BSc (Hons) Nursing Programme Ongoing Achievement Record Exemplar (For Cohort 0911 onwards) Name of Student: Cohort No: Student Number: 1
Contents Section Page Introduction to the Exemplar 3 One: Examples of how the assessment should be recorded and the OAR completed 4 Two: Examples of Competency mapping and other relevant elements of the OAR 13 Three: Examples of how the evidence may be presented 35 Four: Frequently asked questions for Mentors and Students 50 2
Introduction to the Exemplar The exemplar document is designed to act as an aide memoir for students and mentors who are involved in the collection, presentation and assessment of evidence for the practice portfolio associated with the BSc (Hons) Nursing Programmes (Adult and Mental Health) For all student nurses who commence their programme after the 1 st delivered in the form of an Ongoing Achievement Record (OAR). and The OAR is essentially a practice portfolio framework utilised by all Nursing Programmes including the University of Lincoln. This document is a selection of pages from the OAR which have been designed to guide the student and mentor to enable them to complete the assessment in practice affectively. Part one: Part two: Principles of assessment using the Bondy scale Evidence and evidence codes Mentor signature verification sheet Declaration of consent by the student Student Placement Journey and profile An example of how mentors should assess competencies Competency mapping with examples and ideas about the type of evidence that may be generated by the student for each competency An example of how mentors should assess Essential Skills (ESC s) An example of how placement orientation and preliminary, mid-point and final interviews can be completed An example of how section 7, Sign Off mentors could evidence feedback and appraisal logs when mentoring and assessing a management student Part three: Some examples of evidence may be presented by students 3
Part 1 Principles of assessment using the Bondy scale Evidence and evidence codes Mentor signature verification sheet Declaration of consent by the student Student Placement Journey and profile An example of how mentors should assess competencies 4
General Guidance on the principles of assessment during practice placements At the completion of their Nursing Education Programme the student is expected to be able to consistently demonstrate the standard of competency for the field of Adult Nursing as required by the Standards for pre-registration nursing education (2010). These are divided into four domains: 1. Professional Values 2. Communication and Interpersonal Skills 3. Nursing Practice and decision-making 4. Leadership, management and team working In addition there is a generic standard of competence and a more specific field standard of competence for each of the domains. These are detailed in the assessment pages of this OAR document. During each placement the student must provided evidence of their learning and this should be expanded upon during the three years of the programme. Every mentor should review the evidence that has been presented by the student. This may include direct observation by the mentor / assessor, a question & answer session, the presentation of a reflective piece of work. The method of evidence for each specific competency should be negotiated by mentor and student at the beginning of each placement. The mentor / assessor should assess the student for competent in each element of every domain, using the Bondy (1983) skills escalator for pre registration nursing. The Bondy grade currently being achieved by the student should be written in the space provided for each competency, signed and dated by the mentor / assessor. Please refer to the next page for an explanation of the Bondy Skills Escalator and Assessment Framework for use with this Ongoing Achievement Record. 5
An explanation of the Bondy Assessment Framework for use with this Ongoing Achievement Record. Mentor/s should complete all relevant NMC competency assessment sheets during each placement in conjunction with the student on placement This will provide a clear picture of the success that each student is achieving during every placement and at the end of every year of the programme. The Bondy Skills Escalator Assessment Framework has four stages with the first stage (1) being the competency level that the student is believed to be able to achieve at the commencement of their programme of nursing education. Bondy stage or level 2, 3 and 4 are the achievement levels that the mentor / assessor should apply to every competency during each placement. Bondy Level 2 is essentially requiring the mentor to assess the students capability to achieve the criteria set for progression point no 1 in accordance with the Standards for pre-registration nursing education (2010) According to the Standards for pre-registration nursing education (2010) these criteria cover safety, safeguarding and protection of people of all ages, their carers and their families and professional values, expected attitudes and behaviours that must be shown towards people, their carers, their families, and others. The criteria for progression point no 1 will be assessed at the end of the final placement for year 1 and this can be found on pages 103 to 109 of this OAR document. Bondy Level 3 is essentially requiring the mentor to assess the students capability to achieve the criteria set for progression point no 2 in accordance with the Standards for pre-registration nursing education (2010) According to the Standards for pre-registration nursing education (2010) Criteria for progression point no 2 includes the ability of the student to work more independently, with less direct supervision, in a safe and increasingly confident manner and demonstrate potential to