APPENDIX ONE ICAT: Integrated Clinical Assessment Tool
Contents Background...25 ICAT learning objectives...25 Participant information...258 Explanation of scoring of the ICAT...25 Participant responsibilities...25 Clinical resource personnel responsibilities...25 Domain One...20 Professional Practice...20 Domain Two...2 Critical Thinking and Analysis...2 Domain Three...27 Provision and Coordination of Care Disease and treatment related care...28 Provision and Coordination of Care Supportive Care...270 Provision and Coordination of Care Coordinated Care...272 Provision and Coordination of Care Information provision and education...27 Domain Four...275 Collaborative and Therapeutic Practice...275 References... 277 EdCaN Cancer Nursing Program (Entry to Specialty) The National Cancer Nursing Education Project 255
Background The ICAT is a developmental portfolio of evidence of a participant s ability to apply the capabilities expected of an Beginning Specialist Cancer Nurse to their clinical practice. The Integrated Clinical Assessment Tool (ICAT) for the Beginning Specialist Cancer Nurse is drawn from material developed for EdCaN, the national nursing education project, funded by the Australian Government through Cancer Australia. The ICAT is part of the EdCaN Cancer Nursing Program (Entry to Specialty), and was developed in conjunction with Queensland Health, as part of their Queensland Transition Support Program: Cancer Care. The authors acknowledge the work undertaken at Sir Charles Gairdner Hospital in the original ICAT versions. While the EdCaN Cancer Nursing Program (Entry to Specialty) has been developed primarily for RNs who commence practicing in a specialist cancer setting (the Beginning Specialist Cancer Nurse), components of the program will also be relevant for RNs who care for people affected by cancer in a range of other settings such as acute medical and surgical units. ICAT learning objectives It is expected that participation in the ICAT process will enable the Beginning Specialist Cancer Nurse to demonstrate the following: Practises in accordance with legislative, professional and ethical standards for nursing and cancer care. Uses appropriate mechanisms for monitoring own performance and competence as an Beginning Specialist Cancer Nurse. Engages in and contributes to informed critique and exerts influence at the professional and systems level of health and cancer care. Contributes to quality improvement activities aimed at improving outcomes for people affected by cancer. Practices within an evidence-based framework and contributes to the development of evidence for practice. Embraces continuing professional development to ensure practices that incorporate best available evidence and emerging developments in specialist cancer nursing and cancer care. Provides advice and mentorship, as appropriate, to nursing colleagues and others involved in cancer care to promote optimal standards. Participates in activities that contribute to reducing the risk of developing cancer and that promote early detection of cancer. Identifies potential and actual adverse effects of having cancer and receiving cancer therapies. Participates in the safe and effective management of cancer and the delivery of cancer treatments Identifies, validates and prioritises potential and actual health needs across all domains of health of the person affected by cancer throughout the cancer continuum Effectively provides and ensures access to a range of supportive care services and interventions to meet the multiple health needs of the person affected by cancer. Coordinates implementation of care across different phases of the cancer journey and across health-care settings to facilitate continuity of care and effective use of health-care resources relevant to the needs of the person affected by cancer. Provides comprehensive and specialised information in a coordinated manner to assist people affected by cancer to achieve optimal health outcomes, reduce distress and make informed decisions. 25 APPENDIX ONE ICAT: Integrated Clinical Assessment Tool
Provides education to the person affected by cancer to enable them to be active participants in their care and engage in self-management of health-related needs where appropriate to achieve optimal health outcomes across the cancer continuum. Develops therapeutic relationships with people affected by cancer to anticipate and meet their multiple care needs across the cancer continuum. Initiates and ensures ongoing improvements in collaborative relationships with the person affected by cancer and other members of the health-care team to optimise health outcomes. It is recommended that the ICAT is performed at different stages throughout the transition process, in accordance with workplace policy. Copyright You may reproduce the whole or part of this work in unaltered form for your own personal use or, if you are part of an organisation, for internal use within your organisation, but only if you or your organisation do not use the reproduction for any commercial purpose and retain this copyright notice and all disclaimer notices as part of that reproduction. Apart from rights to use as permitted by the Copyright Act 18 or allowed by this copyright notice, all other rights are reserved and you are not allowed to reproduce the whole or any part of this work in any way (electronic or otherwise) without first being given the specific written permission from the Commonwealth to do so. Please refer to the EdCaN website for further information (cancerlearning.gov.au/edcan_resources) EdCaN Cancer Nursing Program (Entry to Specialty) The National Cancer Nursing Education Project 257
