Programme requirements of clinical experience

Programme requirements of clinical experience The main reason for placing students in clinical placements is for them to experience what nursing is all about in a real life setting. Students need to experience what it is like to be part of a team, to deal with unplanned and unexpected events, to work under pressure, and to accept responsibility for providing delegated nursing interventions. However, apart from the hands-on experience, students are required to complete a limited number of written requirements that are all focused on reflecting and learning in and from clinical practice. This document contains information in regard to the most commonly expected written requirements. It is important to realise that much of this shouldn t be done during the actual time in clinical. On the contrary, while the students may need to collect clinical data while in the practice setting, the expectation of the School is that actual processing of data and fulfilling any other written requirements occur outside of clinical, thus after the clinical shift has finished. The information provided here is for agency staff. It is intended to ensure that preceptors are informed and fully aware of the requirements and expectations placed on students. Such knowledge is vital when preceptoring students. Effective support and guidance can only be provided when preceptors understand the goals of clinical experience in general, and the learning objectives of the students in particular. However, clinical agency staff is not required to deal with the paperwork, this is the responsibility of the CTAs. Copyright Massey University 2015 All rights to this document are reserved. No part may be reproduced, transmitted, transcribed, stored in a non-retrieval system, or translated into any language, in any from or by any means, electronic, mechanical, optical, chemical, manual or in any other manner, without prior permission from Massey University at Wellington, P O Box 756, Wellington. Page 1

Orientation Check List Whenever BN students enter a new practice area, they are required to orientate to this new environment. Proper orientation ensures that students settle in quicker; get to know the layout, and know where to find things. This will directly contribute to health and safety in the workplace, which is a legal requirement, but it also will reduce the student s level of anxiety, which in turn will increase readiness for learning. Please ensure that the orientation check list is completed on the first day of the placement (see: Orientation Check List Form, page 10). If the agency has its own orientation programme/check list, the student is expected to complete that instead. Copyright Massey University 2015 All rights to this document are reserved. No part may be reproduced, transmitted, transcribed, stored in a non-retrieval system, or translated into any language, in any from or by any means, electronic, mechanical, optical, chemical, manual or in any other manner, without prior permission from Massey University at Wellington, P O Box 756, Wellington. Page 2

Individualised Learning Objectives All students are required to develop Individualised Learning Objectives (ILOs) for each clinical placement block. ILOSs require students to reflect on the knowledge they have gained in classroom and from their own independent study, on their experiences in previous placement(s), and the feedback they received. ILOs are the tool to help student think about, and put in writing what it is that they would like to learn/master in their current clinical setting. As a registered nurse supporting students, you may ask yourself the question: What is it that you would like the student to learn while they are in your clinical area? Are there unique nursing interventions (skills) that students can only develop in your practice area? If so, suggest these objectives to the students and help them focus on these areas. ILOs should not have a purely academic component but should always involve a client and nursing skill development. ILOs are intended to stretch the student in terms of their learning. ILOs need to be clear, concise, unambiguous, and measurable and accompanied by criteria that describe in consecutive steps how the student will achieve the objective. Evidence-based practice requires students to engage in a literature search to support their learning/findings. Students have been provided with the following guidelines: Write what it is that you would like to learn (this is the learning objective). This should be concise and focused on knowledge as well as skill development. Clinical learning objectives always include a client. I will competently care for a patient who suffers from osteoarthritis. I will demonstrate competent care for a patient who requires rectal administration of medication. I will demonstrate competent assessment skills (when physical focused you may specify the body system) and document my findings using the agency's forms. An example of an inappropriate ILO would be one where the client is missing: 'To learn how Vit B12 works in the body and in what cases it is used', or: 'Safe handling using hoist'. The former learning objective can be done in a library or at home using the internet, while the latter focuses on a piece of equipment instead of the client. Copyright Massey University 2015 All rights to this document are reserved. No part may be reproduced, transmitted, transcribed, stored in a non-retrieval system, or translated into any language, in any from or by any means, electronic, mechanical, optical, chemical, manual or in any other manner, without prior permission from Massey University at Wellington, P O Box 756, Wellington. Page 3

Once the student has formulated their learning objective, they need to develop performance 'criteria', which outline the steps to be taken to achieve the objective. Performance criteria include such things as: A literature review on the topic/skill/procedure. Review/study related clinical protocols/procedures used by the agency and link this to the literature review; Discuss with the CTA/preceptor the protocols/procedures involved to demonstrate knowledge/understanding; Prepare and inform client and seek their consent prior to performing the intervention; Demonstrate competence in the procedure while ensuring appropriate supervision; Demonstrate knowledge of correct documentation/reporting requirements. We encourage agency staff to become involved in, and support students with individualised learning objectives. What can be learned depends very much on the specific setting and you as the preceptor are the expert in the field. Your input, guidance, and support will be truly appreciated by students and CTAs alike. (See: ILO Exemplar, page 11) Copyright Massey University 2015 All rights to this document are reserved. No part may be reproduced, transmitted, transcribed, stored in a non-retrieval system, or translated into any language, in any from or by any means, electronic, mechanical, optical, chemical, manual or in any other manner, without prior permission from Massey University at Wellington, P O Box 756, Wellington. Page 4

