STANDARDS FOR PRACTICE Parkinson’s Disease and Movement Disorder Nurse Specialists 2026 3rd Edition

Grading:	Competent Nurse	Experienced Specialist Nurse	Expert Specialist Nurse
Parkinson’s Disease and Movement Disorder Nurse Specialist Standards for Practice (ANNA MDC)	Competent Nurse	Experienced Specialist Nurse	Expert Specialist Nurse
PDNSA Competencies: A Competency Framework for Nurses Working in Parkinson’s Disease Management	Competent Nurse	Experienced Specialist Nurse	Expert Specialist Nurse
Corresponding Level of Post-Graduate Education	Bachelor of Nursing Working towards post graduate education	Graduate Certificate Graduate Diploma Working towards Master degree or PhD	Masters PhD
Benner’s stages of clinical competence (1984)	Competent Nurse	Proficient Nurse	Expert Nurse
State / Country Grading:	Competent Nurse	Experienced Specialist Nurse	Expert Specialist Nurse
New South Wales	Registered Nurse Clinical Nurse Specialist Grade 1	Clinical Nurse Specialist Grade 2 Clinical Nurse Consultant Grade 1, 2	Clinical Nurse Consultant Grade 2, 3 Nurse Practitioner
Queensland	Nurse Grade 5 Registered Nurse	Nurse Grade 6 Clinical Nurse	Nurse Grade 7 Clinical Nurse Consultant Nurse Practitioner
Victoria	Registered Nurse (Grade2)	Clinical Nurse Specialist (Grade 3)	Clinical Nurse Consultant (Grade 4~5) Nurse Practitioner
South Australia	RN level 1	RN Level 2 (Clinical Nurse)	RN Level 3 (Clinical Nurse Consultant) Nurse Practitioner
Western Australia	RN Level 1–2	Senior registered Nurse level 1–4	Senior registered nurse Level 5–6 Nurse practitioner
Australian Capital Territory	Registered Nurse Level 2	Registered Nurse Level 3 Clinical Nurse	Registered Nurse Level 3 Nurse Practitioner (Registered Nurse level 4, Grade2)
Tasmania	RN Level 2		RN Level 3 (Clinical Nurse Consultant)
Northern Territory	Nurse 3–4	Nurse 5–6	Nurse 7–8
New Zealand	RN level 3–4	Nurse Specialist	Nurse Specialist-Senior Nurse Prescriber Nurse Practitioner

Comprehensive Health Assessment, Formulating Clinical Impressions, and Care Planning

	Competent Nurse	Experienced Specialist Nurse	Expert Specialist Nurse
Comprehensive Health Assessment	Able to enhance clinical assessments into a comprehensive health assessment (CHA) by considering the broader biopsychosocial aspects of care for patients with Parkinson’s disease. This includes awareness of Parkinson’s-specific allied health support, governmental funding guidance, psychological support options, and recognition of carer stress and available support services. Aware of available services, resources, and guidance related to advanced care planning for patients with Parkinson’s disease.	Able to apply comprehensive clinical assessment to target referrals appropriately, specifying reasons for allied health involvement based on individual patient needs. Able to assist patients with governmental documentation, such as NDIS or MAC applications. Engage collaboratively within a multidisciplinary team (MDT) to provide input and expertise in patient care. Supports carer stress management by assessing needs and linking to appropriate services. Able to discuss and support patients in understanding advanced care planning options, facilitate documentation, and make appropriate referrals to specialist services or legal/administrative support.	