Victorian Clinical Assessment Document for nurse training courses in sexual and reproductive health and cervical screening

Victorian Clinical Assessment Document for nurse training courses in sexual and reproductive health and cervical screening This document has been produced in partnership by PapScreen Victoria (Cancer Council Victoria), Family Planning Victoria, The University of Melbourne (Department of General Practice), The University of Melbourne (School of Public Health) and Melbourne Sexual Health Centre as one of the initiatives of the Victorian Preceptor Program. The document is jointly owned by the four organisations and each course will use this document for all of their nurse training courses, with this joint initiative appropriately acknowledged. Revised April 2012 Acknowledgements The revision of this document would not have been possible without the commitment and contribution of: Sandy Anderson and Kirsten Hausknecht - PapScreen Victoria Lorna Moss, Melbourne Sexual Health Centre Tracy Murphy,The Department of General Practice, The University of Melbourne Genevieve Dally and Michelle Cook, Family Planning Victoria. 2

Forward Increasing the number of nurses who provide cervical screening allows greater service provider choice for women. The Victorian Cervical Cytology Registry has identified that nurses practice in cervical screening has tripled over the last ten years. PapScreen Victoria recognises the important role that preceptors play in the education and support of nurses training to become Pap test providers. PapScreen continues to demonstrate its commitment to nurses by working in partnership with all Victorian Pap test training courses to enhance the provision of preceptorship. The training courses involved in this partnership include: Family Planning Victoria The University of Melbourne (Department of General Practice) The University of Melbourne (School of Public Health) Melbourne Sexual Health Centre. As part of this joint project, several initiatives are planned to streamline and enhance preceptorship in Victoria, with the aim of developing a Victorian Preceptor Program. This Victorian Clinical Assessment Document, as one of the joint initiatives, will be used by all Victorian training courses to assist the critical role that preceptors play in cervical screening and sexual and reproductive health education. Hiranthi Perera Manager, PapScreen Victoria 3

Contact details Student Student name: Home address: Postcode: Phone: H: W: M: Email: Workplace: Course date: Date Clinical Assessment Document due: Date Clinical Assessment Document received: 4

This checklist has been developed for potential preceptors and students. It provides examples of questions which can be used to help ensure that a placement is appropriate to meet the learning needs of a potential student. The list is not exhaustive, so please feel free to add your own questions. Clinical placement checklist Questions for preceptors to ask potential students Questions Responses Which course are you doing? How much clinical placement experience do you have so far? Have you been observing or conducting consultations under supervision? What would you like to achieve from your time with me? Is there any specific area/s where you feel you need more practice? Are there any areas where you feel you have achieved the required competence? Where are you currently working? What are your reasons for undertaking this course, as I might be able to help you with your plans? Do you have any questions for me? Have you completed the necessary theoretical component of your course? 5

Clinical placement checklist continued Questions for students to ask potential preceptors Questions Responses What type of service do you provide? What is the range of experience I could expect from a clinical placement with you? Will I be observing or able to have an active role in consultations? How many sessions of clinical supervision can you offer and how long is each session? What time are the sessions? What time should I arrive? Where exactly are you located and what parking/ public transport is available? Can you send me a copy of your history taking form? 6

Table of contents Introduction 8 Clinical placements: sessional log 11 Test results log 32 Summary of clinic placement hours 35 Clinical competency assessments 36 Part One: Core clinical competency assessments 37 Midway assessments 37 Final assessments 43 Part Two: Additional clinical competency assessments 49 Appendix: National standards for nurse Pap test providers 56 7

