Curriculum Library

Work-based learning outcomes

Perform and interpret assessments of blood gas status and identify the requirements for supplemental oxygen therapy.
Observe and assist during full cardiopulmonary exercise testing in the investigation of respiratory, vascular and cardiac disease.
Perform the selection the appropriate mode and pattern of ventilation with respect to the patient’s sedation level and lung pathology and pathophysiology.
Set and assist in the interpretation of data from ventilator alarms and the recognition and rectification of common problems associated with ventilator testing and application in a range of patients.
Perform routine non-invasive monitoring in a critical care setting and responds to trends in physiological variables.
Identify the requirement for and initiate non-invasive ventilation (NIV) in patients with both acute and chronic respiratory failure.
Discuss and agree ventilation and monitoring strategies for critically ill patients and demonstrate the communication skills required to discuss subjects that may be difficult.

Work-based competencies

Work-based assessments

You must complete
3 Case-based discussion(s)
2 of the following DOPS / OCEs

Assessment Title	Type
Participate in the ventilator set up and selection of appropriate ventilator settings ready for a new patient.	DOPS
Set up for and connect NIV ventilator to patient. Discuss ventilator settings with staff.	DOPS
Participate in a CPET investigation. Assist with the patient interface and monitoring.	DOPS
Analyse a blood gas sample and make references to the possible care pathway of the patient	DOPS
Provide clinical technical support to nurse at the bedside regarding safe use of ventilation.	OCE
Initiate the ECG, Resp, and SpO2 monitoring on an awake patient, explaining to the patient the reasons and benefits of each parameter.	OCE
Discuss and agree ventilator mode and settings up for a new patient with medical staff.	OCE
Discuss the key components for consideration when planning a safe transfer of a patient with medical staff.	OCE

Academic Content (MSc in Clincal Science)

Important information

The academic parts of this module will be detailed and communicated to you by your university. Please contact them if you have questions regarding this module and its assessments. The module titles in your MSc may not be exactly identical to the work-based modules shown in the e-portfolio. Your modules will be aligned, however, to ensure that your academic and work-based learning are complimentary.

Learning Outcomes

1. Describe blood gas physiology and acid-base balance.
2. Discuss the principles and role of short- and long-term oxygen therapy in the treatment of disease.
3. Describe the evidence base for oxygen prescription and assessment of patients for long-term oxygen therapy.
4. Describe the role of field exercise testing in the assessment for ambulatory oxygen.
5. Describe the process for ordering oxygen therapy.
6. Discuss the pathophysiology of common causes of respiratory failure.
7. Describe the role of non-invasive ventilation in the treatment of acute and chronic respiratory failure in a range of disorders, to include airway, chest wall and muscle disorders.
8. Discuss the range of ventilators available for the provision of non-invasive ventilation, their modes of action and functions.
9. Discuss the assessment and monitoring of patients receiving non-invasive ventilation in the acute and chronic setting.
10. Describe the structure, function, mechanics and control of the cardiorespiratory system, to include ventilation, gas transport and exchange, haemodynamics and cardiac output during rest and exercise.
11. Recognise the physiological adaptations that occur with exercise training.
12. Describes the range of exercise tests available and their clinical importance.
13. Describe the application of cardiopulmonary exercise testing in the assessment of limitations to exercise.
14. Describe the common protocols used in cardiopulmonary exercise testing.
15. Recognise the uses and limitations of cardiopulmonary exercise testing and its value in clinical practice.
16. Discuss the application of interpretation strategies to respiratory investigations.