Able to provide detailed, directive guidance to allied health teams regarding referral rationale, expected interventions, and priorities based on thorough clinical assessment. Acts as a leadership figure within the MDT, guiding treatment planning, coordinating care, and ensuring tasks are appropriately allocated and executed. Advocates for patients in governmental funding applications and access to services. Leads carer support strategies, including stress management, resource allocation, and connection to relevant services, ensuring a comprehensive, patient- and family-centred care plan. Able to lead and coordinate advanced care planning discussions, integrate patient values and clinical context into care decisions, guide completion of formal documentation, liaise with multidisciplinary and external services, and advocate for patient wishes in all aspects of ongoing care.
Formulating Clinical Impressions	Able to identify issues from the comprehensive health assessment and list them clearly. Demonstrates basic understanding of what is happening with the patient.	Able to refine assessment findings to generate a shortlist of likely differential diagnoses and identify key clinical issues affecting the patient. Able to identify issues warranting escalation to senior clinician.	Able to accurately formulate clinical impressions, integrating all assessment findings, and use these to develop comprehensive care plans. Clearly articulates the clinical reasoning behind decisions and prioritisation of treatment decisions.
Care Planning	Able to perform a basic care plan for the patient, addressing immediate and straightforward issues.	Able to create a care plan that considers Parkinson’s disease–related needs alongside biological, psychological, and social factors. Integrates multidisciplinary team (MDT) coordination and ensures appropriate referrals are made to allied health, psychological support, and social services.	Able to develop highly detailed, complex, and comprehensive care plans that integrate disease-specific management, comorbidities, biopsychosocial factors, and long-term patient goals. Coordinates across multiple MDT members, clearly outlining responsibilities, timelines, and follow-up. Plans across multiple time frames, incorporating contingency strategies to anticipate changes in symptoms, complications, or patient circumstances. Includes advanced planning for device-assisted therapies, medication titration, psychological and cognitive support, carer support strategies, social services engagement, and governmental funding applications. Able to prioritise interventions, anticipate potential complications, and document structured escalation pathways while ensuring patient-centred, evidence-based care throughout.

