Clinical Skills Development Booklet

Transcription

1 Clinical Skills Development Booklet Pre-Registration BSc (HONS) Adult Nursing Programme Name: Trust: Personal Tutor: Clinical Tutor: Version 1.2 Mar16 JH/TH 1

2 Please place in a file as you will need to take this skills log onto your clinical placements Please ensure to practice these skills under supervision (or simulation where applicable). Always read and adhere to local Trust polices at all times. Above all enjoy your clinical skills development and work closely with your mentors and clinical tutors Version 1.2 Mar16 JH/TH 2

3 Clinical skills Log This skills listed below are divided into three sections, one for each of the years on the course. You will be required to demonstrate achievement of the skills listed for each year by the end of that year. In exceptional circumstances some skills may be carried over into the following year. All skills must be undertaken in keeping with local and national guidelines so you will need to familiarise yourself with these prior to undertaking each skills. Skills will be developed using a three-stage approach (Based on the Miller Pyramid), the descriptions below offer guidance on when each of the stages should be signed. This stage will be signed when the learner has demonstrated a clear understanding of the knowledge underpinning the practice of the skills. This includes (where applicable) the underpinning anatomy and physiology, best practice guidelines, local/national policy, potential risks/complications, overriding purpose/goal and scope of professional practice. No skills should be undertaken (even within a practice scenario) without first achieving this stage. Version 1.2 Mar16 JH/TH 3

4 This stage should be signed when you are able to demonstrate consistent successful implementation of the skill with direct supervision and prompting. This stage may be achieved in clinical practice and/or simulation dependent upon the particular skill in question. You will need to follow the guidance of a suitably qualified practitioner. This stage is signed when you are able to consistently demonstrate the undertaking of the skill without requiring guidance or prompts. The length of time it takes you to get to this stage will vary considerably between different skills and the opportunities you get to practice them. Achieving this stage indicates that you are ready to practice that particular skill without direct supervision. During your training however you will not be able to undertake all of these skills without direct supervision. For some of these skills you will need to wait until you have graduated and gained your registration. These skills are highlighted within the skills log. Version 1.2 Mar16 JH/TH 4

5 Core skills Framework By adopting a shared approach to learning it is envisaged that mandatory training will be standardised, reviewed and developed to ensure agreed standards and quality throughout training within the Higher Educational Institutions and the Trusts. Core skills taught sessions have been integrated into year 1 semester 1 and 2 timetables. Once you have attended the taught session and you have reviewed the learning materials on the Core Skills Framework site, you need to complete the accompanying test. The test will need to be completed before you go on your second clinical placement. Please print your completed test paper as evidence and record the date you completed the test in the table below. Your completed test paper should be kept in your portfolio. Core skill Taught session Date test completed Fire Safety Trust Induction and e-learning Moving and Handling NHS Conflict resolution Equality diversity and human rights Resuscitation adult basic life support Resuscitation child basic life support Health and Safety Clinical skills, Trust induction and e-learning Clinical skills, Trust Induction and e-learning University session and e-learning Trust Induction and e-learning Trust Induction and e-learning Trust induction and e-learning Infection prevention and control Trust Induction, Clinical tutor, University and e-learning Safeguarding children Trust induction and e-learning Safeguarding vulnerable adults Trust induction and e-learning Information governance Trust induction and e- learning Version 1.2 Mar16 JH/TH 5

6 Moving and Handling year 1 Copy to be kept in portfolio MANUAL HANDLING Aim: To enable the student nurse to perform safe manual handling under supervision PRACTICED Tick when completed INSTRUCTED Tick when completed Principles of moving a load Principles of carrying a. baby b. child c. Object Palm to palm support standing Managing falls M & H unconscious and paralysed patients Assisting patients on and off beds and chairs Use of equipment a. slide sheet b. Pat slide c. Hoist d. Transfer board e. Handling blocks Date of skill session attendance Is exposed to the skill and is able to observe in practice Taught under supervision Performs under supervision Signature of Registrant Signature of Registrant Signature of Registrant Signature of Registrant Version 1.2 Mar16 JH/TH 6

7 Basic Life Support (BLS) Year 1 Copy to be kept in portfolio INFANT, CHILD AND ADULT BASIC LIFE SUPPORT- CARDIO PULMONARY RESUSCITATION Aim: To enable the student nurse to deliver effective basic life support PRACTICED Tick when completed INSTRUCTED Tick when completed Discuss importance of competency in basic life support Demonstrate assessment of airway, breathing and circulation Discuss/demonstrate effective ventilation technique Discuss/demonstrate effective cardiac massage Recall cardiac arrest procedure for the clinical environment. Date of skills session Is exposed to the skill and is able to observe in practice Taught under supervision Performs under supervision Signature of Skills Lecturer Signature of Registrant Signature of Registrant Signature of Registrant Version 1.2 Mar16 JH/TH 7

