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The benchmark developed by expert practitioners and drawing on previous international work in this area (Australian Nursing and Midwifery Council 2009; Canadian Nurses Association 2008; International Council of Nurses 2008; Scottish Government 2010) has four themes:

clinical /direct care practice

leadership and collaborative practice

improving quality and developing practice

developing self and others.

All the 28 elements of practice defined under these headings would be an expected part of the role of any nurse working explicitly at an advanced level.

Social factors

This section specifically looks at the current characteristics of society and how they affect the provision of nursing care. The most dominant characteristic currently affecting healthcare is the structure of the 60 million population of the United Kingdom (Office for National Statistics 2008); 16% are over 65 years of age and 2% of those are over 80 years. The NHS spends over 40% of its budget on people over 65 years of age (DH 2007b) so over 65% of those who use inpatient acute hospital services on any given day are older people. This has considerable implications for nursing. The National Service Framework for Older People (DH 2001) explicitly sets out standards of care for older people in the care environment.

The aim of Standard 4 of the National Service Framework is to ‘ensure that older people receive the specialist help they need in hospital and that they receive the maximum benefit from having been in hospital’. It states explicitly that:

Older people’s care in hospital is to be delivered through appropriate specialist care and by hospital staff who have the right set of skills to meet their needs.

(www.dh.gov.uk/dr_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4067211.pdf)

Where relevant, specific care for older people has been included in the manual. However, the principles listed in Box 1.5 are relevant to whatever procedure is being carried out with an older person.

Box 1.5 NMC guidelines for the care of the older person (NMC 2009)

Think People

Nurses capable of delivering safe and effective care for older people are:

competent, with the right knowledge, skills, attitude and desire to care for older people

assertive, prepared to challenge poor practice, attitudes and behaviour

reliable, consistent and dependable

empathic, compassionate and kind.

Think Process

Delivering quality care that promotes dignity by nurturing and supporting the older person’s self-respect and self-worth.

Communicating with the person, talking with them and listening to what they have to say.

Assessing need in order to provide individualized care.

Respecting the person’s privacy and dignity.

Working in partnership with the person, their family, carers and, of course, your colleagues.

Think Place

Diverse settings wherever care is provided for older people.

Appropriate and safe environments in which to practise dignified care.

Committed to equality and diversity, providing care in a non-discriminatory, non-judgemental and respectful way.

With the resources, staff and equipment needed to do the job well.

Leadership from managers capable of setting and maintaining standards of care and supporting their teams through training, development, supervision and reflection.

With an increase in the percentage of the population who are older, there is an increase in adults who are vulnerable.

Safeguarding of vulnerable adults

Working with vulnerable people, nurses are likely to identify patients who have been or may be being abused. Many patients who report abuse are fearful as they do not know if they will be taken seriously or what the consequences will be. It may be more difficult to assess if abuse has occurred in a patient with impaired capacity but it should be acknowledged that their lack of capacity makes them more vulnerable. Since 2000 and the launch of No Secrets (DH 2000), all staff working with vulnerable patients have a duty to report any suspicions of abuse to the patient