Introduction In Victoria, sexual and reproductive health (SRH) nurses are credentialled by the Royal College of Nursing, Australia (RCNA) to provide Pap tests according to the National Competency Standards for Nurse Pap test Providers (Jarman, 1997). These standards provide the framework for the safeguarding of quality client care, as well as the basis for education and assessment of nurses undertaking training in this field. This assessment tool acknowledges that the scope of practice of SRH nurses has a broader context than that provided within the standards. Similarly, the courses within Victoria reflect the broader context of practice by teaching more than just the taking of a Pap test. Competency standards are most relevant in guiding SRH nurse practice at this time, with a major focus on becoming a nurse Pap test provider. This assessment document breaks down the standards so that student SRH nurses can be assessed on their competency for putting these standards into practice. What is competency? The dictionary defines competent as: Properly or sufficiently qualified or capable or efficient; having capacity or ability; being effective without wasting time or effort or expense; meeting the proper standards and requirements and training for a position or task. Source: http://www.thefreedictionary.com/competent. This concept must be considered when assessing student SRH nurses for autonomous practice. In order to do this, each task that is undertaken in a consultation is broken down into elements. In a typical Pap test consultation, the nurse will undertake a: history (sexual, medical and psychosocial) Pap test procedure. Depending upon the context of the consultation, this could also include: provision of results from prior tests contraception counselling and education a pregnancy test STI tests (swabs and/ or blood tests) broader women s health issues. To reflect the intrinsic nature of the national standards, the assessments associated with all Victorian education courses providing this training are competency based and not numbers based. It is not how many tasks that are done that determine capable, efficient, quality care, it is the competency of the service provider that will demonstrate this. It is the nature of adult learning that prior experience and learning by individuals will mean that some preceptees will progress quicker than others and some will require more time and intensive input from preceptors. Therefore, numbers are not included as criteria in this assessment document, with the focus entirely on competency. 8

Assessment criteria All courses in Victoria have a set of core assessment criteria that cover: history taking skills taking a Pap test provision of results. Communication and counselling skills are also a core theme throughout each course. For the purpose of assessment, this is incorporated into the three core assessment criteria as an essential component of competent practice. Additional assessment criteria reflect the distinct requirements of each course. Assessments for these additional criteria have also been included to standardise the mechanism for assessment. These criteria can be incorporated into the core criteria to complete the assessment package for each course. The clinical competency assessments are formatted as a checklist for the preceptee and explain what is required of them for their assessments. Ideally, each assessment will be completed at the same time the supervised consultation takes place. If completed afterwards, each should only take a few minutes, allowing for immediate feedback to be given to the student to facilitate their continued learning. They can also be used as a guide for informal feedback rather than as a formal assessment tool if the preceptee is not at the point of a formal assessment. As the content for each course varies, the assessments should focus on the principles of practice according to the national competency standards and not the specifics, such as the questions asked or the completed in the consultation. There are times when specifics are asked for, such as visualisation of the cervix during a Pap test procedure. This is a vital component of assessing competent practice. It is understood that performing a Pap test should involve all elements included in this specific assessment. When assessing sexual history taking, the content will largely depend on the context of the consultation or the organisation in which it is taking place. For example, Melbourne Sexual Health Centre might have a specific focus on STIs and Family Planning Victoria might prioritise contraceptive choice. Where possible, the assessment criterion refers to a national competency standard listed in brackets e.g. (6.1). As several standards are written specific to nurse Pap test providers, some criteria have no standards reference. All Victorian training course providers have agreed that these are essential in the assessment criteria. Midway and final assessments All courses use a midway and/ or final assessment process. Core assessment criteria are assessed midway through the training and again at the end of training (i.e. the point where competency is to be formally assessed). Additional assessment criteria are assessed only at the end point. This dual process gives the preceptee the opportunity to undertake a formal assessment process midway. This allows for feedback and 9

highlights the areas they need to work on in order to reach a satisfactory competency level in their final assessment. Feedback As well as the immediate verbal discussion and feedback that should accompany any clinical learning session and/ or assessment, it is important for constructive written feedback to be provided to the student. This encourages them to continue their learning to the point of competency as they move from one preceptor to the next. This assessment tool encourages both written and verbal feedback and allows sufficient space for written comment by both the preceptor and preceptee. Quality control All assessments should incorporate quality control. As such, all preceptees should be encouraged to seek Pap test results and other tests results undertaken throughout their clinical placements. This allows them to check the application of their learning and quality of their Pap tests. It should not be a defining criterion for pass or fail in the course, but used as another opportunity for learning and discussion with the preceptor. It also increases awareness of what is required of credentialled nurse Pap test providers at the time of re-credentialling, when their statistical data from the Victorian Cytology Service is considered as part of the evaluation process. 10

