The registered nurse must be able to undertake these procedures effectively in order to provide compassionate, evidence-based person-centred nursing care. A holistic approach to the care of people is essential and all nursing procedures should be carried out in a way which reflects cultural awareness
and ensures that the needs, priorities, expertise and preferences of peopleare always valued and taken into account.
Registered nurses in all fields of practice must demonstrate the ability to provide nursing intervention and support for people of all ages who require nursing procedures during the processes of assessment, diagnosis, care and treatment for mental, physical, cognitive and behavioural health challenges.
Where people are disabled or have specific cognitive needs it is essential that reasonable adjustments are made to ensure that all procedures are undertaken safely.
The nursing procedures within this annexe are set out in two sections. These requirements are relevant to all fields of nursing practice although it is recognised that different care settings may require different approaches to the provision of care. It is expected that these procedures would be assessed in a student’s chosen field of practice where practicable.
Those procedures outlined in Annexe B, Part I: Procedures for assessing needs for person-centred care, sections 1 and 2, also apply to all registered nurses, but the level of expertise and knowledge required will vary depending on the chosen field(s) of practice. Registered nurses must therefore be able to demonstrate the ability to undertake these procedures at an appropriate level for their intended field(s) of practice.
At the point of registration, the registered nurse will be able to safely demonstrate the following procedures:
Part 1: Procedures for assessing people’s needs for person-centred care
1. Use evidence-based, best practice approaches to take a history, observe, recognise and accurately assess people of all ages:
1.1 mental health and wellbeing status
1.1.1 signs of mental and emotional distress or vulnerability
1.1.2 cognitive health status and wellbeing
1.1.3 signs of cognitive distress and impairment
1.1.4 behavioural distress based needs
1.1.5 signs of mental and emotional distress including agitation, aggression and challenging behaviour
1.1.6 signs of self-harm and/or suicidal ideation
1.2 physical health and wellbeing
1.2.1 symptoms and signs of physical ill health
1.2.2 symptoms and signs of physical distress
1.2.3 symptoms and signs of deterioration and sepsis.
2. Use evidence-based, best practice approaches to undertake the following procedures:
2.1 take, record and interpret vital signs manually and via
technological devices
2.2 undertake venepuncture and cannulation and blood sampling, interpreting normal and common abnormal blood profiles and venous blood gases
2.3 set up and manage routine electrocardiogram (ECG) investigations and interpret normal and commonly encountered abnormal traces
2.4 manage and monitor blood component transfusions
2.5 manage and interpret cardiac monitors, infusion pumps, blood glucose monitors and other monitoring devices
2.6 accurately measure weight and height, calculate body mass index and recognise healthy ranges and clinically significant low/high readings
2.7 undertake a whole body systems assessment including respiratory, circulatory, neurological, musculoskeletal, cardiovascular and skin status
2.8 undertake chest auscultation and interpret findings
2.9 collect and observe sputum, urine, stool and vomit specimens, undertaking routine analysis and interpreting findings
2.10 measure and interpret blood glucose levels
2.11 recognise and respond to signs of all forms of abuse
2.12 undertake, respond to and interpret neurological observations and assessments
2.13 identify and respond to signs of deterioration and sepsis
2.14 administer basic mental health first aid
2.15 administer basic physical first aid
2.16 recognise and manage seizures, choking and anaphylaxis, providing appropriate basic life support
2.17 recognise and respond to challenging behaviour, providing appropriate safe holding and restraint.
Part 2: Procedures for the planning, provision and management of person-centred nursing care
3. Use evidence-based, best practice approaches for meeting needs for care and support with rest, sleep, comfort and the maintenance of dignity, accurately assessing the person’s capacity for independence and self-care and initiating appropriate interventions
3.1 observe and assess comfort and pain levels and rest and sleep
patterns
3.2 use appropriate bed-making techniques including those required for people who are unconscious or who have limited mobility
3.3 use appropriate positioning and pressure-relieving techniques
3.4 take appropriate action to ensure privacy and dignity at all times
3.5 take appropriate action to reduce or minimise pain or discomfort
3.6 take appropriate action to reduce fatigue, minimise insomnia and support improved rest and sleep hygiene.
4. Use evidence-based, best practice approaches for meeting the needs for care and support with hygiene and the maintenance of skin integrity, accurately assessing the person’s capacity for independence and self-care and initiating appropriate interventions
4.1 observe, assess and optimise skin and hygiene status and determine the need for support and intervention
4.2 use contemporary approaches to the assessment of skin integrity and use appropriate products to prevent or manage skin breakdown
4.3 assess needs for and provide appropriate assistance with washing, bathing, shaving and dressing
4.4 identify and manage skin irritations and rashes
4.5 assess needs for and provide appropriate oral, dental, eye and nail care and decide when an onward referral is needed
4.6 use aseptic techniques when undertaking wound care including dressings, pressure bandaging, suture removal, and vacuum closures
4.7 use aseptic techniques when managing wound and drainage processes
4.8 assess, respond and effectively manage pyrexia and hypothermia.
