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NMC standards aligned to the Public Health Skills and Knowledge Framework (PHSKF)

Registered nurses play a key role in improving and maintaining the mental, physical, cognitive and behavioural health and well-being of people, families, communities and populations.

They support and enable people at all stages of life and in all care settings to make informed choices about how to manage health challenges to maximise their quality of life and improve health outcomes.

They are actively involved in the prevention of and protection against disease and ill health and engage in public health, community development and global health agendas, and in the reduction of health inequalities.

Traditionally, however, nursing and public health education standards have developed in parallel. The NMC standards for pre-registration education and post registration specialist community public Health SCPHN and the Public Health Skills and Knowledge Framework have always been separate to the Public Health Knowledge and Skills Framework for specialists and practitioners in public health. This has not helped foster shared learning and understanding.

Introduction

Public health placements for pre registration student nurses and trainee Nursing Associates will generally incorporate time and experience with school nurses, health visitors and other public health nurses either within a public health or as part of community or primary care placements. It is unusual for them, however, to experience wider public health placement experiences with public health specialist and practitioners, within local authorities or similar as part of their learning.

The Nursing and Midwifery Council (NMC) Future nurse standards of proficiency for registered nurses now include a far wider scope for nursing students to develop public health understanding and skills throughout their education and training. The Public Health Skills and Knowledge Framework now also includes the functions and abilities for a wide range of people in many settings to help understand and improve public health.

Alongside this there is a drive to expand placement opportunities more generally for students in health care as seen in the Health Education England (HEE) Clinical Placements Expansion Programme with the purpose of developing a health care professional workforce able to meet people care needs across populations.

The resource maps the NMC Standards of proficiency for registered nurses and Public Health Skills and Knowledge Framework (PHSKF) functions alongside potential learning opportunities to meet these learning outcomes, this list is not exhaustive.

The purpose if this resource is to:

  • Support nursing students to understand their public health role in all aspects of health care.
  • Support Public health colleagues in other areas of practice to recognise and understand the nursing contribution to public health.
  • Support the development of placements in public health areas for student nurses.

The aim of the resources is to provide a basis for nurses and placement providers to facilitate greater public health engagement for students and enable nurses to recognise their public health skills alongside colleagues in public health:

  • To support the development of public health clinical placements for pre-registration student nurses.
  • Foster a greater understanding in the nursing profession of public health skills, knowledge and attributes so they can embed these into their practice as part of a practice placement so. To understand the wider determinants of health and how these impact health and care and take actions to reduce health inequalities.
  • To promote opportunities to experience practical application of public health practice to consolidate and compliment academic knowledge within a practice learning experience.
  • To be able to relate this to practice as part of a placement experience.
  • Showcase to public health specialists and practitioners how nursing students can experience effective placements within public health teams.
  • Foster a greater awareness in public health specialists and practitioners on how nursing can support the public health agenda.
  • Help show how registered nurses working in public health are working to the NMC code and thereby support revalidation with the NMC.

Alignment to other education guidance and terminology

By definition, public health practice relates to the ‘organised efforts of society’, requiring collaborative action from people, lay to professional, across sectoral and geographical boundaries, to promote and protect the public’s health.

Public health supports individuals, organisations, and society to tackle preventable disease, mortality and disability using:

  • Prevention: reducing the incidence of ill health supporting healthier lifestyle.
  • Protection: surveillance and monitoring of infectious disease, emergency response and immunisation.
  • Promotion: health education and commissioning services to meet specific health needs.

Public health work is also encompassed by wider terms such as, ‘improving the public’s health’ and community health and wellbeing, or population health.

Public health is everyone’s responsibility and actively involves communities and networks at a local level working together. Placements in local authorities gives students an opportunity to experience this.

The standards of proficiency apply to all NMC registered nurses and along with the overall NMC Standards for education and training which set out the NMCs expectations for the delivery of all pre-registration NMC approved nursing education programmes.

The standards aim to provide approved education institutions (AEIs) and their practice learning partners with the flexibility to develop innovative approaches to education for nurses, midwives and nursing associates, while being accountable for the local delivery and management of approved programmes in line with our standards.

Education institutions must comply with these standards to be able to run any NMC approved programmes and for those completing the programmes to be eligible to join the NMC register.


The PHSKF is a capability framework that describes the functions carried out by people and organisations who strive to deliver better public health outcomes for communities and populations, including the reduction of health inequalities. The PHSKF provides a suite of 70 descriptors, written to resonate as much as possible across organisational cultures and devolved authorities across the UK. They are organised into three functional groups:

  • Technical – those functions in which public health professionals, in particular, are highly skilled.
  • Context – those functions that relate to the working environment in which public health activity is typically carried out, including the policy, business and organisational context.
  • Delivery – those functions that relate to specific skill-sets that support the delivery of public health programmes, interventions and services eg: leadership, communication, programme management, resource management.