Clinical placement: sessional log This section is to be completed by preceptees from all courses for each clinical placement that is undertaken. It is a tool for the preceptee to record tasks and experiences undertaken during the clinical placement. It allows the preceptee to reflect on their learning and identity areas for improvement in order to reach competency in their practice. Preceptors can also use this log to review what the preceptee has undertaken previously to facilitate an ongoing learning experience. Both preceptees and preceptors are encouraged to document as comprehensively as possible at each session. Preceptees are encouraged to undertake supervised clinical experience as much as possible, with the acknowledgment that each new placement could require a small amount of observational time prior to conducting consultations. all information in this log is to remain completely confidential. No client should be identified through any written comment or documentation of identifying data. Key to completing sessional log Consultation details: includes the reason for the client s visit (e.g. Pap test, STI check, contraceptive choice). Role of preceptee: either supervised by a preceptor (S) or observing another s practice (O). Comment: room for notes that can be used as a reflective tool on what you have learned (e.g. skills learned in using equipment, infection control tips, comments regarding client history etc). All preceptors are encouraged to leave written feedback at the end of each session to facilitate the preceptees continued learning. 11

Preceptor and placement venue: Date: Hours at placement: CONSULTATION DETAILS (e.g. STI screen, Pap test, contraception consultation, test results etc.) ROLE OF PRECEPTEE (i.e. whether you observed or were supervised for the consultation and or examination) CLIENT ID NUMBER ONLY (no other client details) COMMENTS Issues discussed (e.g. menopause, breast awareness, contraception, continence etc.) Areas of difficulty (e.g. location of cervix, client anxiety, vaginismus etc.) Please note: Preceptors are asked to provide constructive feedback to assist the preceptee with their learning. Preceptor signature: 12

Test results log Please note: log is to be used for tests undertaken by student only All preceptees are required to record the tests they perform throughout their clinical placements. This will help raise awareness of quality in test collection and interpretation and provide course coordinators with a summary of experience undertaken. Other comments can be made on individual results to assist reflective learning e.g. ectropian, vaginal discharge, thrush, cervical atrophy etc. For Pap tests, it might be useful to also document which tools were used for cell collection (e.g. endo cervical brush [cytobrush], cervix sampler broom etc.). Test performed Client ID Age < 50 yrs > 50 yrs Results ATSI status Country of birth and language spoken Comments 32

Test results log continued Test performed Client ID Age < 50 yrs > 50 yrs Results ATSI status Country of birth and language spoken Comments 33

Test results log continued Test performed Client ID Age < 50 yrs > 50 yrs Results ATSI status Country of birth and language spoken Comments 34

Summary of clinic placement hours On the table below, please collate the number of different clinical placements undertaken during the preceptorship program. Please note the number of hours completed for each specialty area. Preceptees are encouraged to seek at least two to three different specialty areas over the course of the program. Name of organisation Clinical placement specialty areas Number of hours completed for specialty areas e.g. RWH Colposcopy clinic 4 e.g. FPV, Box Hill clinic SRH nurse clinic 7 Total preceptorship hours completed 35