Participant information Name: Preceptor/s: Workplace: Participant Signature Assessor Signature Participant Name Assessor Name Date 258 APPENDIX ONE ICAT: Integrated Clinical Assessment Tool
Explanation of scoring of the ICAT (based on Benner s stages of skills acquisition 1 ) Achieved/ Not achieved (A/NA) Overall ment of whether the participant achieves the performance criteria at an appropriate level 1 Novice This level is characterised by rule-governed behaviour, as the novice has no experience of the situation upon which to draw. 2 Advanced Beginner Advanced beginners deliver marginally acceptable performance. Advanced beginners continue to need adequate support from mentors, supervisors and colleagues in the practice setting. Competent The competent practitioner is able to identify priorities and manage their own work. 4 Proficient The proficient practitioner is able to perceive situations holistically and can focus on the most relevant aspects of a problem. Proficiency is normally found in practitioners who have worked in a specific area of practice for several years. 5 Expert This stage is characterised by a deep understanding and intuitive grasp of the total situation. (Table adapted from Skills acquisition in clinical practice website 2 ). The program participant and clinical resource personnel all play a role in evaluating performance. Below is an outline of the key steps in the ment process: Participant responsibilities: 1. On commencement of the program, record your initial self-ment (SA) in the ICAT using the rating scale above in conjunction with Benner s descriptions of stages of practice development. These ratings should be discussed with your clinical resource personnel. Initial self-ment is to be completed within 4 weeks of commencing in clinical area. 2. Identify learning needs and develop an Individual Learning Plan to achieve EdCaN Beginning Specialist Cancer Nurse performance criteria. Ensure regular reflection of progress towards planned learning.. Ensure regular contact (1-2 times/week) by rostering appropriately to access the clinical resource personnel to facilitate achievement of clinical objectives. 4. Record learning experiences in ICAT (at least once a week). 5. Coordinate an opportunity to meet with the clinical resource personnel at allocated ment time points at three, six, nine and twelve to undertake an evaluation of practice, recognize achievements and identify future learning priorities. Document individual learning plan in pages provided. Clinical Resource Personnel responsibilities: 1. Meet with participant to discuss initial self-ment of clinical performance (review rating scale and Benner s description of competence). Initial self-ment to be completed within 4 weeks of commencing in clinical area. 2. Ensure regular contact (2- weekly) with participant is maintained during the year to facilitate achievement of clinical objectives, competency ment and guide the participant s reflective practice.. Undertake an evaluation of the program participant s clinical practice at allocated ment time points at three, six, nine and twelve. Please refer to the rating scale provided above in conjunction with Benner s descriptions and record the evaluation in the ICAT. Following discussion with the participant, document agreed learning priorities on the individual learning plan. EdCaN Cancer Nursing Program (Entry to Specialty) The National Cancer Nursing Education Project 25
Domain 1 Professional practice 1.1 Engages in and contributes to informed critique and exerts influence at the professional and systems level of health and cancer care. Demonstrates safe and effective practice based on local and national guidelines, policies and procedures related to cancer care. Operates within a multidisciplinary team (MDT) framework. Consults effectively with specialist cancer nurses to maintain scope of practice and ensure the needs of the person affected by cancer are met. 20 APPENDIX ONE ICAT: Integrated Clinical Assessment Tool
Domain 1 Professional practice 1.2 Uses appropriate mechanisms for monitoring own performance and competence as a Beginning Specialist Cancer Nurse. Demonstrates a commitment to maintaining competence through participation in professional development activities relevant to cancer care. Adapts practice according to responses and feedback from people affected by cancer and other members of the health-care team about individual effectiveness as a beginning specialist cancer nurse. Actively participates in own performance review processes in accordance with local facilities procedures. EdCaN Cancer Nursing Program (Entry to Specialty) The National Cancer Nursing Education Project 21
Domain 1 Professional practice 1. Practises in accordance with legislative, professional and ethical standards for nursing and cancer care Complies with legislation relevant to cancer. In consultation with the multidisciplinary team, identifies and responds to potential ethical issues that may arise in cancer control settings. Practises in a way that acknowledges the impact of cancer on the culture, dignity, values, beliefs and rights of people affected by cancer. 22 APPENDIX ONE ICAT: Integrated Clinical Assessment Tool
Domain 2 Critical thinking and analysis 2.1 Contributes to quality improvement activities aimed at improving outcomes for people affected by cancer. Uses recognised standards and guidelines in cancer care to guide practice. Participates in activities that contribute to improvements in safety and cancer care outcomes. Demonstrates the skills and values of critical reflection and lifelong learning to inform own practice. EdCaN Cancer Nursing Program (Entry to Specialty) The National Cancer Nursing Education Project 2
