfollow-upinaccordancewithprotocolandtreatmentguidelines.Individualisespatientfollow-uptoensureappropriatemanagementCollatesandinterpretstheresultsandreportsthemtothedoctorstatingactionstobetakeninaccordancewiththeprotocolEvaluatesandreportsgrade4toxicitiesasperprotocolandimplementsseriousadverseeventSAEsreportinginaccordancewithguidelinesFollowsthespecificprotocolrequirementsregardingthetimingsequenceandprocessingofsamplesUndertakesanddeliverstrainingtoensureallstaffmembersareawareofguidelinesDocumentsallresultsinaccordancewithprotocolandinlinewithsponsor-specificrequirementsEnsuresequipmentusediscalibratedandmonitoredinaccordancewithlocalandsponsorrequirementsPlansundertakesevaluatesandreportscomplexunusualbiomedicalinvestigationsandorinterventionsEvaluatestheeffectivenessoftoolstoensurethatclinicaltrialinvestigationsarereportedinlinewiththestudyprotocolEnsurestudyteamawareofreportingrequirements.ReviewspoliciesandproceduresinlinewithdepartmentalandstudyrequirementsDesignsstandardoperatingprocedurestoensuresamplesaretakenandprocessedinaccordancewithprotocolandlaboratorymanualsUndertakeshealthandsafetyandriskassessmentonlaboratoryareatoensureallstaffaretrainedandsafetohandleandprocessofsamplesDesignsandevaluatestrainingprogrammesinclinicaltrialguidelinesEvaluatestheoutcomesofindividualproceduresandinvestigationsinterventionsasawholetodeterminethesuccessoftheapproachesadoptedandanyfurtheractionrequiredDesignsandevaluatesqualitycontrolsystemstomonitorthecollectionprocessingandstorageofsamplescInformationcollectionanddataanalysisLEVEL3LEVEL4GathersanalysesinterpretsandpresentsextensiveandorcomplexdataandinformationDemonstratesanunderstandingoftheimportanceofaccuratedatacollectioninrelationtoGoodClinicalPracticeGCPguidelines36UsesappropriatetoolsandtechniquestocollectdataUnderstandstheprinciplesoftheDataProtectionAct37andcomplieswithInternationalConferenceonHarmonisationICHandGCPinthearchivingandstorageforstudy-relateddocumentation39PlansdevelopsandevaluatesmethodsandprocessesforgatheringanalysinginterpretingandpresentingdataandinformationDemonstratesacomprehensiveunderstandingofthedatacollectionprocessandtheconsequencesonpracticeIdentifiesareasofconcerninregardtomisconductandfraudandactsappropriatelywithinGCPguidelinesandtheResearchGovernanceframework38 NHIVNACOMPETENCIESSpecialistHIVnursingcompetenciesS3ClinicalTrials22LEVEL3LEVEL4IdentifiesandunderstandswhatconstitutesasourcedocumentCollectsdataaccuratelyandsystematicallyinapatientsnotesinaccordancewiththeprotocolIdentifiesdifferenttypesofdatadatacollectionprocessesandverificationissuesduringstudies.IdentifiesappropriatetoolstoassistintheidentifyingofpatientsforclinicaltrialsDemonstratesanunderstandingoftheimportanceofauditingwithinclinicaltrialsAppliesqualityassurancemethodstoensuredataintegrityDesignsandmaintainsdatabasestocaptureactivitydataDesignstrainingprogrammestotrainandsupportstafftoinrelationtoauditsandinspectionsdDevelopmentandinnovationsLEVEL3LEVEL4CoordinatesandcontributestotheplanningandimplementationoftheconductofclinicaltrialsHasafullknowledgeofstudyset-up-relateddocumentationDemonstrateseffectivemanagementofthecoordinationofaprogrammeofstudiesIdentifieskeyresourcesthatarerequiredinordertoconductastudyMaintainsdatabasesofstudyactivityTakesappropriateactionintheeventofprotocoldeviationSAEsparticipantwithdrawalDemonstratesanunderstandingoftheprocesstoobtainresearchethicsapprovalFullyunderstandstheregulatoryaspectsofclinicalresearchDemonstratesanunderstandingoftheelementsofinformedconsentAssessthepatientssuitabilitytoenteraclinicaltrialinliaisonwiththeresearchteamPlansimplementsmonitorsandreviewstheallocationandmanagementofclinicaltrialsDesignstoolsfortheassessmentofresourcerequirementsandimplicationsofallclinicalresearchprojectsAdvisessupervisesandmanagesothersinthecoordinationofstudiesLeadsintheimplementationofthenationalEuropeanandICHguidelinesforthemanagementofresearchstudiesUndertakesfeasibilityassessmentsinaccordancewithsponsorrequirementsProducesdetailedcostingsandresourceutilisationinformationImplementsthedocumentationforresearchethicsapprovalReviewsandimplementstheregulatoryapprovaldocumentsandrequiredRDapprovalsDesignsandevaluatestrainingpackagesandaudittoolsforallelementsofinformedconsentReferences36.SeeGoodClinicalPracticeattheMedicinesandHealthcareproductsRegulatoryAgencyMHRAwebsitewww.mhra.gov.ukInparticularseeDirective200120ECoftheEuropeanParliamentandoftheCouncilof4April2001andalsoEUDirective200528EC.37.DataProtectionAct1998ElizabethII.Chapter29.LondonTheStationeryOffice.Seealsowww.opsi.gov.uk38.DepartmentofHealth.ResearchGovernanceFrameworkforHealthandSocialCare.2ndedn.LondonDepartmentofHealth2005.Seewebsiteforminorupdatesfrom2010www.dh.gov.uk39.InternationalConferenceonHarmonisationofTechnicalRequirementsforRegistrationofPharmaceuticalsforHumanUse.ICHHarmonisedTripartiteGuidelineGuidelineforGoodClinicalPracticeEG6R1.Seewww.ich.organdalsowww.instituteofclinicalresearch.org NHIVNACOMPETENCIESSpecialistHIVnursingcompetenciesS4Paediatric23ForallnursesprovidingcaretopatientswithinanHIVpaediatricsettingorlookingafterHIV-positivechildrenTestingchildrenandyoungpeopleforHIVDisclosureofdiagnosistochildoryoungpersonGrowthanddevelopmentHealtheducationPlansdevelopsandimplementsapproachestopromotehealthandwell-beingandpreventadverseeffectsonhealthandwell-beingDemonstratesawarenessofthemechanismsoftransmissionofHIVtoachildoryoungpersonDemonstratesanunderstandingofmaintainingoptimalhealthinachildwithHIVDemonstratesanawarenessofthemainissuestobeaddressedwhenachildneedstobetestedforHIVDemonstratesanawarenessofthecomplexissuesofdisclosureofdiagnosistochildrenDemonstratesawarenessofchildrensunderstandingofillnessatdifferentdevelopmentalstagesDemonstratesanawarenessofthenormalgrowthpatternsandrangeofdevelopmentalprogressofchildrenandyoungpeopleDemonstratesanawarenessofthehealthneedsofchildrenandfamilieswithHIVProvidesbasicinformationtofamiliesregardingmaintainingoptimalhealthDemonstratesanawarenessofthesexualhealthneedsofadolescentswithHIVPlansdevelopsandimplementsprogrammestopromotehealthandwell-beingandpreventadverseeffectsonhealthandwell-beingDemonstratesin-depthknowledgeontherouteoftransmissionofHIVtoachildoryoungpersonDemonstratesanin-depthknowledgeofpromotingoptimalhealthinachildwithHIVDemonstratesappropriatecounsellingskillswhenundertakingpre-andpost-HIVtestdiscussionsincludinggivingpositiveandnegativeHIVtestresultswithparentsandyoungpeopleSupportscarersandchildrenthroughouttheprocessofdisclosingthediagnosisofHIVtoachildoryoungpersonUndertakesindividualworkwiththechildoryoungpersoninunderstandingtheirillnessdemonstratingin-depthknowledgeofchilddevelopmentandthechildsunderstandingofillnessatdifferentdevelopmentalstagesIdentifiesproblemsingrowthanddevelopmentofachildoryoungpersonandmakesappropriatereferralsDemonstratesanin-depthknowledgeofthesignsandsymptomsofachildwithHIVbecomingunwellDemonstratesanin-depthknowledgeofHIVpathophysiologytransmissionandtreatmentinchildrenEducatescarersandyoungpeopleabouttheirconditionhowtomanageitthesignsofillnessandwhentoseekadviceProvidessexualhealthinformationandadvicetoadolescentswithHIVandmakesappropriatereferralsPromoteshealthandwell-beingandpreventsadverseeffectsonhealthandwell-beingbycontributingtothedevelopmentimplementationandevaluationofrelatedpoliciesDevelopsguidelinesfortestingchildrenandyoungpeopleEnsurescarepathwaysareinplaceforreferralofchildrentobetestedforHIVacrosstheclinicalnetworkDevelopscarepathwaysandresourcesarounddisclosureofdiagnosistochildrenforcarerschildrenandprofessionalsContributestoorundertakesresearchintochildrensunderstandingoftheirillnessorparentsviewsarounddisclosureDevelopshealthpromotionstrategiesacrossaclinicalnetworkEstablishesreferralroutesforaccesstosexualhealthandfamilyplanningservicesLEVEL2LEVEL3LEVEL4 NHIVNACOMPETENCIESSpecialistHIVnursingcompetenciesS4Paediatric24Demonstratesanawarenessoftheyoungpersonssexualhealthneeds.ReferstheyoungpersontoadultMDTforsupportaroundsexualhealthissueswhennecessary.HasanawarenessofHIVandYoungPersonsNetworkHYPNet40DevelopsappropriateadolescenttransitionservicesacrossthenetworkrecognisingtheneedforservicesforverticallyinfectedyoungpeopleLEVEL2LEVEL3LEVEL4MDTworkingandintegratedhealthandsocialcarePhysicalContributestoassessingthehealthandwell-beingneedsofanHIV-positivechildyoungpersonandplanninghowtomeetthoseneedsDemonstratesanunderstandingofanMDTwhoitinvolvesandhowtoworkwithinitDemonstratesanawarenessofsignsofneurologicaldelayandHIVencephalopathyinchildrenUnderstandsHIVinadultsalsoconsiderscarersneedsDemonstratesanawarenessoftheUKvaccinationpolicyAssesseshealthandwell-beingneedsofanHIV-positivechildyoungpersonanddevelopsmonitorsandreviewsplansofcaretomeetspecificneedsEnsurestheMDTisinvolvedinassessingthechildsneurologicaldevelopmentRecognisesadeviationfromnormalchildhooddevelopmentandcanworkwithintheMDTtoensurethechildsneedsaremetDemonstratesanunderstandingofthecarershealthneedsencouragingthecarertoaccessappropriatehealthcareandcanreferthecarertoadultserviceswherevernecessaryUtiliseslinkswithLeadCentreinChildrensHIVNationalNetworkCHINNSharedCareNetworkreferringtoPENTAguidelineswithtreatmentqueriesandalsoCHIVApolicies41Planstheassessmentofthechildshealthandwell-beingneedsandpreparesforittotakeplaceEnsuresthechildsvaccinationhistoryisaccurateandallrelevantvaccinationshavebeenadministeredAssessescomplexhealthandwell-beingneedsofHIV-positivechildrenandyoungpeople.DevelopsmonitorsandreviewsplansofcaretomeetthoseneedsDevelopspoliciesandprotocolsaspartoftheMDTsothatpatientsareassessedonaregularbasisandthusensuringtheirdevelopmentalneedsaremetRecognisesneurologicaldelayinchildrenasadirectresultofHIVconfidentlyliaiseswiththefamilyinrelationtotheeffectsofthedelayonthechildsprognosisandactsasadvocateforthefamilyonbehalfoftheMDTDemonstratesanin-depthknowledgeofHIVtreatmentsingeneralandsocandiscussfullycarersowntreatmentoptionsetc.CanofferinitialconsultationswhencarersthemselveshavenotaccessedtheirownhealthcarethenrefersontoadultservicesHasanongoingrelationshipwithLeadCentreifnotbasedinonedemonstratestheknowledgeandskillstodeveloppoliciesforChildrensHIVAssociationCHIVA42Hastheabilityautonomouslytorecognisewhetherthechildswell-beingneedsarebeingmetandhastheknowledgeandskillstorecognisewhattheMDTcanofferaswellasoutsideagenciesAutonomouslyadvisesparentsandcolleaguesonvaccinatingchildrenwithHIV.Hasin-depthknowledgeofUKvaccinationpolicyandcanadviseparentsandcolleaguesonvaccinatingchildrenwithHIVLEVEL2LEVEL3LEVEL4 NHIVNACOMPETENCIESSpecialistHIVnursingcompetenciesS4Paediatric25SocialParticipatesindiscussionswiththechildregardingwhatcaretheywillreceiveDemonstratesabasiclevelofknowledgeofpaediatricHIVrelevanttotheclinicalareaDemonstratesanunderstandingofclinicalobservationsnecessarytoassessachildsphysicalwell-beingandtakesandrecordsobservationsrecognisinganydeviationsfromthenormParticipatesincaringfortheimmunosuppressedchildandadministeringARTDevelopsanunderstandingofimmunosuppressionandhowitaffectsthebodyDemonstratesanawarenessofsupportagenciesandreferstoseniornursingcolleaguesforadviceEnsuresthechildhasanage-appropriateunderstandingofthecarethatwillbegivenandadvocatesonbehalfofthefamilyiftheyarenotappropriatelyinformedDemonstratesathoroughknowledgeofpaediatricHIVDemonstratesathoroughknowledgeofbaselineinvestigationsrequiredaccordingtolocalguidelinesandorCHIVAguidelinesAdvocatesforthechildwhoisimmunosuppressedandpromotesARTaccordingtoPENTAguidelinesRecognisessymptomsofimmunosuppressionininfantschildrenandadolescentsandactsasaninitialpointofcontactifthechildisunwellortheparentsneedadviceEnsuresthatthechildsinvolvementindecision-makingandconsentisdependentontheirdevelopmentalstageandageunderstandstheimportanceofworkinginpartnershipwiththechildandcarers.EnsurestheclinicalareasforchildassessmentareageappropriateandchildfriendlyDemonstratesafamily-centredapproachandhasaknowledgeofcarersARThistorytoensureoptimalcareforthechildVisitsfamiliesathomeandprovidesinsightintothechildsandfamilyshomeenvironmentProvidesextensiveinformationonsupportagenciesforchildrenandtheircarersandcanreferafamilytorelevantvoluntaryorganisationsandotheragenciesforsupportAssessesthechildandtheircarerwhenARTisfailingandworksinpartnershipwiththefamilytounderstandindividualchallengesaroundadherenceDemonstratesexpertknowledgeofpaediatricHIVandutilisesthatknowledgetosetupteachingpackagesforcarersandprofessionalsAssessesandevaluatesonanongoingbasiswhichbaselineinvestigationsareneededandimplementswhenrequiredaspartoftheMDTInterpretsresultsandplansforhowseverelythechildmaybeaffectedbyimmunosuppression.EnsuresfamilyhasdirectaccesstotheclinicalareaduringthistimeHasthedevelopedskillsettodiscussdifferentdrugcombinationswithcarerswhomayhaveconcernsabouttheirchildcommencingspecificmedicationsAutonomouslymakesrecommendationsonbehalfofthefamilyafterahomevisitWorksinanadvisorycapacitywhenrequestedtobyvoluntaryorganisationstoassistinrecognisingandprovidingthebestsupportpossibletofamiliesUtilisesnurse-ledservicestomaintainregularfollow-upandsupportforthefamily.UnderstandsresistancepatternsandongoingARTcombinationsthatcanbeusedinchildrenLEVEL2LEVEL3LEVEL4 NHIVNACOMPETENCIESSpecialistHIVnursingcompetenciesS4Paediatric26MDTworkingandintegratedhealthandsocialcareSocialContributestoprotectingHIV-positivechildrenyoungpeoplewhoareatriskDemonstratesanawarenessofvoluntaryorganisationsthatofferspecificsupporttofamilieslivingwithHIVRecognisesthedifficultiesfamiliesfacewhencaringforachildwhohaslong-termdevelopmentaldelayandrefersontoseniorcolleagueswhensupportisnotinplaceEnsuresthecarershealthneedsaremetifthechildyoungpersonishospitalisedforanyreasonImplementsaspectsofaprotectionplanandreviewsitseffectivenessPutsplansinplacetoensurethatchildrenandcarersaresupportedinthecommunitybyappropriatemembersoftheMDTandorvoluntaryorganisationsAssessesthefamilysneedforsupportservicesinthecommunityatthetimeofpresentationandreviewsonaregularbasis.EncouragesfamiliestolinkinwithvoluntaryorganisationstogainsupportwherenecessaryThroughcareplanningwiththefamilyofferssupporttochildyoungpersonandcarerwherethechildhasneurologicaldevelopmentaldelayphysicalandormentalasaresultofHIVEnablesthechildyoungpersontodiscussdrugalcoholabuseinasafeconfidentialsettingputsplansinplacetoregularlyreviewsubstanceabusewiththechildyoungpersonRespectstheconfidentialityofthechildrenyoungpeopleandtheirfamilyaccordingtotheNMCprofessionalcodeofconduct11DemonstratesanunderstandingofthecarershealthstatusworkswiththefamilytoputcareplansintoplacewhenthecarerrequireshospitalisationorisunabletocareforthechildyoungpersonforanyreasonAdvocatesforthechildyoungpersoninsituationswherethecarerwillnotaccesshealthserviceseitherforthemselvesorforthechildyoungpersonDevelopsandleadsontheimplementationofanoverallprotectionplanLEVEL2LEVEL3LEVEL4 NHIVNACOMPETENCIESSpecialistHIVnursingcompetenciesS4Paediatric27ContributestoplanningdeliveryandmonitoringofARTDemonstratesanawarenessofARTe.g.howitworksthedifferentclassesofdrugsandindicatorsthatARTisfailingDemonstratesawarenessofformulationsandpreparationsofthevariousARTsandtheircorrectadministrationincludingtimingandfoodrestrictionforchildrenandyoungpeopleDemonstratesanawarenessofthePENTAguidelinesforstartingchildrenonARTFacilitatesthecorrectadministrationofARTinspecialistandnon-specialistsettingsPlansdeliversandevaluatesantiretroviralinterventionsDemonstratesin-depthandup-to-dateknowledgeofARTinchildrenDemonstratesawarenessofpharmacokineticsandmetabolismofARTininfantschildrenandyoungpeople.Demonstratesgoodknowledgeofside-effectsanddruginteractionsDemonstratesanin-depthknowledgeofthePENTAguidelinesforstartingchildrenonARTDemonstratesanin-depthknowledgeofthevarietyoftechniquesforadministeringmedicationstochildrendependingontheagedevelopmentalstageandpreferenceofthechildEstablishessystemstoplandeliverandevaluateARTwheretherearecomplexissuesandorseriousillnessDemonstratesexpertiseinmanagingthecareofchildrenandyoungpeopleonARTDevelopsintegratedcarepathwaysforstartingorswitchingchildrenonARTfornetworkLEVEL2LEVEL3LEVEL4WorkingwithinMDTsUndertakescareactivitiestomeetthehealthandwell-beingneedsofchildrenyoungpeoplewithHIVParticipatesinworkingwiththepaediatricHIVMDT.DemonstratesanunderstandingoftheneedforcoordinationbetweentheMDTcaringforchildrenandfamilieswithHIVUnderstandstheconceptofCHINNforthemanagementofpaediatricandperinatalHIVParticipatesindischargeplanningandmakesappropriatereferralsPlansdeliversandevaluatescaretomeethealthandwell-beingneedsofchildrenyoungpeoplewithHIVFacilitatesMDTmeetings.CoordinatestheMDTprovidingcaretofamilieswithHIVtoprovideeffectivecommunicationandliaisonCoordinatesthesmoothrunningofHIVfamilyclinicsforthecareofchildrenwithHIVandtheirHIV-positiveparentsParticipatesinCHINNmeetingsFacilitatesandcoordinatesthedischargeplanningforchildrenwithHIVParticipatesincaseconferencesandnetworkmeetingsPlansdeliversandevaluatescaretoaddressthecomplexhealthandwell-beingneedsofchildrenyoungpeoplewithHIVParticipatesinworkingwiththewiderMDTincludingadultHIVteamsocialservicesvoluntarysectorandprimarycaretoensurecoordinatedcareforthechildrenandtheirfamiliesRunsnurse-ledclinicsforchildrenwithHIVorthefollow-upofbabiesborntowomenwithHIVinlinewithlocalprotocolsLeadsinidentifyingnursingreferralpathwayswithinownCHINNLeadsinidentifyingpathwaysofcareacrossCHINNforpaediatricandperinatalcaremanagementParticipatesinorcoordinatesnetworksteeringgroupsandfacilitatesservicereviewsacrossnetworkGivesspecialistpaediatricandperinatalHIVadvicetootherworkerslocallyandnationallyLEVEL2LEVEL3LEVEL4 References40.HIVinYoungPersonsNetworkHYPNetseewww.networks.nhs.uk41.SharlandMBlancheSCastelliJetal.PENTASteeringCommittee.PENTAguidelinesfortheuseofantiretroviraltherapy2004.HIVMed20045Suppl26186.Seealsowww.ctu.mrc.ukpenta42.ChildrensHIVAssociationCHIVAseewww.chiva.org.ukNHIVNACOMPETENCIESSpecialistHIVnursingcompetenciesS4Paediatric28ParticipatesinassessmentofreadinesstostartARTandtheplanningandpreparationofthechildandfamilyfortreatment.AnticipatesobstaclestogoodadherenceandidentifiesculturallyappropriateinterventionstofacilitateadherenceDemonstratesawarenessofthemainside-effectsortoxicitiesofARTandisabletoassistinmonitoringchildrenandyoungpeopleDemonstratesanawarenessofdruginteractionswithARTandhowtoaccessinformationondruginteractionsAssessesthechildsandfamilysreadinesstostartART.Formulatesaplanofwhatpreparationsandinterventionsneedtotakeplacepriortostartingtherapy.AnticipatesobstaclestogoodadherenceandidentifiesculturallyappropriateinterventionstofacilitateadherenceInterpretsbloodtestresultsfortreatmentoutcomestoxicitiesside-effectsandtherapeuticdrugmonitoringDemonstratesagoodawarenessofthepotentialdruginteractionsofARTwithotherdrugsandcanaccessinformationProvidesaccurateandup-to-dateinformationonARTtocarersandageanddevelopmentallyappropriateinformationforthechildoryoungpersonDemonstratesanextensiveknowledgeofthefactorsthatmayinfluenceadherencetotherapy.RegularlyassessesandreviewsadherenceDemonstratesanin-depthunderstandingofthemechanismsfordevelopingresistancetoARTanditsimplicationsParticipatesinthemultidisciplinarydecision-makingdiscussionsaroundstartingachildonARTAdvisesothernursesandhealthcareprofessionalsonthemanagementofARTinchildrenandyoungpeopleReviewschildrenonARTindependentlyseekingadviceormakingreferralswhenproblemsareidentifiedAbletorunnurse-ledclinicsformonitoringchildrenonHIVtreatmentandmanagementofadherencepillswallowingetcDemonstratesawarenessofwhenchildrenmayneedtochangeARTandinitiateschangesintherapyCoordinatesMDTdrugmeetingsandtrainingtoensuregoodclinicalgovernanceinmanagementofARTinchildrenDevelopstoolsandinformationresourcesforcarerschildrenandprofessionalsonHIVandARTinchildrenLEVEL2LEVEL3LEVEL4 NHIVNACOMPETENCIESAppendicesGlossaryandfurtherresources29GlossaryARTAntiretroviraltherapyBHIVABritishHIVAssociationCHIVAChildrensHIVAssociationMDTMultidisciplinaryteamPEPPost-exposureprophylaxisPGDPatientgroupdirectionsSTISexuallytransmittedinfectionSAESeriousadverseeventFurtherresourcesBASHHBritishAssociationforSexualHealthandHIVwww.bashh.orgHIVi-BaseAtreatmentactivistgroupHIV-positiveledandcommittedtoprovidingtimelyHIVtreatmentinformationtoHIV-positivepeopleandhealthcareprofessionalswww.i-base.infoNAMAcommunity-basedorganisationthatdeliversHIVinformationacrosstheworldtoHIV-positivepeopleandhealthcareprofessionalswww.aidsmap.com NHIVNACOMPETENCIESAppendicesAcknowledgements30ReviewgroupJaneBrutonClinicalNurseLeadHIVChelseaandWestminsterHospitalNHSFoundationTrustLondonAnnaBamfordClinicalServicesManagerHIVSussexCommunityNHSTrustJulietBennettIndependentSpecialistNurseHIVandTreatmentAdherenceShaunWatsonClinicalNurseSpecialistforHIVChelseaandWestminsterHospitalNHSFoundationTrustLondonInvitedauthorsWewouldliketoacknowledgeandthanktheinvitedauthorsfortheirconsiderableworkindevelopingthespecialistcompetencies.PaediatriccompetenciesSheilaDonaghyPaediatricHIVNurseConsultantStGeorgesHospitalLondonChristinaHanleyPaediatricHIVNurseSpecialistStMarysHospitalLondonOutpatientcompetenciesNathanielAultHIVNurseConsultantBartsandTheLondonNHSTrustClinicaltrialcompetenciesNickyPerryResearchCoordinatorBrightonandSussexUniversityHospitalsNHSTrustSheilaMorrisResearchCoordinatorWesternGeneralHospitalEdinburghOthercontributorsWewouldalsoliketothankthefollowingpeoplewhohavemadeanimportantcontributiontowardsthedevelopmentoftheNationalHIVNursingCompetenciesRoyBrazingtonLizBreadnerChristinaCasleyEnriqueCastro-SnchezSheilaDonaghyLillianGanukBhairviGosraniAnnieHoileMartinJonesCarmelKellyJulianLaBastideSamanthaMabey-PuttockBrendaMannEmmaMcFarlaneMarieMurrayIanNixonSuePennantNickyPerryColinRobertsDeirdreSheedyZoSheppardCeliaSkinnerGuidoTapiaLindaJTuckerJoyceVostShaunWatsonBrianWestChrisWhitehead NHIVNASecretariatMediscriptLtd1MountviewCourt310FriernBarnetLaneLondonN200LDTelephone4402084468898SFacsimile4402084469194SEmailnhivnanhivna.org NHIVNAaimstoprovideanacademicandeducationalforumforthedisseminationoforiginalnursingresearchinthefieldofHIVAIDS.Wealsoaimtoaddressthecommunicationandsupport-needsofnursesworkinginthisarea.WehopethattheseactivitieswillassistinthepromotionofgoodpracticeinthecareofpeoplewithHIV.PublicationdateOctober2013