Community COPD Nurse/Physiotherapist
2 weeks ago
We are seeking a highly skilled and experienced Respiratory Care Specialist to join our team at Oxleas NHS Foundation Trust. As a COPD Specialist Community Matron/Case Manager, you will play a vital role in providing expert care to patients with Chronic Obstructive Pulmonary Disease (COPD) in the community.
Key Responsibilities- Provide Expert Care: Be responsible and accountable for providing expert care to COPD patients who are registered with a Greenwich GP.
- Develop Individualized Care Plans: Utilize advanced clinical skills and expert knowledge to plan, implement, monitor, and review individualized patient-directed programmes of care to patients with COPD, including health promotion interventions.
- Evaluate and Improve Care: Undertake goal-centred interventions that are evidence-based, evaluating the effectiveness of these at regular intervals with a view to improving care continuously.
- Manage Risk: Develop risk management plans that will enable individuals to remain safely within their homes.
- Prescribe Medication: Use expert knowledge and skills as a non-medical prescriber to manage patient medication within own areas of competency, developing clinical management plans in partnership with GP colleagues where necessary.
- Anticipate and Meet Care Needs: Anticipate individual care needs and develop appropriate care plans, involving carers and relatives.
- Promote Patient Choice and Well-being: Develop practices which promote patient choice and well-being.
- Manage Caseload: Manage a caseload of patients with COPD (Specialist community matron/case manager).
- Collaborate with Colleagues: Work with other community matrons/case managers to ensure a consistency of approach to patient care and to support clinical supervision arrangements within the Trust.
- Support Education and Training: Support the COPD self-management programmes such as GRACE and pulmonary rehabilitation.
- Improve Diagnostic Rate: Help improve the diagnostic rate of COPD in primary care supporting the delivery of an ARTP accredited quality assured spirometry clinic.
- Participate in Disease-Specific Audit and Data Collection: Participate in the delivery of education sessions on the Greenwich Respiratory Advice and self-Care Education (GRACE) programme in a community.
- Share Knowledge and Skills: Share knowledge and skills with patients and families as a key therapeutic intervention and to enable self-care and autonomy.
- Identify Educational Requirements: Identify the educational requirements of primary and social care colleagues in relation to the management of COPD and lead on meeting these needs.
- Participate in Clinical Supervision and Appraisal: Participate in clinical supervision, appraisal, and personal development programme.
- Ensure Professional Development: Ensure own professional development and clinical skills through attending courses, workshops, and conferences and applying the knowledge gained in clinical practice.
- Interface with Primary and Secondary Care Teams: Interface with primary and secondary care teams to enable the implementation of managed care pathways in line with local and national guidance.
- Advise on New Initiatives: Advise on and develop new initiatives and ways of working informed by local and national policy.
- Develop Guidelines and Policies: Be involved in the development of guidelines, policies, and protocols within the Trust.
- Promote Collaborative Working: Promote effective collaborative working relationships with health and social care colleagues and those within support networks and the voluntary sector.
- Act as a Change Agent: Act as a change agent and innovator, planning, instigating, and evaluating changes.
- Proactively Demonstrate Impact: Proactively demonstrate the positive impact of case management on the reduction of avoidable admissions and lengths of hospital stay.
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