Examination of the newborn competency tool

Transcription

1 Examination of the newborn competency tool This tool can be used as a guide to assessment of clinical competence (minimal competence level to be achieved by midwives is four) or simply as a checklist for the. Framework for acquisition of clinical competencies: common assessment tool one This stage is characterised by practitioners moving into an unfamiliar or new area of clinical practice. This relates to the medical aspects of the of the newborn namely: of the eyes, heart and respiratory systems, with palpation of the femoral pulses and of the abdomen and hips. There is no prior experience of situations or circumstances from which conclusions can be successfully reached. The practitioner has attained theoretical knowledge and observed relevant practice. two Practitioners have had some clinical experience in the medical aspects of the. They are able to practise under close supervision applying new knowledge gained to the practical situation in the new areas of clinical practice. three The practitioner is able to perform in simulated or contrived practice settings. The practitioner is able to demonstrate greater integration of theory to practise and identify priorities and is able to recognise the importance of timely referral of any deviations from the normal. Following on from this, if a deviation from the normal is found, the practitioner is able to respond appropriately to changes in care pathways with minimal supervision. Examination of the Newborn: An Evidence-Based Guide, Second Edition. Edited by Anne Lomax John Wiley & Sons, Ltd. Published 2015 by John Wiley & Sons, Ltd. Companion Website: 1

2 2 Examination of the newborn competency tool four The practitioner demonstrates a systematic application of knowledge and a critical awareness of the current clinical situation. Nursing and midwifery practitioners will be able to act autonomously in planning and implementing tasks in professional practice. In situations where referral or ongoing management is required, these practitioners will liaise with the wider multidisciplinary team (MDT) as necessary. They will be able to demonstrate higher levels of decision-making and judgement, performing effectively in complex and demanding situations in partnership with the MDT. The practitioner will also demonstrate self-direction and originality in tackling and solving problems within the parameters of their scope of practice. five The practitioner will demonstrate in-depth knowledge acquired through evidenced-based practice enabling them to develop new insights in order to creatively move practice forward. They will consider the enhanced role within the context of service provision within the Trust and contribute to quality assurance and performance management of the service. They will show an intuitive understanding of critical situations requiring prompt and appropriate referral and will be able to anticipate possibilities that may arise. The practitioner will be able to disseminate knowledge and supervise learners within the multidisciplinary team and ensure that the process is standardised and evidence-based information is readily available to support decision making. Adapted from Benner (1984). Competency 1 Determines the relationship between antenatal and intrapartum events that may impact on the newborn s health status, and subsequent events that may impact on the 6 8-week infant. Benchmarks Knowledge/skills 1.1a: Obtains a comprehensive maternal and neonatal health history at the newborn from the maternal/infant notes Maternal/family history: (health, BMI, nutrition, socio-economic factors) Family history: (heart disease, hip requiring a splint)

3 Examination of the newborn competency tool 3 Benchmarks Knowledge/skills 1.1b: Supplemental discussion with mother/father and clinical staff and analyses the data collected to inform the assessment process at each 1.2: Application of knowledge around transition from fetal to neonatal life so that any deviations of normality managed appropriately 1.3: Demonstrates professional competency by choosing to undertake the (Midwives/Health Visitors/Nurses) or refer to a more appropriately qualified member of staff 1.4: Assembles appropriate equipment and documentation to undertake and document the process Antenatal history: (parity, screening and results, previous pregnancies) Labour history: (length of labour, drugs, induction, presentation of baby, type of birth, management of the third stage Newborn history at birth: birth/delivery, reasons for delivery, monitoring, resuscitation, APGARS, interventions during labour, physiological birth Newborn health since birth: infant feeding, vitamin K, safe-guarding issues Fetal adaptation to extra-uterine life by articulating knowledge of the impact of factors above Code of Conduct, Scope of professional practice, autonomy (all professions) Familiar with equipment and in working order, knowledge of health and safety issues relating to equipment including resuscitation equipment. Documentation process and IT SMART programme. Information leaflets. Clean equipment before and after use

