Competencies For Nurses And Nurse Practitioners - Villanova

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Competencies for Nurses and Nurse PractitionersThis document is a set of competencies for practicing registered nurses and nursepractitioners. The literature is clear that registered nurse education programs do notinclude significant information about people with disabilities or how to promote thehealth, well being and autonomy of People with Disabilities (PWD). A recent survey(soon to be published) demonstrates that nurse practitioner programs do not adequatelyinclude this content either. Nurses who are ill prepared to care for PWD continue intonurse practitioners programs without much additional information about PWD. Asnurses and nurse practitioners are an integral part of the primary care system in theUnited States, measurable outcome competencies for registered nurse and nursepractitioner programs are needed. The goal of developing these competencies is toensure nursing education programs have measurable outcome competencies forregistered nurses and for nurse practitioners at the completion of programs.Goal - To improve care by nurses and nurse practitioners, including access andutilization of primary care services, to people with disabilities.KnowledgeRegistered Nurse (RN)Upon completion of Nurse Practitioner(NP) program, demonstratesknowledge, attitude, and skills of thepracticing RN plus the following:PHYSIOLOGICPHYSIOLOGIC Utilizes a conceptual framework ofdisability in the context of humandiversity, health, illness, the lifespan,and the constructed social and culturalenvironments Ex.: Biopsychosocial Model,Interface Model Describes disability and its impact onhealthcare from the perspective of a frameworkor model accepted by the disability community Recognizes PWD can have a high levelof wellness Verbalizes the importance of healthpromotion activities Identifies actual and/or secondaryconditions Describes common unmet health needsfor PWD Acknowledges the importance ofinnovative or novel treatment andmanagement strategies for clinicalpractice Bases practice on current evidence Differentiates the difference between chronicand acute presentations in the PWD Differentiates between primary and secondaryconditions related to disability Recognizes the interrelatedness of primary andsecondary conditions Identifies health promotion activities;encourages PWD and family/caregiverparticipation Screens for common unmet health needs forPWD Explores PWD use of innovative or noveltreatment and management strategies,including complementary and alternativemethods. Provides evidence based guidance inevaluation of these therapies. Considers the changing needs of both PWD andthe family (and caregiver/surrogate) based ontheir agingDevelopment of this content was partially supported by a grant from HRSA (D09HP18998-01-00).1

KnowledgeRegistered Nurse (RN)Upon completion of Nurse Practitioner(NP) program, demonstratesknowledge, attitude, and skills of thepracticing RN plus the following:COMMUNICATIONCOMMUNICATION Identifies and acknowledges theimportance of appropriate, patientspecific communication andfamily/surrogate communication whenPWD is incapable of communicationeven with communication aids Identifies the preferred method ofcommunication of the PWD.ENVIRONMENT Recognizes the ethical and legal rightfor PWDs to access all environmentalfacilities and appropriate treatmentsbased on principles of Universal Design Acknowledges the PWD perception ofhis/her experience during the provisionof health care and the potentialinfluence on future healthcareencounters Explores with PWD andfamily/surrogate prior healthcareexperience. Communicates with the family/surrogate whenPWD is incapable of understanding orcommunicating even with communication aids Screens PWD for need and potential need foralternative and augmentative communication(AAC) Utilizes AAC methods appropriatelyENVIRONMENT Anticipates and identifies actual and/orpotential barriers to providing optimum healthcare to the PWD consistent with The Americanswith Disabilities Act (ADA) Provides healthcare incorporating PWD andfamily/surrogate input regarding his/herexperiencesREFERRAL Identifies areas of strengths and areas forimprovement for the provision of health carebased on PWD and family/surrogate input Recognizes the importance of aninterdisciplinary approach to meet allPWD needs Identifies areas of strengths and areas forimprovement for the provision of health care forPWD based on health team member input Explores prior healthcare experience andpotential impact on seeking healthcareREFERRAL Identifies appropriate referrals to meetphysiologic, psychosocial, medical, andhealthcare needs of the PWD and facilitatesreferrals related to acquisition of services andequipment Demonstrates knowledge of assistive devicesand relevant services that would improvequality of life for PWD Provides periodic evaluation of assistive andcommunication devicesDevelopment of this content was partially supported by a grant from HRSA (D09HP18998-01-00).2

AttitudesRegistered Nurse (RN)Upon completion of Nurse Practitioner(NP) program, demonstratesknowledge, attitude, and skills of thepracticing RN plus the following:PHYSIOLOGICPHYSIOLOGIC Identifies and applies legal and ethicalprinciples to provide optimumhealthcare to PWD Identifies own or others’ actual or potentialattitudinal barriers to optimum health care forPWD Recognizes the potential for attitudinalbarriers towards PWD Identifies strategies to overcome/address ownor others’ actual or potential attitudinal barriersto the provision of optimum health, includingCOMMUNICATIONaccess to intensive care, life-sustainingtreatment, and palliative and end-of-life care Utilizes general principles and etiquettefor interacting with PWD and/or familyCOMMUNICATIONor surrogate Communicates with the PWD based on the Demonstrates respect in interactionrespect for the person as an individual as wellwith PWDthe right of the PWD to make informeddecisions for health care, and communicates Communicates directly with PWDwith family/surrogate when the patient lacks Understands that disability affects thedecisional capacityPWD, family, and social contacts Recognizes the need for greaterunderstanding of the experience ofPWD Obtains information from PWD,caretaker, or surrogate and other healthteam members to increase greaterunderstanding of the experience ofPWDENVIRONMENT Understands that PWD have uniqueneeds for access to the provision ofoptimum health care Encourages and empowers PWD to makeinformed decisions for health care, orfamily/surrogate when appropriate Understands the need for patient-centered careand the importance of understanding quality oflife from PWD perspectives Provides patient-centered care through theunderstanding and respecting of the importanceof quality of life from PWD perspective Identifies the strengths and/or areas ofimprovement as perceived by the PWD andhis/her family and/or social contacts Describes the roles and responsibilitieswithin the PWD’s circle of support Provides care to PWD based on informationgathered from PWD, caretaker, and other healthteam membersREFERRALENVIRONMENT Understands and respects the need foran interdisciplinary approach to meetall of the physiologic, psychosocial, andmedical needs for PWD as determinedby the PWD with the NP Identifies barriers to full access to all aspectsof care including physiologic, psychosocial,and medical needs from all members in thehealthcare settingDevelopment of this content was partially supported by a grant from HRSA (D09HP18998-01-00).3