Indicative Content

Anatomy and physiology

Cardiorespiratory responses to exercise

Normal response to exercise, to include:
- Muscles – structure, metabolism, substrates
- Cardiac response to exercise – control of response, cardiac frequency and stroke volume, cardiac output
- Ventilatory response to exercise – control of response, breathing frequency, tidal volume, ventilation perfusion ratio during exercise
- Circulatory response to exercise – redistribution of blood flow to muscle

Limitations to exercise subjects in normal subjects
Exercise response in disease, to include:
- Cardiac and respiratory (obstructive and restrictive disease) – patterns of response, major limiting factors and assessments of symptoms
- Other disorders – obesity, unfitness, malingering, deconditioning
- Contraindications to exercise testing and safety during exercise tests
- Recognition of indications to terminate the exercise test prematurely,e.g. symptoms

Respiratory failure

Assessment of respiratory failure and control
Differentiation of Type 1 and Type 2 respiratory failure
Acute and chronic respiratory failure
Metabolic disorders
Treatment pathways for patients in respiratory failure
Diagnostic procedures used in the assessment of patients with respiratory failure

Oxygen therapy and assessment

National guidelines for assessment of long-term oxygen therapy and ambulatory oxygen in adults
Protocols for the performance and assessment for oxygen therapy in adults
Methods of oxygen delivery and interfaces
Ordering of oxygen therapy using home oxygen order form (HOOF)
Long-term follow-up of patients using oxygen therapy
The use of hypoxic challenge in patients wishing to fly

Non-invasive ventilation

Clinical indications for NIV
- Acute
  - Protocols for initiation and withdrawal
  - Monitoring
  - Requirements for invasive ventilation
- Chronic
  - Assessment for domiciliary ventilation
  - Nocturnal and diurnal monitoring of patients for domiciliary ventilation
  - Long-term monitoring
- Modes of ventilation (positive and negative)
  - Pressure support
  - Volume support
  - Spontaneous intermittent mechanical ventilation
- Interfaces
- Operational parameters
  - Inspiratory positive airway pressure (IPAP)
  - Expiratory positive airway pressure (EPAP)
  - Respiratory rate
  - Rise time
  - Vt

Field exercise testing

Indications for performing field exercise tests
- Objective assessment of exercise capacity
- Assessment of symptoms
- Unexplained dyspnoea on exertion
- Assessment of disability
- Desaturation on exercise
- Serial monitoring
- Assessment for ambulatory oxygen

Field exercise protocols
- Equipment
- How to decide the most appropriate protocol to use
- Advantages and disadvantages of each protocol
- Six-minute walk, incremental shuttle walk, endurance shuttle walk
- Manual calculation of results and predicted values
Measurements
- Heart rate, oxygen saturation
- Assessment of symptoms: Borg scale, Visual Analogue Scale, Rating of Perceived Exertion
- Observation of full cardiorespiratory exercise tests
Interpretation and reporting of results
- Common patterns of results in disease: cardiac vs respiratory disease
- Symptoms
- Obstructive vs restrictive lung disease

Full cardiopulmonary exercise testing

Indications for performing full cardiopulmonary exercise tests
- Assessment of symptoms
- Differentiation of cardiac versus respiratory impairment
- Unexplained dyspnoea
- Assessment for surgery
Exercise protocols
- Maximal vs submaximal
- Advantages and disadvantages
- Cycle ergometer vs treadmill
- How to decide on the most appropriate protocol

Principles of equipment

Gas analysis
Volume measurement
Blood gases
Quality control and calibration
Graphical representation of results

Measurements
- Ventilation and frequency
- Oxygen uptake and carbon dioxide output
- Heart rate and oxygen pulse
- Respiratory exchange ratio
- Oxygen saturation
- Assessment of symptoms
Exercise facilities
- Health and safety requirements
- Basic Life Support/Advanced Life Support, resuscitation equipment and oxygen
Concepts of interpretation of results
- Graphs and flow charts
- Common patterns of results in disease: cardiac vs respiratory
- Symptoms
- Breathing reserve
- Cardiac reserve
- Obstructive vs restrictive lung disease
- Cardiac disease
- Use of anaerobic threshold in interpretation

Interpretation

Application of various respiratory tests in the confirmation of disease
Awareness of clinical guidelines, e.g. COPD, asthma
Clinical report writing techniques
The role of the respiratory physiologist and critical care scientist in the multidisciplinary team

Lifestyle changes

Smoking cessation strategies
Exercise prescription
Weight management
Pulmonary rehabilitation