Clinical competency assessments The following assessments are divided into two sections: Part 1 includes the core assessment criteria, which is required to be addressed by students undertaking all courses in Victoria. It is further divided into both formative and summative assessments. The formative assessment should be completed approximately half way through clinical placements with the summative assessment completed at the end of clinical placements. The completion date might vary for individuals and should be agreed on by both the preceptee and the preceptor at the start of the clinical session. Part 2 includes the additional competency criteria and should be completed according to the specific requirements of the course being undertaken. Additional clinical competency assessments are required to be undertaken only once during clinical placements, at the point where both the preceptor and preceptee agree to undertake this formal process. The assessments require the preceptor to rate the preceptee against each criterion on a scale of 1-3. For example, in relation to Pap tests, 1-3 are interpreted as follows: 1 = Has not yet reached competent level to work as a beginner level nurse Pap test provider 2 = Has reached competent level to practice as a beginner level nurse Pap test provider 3 = Exceeds level of competency expected for a beginner level advanced practice nurse Pap or test provider Not applicable On this scale, 2 is considered competent, although there is room for recognition of those who excel in their practice. It also identifies preceptees who require further work, targeting the areas they need to work on. There is also a column for Not Applicable, in acknowledging that not all consultations will require all steps (e.g. use of interpreter), but it is still possible to assess someone as being competent. It is highly recommended that preceptors document any comments/ feedback at the bottom of the assessment where it is signed off. This will facilitate the overall assessment process undertaken by course coordinators and acknowledge any divergence from the list or specifics of the assessment. 36

Part one Core clinical competency assessments This section of the assessment document is to be completed by preceptees undertaking all courses in Victoria. Midway assessments (as required by course) Sexual history taking Assessment criteria Rating scale Seeks to establish rapport with the client (3.3) (4.1) Establishes and maintains client comfort, privacy and confidentiality, taking into consideration issues such as mandatory reporting and the client s choice to have a support person (2.1) (5.3) If an interpreter is used, communicates effectively with both the client and interpreter, with a focus on the client (2.2) (4.2) (4.3) Creates an environment that is respectful of the client regardless of their sexual orientation, sexual or other practices, cultural identity or disability Uses both the assessment tool provided and independent assessment skills appropriately to gather a comprehensive sexual health, reproductive health, BBV and STI history (7.1) Asks clear, non-ambiguous, non-judgmental questions in appropriate language to gather the information required for the consultation (4.1) (6.1) Employs effective listening skills to guide consultation, asking for clarification when required and seeking further information where necessary (3.3) (4.1) Uses information gathered to further inform consultation for opportunistically providing health information and/ or education (5.1) Recognises the boundaries of nursing practice by using appropriate referral mechanisms, including providing explanation to the client (3.3) (8.1) Seeks informed consent from the client if referral is required (5.1) (8.1) Documents in the client s file accurately and comprehensively (2.1) 37

Midway assessment Sexual history taking Competency achieved Competency not achieved Preceptor s name Signature Date Preceptee s name Signature Date Has this assessment been discussed with the preceptee? YES NO Comments (please note: If competency is not achieved in this assessment, please provide feedback to assist the preceptee in working towards successful re-assessment). 38

Midway assessment Pap test assessment Assessment criteria Establishes and maintains client comfort, privacy and confidentiality (1.2) (2.1) (5.3) Develops rapport with the client and seeks informed consent (3.3) (4.1) (5.1) (8.1) Demonstrates ability to obtain a relevant sexual, reproductive and cervical screening history (7.1) (2.2) Ensures the client understands what will occur during the Pap test process, including the benefits and limitations of the Pap test, explaining new technologies and offering further information where appropriate (2.2) Demonstrates knowledge of HPV vaccine and offers further information or advises appropriately (1.1) (1.2) (1.3) Rating scale Demonstrates knowledge of Digene testing and offers further information or advises appropriately (1.1) (1.2) (1.3) Ensures the client s physical needs are addressed before and after the procedure and that they are provided with an opportunity to empty their bladder, privacy when undressing and dressing and appropriate comfort and draping during the procedure (5.2) (5.3) Allows the client to actively participate in the consultation by asking questions, offering their opinion or verbalising their discomfort (4.1) (4.2) (4.3) Adheres to principles of infection control and standard precautions (1.3) (5.2) Demonstrates correct preparation and use of equipment (7.2) Demonstrates comprehensive assessment of external genitals and visualizes and inspects the cervix and vaginal walls, recognising abnormalities that require referral (7.2) Recognises boundaries of nursing practice by referring on where appropriate, providing explanation to the client and gaining informed consent (5.1) (3.3) (8.1) (8.2) 39