8 1st Year Clinical Skills Hand washing Aim: to develop in the student nurse a knowledge base underpinning the practice of hand -washing and the ability to carry out a taught hand - washing technique. Define hand washing Identify what contaminates and patients most susceptible to infection Identify solutions used for hand washing Demonstrate effective hand washing techniques in practice Discuss reasons for non compliance Discuss the trust infection control policy Measurement of Blood pressure Aim: To introduce the student nurse to the skill of physical observation and assessment. To develop the student nurses ability to assess blood pressure. Recall anatomy and physiology of the cardiovascular system. Define blood pressure. Discuss rationale/indications for recording blood pressure. Identify equipment: Manual and electronic Prepare the patient for the intervention. Demonstrate palpation of both radial and brachial pulses. Collect and prepare equipment. Assess measure and record blood pressure both manually and electronically. Demonstrate knowledge of factors affecting blood pressure variations Version 1.2 Mar16 JH/TH 8

9 Standard Infection Control Precautions / Aseptic Non-Touch Technique Aim: To enable the student nurse to adopt and practice safe aseptic technique and prevention of cross infection. Define asepsis Discuss methods of preventing infection Identify patients most vulnerable Discuss safe principles that underpin practice i.e. hand-washing, dressing, trolley cleaning Demonstrate ability to put on a pair of sterile surgical gloves Demonstrate check and safe opening of sterile instrument packages/additional equipment Participate in an aseptic technique for wound cleansing/dressing change Carry out aseptic technique (under supervision) Discuss how patient was prepared for the procedure physically and psychologically Identify individual Trust/Clinical area policy and procedure Measurement of Oxygen Saturation Aim To introduce the student nurse to the skill of measurement and assessment and oxygen saturation. To develop the student nurses ability to assess and record oxygen saturation Recall anatomy and physiology of the respiratory system. Define what the measurement of oxygen saturation is. Discuss rationale/indications for recording oxygen saturation. Discuss what else is noted when observing and recording oxygen saturation Version 1.2 Mar16 JH/TH 9

10 Measurement of Heart Rate Aim: To introduce the student nurse to the skill of physical observation and assessment. To develop the student nurses ability to assess pulse rate. Recall anatomy and physiology of the cardio-vascular system, in particular the heart. Define what a pulse is. Locate the major pulse points of the body. Discuss what else is noted when palpating & recording pulse besides rate. Prepare the patient for the intervention. Locate, assess and record the radial pulse, the carotid pulse. Discuss factors affecting variations in pulse rate Measurement of Respiratory Rate Aim: To introduce the student nurse to the skill of physical observation and assessment. To develop the student nurses ability to assess respiration rate. Recall anatomy and physiology of the respiratory system. Define what respiration is. Discuss rationale/indications for recording respiration. Discuss what else is noted when observing and recording respiration e.g. depth, rhythm and effort. Version 1.2 Mar16 JH/TH 10

11 Measurement of Temperature Aim: To introduce the student nurse to the skill of physical observation and assessment. To develop the student nurses ability to assess and record temperature. Recall anatomy and physiology of the skin in relation to body temperature control. Identify methods of recording temperature. Discuss rationale for methods identified. Prepare the patient for the intervention. Identify and prepare equipment. Measure and record body temperature at the axilla, in the oral cavity or tympanic membrane Demonstrate knowledge of variations of the norm Choking Aim: To enable the student nurse to deliver safe and effective first aid to a person who is choking by removing the obstruction and restoring normal breathing. Define choking Recall physical signs and symptoms Demonstrate first aid technique to remove an obstruction in an unconscious Adult/Child NB: Unconscious patient: Ensure clear airway Keep checking response Think about other injuries Identify physical symptoms of shocks and demonstrate appropriate first aid Know about the importance of Tetanus Toxoid vaccination. Version 1.2 Mar16 JH/TH 11

12 Pain Management Aim. To introduce the student the importance and management of pain Outcomes To discuss the different types and signs of pain To discuss the factors that affect pain Explain the assessment tools and select the appropriate assessment tool Be able to use a pain assessment tool. To safely and accurately record assessment of the patients pain Demonstrate referral to clinical team reporting the patients pain Understand the action of analgesia and side effects Understand the need to repeat the pain assessment score post analgesia Discuss non-pharmacological methods of reducing pain and promoting comfort. Eating and Drinking Aim: To develop a knowledge base relation to the nutritional requirement of the client across the lifespan. To introduce the student nurse to the principles of undertaking a nutritional assessment and the identification of, and participation in appropriate nursing interventions. Describe basic anatomy and physiology of the gastro-intestinal tract Identify factors influencing a clients nutritional intake Assess potential nutritional requirements of the client using a nutritional assessment tool Plan nutritional interventions Demonstrate appropriate nutritional intervention i.e. assisting a dependent patient. Promotes dignity at all times Version 1.2 Mar16 JH/TH 12

13 Assisting with Nutritional Intake Aim To enable the student nurse to assist patients with nutritional record safely and effectively Explain / discuss the importance of monitoring and record fluid and nutrition intake Identify methods of recording fluid and nutritional intake. Discuss rationale for methods identified. Monitor and record fluid and nutritional intake safely and effectively and report and concerns. Personal Care Bed making Aim: To enable the student nurse to make/change an occupied / unoccupied bed without increasing risk of infection whilst enhancing the patient s comfort. Assess the need for linen change and choice of appropriate method (occupied or unoccupied) Prepares the patient physically & psychologically obtaining consent Prepares linen and equipment Demonstrates a metered corner Demonstrates pillowcase change Make/change a bed Change bed linen while the patient is in bed Discuss reasons/benefits of bed making in relation to patient care Disposes of linen in accordance with the Trust policy (for laundering) Disposes of clinical waste as per Trust policy Version 1.2 Mar16 JH/TH 13

