Clinical Skills Development Booklet - University of Bolton · To develop the student nurses ability...
Transcript of Clinical Skills Development Booklet - University of Bolton · To develop the student nurses ability...
Version 1.2 Mar16 JH/TH 1
Clinical Skills Development Booklet
Pre-Registration BSc (HONS) Adult Nursing
Programme
Name:
Trust:
Personal Tutor:
Clinical Tutor:
Version 1.2 Mar16 JH/TH 2
Please place in a file as you will need to take this skills log onto your clinical
placements
Please ensure to practice these skills under supervision (or simulation where
applicable).
Always read and adhere to local Trust polices at all times.
Above all enjoy your clinical skills development and work closely with your
mentors and clinical tutors
Version 1.2 Mar16 JH/TH 3
Clinical skills Log
This skills listed below are divided into three sections, one for each of the years on the
course. You will be required to demonstrate achievement of the skills listed for each year by
the end of that year. In exceptional circumstances some skills may be carried over into the
following year. All skills must be undertaken in keeping with local and national guidelines so
you will need to familiarise yourself with these prior to undertaking each skills. Skills will be
developed using a three-stage approach (Based on the Miller Pyramid), the descriptions
below offer guidance on when each of the stages should be signed.
Theorised Practice
This stage will be signed when the learner has demonstrated a clear understanding of the
knowledge underpinning the practice of the skills. This includes (where applicable) the
underpinning anatomy and physiology, best practice guidelines, local/national policy, potential
risks/complications, overriding purpose/goal and scope of professional practice. No skills
should be undertaken (even within a practice scenario) without first achieving this stage.
Version 1.2 Mar16 JH/TH 4
Supervised Practice
This stage should be signed when you are able to demonstrate consistent successful
implementation of the skill with direct supervision and prompting. This stage may be
achieved in clinical practice and/or simulation dependent upon the particular skill in
question. You will need to follow the guidance of a suitably qualified practitioner.
Competent Practice
This stage is signed when you are able to consistently demonstrate the undertaking of the
skill without requiring guidance or prompts. The length of time it takes you to get to this
stage will vary considerably between different skills and the opportunities you get to practice
them. Achieving this stage indicates that you are ready to practice that particular skill
without direct supervision. During your training however you will not be able to undertake all
of these skills without direct supervision. For some of these skills you will need to wait until
you have graduated and gained your registration. These skills are highlighted within the
skills log.
Version 1.2 Mar16 JH/TH 5
Core skills Framework
By adopting a shared approach to learning it is envisaged that mandatory training will be
standardised, reviewed and developed to ensure agreed standards and quality throughout
training within the Higher Educational Institutions and the Trusts. Core skills taught sessions
have been integrated into year 1 semester 1 and 2 timetables.
Once you have attended the taught session and you have reviewed the learning materials on
the Core Skills Framework site, you need to complete the accompanying test. The test will
need to be completed before you go on your second clinical placement. Please print your
completed test paper as evidence and record the date you completed the test in the table
below. Your completed test paper should be kept in your portfolio.
Core skill
Taught session Date test completed
Fire Safety
Trust Induction and e-learning
Moving and Handling
Clinical skills, Trust induction and e-learning
NHS Conflict resolution
Clinical skills, Trust Induction and e-learning
Equality diversity and human rights
University session and e-learning
Resuscitation – adult basic life support
Trust Induction and e-learning
Resuscitation – child basic life support
Trust Induction and e-learning
Health and Safety
Trust induction and e-learning
Infection prevention and control
Trust Induction, Clinical tutor, University and e-learning
Safeguarding children
Trust induction and e-learning
Safeguarding vulnerable adults
Trust induction and e-learning
Information governance
Trust induction and e- learning
Version 1.2 Mar16 JH/TH 6
Moving and Handling year 1 Copy to be kept in portfolio
MANUAL HANDLING
Aim: To enable the student nurse to perform
safe manual handling under supervision PRACTICED Tick when completed
INSTRUCTED Tick when completed
Outcomes:
Principles of moving a load
Principles of carrying
a. baby
b. child
c. Object
Palm to palm support standing
Managing falls
M & H unconscious and paralysed patients
Assisting patients on and off beds and chairs
Use of equipment
a. slide sheet
b. Pat slide
c. Hoist
d. Transfer board
e. Handling blocks
Date of skill session attendance
Is exposed to the skill and is able to observe
in practice
Taught under supervision
Performs under supervision
Signature of Registrant Signature of Registrant Signature of Registrant Signature of Registrant
Version 1.2 Mar16 JH/TH 7
Basic Life Support (BLS) Year 1 Copy to be kept in portfolio
INFANT, CHILD AND ADULT BASIC LIFE SUPPORT- CARDIO PULMONARY RESUSCITATION
Aim: To enable the student nurse to deliver effective basic life support
Outcomes:
Discuss importance of competency in basic life support
Demonstrate assessment of airway, breathing and circulation
Discuss/demonstrate effective ventilation technique
Discuss/demonstrate effective cardiac massage
Recall cardiac arrest procedure for the clinical environment.
