Nursing Practice Skills Inventory

BSc (Hons) Nursing Nursing Practice Skills Inventory Student Name:. Field of Practice: September 2014 1

Contents Introduction and Guidance 3 Essential skills Infection prevention and control 7 Care Compassion and Communication 13 Nutrition and fluid management 19 Medicines management 25 Organisational aspects of care 37 Field Related skills Adult 65 Child 67 Learning Disability 69 Mental Health 71 Generic 73 Other additional skills 75 Skills action plans 77 Personal notes section 83 Sample signature record 89 Compulsory Updates/Core Skills 93 Night Duty/24 Hour Care Record 95 References 97 2

Introduction This inventory forms an important part of your Professional Development Portfolio and is linked to the practice assessment modules in each year of the programme The PAR (Practice Assessment Record) document encompasses the NMC Essential Skills Clusters and this Skills Inventory should be seen as supplementary to the achievement of competencies within the PAR. This document along with the PAR will be reviewed with your Personal Tutor (PT) at regular intervals. The purpose of these meetings is to ensure that you are making satisfactory progress and that all appropriate opportunities for skills acquisition are being utilised Signature Records Any suitably prepared and competent practitioner can sign the skills inventory, providing they feel assured they you have sufficient knowledge and evidence of your ability. Remember to ask each signatory to complete the register of signatures at the back of the inventory Guidance The Skills Inventory contains a range of skills that relate to the NMC Essential Skills Clusters which should apply to all care situations, but which may also be applied in a field specific context. There is also space to record acquisition of further skills (not included in the inventory) to enhance your own personal portfolio of experiences. (See blank record sheet toward the rear of the inventory) All skills must be practised in accordance with the policies and guidelines in place on that particular placement area and performed under the supervision of a suitably prepared Practitioner (NMC 2010) When developing nursing skills in practice you will be expected: to directly observe a practitioner carrying out the skill and discuss its underlying evidence base with your mentor/supervisor. to practise the skill under supervision to be deemed competent by your mentor. Only when your mentor/supervisor feels that you can consistently 3

undertake the skill in a safe and effective manner (under close supervision), they will sign to say that you are competent in that skill (year 1) and competent (under less direct supervision) in Year 2 and developing autonomy in Year 3. These judgements may be made earlier than the expected progression point deadline, but cannot be deferred to a later date. Even if competence has been demonstrated you should continue to take whatever opportunities are available to further practice the skill and maintain your competence on every placement Throughout your programme, you will have 2 main practice experiences per year in a range of different areas. Not all of the practice areas will offer opportunities to practice and/or achieve all of the skills; however whilst on a practice experience, the Hub and Spoke practice model may allow you the opportunity to experience other practice areas and develop wider skill sets. Essential skills Clusters (ESCs) and Progression Points The majority of skills identified in the Skills Inventory are linked to ESCs and have to be achieved at various progression points. Should mentors wish to seek clarification on the level of autonomy and competence expected by the NMC at each progression point can be found in annexe 3 of the Standards for pre-registration nursing education (NMC 2010) Skills Action Plans Action Plans for achievement of skills detailed in this inventory can be found toward the end of this inventory and are tools to help students to self-manage their skills acquisition. A blank template has been provided for each practice learning experience. Completing a plan will help you focus on which skills are yet to be achieved as the programme progresses. Discussing them with your mentor / supervisor will help agree a course of action if gaining competency in a skill is proving difficult or if for example, a lack of opportunity hinders skill development. The action plan may involve simulation in the university, a short visit to another practice area or practitioner, or may simply involve more frequent and focused support. Completed action plans are useful evidence of professional development and should remain a part of the inventory to link to your personal 4