work autonomously, making the most of opportunities to extend knowledge, skills and practice The criteria for progression point no 2 will be assessed at the end of the final placement for year 2 and this can be found on pages 202 to 205 of this OAR document. Bondy Level 4 is essentially requiring the mentor to assess the students capability to achieve the criteria set for completion of the programme in accordance with the Standards for pre-registration nursing education (2010) This is essentially for the student, by the end of year 3, to have completed all practical competencies to a standard that is suitable for the student to be able to safely register with the NMC as a newly qualified Adult Nurse. The Sign Off Mentor should ensure that competencies throughout the programme have been successfully achieved and that the student is still able to achieve the required level. The Bondy Skills Escalator and Assessment Framework are overleaf:- 6
Skills Escalator Pre-Registration Nursing Courses Adapted by the University of Nottingham from Bondy (1983). Used with their permission. The Practice Levels below are the minimum levels of achievement for that part of the course. Students may be assessed at achieving beyond the minimal level and should be encouraged to progress towards the higher levels Registered Practitioner Minimum Level for Progression to Registration Practice Level 4: Student self-assessment: I have practised with minimum supervision and within the NMC and Trust guidelines, meeting the standards of competency, seeking advice and support as appropriate and demonstrating knowledge, skills and attitudes appropriate to this practice level. Indicators: Prioritises care appropriately, demonstrating careful and deliberate planning. Demonstrates evidence-based practice approaches, drawing on a wide range of sources of evidence to support care delivery decisions. Actions underpinned with sound evidence-based rationales, communicated in a coherent and accurate manner. Demonstrates professional behaviour, showing awareness of responsibilities as an accountable practitioner in relation to self and others. Demonstrates ability to adapt behaviour/interventions to needs of client and environment. Safe, co-ordinated and efficient practice associated with an autonomous practitioner. Consistently communicates effectively with multidisciplinary team, users and carers. Minimum Level for End of Year Two Minimum Level for End of Year one Practice Level 3: Student self-assessment: I have practised with decreasing supervision to achieve the standards of competence, requiring occasional support and prompts in the development of appropriate knowledge, skills and attitudes. Indicators: Demonstrates increasing independence in initiating appropriate interventions. Applies knowledge to practice, providing a critical appraisal of the evidence. Makes informed judgements, considering more than one source of evidence. Demonstrates professional behaviour with underpinning ethical framework. Provides safe and efficient care under minimal supervision, demonstrating increasing confidence in own abilities. Gives informed rationale for care, demonstrating transferability of skills and knowledge. Communicates effectively with the nursing team and other health/social care professionals. Practice Level 2: Student self-assessment: I have practised with assistance in the delivery of care to achieve my practice competencies, demonstrating knowledge, skills and attitudes appropriate to this level. Indicators: Prioritises care and adapts to meet client needs with support. Applies knowledge to practice, identifying possible sources of evidence. Makes judgements, providing an evidence based rationale. Demonstrates professional behaviour and understanding of professional responsibilities. Provides safe care under frequent supervision, demonstrating developing confidence in own abilities. Initiates appropriate interventions in relation to essential care without prompts. Communicates effectively with clients and the nursing team Commencing Level for Year 1 Practice Level 1: Student self-assessment: I have practised, with constant supervision, in the delivery of essential care to develop the knowledge skills and attitude required to achieve my practice outcomes. Indicators: Undertakes care with direction and supervision from others. Identifies possible locations of information to support practice. Provides appropriate explanation in relation to care delivery activities. Demonstrates professional behaviour and understanding of personal responsibilities. Developing the ability to deliver safe and accurate practice. Initiates appropriate interventions with prompts. Developing communication skills. 7
EVIDENCE Evidence of learning must be presented by the student to their mentor / assessor to enable the mentor / assessor to assess each competency and award a Bondy Level. Evidence of learning can be generated in an infinite number of ways by the student and the list below is only a guide for both student and mentor. It is recommended that the student should negotiate the nature and quantity of evidence that their mentor will require to award the appropriate Bondy level at the commencement of each placement experience. Direct observation (DO) of the student whilst they are working under supervision. More than one observation of the activity/skill may be appropriate for the mentor to satisfy himself or herself that the student is able to sustain an acceptable level of performance and competence. These observations should take place as part of the normal working role of the student, rather than being contrived for the purpose of assessment. Dates, name of supervisor and location of evidence should be recorded against the appropriate Outcome in the Continuity of Assessment document. Question