Documentation and Comprehensive Reports

	Competent Nurse	Experienced Specialist Nurse	Expert Specialist Nurse
Documentation	Able to document patient information, assessment findings, and interventions accurately in clinical records. Maintains patient confidentiality in a documentation.	Able to produce structured clinical notes and reports, including assessment summaries, medication changes, care plans, and MDT communications. Documentation is able to clearly support ongoing care and ensure continuity across the care team.	Able to create comprehensive, high-level reports integrating assessment data, diagnostic findings, clinical reasoning, care plans, and MDT input. Tailors documentation for multiple purposes, including referrals, governmental applications, and research summaries. Supports decision-making, service planning, and quality improvement initiatives, while ensuring professional and confidential documentation practices are maintained.

Clinical Knowledge and Understanding of Parkinson’s Disease

	Competent Nurse	Experienced Specialist Nurse	Expert Specialist Nurse
Pathophysiology	Able to clearly demonstrate understanding of dopamine depletion, Lewy body pathology, and the progressive nature of Parkinson’s disease.	Able to demonstrate a deep understanding of dopamine depletion, Lewy body pathology, and Braak’s hypothesis, including the proposed progression of pathology from the gut to the brainstem and subsequently to the midbrain and higher cortical regions, as well as a clear understanding of α-synuclein aggregation processes.	Able to demonstrate a deep understanding of dopamine depletion, Lewy body pathology, and Braak’s hypothesis, including the role of α-synuclein aggregation and propagation, and a clear understanding of how the underlying pathophysiology of atypical parkinsonian syndromes differs from Parkinson’s disease, such as progressive supranuclear palsy (PSP), multiple system atrophy (MSA), vascular parkinsonism (VP), Corticobasal Syndrome (CBS) and Normal Pressure Hydrocephalus (NPH).
Clinical Phenomenology and Symptomatology	Able to demonstrate a clear understanding of ON and OFF motor fluctuations, as well as peak-dose dyskinesia and how these phenomena relate in the context of dopaminergic therapy, dopamine levels and disease progression.	Able to demonstrate a clear understanding of ON and OFF motor fluctuations, as well as peak-dose dyskinesia, intermediate dose symptoms such as diphasic dyskinesias and beginning-of-dose motor deterioration (BDMD), and how these phenomena relate in the context of dopaminergic therapy, dopamine levels and disease progression.	Able to demonstrate an expert-level understanding of ON and OFF motor fluctuations, including peak-dose dyskinesia, intermediate-dose effects such as diphasic dyskinesias, and beginning-of-dose motor deterioration (BDMD), with insight into how these phenomena relate to dopaminergic therapy, dynamic dopamine levels, and disease progression.
	Able to demonstrate a sound understanding of the classic motor features of Parkinson’s disease, including tremor, rigidity, bradykinesia, and postural instability.	Able to demonstrate a sound understanding of the classic motor features of Parkinson’s disease, including tremor, rigidity, bradykinesia, and postural instability, with the ability to recognise atypical presentations that warrant escalation for further assessment by senior clinicians.	Able to demonstrate a expert level understanding of the classic motor features of Parkinson’s disease, including tremor, rigidity, bradykinesia, and postural instability, with the ability to distinguish typical from atypical presentations, identify the likely underlying neuroanatomical regions responsible, and determine which additional targeted examinations are required to guide clinical assessment.
	Able to demonstrate awareness that Parkinson’s disease includes non-motor symptoms, including neuropsychiatric, sleep-related, autonomic, cognitive, and sensory disturbances.	Able to demonstrate understanding of how non-motor symptoms impact Parkinson’s disease management, including assessment of severity, need for escalation, and influence on overall patient care.	Able to demonstrate expertlevel understanding of the different non-motor symptoms, their underlying pathophysiology, and why they occur. Able to integrate this information to guide clinical assessment, inform care planning and direct treatment management.
Differential Diagnosis:	Able to demonstrate awareness of atypical parkinsonian syndromes, including progressive supranuclear palsy (PSP), multiple system atrophy (MSA), vascular parkinsonism (VP), corticobasal syndrome (CBS), and normal pressure hydrocephalus (NPH).	Able to demonstrate an experienced understanding of atypical parkinsonism, including basic phenomenology and recognition of red flags that differentiate these conditions from Parkinson’s disease.	Able to demonstrate expert-level understanding of atypical parkinsonism, including detailed knowledge of clinical presentations, underlying pathophysiology, and neuroanatomical correlates, enabling accurate direction of further targeted investigations, examinations, and assessments.