4 4 Examination of the newborn competency tool Competency 2 Ensures that the environment is conducive to effective and safe Benchmarks Knowledge/skills 2.1: Ensures that mother and father s physical and emotional well-being is commensurate with effective communication 2.2: Ensures that infant s physical status is commensurate with an effective 2.3: Enables effective communication of sensitive and confidential information between parent and examiner 2.4: Ensures that the infant s safety and comfort before, during and following completion of Knowledge of the effect of parent s emotional state when receiving information, including hormonal changes and alterations in mood. Recognition of any symptoms of postnatal depression. Impact of partner not being present and effect of unsettled infant if applicable Confirms identity and relationship to adult present. Considers factors influencing effective communication and if appropriate to examine baby by considering: timing of, infant feeding, hygiene and elimination Maintains confidentiality of information by taking into account environment and so on Appropriate environment (heat to maintain normal thermoregulation and light to assess infant colour) undress baby fully but maintain thermoregulation. Examine newborn hips on a firm surface. Dress the infant following completion of the or ask the parent to do so. Parent information around sleep position, co-sleeping, safe transport, car seats

5 Examination of the newborn competency tool 5 Competency 3 Facilitates effective informed decision-making Benchmarks Knowledge/skills 3.1: Ensures that parent/infant s Clear and articulate communication skills physical and emotional status is commensurate to effective through the use of open and closed questioning, active listening and communication and paraphrasing. Ability to engage in by ensuring the following: conversation with parent(s) and pitched at appropriate level (primip, (Reference to competency 2). multip, teenager etc.). Knowledge of cultural issues related to effective communication and use of interpreter if appropriate. 3.2: Mother and Father Value of detection and early intervention, understand reasons for why no failsafe guarantee of future by the is undertaken, an overview is confirming normality at the time of as assessment may detect provided and is aware that some but not all major abnormalities. the mother and father understand the benefits and limitations of the physical 3.3: Elicits mother and father s Recognition that mother and father can view of health/wellness contribute to the assessment of the status of infant and acknowledges any anxieties infant. Ongoing discussion of the issues in context helps parental understanding. The examiner allows opportunity for discussion following 3.4: Obtains consent to Introduces themselves appropriately to undertake in accordance with Trust the woman. Consent obtained once examiner satisfied mother and father policy/standards of understand as above. professional practice 3.5: Draws upon Trust Familiar with and able to adapt Trust guidelines, professional policy in line with NIPE competencies codes for practice to make an informed decision regarding and working within own professional framework. the appropriateness and Able to access and elicit support from timeliness of the and to support dialogue with unit staff should an emergency arise and assistance is required. mother and father. Use of equipment: see 1.4

6 6 Examination of the newborn competency tool Benchmarks Knowledge/skills 3.6: Provides supplementary information following completion of the Knowledge of key public health promotion topics and demonstrates ability to discuss relevant information (SIDS, feeding/nutrition bed-sharing/co-sleeping, skin care). Knowledge of leaflets if appropriate and relevant charity organisations (e.g. STEPS). Competency 4 (please also read supplementary information for this competency) Utilises a holistic, systematic approach, to comprehensively examine the neonate/infant. Benchmarks Knowledge/skills 4.1: cross ref : Uses assessment skills Knowledge of and ability to of inspection, auscultation, percussion correctly perform appropriate technique relevant to the and palpation to system/organ under informed decision-making. Assesses infant behaviour, eyes, auditory, cardio vascular system, respiratory system, hips and genitalia, skin, skeletal and genitourinary systems 4.3: Undertakes observational Accurately records these observations in line with code assessment of infants of record keeping and Trust status at rest documentation 4.4: assess gestational age Currently under discussion 4.5: Completes base line observations for 6 8 week check newborn and at 6 8 weeks