Mapping tool

This mapping tool resource presents:

The NMC standards against the broad descriptors in the Public Health Skills and Knowledge Framework (PHSKF) to the potential learning opportunities which may be available or that present to students in a public health placement.

The NMC learning outcomes:

These relate specifically to the knowledge, understanding and abilities required of a registered nurse. These primarily relate to individual or patient-centred activities within clinical settings.

The public health descriptors in the Public Health Skills and Knowledge Framework (PHSKF):

These relate to the knowledge skills and attributes for workers across a wide area of public sector organisations; these include clinical settings and local authorities, but extend beyond e.g.: workplaces, private industry, the voluntary, community and social enterprise sector (VCSE).

The learning opportunities:

The AEI is responsible for setting the learning outcomes for theory modules. The learning opportunities available in placements are agreed with the practice area.

The learning opportunities in this tool are provided against the broad descriptor of the NMC platforms and Public Health Skills and Knowledge Framework (PHSKF) descriptors as ideas for the students and placement areas help support public health learning and wider engagement and understanding in public health outcomes.

They are not intended to provide a definitive list of activities but as a basis for ideas for the public health placement of what activities the students can do to support their learning against both the NMC standards and the Public Health Skills and Knowledge Framework (PHSKF).

It is acknowledged also that many learning opportunities will support learning against multiple standards in the NMC and Public Health Skills and Knowledge Framework (PHSKF) they are not repeated in every incident but may be useful to consider for achieving across a range of the outcomes.

The examples and learning opportunities list is not exhaustive it is intended to generate ideas and discussion for learning on placement.

Platform one

Being an accountable professional

PHSKF - Public Health Skills and Knowledge Framework

These could include:

  • ethical dilemmas
  • PH guidance and advice
  • evidence based practice.

Consider the differences between medical ethics and Public Health ethics for example the ethics on public health messages for not doing certain things; smoking in public places? Vs Human rights?

Quarantine for individuals exposed to infectious disease such as COVID-19 social distancing impact or wider determinants of health.

See: ‘Public health ethics in practice’ developed as part of the work to update the PHSKF

Consider population demographics, and local community profiles.

Consider your own attitudes to healthy activities and healthy living. What are the barriers for you as an individual to adopt a healthier lifestyle and how can this inform your practice and conversations with patients and public.

Look up the local health profiles and local health needs assessment (Joint Strategic Needs Assessment – JSNA) Local authority profiles; PHE fingertips data, Wales PH observatory

Critically consider:

  • What are the specific needs of the population?
  • Are all sectors of the community served by general health care provision?
  • For individual needs consider what are the specific religious cultural ethnic or gender specific needs?
  • Are there any initiatives where local communities are helping and supporting public health strategies? (for example vaccine clinics or healthy living centres).
  • Migrant population needs for travel health, for example, visiting friends and relatives.
  • Consider the needs of communities with high rates of domestic abuse, female genital mutilation, forced marriage etc what is being done to support?
  • How might services be arranged to better to serve groups that don’t access health care? As examples think of; smoking cessation for example or men’s health.
  • Health literacy – do patients understand where to go in your unit trust hospital, how easy is it to navigate to where they need to be? e.g; Signs for Imaging rather than x ray cardiology – are these understood by the population?
  • How does social media influence and inform health behaviours consider conducting a SWOT analysis on the benefits and challenges see the Royal Society resource from the Royal Society 2022 The online information environment.
  • This will significantly impact on how the individual feels by the time they navigate through the system to actually see a practitioner. It will potentially affect their care or motivation to engage with services?
  • Consider what is already being done? And is this effective?
  • Reflect on; how the service is delivered, is this available for all in the population, could it be improved and how?
  • Students could also help to form and/or implement a quality improvement type project to improve population health.

See further RCN clinical and professional resources:

Public Health
Domestic abuse
Modern slavery and human trafficking
Inclusion health care
Migrant health

Platform two 

Promoting health and preventing ill health

PHSKF - Public Health Skills and Knowledge Framework

This whole area is related to public health and population health as such there is more detail against this platform.

2.1 Understand and apply the aims and principles of health promotion, protection and improvement and the prevention of ill health when engaging with people:

Work with team to identify areas of work against these three key areas of PH how they overlap.

Understand case studies of local work and how these principles apply.