Clinical Assessment of Parkinson’s Disease

	Competent Nurse	Experienced Specialist Nurse	Expert Specialist Nurse
Clinical Assessment – History	Able to demonstrate awareness of prodromal symptoms of Parkinson’s disease, including early non-motor features, and understand the importance of factors such as age of onset, disease duration, and family history in the clinical context.	Able to demonstrate an experienced understanding of prodromal symptoms and the relevance of age of onset, disease duration, and family history, recognising red flags that may indicate atypical parkinsonism and warrant escalation to senior clinicians. Able to reliably obtain a comprehensive patient history, appreciating its importance in supporting diagnosis and differentiating Parkinson’s disease from other	Able to demonstrate expert understanding of prodromal features, age of onset, disease duration, and family history in the diagnostic weighting of differential diagnoses. Able to obtain a thorough and accurate history for diagnostic and clinical management purposes, integrating this information to guide targeted examination, investigations, and escalation where appropriate.
Clinical Assessment – Certification in Unified Parkinson’s Disease Rating Scale (MDS-UPDRS)	Certified in UPDRS through MDS training and able to administer the test as part of routine history taking.	Certified in UPDRS through MDS, able to administer the assessment confidently, familiar with the flow and structure of the tool, and able to interpret its results to identify gaps or limitations, integrating additional assessments as needed.	Certified in UPDRS through MDS, able to administer the assessment fluently without reference to score sheets or prompts, with near-complete mastery of the tool, and able to use the results to guide management, direct care planning, and target interventions precisely.
Clinical Assessment – Physical Examination	Able to perform a safe clinical examination using UPDRS Part 3 as a guide, including scoring, with attention to patient safety during manoeuvres such as the pull test for postural instability.	Able to conduct a proficient clinical examination using UPDRS Part 3, completing the assessment with smooth flow and minimal prompts, and able to recognise abnormal findings that may indicate atypical features requiring escalation to a senior clinician.	Able to perform the clinical examination proficiently but also identify atypical clinical signs and integrate additional targeted neurological assessments, such as eye movements, cerebellar function, and frontal lobe testing, to correlate with red flags from the history. Able to also analyse the source or root cause of symptom presentation and correlate to neuroanatomy. Uses this integrated information to guide further investigation, management planning, and escalation appropriately.
Clinical Assessment – Other Assessment tools	Able to demonstrate awareness of other and/or MDS-recommended rating scales and able to administer appropriate tools for routine clinical care.	Able to understand which assessment tools and/or MDS-recommended rating scales are suitable for specific clinical settings and when to incorporate additional tools based on patient history and clinical assessment.	Able to select, critically appraise, and develop appropriate rating scales, and design protocols that integrate combinations of scales effectively for clinical service delivery or research, with consideration of the time required for admin-
Clinical Assessment – Cognitive Testing	Able to demonstrate awareness of cognitive assessment tools appropriate for Parkinson’s disease and able to administer them in routine clinical care.	Able to select and administer cognitive tests confidently and understand which tools are most suitable for specific clinical settings or patient contexts.	Able to administer and interpret cognitive assessments in the context of the overall clinical situation, using results to aid in differential diagnosis (including atypical parkinsonism), evaluate suitability for device-assisted therapies such as DBS, and guide treatment planning and clinical management.
Clinical Assessment – Diagnostic Assessments	Able to demonstrate understanding of different diagnostic assessments that may be performed by a PDMDNS based on referral needs, such as levodopa challenge or dose cycles, to support phenomenological characterisation and diagnosis.	Able to proficiently perform diagnostic assessments, including levodopa challenges and medication dose cycles, and adapt these approaches to other diagnostic contexts where appropriate, such as tap tests for suspected normal pressure hydrocephalus (NPH). Able to assist with assessment by systematically acquiring and synthesising clinical evidence to support the establishment of differential diagnoses based on assessment findings.	Able to proficiently perform and critically analyse diagnostic assessment results. Use the findings to direct treatment modifications, recommend medication changes, support referrals for device-assisted therapies, and contribute to revision or refinement of the medical diagnosis in collaboration with medical officers.
Clinical Assessment – Telehealth	Able to conduct structured telehealth assessments for people with Parkinson’s disease, including obtaining a relevant history, assessing motor and non-motor symptoms within the limitations of virtual review, and identifying red flags requiring escalation. Demonstrates understanding of the limitations of telehealth in clinical assessment and when in-person review is required.	Able to perform comprehensive and targeted telehealth assessments, adapting examination techniques to optimise remote evaluation of motor function (e.g. tremor, bradykinesia, gait where feasible) and non-motor symptoms. Able to synthesise information from patients, carers, and available data to support clinical decision-making, including medication adjustments and identification of complications. Demonstrates ability to triage patients appropriately and coordinate care, including escalation to medical staff or arranging face-to-face review when indicated.	Able to lead and deliver advanced telehealth assessments with a high level of clinical reasoning, integrating complex clinical information to guide management decisions. Critically evaluates the reliability and limitations of remote assessments and implements strategies to mitigate these. Uses telehealth findings to independently recommend and guide treatment modifications, contribute to advanced care planning discussions, and support referrals for device-assisted therapies or other specialist services. Provides leadership in developing telehealth models of care, mentoring others, and optimising virtual care delivery for patients with Parkinson’s disease across the service.

Medication Management Disclaimer: Medication dosing and titration for device-assisted therapies (DATs) must only be performed by a nurse with prescribing authority or in collaboration with a medical officer_

