Table 2

Technical and non-technical skills and knowledge specific information required for each respiratory condition

	Technical skills	Non-technical skills	Knowledge
Asthma	Carry out: S_pO₂ (arterial saturation) Respiratory rate Heart rate and pulse assessment Administration of steroids Accessory muscle use assessment ABG Spirometry and reversibility testing Blood collection for blood testing Breathing exercise programmes Chest auscultation Sputum collection including sputum induction Skin testing Weight monitoring F_eNO testing Monitor: PEF FEV₁ P_aO₂ P_aCO₂ FVC Administer: Oxygen therapy Bronchodilators i.v. fluids Monoclonal antibodies	Education: Training patient on inhaler technique Asthma education and support PEF recording with written PEF and symptoms based PAAP Comorbid issues Good asthma control during pregnancy Provide: Personal action plans Asthma control questionnaire Mini AQLQ Support: Organise GP follow up On-going clinical support via follow-up Via self-management plan and personal action plan	Understand: Types of asthma severity Different clinical values for adults and children Coexistence of atopic disease Spirometry Comorbidities and contributing factors Allergens Chest radiographs How an inhaler works Understand pharmacology of: Steroids Bronchodilators Oxygen
COPD	Carry out: S_pO₂ ABG Calorie and food intake Weight measurement Breathing exercises Monitor: FEV₁ Noninvasive ventilation Invasive ventilation P_aO₂ P_aCO₂ Administer: Oxygen therapy Bronchodilator administration Steroid administration	Education: Training patient on oral and inhaled therapies Inhaler technique To promote better self-management Education for maintenance regime Instructions for therapy Provide: Care plan and management plans Nutritional plan Intervention implementation Support: Ensure 2 week follow-up is booked in SGRQ Post-discharge plan	Understand: Palliative treatment and management Weight loss and muscle loss in end stage COPD How to treat weight loss, muscle loss and bone mineral density loss via diet and nutritional supplementation Depression and anxiety Invasive and noninvasive ventilation Understand pharmacology of: Corticosteroids Bronchodilators Oxygen therapy
Lung cancer	Carry out: Weight measurement Calorie and food intake Sleep monitoring Wound management Air leak management (ventilation) Monitor: T_LCO FEV₁ V′_O₂ Administer: Opioid drug administration	Education: Disease education Support: Follow-up appointment booked Give protocol driven follow-up Contact given for a lung cancer nurse Ensure: Documents, personal information, consent and allergies are filled out Good communication skills with patient	Understand: Different types of cancer Communication needs and methods Pre- and post-surgery needs Anxiety and depression BMI Caloric requirements Understand pharmacology of: Radiotherapy and management Chemotherapy and management Opioids
Pneumonia	Carry out: Respiratory rate Blood pressure Blood testing S_pO₂ Sputum culture collection Urinary collection and testing Mental test/mental status Swallowing assessment Secretion collection Blood collection for blood test Monitor: P_aO₂ F_IO₂ Temperature positive pressure ventilation Noninvasive ventilation Invasive ventilation Administer: Antibiotics	Education: Oral hygiene skills Provide: Communication on discharge about how symptoms should improve in a timeframe	Understand: Blood test result interpretation CRB-65 score and CURB-65 score Mental test scores and how to administer Urine antigen testing Swallowing assessment Local microbial pathogens if hospital acquired pneumonia Importance of oral hygiene Microbiology Difference between viral and bacterial pneumonia Noninvasive and invasive ventilation Understand antibiotic resistance issues Understand pharmacology of: Antibiotic therapy and antibiotic resistance issues
Smoking cessation	Administer: NRT including licensed nicotine-containing products	Education: Pharmacotherapies and non-pharmacotherapies Provide: Information for behavioural support Brief intervention on smoking cessation Support: Ensure patient receives referral for smoking cessation Ensure access/referral to non-pharmacotherapies including counselling Ensure: Equipment understanding	Understand: Smoking cessation with regards to respiratory conditions Anxiety and depression Behavioural changes when a patient stops smoking Understand pharmacology of: NRT and other licensed nicotine-containing products Understand pharmacotherapies and non-pharmacotherapies