Nursing Care Plan (NCP) The ability to develop a NCP requires in-depth knowledge of the patient, the reason for admission, the main health complaints/concerns, the goals to be aimed for, the selection of appropriate nursing interventions, and strategies to evaluate the effectiveness of the interventions. Even if NCPs are no longer used as frequently as in the past, for educational/learning purposes they are still a very useful tool. For this reason, Massey University requires students to complete NCPs during a variety of clinical placements. NCPs will be adapted to the level the student is at and even the name and format might change slightly i.e. Patient Health Plan. While students are expected to complete the bulk of the writing outside of clinical practice, there is a need to interview patients as well as have access to the patients file in order to obtain the required data. NCP are checked by CTAs but your support and feedback will at all times be truly appreciated. Guidelines for the assessment of clinical nursing care plans Patient assessment Except during the very first clinical experience (168.121), when students have not been taught interview- and health assessment skills (paper 168.123), all NCP submitted for competence assessment, require a comprehensive patient assessment on which the diagnosis, goal setting, interventions, and evaluation will be based. Preferably, students utilise the health/nursing/patient assessment documentation that it routinely used in the clinical agency. An extra page can be used to document additional assessment data obtained through interview, through systematic objective assessment using inspection, palpation, percussion and auscultation, or for information obtained from secondary sources such as family, significant others, health team members, and health records. A combination of functional health patterns and body system review can provide the assessment framework for collecting and organising data which in turn forms the foundation for a personalised nursing care plan. CTA assessment considerations: Has the student used the documentation appropriately? Does the quality of data collected suggest good interview skills? Does the data suggest a comprehensive assessment using subjective and objective data as well as secondary sources? Is the assessment data consistent, accurate and concise, using a set framework to organise the findings? If relevant, have safety concerns been identified and prioritised? Copyright Massey University 2015 All rights to this document are reserved. No part may be reproduced, transmitted, transcribed, stored in a non-retrieval system, or translated into any language, in any from or by any means, electronic, mechanical, optical, chemical, manual or in any other manner, without prior permission from Massey University at Wellington, P O Box 756, Wellington. Page 5

Nursing diagnosis The analysis of client data clusters will lead to the identification of: actual nursing diagnoses: patient response to current health condition(s) risk diagnoses (soime also called potential problem : risk factors that contribute to increased vulnerability wellness diagnoses: opportunities for enhancement of a healthy state Furthermore, nursing diagnoses need to be prioritised, and coping patterns/patient strengths to prevent or resolve the health challenge need to be identified. CTA assessment considerations: Has the right data been clustered, resulting in a well-defined nursing diagnosis? Does the nursing diagnosis encapsulate the health concern/risk identified? Are the nursing diagnoses listed in priority order? Do you as CTA recognise the patient in this NCP? Do the identified nursing diagnoses go beyond the medical diagnosis? Do the identified nursing diagnoses go beyond the patient s physical health (is it holistic)? Nursing outcomes The formulation of outcomes includes measurable, realistic, goals that provide the basis for implementing nursing interventions to prevent, reduce, or eliminate the identified nursing diagnosis/problem. The focus is on health promotion, health maintenance, and health restoration. Nursing outcomes: Provides a basis for individualised care Promotes patient participation Allows for involvement of support people Outcomes are realistic and measurable CTA assessment considerations: Do the nursing outcomes contain measurable goals that are realistic/achievable within the time frame given? Do the outcomes relate to the nursing diagnoses? Is the focus on health promotion, health maintenance, and health restoration? Do the nursing outcomes focus on the individual and does it promote patient participation? Are the outcomes realistic and measurable? Nursing interventions Nursing interventions are all the activities carried out by the nurse to achieve the nursing outcomes. Interventions relate directly to the identified nursing problem and outcome. CTA assessment considerations: Do the nursing interventions relate to the goals aimed for? Do you consider the interventions listed to be appropriate and likely to be effective? Is the full range of nursing interventions prescribed? Copyright Massey University 2015 All rights to this document are reserved. No part may be reproduced, transmitted, transcribed, stored in a non-retrieval system, or translated into any language, in any from or by any means, electronic, mechanical, optical, chemical, manual or in any other manner, without prior permission from Massey University at Wellington, P O Box 756, Wellington. Page 6