2.2 Demonstrate knowledge of epidemiology, demography, genomics and the wider determinants of health, illness and wellbeing and apply this to an understanding of global patterns of health and wellbeing outcomes:

Work with team to consider local needs and demography and consider protective characteristics used in local authorities.

Complete neighbourhood study and or work on local JSNA.

Look at:

2.3 Understand the factors that may lead to inequalities in health outcomes:

Consider what the local wider determinants of health are?

What are the challenges given the local population epidemiology and demographic?

2.4 Identify and use all appropriate opportunities, making reasonable adjustments when required, to discuss the impact of smoking, substance and alcohol use, sexual behaviours, diet and exercise on mental, physical and behavioural health and wellbeing, in the context of people’s individual circumstances:

Consider local strategies, i.e. smoking cessation addiction services etc.

Look at:

Complete one of the modules and reflect with supervisor against local initiatives:

  • Case based discussion on Obesity Foresight Map and application to influencing behaviour change.
  • Understanding MECC and other tools.

Supporting people with learning disabilities.

Consider mapping/connecting with specialist learning disability services, identifying reasonable adjustments for people with learning disabilities; i.e Health Passports and communication needs.

Consider capacity to consent to health interventions and how decisions are made when capacity is limited.

Knowledge of the relevant legislation.

2.5 Promote and improve mental, physical, behavioural and other health related outcomes by understanding and explaining the principles, practice and evidence-base for health screening programmes:

Resources within the PHE 'All our health' as above.

Complete one of the ‘All our health’ modules.

Reflect on learning with supervisor and how this relates to local initiatives.

2.6 Understand the importance of early years and childhood experiences and the possible impact on life choices, mental, physical and behavioural health and wellbeing:

Consider how:

  • Health visiting and school nursing services are planned and commissioned; nationally, regionally and locally.
  • Family Nurse Partnership FNP links to Tavistock services where available?
  • What are the local challenges for these services? What is the evidence base behind them and the outcomes for the public from these services?
  • Potential to spend time with provider teams? (NB students may also do this as part of community placement)
  • National Child Measurement Programme (NCMP) – understanding of this and local delivery links to 2.2.

2.7 Understand and explain the contribution of social influences, health literacy, individual circumstances, behaviours and lifestyle choices to mental, physical and behavioural health outcomes:

Link to local demographic and diversity within the population.

Consider from the data what are the local issues?

Are any local strategies developed specifically to support this? Think place based services.

2.8 Explain and demonstrate the use of up to date approaches to behaviour change to enable people to use their strengths and expertise and make informed choices when managing their own health and making lifestyle adjustments:

Look at motivational interviewing skills.

RCN supporting behaviour change.

2.9 Use appropriate communication skills and strength based approaches to support and enable people to make informed choices about their care to manage health challenges in order to have satisfying and fulfilling lives within the limitations caused by reduced capability, ill health and disability:

Consider behaviour change challenges and the psychology of behaviour change, look at the COM-B model (Capability Opportunity Motivation to inform and change Behaviour).

What are the local initiatives in relation to MECC?

2.10 Provide information in accessible ways to help people understand and make decisions about their health, life choices, illness and care:

Look at local and national health promotion resources.

How these are used and the evidence base behind them? for e.g. easy read documents.

2.11 Promote health and prevent ill health by understanding and explaining to people the principles of pathogenesis, immunology and the evidence-base for immunisation, vaccination and herd immunity:

Spend time with local health protection team understand how notifiable infectious disease are reported and look at how outbreaks and managed.

Complete the e-learning immunisation module.

2.12 Protect health through understanding and applying the principles of infection prevention and control, including communicable disease surveillance and antimicrobial stewardship and resistance:

Possible spend time with health protection team.

Understand how notifiable infectious disease are reported and look at how outbreaks and managed. How this relates to international travel?

See how data on local infection is used locally.

Platform three

Assessing needs and planning care

PHSKF - Public Health Skills and Knowledge Framework

Consider person centred care.

Engaging with services and stakeholders across the system.

The health needs of the population. The inequalities in access to health care and the impact of wider determinants on health.

Physiological needs impacted by wider society and peoples coping strategies.

Management of health care considered in the context of how the individual lives within their society and what friends family wider support systems they may have.

Health literacy
Mental health
Isolation
Loneliness
Learning disabilities
Dementia

Co morbidities and associated ill health both physical and mental health.

Connecting with specialist learning disability services, identifying reasonable adjustments for people with learning disabilities; Health Passports and communication needs.

Critically consider what are people’s individual capacity to care personalised care and salutogenic approaches to health care.

How can you and the wider community support people to engage and be actively involved in their decision making?

How are Patients and service user experiences and patient participation groups used in care planning?