Continued Demonstrates assessment of correct sampling instruments to use and correct sampling technique (7.2) Demonstrates correct handling of sample including application of cervical cells, fixing, labeling and bagging (7.2) Ensures the women is aware of the Pap test registry and the option to opt off (1.2) (4.3) Rating scale Ensures all documentation is handled appropriately and completed correctly (i.e. file notes, VCS request, specimens) (2.1) Discusses results process with the client (6.1) Documents in the client s file accurately and comprehensively (2.1) (7.1) Midway assessment Pap test assessment Competency achieved Competency not achieved Preceptor s name Signature Date Preceptee s name Signature Date Has this assessment been discussed with the preceptee? YES NO Comments (please note: If competency is not achieved in this assessment, please provide feedback to assist the preceptee in working towards successful re-assessment). 40

Midway assessment Provision of results: Pap test or STI Assessment criteria Maintains confidentiality and considers policies and procedures of the organisation when giving results (2.1) (1.3) Rating scale Demonstrates comprehensive knowledge to enable accurate interpretation of Pap test results (6.2) Adheres to national policy and guidelines for cervical screening and the management of clients with screen detected abnormalities (1.1) Implements strategies to ensure women with abnormal Pap test or STI results are contacted as soon as possible (6.2) Explains results in clear, unambiguous language (6.1) Allows the client to actively participate in the conversation or consultation by allowing her to express her opinions or concerns and ask questions (4.1) (4.2) (4.3) Provides written material to reinforce results being given (6.1) (4.1) Discusses referral options if required, allowing the client to actively participate by offering opinions (e.g. colposcopy) (8.1) Considers the need for Contract Tracing, explains options consultation with the client and instigates where appropriate (1.1) (1.2) (1.3) Obtains informed consent if required (5.1) (8.1) Offers the client appropriate follow up and support mechanisms if required (3.3) (4.2) 41

Midway assessment Provision of results: Pap test or STI Competency achieved Competency not achieved Preceptor s name Signature Date Preceptee s name Signature Date Has this assessment been discussed with the preceptee? YES NO Comments (please note: If competency is not achieved in this assessment, please provide feedback to assist the preceptee in working towards successful re-assessment). 42

Final assessments Sexual history taking Assessment criteria Rating scale Seeks to establish rapport with the client (3.3) (4.1) Establishes and maintains client comfort, privacy and confidentiality taking into consideration issues such as mandatory reporting, client s choice to have a support person etc. (2.1) (5.3) If an interpreter is used, communicates effectively with both client and interpreter, with a focus on the client (2.2) (4.2) (4.3) Creates an environment that is respectful of the client regardless of their sexual orientation, sexual or other practices, cultural identity or disability Uses both the assessment tool provided and independent assessment skills appropriately, to gather a comprehensive sexual health, reproductive health, BBV and STI history (7.1) Asks clear, non-ambiguous, non judgemental questions in appropriate language to gather the information required for the consultation (4.1) (6.1) Employs effective listening skills to guide consultation, asking for clarification when required and seeking further information when necessary (3.3) (4.1) Uses information gathered to inform consultation further to opportunistically provide health information and/or education (5.1) Recognises the boundaries of nursing practice by utilising appropriate referral mechanisms including providing explanation to client (3.3) (8.1) Seeks informed consent from client if referral is required (5.1) (8.1) Documents in client s file accurately and comprehensively (2.1) 43