Do the nursing interventions reflect a level professional knowledge expected of the student concerned? Nursing evaluation Nursing evaluation is systematic and ongoing, and measures how well the patient has achieved the goals/outcomes specified in the care plan. The evaluation identifies factors that have positively or negatively influenced goal achievement and may lead to changes in nursing interventions. CTA assessment considerations: Is there written evidence of (ongoing) evaluation? Is evaluation of nursing interventions based on patient s responses? Does the evaluation reflect a thorough systematic review of each intervention? Does the evaluation determine whether the nursing outcomes have been achieved? Copyright Massey University 2015 All rights to this document are reserved. No part may be reproduced, transmitted, transcribed, stored in a non-retrieval system, or translated into any language, in any from or by any means, electronic, mechanical, optical, chemical, manual or in any other manner, without prior permission from Massey University at Wellington, P O Box 756, Wellington. Page 7

Clinically-based Written Assignments Depending on the Year Level and the specific paper, students will be required to base some of their academic requirements on data obtained from the clinical setting. The assignment task may for example be a: Case study of a patient actually cared for in the clinical setting; Critical review of a clinical protocol/policy; Proposal for a clinical teaching session with a fully prepared plan including resources; The above list is only a small sample of potential tasks and is certainly not all inclusive. Students are also required to develop a Professional Portfolio which contains a number of different tasks to be completed. While there will be written requirements that change from year to year, there is one rule that will remain applicable to all students and all situations: Students can use clinical time to gather the information they require for the task at hand, but they are not allowed to complete the written requirements during clinical time. The actual writing of the assignment needs to be done after the work day has finished. Competency-based Assessment The assessment of the students clinical competence is the responsibility of the CTA, although it is acknowledged that preceptors play a key role in this activity. Working alongside the students for 8 hours a day, the preceptor is in a privileged position to really get to know the student s capabilities and competence. It is vital that the preceptor provides feedback to the CTA, or raises the alarm if there are concerns. It is the CTA s responsibility to deal with any concerns and ensure that measures are taken to maintain a safe learning environment. It is also the CTA s responsibility to complete the written Competency-based Assessment Form. This assessment process will be completed in two stages but relies heavily on preceptors providing ongoing feedback over the period of the clinical experience. Stage 1: This is the formative assessment undertaken halfway through the clinical experience (or earlier if there are concerns). Formative assessment is feedback, intended to highlight strength and to address any concerns. It occurs largely verbally with the CTA although we encourage preceptors to be present and where possible contribute to the discussion. Stage 2: This is the summative written assessment which is completed at the end of the clinical experience by the CTA with input from the preceptor. Competency-based assessments do Copyright Massey University 2015 All rights to this document are reserved. No part may be reproduced, transmitted, transcribed, stored in a non-retrieval system, or translated into any language, in any from or by any means, electronic, mechanical, optical, chemical, manual or in any other manner, without prior permission from Massey University at Wellington, P O Box 756, Wellington. Page 8

not result in a grade; rather the outcome is expressed in either Pass (being competent), NF (not finalised = not yet competent), or Fail (not competent). All competence-based assessments are based on some or all of the following: observed clinical practice including written client reports; knowledge displayed in face-to-face discussions; student s participation in tutorials; feedback from agency staff (mostly Preceptors); feedback from clients; written documentation such as nursing care plans, case studies etc. The documentation related to summative competence-based assessments are: Competency-based Assessment 100 Level (Year One) page 13 Competency-based Assessment 200 Level (Year Two) page 19 Competency-based Assessment 300 Level (Year Three) page 26 Final Pre-Graduate Competency-based Assessment page 33 Copyright Massey University 2015 All rights to this document are reserved. No part may be reproduced, transmitted, transcribed, stored in a non-retrieval system, or translated into any language, in any from or by any means, electronic, mechanical, optical, chemical, manual or in any other manner, without prior permission from Massey University at Wellington, P O Box 756, Wellington. Page 9

Orientation Check List Form Name of the Agency/Ward: Responsibilities of Student in the event of: Cardiac arrest-phone no., equipment Fire-phone no., exits, extinguishers Civil emergency-phone no. Aggression or violence Date of orientation and sign-off Location of Emergency Equipment including: Oxygen wall outlet, portable Suction wall outlet, portable Resuscitation Trolley bag-valve-mask device Physical layout of agency/ward/unit including: Staff toilet Sluice room, preparation room Linen cupboard Emergency Exits Relevant Protocols/Policies Health and Safety requirements Location of additional equipment: IV pole and fluids Dressing packs and trolleys Charts/Forms: incident forms, FBC, TPR etc Mobility equipment and instruction for safe use Relevant Phone Numbers including: CTA/Practicum lecturer Clinical agency contact number Copyright Massey University 2015 All rights to this document are reserved. No part may be reproduced, transmitted, transcribed, stored in a non-retrieval system, or translated into any language, in any from or by any means, electronic, mechanical, optical, chemical, manual or in any other manner, without prior permission from Massey University at Wellington, P O Box 756, Wellington. Page 10