development portfolio and personal tutor reviews. Tips for Effective Skills Acquisition (1) Professional education is underpinned by an adult learning ethos. Although your mentor will be keen to develop an effective partnership in facilitating your learning, the ownership and ultimate responsibility for your learning remains with you. (2) Keep this inventory with you whilst on practice and ideally refer to it each shift (3) Get into the habit of considering which skills experience to aim for at the start of a shift and discuss your achievements to the practitioners you have worked with when you feel ready to be signed off. (4) Ask for help from your mentor/supervisor. Some skills are more complex than others and require different expectations of performance depending on experience (e.g. Safeguarding Children and Vulnerable adult). In these situations further guidance has been given as to the expected level of performance for each progression point. (5) Remember that any suitably prepared and competent practitioner can sign you as competent in a skill, providing they feel assured they have sufficient knowledge and evidence of your ability to do so. (6) Don t lose yours skills booklet! Periodic photocopying of completed pages for safe storage in your wider portfolio guards against loss. You can replace a blank inventory but it will be extremely difficult to replace hard earned competency signatures. (7) Ensure you complete the skills that are linked to progression points. Your mentor and practice module leader will guide you in what is appropriate. (8) Use a variety of ways to demonstrate your skill. Demonstrating to a mentor or supervisor that you are competent in a skill can be through observable demonstration, answering questions, obtaining statements from other practitioners, undertaking a simulated skill in practice, or sharing a reflection on the skill. A mixture of these forms of evidence will be used in any assessment by a mentor or supervisor. (9) Keep practising and use every opportunity to acquire new skills. You are advised to focus on achieving all additional skills within your own field whilst familiarising yourself with the other field specific additional skills to promote inter-professional understanding. (10) Remember to ask each signatory to complete the register of signatures at the back of the inventory 5

ESC DOMAIN: INFECTION PREVENTION AND CONTROL 1. Hand Decontamination Consistent, reliable and competent demonstration of hand decontamination (mapped to ESC 22) Components of Skill (for guidance only) Applies universal precautions in relation to infection control Selects appropriate agent to decontaminate hand Appropriately times when to carry out hand decontamination Correctly applies hand decontamination technique Correctly disposes of paper towels 8

Signatories please complete the signature log at the back of this inventory Year 1: Progression Point one: Safely demonstrates fundamental skills & activities with care, compassion, underpinning knowledge & appropriate attitudes under close supervision... Year 2: Progression Point Two: Consistently demonstrate skills and activities at an emerging level of competence with care, compassion, underpinning knowledge and appropriate attitudes. Expected to take responsibility and develop more independence in care delivery with less direct supervision..... Year 3: By Registration: Consistently demonstrate and promote evidence based care with compassion, confidence, competence and appropriate attitudes. Take increasing responsibility for care delivery and give support to novice students. Supervision level should reflect developing autonomy.. 9

2. Applying the Principle of Asepsis Consistent and competent application of principles of asepsis when performing invasive nursing procedure (mapped to ESC 21, 22, 23, 24, 25 & 26) Components of Skill (for guidance only) Adheres to local policy and national guidelines on dress code for prevention and control of infection, including: footwear, hair, piercing and nails and use of sterile gloves where appropriate Applies standard precautions in relation to infection control Uses appropriate communication skills to greet, explain procedure(s) and gain consent of adult/child/young person/family. If equipment is used, appropriately selects and completes checks to ensure equipment is sterile, in date, intact, undamaged and dry Ensures comfort, privacy and dignity Appropriately disposes of waste, applying standard universal precautions Under direct supervision, accurately and clearly records findings, noting any deviations and reporting appropriately Provides adult/child/young person/family with appropriate accurate information on the management of any device, site or wound to prevent and control infection and promote healing. 10

3. Identification of the Safe Management of Risk Consistent, reliable and competent identification of the safe management of risk (mapped to ESC18) Components of Skill (for guidance only) Under supervision, works within clinical governance frameworks. Promotes a safe environment for adult/child/young person/families/visitors Appropriately and clearly records and reports any risk factors Demonstrates knowledge and applies principles of the Health and Safety at Work Act Applies principles of infection control policies appropriately Observes for potential risk and reduces any potential for harm as appropriate Remains aware of and responsive to the needs of vulnerable people Manages overall environment to minimise risk. Assesses, evaluates and interprets risk indicators and balances risks against benefits, taking account of the level of risk people are prepared to take. Reflects on and learns from safety incidents as an individual and as a team member and contributes to team learning 12

