AUTHOR Karen Logan, MSc, RGN, is nurse consultant, head of continence services, Gwent Health Care NHS Trust.
ABSTRACT Logan, K. (2008) Designing a catheter skills training programme. Nursing Times; 104: 41, 42–43.
Karen Logan describes how a team of continence advisers designed and implemented a training programme that allows local nurses to meet the national occupational standards and competencies in catheterisation and catheter care.
In March this year, 13 national competencies, called national occupational standards (NOSs), for bowel and bladder care were launched.
These UK-wide competencies (Box 1) were the result of a project between the RCN and Skills for Health and were supported by a grant from Coloplast. Skills for Health is the skills council for the UK health sector and its purpose is to help develop a skilled and flexible workforce. One of its main functions is to develop NOSs and national workforce competencies.
NOSs are statements of competence describing good practice and are written to measure performance outcomes. They can be used by individuals, employers and education providers. They describe how a function, for example catheterisation, should be carried out. Competencies do not apply to diseases or conditions. For example, there is no competency for stress urinary incontinence but there is a bundle of competencies to manage patients who have this condition. The way in which NOSs can be used are listed in Box 2.
BOX 1. CONTINENCE SUITE OF COMPETENCIES
Competency number and title
CC01 Assess bladder and bowel dysfunction.Covers the specialist assessment of bladder and bowel dysfunction
CC02 Insert and secure urethral catheters
CC03 Care for individuals with urethral catheters
CC04 Manage suprapubic catheters
CC05 Undertake a trial without catheter
CC06 Enable individuals to carry out intermittent catheterisation
CC07 Review catheter care
CC08 Care for individuals using containment products
CC09 Enable individuals to effectively evacuate their bowels
CC10 Assess residual urine by use of portable ultrasound
CC11 Implement toileting programmes for individuals
CC12 Enable individuals to undertake pelvic floor muscle exercises
CC13 Enable individuals with complex pelvic floor dysfunction to undertake pelvic floor muscle rehabilitation
Finding the competencies
Competencies are available at the SfH website at skillsforhealth.org.uk. Click on Competencies on the home page, then on Completed Competencies, then List at foot of page, then select CC Continence Care.
Using competencies in practice
The Gwent Healthcare NHS Trust continence team is lead by a full-time nurse consultant and seven part-time continence advisers providing services to a population of 600,000 and training programmes to approximately 6,000 nurses who work in the local hospitals and community.
The continence specialist nurses have provided a male catheterisation study day for the past 10 years.
However, it became evident that this study day was failing to address issues on female catheterisation or competence to practice and was no longer fit for developing practice.
The team set about redesigning a new one day course underpinned by the Skills for Health/RCN NOSs catheter competencies.
The NOSs that related to catheterisation and catheter care, including suprapubic catheterisation (CC02–CC04), were chosen to develop and design a new catheter skills training programme for staff.
How were the NOSs used?
The NOSs worked as a checklist to ensure that the course covered the full scope of catheterisation including local discharge, practices, policy and pathways.
A meeting was held with the continence nurses to review the catheter suites CC02–CC04 and a teaching plan and training programme was developed. Each continence adviser chose to write a lecture and presentation covering a section of the NOSs and ensured all aspects were covered.
A training needs analysis tool was used to measure the nurses’ level of knowledge before and after the course. This tool was based on the NOSs and nurses attending the course rated their knowledge using a simple scoring of one to three before and after the training.
A competency framework form was given to all the nurses who attended so they could gather evidence to demonstrate that they were competent to carry out catheterisation in practice.
Information about SfH and its website address was also given to the nurses who were told to download the suite of catheter competencies for their own personal reference.
The training day was used to highlight system failures faced locally and reflect on local catheter-related problems regarding poor discharge and consequent inappropriate readmission for catheterisation. For example, catheterised patients could be discharged from hospital without referral to the district nurses, often with the wrong catheters in situ and or no catheter equipment arranged for ongoing management.
The training day is an important opportunity to raise the profile of the new catheter discharge policy and management of the catheterised patient pathway. This is addressed under the section on professional and legal issues. The aim is to help community staff to tackle catheter management/problems in the community and to encourage adherence to the policy/pathway, which demonstrates how to reduce admission for emergency catheter-related problems.
BOX 2. HOW NOSs CAN BE USED IN PRACTICE
Results of the training
The newly designed competency-based catheter skills day was evaluated and deemed a success by the trainers and the nurses who attended.
The training needs analysis tool identified that the nurses’ knowledge in all aspects of catheter NOSs had significantly improved, giving them the knowledge base required for catheterisation and catheter care. The competency framework gave nurses a structured system to practice and document their practical skills and competencies.
This approach to training and follow-up assessment of competence provided a systematic structure that fits with the KSF and contributes to the appraisal process. It provides tangible evidence of training and competency in catheterisation.
Ultimately, it encourages a system that bridges the gap between research, education in the classroom and gaining practical skills and competence.
Benefits of using NOSs?
The NOSs provided a useful and logical structure to follow in designing the study day and gave the trainers confidence that they were enabling nursing to meet the national standard required in catheterisation and ongoing catheter care.
More importantly, they were useful for reflection on practice and in highlighting and addressing poor practice around hospital discharge/readmission in relation to catheterisation.
Policy, patient safety and legal issues received high priority, as the course was underpinned by the local catheter policy for the trust as well as national policy. As the course was based on the SfH/RCN NOSs, it raised the profile of the training programme and gave it credibility.
It is highly recommended that continence advisers running catheter courses use the NOSs. Our experience demonstrates how they can be used to develop a successful course and provide a robust structure to guide the design of training programmes.
NOSs also provide a standard and a benchmark to establish the knowledge and competencies for catheter management.
First national standards for bladder and bowel care to improve good practice (NT Continence Journal, 1 April, p64)
RCN (2008)Catheter Care. RCN Guidance for Nurses. London: RCN.