PRACTICED Tick when completed
INSTRUCTED Tick when completed
Date of skills session
Is exposed to the skill and is able to observe
in practice
Taught under
supervision
Performs under
supervision
Signature of Skills Lecturer Signature of Registrant Signature of Registrant Signature of Registrant
Version 1.2 Mar16 JH/TH 8
1st Year Clinical Skills
Hand washing
Aim: to develop in the student nurse a knowledge base underpinning the practice of hand -washing and the ability to carry out a taught hand - washing technique.
Outcomes:
Define hand – washing
Identify what contaminates and patients most susceptible to infection
Identify solutions used for hand washing
Demonstrate effective hand – washing techniques in practice
Discuss reasons for non – compliance
Discuss the trust infection control policy
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed Signed Signed
Print Print Print
Measurement of Blood pressure Aim: To introduce the student nurse to the skill of physical observation and assessment.
To develop the student nurses ability to assess blood pressure.
Outcomes:
Recall anatomy and physiology of the cardiovascular system.
Define blood pressure.
Discuss rationale/indications for recording blood pressure.
Identify equipment: Manual and electronic
Prepare the patient for the intervention.
Demonstrate palpation of both radial and brachial pulses.
Collect and prepare equipment.
Assess measure and record blood
pressure both manually and
electronically.
Demonstrate knowledge of factors
affecting blood pressure variations
Theorised
Practice
Supervised
Practice
Competent
Practice
Version 1.2 Mar16 JH/TH 9
Standard Infection Control Precautions / Aseptic Non-Touch Technique Aim: To enable the student nurse to adopt and practice safe aseptic technique and
prevention of cross infection.
Outcomes:
Define asepsis
Discuss methods of preventing infection
Identify patients most vulnerable
Discuss safe principles that underpin practice i.e. hand-washing, dressing, trolley cleaning
Demonstrate ability to put on a pair of sterile surgical gloves
Demonstrate check and safe opening of sterile instrument packages/additional equipment
Participate in an aseptic technique for wound cleansing/dressing change
Carry out aseptic technique (under supervision)
Discuss how patient was prepared for the procedure physically and psychologically
Identify individual Trust/Clinical area policy and procedure
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed Signed
Print Print
Measurement of Oxygen Saturation
Aim To introduce the student nurse to the skill of measurement and assessment and oxygen
saturation. To develop the student nurses ability to assess and record oxygen saturation
Outcomes:
Recall anatomy and physiology of the respiratory system.
Define what the measurement of oxygen saturation is.
Discuss rationale/indications for recording oxygen saturation.
Discuss what else is noted when observing and recording oxygen saturation
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed Signed
Print Print
Version 1.2 Mar16 JH/TH 10
Measurement of Heart Rate
Aim: To introduce the student nurse to the skill of physical observation and assessment.
To develop the student nurses ability to assess pulse rate.
Outcomes:
Recall anatomy and physiology of the cardio-vascular system, in particular the heart.
Define what a pulse is.
Locate the major pulse points of the body.
Discuss what else is noted when palpating & recording pulse besides rate.
