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Appendices

08

Appendix 1: How the Framework was Developed

This framework has been co-produced by NHS Education for Scotland (NES) and the National Dermatology Specialty Delivery Group (SDG). The development is described in detail above in the Background and Strategic Alignment section.

The membership of the Task and Finish Group responsible for undertaking the work was as follows:

Chair: Fiona Macdonald, Consultant Dermatologist, Chair Dermatology Specialty Delivery Group
Co-chair: Gav Dolan, National Associate Clinical Director (Nursing), CfSD

Charlotte Ashton, Lead Nurse, Dermatology, NHS Greater Glasgow and Clyde
David Murray, National Associate Clinical Director (AHPs), CfSD
Dianne Ross, Dermatology Nurse Educator, NHS Greater Glasgow and Clyde
Helen McKendrick, Lead Dermatology Nurse Specialist, NHS Borders
Helen Smith, Lead Clinical Dermatology Nurse Specialist, NHS Dumfries and Galloway
Jamie Cochrane, Head of Programmes, Modernising Patient Pathways, CfSD
Linzi Deighton, Advanced Nurse Practitioner, Dermatology / Lead Facilitator – Advanced Practice & NMP, Practice & Professional Development, NHS Fife
Martin Cardno, Project Manager, Modernising Patient Pathways, CfSD
Sarah Whyte, Senior Educator, Nursing, Midwifery and Allied Health Professions, Workforce Education and Career Development Programme, NHS Education for Scotland

The Dermatology Specialty Delivery Group which subsequently reviewed and approved the document includes nominated representation from all Health Boards providing Dermatology services in Scotland, including (for each Board) a Clinical Lead, an Operational Management Lead, and a Nursing Lead.

Appendix 2: Scottish Credit & Qualifications Framework (SCQF)

SCQF is the national qualifications framework. Senior Healthcare support workers are normally working at SCQF level 7 and Assistant Practitioners at SCQF level 8.  There are some example qualifications in the table below. The minimum SCQF level for entry into the NMAHP professions is Level 9 (Ordinary Degree). Advanced Practice has been mapped to SCQF Level 11 study (Master's level). It is neither necessary nor desirable to map all post-registration education to academic levels, but where it is appropriate, the following can be used as a guide.

More information can be found at - Interactive Framework | Scottish Credit and Qualifications Framework (scqf.org.uk)

Career Framework level

Minimum associated SCQF level

6 Senior Practitioner

Level 10 – Honours Degree level

7 Advanced Practitioner

Level 11 – Master’s Degree level

 

Appendix 3 – 6C30  & 7C26 : Assessment Required in Caring for Patients with Skin Cancer

 

Assessment

  • Patient history taking
  • Skin examination and documentation:
    • Site
    • Size
    • Description
    • Duration of lesion
    • Skin phototype
    • Freckle density
  • Assessment of individual’s risk factors
  • Identification of benign lesions/differentials
  • Identification of skin cancer/differentials
  • Use of ABCDE rule
  • Use of dermoscopy
  • Use of magnifying light
  • Use of digital photography
  • Mole mapping and clinical photography
  • Lymph node examination
  • Palpation for organomegaly
  • Multidisciplinary team working

Appendix 4 – 6C31 & 7C27: Investigations needed for Skin Cancer / Patients with Skin Conditions

 

Histology

  • Punch biopsy
  • Shave biopsy
  • Incisional biopsy
  • Curettage and cautery
  • Excisional biopsy
  • Ellipse excision
  • FNA (Fine Needle Aspiration)
  • Sentinel lymph node biopsy (SLNB)
  • Wide local excision

Blood chemistry

  • LDH

Genome testing

  • Blood
  • Tissue

Radiology

  • X-ray: Lungs, skeletal system

Magnetic Resonance Imaging (MRI):

  • Brain, neck, axilla, abdomen, pelvis, groin

Computerise Tomography (CT) Scan:

  • Brain, head, neck, chest, abdomen, pelvis (with or without contrast)

Ultrasound:

  • Ultrasound guided biopsy/FNA

Positron Emission Tomography (PET) CT Scan

Isotope Bone Scan

Nuclear Medicine:

  • Lymphoscintigraphy

Appendix 5 – 6C32 & 7C28: Therapeutic Interventions Required in Caring for Patients with Skin Cancer / Patients with Skin Conditions

 

Photo Dynamic Therapy (PDT)

  • Performing treatments
  • Supporting patients during treatment session
  • Assessing effects of treatment

 

Topical treatments for skin cancer

  • Prescribing (independent prescribing)
  • Maintenance of competencies
  • Telephone support for patients
  • Assessing effects of treatment

 

Cryotherapy (see Best Practice in Cryosurgery: A Statement for Healthcare Professionals, Dermatological Nursing 10(2) supplement)

  • Performing procedure
  • Assessing effects of treatment

 

Radiotherapy

  • Refer patients for radiotherapy
  • Support patients through side-effects
  • Telephone follow-up service for patients having received

 

Surgical

  • Punch biopsy
  • Shave excision/biopsy
  • Curettage
  • Incisional biopsy
  • Ellipse excision
  • Wide local excision +/- skin grafts (level 7)
  • Wide local excision +/- flap repairs
  • Sentinel lymph node biopsy
  • Lymph node clearance/dissection/lymphadenectomy
  • Management of post-operative complications
  • Wound care and dressing advice

 

Consent

  • Obtaining informed consent
  • Use of appropriate consent forms
  • Protection of vulnerable adults
  • Knowledge of Mental Capacity Act
  • Local policy on consent

 

Lymphoedema services

  • Running of clinics
  • Support of patients with lymphoedema

 

Oncology

  • Clinical trials nurse/co-coordinator
  • Immunotherapy
  • Chemotherapy
  • Biologic therapy

 

Neurology

  • Recognise symptoms of cerebral metastases and appropriate management
  • Refer to appropriate clinician

 

Palliative

  • Symptom control
  • Involvement of hospice services

 

Electro Chemo Therapy (ECT)

  • Prepare patient for treatment
  • Assist with treatment
  • Monitor effects

 

Isolated Limb Infusion (ILI)/Isolated Limb Perfusion (ILP)

  • Prepare patient for treatment
  • Assist with treatment
  • Monitor effects

 

Hepatosurgery

  • Assist with preparation
  • Support post-operatively

 

Ascities

  • Recognise need for procedure on a patient
  • Support during and post- procedure
  • Monitor/evaluate efficacy

 

New lesions

  • Identify new lesions and determine treatment pathway
  • Benign lesions/discharge

 

Nurse-led follow-up clinics

  • Protocols for melanoma follow-up as per local national guidelines
  • Non-melanoma follow-up clinics/telephone advice
  • Telephone advice with regards to side-effects
  • Break bad news clinics/Holistic needs assessment
  • Discharge of patients

Appendix 6 – 6C35 & 7C32 : Psychological Impact of Living with Skin Cancer

 

Use of validated assessment tools to identify psychosocial distress

  • Genograms
  • Family Systems Illness Model, John Rolland, 1994 — use of life cycle
  • HADS (Hospital Anxiety and Depression Scale)
  • Adjustment check-ups (Rolland, 1995)
  • Beck Hopelessness Scale
  • Distress thermometer — produced by Dr James Brennan, Consultant Clinical Psychologist, Bristol Haematology and Oncology Centre, University Hospitals Bristol NHS Foundation Trust
  • Revised impact of event scale
  • PEPSI COLA AIDE MEMOIR — Holistic Common Assessment of Supportive and Palliative Care needs for Adults with Cancer (NHS Holistic Common Assessment Supportive Palliative Care Needs, Prof Alison Richardson, Mar 07. NICE Supportive and Palliative Care Improving Outcomes Guidance 2004)
  • SPARC (Sheffield Profile for Assessment and Referral to Care)
  • BEDS (Brief Edinburgh Depression Scale) M Lloyd-Williams, C Shiels, C Dowrick, 2007; The development of the Brief Edinburgh Depression Scale to screen for depression in patients with advanced cancer. Journal of Affective Disorders (99): 259-264
  • SAFE-T Suicide Risk Assessment
  • FACT-M Functional Assessment of Cancer Therapy – Melanoma – to assess health-related quality of life in patients with melanoma