Useful information

Clinical experiential learning - Module guidance

Number	Work-based learning outcome	Title	Knowledge
1	1, 2, 3,5	Control infection risks in accordance with departmental protocols.	View Respiratory and Sleep Science 2 Critical Care - Competency 1 Control infection risks in accordance with departmental protocols. Knowledge and skills you might demonstrate Protocols and requirements for hygiene and infection control related to the relevant range of investigations, including preparation, conduct and completion of investigation. Protocol for hand washing and how effective hand washing contributes to control of infection.
2	1, 2, 3,4,5	Minimise risks and hazards in compliance with health and safety policies.	View Respiratory and Sleep Science 2 Critical Care - Competency 2 Minimise risks and hazards in compliance with health and safety policies. Knowledge and skills you might demonstrate The relevant health and safety regulations specific to respiratory and sleep science investigations, the potential hazards and risks, and the actions to be taken to minimise these.
3	1, 2, 3, 5	Select suitable technology for each type of investigation, choosing and adapting the appropriate diagnostic technique, patient position, machine settings and transducer for each patient.	View Respiratory and Sleep Science 2 Critical Care - Competency 3 Select suitable technology for each type of investigation, choosing and adapting the appropriate diagnostic technique, patient position, machine settings and transducer for each patient. Knowledge and skills you might demonstrate Factors influencing the choice of technology for investigating respiratory and sleep symptoms. Clinical indications for, contraindications to and patient benefit for respiratory and sleep investigations. Medication used to treat respiratory symptoms and conditions.
4	1, 2, 3, 4, 5	Set up equipment ready for use for each type of investigation.	View Respiratory and Sleep Science 2 Critical Care - Competency 4 Set up equipment ready for use for each type of investigation. Knowledge and skills you might demonstrate Range of equipment used, relative merits and principles of measurement, including: recognition of the errors or potential risks of using defective equipment in clinical practice and the implications of use identification of common faults and remedial action current safety standards, including safety testing
5	1, 2, 3	Obtain a suitably completed request form, greet the patient, check patient ID and ensure that the patient’s identity is confirmed as correct and fully identified on each type of recording system.	View Respiratory and Sleep Science 2 Critical Care - Competency 5 Obtain a suitably completed request form, greet the patient, check patient ID and ensure that the patient’s identity is confirmed as correct and fully identified on each type of recording system. Knowledge and skills you might demonstrate The requirements for correct completion of request forms and how to validate the request. The importance of checking and confirming the patient identity and the implications of not doing so.
6	1, 2, 3	Explain the procedure for each type of investigation to the patient and address any questions they may have relating to the procedure, including the process after the procedure and how the patient will be informed of the results.	View Respiratory and Sleep Science 2 Critical Care - Competency 6 Explain the procedure for each type of investigation to the patient and address any questions they may have relating to the procedure, including the process after the procedure and how the patient will be informed of the results. Knowledge and skills you might demonstrate The pathophysiology of the respiratory and sleep system and the appropriate choice of investigation, considering the findings from the history and clinical examination. Common questions and concerns of patients about procedures. Risks and benefits of undertaking the investigation. The information needs of patients following investigation. The authority level for provision of information to patients.
7	1, 2, 3	Gain appropriate consent for each investigation/consultation as appropriate to the individual patient in the critical care setting.	View Respiratory and Sleep Science 2 Critical Care - Competency 7 Gain appropriate consent for each investigation/consultation as appropriate to the individual patient in the critical care setting. Knowledge and skills you might demonstrate The importance of explaining the procedure for each investigation to the patient and gaining informed consent. Importance of introducing yourself and your role as a clinical scientist trainee as part of the process of introduction and consent. The relevant procedures and requirements for patient conformance. Clinical indications for and contraindications to challenge testing. Principles, guidance and law with respect to informed consent, including the unconscious patient.
