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Dietitian

As a Dietitian you have an important role to play in ensuring stroke survivors do not become undernourished, particularly if they have developed dysphagia as a consequence of stroke. To provide the best possible care for stroke survivors your job role and band has been analysed and broken down into 16 key elements. These 16 elements have then been further analysed and broken down into two categories: knowledge and skills. A score from 1 to 5 has been allocated to each knowledge and skills element with 1 = a minimum level of knowledge and skill (light shade of pink) up to 5 = a critical level of knowledge and skill (dark shade of pink). Some elements may not be applicable (n/a) to your job role profile and will be marked as zero (0). Take a look at the table below to see what level of stroke care knowledge and skills are expected of someone in your job role and level of responsibility.

Band 5

Profile AverageKnowledgeSkillsE1E2E3E4E5E6E7E8E9E10E11E12E13E14E15E16
Elements coveredKnowledgeSkills
E1: Awareness raising1.10.1
E2: Managing risk1.11.6
E3: Information1.31.3
E4: User involvement1.01.3
E5: Assessment (TIA)1.00.2
E6: Treatment (TIA)0.80.2
E7: Urgent response1.51.0
E8: Assessment (stroke)1.11.0
E9: Treatment (stroke)1.61.3
E10: Specialist rehabilitation1.61.8
E11: End-of-life care1.01.0
E12: Seamless transfer of care2.01.6
E13: Long-term care1.71.7
E14: Review2.01.9
E15: Participation in community1.91.4
E16: Return to work1.11.0
E1Awareness raisingLevel
Knowledge and understanding of…
e1k_1Signs and symptoms of stroke2
e1k_2Features of less common (atypical) presentation of stroke1
e1k_3Stroke mimics and likely presentation1
e1k_4Stroke and TIA as medical emergencies1
e1k_5Emergency response, investigations, interventions and treatments for stroke and TIA1
e1k_6Timeframe for emergency investigations, interventions and treatments for stroke and TIA1
e1k_7Anatomy and physiology of the central nervous system1
e1k_8Timeframe of physiological and neurological changes during a stroke1
e1k_9Advocates for stroke patients when there is a legal duty to instruct an IMCA, taking account of religious and cultural aspirations1
Skills and ability to…
e1s_1Initiate emergency protocol (Stroke Improvement Programme)n/a
e1s_2Communicate current event and need for emergency treatmentn/a
e1s_3Know when to apply screening tests for stroke (FAST) and how to act on the resultsn/a
e1s_4Know when to apply vascular risk assessment tools for TIA (ABCD2) and how to act on the resultsn/a
e1s_5Identify emergency interventions and treatments for stroke and TIA available locally and know how to refer patients efficientlyn/a
e1s_6Take and interpret thorough history, taking third party information where possible, and assess mental capacity1
e1s_7Identify and appropriately treat stroke mimics, e.g. hypoglycaemia, epileptic seizuren/a
E2Managing riskLevel
Knowledge and understanding of…
e2k_1Risk factors for stroke and TIA (e.g. lifestyle, socioeconomic, cultural, vascular, familial, genetic, concurrent medications, comorbidities)2
e2k_2Stroke types and their aetiologies1
e2k_3Risk of stroke depending on type and aetiology1
e2k_4Advocates for stroke patients when there is a legal duty to instruct an IMCA, taking account of religious and cultural aspirations1
e2k_5Who provides interventions for primary and secondary prevention of stroke1
e2k_6Pharmacological and non-pharmacological interventions for primary and secondary prevention of stroke, and side effects of treatment1
e2k_7Methods of changing behaviour 1
Skills and ability to…
e2s_1Take and interpret thorough history, taking third party information where possible, and assess mental capacity2
e2s_2Determine, plan and initiate appropriate assessments/investigations and interventions/treatments; provide information, relevant to individual needs and aspirations (personalise information)3
e2s_3Elicit needs and aspirations of those at risk of stroke and those affected by stroke1
e2s_4Identify risk factors and apply vascular risk assessment toolsn/a
e2s_5Communicate and discuss: current event; risk of future vascular event; need for assessments/investigations, interventions/ treatments and their timeframes; rationale for treatment and possible side effects of treatment; and provide timely information, advice and support2
e2s_6Assess services (health, social, voluntary and independent) available locally for those affected by stroke: identify the full range available; establish relevance; communicate and liaise with services; signpost service1
e2s_7Assess motivation and take steps to augment management 1
e2s_8Monitor progress and agree or change a maintenance or management plan2
e2s_9Assess and facilitate concordance2
E3InformationLevel
Knowledge and understanding of…
e3k_1Stroke types and their aetiologies1
e3k_2Risk factors for further vascular events (e.g. type and aetiology of current event, lifestyle, socioeconomic, cultural, vascular, familial, genetic, concurrent medications, comorbidities) 2
e3k_3Pharmacological and non-pharmacological interventions for primary and secondary prevention of stroke, and side effects of treatment1
e3k_4Advocates for stroke patients when there is a legal duty to instruct an IMCA, taking account of religious and cultural aspirations1
e3k_5Who provides interventions for primary and secondary prevention of stroke1
e3k_6Full range of services (health, social, community, voluntary and independent) available locally for those affected by stroke1
e3k_7How to assess and overcome barriers to problems: psychological and emotional; social and relationship; cognitive and communication; physical and functional; visual and sensory impairments and pain; medical2
e3k_8The impact of stroke on the individual, carer and family2
e3k_9The implications of stroke for lifestyle, driving, work and family1
e3k_10Methods of changing behaviour 1
Skills and ability to…
e3s_1Take and interpret thorough history, taking third party information where possible, and assess mental capacity1
e3s_2Elicit needs and aspirations of those affected by stroke1