7 Examination of the newborn competency tool 7 Benchmarks Knowledge/skills 4.6: Completes a systematic head to toe physical of the infant in accordance with current recommendations 4.7: Demonstrates and applies knowledge of normal and abnormal development to determine the baby s wellness/altered health status 4.8: Relates assessment findings to, history, underlying pathology or physiological changes 4.9: Ensures that the incorporates all screening activities in accordance with recent National recommendations, which currently include; eyes, heart, hips and genitalia. Note: If appropriate may incorporate first immunisations Ensures logical approach to, at times it may be an opportunistic approach to examining Importance of a logical approach to (this does not imply a fixed order of as this would be determined on an individual basis) and understands importance of initial cardiac prior to undressing/disturbing the baby. Proceed to examine scalp, head, face, mouth ears, eyes, neck, hands and feet, arms and legs, respiratory system, abdomen, skin, umbilicus, genitalia, groin, hips, spine, central nervous system. The should be performed in full unless safety issues dictate otherwise.

8 8 Examination of the newborn competency tool Benchmarks Knowledge/skills 4.10: Discusses health promotion issues relevant to the families socio-economic situation 4.11: Utilises best available evidence to inform analysis of findings 4.12: Distinguishes between abnormal/normal development/presentations and prioritises actions accordingly. 4.13: Utilises communication systems to elicit support from unit personnel should an emergency arise and assistance is required 4.14: Safely and appropriately initiates resuscitation if the baby or parent suddenly 4.15: Works within limitation of own competence and actively seeks assistance when these limitations are reached. Can be assessed theoretically Cross reference to benchmark 3.6 Cross reference to benchmark 5.4 Cross reference to benchmark 3.5 Cross reference to benchmark 3.5 Cross reference to benchmark 1.3 Competency 5 Effectively and sensitively records and communicates findings to mother and father and relevant professionals Benchmarks Knowledge/skills 5.1: Ensures that details of the are correctly documented in accordance with Trust policy including Personal Child Health Record if relevant. IT system for record keeping if relevant. Professional guidelines for record keeping. Knowledge of and familiarity of local documentation to record findings including the recording and follow-up of mother and /or father who did not consent to the.

9 Examination of the newborn competency tool 9 Benchmarks Knowledge/skills 5.2: Sensitively communicated the outcome of the and the need for any referral to the mother and father 5.3: Provides information on the referral process and possible outcomes 5.4: Informs staff of findings both in terms of normality/abnormality and refers the newborn to the appropriate member of staff if advice or confirmation of findings is required. Knowledge of guidelines if having to communicate unexpected findings. Knowledge of false positive/negative results Understanding of the reason for referral and knowledge of what the mother and father may expect at the next stage in the referral process. Awareness of resources available to the mother and father (leaflets/charities) and opportunities provided for further discussions with appropriate staff. Local policies on referral routes for all potential problems identified from the routine of the newborn. Ideally this is directly to paediatric services and if in the community the GP/Community midwives should be aware of referral process. Automatic referral pathway for babies in which risk factors are present, regardless of clinical findings (e.g. family history of DDH) can reduce the incidence of late presentation of hip abnormalities. Knowledge of key staff and how to contact them especially if took place in a community setting. See above. Knowledge of professional issues in relation to the referral process (accountability and duty of care)

10 10 Examination of the newborn competency tool Competency 6 Maintain and further develop professional competence in the of the newborn/6 8 week infant Benchmarks Knowledge/skills 6.1. Professionals trained in the routine of the baby will have the opportunity to maintain their knowledge and skills through practice and periodic updating Undertake study relevant to of the newborn and attend workshops/forums to update knowledge and skills Utilise IT /SMART and other resources to facilitate professional development of self and others. Application of own professional codes. Take responsibility to organise and undertake assessment by a senior practitioner to confirm competence.. Knowledge of national recommendations and Trust policies. Attend Trust forums to maintain knowledge around local Trust practice, maintenance of professional portfolio, access to online journals, attendance and feedback of knowledge acquisition if attending study days funded by Trust. Adapted from UK Screening Committee (Public Health for England) Newborn and Infant Physical Examination Standards and Competencies 2008.