14 Personal Care - Bed bathing Aim: To enable the student nurse to assist a bedfast patient to maintain personal hygiene Assess patients need for bathing and other personal hygiene activities. Assess patients ability to contribute to own care Assess patient safety Recognise physical and psychological barriers for this nursing practice and prepare the patient appropriately. Obtain patient consent Identify and prepare equipment Demonstrate a bed bath Identify positive outcomes for the practice of bed bathing Disposes of clinical waste in line with Trust policy Disposes of bed linen in line with Trust policy (for laundering) Demonstrates dignity and respect at all times Personal Care - Oral Hygiene Aim: To enable the student nurse to perform oral hygiene according to the individual needs of the patient Recall anatomy and physiology of the mouth cavity including the tongue and teeth (or dentures). Identify the need for this nursing Intervention or assisting the patient with this intervention Prepare the patient and obtain consent Able to discuss evidence based policy for mouth care and the equipment or products required Able to discuss assessment for oral care and what underpins regularity of assessment and the performing of oral care Identify, collect and prepare equipment Demonstrate safe and effective oral hygiene technique. Able to use educational strategies with the patient if appropriate Version 1.2 Mar16 JH/TH 14

15 Personal Care- Eye Care Aim: To enable the student nurse to perform eye care (swabbing / irrigation) Identify the need for this intervention Prepare equipment Prepare the patient (or carer) for the procedure and obtain consent Demonstrate effective eye care Adhere to infection control procedures Adhere to individual Trust Policy Continence Care Aim: The student nurse will be able to assist and support the patient with the process of elimination Discuss the process of elimination Define continence Explain the conditions necessary for elimination to occur Discuss nursing care of a patient suffering with altered bladder/bowel function Demonstrate provision of facilities necessary for elimination Discusses the use of a variety of continence products and their use Promotes dignity and compassion at all times during continence care Version 1.2 Mar16 JH/TH 15

16 Urinary Catheterisation and catheter Care Aim: To facilitate safe practice in the skill of urinary catheterisation and care of the indwelling catheter Discuss rationale for urinary catheterisation related to the patient s condition Prepare equipment and discuss rationale for catheter choice Prepare patient physically and psychologically for the procedure obtaining consent Observe the steps of the procedure for urinary catheterisation (female) Undertake catheterization under supervision according to Trust Policy and ANTT principles Discuss choice of drainage systems Discuss associated risks and nursing care which will prevent/reduce these risks Discuss patient education in relation to this intervention Demonstrates accurate record keeping and documentation **Please note some Trusts have a policy that this skill must not be practiced by student nurses until the 2 nd year of the programme. Please discuss this with your clinical tutor** Version 1.2 Mar16 JH/TH 16

17 Urinalysis Aim To enable the students to develop safe and effective skill in urinalysis Able to discuss the need for urinalysis Able to discuss the principles of collecting an MSU, CSU and 24 hour collection of urine Understand the principles of infection control for the safety of the patient and staff Able to check patient identity, prepare the patient and obtain consent Able to prepare the equipment in accordance with local Trust policy Performs relevant checks of urinalysis strips prior to urinalysis Undertake urine specimen whilst maintaining privacy and dignity / cultural attitudes at all times Prevent cross infection during specimen collection during procedure Undertake urinalysis, interpret results, document, act upon and communicate results to clinical team Dispose of the urine specimen and clinical waste appropriately. Identify clear rationale for repeat urine testing Version 1.2 Mar16 JH/TH 17

18 Oxygen Therapy Aim: To enable the student nurse to participate in the care of a patient requiring/receiving oxygen therapy. Review/describe the respiratory system Identify reasons why patients require oxygen therapy Discuss methods of assessing respiratory function Demonstrate/discuss preparation of a patient to receive oxygen therapy physically and psychologically Identify equipment Discuss rationale for low, medium and high flow rates Administer (under supervision) prescribed oxygen to a patient Identify methods to maintain patient comfort Identify hazards Assist with accurate documentation Understand the need for oxygen to be prescribed and administered by a qualified healthcare professional Injection Technique Aim: To enable the student nurse to develop safe and effective skills in the delivery of intramuscular (IM) and subcutaneous (SC) injections Discuss patient preparation for the procedure physically and psychologically Identify safe anatomical sites for IM and SC infections and explain rationales for use Discuss methods of skin preparation (to cleanse or not) Identify equipment needed Draw up medication as prescribed (under supervision) Demonstrate safe injection technique Always under direct supervision Demonstrate safe sharps disposal Discuss policy/procedure should needle stick injury occur Demonstrate accurate record/documentation of drug given Version 1.2 Mar16 JH/TH 18