e3s_3Communicate and discuss: current event; risk of future vascular event; need for assessments/investigations, interventions/ treatments and their timeframes; rationale for treatment and possible side effects of treatment; and provide timely information, advice and support2
e3s_4Identify full range of services (health, social, community, voluntary and independent) available locally for those affected by stroke1
e3s_5Assess relevance and suitability of available services for those affected by stroke; communicate and liaise with services; share information; work across agencies; signpost services for those affected by stroke1
e3s_6Implement information sharing methods and reflect on effectiveness of information sharing1
e3s_7Assess motivation and take steps to augment management 2
e3s_8Monitor progress and agree or change a maintenance or management plan in conjunction with those affected by stroke, identifying resources to facilitate participation and inclusion1
E4User involvementLevel
Knowledge and understanding of…
e4k_1The services relevant for stroke patients and carers1
e4k_2How to assess and overcome barriers to problems: psychological and emotional; social and relationship; cognitive and communication; physical and functional; visual and sensory impairments and pain; medical1
e4k_2How to assess and overcome barriers to problems: psychological and emotional; social and relationship; cognitive and communication; physical and functional; visual and sensory impairments and pain; medical1
e4k_3Methods to empower patients; patient advocacy1
e4k_4Methods that can be used to involve stroke patients and carers in service planning1
e4k_5Methods that can be used to capture stroke patient and carer views1
e4k_6Methods for using views to influence services1
e4k_7Factors that influence people’s ability to be involved in care and service planning1
e4k_8Methods of feeding back to stroke patients and carers how their contributions have influenced services1
e4k_9How service planning and decision making processes work and how they can be influenced1
Skills and ability to…
e4s_1Assess services (health, social, voluntary and independent) available locally for those affected by stroke: identify the full range available; establish relevance; communicate and liaise with services; signpost service1
e4s_2Create an open and honest environment that is not intimidating and offers stroke patients and their carers the opportunity to freely give their views2
e4s_3Interact with people who have one or more of the following problems: communication; physical/functional; psychological; social; medical2
e4s_4Translate the views of those affected by stroke into service planning, development, delivery and monitoring1
e4s_5Identify hard-to-reach groups and ensure that their views are included1
e4s_6Overcome the factors that prevent those affected by stroke from being involved in care and service planning1
e4s_7Identify local opportunities and appropriate formats for formal and informal feedback (e.g. PALS, PPI)1
e4s_8Handle complaints to the satisfaction of all parties1
E5Assessment (TIA)Level
Knowledge and understanding of…
e5k_1Anatomy and physiology of the central nervous system2
e5k_2Risk factors for stroke and TIA (e.g. lifestyle, socioeconomic, cultural, vascular, familial, genetic, concurrent medications, comorbidities)2
e5k_3The signs and symptoms of TIA2
e5k_4How to distinguish between stroke and TIAn/a
e5k_5The future risk of stroke and TIA (e.g. ABCD2 and other risk scoring methods)1
e5k_6The features of atypical presentation of TIA/stroke and mimics and how to act when they are identifiedn/a
e5k_7Investigations, interventions and treatments for TIA (e.g. imaging, vascular, medical, cardiac, surgical)1
e5k_8Implications of the Mental Capacity Act and how it applies to TIA1
e5k_9Advocates for stroke and TIA patients when there is a legal duty to instruct an IMCA, taking account of religious and cultural aspirations1
e5k_10The timeframe for emergency and follow-on investigations, interventions and treatments for TIA1
e5k_11How to initiate emergency and ongoing treatment for TIA and vascular prevention1
e5k_12The indications, contraindications and limitations for imaging, investigations and interventions1
e5k_13Local protocols for imaging and reportingn/a
e5k_14Any complications of surgical procedures (e.g. stenting, carotid endarterectomy, closure of atrial septal defect (ASD) and patent foramen ovale (PFO))n/a
e5k_15The results of investigations1
e5k_16The implications of TIA for lifestyle, driving, work and family2
e5k_17Management options for TIA/stroke and mimics, and other conditions1
Skills and ability to…
e5s_1Take and interpret thorough history, record third party information where possible, and assess mental capacity1
e5s_2Determine, plan and initiate appropriate assessments/investigations and interventions/treatments; provide information, relevant to individual needs and aspirations (personalise information)n/a
e5s_3Identify risk factors and apply vascular risk assessment tools for TIA (ABCD2) and screening tests for stroke (FAST)n/a
e5s_4Identify stroke, high risk TIA, lower risk TIA, atypical stroke and stroke mimicsn/a
e5s_5Establish the cause of TIAn/a
e5s_6Recognise patients who have had a stroke rather than a TIA and to refer on for appropriate investigation and managementn/a
e5s_7Communicate and discuss: current event; risk of future vascular event; need for assessments/investigations, interventions/ treatments and their timeframes; rationale for treatment and possible side effects of treatment; and provide timely information, advice and supportn/a
e5s_8Identify emergency interventions and treatments for TIA available locally and know how to refer patients efficientlyn/a
e5s_9Identify the service(s) to which the individual should be referred and to liaise effectively with those servicesn/a
e5s_10Perform a physiological assessment and assess vital signsn/a
e5s_11Decide on a relevant investigation and its level of urgencyn/a
e5s_12Apply radiological knowledge for recognised investigationsn/a
e5s_13Apply technical knowledge for recognised investigations and interventionsn/a
e5s_14Apply surgical knowledge for recognised vascular interventionsn/a
e5s_15Recognise and manage postoperative complications after stenting, endarterectomy, PFO and ASD closuren/a