Prepare the patient for the intervention.
Locate, assess and record the radial pulse, the carotid pulse.
Discuss factors affecting variations in pulse rate
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed
Signed
Measurement of Respiratory Rate
Aim: To introduce the student nurse to the skill of physical observation and assessment.
To develop the student nurses ability to assess respiration rate.
Outcomes:
Recall anatomy and physiology of the respiratory system.
Define what respiration is.
Discuss rationale/indications for recording respiration.
Discuss what else is noted when observing and recording respiration e.g. depth, rhythm and effort.
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed Signed
Print Print
Version 1.2 Mar16 JH/TH 11
Measurement of Temperature
Aim: To introduce the student nurse to the skill of physical observation and assessment.
To develop the student nurses ability to assess and record temperature.
Outcomes:
Recall anatomy and physiology of the skin in relation to body temperature control.
Identify methods of recording temperature.
Discuss rationale for methods identified.
Prepare the patient for the intervention.
Identify and prepare equipment.
Measure and record body temperature at the axilla, in the oral cavity or tympanic membrane
Demonstrate knowledge of variations of the norm
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed Signed
Print Print
Choking Aim: To enable the student nurse to deliver safe and effective first aid to a person who is choking by removing the obstruction and restoring normal breathing.
Outcomes:
Define choking
Recall physical signs and symptoms
Demonstrate first aid technique to remove an obstruction in an unconscious Adult/Child NB: Unconscious patient:
Ensure clear airway Keep checking response Think about other injuries
Identify physical symptoms of shocks and demonstrate appropriate first aid
Know about the importance of Tetanus Toxoid vaccination.
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed Signed
Print Print
Version 1.2 Mar16 JH/TH 12
Pain Management Aim. To introduce the student the importance and management of pain
Outcomes
To discuss the different types and signs of pain
To discuss the factors that affect pain
Explain the assessment tools and select the appropriate assessment tool
Be able to use a pain assessment tool.
To safely and accurately record assessment of the patients pain
Demonstrate referral to clinical team reporting the patients pain
Understand the action of analgesia and side effects
Understand the need to repeat the pain assessment score post analgesia
Discuss non-pharmacological methods of reducing pain and promoting comfort.
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed Signed
Print Print
Eating and Drinking
Aim: To develop a knowledge base relation to the nutritional requirement of the “client” across the
lifespan. To introduce the student nurse to the principles of undertaking a nutritional assessment and the identification of, and participation in appropriate nursing interventions.
Outcomes:
Describe basic anatomy and physiology of the gastro-intestinal tract
Identify factors influencing a clients nutritional intake
Assess potential nutritional requirements of the client using a nutritional assessment tool
Plan nutritional interventions
Demonstrate appropriate nutritional intervention i.e. assisting a dependent patient.
Promotes dignity at all times
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed Signed
Print Print
Version 1.2 Mar16 JH/TH 13
Assisting with Nutritional Intake Aim To enable the student nurse to assist patients with nutritional record safely and effectively
Outcomes:
Explain / discuss the importance of monitoring and record fluid and nutrition intake
Identify methods of recording fluid and nutritional intake.
Discuss rationale for methods identified.
Monitor and record fluid and nutritional intake safely and effectively and report and concerns.
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed Signed
Print Print
Personal Care – Bed making Aim: To enable the student nurse to make/change an occupied / unoccupied bed without increasing
risk of infection whilst enhancing the patient’s comfort.
Outcomes:
Assess the need for linen change and choice of appropriate method (occupied or unoccupied)
Prepares the patient physically & psychologically obtaining consent
Prepares linen and equipment
Demonstrates a metered corner
Demonstrates pillowcase change
Make/change a bed
Change bed linen while the patient is in bed
Discuss reasons/benefits of bed making in relation to patient care
Disposes of linen in accordance with the Trust policy (for laundering)
Disposes of clinical waste as per Trust policy
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed
Signed
Version 1.2 Mar16 JH/TH 14
Personal Care - Bed bathing Aim: To enable the student nurse to assist a bedfast patient to maintain personal hygiene
Outcomes:
Assess patients need for bathing and other personal hygiene activities.
