RDGY30560

This module was initially developed following Statutory Instrument (S.I.) No. 303 European Communities (Medical Ionising Radiation Protection) (Amendment) Regulation 2007 and continues to be supported by recent update of the legislation (SI 256 2018) to infer the specific knowledge, skills and competence on students to refer patients for radiological procedures. This statutory instrument amended the definition of referrers of medical ionising radiation to include registered nurses maintained on the register of nurses by An Bord Altranais. The development and delivery of a standardised national education programme facilitates nurses to develop the competencies necessary to fulfil their role as referrers for radiological procedures. The nurse education programme was developed in consultation with key stakeholders and aims to support this collaborative multidisciplinary approach in introducing nurses to the basic prinicple and theories when referring patients for radiological procedures. In line with the new legislation, SI 256 2018, the term prescriber has been superceded by the term referrer.

This module will be structured with reference to the Professional Standards of Nursing document titled ‘Nurse authority to refer for radiological procedures' and will consist of two distinct components, theoretical and clinical.

THEORETICAL COMPONENT:
The theoretical component can be broadly divided into 3 parts:
1. Principles of the referring process for radiological procedures:
The current guidelines on making the best use of the department of clinical radiology will be discussed along with other referring guidelines such as the Ottawa rules, and other best practice guidelines. Consideration of appropriate referring practice will be also discussed in line with iRefer guidelines. Each of the areas within the scope of practice will be considered. Working in a multi-disciplinary team to refer for radiological procedures will be explored and difficulties and strengths identified. Specified learning activities in this unit will include the consideration of common referral pathways and the appropriate justification of radiological procedures.
The issues considered here will also form a best practice baseline for the students clinical practice and when referring patients in the clinical environment. The student will have to consider their responsibilities, under the law, guidelines and local rules while understanding the potential dangers of referring for justified radiological procedures.

2. Ionising Radiation and Protection:
The nature of radiation and its biological effects will be explained. The relative dangers of radiation will be explained in terms that can be used to ease the concerns of patients. Justification, optimisation and diagnostic dose limitation will be discussed. There will be consideration of specific literature on these three pillars of radiation protection. The area of justification of x-rays will be of particular importance, with specific focus on referring the paediatric patient for radiologic procedures. Issues pertaining to MRI safety will also be covered here and should be explained on in the clinical setting.


3. Professional Accountability and Responsibility and the Associated Legal and Ethical Aspects:
This will encompass the professional responsibilities of the referrer when requesting a radiological procedure for adults and children. The roles and responsibilities of each of the groups involved in the use of ionising radiation will be outlined. Legislation, guidelines, codes of practice and local rules will be considered.

CLINICAL COMPONENT:
The aim of the clinical practice experience is to enable the student, with the support of their clinical superviser, to integrate theory and practice as they work and refer patients for radiological procedures within their scope of practice.
This process aims to facilitate the progressive development of the clinical skills, knowledge and competence in relation to referring a patient for radiological procedures and thereby achieving the learning outcomes. The clinical component of the education programme will be provided in the specific clinical area in which the nurse is practicing.

ASSESSMENT STRATEGIES:
Theoretical Assessment - Total: 90%
MCQ 40%
Reflective Essay (2500 words) 50%

Clinical Assessment (10%)
Clinical Portfolio:
Record of no less than 10 supervised episodes of referring patients for radiological procedures reflective of scope of practice.
5 episodes should reflect adult referral episodes and 5 should reflect paediatric episodes.
Two oral assessments to be undertaken by the clinical supervisor at episodes 5 and 10: Pass /Fail
As part of the must-pass clinical portfolio, 100 hours of supervised clinical hours working in the referrers area of practice should be documented. This time is necessary to allow the referrer to consolidate their skills in transferring their theoretical knowledge into clinical practice.