e5s_16Obtain and interpret the results of investigations: this includes formulating an immediate and ongoing management plan, and initiating treatments within the relevant timelinesn/a
e5s_17Confirm and communicate diagnosis, lifestyle advice and methods of secondary prevention to patients and carersn/a
e5s_18Communicate and discuss with the patient, carer, and health and social care professionals a diagnosis, results of investigations and subsequent needs and aspirations and a management plan, as well as the actions to be taken if a further vascular event occursn/a
e5s_19Advise on lifestyle, driving, work and family1
e5s_20Identify local management and referral routes for TIA/stroke and mimics, and other conditions1
E6Treatment (TIA)Level
Knowledge and understanding of…
e6k_1The signs and symptoms of TIA1
e6k_2Atypical presentation of TIA and TIA mimics and how to act when they are identified1
e6k_3How to distinguish between stroke and TIAn/a
e6k_4Risk factors for further vascular events (e.g. type and aetiology of current event, lifestyle, socioeconomic, cultural, vascular, familial, genetic, concurrent medications, comorbidities) 1
e6k_5Pharmacological and non-pharmacological interventions, and the level of urgency for risk factor managementn/a
e6k_6Side effects of pharmacological and non-pharmacological interventions as well as the prevention and management of vascular eventsn/a
e6k_7Late complications of surgical procedures (e.g. stenting, carotid endarterectomy, closure of ASD and PFO) and the implications of the procedures on lifestylen/a
e6k_8Implications of TIA for lifestyle, driving, work and family2
e6k_9Potential interventions for immediate and ongoing risk factor management1
e6k_10Methods of changing behaviour 1
e6k_11How QOF and community targets for risk factor management affect prevention strategies1
e6k_12Concordance: how to assess; how it is affected by individual preference; how to motivate; how to manage non-concordance1
e6k_13Likely persistent deficits or other ongoing problems1
e6k_14Why TIA/stroke review is important1
Skills and ability to…
e6s_1Recognise recurrent vascular eventsn/a
e6s_2Perform a holistic overview, including assessment of pharmacological and non-pharmacological interventionsn/a
e6s_3Perform and interpret blood pressure measurement and ECGn/a
e6s_4Assess and facilitate concordancen/a
e6s_5Assess motivation and take steps to augment management 1
e6s_6Monitor progress and agree on or change to a maintenance or management plan1
e6s_7Use results of history and investigations to confirm a diagnosis and make an individual management plan for the patient, taking into account personal preferencesn/a
e6s_8Identify interventions and treatments for stroke and TIA available locally and know how to refer patients efficientlyn/a
e6s_9Communicate and discuss with the patient, carer, and health and social care professionals a diagnosis, results of investigations and subsequent needs and aspirations and a management plan, as well as the actions to be taken if a further vascular event occursn/a
e6s_10Identify who provides interventions for immediate and ongoing risk factor management locally and refern/a
e6s_11Identify where QOF and community targets for risk factor management may affect prevention strategies and take steps to overcome thisn/a
e6s_12Recognise individuals with persistent deficits or other ongoing problems and arrange rehabilitation, support and managementn/a
e6s_13Encourage people to come for review1
E7Urgent responseLevel
Knowledge and understanding of…
e7k_1Signs and symptoms of stroke2
e7k_2Features of less common (atypical) presentation of stroke1
e7k_3Stroke mimics and likely presentation1
e7k_4Stroke and TIA as medical emergencies1
e7k_5Emergency response, investigations, interventions and treatments for stroke and TIA1
e7k_6The timeframe for emergency investigations, interventions and treatments for stroke and TIA1
e7k_7The anatomy and physiology of the central nervous system3
e7k_8The physiological and neurological effects of stroke and their timeframe during and after a stroke3
e7k_9Monitoring and acting upon physiological and neurological changes during and after a stroke1
e7k_10How stroke can affect communication2
e7k_11Implications of the Mental Capacity Act and how it applies to TIA1
e7k_12Advocates for stroke and TIA patients when there is a legal duty to instruct an IMCA, taking account of religious and cultural aspirations1
e7k_13Complications after stroke (e.g. aspiration, airway obstruction, hypoxia, hypotension, hypertension, hyperglycaemia, bedsores), and preventing and managing them 1
Skills and ability to…
e7s_1Take and interpret thorough history, record third party information where possible, and assess mental capacity1
e7s_2Communicate and discuss: current event; risk of future vascular event; need for assessments/investigations, interventions/ treatments and their timeframes; rationale for treatment and possible side effects of treatment; and provide timely information, advice and support1
e7s_3Identify suspected stroke, perform screening tests (e.g. FAST) and act on results1
e7s_4Perform basic neurological and physiological assessment (vital signs)1
e7s_5Perform ABCDs (airways, breathing, circulation, disability), pulse oximetry and blood glucose assessment and to act on abnormal findings1
e7s_6Identify and use methods of moving and handling the patient that are safe, depending on the individual patient or staff needs1
e7s_7Recognise stroke-related communication problems and to adapt methods of communication2
e7s_8Identify emergency investigations, and interventions for stroke and TIA patients available locally (Stroke Networks) and know where to take them1
e7s_9Identify and appropriately treat stroke mimics, e.g. hypoglycaemia, epileptic seizuren/a
E8Assessment (stroke)Level
Knowledge and understanding of…
e8k_1The signs and symptoms of stroke2
e8k_2The neurological and physiological effects of stroke and the timeframe of changes during and after a stroke1
e8k_3How to monitor, and act upon, neurological and physiological changes during and after a stroke1
e8k_4Implications of the Mental Capacity Act and how it applies to stroke and TIA1