SkillsRegistered Nurse (RN)Upon completion of Nurse Practitioner(NP) program, demonstratesknowledge, attitude, and skills of thepracticing RN plus the following:PHYSIOLOGICPHYSIOLOGIC Identifies that a person has a disability Assesses PWD need for accommodations andassistive devices, including use, efficacy, andfunction of devices, needed to functionoptimally in the home and community Describes differences betweenimpairment, handicap, disability,according to World Health Organization(WHO) definitions Verbalizes differences between primaryand secondary conditions of PWD Acknowledges accommodations andassistive devices utilized by PWD Identifies signs of abuse (physical,psychological, emotional, financial,sexual) and vulnerability forexploitation Identifies common psychiatricconditions Verbalizes the impact of actual orpotential cognitive or physical declineon a PWD independence across thelifespan Implements assessments that include:evaluations about mobility, communication,need for alternate formats of communicationand educational needs for self care Provides counseling about secondaryconditions Provides information about the prevention andmanagement of secondary conditions Anticipates progression of chronic conditionswith aging and possible increased needsnecessitating increased services or change inplacement Screens for signs of abuse or exploitation usingthe Abuse Assessment Screen-Disability (AASD) Verbalizes understanding ofmedications including: indication, common side effects,and potential for polypharmacy Screens for common psychiatric conditions Acknowledges the importance ofpreventive healthcare Evaluates patient for potential polypharmacyCOMMUNICATION Screens for the impact of actual or potentialcognitive or physical decline on PWDindependence Encourages health promotion behaviors andprovides routine and targeted screening andpreventive healthcare Verbalizes the importance of gatheringinformation regarding the PWD from allappropriate resources (PWD andcaretaker, residential sources) Adjusts medication regimen, as indicated, toreduce or eliminate polypharmacy Communicates directly with the PWD Assesses the developmental level andfunctional health literacy of PWD Gathers information regarding the PWDfrom all appropriate resources (PWDand caretaker, residential sources) Describes various methods ofalternative and augmentativecommunication utilized by PWD Describes the importance of methods toassess the developmental level andfunctional health literacy of PWDCOMMUNICATION Assesses PWD for preferred method ofcommunication Communicates effectively with PWD utilizinghis/her preferred method of communication Provides treatment in consultation withcollaborating providers, based on informationregarding the PWD from all appropriateresources (PWD, caretaker, and residentialsources)Development of this content was partially supported by a grant from HRSA (D09HP18998-01-00).4

SkillsRegistered Nurse (RN)Upon completion of Nurse Practitioner(NP) program, demonstratesknowledge, attitude, and skills of thepracticing RN plus the following:COMMUNICATIONCOMMUNICATION Articulates the need to assess PWD forhis/her specific needs to provideoptimum healthcare Assesses the PWD concerning his/her lifeview and perceived quality of life Provides health care information andtreatment that are consistent with thePWD’s life view and perceived quality oflife Ensures that PWD has Advance Directivesif PWD is developmentally capable Question if PWD has AdvanceDirectivesENVIRONMENT Acknowledges that PWD has uniqueneeds for access to and safe provisionof health care as well as the safety ofstaff within the facility.ENVIRONMENT Verbalizes the ethical and legal right ofPWD to obtain appropriate referral tomeet all actual and anticipated needs.Ensures that practice facilities areaccessible: clinic/office rooms, waitingarea, and bathroom facilities to provideoptimum healthcare includingcommunication, transfer, and access toservices Identifies appropriate health careresources for further evaluation andmanagement of PWDIdentifies accessible communityresources and sites for primary carescreening and referral services Asks and assesses PWD about his/herspecific needs and optimal strategies toprovide care, including transferring fromwheelchair to bed or exam table withoutjeopardizing the PWD’s or staff’s health orsafety Asks and assesses PWD about his/herspecific needs for assistance andassistive devices (mobility, hearing, sight) Maintains dignity and privacy of PWDREFERRALREFERRAL Identifies, refers, and obtains appropriatehealth care resources for PWD seekinghealth care including and not limited toaccommodations and assistive devices asneeded Identifies accessible sources of supportfor PWD and family/caretaker both withinthe healthcare environment and thecommunity Facilitates access to appropriateresources or referrals for mobility,communication, and need for alternateformatsDevelopment of this content was partially supported by a grant from HRSA (D09HP18998-01-00).5

nurse practitioners programs without much additional information about PWD. As nurses and nurse practitioners are an integral part of the primary care system in the United States, measurable outcome competencies for registered nurse and nurse practitioner programs are needed. The goal of developing these competencies is to