8	1, 2, 3	Initiate a consultation, elicit information, clarify as necessary, summarise, and empathise and use active listening techniques while taking a patient history.	View Respiratory and Sleep Science 2 Critical Care - Competency 8 Initiate a consultation, elicit information, clarify as necessary, summarise, and empathise and use active listening techniques while taking a patient history. Knowledge and skills you might demonstrate The features that should be present in an effective patient consultation. Structure of a consultation model, e.g. the Calgary-Cambridge model, using a logical sequence that includes: brief biographical history of presenting complaint past history smoking/alcohol medication (prescribed and other) allergies family/social concerns and expectations summary common questioning techniques used during history taking and know when to use them. Difference between a health professional-centred and patient- centred consultation. How to modify techniques for patients with special needs, relevant to the circumstances of the patient. The importance of checking for patient allergies in case they are not already documented. Key symptoms relating to respiratory and sleep disorders. Changes in the normal anatomy and physiology resulting in abnormalities of respiratory and sleep systems.
9	1, 2, 3, 5	Treat patients in a way that respects their dignity, rights, privacy and confidentiality, taking appropriate action to respond to the specific needs of the patient, as defined by department protocol.	View Respiratory and Sleep Science 2 Critical Care - Competency 9 Treat patients in a way that respects their dignity, rights, privacy and confidentiality, taking appropriate action to respond to the specific needs of the patient, as defined by department protocol. Knowledge and skills you might demonstrate The rights of the patient with regard to consent for treatment and confidentiality of consultation and medical records. Requirements of patients with disabilities and special needs. Key factors influencing dignity, rights, privacy and confidentiality, including age, gender, culture and beliefs. Recognition of the contraindications to testing prior to the test, as defined by department protocol. The range of needs of people with disabilities within a typical care pathway for critically ill patients.
10	1	Assess the patient’s suitability for the proposed investigation and obtain a blood gas sample suitable for the assessment of blood gas status using a recognised technique.	View Respiratory and Sleep Science 2 Critical Care - Competency 10 Assess the patient’s suitability for the proposed investigation and obtain a blood gas sample suitable for the assessment of blood gas status using a recognised technique. Knowledge and skills you might demonstrate Common presenting conditions and pathological processes underlying the presentation of patients referred for these investigations. Standard operating procedures (SOPs) for each investigation. Procedure and protocols for performing either arterial blood gases or an ear lobe capillary sample. Advantages and disadvantages of each technique.
11	1	Analyse and interpret a range of blood gas results and take appropriate action with the required degree of urgency in a range of conditions, including normal, Type 1 and Type 2 respiratory failure.	View Respiratory and Sleep Science 2 Critical Care - Competency 11 Analyse and interpret a range of blood gas results and take appropriate action with the required degree of urgency in a range of conditions, including normal, Type 1 and Type 2 respiratory failure. Knowledge and skills you might demonstrate Common presenting conditions and pathological processes underlying the presentation of patients referred for this investigation. Normal blood gas values. Abnormal blood gas values, including Type 1 and Type 2 respiratory failure. Routine maintenance, calibration and quality assurance.
12	1,6	Identify requirements for long-term oxygen therapy, including ambulatory, and undertake assessments in accordance with national guidelines, titrating oxygen according to patient requirements and clinical indications.	View Respiratory and Sleep Science 2 Critical Care - Competency 12 Identify requirements for long-term oxygen therapy, including ambulatory, and undertake assessments in accordance with national guidelines, titrating oxygen according to patient requirements and clinical indications. Knowledge and skills you might demonstrate Common presenting conditions and pathological processes underlying the presentation of patients referred for this investigation. Requirements for ambulatory oxygen therapy. Indications for and contraindications to oxygen therapy. Health and safety regulations for oxygen therapy. Mechanism of action of a range of respiratory drugs delivered to patients.
13	1	Complete appropriate documentation based on the results of the assessment undertaken and the patient’s clinical needs, and identify further investigations and/or future management plans.	View Respiratory and Sleep Science 2 Critical Care - Competency 13 Complete appropriate documentation based on the results of the assessment undertaken and the patient’s clinical needs, and identify further investigations and/or future management plans. Knowledge and skills you might demonstrate SOPs for the investigation. Requirements for further investigations and/or future management. Procurement arrangements for the provision of long-term oxygen therapy.