e8k_5Advocates for stroke patients when there is a legal duty to instruct an IMCA, taking account of religious and cultural aspirations1
e8k_6Features of atypical presentation of stroke and stroke mimics1
e8k_7Stroke types and their aetiologies1
e8k_8Different modalities to facilitate diagnosis and treatment of stroke (e.g. telemedicine)1
e8k_9Emergency investigations (e.g. imaging of brain, heart and cerebral arteries, blood tests) and interventions for stroke (e.g. intravenous and intra-arterial thrombolysis, vascular surgery, stenting, hemicraniotomy, evacuation of haematoma) and the timeframe within which they should be given1
e8k_10The indications and contraindications for investigations, interventions and treatments for stroke1
e8k_11Any complications of investigations, interventions and treatments for stroke and how to prevent and manage them1
Skills and ability to…
e8s_1Take and interpret thorough history, record third party information where possible, and assess mental capacity1
e8s_2Determine, plan and initiate appropriate assessments/investigations and interventions/treatments; provide information, relevant to individual needs and aspirations (personalise information)2
e8s_3Perform neurological and physiological assessment and assess vital signs1
e8s_4Perform a standardised neurological assessment using a recognised stroke scale (e.g. NIHSS, SNSS)1
e8s_5Interpret the results of investigations (e.g. imaging, vascular, blood tests) and the actions to be taken as a result1
e8s_6Diagnose stroke using clinical information and investigations: distinguish between a stroke and a TIA; identify atypical strokes and stroke mimics; formulate and implement a management plan accordinglyn/a
e8s_7Communicate and discuss: current event; risk of future vascular event; need for assessments/investigations, interventions/ treatments and their timeframes; rationale for treatment and possible side effects of treatment; and provide timely information, advice and support1
e8s_8Identify the need for more specialist or differing treatments when necessary1
e8s_9Monitor progress, identify complications or deteriorations and deliver treatments for complications or deteriorations1
e8s_10Identify the level of urgency for any relevant medical, surgical and radiological investigations, interventions and treatments1
e8s_11Obtain and interpret the results of investigations and formulate an immediate and ongoing management plan; initiate treatments within the relevant timescales1
E9Treatment (stroke)Level
Knowledge and understanding of…
e9k_1Signs and symptoms of stroke1
e9k_2Neurological and physiological effects of stroke, monitoring, and the timeframe of changes, during and after a stroke1
e9k_3The need for early mobilisation and positioning1
e9k_4Assessing swallowing and managing of dysphagia1
e9k_5Alternative methods of feeding, hydration and drug administration for patients with dysphagia3
e9k_6The interactions between enteral feeds, fluids and drug treatment3
e9k_7The effects of stopping ongoing drug treatment because of swallowing problems2
e9k_8Symptoms and effects of malnourishment4
e9k_9The importance and methods of oral hygiene3
e9k_10The importance of avoiding catheters, as well as managing retention and promoting continence1
e9k_11Assessing and managing problems: psychological and emotional; social and relationship; cognitive and communication; physical and functional; sensory impairment and pain; medical1
e9k_12Cognitive effects of the stroke and their impact on the patient’s ability to consent to treatment1
e9k_13Advocates for stroke patients when there is a legal duty to instruct an IMCA, taking account of religious and cultural aspirations1
e9k_14The impact of the stroke on family, friends and carers2
e9k_15Assessment and management options for neurological, physiological, functional and psychological problems after stroke1
e9k_16Complications after stroke and how to prevent and manage them2
e9k_17When to refer for other specialist care (e.g. intensive care unit, hemicraniotomy, haematoma evacuation, interventional radiology, vascular surgery)1
e9k_18Any complications of investigations, interventions and treatments for stroke and how to prevent and manage them1
e9k_19The roles, level and number of health and social service professionals who should contribute to the care and support of individuals with stroke and those affected by stroke 1
e9k_20How to manage strokes that occur as a complication of another primary pathology1
Skills and ability to…
e9s_1Take and interpret thorough history, record third party information where possible, and assess mental capacity1
e9s_2Determine, plan and initiate appropriate assessments/investigations and interventions/treatments; provide information, relevant to individual needs and aspirations (personalise information)1
e9s_3Perform neurological and physiological assessment and assess vital signs1
e9s_4Perform a standardised neurological assessment using a recognised stroke scale (e.g. NIHSS, SNSS)1
e9s_5Identify the need and level of urgency for the relevant medical, surgical and radiological investigations, interventions and treatments; obtain and interpret the results of investigations: formulate an immediate and ongoing management plan; initiate treatments within the relevant timescales1
e9s_6Diagnose stroke using clinical information and investigations: distinguish between a stroke and a TIA; identify atypical strokes and stroke mimics; formulate and implement a management plan accordinglyn/a
e9s_7Communicate and discuss: current event; risk of future vascular event; need for assessments/investigations, interventions/ treatments and their timeframes; rationale for treatment and possible side effects of treatment; and provide timely information, advice and support1
e9s_8Identify the need for more specialist or differing treatments when necessary and be able to refer to those services1
e9s_9Monitor progress, identify neurological and non-neurological complications or deterioration and to deliver treatments1
e9s_10Obtain and interpret the results of investigations and formulate a management plan accordingly1
e9s_11Identify and use therapeutic methods of moving and handling the patient that are safe, depending on the individual patient or staff needs and aspirations1