Final assessment Sexual history taking Competency achieved Competency not achieved Preceptor s name Signature Date Preceptee s name Signature Date Has this assessment been discussed with the preceptee? YES NO Comments (please note: If competency is not achieved in this assessment, please provide feedback to assist the preceptee in working towards successful re-assessment). 44

Final assessment Pap test assessment Assessment criteria Establishes and maintains client comfort, privacy and confidentiality (1.2) (2.1) (5.3) Develops rapport with the client and seeks informed consent (3.3) (4.1) (5.1) (8.1) Demonstrates ability to obtain a relevant sexual and reproductive and cervical screening history (7.1) (2.2) Ensures the woman understands what will occur during the Pap test process including the benefits and limitations of the Pap test, explains new technologies and offers if appropriate (2.2) Demonstrates knowledge of HPV vaccine and offers / advises appropriately (1.1) (1.2) (1.3) Demonstrates knowledge of Digene testing and offers / advises appropriately (1.1) (1.2) (1.3) Ensures the woman s physical needs are addressed before and after the procedure; they are provided with an opportunity to empty their bladder, privacy whilst undressing and dressing and appropriate comfort and draping during the procedure (5.2) (5.3) Allows the woman to actively participate in the consultation by asking questions, offering their opinion or verbalizing their discomfort (4.1) (4.2) (4.3) Rating scale Adheres to principles of infection control and standard precautions (1.3) (5.2) Demonstrates correct preparation and use of equipment (7.2) Demonstrates comprehensive assessment of external genitals and visualizes and inspects the cervix and vaginal walls, recognising abnormalities that require referral (7.2) Recognises boundaries of nursing practice by referring on when appropriate, providing explanation to client and gaining informed consent (5.1) (3.3) (8.1) (8.2) 45

Continued Demonstrates assessment of correct sampling instruments to use and correct sampling technique (7.2) Rating scale Demonstrates correct handling of sample including application of cervical cells, fixing, labeling and bagging (7.2) Ensures the client is aware of the Pap test registry and the option to opt off (1.2) (4.3) Ensures all documentation is handled appropriately and completed correctly (file notes, VCS request, specimens) (2.1) Discusses results process with client (6.1) Documents in client s file accurately and comprehensively (2.1) (7.1) Final assessment Pap test assessment Competency achieved Competency not achieved Preceptor s name Signature Date Preceptee s name Signature Date Has this assessment been discussed with the preceptee? YES NO Comments (please note: If competency is not achieved in this assessment, please provide feedback to assist the preceptee in working towards successful re-assessment). 46

Final assessment Provision of results Pap test or STI Assessment criteria Maintains confidentiality and considers policies and procedures of the organisation when giving results (2.1) (1.3) Rating scale Demonstrates comprehensive knowledge to enable accurate interpretation of Pap test results (6.2) Adheres to national policy and guidelines for cervical screening and the management of women with screen-detected abnormalities (1.1) Implements strategies to ensure the woman with abnormal Pap test and STI results are contacted as soon as possible (6.2) Explains results in clear unambiguous language (6.1) Allows the client to actively participate in the conversation/ consultation by allowing her to express her opinions, concerns and questions (4.1) (4.2) (4.3) Provides written material to reinforce results being given (6.1) (4.1) Discusses referral options if required, allowing the client to actively participate by offering opinions e.g.: colposcopy (8.1) Considers the need for Contract Tracing and in consultation with the client, explains options. Instigates such as appropriate (1.1) (1.2) (1.3) Obtains informed consent if required (5.1) (8.1) Offers the client appropriate follow up and support mechanisms if required (3.3) (4.2) 47

Final assessment Provision of results: Pap test or STI Competency achieved Competency not achieved Preceptor s name Signature Date Preceptee s name Signature Date Has this assessment been discussed with the preceptee? YES NO Comments (please note: If competency is not achieved in this assessment, please provide feedback to assist the preceptee in working towards successful re-assessment). 48