DOMAIN: CARE, COMPASSION & COMMUNICATION 4. Engagement with an Adult/Child/Young Person Engages in meaningful therapeutic relationship with adult/child/ young person or carer (mapped to ESC 1, 3, 4, 5, 8) Components of Skill (for guidance only) Introduces self to adult/child/young person appropriately Initiates appropriate conversation Seeks consent prior to any interaction, intervention or procedure Is able to obtain meaningful information through effective communication which informs care planning Demonstrates verbal communication skills appropriate to the adult/child/young person/family and the environment Uses non verbal communication skills to communicate and actively listen to the adult/child/young person/family Demonstrates warmth, genuineness and sensitivity to build a therapeutic relationship with adult/child/young person within the boundaries of the practice placement Demonstrates a range of engagement skills appropriate to the practice placement Respect individuals and strive to help them the preserve their dignity at all times Respects and advocates for a adult / child / young 15

person or their carer s rights 16

5. Conflict Resolution Safely and confidently prevents and resolves conflict to maintain a safe environment (mapped to ESC 20) Components of Skill (for guidance only) Recognises signs of aggression and responds appropriately to keep self and others safe. Assists others or obtains assistance when help is required. Identifies appropriate strategies and techniques for conflict resolution. 18

6. Assessment of an Adult/Child/Young Person To participate in comprehensive, collaborative, holistic needs-based assessment (mapped to ESC 6, 9) Components of Skill (for guidance only) Introduces self to adult/child/young person Participates in the identification and assessment of a adult/child/young person s needs under supervision, using appropriate assessment tools. Demonstrates verbal communication skills appropriate to the adult/child/young person and the environment Uses non-verbal communication skills to communicate and actively listen to the adult/child/young person/family Responds appropriately to the needs of vulnerable people Demonstrates appropriate observation skills to enhance the structured assessment process Actively engages the adult/child/young person in the assessment process Engages, where appropriate with family, carers and relevant professionals from the multidisciplinary team to obtain assessment information Participates in the written documentation of the assessment in accordance with local, legal and regulatory requirements 20

ESC DOMAIN: NUTRITION AND FLUID MANAGEMENT 7. Fluid Intake Reliable and competent assistance of a adult/child/young person to maintain fluid intake (mapped to ESC 27, 28) Components of Skill (for guidance only) Appropriately assesses the adult/child/young person and identifies potential risks Identifies issues which may affect fluid intake Appropriately supports the individual in safe management of fluid intake Encourages adult/child/young person s participation as appropriate Collaborates with the multi disciplinary team, where appropriate, to choose the correct fluid regime and/or appropriate method of intake. Measures and records accurately and clearly the adult/child/young person s fluid intake noting any deviations, communicating evaluations appropriately 22

8. Nutrition Reliable and competent assistance of a adult/child/young person to maintain nutrition (mapped to ESC 27, 28 & 30 & 31 in Year 2 & 3) Components of Skill (for guidance only) Appropriately assesses the adult/child/young person and identifies potential risks and Identifies issues which may affect eating or drinking Ensures comfort, appropriate positioning and environment for the adult/child/young person specific to their nutritional needs. Encourages adult/child/young person s participation as appropriate Assists in assessing temperature of food/drink Offers the adult/child/young person the opportunity to meet hygiene needs e.g. wash hands, brush teeth Assesses appropriate nutritional and fluid needs including the identification of level of risk e.g. body mass index; M.U.S.T. Collaborates with relevant members of multidisciplinary team, where appropriate, to select appropriate diet and method of nutrition for the individual adult/child/young person s needs Maintains client comfort, privacy & dignity Measures and records accurately the adult/child/young person s intake noting any deviations, communicating and reporting appropriately Calculates if an infant is taking appropriate amounts of feed to sustain growth and development (may be simulated) Bottle feeds a baby correctly (where able, may be simulated) Where appropriate, uses electronic devices to deliver and 24

monitor continuous gastric feeds Signatories please complete the signature log at the back of this inventory Year 1: Progression Point one: Safely demonstrates fundamental skills & activities with care, compassion, underpinning knowledge & appropriate attitudes under close supervision... Year 2: Progression Point Two: Consistently demonstrate skills and activities at an emerging level of competence with care, compassion, underpinning knowledge and appropriate attitudes. Expected to take responsibility and develop more independence in care delivery with less direct supervision..... Year 3: By Registration: Consistently demonstrate and promote evidence based care with compassion, confidence, competence and appropriate attitudes. Take increasing responsibility for care delivery and give support to novice students. Supervision level should reflect developing autonomy.. 25