19 Use of Automated External Defibrillator (AED) Aim: To enable the student nurse to understand the implications, use and safety of AED use This can be completed in simulated scenarios or observed within clinical placements Discusses the need for defibrillation and recognition of basic shock able arrhythmias Demonstrates attaching electrodes in acceptable positions Allows rhythm analysis without touching the or AED Demonstrates rapid and safe delivery of a single shock (including visual check and verbal instruction to stand clear) Resumes CPR immediately, as guided by the voice prompts, starting with chest compressions Minimises interruptions in chest compressions If observed in clinical practice to discuss with mentor and undertake critical reflection and debrief Bleeding and Shock Aim: To introduce student nurses to the principles of first aid. To provide information / facilitate learning which will allow students to act appropriately giving immediate assistance to someone bleeding and or / shocked before the arrival of an ambulance, doctor or appropriately qualified person. (Remember safe approach and A - E) Recall the blood clotting process Recognise types of wounds and identify Recognise/identify types of bleeding Define external bleeding and demonstrate appropriate first aid, pressure dressing, bandaging, and elevation. Define internal bleeding and identify signs and symptoms Identify physical symptoms of shock and demonstrate appropriate first aid Know about the importance of Tetanus Toxoid vaccination. Discuss rapid escalation Version 1.2 Mar16 JH/TH 19

20 Empathy and rapport Aim: To enable the student nurse to demonstrate the ability to listen with empathy Demonstrates safe, effective, compassionate and respectful communication skills Acts in a manner than is attentive, kind, sensitive, compassionate and nondiscriminatory, that values diversity and acts within professional boundaries. Version 1.2 Mar16 JH/TH 20

21 Second Year Clinical Skills Version 1.2 Mar16 JH/TH 21

22 Moving and handling year 2 in addition to year 1 skills Copy to be kelp in portfolio MANUAL HANDLING Aim: To enable the student nurse to perform safe manual handling under supervision STYLE (Assessment of Load) Principles of Moving and Handling Standing and walking person from chair (palm to palm) Turning using Slide Sheet in bed Transfer using PAT slide trolley to bed Transfer using hoist bed to chair Instructed Tick when completed d Tick when completed Solving Problems from / Who to contact - discussion Students signing here agree that: Student Signature: Print Name: a. Instruction and practice has been undertaken as indicated b. They will re-read the University Moving and Handling booklet on the Clinical Skills are of Blackboard Date of skill session attendance Is exposed to the skill and is able to observe in practice Taught under supervision Performs under supervision Signature of Registrant Signature of Registrant Signature of Registrant Signature of Registrant Version 1.2 Mar16 JH/TH 22

23 Moving and Handling skills year 2 In addition to year 1 competencies Copy to be kept in portfolio INFANT, CHILD AND ADULT BASIC LIFE SUPPORT CARDIO PULMONARY RESUSCITATION Aim: To enable the student nurse to deliver effective basic life support Instructed Tick when completed d Tick when completed Reflect on experience in practice Discuss the role of the cardiac arrest team Identify and demonstrate common items of equipment used:- Oral Airways Face masks Ambu bags Et tubes Mini-jets for drug administration Defibrillator Demonstrate effective BLS procedure Date of skill session attendance Is exposed to the skill and is able to observe in practice Taught under supervision Performs under supervision Signature of Registrant Signature of Registrant Signature of Registrant Version 1.2 Mar16 JH/TH 23

24 Blood Glucose Monitoring Aim: To enable the student to develop safe and effective skills in taking and monitoring blood glucose Be able to discuss the reason for the patient needing blood glucose monitoring. Be able to discuss the limitations of using a blood glucose meter. Be able to discuss the rationale for calibrating the meter, ensuring test strips are in date, performing internal Quality Control Discusses the correct method to obtain blood sample. Discusses the significance of test results and how to interpret. Demonstrates the correct operation the meter (Trust equipment only) Abe to check the patients identity and obtain consent Offer reassurance to the patient Discusses and demonstrates the correct procedure for skin preparation. Discusses and demonstrates the correct method to obtain blood sample. s in accordance with Trust Infection Control Policy and Sharps Disposal and Management Policy to avoid needle stick injury. s in accordance with Trust Infection Prevention and Control Policy and Hand Hygiene Procedure and Standard Precautions Procedure to avoid contamination and cross infection. Documents all care given in accordance with Trust policy & procedures. Version 1.2 Mar16 JH/TH 24

25 Care of Patients in Isolation Aim: To enable the student nurse to care for patients in isolation Outcomes Discuss the reason why patients need to be cared for in isolation Discuss methods of preventing infection Identify patients most vulnerable and would need to be cared for in isolation Discuss safe principles that underpin practice this care Discuss how patient was prepared for the care both physically and psychologically Intravenous Therapy Aim: To enable the student nurse to assist in the introduction of intravenous therapy, and to care for a patient who is receiving intravenous fluid replacement therapy Discuss rationale for an intravenous infusion and relate this to the patient s condition Identify intravenous routes for peripheral intravenous therapy Assist with accurate calculation of infusion rates for standard and blood infusion sets Identify equipment necessary Discuss the different fluids used in IV therapy Prime infusion set and interpret fluid prescription sheet (under supervision) Discuss practitioner responsibility in care of a cannula site Demonstrates accurate record keeping Demonstrates accurate fluid balance documentation Understands the risk factors associated with IV therapy Discuss/demonstrate care of a patient receiving fluid replacement therapy Discuss methods which enable the nurse to maintain the intravenous infusion as prescribed and document accordingly. **Please note Student nurses must NOT attach infusion devices or commence/ replace any IV fluids with direct supervision** Version 1.2 Mar16 JH/TH 25