and answer session (QA) to assess underpinning knowledge the student should demonstrate understanding and application. Dates, name of mentor / assessor and location of evidence should be recorded against the appropriate Outcome in the Continuity of Assessment document. Reflective discussion (RD) between the mentor and the student regarding the progress in relation to knowledge, understanding and application. Dates, name of supervisor and location of evidence should be recorded against the appropriate Outcome in the Continuity of Assessment document. Reflective Writing (RW) demonstrating knowledge and understanding as applied to specific placement experiences supported by sources of evidence. This must be retained in the student s portfolio. If appropriate the use of a reflective model would enhance this process. Testimony Evidence (TE) from other professionals engaged in the student s learning and patients that have received nursing care from the student as part of their placement learning experiences. The student must discuss the suitability of approaching a patient with their mentor before requesting a testimony from the patient. Development Plan (DP) An account of a plan for development made by the student, often in conjunction with their mentor during a practice placement. This should be supplementary to all mandatory action plans written during placement interviews in the course of a normal placement interview schedule. Work Product (WP) A development by the student such as an anonymised care plan, a risk assessment or a fluid balance chart to demonstrate knowledge and competence and this should normally be supplemented by other evidence regarding policy, best practice guidelines, quality and NMC requirements. Case study (CS) written by the student demonstrating their involvement in and understanding of the holistic care of a patient. 8
Valerie Martin James Thompson Name of Mentor Annabel Markiss Designation DN RGN RN (Comm) Workplace Address The new surgery Wasingbourne The Grange Nursing Home Saltfleet Johnstone Ward Sleafould Hospital Signature Valerie Martin James Thompson Annabel Markiss Date 19/10.01 23/03/02 17/07/02 Ongoing Achievement Record Exemplar for BSc (Hons) Nursing Programmes 2011 onwards Version 1.3 2012 - TS 9
Declaration of consent to the processing of confidential data about the student to be shared between successive mentors and the University of Lincoln nursing programme team in the process of assessing fitness for practice. The Standards to support learning and assessment in practice (NMC 2006, page 30) requires that: An ongoing achievement record including comments from mentors, must be passed from one placement to the next to enable judgments to be made on the student s progress. The Data Protection Act 1998 has confirmed that the NMC is perfectly competent to require the nurse to consent to the processing of confidential data about him or her in the process of assessing her fitness to be a nurse. This data might include both personal data and sensitive personal data as described within Sections 1 and 2 of the Data Protection Act 1998. (In this context nurse relates to student nurse and also applies to student midwife ). Should the student not consent to the sharing of confidential data, then this would be incompatible with ensuring fitness for practice and therefore the student would be unable to meet programme requirements. The Nursing and Midwifery Council and the University of Lincoln require the student nurse to consent to the processing of personal data as part of the Ongoing Achievement Record (OAR). The students data for the purposes of the fitness assessment will be held in the OAR that is maintained by the student and a carbon copy of each completed assessment page will be removed from the OAR and placed in the students personal record and stored for a minimum of five years after the student has left the programme. Declaration: Student Name Caroline Parnell.. UoL ID No 010102367 I declare that I have read and understood the information provided about the use of my personal data as part of the ongoing assessment process in the Ongoing Achievement Record (OAR) I consent to the data generated about me in the OAR being used for this purpose. Signature Caroline Parnell Date 17 th September 2001 10
Student Placement Profile Placement Name Washingbourne DN Team The Grange Nursing Home Saltfleet Lincs Placement Speciality Community Nursing Caring for clients in a nursing home Placement Dates 19 th October 2001 to 23 rd March 2002 23 rd March 2002 to 30 th April 2002 Mentor Name Mentor Contact Details Valerie Martin The new surgery Washingbourne Lincolnshire 01534 679456 James Thompson 01345 679345 Johnstone ward Sleafould Acute Medicine 17 th July 2002 to 23 rd August 2002 Annabel Markiss 01654 784567 11
NMC Domain 4: Leadership, management and team working Outcomes Generic Standard for Competence: All nurses must be professionally accountable and use clinical governance processes to maintain and improve nursing practice and standards of healthcare. They must be able to respond autonomously and confidently to planned and uncertain situations, managing themselves and others effectively. They must create and maximise opportunities to improve services. They must also demonstrate the potential to develop further management and leadership skills during their period of preceptorship and beyond. Field Standard for Competence: Adult nurses must be able to provide leadership in managing adult nursing care, understand and coordinate interprofessional care when needed, and liaise with specialist teams. They must be adaptable and flexible, and able to take the lead in responding to the needs of people of all ages in a variety of circumstances, including situations where immediate or urgent care is needed. They must recognise their leadership role in disaster management, major incidents and public health emergencies, and respond appropriately according to their levels of competence. Year 1 Community Placement Year 1 In-patient Placement NMC Domain 4: Leadership, management and team working 1 2 3 12 Competencies All nurses must act as change agents and provide leadership through quality improvement and service development to enhance people s wellbeing and experiences of healthcare. All nurses must systematically evaluate care and ensure that they and others use the findings to help improve people s experience and care outcomes and to shape future services. All nurses must be able to identify priorities and manage time and resources effectively to ensure the quality of care is maintained or enhanced. Mid Placement Bondy Level Intermediate interview Signature & Date At the intermediate interview the student needs to gauge how well they are progressing To achieve this we would ask their mentor to grade their mid placement level against Bondy on page 5, 6 & 7 of this document 1 End of Placement Bondy Level U 2 Tsimpson 1 14/03/2008 Final interview Signature & Date Tsimpson Tsimpson 15/03/2008 Tsimpson 05/04/ 2008 Mid Placement Bondy Level In this illustration the student has been unable to complete competency no 1 due to a lack of opportunity and awarded a U For competency No 2 they have achieved the desired Bondy level 2 For competency No 3 they have only achieved Bondy level 1 Intermediate interview Signature & Date End of Placement Bondy Level Final interview Signature & Date Evidence Code and Portfolio Page No At the final interview 12/03/2008 the mentor must assess DO the student against the None proficiency and attribute the appropriate Bondy level of achievement. Bondy rating scale information can be found on page 5, 6 & 7 of this document The required level for completion of year is Bondy Level 2 The evidence code, relating to the information on page 8 of this document gives the type of evidence being used to confirm competency and the portfolio page no relates to the page in the student s portfolio of evidence for this competency. RD p 7 RW p 39
Part 2 Competency mapping with examples and ideas about the type of evidence that may be generated by the student for each competency An example of how mentors should assess Essential Skills (ESC s) An example of how placement orientation and preliminary, mid-point and final interviews can be completed An example of how section 7, Sign Off mentors could evidence feedback and appraisal logs when mentoring and assessing a management student 13
NMC Competency Mapping 1 1.1 3 4 5 Domain 1: Professional Values All nurses must practise with confidence according to The code: Standards of conduct, performance and ethics for nurses and midwives (NMC 2008), and within other recognised ethical and legal frameworks. They must be able to recognise and address ethical challenges relating to people s choices and decision-making about their care, and act within the law to help them and their families and carers find acceptable solutions. Adult nurses must understand and apply current legislation to all service users, paying special attention to the protection of vulnerable people, including those with complex needs arising from ageing, cognitive impairment, long-term conditions and those approaching the end of life. All nurses must support and promote the health, wellbeing, rights and dignity of people, groups, communities and populations. These include people whose lives are affected by ill health, disability, ageing, death and dying. Nurses must understand how these activities influence public health. All nurses must work in partnership with service users, carers, families, groups, communities and organisations. They must manage risk, and promote health and wellbeing while aiming to empower choices that promote self-care and safety. All nurses must fully understand the nurse s various roles, responsibilities and functions, and adapt their practice to meet the changing needs of people, groups, communities and populations. Some examples of evidence (Students should be encouraged to generate a range of different individualised evidence) A reflective account by the student thinking about professional regulation with respect to nursing and patient care. A reflective account or a professional / reflective discussion between mentor and student about professional regulation A discussion between mentor and student about the rights of patients in their care (e.g. making decisions about their care, refusal of treatment). The student may reflect on the public health needs of the patients in their care and discuss mechanisms to improve health & wellbeing for them. A discussion between mentor and student about the choices that patients may make and how healthcare professionals should respond to their decisions. A short reflection on the need for the student to understand risk appraisal by creating and maintaining safe environments for patients in their care. A discussion or piece of reflective writing on boundaries of care, the roles of the nurse in differing situations with individual patients and the skill of adaptation dependent upon the needs of the patient/s in their care. 6 All nurses must understand the roles and responsibilities of other health and social care professionals, and seek to work with them collaboratively for the benefit of all who need care. The student may wish to create a profile of the professional groups that contribute to patient care and critically appraise how nurses work with them to ensure quality patient care and outcomes. 14