e9s_12Assess and manage: oral problems including dysphagia, nutrition and hydration; cognition; psychological and emotional problems; continence; pressure areas; mobility problems etc in collaboration with members of the multidisciplinary team 3
e9s_13Deliver relevant methods of nutrition, hydration and medication in patients with dysphagia4
e9s_14Assess and discuss realistic goals with those affected by stroke, plan discharge and link to follow-up services for patients and carers2
e9s_15Recognise impending death and initiate palliative care where necessary n/a
E10Specialist rehabilitationLevel
Knowledge and understanding of…
e10k_1The impact of stroke on the individual, carer and family2
e10k_2Advocates for stroke patients when there is a legal duty to instruct an IMCA, taking account of religious and cultural aspirations1
e10k_3The implications of stroke for lifestyle, driving, work, family and acceptance in the community2
e10k_4MDT assessment: the principles of stroke rehabilitation and rehabilitation referral; therapy techniques and their application2
E10k_5A range of neurological treatment approaches and their applications2
e10k_6Psychological and emotional problems after stroke (e.g. depression, emotionalism, anxiety, self esteem, confidence, well-being, challenging behaviour)2
e10k_7Social and relationship problems after stroke (e.g. sex, lifestyle, work, housing, driving, transport, leisure, financial/ income, work/employment, children, family, support network, carers, respite, pets)1
e10K_8Cognitive and communication problems after stroke (e.g. spatial awareness (neglect/inattention); visual field deficits; hemianopia; memory; attention; praxis; executive function; aphasia, dysarthria, articulatory dyspraxia)1
e10k_9Physiological, physical and functional problems after stroke (e.g. rest and sleep; respiratory, mobility; balance; senses; incontinence; bladder and bowel management; swallowing; feeding, nutrition and hydration; skin integrity; sexual; motor control; ADL)3
e10k_10Neurological, visual and sensory impairments and pain problems (e.g. shoulder pain, central post-stroke pain, spasticity, seizures)1
e10k_10Neurological, visual and sensory impairments and pain problems (e.g. shoulder pain, central post-stroke pain, spasticity, seizures)1
e10k_11Medical problems (e.g. medication, comorbidities, complications)1
e10k_12The process of transfer to the community (e.g. discharge planning, long-term management, further rehabilitation, social function)2
e10k_13The causes of, and how to assess, manage and treat, problems after stroke: psychological and emotional; social and relationship; cognitive and communication; physiological, physical and functional; neurological, visual and sensory impairments and pain; medical2
e10k_14The impact of problems after stroke on day-to-day and outdoor functioning: psychological and emotional; social and relationship; cognitive and communication; physiological, physical and functional; neurological, visual and sensory impairments and pain; medical2
e10k_15Methods that will support those affected by stroke with their recovery and help them to cope with problems after stroke: psychological and emotional; social and relationship; cognitive and communication; physiological, physical and functional; neurological, visual and sensory impairments and pain; medical2
e10k_16Risk factors for further vascular events (e.g. type and aetiology of current event, lifestyle, socioeconomic, cultural, vascular, familial, genetic, concurrent medications, comorbidities) 2
e10k_17Pharmacological and non-pharmacological interventions for secondary prevention that will also help recovery after stroke, and their side effects 2
e10k_18Any support services, organisations and resources available (e.g. health, social, voluntary, independent sector; packages of care, finance and personal budgets, self-management, respite care, equipment, adaptations, rehabilitation, psychological, educational, employment, housing, transport)1
e10k_19Methods to facilitate communication with those affected by stroke2
e10k_20Therapeutic moving and handling 1
e10k_21Methods of changing behaviour 1
e10k_22The use of assessments and measures 1
e10k_23The principles of goal setting 2
e10k_24Assistive technology and other therapy interventions (e.g. functional electrical stimulation, orthotics)1
e10k_25Equipment and adaptations 1
e10k_26Concordance: how to assess; how it is affected by individual preference; how to motivate; how to manage non-concordance1
Skills and ability to…
e10s_1Take and interpret thorough history, including information from carers, relatives and other agencies where possible, and assess mental capacity2
e10s_2Determine, plan and initiate appropriate assessments/investigations and interventions/treatments; provide information, relevant to individual needs and aspirations (personalise information)2
e10s_3Provide a range of neurological intervention processes and to be able to clinically reason the selection and administration of an approach1
e10s_4Communicate and discuss: current event; risk of future vascular event; need for assessments/investigations, interventions/ treatments and their timeframes; rationale for treatment and possible side effects of treatment; and provide timely information, advice and support2
e10s_5Assess, discuss and review with those affected by stroke, including client-centred goal-setting and outcomes2
e10s_6Identify rehabilitation and support services in hospital and after discharge: inform the individual about services and how to access them; check availability and agree referral2
e10s_7Identify need and when to refer for more specialist or differing treatments where necessary: also agree referral (e.g. assistive technology, major adaptations to the home, disability employment adviser)2
e10s_8Provide advice and support on driving and refer to specialist centres as required1
e10s_9Identify local services and resources (e.g. health, social, voluntary, independent sector; equipment and adaptations, rehabilitation, psychological, educational, employment, housing, transport) to overcome barriers, facilitate participation and inclusion: also identify waiting times and implications for those affected by stroke1