5. Use evidence-based, best practice approaches for meeting needs for care and support with nutrition and hydration, accurately assessing the person’s capacity for independence and self-care and initiating appropriate interventions
5.1 observe, assess and optimise nutrition and hydration status and determine the need for intervention and support
5.2 use contemporary nutritional assessment tools
5.3 assist with feeding and drinking and use appropriate feeding and drinking aids
5.4 record fluid intake and output and identify, respond to and manage dehydration or fluid retention
5.5 identify, respond to and manage nausea and vomiting
5.6 insert, manage and remove oral/nasal/gastric tubes
5.7 manage artificial nutrition and hydration using oral, enteral and parenteral routes
5.8 manage the administration of IV fluids
5.9 manage fluid and nutritional infusion pumps and devices.
6. Use evidence-based, best practice approaches for meeting needs for care and support with bladder and bowel health, accurately assessing the person’s capacity for independence and self-care and initiating appropriate interventions
6.1 observe and assess level of urinary and bowel continence to determine the need for support and intervention assisting with toileting, maintaining dignity and privacy and managing the use of appropriate aids
6.2 select and use appropriate continence products; insert, manage and remove catheters for all genders; and assist with self catheterisation when required
6.3 manage bladder drainage
6.4 assess bladder and bowel patterns to identify and respond to constipation, diarrhoea and urinary and faecal retention
6.5 administer enemas and suppositories and undertake rectal examination and manual evacuation when appropriate
6.6 undertake stoma care identifying and using appropriate products and approaches.
7. Use evidence-based, best practice approaches for meeting needs for care and support with mobility and safety, accurately assessing the person’s capacity for independence and self-care and initiating appropriate interventions
7.1 observe and use evidence-based risk assessment tools to determine need for support and intervention to optimise mobility and safety, and to identify and manage risk of falls using best practice risk assessment approaches
7.2 use a range of contemporary moving and handling techniques and mobility aids
7.3 use appropriate moving and handling equipment to support people with impaired mobility
7.4 use appropriate safety techniques and devices.
8. Use evidence-based, best practice approaches for meeting needs for respiratory care and support, accurately assessing the person’s capacity for independence and self-care and initiating appropriate interventions
8.1 observe and assess the need for intervention and respond to restlessness, agitation and breathlessness using appropriate interventions
8.2 manage the administration of oxygen using a range of routes and best practice approaches
8.3 take and interpret peak flow and oximetry measurements
8.4 use appropriate nasal and oral suctioning techniques
8.5 manage inhalation, humidifier and nebuliser devices
8.6 manage airway and respiratory processes and equipment.
9. Use evidence-based, best practice approaches for meeting needs for care and support with the prevention and management of infection, accurately assessing the person’s capacity for independence and self-care and initiating appropriate interventions
9.1 observe, assess and respond rapidly to potential infection risks using best practice guidelines
9.2 use standard precautions protocols
9.3 use effective aseptic, non-touch techniques
9.4 use appropriate personal protection equipment
9.5 implement isolation procedures
9.6 use evidence-based hand hygiene techniques
9.7 safely decontaminate equipment and environment
9.8 safely use and dispose of waste, laundry and sharps
9.9 safely assess and manage invasive medical devices and lines.
10. Use evidence-based, best practice approaches for meeting needs for care and support at the end of life, accurately assessing the person’s capacity for independence and self-care and initiating appropriate
interventions
10.1 observe and assess the need for intervention for people, families and carers, identify, assess and respond appropriately to uncontrolled symptoms and signs of distress including pain, nausea, thirst, constipation restlessness, agitation, anxiety and depression
10.2 manage and monitor effectiveness of symptom relief medication, infusion pumps and other devices
10.3 assess and review preferences and care priorities of the dying person and their family and carers
10.4 understand and apply organ and tissue donation protocols, advanced planning decisions, living wills and health and lasting powers of attorney for health
10.5 understand and apply DNACPR (do not attempt cardiopulmonary resuscitation) decisions and verification of expected death
10.6 provide care for the deceased person and the bereaved, respecting cultural requirements and protocols.
11. Procedural competencies required for best practice, evidence-based medicines administration and optimisation
11.1 carry out initial and continued assessments of people receiving care and their ability to self-administer their own medications
11.2 recognise the various procedural routes under which medicines can be prescribed, supplied, dispensed and administered; and the laws, policies, regulations and guidance that underpin them
11.3 use the principles of safe remote prescribing and directions to administer medicines
11.4 undertake accurate drug calculations for a range of medications
11.5 undertake accurate checks, including transcription and titration, of any direction to supply or administer a medicinal product
11.6 exercise professional accountability in ensuring the safe administration of medicines to those receiving care
11.7 administer injections using intramuscular, subcutaneous, intradermal and intravenous routes and manage injection equipment
11.8 administer medications using a range of routes
11.9 administer and monitor medications using vascular access devices and enteral equipment
11.10 recognise and respond to adverse or abnormal reactions to medications
11.11 undertake safe storage, transportation and disposal of medicinal products.
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