7 8 9 Domain 1: Professional Values All nurses must be responsible and accountable for keeping their knowledge and skills up to date through continuing professional development. They must aim to improve their performance and enhance the safety and quality of care through evaluation, supervision and appraisal. All nurses must practise independently, recognising the limits of their competence and knowledge. They must reflect on these limits and seek advice from, or refer to, other professionals where necessary. All nurses must appreciate the value of evidence in practice, be able to understand and appraise research, apply relevant theory and research findings to their work, and identify areas for further investigation. Some examples of evidence (Students should be encouraged to generate a range of different individualised evidence) The student may wish to scope the different models of portfolio and evidence with due regard to their needs as a student to create evidence of knowledge and skills of nursing. The scope could report on the various different ways that evidence of progressive learning could be collated and then use this new understanding as a blueprint for their own student portfolio. Direct observation of the student seeking help and advice when faced with a new or unfamiliar set of circumstances. Reflective discussion about recognising own limitations The student may wish to create a log of evidence informed policy as they journey through their nurse education course, enabling an understanding of the need for continuous updating and scrutiny of policy and evidence relate to nursing care. 15
NMC Competency Mapping Domain 2: Communication and interpersonal skills Outcomes 1 All nurses must build partnerships and therapeutic relationships through safe, effective and nondiscriminatory communication. They must take account of individual differences, capabilities and needs. Some examples of evidence (Students should be encouraged to generate a range of different individualised evidence) The mentor may use direct observation (DO) to assess the student s ability to communicate effectively with patients, relatives and other members of the healthcare team in a way that is non-discriminatory by tailoring communication to the needs and capabilities patients. This may be supported by a question and answer session following a period of observation of the student. 2 3 3.1 4 All nurses must use a range of communication skills and technologies to support person-centred care and enhance quality and safety. They must ensure people receive all the information they need in a language and manner that allows them to make informed choices and share decision making. They must recognise when language interpretation or other communication support is needed and know how to obtain it. All nurses must use the full range of communication methods, including verbal, non-verbal and written, to acquire, interpret and record their knowledge and understanding of people s needs. They must be aware of their own values and beliefs and the impact this may have on their communication with others. They must take account of the many different ways in which people communicate and how these may be influenced by ill health, disability and other factors, and be able to recognise and respond effectively when a person finds it hard to communicate. Adult nurses must promote the concept, knowledge and practice of self-care with people with acute and longterm conditions, using a range of communication skills and strategies. All nurses must recognise when people are anxious or in distress and respond effectively, using therapeutic principles, to promote their wellbeing, manage personal safety and resolve conflict. They must use effective communication strategies and negotiation techniques to achieve best outcomes, respecting the dignity and human rights of all concerned. They must know when to consult a third party and how to make referrals for advocacy, mediation or arbitration. 16 The student may also wish to reflect upon an experience to support their evidence of understanding communication. The mentor may use direct observation (DO) to assess the student s ability to communicate effectively with patients, relatives and other members of the healthcare team in a way that is non-discriminatory by tailoring communication to the needs and capabilities patients. This may be supported by a question and answer session following a period of observation of the student. The student may also wish to reflect upon an experience to support their evidence of understanding communication. The student may profile examples of how they would communicate using different methods as part of their nursing education and patient care experiences. The student may wish to profile how communication with vulnerable adults and children can be carried with critical analysis of how ill health, disability can influence the way effective communication can be achieved. The student may choose to reflect upon an incident in practice that lead them to consider who the nature of communication affected a care episode either negatively or positively. This may include profiling those professionals involved in the care, their role and their needs in terms of communication which can be complex in some cases. The student may wish to create a case study for a patient with a long term condition and use the example to demonstrate the importance of encouraging self care behaviours for all patients and the role of communication to enable this care strategy. The student must be able to demonstrate effective communication skills in all aspects of patient care delivery with patients, relatives, other professionals and the public. There must also be a recognition by the student about when referrals to others should occur. This could be evidenced by Direct Observation by their mentor, by question and answer session with their mentor and as part of a reflection on practice by the student.