9. Intravenous Therapy Consistent, reliable and competent administration of intravenous fluids (mapped to ESC 32) Components of Skill (for guidance only) NB: This skill may not be appropriate to all fields of nursing and may be addressed through simulation within the University setting when not available in clinical practice Monitors and assesses people receiving intravenous fluids. Monitors infusion site for signs of abnormality, and takes the required action reporting and documenting signs and actions taken. Documents infusion progress against prescription including markers of hydration Understands and applies knowledge of intravenous fluids and how they are prescribed and administered within local administration of medicines policy. 26

ESC DOMAIN: MEDICINES MANAGEMENT 10. Numeracy Consistent, reliable and competent application of numeracy to all nursing situations (mapped to ESC 33 all years & 32, 34 & 35 years 2&3) Components of Skill (for guidance only) Utilises weight and height measurements to accurately calculate the body mass index, and responds appropriately to findings outside the normal range. Demonstrates ability to calculate the differences from previous assessments Utilises measurements of vital signs to demonstrate the ability to calculate differences from previous assessments and identify findings outside the normal range. Is competent in basic medication calculations tablets and capsules liquid medicines injections, including unit dose, sub and multiple unit dose, SI unit conversion Demonstrates an ability to apply numeracy skills in a range of practice contexts eg. calculation of fluid and nutritional intake / output 28

11. Assisting in the administration of Medicines (Direct Supervision at all times) Consistent, reliable and competent assistance in the administration of medications (mapped to ESC 33 all years and ESC 34 & 35 Years 2 & 3) Components of Skill (for guidance only) Uses appropriate communication skills to greet, explain procedures and gain consent of adult/child/young person/family. Works in collaboration with adult/child/young person/family Demonstrates safe practice in the administration of medicines and adhere to the 5 rights ie right drug; right dose; right time; right route and checks expiry dates Supports the individual to self medicate as appropriate Assists adult/child/young person to take medication, offering a drink if appropriate Assesses adult/child/young person/family s knowledge of medication and provides additional information as appropriate Accurately and clearly records dose of medication given Monitors the therapeutic effect/side effects of medication (e.g. pain relief from analgesia) and acts appropriately and promptly Applies placement policy if medication is refused, including documentation of refusal Demonstrates knowledge of the legal requirements which inform the Patient Group Direction (PGD) 30

12. Oxygen Therapy (Direct Supervision at all times) Consistent, reliable and competent administration of prescribed oxygen therapy (mapped to ESC 37) Components of Skill (for guidance only) Uses appropriate communication skills to greet, explain the procedure and gain consent of adult/child/young person/family Works in collaboration with the adult/chid/family Demonstrates safe practice in the administration of oxygen therapy and adhere to the 5 rights of administration: right patient, right drug, right dose, right time, right route and checks expiry dates. Consults prescription sheet to determine percentage, mode of delivery and duration of oxygen therapy Identifies potential risks, chooses appropriate equipment (mask/nasal cannula) and checks expiry date. Ensures comfort and assists adult/child/young person in positioning mask/cannula Appropriately delivers prescribed rate of oxygen with correct setting of flow meter as appropriate to situation Monitors the therapeutic effect of oxygen therapy including oxygen saturation monitoring where appropriate Accurately and clearly records the therapeutic effects of oxygen therapy and acts appropriately and promptly 33

13. Intra-Muscular Injection (Direct Supervision at all times) Consistently competent administration of prescribed intra-muscular injection (mapped to ESC 33, 38) Components of Skill (for guidance only) Applies universal precautions in relation to infection control Uses appropriate communication skills to greet, explain procedure and gain consent of adult/child/young person/family. Demonstrates safe practice with the administration of IM injections and observes the 5 rights of administration: right patient, right drug, right dose, right time, right route and checks expiry dates Consults prescription sheet Collects and checks all equipment Accurately selects and calculates correct dose of medication in the required volume, dilution, dosage and checks expiry date Records controlled drugs in Controlled Drug Book in accordance with the University and local Trust policy Uses protective equipment / clothing if appropriate Selects appropriate site and applies correct technique Safely disposes of equipment Accurately and clearly records dose of medication given Applies practice area policy if medication is refused, including documentation of refusal Monitors the therapeutic effect/side effects of medication (e.g. pain relief) and acts appropriately 35