e10s_10Monitor progress and agree or change a maintenance or management plan2
e10s_11Identify resources to help with participation and inclusion2
e10s_12Assess motivation and take steps to augment management 2
e10s_13Assess and help with concordance 2
e10s_14Identify and use therapeutic methods of moving and handling the patient that are safe, depending on the individual patient or staff needs and aspirations, and that will help with the optimum return of functional abilities1
e10s_15Assist, encourage and facilitate post-stroke physical, social and cultural reintegration 2
e10s_16Recognise the signs, symptoms and impact of psychological and emotional problems after stroke (e.g. depression, emotionalism, anxiety, self esteem, confidence, well-being, challenging behaviour) and to help patients and their families to cope and manage; build self-esteem and confidence, encourage recovery and maximise potential2
e10s_17Recognise the signs, symptoms and impact of social and relationship problems after stroke (e.g. lifestyle, work, housing, driving, transport, leisure, financial/income, work/employment, children, family, support network, carers, relating, respite, pets) and to help patients and their families to cope and manage; encourage recovery and maximise potential1
e10s_18Recognise the signs, symptoms and impact of cognitive and communication problems after stroke (e.g. spatial awareness (neglect/inattention); visual field deficits; memory; attention; praxis; executive function; aphasia, dysarthria, articulatory dyspraxia) and to help patients and their families to cope and manage; encourage recovery and maximise potential1
e10s_19Recognise the signs, symptoms and impact of physiological, physical and functional problems after stroke (e.g. rest and sleep; respiratory, mobility; balance; senses; incontinence: bladder and bowel management; swallowing; feeding, nutrition and hydration; skin integrity; sexual; motor control; ADL) and to help patients and their families to cope and manage; encourage recovery and maximise potential3
e10s_20Recognise the signs, symptoms and impact of neurological, visual and sensory impairments and pain problems (e.g. shoulder pain; central post-stroke pain; spasticity, seizures) and to help patients and their families to cope and manage; encourage recovery and maximise potential1
e10s_21Recognise the signs, symptoms and impact of medical problems (e.g. medication, comorbidities, complications) and to help patients and their families to cope and manage; encourage recovery and maximise potential1
e10s_22Use a range of communication resources and approaches to ensure that patients and their carers are fully involved in the decision making process and their care3
e10s_23Provide a client-centred approach to care and manage any challenging behaviour3
E11End-of-life careLevel
Knowledge and understanding of…
e11k_1End-of-life care strategies, advanced directives, and palliative care tools in relation to stroke1
e11k_2The implications of the Mental Capacity Act for stroke patients1
e11k_3Advocates for stroke patients when there is a legal duty to instruct an IMCA, taking account of religious and cultural aspirations1
e11k_4The range of support groups and services for those affected by stroke with palliative care needs1
e11k_5The needs and aspirations of those affected by stroke (i.e. patient, carer and family)1
e11k_6The assessment and management of problems, how they can be controlled and the implications for prognosis: psychological and emotional; social and relationship; cognitive and communication; physiological, physical and functional; neurological, visual and sensory impairments and pain; medical1
e11k_7Pharmacological and non-pharmacological interventions for end-of-life care after stroke1
e11k_8The side effects of pharmacological and non-pharmacological interventions for end-of-life care after stroke1
Skills and ability to…
E11s_1Take and interpret thorough history, including information from carers, relatives and other agencies where possible, and assess mental capacity1
E11s_2Determine, plan and initiate appropriate assessments/investigations and interventions/treatments; provide information, relevant to individual needs and aspirations (personalise information)1
E11s_3Communicate and discuss: current event; interventions/treatments and their timeframes; rationale for treatment; possible side effects of treatment; and provide advice and prognosis1
E11s_4Assess capacity and “best interests” according to the statutory principles1
E11s_5Provide sufficient information to enable informed choice and decision making by those affected by stroke1
E11s_6Identify need and when to refer for more specialist or differing treatments where necessary: agree referral1
E11s_7Recognise and manage symptoms taking account of individual needs and aspirations1
E11s_8Use palliative care, or other relevant tools, and care pathways1
E11s_9Identify local services and resources, including waiting times and implications for those affected by stroke1
E11s_10Use strategies to help with breaking bad news, managing emotions and obtaining information on advanced directives1
E11s_11Develop mechanisms to support the palliative care team and provide opportunities for debriefing sessions1
E12Seamless transfer of careLevel
Knowledge and understanding of…
e12k_1The assessment and management of problems: psychological and emotional; social and relationship; cognitive and communication; physiological, physical and functional; neurological, visual and sensory impairments and pain; medical; and how to involve users and carers1
e12k_2Advocates for stroke patients when there is a legal duty to instruct an IMCA, taking account of religious and cultural aspirations2
e12k_3The implications of stroke for lifestyle, driving, work and family2
e12k_4Methods to facilitate communication with those affected by stroke3
e12k_5Support services, organisations and resources available (e.g. health, social, voluntary, independent sector; packages of care, finance and personal budgets, self management, respite care, equipment, adaptations, rehabilitation, psychological, educational, employment, housing, transport) including exit strategies2