Part two Additional clinical competency assessment Please note: the following assessments are only to be completed according the specific requirements of the course being undertaken. Additional assessment Sexually transmitted infections Assessment criteria Establishes and maintains client comfort, privacy and confidentiality (1.2) (2.1) (5.3) Rating scale Demonstrates ability to obtain a sexual history and explains the relevance of data collection (2.2) (7.1) (4.3) Accurately assesses risk for STIs/BBVs and where appropriate and discusses screening and/ or testing options (e.g. chlamydia) (1.1) (2.2) (3.3) (4.1) Provides appropriate verbal and printed information for the client (4.1) Promotes safe sex and where relevant provides information regarding injecting drug, tattooing and piercing and strategies for harm minimisation Demonstrates comprehensive knowledge and awareness of potential complications of STIs such as pelvic inflammatory disease (PID) and refers appropriately Recognises the boundaries of nursing practice by referring on when appropriate, providing explanation to the client (3.3) (8.1) (8.2) Offers the client appropriate follow up and support mechanisms if required (3.3) (4.2) Documents consultation accurately and comprehensively (2.1) (7.1) 49

Additional assessment Sexually transmitted infections Competency achieved Competency not achieved Preceptor s name Signature Date Preceptee s name Signature Date Has this assessment been discussed with the preceptee? YES NO Comments (please note: If competency is not achieved in this assessment, please provide feedback to assist the preceptee in working towards successful re-assessment). 50

Additional assessment Contraception The following table lists the various contraceptive options that preceptees might be assessed against for competency. The assessment criteria on the following page are to be used as the basis for each individual assessment. Once complete, the specific option assessed should be signed and dated by the preceptor. When all required sections are complete, the Contraception Assessment Tool is to then be completed. Contraception Preceptor name Signature Date Combined oral contraception Progesterone only oral contraception Implant contraception (e.g. Implanon) Injectable contraception (e.g. Depo Provera) Emergency contraception Barrier methods (e.g. male/ female condoms) Barrier method (e.g. Diaphragm) Intrauterine device Surgical contraception (male/ female) 51

Additional assessment Contraception Assessment criteria Establishes and maintains client comfort, privacy and confidentiality (1.2) (1.3) (5.3) Rating scale Demonstrates ability to obtain a relevant health history and uses this information to inform consultation (1.2) (1.3) (2.2) (4.3) (7.1) Can list a minimum of 5 factors that influence contraceptive choice (7) Differentiates between types of contraception and rationale for use Can assess the client accurately and competently for the chosen type of contraception etc. (e.g. diaphragm, emergency contraception) (4.3) (2.2) Explains the benefits and disadvantages of the different types of contraception available Provides the client with the opportunity to make informed decisions (4.2) (6) Discusses the client s contraceptive choice in clear and unambiguous language Demonstrates knowledge of specific contra-indications for the chosen contraception Correctly explains the therapeutic action and efficacy of the chosen type of contraception Accurately explains administration or use of the chosen type of contraception (e.g. emergency contraception, condoms, diaphragm etc.) Recognises the boundaries of nursing practice by offering appropriate referral if required (3.3) (8.1) (8.2) Documents the consultation accurately and comprehensively (2.1) (7.1) 52

Additional assessment Contraception Competency achieved Competency not achieved Preceptor s name Signature Date Preceptee s name Signature Date Has this assessment been discussed with the preceptee? YES NO Comments (please note: If competency is not achieved in this assessment, please provide feedback to assist the preceptee in working towards successful re-assessment). 53