5 6 7 8 Domain 2: Communication and interpersonal skills Outcomes All nurses must use therapeutic principles to engage, maintain and, where appropriate, disengage from professional caring relationships, and must always respect professional boundaries. All nurses must take every opportunity to encourage health-promoting behaviour through education, role modelling and effective communication. All nurses must maintain accurate, clear and complete records, including the use of electronic formats, using appropriate and plain language. All nurses must respect individual rights to confidentiality and keep information secure and confidential in accordance with the law and relevant ethical and regulatory frameworks, taking account of local protocols. They must also actively share personal information with others when the interests of safety and protection override the need for confidentiality. Some examples of evidence (Students should be encouraged to generate a range of different individualised evidence) The student must be able to recognise professional boundaries and how the use of communication sets those boundaries for the patient and other professionals. The student must also learn when and how to engage and disengage in therapeutic relationships with patients and other professionals. This may be evidenced with Direct Observation by their mentor, by Question & Answer session with their mentor and by student reflection. The student should be able to indentify and act upon an opportunity for health-promoting behaviour in most episodes of healthcare delivery. This will require a good sense of role modelling by the student and effective communication skills. This may be evidenced with Direct Observation by their mentor, by Question & Answer session with their mentor and by student reflection. The student must understand the importance of accurate and appropriate record keeping for patient care using electronic care records, paper based records while ensuring their recordings are easily understood, meets the NMC standards for record keeping and is written / typed in a legible and understandable format. The student could evidence this by creating a work product of a care plan in order to be able to demonstrate their ability to contribute succinctly, accurately and appropriately to patient care records. The student must be able to understand the need for the rights to confidentiality of personal information for their patients. In addition the mentor must be satisfied that the student can consistently achieve high standards of confidential information handling and storage. The student must be able to describe circumstances where they would actively share personal information with others in the interests of safety and protection which override the need for confidentiality. This could be evidenced by the student by use of a case study or a reflective account of an incident during a practice placement. 17
NMC Competency Mapping Domain 3: Nursing Practice and decision-making Outcomes 1 1.1 2 3 All nurses must use up-to-date knowledge and evidence to assess, plan, deliver and evaluate care, communicate findings, influence change and promote health and best practice. They must make person-centred, evidencebased judgments and decisions, in partnership with others involved in the care process, to ensure high quality care. They must be able to recognise when the complexity of clinical decisions requires specialist knowledge and expertise, and consult or refer accordingly. Adult nurses must be able to recognise and respond to the needs of all people who come into their care including babies, children and young people, pregnant and postnatal women, people with mental health problems, people with physical disabilities, people with learning disabilities, older people, and people with long term problems such as cognitive impairment. All nurses must possess a broad knowledge of the structure and functions of the human body, and other relevant knowledge from the life, behavioural and social sciences as applied to health, ill health, disability, ageing and death. They must have an in-depth knowledge of common physical and mental health problems and treatments in their own field of practice, including comorbidity and physiological and psychological vulnerability. All nurses must carry out comprehensive, systematic nursing assessments that take account of relevant physical, social, cultural, psychological, spiritual, genetic and environmental factors, in partnership with service users and others through interaction, observation and measurement. Some examples of evidence (Students should be encouraged to generate a range of different individualised evidence) The student must be able to define the nursing process and describe the links to contemporary evidence and knowledge in the delivery of care. They must also be able to demonstrate the need for care to be tailored to every individual patient and the use of decision making and the need for referral to specialists as part of care planning and care delivery. To evidence this, the student could devise a case study to demonstrate their knowledge and skills of utilising Assessment Planning Implementation Evaluation (APIE). They could also include a scenario that includes the need for specialist referral and then create a work product referral form and a short piece of reflection to demonstrate knowledge of this process and when to appropriately refer to a specialist. The student must be able to understand the care of clients that are normally cared for by nurses from other fields, including midwifery, child, mental health and learning disability and older patients from the adult field that may be vulnerable due to long term conditions such as cognitive impairment. To evidence this the student should seek to engage in learning with professionals and patients accessing other fields of nursing and older persons care using reflection, workshops, workbooks, testimony from supervisors and patients where appropriate and work products to reflect the needs of these vulnerable groups of patients. The student must demonstrate a good level of knowledge of normal human physiology and abnormal human physiology in terms of physical and psychological symptoms. The student may choose to utilise a case study to demonstrate their knowledge of anatomy and physiology and pathophysiology of the patient. The mentor may utilise Direct Observation and Question & Answer session to gauge the knowledge of A&P of the student. The student must be able to demonstrate appropriate knowledge and skill of how to complete a comprehensive systematic nursing assessment by the use of a model or framework that is suitable for the client group and nursing situation that they are working within. The student may choose to utilise a case study and present a work product of a comprehensive assessment form, complemented by a piece of reflection, a critique of the model in use. The mentor may choose to use Direct Observation of the student completing a patient assessment interview and to use a Question & Answer session to follow-up and test the knowledge and skills of the student. 18