Exemplar of Individualised Learning Outcome (Yr Two BN) Student Name: Date: Agency s Name: CTA: ILO: I will competently administer medication via IM/SC injection Criteria: (this is what I have to achieve/demonstrate) I will: Study one evidence-based article related to administration of medication via IM/SC injection; Discuss the difference in technique between IM and SC injections, as well as nursing considerations; Demonstrate knowledge of agency s protocols related to the administration of IM/SC medications. Demonstrate skills in the preparation of the medication; Explain the procedure to the client and ask for consent to proceed; Prepare client for nursing intervention; Safely administer medication via IM/SC route under direct supervision; Dispose of used equipment appropriately; Complete all documentation according to protocol; Monitor effects of medication on patient. Self evaluation: CTA s comment: ILO : YES / NO CTA s Signature: Date: Copyright Massey University 2015 All rights to this document are reserved. No part may be reproduced, transmitted, transcribed, stored in a non-retrieval system, or translated into any language, in any from or by any means, electronic, mechanical, optical, chemical, manual or in any other manner, without prior permission from Massey University at Wellington, P O Box 756, Wellington. Page 11

Copyright Massey University 2015 All rights to this document are reserved. No part may be reproduced, transmitted, transcribed, stored in a non-retrieval system, or translated into any language, in any from or by any means, electronic, mechanical, optical, chemical, manual or in any other manner, without prior permission from Massey University at Wellington, P O Box 756, Wellington. Page 12

Competency-based Assessment 100 Level This is a summative assessment. Students need to meet all criteria (lefthand column) as well as any other predetermined requirements in order to pass this paper successfully. Assessment criteria for students at 100 Level of the Bachelor of Nursing programme Student s name: Paper No: 168.1 CTA/Preceptor s name: Clinical placement: Placement period from till Professional responsibility This domain contains competencies that relate to professional, legal and ethical responsibilities and cultural safety. These include being able to demonstrate knowledge and judgement and being accountable for own actions and decisions, while promoting an environment that maximises clients' safety, independence, quality of life and health. Criteria: Indicators at 100 Level: CTA/Preceptor s assessment: Met Not Accepts responsibility for ensuring that his/her nursing practice and conduct meet the standards as set out in this document. Practises nursing in accordance to the guidelines and protocols as set out by Massey University BN programme. Upholds client rights by seeking informed consent prior to any nursing interventions. Accepts responsibility for own actions within scope of practice. Accesses agency s policies and procedural guidelines and acts in accordance with established protocols. At a beginning level, is able to discuss with agency staff/cta specific aspects of policies and procedures that relate to the clinical experience i.e. fire and evacuation procedures, infection control, safe patient handling. Displays behaviour that demonstrates respect for clients, peers/colleagues, agency staff and CTA. Is punctual and reliable; follows through on promises made. Complies with all standards of dress code. 13

Professional responsibility (cont.) Criteria: Indicators at 100 Level: CTA/Preceptor s assessment: Met Not Demonstrates the ability to apply the principles of the Treaty of Waitangi/Te Tiriti 0 Waitangi to nursing practice. Demonstrates accountability for nursing care provided. Promotes an environment that enables client safety, independence, quality of life, and health. Practises nursing in a manner that the client determines as being culturally safe. Is aware of the Treaty of Waitangi/Te Tiriti 0 Waitangi and its relevance to the health of Maori in Aotearoa/New Zealand. Is aware of differing health and socioeconomic status of Maori and non-maori. Avoids imposing prejudice onto others Understands personal accountability as it relates to own nursing actions. Seeks advice from appropriate agency staff when unsure about own role or the nursing skill to be carried out. Arranges for supervision for any skill carried out for the first time in clinical practice. Informs agency staff and/or CTA of any mishap or perceived safety concern. Is aware of the location of emergency equipment and where supplies are stored. At a beginning level maintains infection control principles. Informs agency staff or CTA when the client requests additional support or has limited ability to make decisions. Assists with the provision of care that best meets the needs and interests of the clients. Begins to recognise own beliefs, values and prejudices. Acknowledges each person as a unique individual. Respects the client s right to hold personal beliefs, values and goals. Is aware of the culture of nursing and its potential influence on individual clients. Seeks support and advice from agency staff/cta when unsure about providing culturally safe care. At a beginning level, reflects on own beliefs and values in relation to the client's age, ethnicity, culture, beliefs, gender, sexual orientation and/or disability, and the impact these have on the provision of nursing care. Comments 14