Influenza	Carry out: Temperature Respiratory rate Blood pressure ECG Blood collection for blood test Nose and throat swab Urine collection and testing Sputum collection Tracheal/endotracheal aspirate sample Pulse oximetry Mental status assessment Fluid chart monitoring Glasgow coma scale Chest assessment Infection control procedure Monitor and/or perform: P_aO₂ Inspired oxygen concentration Administer: Oxygen therapy Antibiotics Antivirals	Education: Medication, smoking and lifestyle advice Illness, treatments and treatment schedule Provide: Action plan in event of relapse of symptoms Support: Ensure patient is aware that 6 week follow-up is required Ensure: Nurse carries out assessment of the likelihood of influenza	Understand: Symptoms and complications CRB-65 score Difference between bacterial and viral infections Dietary and fluid needs Signs and septicaemia Components of chest assessment in assessing respiratory distress Infection control procedures Understand pharmacology of: Antibiotic therapy and antibiotic resistance issues Understand antiviral drugs including side-effects
Oxygen therapy	Carry out: Pulse oximetry Respiratory rate Heart rate Blood pressure ABG Earlobe blood gases Positioning of patient Monitor: Inspired oxygen concentration Noninvasive ventilation F_IO₂ P_aO₂ Administer: Oxygen administration Bronchodilator administration	Education: On need for oxygen to assist compliance	Understand: Oxygen transfer Oxygen delivery equipment National early warning score How to monitor oxygen saturation range When and how to reduce oxygen in a stable patient Difference between hypoxaemia and breathlessness Posture positioning Target S_pO₂ and how to maintain Oxygen carrying capacity of the blood Adverse effects Drug and oxygen administration chart Recording of S_pO₂ and delivery system on chart Oxygen prescription Understand pharmacology of: Oxygen therapy Drug treatments
TB	Carry out: Sputum and secretion sample collection Aerosol-generating procedures including, sputum induction and nebuliser treatment Sample collection from various sites of mycobacterial disease Blood testing Skin testing Administer: Drug treatments Neonatal BCG vaccination	Education: Communicate on discharge the symptoms of TB and contact details for a relapse Education on factors of adherence including management of TB Medication education Provide: Education booklet on discharge Referral to support groups Ensure: Nurse carries out risk assessment for treatment adherence Transportation and correct identification of samples	Understand: Mantoux testing Clinical testing tools Infection control Directly observed therapy Drug-resistant TB More at risk groups for TB Clinical features of TB and HIV Microbiology background and how antibiotics work TB transmission Hospital policy Non-compliance and strategies to improve compliance Personal protective equipment Understand pharmacology of: Neonatal BCG vaccination Drug treatments
PR	Perform: MRC dyspnoea scale Administer: Oxygen therapy	Provide: Ensure patient has access to or is booked into a PR programme Encouragement	Understand: Pulmonary programmes and what is involved Physiological and sociological impact of PR MRC dyspnoea scale Oxygen therapy in PR context Assessment and outcome measures and techniques Role of PR in integrated care of patients with chronic respiratory disease Delivery of PR Benefits of PR

TB: tuberculosis; PR: pulmonary rehabilitation; S_pO₂: arterial oxygen saturation measured by pulse oximetry; ABG: arterial blood gases; F_eNO: exhaled nitric oxide fraction; PEF: peak expiratory flow; FEV₁: forced expiratory volume in 1 s; P_aO₂: arterial oxygen tension; P_aCO₂: arterial carbon dioxide tension; FVC: forced vital capacity; PAAP: personalised asthma action plan; AQLQ: Asthma Quality of Life Questionnaire; GP: general practitioner; SGRQ: St George’s Respiratory Questionnaire; T_LCO: transfer factor of the lung for carbon monoxide; V′_O₂: oxygen uptake; BMI: body mass index; F_IO₂: inspiratory oxygen fraction; CRB-65: confusion, respiratory rate ≥30 breaths·min^-1, blood pressure <90 mmHg (systolic) or ≤60 mmHg (diastolic), age ≥65 years; CURB-65: confusion, urea >7 mmol·L^-1, respiratory rate ≥30 breaths·min^-1, blood pressure <90 mmHg (systolic) or ≤60 mmHg (diastolic), age ≥65 years; NRT: nicotine replacement therapy; BCG bacille Calmette-Guérin; MRC: Medical Research Council.