	Competent Nurse	Experienced Specialist Nurse	Expert Specialist Nurse
Medication Management - Parkinson’s medications	Able to demonstrate understanding of the mechanisms of action, key differences, and common side effects of Parkinson’s medications, including dopaminergic agents, MAO-B inhibitors, COMT inhibitors, and dopamine agonists.	Able to understand treatment rationale, recognise when medication regimens or schedules appear suboptimal, and identify issues that warrant escalation to senior clinicians.	Able to critically evaluate and optimise prescribing, including dosing, frequency, and titration plans. Able to select appropriate medications based on clinical assessment, patient history, and disease characteristics, and design dosing, scheduling, and titration plans tailored to the individual, while anticipating complications such as dyskinesias or motor fluctuations and adjusting therapy in a structured, evidence-based manner.
Medication Management – Other medications	Able to demonstrate awareness of other medications used to manage conditions commonly associated with Parkinson’s disease, such as restless legs syndrome (RLS), REM sleep behaviour disorder (RBD), constipation, cognitive impairment, and neuropsychiatric symptoms.	Able to recognise symptoms that are not part of the core features of Parkinson’s disease but are commonly associated with the condition. Understands which of these symptoms are potentially treatable and can escalate appropriately for management.	Able to accurately identify Parkinson’s-related symptoms, select and prescribe appropriate treatments with clear clinical rationale, and design titration and care plans tailored to the individual. Understands how these treatments interact with Parkinson’s medications, including potential impacts on symptom control, absorption, and contraindications, to optimise safe and effective overall management.
Medication Management – Side Effect Monitoring	Able to demonstrate awareness of common Parkinson’s medication side effects, such as hypotension, nausea, and dyskinesia.	Able to identify and differentiate medication side effects from non-motor symptoms of Parkinson’s disease, and develop appropriate management strategies to mitigate these side effects.	Able to accurately distinguish medication side effects from disease-related symptoms, design and implement advanced management strategies—including alternative titration approaches—and prescribe or recommend additional medications when appropriate to optimise symptom control while minimising adverse effects.

Professional Leadership

	Competent Nurse	Experienced Specialist Nurse	Expert Specialist Nurse
Professional Development and Leadership	Engaged with peak professional bodies, such as ANNA and MDC, for peer supervision. Demonstrates commitment to personal and professional development by participating in ongoing education related to Parkinson’s disease and nursing practice. Engages in reflective practice, recognising areas for improvement and taking steps to enhance skills and knowledge. Participates in clinical supervision and mentorship.	Contributes to clinical research and quality improvement initiatives to advance care for patients with Parkinson’s disease. Engages in continuous learning and specialisation, staying current with emerging clinical developments and treatments. Actively participates in professional networks and forums, contributing to the evolution and development of Parkinson’s nursing practice. Engaged with generating nurse-led research, publications, and contributions to the evidence base that advance Parkinson’s care and nursing practice.	Teaches advanced clinical skills to colleagues and students, fostering a learning environment for the development of Parkinson’s nursing expertise. Advocates for the continued education and professional development of Parkinson’s nurse specialists within the broader healthcare community. Acts as a leader and instigator in generating nurse-led research, publications, and contributions to the evidence base that advance Parkinson’s care and nursing practice.