Management of nursing care This domain contains competencies related to client assessment and managing client care, which is responsive to clients' needs, and which is supported by nursing knowledge and evidence based research. Criteria: Indicators at 100 Level: CTA/Preceptor s assessment: Met Not Provides planned nursing care to achieve identified outcomes. At a beginning level, provides delegated care safely and within own scope of practice. Demonstrates a beginning understanding of the processes and environments that support recovery. With supervision/guidance, undertakes fundamental practice procedures and skills in a competent and safe manner. Ensures the client has adequate explanation of the intended nursing care. Undertakes an accurate nursing assessment of clients. Explains to clients the intended nursing care and obtains informed consent prior to commencement of care. With guidance, is able to make appropriate decisions regarding the extent to which the client is capable of participating in his/her care. At a beginning level, is aware of the ethical issues related to nursing practice, (for example: informed consent, privacy, refusal of treatment). Is aware of, and respects the client's right to choose amongst alternatives. Seeks guidance from agency staff/cta regarding the individual's request to change and/or refuse care. Takes the client's preferences into consideration when providing care. At a beginning level, uses an appropriate framework to assess clients. Is able to conduct a limited subjective health assessment. Uses a limited range of assessment tools/equipment appropriately, and is able to discuss normal findings. With guidance, begins to make judgements on the client s health status. Seeks guidance when assessment findings are outside the normal range. 15

Management of nursing care (cont.) Criteria: Indicators at 100 Level: CTA/Preceptor s assessment: Met Not Ensures documentation is accurate and maintains confidentiality of information. With guidance is able to document accurately assessment findings (i.e. TPR, BP) in client records. Is able to write a DRAFT client progress report, demonstrating literacy and the use of a framework (i.e. SOAPIE). Evaluates client's progress toward expected outcomes in partnership with clients. Reflects upon, and evaluates with agency staff/cta the effectiveness of nursing care provided. Maintains professional development. With guidance from agency staff/cta, evaluates the effectiveness of own interactions and interventions in regard to the client s identified needs. Reflects on client s feedback concerning the cares provided Is aware of own level of competence and seeks guidance and direction as necessary. Actively seeks feedback on own performance from agency staff/cta and responds appropriately to feedback. Begins to take responsibility for own professional development and for sharing knowledge with peers/cta. With assistance, sets appropriate learning objectives. Takes part in formal and informal educational sessions. Makes use of learning opportunities as provided by the agency staff. Attends and contributes to tutorials/clinical sessions as provided by the CTA. Attends discussions/team meetings concerning client needs/cares to increase understanding/knowledge. Takes initiative when realising that deficit in knowledge or skills is hindering professional progress. 16

Interpersonal relationships This domain contains competencies related to interpersonal and therapeutic communication with clients, other nursing staff and interprofessional communication and documentation. Criteria: Indicators at 100 Level: CTA/Preceptor s assessment: Met Not Establishes, maintains and concludes therapeutic interpersonal relationships with client. Demonstrates respect, empathy and interest in clients. Establishes rapport and trust with clients. At a beginning level, utilises effective interpersonal skills in interactions with clients. Demonstrates verbal and non-verbal skills of clarification. Responds appropriately to the client s questions and requests. Practises nursing in a negotiated partnership with the client where and when possible. Communicates effectively with clients and members of the health care team. Implements delegated nursing care in partnership with the clients. Implements delegated nursing care in a safe and respectful manner. Begins to recognise, and supports the personal resourcefulness of people with physical illness. Is aware of the importance of family/whanau perspectives and supports their participation in nursing care. At a beginning level, uses a variety of communication techniques. Uses language that is appropriate to the client and context. With assistance establishes alternative communication hods when clients are unable to verbalise. Is aware of the boundaries of a professional relationship and acts accordingly. Raises questions in the appropriate forum. 17