Assess patients ability to contribute to own care
Assess patient safety
Recognise physical and psychological barriers for this nursing practice and prepare the patient appropriately.
Obtain patient consent
Identify and prepare equipment
Demonstrate a bed bath
Identify positive outcomes for the practice of bed bathing
Disposes of clinical waste in line with Trust policy
Disposes of bed linen in line with Trust policy (for laundering)
Demonstrates dignity and respect at all times
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed
Signed
Print Print Print
Personal Care - Oral Hygiene Aim: To enable the student nurse to perform oral hygiene according to the individual needs of the
patient
Outcomes:
Recall anatomy and physiology of the mouth cavity – including the tongue and teeth (or dentures).
Identify the need for this nursing
Intervention or assisting the patient
with this intervention
Prepare the patient and obtain consent
Able to discuss evidence based policy for mouth care and the equipment or products required
Able to discuss assessment for oral care and what underpins regularity of assessment and the performing of oral care
Identify, collect and prepare equipment
Demonstrate safe and effective oral hygiene technique.
Able to use educational strategies with the patient if appropriate
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed Signed
Print Print
Version 1.2 Mar16 JH/TH 15
Personal Care- Eye Care
Aim: To enable the student nurse to perform eye care (swabbing / irrigation)
Outcomes:
Identify the need for this intervention
Prepare equipment
Prepare the patient (or carer) for the procedure and obtain consent
Demonstrate effective eye care
Adhere to infection control procedures
Adhere to individual Trust Policy
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed Signed Signed
Print Print Print
Continence Care
Aim: The student nurse will be able to assist and support the patient with the process of elimination
Outcomes:
Discuss the process of elimination
Define continence
Explain the conditions necessary for elimination to occur
Discuss nursing care of a patient suffering with altered bladder/bowel function
Demonstrate provision of facilities necessary for elimination
Discusses the use of a variety of continence products and their use
Promotes dignity and compassion at all times during continence care
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed Signed
Print Print
Version 1.2 Mar16 JH/TH 16
Urinary Catheterisation and catheter Care Aim: To facilitate safe practice in the skill of urinary catheterisation and care of the indwelling catheter
Outcomes:
Discuss rationale for urinary catheterisation related to the patient’s condition
Prepare equipment and discuss rationale for catheter choice
Prepare patient physically and psychologically for the procedure obtaining consent
Observe the steps of the procedure for urinary catheterisation (female)
Undertake catheterization under supervision according to Trust Policy and ANTT principles
Discuss choice of drainage systems
Discuss associated risks and nursing care which will prevent/reduce these risks
Discuss patient education in relation to this intervention
Demonstrates accurate record keeping and documentation
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed Signed
Print Print
**Please note – some Trusts have a policy that this skill must not be practiced by
student nurses until the 2nd year of the programme. Please discuss this with your
clinical tutor**
Version 1.2 Mar16 JH/TH 17
Urinalysis
Aim To enable the students to develop safe and effective skill in urinalysis
Outcomes:
Able to discuss the need for urinalysis
Able to discuss the principles of collecting an MSU, CSU and 24 hour collection of urine
Understand the principles of infection control for the safety of the patient and staff
Able to check patient identity, prepare the patient and obtain consent
Able to prepare the equipment in accordance with local Trust policy
Performs relevant checks of urinalysis strips prior to urinalysis
Undertake urine specimen whilst maintaining privacy and dignity / cultural attitudes at all times
Prevent cross infection during specimen collection during procedure
Undertake urinalysis, interpret results, document, act upon and communicate results to clinical team
Dispose of the urine specimen and clinical waste appropriately.
Identify clear rationale for repeat urine testing
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed Signed
Print Print
Version 1.2 Mar16 JH/TH 18
Oxygen Therapy
Aim: To enable the student nurse to participate in the care of a patient requiring/receiving oxygen
therapy.