26 Intravenous Therapy Blood Transfusion Therapy Aim: To enable the student nurse to observe, monitor and recognise adverse reactions to blood transfusion therapy in patients PLEASE REFER TO TRUST POLICY FOR STUDENT NURSES Identify the procedure for checking and administrating blood products utilising local trust guidelines (obtaining products from lab or blood fridge) N.B student are not competent to obtain blood products alone Utilise correct checking procedure for patients receiving blood products prior to administration Obtains patient consent Observes qualified clinical staff administering blood products in line with local Trust and National policy Discuss adverse reactions which may occur Demonstrate knowledge of effective response to adverse patient reactions Discuss necessity of 15 minute recording of vital signs Demonstrates accurate documentation Demonstrates accurate record keeping Version 1.2 Mar16 JH/TH 26

27 Percutaneous Feeding Aim To provide the student nurse with knowledge and skill to undertake the care of Percutaneous tubes and assist with feeding (under supervision) Able to link anatomy knowledge to practice Able to discuss the need for percutaneous feeding Able to discuss the impact upon a patients psychological state Able to define gastrostomy, jejunostomy and percutaneous endoscopic gastrostomy Able to discuss the need for monitoring the percutaneous site for signs of infection (including patient reported pain) Discusses the need to observe stoma site for signs of swelling, leakage, redness, irritation, skin erosion or soreness. Demonstrates the timely reporting to senior clinical staff Demonstrates accurate documentation of site observation and actions taken Able to swab the site and send sample for culture and sensitivity if infection is suspected, liaising with senior clinical staff Adheres to local Trust infection control policy when managing and caring for the patient Able to assist with nutritional input via percutaneous tube as prescribed by dietician under supervision of a qualified practitioner Able to assist with the administration of prescribed medication under supervision of a qualified practitioner Demonstrates accurate documentation of the above Version 1.2 Mar16 JH/TH 27

28 Nasogastric Tube Insertion and Care Aim: To familiarise the student nurse with the procedure and practice of nasogastric intubation. Review/Describe the gastrointestinal tract Discuss indications for nasogastric intubation Discuss the different NG tubes and their uses Identify and prepare equipment required for the procedure Demonstrate/discuss preparation of the patient physically and psychologically including consent for the procedure Observe the procedure of passing a nasogastric tube and rationale for actions undertaken Discuss the methods of checking the correct placement of the nasogastic tube Discuss patient care and safety Discuss indications for nasogastric feeding relate to the patient s condition Identify and prepare equipment Discuss associated complications with this intervention and nursing care which will help prevent/reduce these including the checking and documenting of tube placement at every shift Discuss indications of tube displacement Discuss actions required if tube displacement suspected Discuss Trust policy and guidelines on techniques and procedures to ensure correct tube placement for patient safety **Please refer to individual Trust Policy and discuss with Clinical tutors. Many Trusts do not allow student nurses to pass nasogastic tubes even under supervision** Version 1.2 Mar16 JH/TH 28

29 Three & Twelve Lead ECG Measurement Aim To enable student to develop safe and effective skills in assisting in measuring and reading three and twelve lead ECGs Able to describe the normal conduction pathway and associated events in the cardiac cycle. Able to discuss the need for 3 or 12 lead ECG monitoring/procedure Able to explain the need for ECG machine to be kept on charge, cleaned and checked in accordance with local Trust policy for infection control Able to prepare and reassure the patient including obtaining consent Demonstrate ability to position patients ensuring satisfactory recording. Able to correctly place electrodes on the patient promoting dignity and comfort Discuss Einthoven s triangle Able to discuss the factors associated with artifacts and how to troubleshoot these Able to undertake a 12 lead ECG procedure under supervision Demonstrates the safe disposal of clinical waste adhering to local Trust policy Able to demonstrate the need for skin care and post procedural skin monitoring observing for any reactions to electrode adhesive products Able to recognized normal sinus rhythm Able to interpret 3 basic arrhythmias Demonstrates immediate reporting to senior clinical staff if arrhythmias detected Demonstrates accurate record keeping Version 1.2 Mar16 JH/TH 29

30 Neurological Observations Aim: To provide the student nurse with knowledge and skill to undertake neurological observations and to record and repeat them accurately Define what neurological observations are Identify why they are carried out and who requires them Identify equipment required to record neurological observations Demonstrate the application of the Glasgow Coma Scale. Demonstrate neurological observations under supervision Document neurological observations accurately under the supervision of mentor Discuss the implications of neurological observations Discuss signs of neurological deterioration Able to discuss escalation if deterioration suspected Early Warning Scores (EWS) - (NEWS) National early warning score Aim To enable student to develop skills to safely and effectively monitoring, record and report early warning scores To understand the importance of correctly using EWS and effective use of the monitoring and escalation plan Signed Signed Signed To demonstrate competence when using the Adult Observation Chart and Early Warning Scoring (EWS) tool as per Trust Policy and Guidelines To discuss the outcome of the EWS for individual patients and possible actions to be taken in consultation with senior members of the clinical team To achieve quality, safe and timely clinical care through proficient measurement, recording, and communicating of changes in observations and EWS score to senior members of the clinical team. **Please note the use of NEWS was advocated by the Royal College of physicians in May It is vital you adhere to your individual local Trust policy** Version 1.2 Mar16 JH/TH 30