 

Coping Strategies

  • Relaxation techniques
  • Distraction techniques
  • Problem solving
  • Activities that improve mood: exercise, energy levels, social interaction, keeping busy
  • Information leaflets on managing panic, anxiety, depression and low mood: self-help guides (Northumberland Mental Health NHS, 1999)

 

Examples of National Initiatives & Organisations involved in Provision of Psychosocial Support

Appendix 7 – 6C36& 7C33 : Health promotion and self-management strategies in relation to skin cancer prevention / management

 

Patients’ self-management strategies in relation to skin cancer prevention/management

  • Skin examination
  • Lymph node examination
  • Insurance:
    • Critical illness -
    • Travel -
    • Personal -
    • Work-related
  • Financial
  • Patient information prescriptions
  • Lymphoedema recognition
  • Blood donor issues
  • Pregnancy issues
  • Understanding their diagnosis/prognosis
  • Wound management
  • Patient pathways/likely progression

 

Health Promotion Strategies in Relation to Skin Cancer Prevention / Management

  • Health promotion — issues with individual/public/professional
  • Sun protection
  • Other skin cancer-related issues, i.e. research
  • Support groups/organisations (national/regional/local):
    • Teenage Cancer Trust
    • Macmillan
    • Marie Curie
    • SKcin
    • Wessex Cancer Trust -
    • South Cancer Hub
    • Managed Clinical Networks Regional
    • GenoMEL

Appendix 8: Assessment of learning and clinical competencies

 

In Health Board areas, a competence assessment and sign-off process is implemented for Level 7 Advanced Nurse Practitioners (ANPs). This process requires evidence of clinical competence to ensure that ANPs possess a nationally recognised and transferable level of knowledge and expertise, as outlined by CNOD (2021a).

This framework can be used to evidence and support development of assessment/competencies required of the service area.  

 

It may be helpful to complete the development needs analysis tool (DNAT) which can be found on the NMAHP development framework webpage.

The DNAT is designed to help staff reflect on their current job role and to identify areas where they may benefit from further training, education and development to enhance or develop their role. The Knowledge, Skills and Behaviours (KSBs) in the DNAT are arranged under the 4 Pillars of Practice.

Appendix 9: Reference List

 

Scottish Government (2021) Transforming Nursing, Midwifery And Health Profession (NMaHP) roles: review of Clinical Nurse Specialist and Nurse Practitioner roles within Scotland (Transforming Roles: Paper 8). Available at https://www.gov.scot/publications/transforming-nursing-midwifery-health-profession-nmahp-roles-review-clinical-nurse-specialist-nurse-practitioner-roles-within-scotland/.

British Dermatological Nursing Group (2012). Dermatology Nursing Competencies: Developing Dermatology Nurses from Novice to Expert. Available at https://bdng.org.uk/wp-content/uploads/2017/02/nursing_competencies_2.pdf nursing_competencies_2.pdf

British Dermatological Nursing Group (2013). Dermatology Nursing Competencies: Skin Cancer Nursing Competencies. Available at https://bdng.org.uk/wp-content/uploads/2017/02/skin-cancer-competencies-final.pdf.

Ministry of Justice (2012) Public sector equality duty. Available at: Public sector equality duty - GOV.UK (www.gov.uk)

Scottish Government (2013) Everyone matters: 2020 health workforce vision. Available from: Everyone matters: 2020 health workforce vision - gov.scot (www.gov.scot)

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