Device Assisted Therapies (DAT) Management

	Competent Nurse	Experienced Specialist Nurse	Expert Specialist Nurse
Device Assisted Therapies (DAT) Management – Theory	Able to demonstrate awareness of currently available device-assisted therapies (DATs), including apomorphine, Foslevodopa/Foscarbidopa (Vyalev®), Levodopa-Carbidopa Intestinal Gel (Duodopa®), and Deep Brain Stimulation (DBS), and has a basic understanding of how these treatments work.	Able to demonstrate a solid understanding of DATs, including mechanisms of delivery, identify patients who may be potentially suitable, and provide informed recommendations for referral, advising appropriately on whether a DAT is likely to be beneficial or less suitable based on clinical assessment.	Demonstrates expert knowledge of DATs, including mechanisms of action, treatment suitability to patient, and treatment implications. Able to integrate patient assessment, disease characteristics, and treatment considerations to make informed recommendations and guide clinical decision-making regarding DAT initiation and management.
Device Assisted Therapies (DAT) Management – Apomorphine Injections and Infusions	Able to demonstrate a good understanding of apomorphine therapy, including its role as a rescue treatment and as an infusion therapy, the clinical situations and symptoms for which it is indicated, expected treatment response times and duration of benefit, and the need for side effect monitoring, including impulse control disorders (ICDs).	Able to demonstrate practical understanding of apomorphine therapy, including injections and infusion. Ability to train patients on proper use of the equipment, recognise signs of over- or under-treatment, and escalate appropriately to senior clinicians. Able to perform an apomorphine challenge as part of dose-finding assessment, Able to appropriately perform side effect monitoring and basic management, including prompting ECG monitoring and referral for blood tests to detect Coombs-positive haematologic anaemia. Able to manage infusion pump functions competently, including set-up, adjusting rates, activating safety locks, and troubleshooting issues remotely.	Able to demonstrate expert understanding of apomorphine therapy, including detailed mechanisms of action, dosing, titration, and frequency. Can perform apomorphine challenges independently, identify optimal dosing strategies Able to implement comprehensive side effect monitoring and management, including nausea (with domperidone), ICDs, ECG monitoring for QT prolongation, and appropriate investigations such as Coombs tests. Proficient in managing infusion pump therapy, including setup, rate adjustments, safety locks, troubleshooting, and designing tailored titration plans for initiation or transition of therapy, such as reducing oral medications while increasing infusion rates.
Device Assisted Therapies (DAT) Management – Apomorphine Injections and Infusions	Able to demonstrate a good understanding of apomorphine therapy, including its role as a rescue treatment the clinical situations and and as an infusion therapy, symptoms for which it is indicated, expected treatment response times and duration of benefit, and the need for side effect monitoring, including impulse control disorders (ICDs) and infusion site reactions.	Able to demonstrate practical understanding of apomorphine therapy, including injections and infusion. Ability to train patients on proper use of the equipment, recognise signs of over- or under-treatment, and escalate appropriately to senior clinicians. Able to perform an apomorphine challenge as part of dose-finding assessment. Able to appropriately perform side effect monitoring and basic management, including infusion site reactions, prompting ECG monitoring and referral for blood tests to detect Coombs-positive haematologic anaemia. Able to manage infusion pump functions competently, including set-up, adjusting rates, activating safety locks, and troubleshooting issues remotely.	Able to demonstrate expert understanding of apomorphine therapy, including detailed mechanisms of action, dosing, titration, and frequency. Can perform apomorphine challenges independently, identify optimal dosing strategies. Able to implement comprehensive side effect monitoring and management, including nausea (with domperidone), infusion site reactions, ICDs, ECG monitoring for QT prolongation, and appropriate investigations such as Coombs tests. Proficient in managing infusion pump therapy, including setup, rate adjustments, safety locks, troubleshooting, and designing tailored titration plans for initiation or transition of therapy, such as reducing oral medications while increasing infusion rates.
Device Assisted Therapies (DAT) Management – Foslevodopa/Foscarbidopa (Vyalev®) Infusion	Able to demonstrate a good understanding of Foslevodopa/Foscarbidopa (Vyalev®) therapy, including its role as a continuous subcutaneous levodopa infusion, the clinical situations and symptoms for which it is indicated, expected treatment response times and duration of benefit, and the need for side effect monitoring, including dyskinesias, infusion site reactions, and neuropsychiatric effects.	Able to demonstrate practical understanding of Foslevodopa/Foscarbidopa therapy, including patient education and training on correct use of equipment. Able to recognise signs of over- or under-treatment and escalate appropriately to senior clinicians Able to accurately perform dose calculations when converting from oral levodopa regimens to continuous infusion rates. Able to support initiation and dose-finding processes, monitor treatment response, and perform appropriate side effect monitoring and basic management, including infusion site reactions Able to manage infusion pump functions competently, including set-up, adjusting infusion rates, activating safety locks, and troubleshooting common technical issues remotely.	