31 Unconscious Patients Aim To provide the student nurse with knowledge and skill to care for the unconscious patient Define consciousness and have an understanding of the related anatomy and physiology. Discuss the various levels of impaired consciousness. List the causes of unconsciousness. Able to assess the conscious level of patients documenting accurately Able to identify and discuss the total needs of the unconscious patient Prioritise patient care, recognising the skills required for the assessment, planning and implementation of nursing care. Demonstrates timely referral to senior clinical staff when changes are detected Able to offer support and reassurance to family/carers Wound Drainage To provide the student nurse with knowledge and skill to undertake monitor and record wound drainage accurately Able to discuss the need for wound drains applying anatomy and physiology knowledge Able to identify and discuss the various types wound drainage systems Able to discuss the management of wound drainage systems reducing the risk of mechanical injury Able to discuss the management of wound drainage systems adhering to local Trust infection control guidelines Able to identify types of/measure wound drainage adhering to local Trust infection control guidelines Able to accurately record wound drainage/puncture site and refer to senior clinical staff if detecting signs of infection and/or bleeding Able to educate the patient on the care of wound drainage system Monitor patient for pain and comfort Version 1.2 Mar16 JH/TH 31

32 Suture/Clip Removal To provide the student nurse with knowledge and skill to undertake suture and clip removal (under Supervision) accurately Able to describe the anatomy and physiology of the skin Able to discuss the process of wound healing Discusses the need for suture/clip removal and describes the procedure Able to discuss signs of wound infection and action to be taken including obtaining a wound swab Able to prepare equipment for procedure Identifies patient, explains procedure and obtains consent. Positions patient in a position so that sutures/staples/clip are accessible and without undue tension ensuring privacy and dignity at all times Assess wound edges prior and post. Performs suture/clip removal under supervision according to local Trust policy using ANTT using correct technique whilst monitoring patient comfort Understands when to stop procedure and consult senior clinical staff if drainage or dehiscence of wound detected. Performs wound care as per protocol Documents procedure and appearance of wound site accurately. Print Print Version 1.2 Mar16 JH/TH 32

33 MRSA Screening Aim To provide the student nurse with knowledge and skill to undertake MRSA Screening accurately Able to define MRSA and its management/treatment Able to discuss the local Trust policy for MRSA screening Able to assemble the equipment required for MRSA screening Able to identify the patient and obtain consent offering reassurance Able to perform MRSA screening using the correct swab procedure according to Trust policy ensuring dignity and respect at all times Adheres to Trust policy for infection control and the use of universal precautions Labels swabs and microbiology forms accurately ensuring samples are transported to the relevant department in a timely manner Is able to access microbiology results discussing implications and management Able to discuss microbiology results with patients and family/carers Able to discuss care of the patient with MRSA and minimize hospital acquired infection across the clinical area Version 1.2 Mar16 JH/TH 33

34 Specimen Collection (Non-Blood Based) Aim To provide the student nurse with knowledge and skill to undertake specimen collections accurately Able to define reasons for obtaining specimens. Demonstrate understanding of basic anatomy and physiology relevant to the type of specimen collection Discuss the procedures and techniques including specimen types, usual tests and possible adverse effects. Prepare materials and equipment used within the Trust for collection of specimens. Able to identify the patient, the specimen required and obtain consent from the patient Discuss the need for the specimen with the patient Obtains specimen in accordance with Trust guidelines respecting privacy and dignity Demonstrates Infection Prevention and Control measures such as hand hygiene and use of Personal Protective Equipment (PPE) and safe disposal of equipment Demonstrates effective labeling of specimen and timely transportation to relevant department. Demonstrates accurate clinical record keeping and documentation including appropriate referral if required Version 1.2 Mar16 JH/TH 34

35 Principles of Wound Care To provide the student nurse with knowledge and principles of wound care Has been assessed as competent to perform aseptic non touch / clean dressing technique Can identify the 4 main phases of wound healing Can carry out full wound assessment Can state the clinical appearance of: Epithelializing tissue Granulation tissue Slough Maceration Necrotic tissue Infected wound Can rationalise the use of various types of dressing: hydrofilm hydrocolloid hydrofibre hydrogel alginates antimicrobial Records assessment findings on wound care template as per Trust Policy Records evidence of ongoing assessment. Can advise patients about principles of good nutrition, hygiene, mobility and elevation of limbs where this has an impact upon wound care. Can correctly state the method used in taking a wound swab and when this should be done. Disposes of clinical waste in accordance with local infection control guidelines. Can recognise the need for wound debridement and can identify when this should and shouldn t be done. Recognises own limitations with the management of wounds and refers for further assessment by wound care/tissue viability specialists promptly Version 1.2 Mar16 JH/TH 35