3.1 4 4.1 4.2 5 Domain 3: Nursing Practice and decision-making Outcomes Adult nurses must safely use a range of diagnostic skills, employing appropriate technology, to assess the needs of service users. All nurses must ascertain and respond to the physical, social and psychological needs of people, groups and communities. They must then plan, deliver and evaluate safe, competent, person-centred care in partnership with them, paying special attention to changing health needs during different life stages, including progressive illness and death, loss and bereavement. Adult nurses must safely use invasive and non-invasive procedures, medical devices, and current technological and pharmacological interventions, where relevant, in medical and surgical nursing practice, providing information and taking account of individual needs and preferences. Adult nurses must recognise and respond to the changing needs of adults, families and carers during terminal illness. They must be aware of how treatment goals and service users choices may change at different stages of progressive illness, loss and bereavement. All nurses must understand public health principles, priorities and practice in order to recognise and respond to the major causes and social determinants of health, illness and health inequalities. They must use a range of information and data to assess the needs of people, groups, communities and populations, and work to improve health, wellbeing and experiences of healthcare; secure equal access to health screening, health promotion and healthcare; and promote social inclusion. Some examples of evidence (Students should be encouraged to generate a range of different individualised evidence) The student must be able to demonstrate their knowledge and skills of essential nursing diagnostics and techniques and more complex tests and procedures related to assessing the patient and completing a comprehensive assessment. The student may choose to utilise a case study and present a work product of a comprehensive assessment form, complemented by a piece of reflection, a critique of the model in use. The mentor may choose to use Direct Observation of the student completing a patient assessment interview and to use a Question & Answer session to follow-up and test the knowledge and skills of the student. The student must be able to demonstrate an appropriate response to the changing needs of patients in their care by being responsive to progressive illness or indeed recovery. The student could profile a case and reflect upon the needs of the patient over a period of time detailing the different needs at different times of the care journey. Finally the reflection could reflect the adaptive approach to nursing care as the patients care needs changed. The student must be able to demonstrate their knowledge and skills of essential nursing diagnostic tests and procedures related to assessing the patient and completing a comprehensive assessment which ultimately reflects the needs of the patient and details the appropriate actions as a result of the tests. The student may choose to utilise a case study and present a work product of a comprehensive assessment form, complemented by a piece of reflection, a critique of the model in use. The mentor may choose to use Direct Observation of the student completing a patient assessment interview and to use a Question & Answer session to follow-up and test the knowledge and skills of the student. The student must be able to recognise the specific needs of a patient and their family in the end of life situations and terminal illnesses. The student must be able to recognise the role of the nurse under these circumstances and the importance of placing the patient and their family at the heart of all decision making about the planned care. The student may wish to use a reflective piece to demonstrate a care episode with regards to end of life care. The student must be able to use skills to research and understand the key elements of public health principles related to all spheres of nursing practice. The student could choose to profile a group of patients related to a clinical area, a geographical area or community with regards to the needs of that population and comment on the priorities, care delivery models to improve and maintain wellbeing by understanding health screening, health promotion and social inclusion initiatives. 19
NMC Competency Mapping Domain 3: Nursing Practice and decision-making Outcomes 6 7 7.1 7.2 All nurses must practise safely by being aware of the correct use, limitations and hazards of common interventions, including nursing activities, treatments, and the use of medical devices and equipment. The nurse must be able to evaluate their use, report any concerns promptly through appropriate channels and modify care where necessary to maintain safety. They must contribute to the collection of local and national data and formulation of policy on risks, hazards and adverse outcomes. All nurses must be able to recognise and interpret signs of normal and deteriorating mental and physical health and respond promptly to maintain or improve the health and comfort of the service user, acting to keep them and others safe. Adult nurses must recognise the early signs of illness in people of all ages. They must make accurate assessments and start appropriate and timely management of those who are acutely ill, at risk of clinical deterioration, or require emergency care. Adult nurses must understand the normal physiological and psychological processes of pregnancy and childbirth. They must work with the midwife and other professionals and agencies to provide basic nursing care to pregnant women and families during pregnancy and after childbirth. They must be able to respond safely and effectively in an emergency to safeguard the health of mother and baby. Some examples of evidence (Students should be encouraged to generate a range of different individualised evidence) The student must be aware of the principles of safe practice and they should also be able to demonstrate knowledge of hazards of patient care interactions (equipment, treatments and drug side effects) and be able to report concerns about patient safety to the appropriate person / authority. The student may wish to profile the clinical area where they are working to present the risks and hazards related to patient care. They could enhance this by the use of a case study or reflection on a witnessed incident or near miss. The mentor could ask the student to verbally present the risks and hazards associated with a case and ask questions of the student about actions to be taken in the event a risk is discovered that isn t being managed. The student must be able to determine the physical and mental wellbeing of any patient at any time by recognising signs and symptoms of ill health. They must also be able to respond appropriately to these situations by reporting and recording changes of health, ensuring comfort and safety of the patient at all times. The student could utilise a case study to achieve this outcome by profiling a patient care episode, followed by a reflection on the circumstances. The mentor could use Direct Observation, a Question and Answer session to determine the student s