Able to demonstrate expert understanding of Foslevodopa/Foscarbidopa therapy, including detailed pharmacology, mechanisms of action, dosing principles, titration strategies, and frequency adjustments. Able to accurately perform dose calculations when converting from oral levodopa regimens to continuous infusion rates Able to design and guide tailored titration plans for initiation or transition of therapy, including structured reduction of oral levodopa while optimising infusion dosing Able to implement comprehensive side effect monitoring and management, including dyskinesias, neuropsychiatric complications, autonomic effects, and infusion site reaction. Proficient in advanced infusion pump management, troubleshooting complex issues, and integrating clinical assessment, disease stage, and treatment response to guide long-term therapy planning.
Device Assisted Therapies (DAT) Management – Levodopa Carbidopa Intestinal Gel (LCIG / Duodopa®) Infusion	Able to demonstrate a good understanding of Duodopa® therapy, including its role as a continuous intestinal levodopa infusion, the clinical situations and symptoms for which it is indicated, expected treatment response times and duration of benefit, and common complications associated with PEG-J therapy, including device-related and gastrointestinal issues.	Able to demonstrate practical understanding of Duodopa® therapy, including patient education and training on daily pump use, cassette handling, and basic troubleshooting. Able to recognise signs of over- or under-treatment and escalate appropriately to senior clinicians. Able to support routine PEG-J care, including connector changes, basic stoma assessment, and recognition of common stoma-related complications Able to prompt and support appropriate management, including prescription or escalation for treatments such as hypertonic saline, barrier creams, or topical agents for stoma care, in collaboration with prescribing clinicians.	Able to demonstrate expert understanding of Duodopa® therapy, including pharmacology, dosing principles, titration strategies, and infusion scheduling. Able to perform dose calculations when converting from oral levodopa regimens to intestinal infusion rates and guide structured transitions between therapies. Proficient in advanced PEG-J management, including connector changes, comprehensive stoma assessment and management, troubleshooting device and infusion complications, and directing treatment for stoma-related issues, including prescribing or recommending hypertonic saline, topical creams, and other targeted therapies as appropriate. Able to recognise and diagnose complex gastrointestinal tube complications, such as buried bumper syndrome and bezoar formation, and appropriately escalate care, including referral for imaging and specialist review.
Device Assisted Therapies (DAT) Management – Deep Brain Stimluation (DBS)	Able to demonstrate awareness of Deep Brain Stimulation (DBS) as a treatment option for Parkinson’s disease and other movement disorders, including basic principles of how DBS works, common targets, and general indications. Able to use the patient programmer to perform basic checks, including confirming stimulation is on, current programmed stimulation levels and checking battery status.	Able to demonstrate a solid understanding of DBS therapy, including patient suitability criteria, expected benefits, limitations, and common contraindications. Able to identify patients who may be appropriate for referral based on clinical assessment, motor fluctuations, cognitive and neuropsychiatric status, and response to levodopa. Able to counsel patients at a general level regarding the DBS pathway, perioperative considerations, and realistic expectations, and escalate appropriately to the specialist DBS team. Able to perform basic clinician-level interrogation of the DBS device, accurately document clinician-level settings, and make basic adjustments in collaboration with a DBS clinician. Able to clinically assess and identify basic side effects associated with under or over treatment of DBS.	Able to demonstrate expert-level understanding of DBS therapy, including mechanisms of action, target selection (e.g. STN vs GPi), and the interaction between stimulation and both motor and non-motor symptoms. Able to integrate detailed clinical assessment, neuroanatomical knowledge, cognitive and neuropsychiatric profiles, and medication response to guide treatment suitability, patient selection, and optimal referral timing. Able to perform comprehensive DBS assessment processes, including pre-DBS dose cycles and post-DBS outcome assessments. Able to differentiate Parkinsonian symptoms from stimulation-induced adverse effects to appropriately guide medication adjustments and DBS titration. Able to perform expert-level clinician programming, including full device interrogation and adjustment of stimulation parameters such as amplitude, pulse width, and frequency. Demonstrates advanced proficiency with device- and manufacturer-specific functions, including technologies such as BrainSense and Neurosphere® remote programming capabilities.

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DOI: https://doi.org/10.2478/ajon-2026-0010 | Journal eISSN: 2208-6781 | Journal ISSN: 1032-335X

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Language: English

Page range: 100 - 126

Published on: May 18, 2026

Published by: Australasian Neuroscience Nurses Association

In partnership with: Paradigm Publishing Services

Publication frequency: 2 issues per year

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© 2026 David Tsui, published by Australasian Neuroscience Nurses Association
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Volume 36 (2026): Issue 1 (May 2026)