Consider people’s capacity to consent to health interventions and how decisions are made when capacity is limited.

Consider and look into the COM-B model for behaviour change:

  • Capability
  • Opportunity
  • Motivation

Motivational interviewing approaches to support engagement RCN behaviour change tool.

Consider how the wider system might work together. Multidisciplinary and multi-agency working.

Sharing information and resources.

RSPH Bringing the health improvement workforce together behaviour change development tool.

HEE toolkit for behaviour change describes the various levels for training needs in behaviour change for individuals and service planners depending on the need.

This video describes this.

Students could:

  • Consider audit of what is already being done? and is this effective?
  • Consider developing and/or implement a quality improvement type project to improve population health.

Platform four  

Providing and evaluating care

PHSKF - Public Health Skills and Knowledge Framework

Audit and evaluation for evidence based practice is fundamental to nursing care but similarly to public health.

How the wider system can be used in service design.

Consider clinical governance and how this relates to wider governance (clinical and non clinical); project and programme management and corporate governance systems (clinical and non clinical).

CQC standards and equivalent care inspectorate.

Are systems and process created with service users and co designed across the system? Are local councils involved in planning and wider charities business?

How is this done and how could it be strengthened?

Student nurses need to be familiar with the language of quality improvement, what this means and how it relates to service development.

Consider a service / quality improvement project.

Context of health care:

Students understanding that they work within an organisation and how the organisation fits with the wider delivery of health care for the community and to individuals.

Supporting people with learning disabilities:

Consider connecting with specialist learning disability services, identifying reasonable adjustments for people with learning disabilities such as Health Passports and communication needs.

Consider capacity to consent to health interventions and how decisions are made when capacity is limited.

Have you and the wider community been used to support people to engage and be actively involved in their decision making?

How are patients and service user experiences and patient participation groups used in care planning?

Please also refer to learning opportunities in other sections.

Platform five 

Leading and managing nursing care and working in teams

PHSKF - Public Health Skills and Knowledge Framework

Many of these aims are not specific to public health or to clinical practice.

Supporting the learning of others in service training workforce, service users populations and working with teams and informal carers.

Working to drive improvement in health outcomes and reduction in inequalities.

Student nurses need to be familiar with the language of quality improvement, what this means and how it relates to service development.

Consider a service / quality improvement project.

Consideration of health equality.

Using equality impact assessment tools as a fundamental part of all service planning.

Leadership and teams.

Shared goals and objectives.

Engagement with local communities and individuals in leading care.

Promoting health.


Platform six 

Improving safety and quality of care

PHSKF - Public Health Skills and Knowledge Framework

Links to the learning outcomes for platform 4 and 5.

Co-production evaluation audit.

Consider how governance and health care Legislation is used.

Consider how to conduct risk assessments develop a risk plan implement this and then evaluate the plan.

Health and safety legislation.

Infection prevention and control procedures and the monitoring of these.

Antimicrobial infection would link to health protection opportunities and vaccination.

Use of Personal Protective Equipment (PPE) both in health and care sector but also other industries or workplaces.

See: RCN tools of the trade 

Consider the overall impact supply chain.

See: RCN small changes big differences campaign 

Environmental sustainability issues see: RCN Sustainability and greening the workplace

Platform seven  

Coordinating care

PHSKF - Public Health Skills and Knowledge Framework

These would mirror the learning opportunities as described against platforms 1 and 3 in particular.

Working across systems and understanding the wider determinants of health and how communities and individuals as well as organisations might work together.

Also to consider the economic cost and value of interventions.

Consider an evaluation of a recent health and social care paper and or legislation how this relates to delivering care across the system. Consider the political context of this.

See the RCN resources on the value of nursing.

The value of nursing to public health.

The 'All our health' resources include various return of investment information and data for various aspects of public health.

RCN public health nursing clinical resources.

Consider the wider determinants of health and how these impact on health care.

Feedback and evaluation

We are keen to hear from people who have used this tool and how it has supported wider knowledge and experience in public health.

Please let us know;

  • Students who have used the tool to enhance placement experience and improve understanding of public health.
  • Universities and or placement providers on how you have used the tool to enhanced the learning environments for students to understand their public health role and contribution.

Please see here for an example and share your own experience.


Acknowledgements

With thanks to:

The nursing department professional leads and the RCN Public Health Forum

Claire Cotter MFPH -PHE Programme Manager for the Public Health Skills and Knowledge Framework (PHSKF) (2016)

Pam Hodge - Senior Lecturer in Practice Learning at Middlesex University

Clare Slater-Robins RGN, SCPHN-HV, MSc - Senior CYP Commissioner London Borough of Barnet