and promptly 36

14. Subcutaneous Injection (Direct Supervision at all times) Consistent, reliable and competent administration of prescribed subcutaneous injection (mapped to ESC 33, 38) Components of Skill (for guidance only) Applies universal precautions in relation to infection control Uses appropriate communication skills to greet, explain procedure and gain consent of adult/child/young person/family. Demonstrates safe practice in relation to SC injection administration and adhere to the 5 rights of administration: right patient, right drug, right dose, right time, right route and checks expiry dates Consults prescription sheet Collects and checks all equipment Accurately selects and calculates correct dose of medication in the required volume, dilution, dosage and checks expiry date Records any controlled drugs in Controlled Drug Book in accordance with University and local Trust policy Selects appropriate site and applies correct technique Safely disposes of equipment Accurately and clearly records dose of medication given Applies placement policy if medication is refused, including documentation of refusal Monitors the therapeutic effect/side effects of medication (e.g. pain relief from analgesia) and acts 38

appropriately and promptly 39

15. Medicines Management Consistently work within legal and ethical frameworks that underpin safe and effective medicines management (mapped to ESC 34, 35, 37, 38, 39, 40, 41) Components of Skill (for guidance only) Demonstrates understanding of their role in medication management related to NMC and local requirements for a range of medication directions used within the practice area Demonstrates the importance of establishing an adult /child/ young person understanding in relation to the use of medicines and responds appropriately Demonstrates the correct disposal of all medication Demonstrates ability to assess an adult /child/ young person and respond to any change in condition Demonstrates appropriate delivery of clear and accurate information relating to medication Demonstrates support of clients to make safe and informed choices about medicines Demonstrates safe and legal dispensing of medication to an adult /child/ young person for either selfadministration, administration by another professional or by themselves Demonstrates the effective recording of decisions and/ or care received in relation to management of medication Articulates the management and reporting of an adverse reaction e.g. anaphylaxis Demonstrates the correct methods for the storage and transportation of medication Verbalises the procedure for registrants in the event of a 41

drug error being identified. 42

DOMAIN: 0RGANISATIONAL ASPECTS OF CARE 16. Evaluating effectiveness of Nursing Interventions Consistent and effective evaluation of Care (mapped to ESC 10) Components of Skill (for guidance only) Acts collaboratively with people and their carers enabling and empowering them to take a shared and active role in the delivery and evaluation of nursing interventions. Works within the limitations of own knowledge and skills to question and provide safe and holistic care. Actively seeks to extend knowledge and skills using a variety of methods in order to enhance care delivery. Detects, records, reports and responds appropriately to signs of deterioration or improvement. Provides safe and effective care in partnership with people and their carers within the context of people s ages, conditions and developmental stages. Prioritises the needs of groups of people and individuals in order to provide care effectively and efficiently. Involves the person in review and adjustments to their care, communicating changes to colleagues. 44

17. Safeguarding Children and Vulnerable Adults Consistently supports and protects the vulnerable (mapped to ESC 11) Components of Skill (for guidance only) Acts within legal frameworks and local policies in relation to safeguarding adults and children who are in vulnerable situations. Shares information with colleagues and seeks advice from appropriate sources where there is a concern or uncertainty. Uses support systems to recognise, manage and deal with own emotions Documents concerns and information about people who are in vulnerable situations. Recognises and responds when people are in vulnerable situations and at risk, or in need of support and protection. Shares information safely with colleagues and across agency boundaries for the protection of individuals and the public. Makes effective referrals to safeguard and protect children and adults requiring support and protection. Works collaboratively with other agencies to develop, implement and monitor strategies to safeguard and protect individuals and groups who are in vulnerable situations. Supports people in asserting their human rights. Challenges practices which do not safeguard those in need of support and protection. 46