Domain 2 Critical thinking and analysis 2.2 Practices within an evidence-based framework and contributes to the development of evidence for practice Uses evidence-based resources to improve the health outcomes of people affected by cancer. Identifies research findings relevant to clinical decision making. Critically reflect upon research. Uses current information technology and resources relevant to cancer nursing and the development of practice. 24 APPENDIX ONE ICAT: Integrated Clinical Assessment Tool
Domain 2 Critical thinking and analysis 2. Embraces continuing professional development to ensure practices that incorporate best available evidence and emerging developments in specialist cancer nursing and cancer care Uses relevant sources to seek additional information when presented with complex or challenging situations. Identifies learning needs through critical reflection, performance review and ment of local practice needs. Demonstrates knowledge of relevant professional development resources and activities in cancer nursing. EdCaN Cancer Nursing Program (Entry to Specialty) The National Cancer Nursing Education Project 25
Domain 2 Critical thinking and analysis 2.4 Provides advice and mentorship to nursing colleagues and others involved in cancer care to promote optimal standards. Actively participates in education and staff development activities relevant to cancer care. Utilise colleagues and networks to access advice and mentorship. Seek advice and professional support from nursing colleagues and others involved in cancer care to establish professional networks. 2 APPENDIX ONE ICAT: Integrated Clinical Assessment Tool
Domain Provision and coordination of care: Disease and treatment related care.1.1 Participates in activities that contribute to reducing the risk of developing cancer and that promote early detection of cancer. Demonstrates an understanding of the principles of cancer s epidemiology, risk factors, and genetics. Prepares supports and monitors people undergoing diagnostic tests. EdCaN Cancer Nursing Program (Entry to Specialty) The National Cancer Nursing Education Project 27
Domain Provision and coordination of care: Disease and treatment related care.1.2 Identifies potential and actual adverse effects of having cancer and receiving cancer therapies. Demonstrates understanding of the principles of biology and pathophysiology of cancer, its diagnosis and presentation across the disease continuum. Demonstrates understanding of the fundamental mechanisms involved in cancer therapies and their related clinical effects, both acute and delayed. Demonstrates a fundamental understanding of the role of cancer clinical trials for a person s care. Undertakes and documents a comprehensive and timely ment of current and potential effects experienced by the person affected by cancer using a systematic, evidence-based approach. Monitors and responds to potential adverse events associated with cancer and having cancer treatment, using evidence-based knowledge. Communicates outcomes of ment with other members of the health-care team and the person affected by cancer following collaboration with the SCN to facilitate identification of current and potential adverse effects of having cancer and cancer treatment. 28 APPENDIX ONE ICAT: Integrated Clinical Assessment Tool
Domain Provision and coordination of care: Disease and treatment related care.1. Participates in the safe and effective management of cancer and the delivery of cancer treatments Plans and delivers nursing care to prevent, minimise and manage the acute and delayed effects of having cancer and its treatment, based on systematic ment of the person affected by cancer. Identifies treatment protocols and clinical guidelines, including non-pharmacological treatments, in the context of cancer. Demonstrates safe and effective use of clinical procedures and technologies in the provision of optimum care related to cancer treatment and palliation. Continuously evaluates the condition and response of the person affected by cancer to interventions in a timely manner, using validated and focused ment tools. Modifies the management plan in collaboration with the multidisciplinary team when necessary to achieve optimal health outcomes for people affected by cancer. EdCaN Cancer Nursing Program (Entry to Specialty) The National Cancer Nursing Education Project 2
Domain Provision and coordination of care: Supportive Care.2.1 Identifies, validates and prioritises potential and actual health needs across all domains of health of the person affected by cancer throughout the cancer continuum. Demonstrates understanding of the impact of cancer and its treatment on all domains of health for the person affected by cancer. Undertakes and documents comprehensive and timely ment of current and potential health needs, including co-morbid conditions and support needs across the cancer continuum. Communicates effectively with members of the multidisciplinary team and refers appropriately to facilitate efficient, timely and comprehensive ment and identification of current and potential needs of the person affected by cancer. 270 APPENDIX ONE ICAT: Integrated Clinical Assessment Tool
