Clinical Nurse Specialist (Outreach)

Clinical Nurse Specialist (Outreach)

Job Specification, Terms & Conditions

• One permanent, whole-time post initially based in the Dochas Centre, Drogheda
• One permanent, whole-time post initially based in Aeta Place, Gortnakesh, Cavan
• Two permanent, whole-time posts initially based in Community Health Unit, Old Athboy Road, Navan

• Impeccable assessment is undertaken, decisions made and actions taken in accordance with the persons needs and wishes. Plans of care are regularly reviewed and decisions revised accordingly.

• Sensitive, open and timely communication takes place between staff and the patient, and those that are identified as important to them.

• The patient and those identified as important to them, are involved in decisions about treatment and care.

• The needs of families and others as identified as important to the patient are actively explored, respected and met as far as possible.

• An individual plan of care, which includes food and drink, symptom control and psychological, social and spiritual support is agreed, co-ordinated and delivered with compassion and kindness by well trained and a supported workforce.

• Professionally accountable to the Director of Palliative Care Nursing
• Clinically accountable to the Clinical Director of Regional Specialist Palliative Care

• Articulate and demonstrate the concept of nursing and midwifery specialist practice within the framework of relevant legislation, the Scope of Nursing & Midwifery Practice Framework (ABS 2000), The Code of Professional Conduct (ABA 2000) and Guidelines for Midwives (ABA 2001).
• Perform nursing assessments and plan and initiate care and treatment modalities within agreed interdisciplinary protocols to achieve patient / client centred outcomes; evaluates their effectiveness.
• Identify health promotion priorities in the area of specialist practice.
• Implement health promotion strategies for patient / client groups in accordance with the public health agenda.
• Have a working knowledge of HIQA Standards as they apply to the role, for exampleNational Quality Standards for Residential Care Settings for Older People in Ireland, Standards for Healthcare, National Standards for the Prevention and Control of Healthcare Associated Infections, Hygiene Standards etc. and comply with associated HSE protocols for implementing and maintaining these standards.
• Be responsible for empowering care home staff in caring for the patient with palliative care needs and at the end of life, utilising the Palliative Care Competence Framework specifically for Nursing Staff and Health care Assistants.
• Advise staff on general palliative care issues.
• Implement and encourage the use of assessment tools with particular attention to pain, constipation, nausea, vomiting, delirium and depression.
• Implement and sustain the clinical skills and other resources required to manage care in the last days of life.
• Ensure sufficient information is obtained to facilitate a decision by the team with regard to the applicability of a visit by a CNS in Palliative in regard to the applicability of ongoing supportive and symptomatic management by the specialist palliative care team.
• Provide pain and symptom control, advice and support to patients with palliative care needs.
• Plan and implement appropriate nursing interventions within their scope of practice and advise on changes to a patients’ planned care as and when the patients’ condition dictates, based on the most up-to-date clinical information available.
• Monitor programmes, maintain records and provide reports on the effectiveness of treatment and indicate future therapeutic requirements.
• Ensure sufficient information is obtained to facilitate a decision by the team with other professionals regarding any proposed changes in the patients’ management.
• Monitor and facilitate systems of recording all drugs administered to patients for their palliative care needs. Advise staff on the policies and procedures for the safe administration of controlled drugs in the care home.
• Empower and facilitate staff to advise and provide appropriate support to patients and their families in a relaxed and informal atmosphere so that the patient and his/her family feel that there is adequate time to discuss their problems of whatever nature.
• Where appropriate, work collaboratively with MDT colleagues across Primary and Secondary Care to provide a seamless service delivery to the patient, family and/or carer as appropriate.
• Assess residents with specialist palliative care needs.
• Expedite referral to SPCS patients identified with complex palliative care needs.
• Participate in case conferences on the patients’ progress, and attending meetings as required.
• Maintain appropriate and accurate reports and furnish such reports as may be required by the HSE.
• Furnish monthly report of duties performed to the Team Manager. Complete such records and supply reports and other information as may be required by the HSE from time to time.

• Act as a resource to all caregivers and healthcare professionals in palliative care management issues within the care homes.
• Undertake regular reflective and de-briefing sessions with staff following the death of a patient.
• Act as a resource to all staff in assisting them to identify families who are at risk of developing complex bereavement issues and the follow up care required.