Additional assessment Pregnancy testing Assessment criteria Demonstrates ability to obtain a relevant health history (1.2) (1.3) (2.2) (4.3) (7.1) Rating scale Demonstrates an awareness of and appropriate management response to ectopic pregnancy Demonstrates ability to perform a pregnancy test Explains reasons for both false positive and negative results Discusses referral options if required, allowing the client to actively participate by offering opinions and asking questions (3.3) (8.1) (8.2) Offers the client appropriate follow up and support mechanisms if required (3.3) (4.2) (6.2) Discusses contraception issues with the client where appropriate Discusses STI risks and appropriate time frames for testing where appropriate Documents consultation accurately and comprehensively (2.1) (7.1) Identifies and understands the legal implications of legislation in relation to nursing practice, particularly in relation to competent minors, abortions etc. (1.2) (3.1) 54

Additional assessment Pregnancy testing Competency achieved Competency not achieved Preceptor s name Signature Date Preceptee s name Signature Date Has this assessment been discussed with the preceptee? YES NO Comments (please note: If competency is not achieved in this assessment, please provide feedback to assist the preceptee in working towards successful re-assessment). 55

Appendix Below are the national competency standards identified in Making Quality Visible - National Standards for Nurse Pap Test Providers, National Cervical Screening Program 1997, National Cancer Prevention & Control Unit, Commonwealth Department of Health and Family Services, Canberra, written by Heather Jarman. Competency 1: Demonstrates accurate knowledge for safe practice 1.1 Demonstrates an accurate and comprehensive knowledge base of cervical screening, thereby ensuring safe practice Examples from practice Demonstrates an accurate and comprehensive knowledge of the etiology of cervical cancer and its prevention Effectively uses theoretical knowledge in clinical practice Demonstrates accurate and comprehensive knowledge of normal female anatomy and reproductive physiology Recognises the differences between screening services and diagnostic services and practices accordingly by: ensuring women understand the limitations and benefits of cervical screening referring symptomatic clients, even in the presence of a normal Pap test result adhering to national policy and guidelines for cervical screening and the management of women with screen detected abnormalities. 1.2 Demonstrates an accurate and comprehensive knowledge of the legislation pertinent to the provision of a cervical screening service Examples from practice Identifies and understands the legal implications of legislation in relation to nursing practice (e.g. confidentiality) Conforms to legislative requirements according to the practice setting )e.g. State or Territory cervical cytology registers) 1.3 Demonstrates accurate and comprehensive knowledge of policies, protocols and other relevant documentation for nursing practice and participates in review processes Examples from practice Participates in the development and review of policies and procedural guidelines to ensure compliance with current national and state or territory cervical screening policies Uses policies and procedural guidelines relevant to the health care setting to guide rather than direct practice 56

Competency 2: Protects the rights of individuals 2.1 Consistently and effectively ensures the confidentiality of individual clients Examples from practice Consistently demonstrates confidentiality when dealing with patient information (e.g. in discussions with individual clients, in sharing information with others, etc.) Maintains the confidentiality and security of histories/records and reports (i.e. within the health care setting and/ or when providing outreach services) 2.2 Consistently and effectively ensures the rights of clients to make informed decisions regarding their care Examples from practice Ensures clients are informed and understand the benefits and limitations of cervical screening, including new technologies Recognises the rights of clients to full and comprehensive information regarding their care Competency 3: Recognises own ability and level of professional competence 3.1 Assesses own abilities independently and comprehensively and practices within these limits and scopes of practice Examples from practice Functions independently and interdependently with others using advanced practice knowledge and skills Recognises the boundaries of own nursing practice and refers women accordingly Regularly reflects on own standard of practice and sets appropriate performance objectives 3.2 Engages in activities to enhance own level of practice Examples from practice Seeks to maintain currency of practice regarding the provision of a cervical screening service (e.g. participates in professional development activities, and seeks peer review etc.) Critically evaluates research findings using those that have relevance to own practice setting Ensures the integration of new knowledge regarding cervical screening and management of clients with screen detected abnormalities into own practice Actively participates in quality assurance or improvements activities and uses feedback to improve clinical performance (e.g. cytology laboratory Pap test statistics) 57