Domain Provision and coordination of care: Supportive Care.2.2 Effectively provides and ensures access to a range of supportive care services and interventions to meet the multiple health needs of the person affected by cancer. Plans and delivers care within a multidisciplinary approach to meet the multiple health and support needs of the person affected by cancer. Applies knowledge of clinical and supportive care guidelines and evidence in the context of cancer. Identifies the role of supportive care services available to the person affected by cancer and refers them to the relevant service provider. Adapts and prioritises nursing care of the person affected by cancer in collaboration with nursing colleagues, according to their needs across all domains of health and clinical circumstances. Determines the effectiveness of nursing interventions on clinical outcomes via regular and ongoing ment of the person affected by cancer, and modifies the management plan in consultation with the multidisciplinary team and nursing colleagues. Identifies and documents the person s use of complementary and alternative health-care practices and communicates this with appropriate members of the multidisciplinary team. EdCaN Cancer Nursing Program (Entry to Specialty) The National Cancer Nursing Education Project 271
Domain Provision and coordination of care: Coordinated Care..1 Coordinates implementation of care across different phases of the cancer journey and across health-care settings to facilitate continuity of care and effective use of health-care resources relevant to the needs of the person affected by cancer. Plans and delivers care using a comprehensive care plan incorporating interventions to promote continuity of care. Ensures that the person affected by cancer has access to information and resources to enable continuity of their care. Identifies health services and community resources relevant to cancer care across the continuum. Refers individuals to service providers in various care contexts to facilitate the delivery of services in a coordinated, consistent and timely manner in collaboration with the SCN and multidisciplinary team. 272 APPENDIX ONE ICAT: Integrated Clinical Assessment Tool
Domain Provision and coordination of care: Information provision and education.4.1 Provides comprehensive and specialised information in a coordinated manner to assist people affected by cancer to achieve optimal health outcomes, reduce distress and make informed decisions Assesses the understanding of the person affected by cancer of their clinical circumstances, treatment and care plan, and their preference for information. Provides information that reflects fundamental knowledge of the pathophysiology and progression of cancer, and current evidence regarding cancer treatments across the care continuum. Demonstrates knowledge of information resources for the person affected by cancer and facilitates access to resources relevant to their needs and preferences. Collaborates with other members of the health-care team to ensure a coordinated and documented approach to providing consistent and timely information to people affected by cancer, avoiding duplication and addressing gaps where required. EdCaN Cancer Nursing Program (Entry to Specialty) The National Cancer Nursing Education Project 27
Domain Provision and coordination of care: Information provision and education.4.2 Provides education to the person affected by cancer to enable them to be active participants in their care and engage in self-management of health-related needs where appropriate to achieve optimal health outcomes across the cancer continuum. Provides information and refers to other health professionals and resources to support the person affected by cancer to participate in decisions about their treatment and care at all stages of the cancer continuum according to their preferences. Participate in the provision of evidence-based educational interventions to assist people affected by cancer to develop knowledge, skills and confidence to manage their health needs and the problems associated with cancer and its treatments. Documents the response of the person affected by cancer to educational interventions and modifies educational strategies when necessary, in collaboration with the multidisciplinary team, to achieve optimal health outcomes. 274 APPENDIX ONE ICAT: Integrated Clinical Assessment Tool
Domain 4 Collaborative and therapeutic practice 4.1 Develops therapeutic relationships with people affected by cancer to anticipate and meet their multiple care needs across the cancer continuum. Uses effective communication skills to establish and maintain therapeutic relationships with people affected by cancer. Assesses and documents preferences and decisions of the person affected by cancer regarding care and treatment. Promotes the ability of the person affected by cancer to participate in care decisions and selfmanagement of their health needs according to their preferences and resources. EdCaN Cancer Nursing Program (Entry to Specialty) The National Cancer Nursing Education Project 275
Domain 4 Collaborative and therapeutic practice 4.2 Initiates and ensures ongoing improvements in collaborative relationships with the person affected by cancer and other members of the health-care team to optimise health outcomes. Actively facilitates the involvement of the person affected by cancer as a partner in the multidisciplinary team. Demonstrates an understanding of the roles of the various members of the multidisciplinary team in achieving optimal outcomes for people affected by cancer. Communicates and networks to promote the exchange of information about care needs within the multidisciplinary team. Contributes as part of a multidisciplinary team to the review of individual care outcomes. 27 APPENDIX ONE ICAT: Integrated Clinical Assessment Tool
References 1. Benner P. From novice to expert: Excellence and power in clinical nursing practice. Menlo Park: Addison-Wesley; 184. 2. NTRG: The Resource Group for Healthcare Professionals. Skills acquisition in clinical practice. [01.0.20]; Available from: http://www.ntrg.u-net. com/html/skills_acquisition_in_clinical.html. EdCaN Cancer Nursing Program (Entry to Specialty) The National Cancer Nursing Education Project 277