This is a summative assessment. Students need to meet all criteria (lefthand column) as well as any other predetermined requirements in order to pass this paper successfully. Competency-based Assessment 200 Level Assessment criteria for students at 200 Level of the Bachelor of Nursing programme Student s name: Paper No: 168.2 CTA/Preceptor s name: Clinical placement: Placement period from till Professional responsibility This domain contains competencies that relate to professional, legal and ethical responsibilities and cultural safety. These include being able to demonstrate knowledge and judgement and being accountable for own actions and decisions, while promoting an environment that maximises clients' safety, independence, quality of life and health. Criteria: Indicators at 200 Level: CTA/Preceptor s assessment: Met Not Accepts responsibility for ensuring that his/her nursing practice and conduct meet the standards of the professional, ethical and relevant legislated requirements. Practises nursing in accord with the guidelines and protocols as set out by Massey University BN programme. Begins to relate own nursing practice to relevant legislation/codes/policies and upholds clients rights derived from that legislation. Accepts responsibility for own actions, and in partnership with agency staff/cta makes decision within scope of practice. Identifies perceived breaches of law that may occur in practice and discusses these with appropriate agency staff/cta. Accesses and, at a beginning level, demonstrates knowledge of policies and procedural guidelines that have implications for practice. Uses the professional standards of practice as set out in this document. Demonstrates the ability to apply the principles of the Treaty of Waitangi/Te Tiriti 0 Waitangi to nursing practice. At a beginning level, understands the Treaty of Waitangi/Te Tiriti 0 Waitangi and its relevance to the health of Maori in Aotearoa/New Zealand. Is able to discuss the discrepancies of health and socioeconomic status between Maori and non-maori. Begins to apply the Treaty of Waitangi/Te Tiriti 0 Waitangi to nursing practice. 19

Professional responsibility (cont.) Criteria: Indicators at 200 Level: CTA/Preceptor s assessment: Met Not Demonstrates accountability for nursing care provided. Promotes an environment that enables client safety, independence, quality of life, and health. Practises nursing in a manner that the client determines as being culturally safe. Demonstrates accountability for delivering and evaluating nursing care. Seeks advice and clarification from agency staff/cta regarding any aspect of nursing care if unsure. Arranges for supervision for any skill carried out for the first time in clinical practice. Makes appropriate and efficient use of resources available. Informs agency staff when delegated nursing task exceeds personal ability or scope of nursing practice. Begins to identify situations that affect client or staff members' health or safety and reports these appropriately. Knows the location of emergency equipment and supplies and at a beginning level is able to use these. Maintains infection control principles. Recognises potential physical, social and psychological risks for clients in a health care setting and provides care that best meets the needs and interests of clients and the public. Begins to apply the principles of cultural safety in own nursing practice. Is aware of the culture of nursing and its impact on client care and endeavours to protect the client's wellbeing within this culture. Respects each client's identity and right to hold personal beliefs, values and goals. Informs agency staff/cta of the need to assist the client to gain appropriate support and representation from those who understand the client's culture, needs and preferences. Reflects on his/her own practice and values that impact on nursing care in relation to the client's age, ethnicity, culture, beliefs, gender, sexual orientation and/or disability. Avoids imposing prejudice on others and is able to discuss advocacy strategies when prejudice is apparent. 20

Management of nursing care This domain contains competencies related to client assessment and managing client care, which is responsive to clients' needs, and which is supported by nursing knowledge and evidence based research. Criteria: Indicators at 200 Level: CTA/Preceptor s assessment: Met Not Provides planned nursing care to achieve identified outcomes. Ensures the client has adequate explanation of the effects, consequences of the proposed nursing care options. Works in close collaboration with clients and agency staff/cta when planning care, and demonstrates an understanding of the client s right to make informed decisions. At a beginning level, demonstrates understanding of the processes and environments that support recovery and healing. Nursing care is based on situational and current knowledge and supported by clear rationale. Undertakes appropriately delegated practice procedures and skills in a competent and safe way. Administers medications in accordance to agency policies and under direct supervision of agency staff/cta. Provides clients with appropriate information concerning intended nursing care to protect their rights and to allow informed decision-making. Begins to take into account the readiness of the client to participate in health education. With guidance, makes appropriate professional judgement regarding the extent to which the client is capable of participating in decisions related to his/her care. At a beginning level, discusses ethical issues related to health care/nursing practice, (for example: informed consent, privacy, refusal of treatment and rights of formal and informal clients). Assists in the facilitation of the client's access to appropriate therapies or interventions. Respects the client's right to choose amongst alternatives. Seeks clarification from relevant members of the health care team regarding the individual's request to change and/or refuse care. Takes the client's preferences into consideration when providing care. 21