Outcomes:
Review/describe the respiratory system
Identify reasons why patients require oxygen therapy
Discuss methods of assessing respiratory function
Demonstrate/discuss preparation of a patient to receive oxygen therapy physically and psychologically
Identify equipment
Discuss rationale for low, medium and high flow rates
Administer (under supervision) prescribed oxygen to a patient
Identify methods to maintain patient comfort
Identify hazards
Assist with accurate documentation
Understand the need for oxygen to be prescribed and administered by a qualified healthcare professional
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed
Signed
Print Print Print
Injection Technique Aim: To enable the student nurse to develop safe and effective skills in the delivery of intramuscular
(IM) and subcutaneous (SC) injections
Outcomes:
Discuss patient preparation for the procedure physically and psychologically
Identify safe anatomical sites for IM and SC infections and explain rationales for use
Discuss methods of skin preparation (to cleanse or not)
Identify equipment needed
Draw up medication as prescribed (under supervision)
Demonstrate safe injection technique Always under direct supervision
Demonstrate safe sharps disposal
Discuss policy/procedure should needle stick injury occur
Demonstrate accurate record/documentation of drug given
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed Signed
Print Print
Version 1.2 Mar16 JH/TH 19
Use of Automated External Defibrillator (AED)
Aim: To enable the student nurse to understand the implications, use and safety of AED use
This can be completed in simulated scenarios or observed within clinical placements
Outcomes:
Discusses the need for defibrillation and recognition of basic ‘shock able’ arrhythmias
Demonstrates attaching electrodes in acceptable positions
Allows rhythm analysis without touching the or AED
Demonstrates rapid and safe delivery of a single shock (including visual check and verbal instruction to stand clear)
Resumes CPR immediately, as guided by the voice prompts, starting with chest compressions
Minimises interruptions in chest compressions
If observed in clinical practice to discuss with mentor and undertake critical reflection and debrief
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed Signed
Print Print
Bleeding and Shock Aim: To introduce student nurses to the principles of first aid. To provide information / facilitate learning which will allow students to act appropriately giving immediate assistance to someone bleeding and or / shocked before the arrival of an ambulance, doctor or appropriately qualified person. (Remember safe approach and A - E)
Outcomes:
Recall the blood clotting process
Recognise types of wounds and identify
Recognise/identify types of bleeding
Define external bleeding and demonstrate appropriate first aid, pressure dressing, bandaging, and elevation.
Define internal bleeding and identify signs and symptoms
Identify physical symptoms of shock and demonstrate appropriate first aid
Know about the importance of Tetanus Toxoid vaccination.
Discuss rapid escalation
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed Signed
Print Print
Version 1.2 Mar16 JH/TH 20
Empathy and rapport Aim: To enable the student nurse to demonstrate the ability to listen with empathy
Outcomes:
Demonstrates safe, effective, compassionate and respectful communication skills
Acts in a manner than is attentive, kind, sensitive, compassionate and non-discriminatory, that values diversity and acts within professional boundaries.
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed Signed
Print Print
Version 1.2 Mar16 JH/TH 22
Moving and handling year 2 in addition to year 1 skills
Copy to be kelp in portfolio
MANUAL HANDLING
Aim: To enable the student nurse to perform safe manual handling under supervision
Outcomes:
Instructed Tick when completed
Practiced Tick when completed
STYLE (Assessment of Load)
Principles of Moving and Handling
Standing and walking person from chair (palm to palm)
Turning using Slide Sheet in bed
Transfer using PAT slide trolley to bed
Transfer using hoist bed to chair
Solving Problems from Practice/ Who to contact -discussion
Students signing here agree that: Student Signature: Print Name:
a. Instruction and practice has been undertaken
as indicated
b. They will re-read the University Moving and Handling booklet on the Clinical Skills are of Blackboard
Date of skill session attendance
Is exposed to the skill and is able to observe in
practice
Taught under supervision
Performs under supervision
Signature of Registrant Signature of Registrant Signature of Registrant Signature of Registrant
Version 1.2 Mar16 JH/TH 23
Moving and Handling skills year 2
In addition to year 1 competencies
Copy to be kept in portfolio
INFANT, CHILD AND ADULT BASIC LIFE SUPPORT CARDIO PULMONARY RESUSCITATION
Aim: To enable the student nurse to deliver effective basic life support
Outcomes:
Reflect on experience in practice
Discuss the role of the cardiac arrest team
Identify and demonstrate common items of equipment used:-
Oral Airways Face masks Ambu bags Et tubes Mini-jets for drug administration Defibrillator
Demonstrate effective BLS procedure
Instructed Tick when completed
Practiced Tick when completed
Date of skill session attendance
Is exposed to the skill and is able to observe in
practice
Taught under supervision
Performs under supervision
Signature of Registrant Signature of Registrant Signature of Registrant
Version 1.2 Mar16 JH/TH 24
Blood Glucose Monitoring Aim: To enable the student to develop safe and effective skills in taking and monitoring blood
glucose
Outcomes:
Be able to discuss the reason for the patient needing blood glucose monitoring.