e12k_6The principles of good planning for transition between services or cessation of services and for transfer of care to the community, including the education of those affected by stroke2
e12k_7All agencies that are potentially involved along the whole of the Stroke Pathway2
e12k_8The principles of multi-agency working2
Skills and ability to…
e12s_1Take and interpret thorough history, including information from carers, relatives and other agencies where possible, and assess mental capacity1
e12s_2Determine, plan and initiate appropriate assessments/investigations and interventions/treatments; provide information, relevant to individual needs and aspirations (personalise information)2
e12s_3Assess, discuss and review with those affected by stroke: goal-setting, outcomes and exit strategies2
e12s_4Monitor progress and agree or change a maintenance or management plan2
e12s_5Identify need and when to refer for more specialist or differing treatments where necessary2
e12s_6Identify local services and resources (e.g. health, social, voluntary, independent sector; equipment and adaptations, rehabilitation, psychological, educational, employment, housing, transport) to facilitate participation and inclusion: check availability and waiting times; inform individual about services, identify how to access, or re-access, them and agree referral2
e12s_7Liaise with and work across agencies2
e12s_8Identify and utilise resources available locally and nationally to support those affected by stroke1
e12s_9Reflect on processes and pathways of care including mechanisms for review and exit strategies1
e12s_10Reflect on methods and effectiveness of information sharing1
E13Long-term careLevel
Knowledge and understanding of…
e13k_1The assessment and management of problems: psychological and emotional; social and relationship; cognitive and communication; physiological, physical and functional; neurological, visual and sensory impairments and pain; medical2
e13k_2Advocates for stroke patients when there is a legal duty to instruct an IMCA, taking account of religious and cultural aspirations2
e13k_3The needs and aspirations of those affected by stroke, particularly those related to the problems listed above, and how these needs and aspirations can be met2
e13k_4The impact of stroke on the individual, carer and family2
e13k_5The implications of stroke for lifestyle, driving, work and family2
e13k_6Risk factors for further vascular events (e.g. type and aetiology of current event, lifestyle, socioeconomic, cultural, vascular, familial, genetic, concurrent medications, comorbidities) 1
e13k_7Pharmacological and non-pharmacological interventions for secondary prevention and to facilitate recovery after stroke and their side effects1
e13k_8Support services, organisations and resources available (e.g. health, social, voluntary, independent sector; packages of care, finance and personal budgets, self-management, respite care, equipment, adaptations, rehabilitation, psychological, educational, employment, housing, transport)2
e13k_9Assistive technology and other therapy interventions (e.g. functional electrical stimulation, orthotics)1
e13k_10Methods to facilitate communication with those affected by stroke2
e13k_11Concordance: how to assess; how it is affected by individual preference; how to motivate; how to manage non-concordance2
Skills and ability to…
e13s_1Take and interpret thorough history, including information from carers, relatives and other agencies where possible, and assess mental capacity2
e13s_2Communicate and discuss: current event; risk of future vascular event; need for assessments/investigations, interventions/ treatments and their timeframes; rationale for treatment and possible side effects of treatment; and provide timely information, advice and support2
e13s_3Monitor the individual’s progress and agree on or change a maintenance or management plan2
e13s_4Assess, discuss and review with those affected by stroke: goal-setting and outcomes2
e13s_5Identify need and when to refer for more specialist or differing treatments when necessary2
e13s_6Identify relevant rehabilitation and social support services after discharge: inform the individual about services and how to access them and agree referral1
e13s_7Identify the individual’s motivation and take steps to modify behaviour2
e13s_8Know of local services, their waiting times and implications for those affected by stroke and ensure that the individual is aware1
e13s_9Understand how those affected by stroke can be empowered (e.g. through self-management programmes)1
e13s_10Assess and facilitate concordance2
E14ReviewLevel
Knowledge and understanding of…
e14k_1The assessment and management of problems: psychological and emotional; social and relationship; cognitive and communication; physiological, physical and functional; neurological, visual and sensory impairments and pain; medical2
e14k_2Advocates for stroke patients when there is a legal duty to instruct an IMCA, taking account of religious and cultural aspirations2
e14k_3The needs and aspirations of those affected by stroke, particularly those related to the problems listed above, and how these needs and aspirations can be met2
e14k_4Support services, organisations and resources available (e.g. health, social, voluntary, independent sector; packages of care, finance and personal budgets, self-management, respite care, equipment, adaptations, rehabilitation, psychological, educational, employment, housing, transport)2
e14k_5The impact of stroke on the individual, carer and family2
e14k_6The implications of stroke for lifestyle, driving, work and family2
e14k_7Risk factors for further vascular events (e.g. type and aetiology of current event, lifestyle, socioeconomic, cultural, vascular, familial, genetic, concurrent medications, comorbidities) 2
e14k_8Pharmacological and non-pharmacological interventions for secondary prevention and how to help recovery after stroke2
e14k_9Side effects of risk factor interventions and treatments to help with recovery after stroke2
e14k_10Methods to help communication with those affected by stroke when conducting a review2
e14k_11Concordance: how to assess; how it is affected by individual preference; how to motivate; how to manage non-concordance2