14	2	Assess the patient and undertake cardiopulmonary exercise testing using an appropriate protocol in patients with respiratory, vascular and cardiac disease.	View Respiratory and Sleep Science 2 Critical Care - Competency 14 Assess the patient and undertake cardiopulmonary exercise testing using an appropriate protocol in patients with respiratory, vascular and cardiac disease. Knowledge and skills you might demonstrate SOPs for the investigation. Common presenting conditions and pathological processes underlying the presentation of patients referred for these investigations. Indications for and contraindications to exercise testing. Suitability of the patient for the proposed investigation. Range and use of exercise protocol. Baseline measurements appropriate to the clinical question. How to choose and adapt diagnostic technique, patient position, machine settings and transducer for each patient. Routine maintenance, calibration and quality assurance.
15	2	Record results of cardiopulmonary exercise testing accurately in an appropriate format and analyse and technically interpret full cardiopulmonary exercise tests.	View Respiratory and Sleep Science 2 Critical Care - Competency 15 Record results of cardiopulmonary exercise testing accurately in an appropriate format and analyse and technically interpret full cardiopulmonary exercise tests. Knowledge and skills you might demonstrate Technical comments that may influence the test outcome. Appropriate lifestyle change techniques for supporting the patient in their treatment and management plan. Requirements for further investigations and/or future management. Normal/abnormal ranges.
16	3, 5, 6	Assess the patient, determine the appropriate settings and obtain accurate baseline measurements of NIV therapy where appropriate. Initiate appropriate NIV therapy and monitor clinical status.	View Respiratory and Sleep Science 2 Critical Care - Competency 16 Assess the patient, determine the appropriate settings and obtain accurate baseline measurements of NIV therapy where appropriate. Initiate appropriate NIV therapy and monitor clinical status. Knowledge and skills you might demonstrate SOPs for the investigation. Common presenting conditions and pathological processes underlying the presentation of patients referred for these investigations. Suitability of the patient for the proposed investigation. Appropriate interface and equipment settings to optimise NIV therapy. Potential impact of NIV therapy on the patient’s symptoms, using objective and subjective assessment.
17	7	Undertake consultations with patients to explain and agree therapeutic strategies for the management of their respiratory conditions.	View Respiratory and Sleep Science 2 Critical Care - Competency 17 Undertake consultations with patients to explain and agree therapeutic strategies for the management of their respiratory conditions. Knowledge and skills you might demonstrate Relationships that exist between body weight and dysfunctions of the cardiac, respiratory and endocrine systems which result in respiratory disorders. Therapuetic strategies for the management of respiratory conditions including the underpinning evidence base. Patient-centred consultations. Effective listening and speaking.
18	1, 2, 3, 5	Decontaminate equipment and leave in a suitable condition for reuse.	View Respiratory and Sleep Science 2 Critical Care - Competency 18 Decontaminate equipment and leave in a suitable condition for reuse. Knowledge and skills you might demonstrate Methods of equipment decontamination.
19	4	Set ventilator alarms in a range of patients.	View Respiratory and Sleep Science 2 Critical Care - Competency 19 Set ventilator alarms in a range of patients. Knowledge and skills you might demonstrate Purpose and principles of use and function of ventilator alarms. How to set ventilator alarms in accordance with Standard Operating Procedures and current guidelines. Common problems with ventilator alarms and how to minimise these. Importance of prioritising patient safety.
20	4	Assist in the interpretation of data from ventilator alarms recognising and rectifying common problems associated with ventilator troubleshooting and the use of ventilators in a range of patients.	View Respiratory and Sleep Science 2 Critical Care - Competency 20 Assist in the interpretation of data from ventilator alarms recognising and rectifying common problems associated with ventilator troubleshooting and the use of ventilators in a range of patients. Knowledge and skills you might demonstrate Role of the Clinical Scientist in Critical Care with respect to responding to ventilator alarms. How to interpret data from ventilator alarms. Common problems associated with ventilator testing. Common problems associated with the use of ventilators in a range of patients. How to rectify common problems.

Respiratory and Sleep Science 2 Critical Care (SPS135) Copy