Be able to discuss the limitations of using a blood glucose meter.
Be able to discuss the rationale for calibrating the meter, ensuring test strips are in date, performing internal Quality Control
Discusses the correct method to obtain blood sample.
Discusses the significance of test results and how to interpret.
Demonstrates the correct operation the meter (Trust equipment only)
Abe to check the patients identity and obtain consent
Offer reassurance to the patient
Discusses and demonstrates the correct procedure for skin preparation.
Discusses and demonstrates the correct method to obtain blood sample.
Practices in accordance with Trust Infection Control Policy and Sharps Disposal and Management Policy to avoid needle stick injury.
Practices in accordance with Trust Infection Prevention and Control Policy and Hand Hygiene Procedure and Standard Precautions Procedure to avoid contamination and cross infection.
Documents all care given in accordance with Trust policy & procedures.
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed Signed
Print Print
Version 1.2 Mar16 JH/TH 25
Care of Patients in Isolation
Aim: To enable the student nurse to care for patients in isolation
Outcomes
Discuss the reason why patients need to be cared for in isolation
Discuss methods of preventing infection
Identify patients most vulnerable and would need to be cared for in isolation
Discuss safe principles that underpin practice this care
Discuss how patient was prepared for the care both physically and psychologically
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed Signed
Print Print
Intravenous Therapy
Aim: To enable the student nurse to assist in the introduction of intravenous therapy, and to care
for a patient who is receiving intravenous fluid replacement therapy
Outcomes:
Discuss rationale for an intravenous infusion and relate this to the patient’s condition
Identify intravenous routes for peripheral intravenous therapy
Assist with accurate calculation of infusion rates for standard and blood infusion sets
Identify equipment necessary
Discuss the different fluids used in IV therapy
Prime infusion set and interpret fluid prescription sheet (under supervision)
Discuss practitioner responsibility in care of a cannula site
Demonstrates accurate record keeping
Demonstrates accurate fluid balance documentation
Understands the risk factors associated with IV therapy
Discuss/demonstrate care of a patient receiving fluid replacement therapy
Discuss methods which enable the nurse to maintain the intravenous infusion as prescribed and document accordingly.
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed
Signed
**Please note – Student nurses must NOT attach infusion devices or commence/
replace any IV fluids with direct supervision**
Version 1.2 Mar16 JH/TH 26
Intravenous Therapy – Blood Transfusion Therapy
Aim: To enable the student nurse to observe, monitor and recognise adverse reactions to blood transfusion therapy in patients PLEASE REFER TO TRUST POLICY FOR STUDENT NURSES
Outcomes:
Identify the procedure for checking and administrating blood products utilising local trust guidelines (obtaining products from lab or blood fridge) N.B student are not competent to obtain blood products alone
Utilise correct checking procedure for patients receiving blood products prior to administration
Obtains patient consent
Observes qualified clinical staff administering blood products in line with local Trust and National policy
Discuss adverse reactions which may occur
Demonstrate knowledge of effective response to adverse patient reactions
Discuss necessity of 15 minute recording of vital signs
Demonstrates accurate documentation
Demonstrates accurate record keeping
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed
Signed
Version 1.2 Mar16 JH/TH 27
Percutaneous Feeding Aim To provide the student nurse with knowledge and skill to undertake the care of Percutaneous tubes and assist with feeding (under supervision)
Outcomes:
Able to link anatomy knowledge to practice
Able to discuss the need for percutaneous feeding
Able to discuss the impact upon a patients psychological state
Able to define gastrostomy, jejunostomy and percutaneous endoscopic gastrostomy
Able to discuss the need for monitoring the percutaneous site for signs of infection (including patient reported pain)
Discusses the need to observe stoma site for signs of swelling, leakage, redness, irritation, skin erosion or soreness.