Management of nursing care (cont.) Criteria: Indicators at 200 Level: CTA/Preceptor s assessment: Met Not Undertakes a comprehensive and accurate nursing assessment of clients in a variety of settings. Ensures documentation is accurate and maintains confidentiality of information. Acts appropriately to protect oneself and others when faced with unexpected client responses, confrontation, personal threat or other crisis situations. Evaluates client's progress toward expected outcomes in partnership with clients. Assists with, and uses an appropriate framework to assess and determine client health status. Is able to conduct a subjective health assessment Uses suitable assessment tools/equipment to assist the collection of objective data. Reports and seeks guidance when assessment findings are outside the normal range. Begins to apply relevant research data to underpin nursing assessment. With guidance, maintains clear, concise, accurate client records. Begins to understand the legal and ethical aspects that applies to documentation. With minimal guidance is able to complete a wide range of forms that are part of nursing documentation (i.e. FBC, diabetic record, PF record). Is aware of the agency s emergency procedures and lines of communication in a crisis situation. Informs immediately agency staff of any situation that compromise client safety and wellbeing. Is aware of own limitations and seeks assistance as necessary. At a beginning level, identifies criteria for evaluation of expected outcomes of care. With guidance from agency staff/cta and in collaboration with the client, evaluates the effectiveness of the client's response to prescribed treatments, interventions and health education. Reflects on client feedback on the evaluation of nursing care and health service delivery. 22

Management of nursing care (cont.) Criteria: Indicators at 200 Level: CTA/Preceptor s assessment: Met Not Provides health education appropriate to the needs of the client within a nursing framework. Checks clients' level of understanding of health care when answering their questions and providing information. At a beginning level, uses informal and formal hods of teaching that are appropriate to the client's abilities. Begins to participates in health education, and ensures client understands relevant information related to their health care. Reflects upon, and evaluates with agency staff/cta the effectiveness of nursing care provided. Identifies own level of competence and seeks assistance and guidance as necessary. Accesses advice/support and acts accordingly. Recognises need for debriefing and takes steps to obtain this as necessary. Maintains development. professional Takes responsibility for one's own professional development and for sharing knowledge with others. Takes actively part in formal and informal educational sessions. Sets personal learning objectives that are appropriate for the setting and achievable in the time available. Pursues learning opportunities that extend own professional knowledge/skills base. Identifies knowledge/skills deficits and takes appropriate initiatives to resolve these. Responds to feedback by setting new objectives that address the areas that require improvement. 23

Interpersonal relationships This domain contains competencies related to interpersonal and therapeutic communication with clients, other nursing staff and interprofessional communication and documentation. Criteria: Indicators at 200 Level: CTA/Preceptor s assessment: Met Not Establishes, maintains and concludes therapeutic interpersonal relationships with client. At a beginning level, initiates, maintains and concludes interpersonal interactions with clients. Begins to incorporate therapeutic use of self as the basis for nursing care. Utilises effective interviewing skills in interactions with clients. Demonstrates respect, empathy and interest in client. Establishes rapport and trust with the client. Practises nursing in a negotiated partnership with the client where and when possible. Communicates effectively with clients and members of the health care team. Ensures that clients receive and understand information concerning their health care in order to make an informed choice. Implements nursing care in a manner that facilitates the independence, self-esteem and safety of the client and an understanding of therapeutic and partnership principles. Recognises and supports the personal resourcefulness of people with mental and/or physical illness. Acknowledges family/whanau perspectives and supports their participation in nursing care. Utilises a variety of effective communication techniques. Demonstrates verbal and non-verbal skills of clarification. Employs appropriate language to context. Provides adequate time for discussion. Endeavours to establish alternative communication hods when clients are unable to verbalise. Communicates in a manner that respects the boundaries of a professional relationship. Communicates clearly and concisely in writing to ensure continuity of care and recovery. Discussions concerning clients are restricted to settings, learning situations and relevant members of the health care team including CTA. 24

Interprofessional health care & quality improvement This domain contains competencies to demonstrate that, as a member of the health care team, the nurse evaluates the effectiveness of care and promotes a nursing perspective within the interprofessional activities of the team. Criteria: Indicators at 200 Level: CTA/Preceptor s assessment: Met Not Collaborates and participates with colleagues and members of the health care team to facilitate and coordinate care. Recognises and values the roles and skills of all members of the health care team in the delivery of care. Participates in quality improvement activities to monitor and improve standards of nursing. Collaborates with the client and agency staff in order to develop and implement a plan of care. Assists in the development of a discharge plan and follow up care in consultation with the client and agency staff. Demonstrates knowledge of the formal referral system to other health care team members for clients who require consultation. Demonstrates the ability to work effectively as a team member. Is knowledgeable about the roles and responsibilities of the Registered Nurse within the clinical setting. Demonstrates a beginning understanding of the roles, responsibilities, and skills of other members of the health team. Assists with the co-ordination of care to maximise health outcomes for the client. Collaborates with, and provides accurate information to, the client and other health professionals about the prescribed nursing interventions. Demonstrates knowledge of community services and resources and encourages clients to use them when appropriate. Begins to identify researchable practice issues and discusses these during clinical tutorials and/or with CTA. Engages in literature searches to find evidence-based nursing interventions. Raises in an appropriate forum, valid questions about current nursing practices and protocols. This assessment has been discussed with the student: YES / NO Student comments (optional): Student s signature: CTA/Preceptor s name: Date: CTA/Preceptor s signature: 25