36 Pressure Area Care Aim - To provide the student nurse with knowledge and skill to undertake Pressure area care Describes the structure of the skin and its function. Recognises the structures involved in each stage of tissue breakdown Discusses the need for regular positional changes, how these are performed and what underpins the regularity of positional changes Performs a holistic assessment in relation to skin condition identifying areas at risk of pressure related damage. At all times maintains the dignity and safety of the individual during the assessment. Describes the factors that increase individuals risk of developing skin and tissue damage and undertakes the risk assessment in relation to pressure area care and the risk of skin breakdown Describes the importance of a holistic risk assessment. Performs risk assessment appropriate to the individuals risk and plans the care to minimise risk factors where appropriate with individuals and/or carers. Identifies when a risk assessment should be performed. Describe the categories of tissue pressure damage. Performs reliable assessment of pressure areas with supervision. Categorises tissue and skin damage in line with the local protocol with supervision Reliably documents accurate findings of risk and skin assessments. Reliably develops individual care/treatment plans to ensure consistency in care. Performs rational reassessment of individual s risk factors. Refer individuals to specialist services for assistance if required. CONT Version 1.2 Mar16 JH/TH 36

37 Monitor and assess individuals after treatment, reviewing and evaluating care/treatment plans. Undertake treatments and dressings related to the care of wounds. Demonstrate an understanding of the equipment options available for reducing an individual s risk of developing pressure damage. Assists with the ordering and return of equipment for individual patients Fit appropriate equipment to reduce skin damage (for example, pressure relieving devices). Safely use the equipment available for reducing the risk of skin damage Identifies the need to reassess the needs of the individual in relation to equipment provision. Demonstrates an understanding of the importance of accurate nursing records and their impact on nursing care Can access resources to support decision making in relation to maintaining skin health and reducing risk of pressure damage. Has the ability to access National and local guidelines, protocols and research articles in relation to maintaining skin health and reducing risk of pressure damage. Identifies personal and professional responsibilities in the evaluation of the care prescribed. Ensures professional competence in relation to the prevention of skin damage. Monitors level of stock to ensure accessibility of equipment Version 1.2 Mar16 JH/TH 37

38 Pre-Operative Care & Preparation Aim To provide the student nurse with knowledge and skill to undertake Pre-operative care & preparation (under supervision) accurately Objectives: Discuss the objectives of preoperative assessment Define when and where pre-operative assessment should take place and who performs the assessment Discuss the principles of preoperative care Able to demonstrate an insight into the psychological care of the patient offering information and reassurance Able to discuss the need for informed consent whilst observing this in practice Able to discuss and assist with the physical preparation of the patient pre-operatively Able to identify potential risks and hazards pre-operatively and how these are managed/avoided Able to assist in accurate preoperative checks in accordance with local Trust policy Able to accurately document preoperative checks including preoperative patient pathway according to Trust policy (under supervision) Escorts the patient to theatre (with supervision) and observes/assists with patient handover with the delivery of accurate information, using checklists according to policy Demonstrates the caring and support of family/carers throughout the procedure if applicable Version 1.2 Mar16 JH/TH 38

39 Post-Operative Care Aim To provide the student nurse with knowledge and skill to undertake Post -operative care & preparation (under supervision) accurately Discuss the principles of post operative care Discusses and participates in post operative monitoring Able to discuss post operative observations with mentor, including implications Accurately records post operative physiological observations Able to discuss and participate in total post operative care in accordance with relevant pathway and Trust protocol under supervision Able to undertake accurate pain assessment and non pharmacological management (under supervision) Discuss pain assessment score with clinical team member and assist with analgesia administration according to local Trust policy Able to describe the analgesic ladder and classes of analgesia Able to discuss post operative complications and management, including the importance of immediate referral to clinical team members Offers patient reassurance and promotes comfort at all times Version 1.2 Mar16 JH/TH 39

40 Care of the deceased Aim: To enable the student nurse to participate/undertake the procedure of Last Offices for the deceased patient, as appropriate. Discuss own attitudes to death and dying across the lifespan Discuss the clinical situations in which you have encountered death Identify physiological changes which can occur at death Discuss how and who certifies a patients death Respect religion and cultural difference Identify needs of family/carers and the supportive measures which can be offered to them. With support from mentor can assist with the support of families/carers Be familiar with last offices policy/procedure Identify/prepare equipment needed Participate in the last office procedure (with the support of mentor) Able to discuss what happens once the patient has been transferred to the mortuary Able to discuss when and why a post mortem maybe required Version 1.2 Mar16 JH/TH 40

41 3 rd Year Clinical Skills Manual Handling (Update) Year 3 (in addition to year 1 and 2 competencies) Copy to be kept in Portfolio MANUAL HANDLING Aim: To enable the student nurse to perform safe manual handling under supervision in year 3 Instructed Tick when completed d Tick when completed STYLE (Assessment of Load) Principles of Moving and Handling Mentor/registrant/ clinical tutor signature Mentor/registrant/ clinical tutor signature Standing and walking person from chair (palm to palm) Turning using Slide Sheet in bed Print name Print name Transfer using PAT slide trolley to bed Transfer using hoist bed to chair Solving Problems from / Who to contact discussion Students signing here agree that: Student Signature: Print Name: a. Instruction and practice has been undertaken as indicated b. They will re-read the Trust Moving and Handling policy Date of skill session attendance Is exposed to the skill and is able to observe in practice Taught under supervision Performs under supervision Signature of Registrant Signature of Registrant Signature of Registrant Version 1.2 Mar16 JH/TH 41