Demonstrates the timely reporting to senior clinical staff
Demonstrates accurate documentation of site observation and actions taken
Able to swab the site and send sample for culture and sensitivity if infection is suspected, liaising with senior clinical staff
Adheres to local Trust infection control policy when managing and caring for the patient
Able to assist with nutritional input via percutaneous tube as prescribed by dietician under supervision of a qualified practitioner
Able to assist with the administration of prescribed medication under supervision of a qualified practitioner
Demonstrates accurate documentation of the above
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed Signed
Print Print
Version 1.2 Mar16 JH/TH 28
Nasogastric Tube Insertion and Care
Aim: To familiarise the student nurse with the procedure and practice of nasogastric intubation.
Outcomes:
Review/Describe the gastrointestinal tract
Discuss indications for nasogastric intubation
Discuss the different NG tubes and their uses
Identify and prepare equipment required for the procedure
Demonstrate/discuss preparation of the patient physically and psychologically including consent for the procedure
Observe the procedure of passing a nasogastric tube and rationale for actions undertaken
Discuss the methods of checking the correct placement of the nasogastic tube
Discuss patient care and safety
Discuss indications for nasogastric feeding – relate to the patient’s condition
Identify and prepare equipment
Discuss associated complications with this intervention and nursing care which will help prevent/reduce these including the checking and documenting of tube placement at every shift
Discuss indications of tube displacement
Discuss actions required if tube displacement suspected
Discuss Trust policy and guidelines on techniques and procedures to ensure correct tube placement for patient safety
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed
Signed
**Please refer to individual Trust Policy and discuss with Clinical tutors.
Many Trusts do not allow student nurses to pass nasogastic tubes
even under supervision**
Version 1.2 Mar16 JH/TH 29
Three & Twelve Lead ECG Measurement
Aim – To enable student to develop safe and effective skills in assisting in measuring and reading
three and twelve lead ECGs
Outcomes:
Able to describe the normal conduction pathway and associated events in the cardiac cycle.
Able to discuss the need for 3 or 12 lead ECG monitoring/procedure
Able to explain the need for ECG machine to be kept on charge, cleaned and checked in accordance with local Trust policy for infection control
Able to prepare and reassure the patient including obtaining consent
Demonstrate ability to position patients ensuring satisfactory recording.
Able to correctly place electrodes on the patient promoting dignity and comfort
Discuss Einthoven’s triangle
Able to discuss the factors associated with artifacts and how to troubleshoot these
Able to undertake a 12 lead ECG procedure under supervision
Demonstrates the safe disposal of clinical waste adhering to local Trust policy
Able to demonstrate the need for skin care and post procedural skin monitoring observing for any reactions to electrode adhesive products
Able to recognized normal sinus rhythm
Able to interpret 3 basic arrhythmias
Demonstrates immediate reporting to senior clinical staff if arrhythmias detected
Demonstrates accurate record keeping
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed Signed
Print Print
Version 1.2 Mar16 JH/TH 30
Neurological Observations Aim: To provide the student nurse with knowledge and skill to undertake neurological observations and to record and repeat them accurately
Outcomes:
Define what neurological observations are
Identify why they are carried out and who requires them
Identify equipment required to record neurological observations
Demonstrate the application of the Glasgow Coma Scale.