• Enable patients / clients, families and communities to participate in decisions about their health needs.
• Articulate and represent patient / client interests in collaboration with the multidisciplinary team.
• Implement changes in healthcare service in response to patient / client need and service demand.
• Empower staff of nursing homes to be the patient advocate through education and support.
• Communicate, negotiate and represent patient’s values and decisions in relation to their condition in collaboration with MDT Implement changes in healthcare service in response to patient/client need and service demand.
• Actively promote positive approaches to palliative care management.
• Advocate for the development of further services/resources to support and drive the management of positive approaches to palliative care.
• Advocate for appropriate assessments, support and strategies for patients with palliative care needs.
• Respect and maintain the privacy, dignity and confidentiality of the patient, family and/or care.
• Establish, maintain and improve procedures for collaboration and cooperation between community services, general practitioners, acute hospital staff and voluntary organisations.

• Provide mentorship, preceptorship, teaching, facilitation and professional supervisory skills for nurses and midwives and other healthcare workers within care homes.
• Educate patients / clients, families and communities in relation to their healthcare needs in the specialist area of practice.
• Identify own continuing professional development needs and engage accordingly in order to maintain clinical competence.
• Be proactive and take responsibility for continuing personal development within the scope of professional practice by maintaining and developing personal standards of expertise in the field of palliative care and related disciplines.
• Promote developments to support nursing care and practice development through the use of reflective practice, clinical supervision, significant event analysis and staff support within the multi-disciplinary team.
• Manage and promote individual best practice interventions in accordance with identified needs of patients and families.
• Provide instruction and guidance to families, carers and other professionals on the patients’ care as necessary.
• Participate in training and education programmes for healthcare professionals and other healthcare providers on palliative care when required.
• Act as a resource to all caregivers and healthcare professionals in palliative care management issues within the care homes.
• Seek advice and assistance with assigned cases, which prove to be beyond the scope of his/her professional competence.

• Identify, critically analyse, disseminate and integrate nursing / midwifery and other evidence into the area of specialist practice.
• Initiate and participate in evaluations and audits.
• Use the outcomes of audit to improve service provision.
• Contribute to service planning and budgetary processes through use of audit data and specialist knowledge.
• Lead on audit and research that evaluates particular aspects of the development of end of life care in residential care units.
• Evaluate improvements in the quality of patient care.
• Contribute to nursing research relevant to the area of practice.
• Collect and evaluate data about the patient group and demonstrate the achievement of the objectives of the service.
• Review policies, procedures, guidelines and protocols in relation to palliative care service to ensure they are continually updated in line with best practice evidence.
• Monitor, access, utilise and disseminate current relevant research to advise and ensure the provision of informed evidence based practice.

• Provide leadership in clinical practice and act as a resource and role model for specialist practice.
• Generate and contribute to the development of clinical standards of practice and guidelines that are evidence based safe and achievable standards for patient care.
• Use specialist knowledge to support and enhance generalist nursing practice.
• Consult with and act as a resource person for all staff involved in the care of patients with palliative care needs.
• Consult with nurses’ internal and external to the service, and with members of the inter-disciplinary team.
• Work with, support, advise and help build up knowledge of expertise of the primary care team in providing an appropriate system of care to meet the needs of the patient and their family.

• Contribute to the development of policies, procedures, guidelines and safe professional practice and adhere to relevant legislation, regulations and standards.
• Have a working knowledge of HIQA Standards as they apply to the role / care setting, for example, National Quality Standards for Residential Care Settings for Older People in Ireland, Standards for Healthcare, National Standards for the Prevention and Control of Healthcare Associated Infections, Hygiene Standards etc.
• Observe, report and take appropriate action on any matter which may be detrimental to staff and or service user, or may be inhibiting the efficient provision of care.
• Assist in observing and ensuring implementation and adherence to established policies, procedures and guidelines.
• Support and comply with the management of incidents and complaints adhering to the National Incident Management System (NIMS).
• Adhere to department policies in relation to the care and safety of all equipment used in the course of one’s duties.
• Participate and cooperate with legislative and regulatory requirements with regard to quality, risk and safety.

• Provide an efficient, effective, and high quality service, respecting the needs of each patient / client.
• Effectively manage time and caseload in order to meet the needs of a changing and developing service.
• Continually monitor the service to ensure it reflects current needs.
• Implement and manage identified changes.
• Ensure that confidentiality in relation to patient /client records is maintained.
• Maintain accurate and up to date statistics of the service provided, including audit of patient / client contacts.
• Represent the specialist service at local, national and international meetings as required.
• Maintain accurate and contemporaneous records/data on all matters pertaining to the planning, management, delivery and evaluation of this service in line with HSE requirements.