Skills and ability to…
e14s_1Take and interpret thorough history, including information from carers, relatives and other agencies where possible, and assess mental capacity1
e14s_2Communicate and discuss: current event; risk of future vascular event; need for assessments/investigations, interventions/ treatments and their timeframes; rationale for treatment and possible side effects of treatment; and provide timely information, advice and support2
e14s_3Monitor the individual’s progress and agree or change a maintenance or management plan2
e14s_4Assess, discuss and review with those affected by stroke: goal-setting and outcomes2
e14s_5Plan assessments and treatments; provide information, relevant to individual needs and aspirations (personalise information)2
e14s_6Identify need and when to refer for more specialist or differing interventions/treatments where necessary2
e14s_7Review process in your area and act on the review2
e14s_8Assess and facilitate concordance2
E15Participation in communityLevel
Knowledge and understanding of…
e15k_1The assessment and management of problems: psychological and emotional; social and relationship; cognitive and communication; physiological, physical and functional; neurological, visual and sensory impairments and pain; medical1
e15k_2Advocates for stroke patients when there is a legal duty to instruct an IMCA, taking account of religious and cultural aspirations2
e15k_3The needs and aspirations of those affected by stroke, particularly those related to the problems listed above, and how these needs and aspirations can be met2
e15k_4Support services, organisations and resources available (e.g. health, social, voluntary, independent sector; packages of care, finance and personal budgets, self-management, respite care, equipment, adaptations, rehabilitation, psychological, educational, employment, housing, transport)2
e15k_5The impact of stroke on the individual, carer and family2
e15k_6The implications of stroke for lifestyle; driving; work, including voluntary and family2
e15k_7Methods to help communication with those affected by stroke, including when conducting a review2
Skills and ability to…
e15s_1Take and interpret thorough history, including information from carers, relatives and other agencies where possible, and assess mental capacity1
e15s_2Communicate and discuss: current event; risk of future vascular event; need for assessments/investigations, interventions/ treatments and their timeframes; rationale for treatment and possible side effects of treatment; and provide timely information, advice and support1
e15s_3Assess, discuss and review with those affected by stroke: goal-setting and outcomes1
e15s_4Monitor the individual’s progress and agree on or change a maintenance or management plan1
e15s_5Plan assessments and treatments; provide information, relevant to individual needs and aspirations (personalise information)2
e15s_6Identify need and when to refer for more specialist or differing treatments where necessary2
e15s_7Know of local services, their waiting times and implications for those affected by stroke2
E15s_8Use individual commissioning1
E16Return to workLevel
Knowledge and understanding of…
e16k_1The effects of stroke (cognitive, physical, sensory, visual, emotional, confidence) and how it may affect a return to work and/or education1
e16k_2Assessing the effects of stroke (cognitive, physical, sensory, visual, emotional, confidence)1
e16k_3Employment law, the Disability Discrimination Act, health and safety at work1
e16k_4The roles of healthcare and other professionals in employment-related services (occupational health, occupational psychologist, disability employment adviser)1
e16k_5The occupational therapist’s role in vocational rehabilitation2
e16k_6Jobcentre Plus, its services and its effectiveness for stroke1
e16k_7What is meant by “reasonable adjustment” in the workplace, how to adapt or instigate adaptation to the work environment and the employer’s responsibility1
e16k_8Available helpful technology for overcoming functional and activity limitations in the workplace1
e16k_9Ergonomic principles and how to overcome access issues1
e16k_10Return to work education1
e16k_11Health, work and well-being – the role of purposeful occupation and the detrimental effects of worklessness1
e16k_12The benefits system in relation to work1
e16k_13Workplace assessment including risk, job analysis, work hardening, return to work planning and job retention1
e16k_14Models of vocational rehabilitation for stroke and vocational case management1
e16k_15Vocational rehabilitation guidelines and standards for people with stroke (British Society of Rehabilitation Medicine; Vocational Rehabilitation Association; UK Rehabilitation Council)1
Skills and ability to…
e16s_1Refer to a vocational rehabilitation service1
e16s_2Assess or refer for the assessment of visual, cognitive, functional and physical deficits following stroke1
e16s_3Identify local and national services for return to work, their availability and how they can be accessed1
e16s_4Know which professionals people should be referred to for employment-related services1
e16s_5Assess for, advise on and review the need for workplace adaptation1
e16s_6Assess for, advise on and review the need for assistive technology and environmental adaptations to overcome work-related activity limitations1
e16s_7With a stroke survivor, advise, prepare and plan a return to work or education and how they can be supported on the return to work pathway1
e16s_8Advise employers/educators about stroke and its effects and negotiate a return to work of the stroke survivor1
e16s_9Communicate stroke-related deficits to employers, colleagues, educators, family members and friends 1
e16s_10Give benefits advice or refer1
e16s_11Carry out a workplace assessment and risk assessment, or refer1
e16s_12Carry out job analysis, or refer1
e16s_13Set goals for work return/retention1
e16s_14Case manage and refer to a case management service for a return to work after stroke1
e16s_15Implement guidelines in practice1
e16s_16Help the stroke survivor to remain in work, review the stroke survivor at work/in education and advise on workplace accommodations1