42 Year 3 Basic life support in addition to years 1 and 2 competencies INFANT, CHILD AND ADULT BASIC LIFE SUPPORT CARDIO PULMONARY RESUSCITATION Aim: To enable the student nurse to deliver effective basic life support Instructed Tick when completed d Tick when completed Demonstrate effective BLS procedure Discuss cardiac arrest in special circumstances Poisoning Drowning Electrocution Pregnancy Explore ventilation of a patient with a tracheostomy Be familiar with drugs used Date of skill session attendance Is exposed to the skill and is able to observe in practice Taught under supervision Performs under supervision Signature of Registrant Signature of Registrant Signature of Registrant Version 1.2 Mar16 JH/TH 42

43 Venepuncture Aim: To demonstrate the knowledge and techniques needed for safe venepuncture. **Whilst you may undertake venepuncture as a skill in the clinical simulation area this is NOT a skill you will be performing as a student nurse. You should, however be able to prepare the patient, the equipment and assist with the location of viable veins for venepuncture. Please refer to individual Trust Polices** Describe relevant anatomy and physiology of the peripheral venous system. Demonstrate familiarity of the equipment to meet the goals of venepuncture and blood sample collection. Prepare the equipment required for the procedure, including the labeling of bottles and forms Identify the patient, obtain consent and prepare the patient psychologically for the procedure. Identify the peripheral veins suitable for venepuncture. Perform venepuncture (clinical simulation only) in line with local Trust policy. Demonstrate and describe infection prevention measures. Dispose of clinical waste and sharps safely Identify measures to minimize and address difficulties encountered during venepuncture. List complications associated with venepuncture, their prevention, management strategies Identify the action required in the event of a needle stick injury or blood and blood fluid exposure. Completes accurate documentation following the procedure Gives psychological to the patient checking puncture site regularly, particularly if the patient is prescribed anticoagulants Version 1.2 Mar16 JH/TH 43

44 Cannulation: Be able to assist with the preparation of the patient for a cannulation procedure and demonstrate the safe assessment, monitoring and documentation of venous cannulas **Whilst you may undertake cannulation as a skill in the clinical simulation area this is NOT a skill you will be performing as a student nurse. You should, however be able to prepare the patient, the equipment and assist with the location of viable veins for cannulation. Please refer to individual Trust Polices** Outcome: KNOWLEDGE Identify local policies and national guidelines regarding peripheral venous cannulation Describe the anatomy and physiology of the venous and arterial circulatory systems. Differentiate between a vein and an artery Identify the physiological need for performing the procedure Identify and describe the following potential hazards relating to peripheral venous cannulation: o Air embolism o Infection o Haematoma o Extravasation o Infiltration o Phlebitis o Faulty equipment o Incorrect cannula fixation PROCEDURE Understands the importance of: Checking the name of the patient against the patient s wristband. Confirming the name of the patient verbally. If verbal identification of identity is not possible, checking the patient s identity with a second practitioner. Assessing the individual needs of the patient. Preparing and demonstrating the correct and appropriate use of equipment. Identifying a suitable vein and positioning the patient appropriately. CONT Version 1.2 Mar16 JH/TH 44

45 Where appropriate, the preparation and use of local anaesthesia as prescribed. Insert a peripheral cannula correctly (simulation only) using ANTT Flush the cannula with 0.9% saline using at least a 10ml syringe (simulation only) Fixate the cannula using the appropriate dressing Safely dispose of all equipment according to Trust policies. Identify the action required in the event of a needle stick injury or blood and blood fluid exposure. Document the procedure correctly MONITORING PATIENT SAFETY Understands the importance of monitoring the cannulation site and documenting any signs of: Pain Infection Haematoma Extravasation Infiltration Phlebitis According to local Trust policy Immediately refers any of the above to mentor or other qualified member of the clinical team REMOVAL OF PERIPHERAL CANNULA Checks the identity of the patient Accurate checking that cannula/correct site of cannula for removal Obtains consent from the patient Discusses and demonstrates infection control Removes the cannula under supervision according to local Trust policy Applies pressure to the cannula site with sterile gauze for 2-3 minutes (or until the bleeding has stopped) Covers the puncture site with sterile dressing Safe disposal of clinical waste and plastic cannula Discusses management if signs of infection are seen including the swabbing of the site/cannula tip to microbiology for C & S Version 1.2 Mar16 JH/TH 45

46 Oral Suctioning: For the student nurse to perform this skill safely and competently PLEASE REFER TO TRUST POLICY Outcome: Can explain the basic anatomy of the upper airway and buccal area Understands the indications for oral cavity suctioning Can identify general reasons for oral suctioning Shows a clear understanding of contraindications and complications in oral suctioning Can explain all parts of the oral suctioning equipment and demonstrates correct set up procedure Gains consent and explains procedure Positions patient in comfortable and effective position Uses correct PPE and infection control technique Demonstrates safe oral suctioning technique under the supervision of qualified healthcare professional Version 1.2 Mar16 JH/TH 46