knowledge and skill in this regard. The student must be able to recognise the signs and symptoms of deteriorating health in patients. They must also be able to respond appropriately to these situations by reporting and recording changes of health and acting in a timely and appropriate manner to avoid further deterioration of the patient. The student could utilise a case study to achieve this outcome by profiling a patient care episode, followed by a reflection on the circumstances. The mentor could use Direct Observation, a Question and Answer session to determine the student s knowledge and skill in this regard. The student must demonstrate the health needs of expectant mothers, recent mothers and their babies and know how to work with Midwives and other professionals to provide appropriate care for women and their babies. They must know how to respond appropriately and safely to maintain the safety of this vulnerable client group. The student could utilise a case study to achieve this outcome by profiling a patient care episode, followed by a reflection on the circumstances. 20
NMC Competency Mapping Domain 4: Leadership, management and team working Outcomes 1 2 3 4 5 All nurses must act as change agents and provide leadership through quality improvement and service development to enhance people s wellbeing and experiences of healthcare. All nurses must systematically evaluate care and ensure that they and others use the findings to help improve people s experience and care outcomes and to shape future services. All nurses must be able to identify priorities and manage time and resources effectively to ensure the quality of care is maintained or enhanced. All nurses must be self-aware and recognise how their own values, principles and assumptions may affect their practice. They must maintain their own personal and professional development, learning from experience, through supervision, feedback, reflection and evaluation. All nurses must facilitate nursing students and others to develop their competence, using a range of professional and personal development skills. Some examples of evidence (Students should be encouraged to generate a range of different individualised evidence) The student must be able to articulate their knowledge of the need skills of leadership within nursing for the benefit of quality improvements to care and service development for the benefit of patient care. The student could evidence this by Discussion with their mentor followed by a reflection contextualising the leadership styles of nurses they work with in practice. The student must be able to recognise the need for improvement in care by evaluating and reflecting upon current practice and striving to improve the knowledge and skills of both themselves and others in practice to ensure quality of care. The student could evidence this by providing examples of when they have reflected upon their practice and considered how to enhance knowledge and skill in order to improve the care they deliver for patients. The student must be able to recognise the priority of patient care and operate within a team as a leader and as a contributor to ensure care is delivered in a timely and appropriate way for all students. The mentor could use Direct Observation, followed by Question & Answer session to understand how skilful and knowledgeable the student is regarding identifying priorities, managing time and using resources effectively for the benefit of patient care. The student must be able to demonstrate their understanding of their own skills and knowledge in terms of ability and limitation. The student must also be able to plan and develop their personal development based on feedback, mentorship, opportunity, incidents in practice and reflective evaluation of the care they deliver. The student could use a reflective account of how they understand their own care delivery and their plan to continuously improve the care they deliver. The student must have an understanding of the role of the nurse to develop and mentor student nurses to reach the minimum standards of care as required by the NMC. The student could demonstrate their ability and willingness to engage in the education and progression of others in the team including their peer group by demonstrating to their mentor one to one discussions, presentation of discrete skills and transfer of knowledge. This may be during ad-hoc opportunities observed and witnessed by their mentor or as part of a pre-arranged teaching session presented to peers and other professionals from the clinical area. 21
NMC Competency Mapping Domain 4: Leadership, management and team working Outcomes Some examples of evidence (Students should be encouraged to generate a range of different individualised evidence) The student must recognise the demand for independently planned, delivered and evaluated care that the individual nurse is accountable for. They are required to also understand the principles of safe and effective delegation and supervision of other care workers by managing risk while remaining ultimately accountable for the care delivered. 6 7 All nurses must work independently as well as in teams. They must be able to take the lead in coordinating, delegating and supervising care safely, managing risk and remaining accountable for the care given. All nurses must work effectively across professional and agency boundaries, actively involving and respecting others contributions to integrated person-centred care. They must know when and how to communicate with and refer to other professionals and agencies in order to respect the choices of service users and others, promoting shared decision making, to deliver positive outcomes and to coordinate smooth, effective transition within and between services and agencies. The student could evidence this by demonstrating the ability to recognise opportunities to delegate and supervise others safely to maximise safe and efficient care. This may include being responsible while supervised by their mentor for the care of a group of patients depending upon the suitability of the area and the skills of the student. These factors will have to be considered by the mentor to determine the level of autonomy for this evidence. The mentor could also Directly Observe the student in their role as nurse designate for one patient, a small caseload of patients or a whole caseload of patients, depending upon their skills and ability. The student and mentor could also hold a reflective discussion which leads to a piece of reflective writing by the student on their experiences of leading care delivery. The nurse must be able to understand the theoretical principles of interprofessional working and multi-agency working to benefit patient care. The student could achieve this competency by profiling the professional groups and agencies typically engaged in the care of patients connected to the clinical area they are attached. The student could also develop a case study of interprofessional and multi-agency working for a patient in their care. The mentor and student could hold a reflective discussion and question and answer session to evidence the knowledge and skills of the student in this regard. 22