18. Personal Hygiene and Dressing Consistent, reliable and competent demonstration of assisting a adult/child/young person to maintain his/her own personal hygiene and dressing needs in a safe manner (mapped to ESC 2) Components of Skill (for guidance only) Applies universal precautions in relation to infection control Provides a conducive environment ensuring dignity, privacy and warmth Uses appropriate communication skills to greet, explain procedure(s) and gain consent of adult/child/young person/family. Works in collaboration with adult/child/young person/family Selects appropriate equipment/toiletries Safely transfers adult/child/young person to bathroom if appropriate Provides oral, hair, nail and aural care. Encourages adult/child/young person to participate as much as possible, determining preferences to maximise comfort and dignity Chooses appropriate clothing whilst respecting personal choice, culture, comfort and dignity Within current sphere of knowledge and proficiency, assesses and identifies potential risks, including for vulnerable groups Observes and records the condition and integrity of skin, including unexplained injuries and signs of tissue damage. 48

19. Manual Handling Consistent and reliable demonstration of manual handling techniques Components of Skill (for guidance only) Applies standard universal precautions in relation to infection control Demonstrates knowledge and applies principles of the Health and Safety at Work Act Uses appropriate communication skills to greet, explain procedure(s) and gain consent of adult/child/young person Ensures comfort of the adult/child/young person during procedure Appropriately assesses the adult/child/young person, identifies potential risks and chooses appropriate equipment Safely transfers adult/child/young person from bed to chair/trolley using appropriate equipment Safely uses mechanical hoist (where appropriate) Safely and appropriately assists adult/child/young person who requires assistance with walking/standing Safely and appropriately positions/repositions adult/child/young person in bed/chair 50

20. Near Testing (Immediate diagnostic tests e.g BM; Urinalysis) Consistent and reliable demonstration of diagnostic testing (mapped to ESC 9) Components of Skill (for guidance only) Applies universal precautions in relation to infection control Uses appropriate communication skills to greet, explain procedure and gain consent of adult/child/young person/family Encourages adult/child/young person to participate as much as possible, Within current sphere of knowledge and proficiency, assesses and identifies potential risks in a timely manner Appropriately selects test equipment and completes checks to ensure products are sterile, in date, intact, undamaged and dry Correctly collects sample, whilst providing a conducive environment that ensures dignity, privacy and comfort of adult/child/young person Completes near testing procedure as per manufacturers guidance Appropriately disposes of waste, applying universal precautions Accurately and clearly records findings, noting any deviations and reports appropriately Informs adult/child/young person/family of recording where appropriate Responds appropriately to findings outside the normal 52

range 53

21. Measuring and Recording Temperature Reliable, competent measurement of temperature in a adult/child/young person (mapped to ESC 9) Components of Skill (for guidance only) Applies standard universal precautions in relation to infection control Uses appropriate communication skills to greet, explain procedure(s) and gain consent of adult/child/young person/family. Appropriately assesses the adult/child/young person, identifies potential risks and chooses appropriate equipment and site. Ensures comfort of adult /child/young person during procedure Measures and records temperature accurately and clearly Compares findings with past recordings where appropriate Informs adult/child/young person/family of recording where appropriate Responds appropriately to findings outside the normal range in a timely manner 55

22. Measuring and Recording Respiration Reliable and competent measurement of respirations in a adult/child/young person (mapped to ESC 9) Components of Skill (for guidance only) Applies universal precautions in relation to infection control Uses appropriate communication skills to greet, explain procedure(s) and gain consent of adult/child/young person/family. Ensures comfort of adult/child/young person during procedure Counts the respirations for one minute whilst observing and monitoring the rate, rhythm, depth and respiratory effort Listens for any abnormal sounds associated with breathing (e.g. wheezing) Measures and records respirations accurately and clearly Compares findings with past recordings where appropriate Informs adult/child/young person/family of recording where appropriate Responds appropriately to findings outside the normal range in a timely manner 57

23. Measuring and Recording Pulse Reliable and competent measurement of taking and recording the pulse in a adult/child/young person (mapped to ESC 9) Components of Skill (for guidance only) Applies universal precautions in relation to infection control Uses appropriate communication skills to greet, explain procedure(s) and gain consent of adult/child/young person/family. Ensures comfort of adult/child/young person during procedure Assesses adult/child/young person and locates an appropriate pulse site Uses correct finger position and applies sufficient pressure for accurate pulse measurement Observes and monitors rate, rhythm and volume Compares findings with past recordings where appropriate Measures pulse for one minute and records pulse accurately and clearly Informs adult/child/young person/family of recording where appropriate Responds appropriately to findings outside the normal range in a timely manner 59