Competency-based Assessment 300 Level This is a summative assessment. Students need to meet all criteria (lefthand column) as well as any other predetermined requirements in order to pass this paper successfully. Assessment criteria for students at 300 Level of the Bachelor of Nursing programme Student s name: Paper No: 168.3 CTA/Preceptor s name: Clinical placement: Placement period from till Professional responsibility This domain contains competencies that relate to professional, legal and ethical responsibilities and cultural safety. These include being able to demonstrate knowledge and judgement and being accountable for own actions and decisions, while promoting an environment that maximises clients' safety, independence, quality of life and health. Criteria: Indicators at 300 Level: CTA/Preceptor s assessment: Met Not Accepts responsibility for ensuring that his/her nursing practice and conduct meet the standards of the professional, ethical and relevant legislated requirements. Practises nursing in accord with relevant legislation/codes/policies and upholds client rights derived from that legislation. Accepts responsibility for own actions and decision making within scope of practice. Identifies breaches of law that occur in practice and reports them to the appropriate agency staff/cta. Demonstrates knowledge of, and accesses, policies and procedural guidelines that have implications for practice. Uses professional standards of practice. Demonstrates the ability to apply the principles of the Treaty of Waitangi/Te Tiriti 0 Waitangi to nursing practice. Understands the Treaty of Waitangi/Te Tiriti 0 Waitangi and its relevance to the health of Maori in Aotearoa/New Zealand. Demonstrates knowledge of differing health and socioeconomic status of Maori and non-maori. Applies the Treaty of Waitangi/Te Tiriti 0 Waitangi to nursing practice. 26

Professional responsibility (cont.) Criteria: Indicators at 300 Level: CTA/Preceptor s assessment: Met Not Demonstrates accountability for directing, monitoring and evaluating nursing care that is provided by nurse assistants, enrolled nurses and others. Promotes an environment that enables client safety, independence, quality of life, and health. Practises nursing in a manner that the client determines as being culturally safe. Understands the various aspects for directing, monitoring and evaluating nursing care that is provided by nurse assistants, enrolled nurses and others. Is able to discuss accountability issues related to directing, monitoring and evaluating nursing care. Seeks advice from a senior registered nurse if unsure about the role and competence of nurse assistants, enrolled nurses and others when delegating work. Identifies and reports situations that affect client or staff members' health or safety. Accesses, maintains and uses emergency equipment and supplies. Maintains infection control principles. Recognises and manages risks to provide care that best meets the needs and interests of clients and the public. Applies the principles of cultural safety in own nursing practice. Recognises the impact of the culture of nursing on client care and endeavours to protect the client's wellbeing within this culture. Practises in a way that respects each client's identity and right to hold personal beliefs, values and goals. Assists the client to gain appropriate support and representation from those who understand the client's culture, needs and preferences. With guidance of agency staff, consults with members of cultural and other groups as requested and approved by the client. Reflects on his/her own practice and values that impact on nursing care in relation to the client's age, ethnicity, culture, beliefs, gender, sexual orientation and/or disability. Avoids imposing prejudice onto others and provides advocacy when prejudice is apparent. 27

Management of nursing care This domain contains competencies related to client assessment and managing client care, which is responsive to clients' needs, and which is supported by nursing knowledge and evidence based research. Criteria: Indicators at 300 Level: CTA/Preceptor s assessment: Met Not Provides planned nursing care to achieve identified outcomes. Contributes to care planning, involving clients and demonstrates an understanding of clients' rights, to make informed decisions. Demonstrates understanding of the processes and environments that support recovery. Identifies examples of the use of evidence in planned nursing care. Undertakes practice procedures and skills in a competent and safe manner. Administers interventions, treatments and medications, within legislation, codes and scope of practice; and according to authorised prescription, established policy and guidelines. Ensures the client has adequate explanation of the effects, consequences and alternatives of proposed treatment options. Provides appropriate information to clients to protect their rights and to allow informed decisions. Assesses the readiness of the client to participate in health education. With minimal guidance, makes appropriate professional judgement regarding the extent to which the client is capable of participating in decisions related to his/her care. Discusses ethical issues related to health care/nursing practice, (for example: informed consent, privacy, refusal of treatment and rights of formal and informal clients). With guidance, facilitates the client's access to appropriate therapies or interventions and respects the client's right to choose amongst alternatives. Seeks clarification from relevant members of the health care team regarding the individual's request to change and/or refuse care. Takes the client's preferences into consideration when providing care. 28