Demonstrate neurological observations under supervision
Document neurological observations accurately under the supervision of mentor
Discuss the implications of neurological observations
Discuss signs of neurological deterioration
Able to discuss escalation if deterioration suspected
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed
Signed
Print Print Print
Early Warning Scores (EWS) - (NEWS) National early warning score Aim – To enable student to develop skills to safely and effectively monitoring, record and report early warning scores
Outcomes:
To understand the importance of correctly using EWS and effective use of the monitoring and escalation plan
To demonstrate competence when using the Adult Observation Chart and Early Warning Scoring (EWS) tool as per Trust Policy and Guidelines
To discuss the outcome of the EWS for individual patients and possible actions to be taken in consultation with senior members of the clinical team
To achieve quality, safe and timely clinical care through proficient measurement, recording, and communicating of changes in observations and EWS score to senior members of the clinical team.
**Please note – the use of NEWS was advocated by the Royal College of physicians in May 2015. It is vital you adhere to your individual local Trust policy**
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed Signed
Print Print
Version 1.2 Mar16 JH/TH 31
Unconscious Patients
Aim To provide the student nurse with knowledge and skill to care for the unconscious patient
Outcomes:
Define consciousness and have an understanding of the related anatomy and physiology.
Discuss the various levels of impaired consciousness.
List the causes of unconsciousness.
Able to assess the conscious level of patients documenting accurately
Able to identify and discuss the total needs of the unconscious patient
Prioritise patient care, recognising the skills required for the assessment, planning and implementation of nursing care.
Demonstrates timely referral to senior clinical staff when changes are detected
Able to offer support and reassurance to family/carers
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed Signed
Print Print
Wound Drainage To provide the student nurse with knowledge and skill to undertake monitor and record wound drainage accurately
Outcomes:
Able to discuss the need for wound drains applying anatomy and physiology knowledge
Able to identify and discuss the various types wound drainage systems
Able to discuss the management of wound drainage systems reducing the risk of mechanical injury
Able to discuss the management of wound drainage systems adhering to local Trust infection control guidelines
Able to identify types of/measure wound drainage adhering to local Trust infection control guidelines
Able to accurately record wound drainage/puncture site and refer to senior clinical staff if detecting signs of infection and/or bleeding
Able to educate the patient on the care of wound drainage system
Monitor patient for pain and comfort
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed Signed
Print Print
Version 1.2 Mar16 JH/TH 32
Suture/Clip Removal
To provide the student nurse with knowledge and skill to undertake suture and clip removal (under Supervision) accurately
Outcomes:
Able to describe the anatomy and physiology of the skin
Able to discuss the process of wound healing
Discusses the need for suture/clip removal and describes the procedure
Able to discuss signs of wound infection and action to be taken including obtaining a wound swab
Able to prepare equipment for procedure
Identifies patient, explains procedure and obtains consent.
Positions patient in a position so that sutures/staples/clip are accessible and without undue tension – ensuring privacy and dignity at all times
Assess wound edges prior and post.
Performs suture/clip removal under supervision according to local Trust policy using ANTT using correct technique whilst monitoring patient comfort
Understands when to stop procedure and consult senior clinical staff if drainage or dehiscence of wound detected .
Performs wound care as per protocol
Documents procedure and appearance of wound site accurately.
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed Signed
Print Print
Version 1.2 Mar16 JH/TH 33
MRSA Screening Aim To provide the student nurse with knowledge and skill to undertake MRSA Screening accurately
Outcomes:
Able to define MRSA and its management/treatment
Able to discuss the local Trust policy for MRSA screening
Able to assemble the equipment required for MRSA screening
Able to identify the patient and obtain consent offering reassurance
Able to perform MRSA screening using the correct swab procedure according to Trust policy ensuring dignity and respect at all times
Adheres to Trust policy for infection control and the use of universal precautions
Labels swabs and microbiology forms accurately ensuring samples are transported to the relevant department in a timely manner
Is able to access microbiology results discussing implications and management
Able to discuss microbiology results with patients and family/carers
Able to discuss care of the patient with MRSA and minimize hospital acquired infection across the clinical area
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed Signed
Print Print
Version 1.2 Mar16 JH/TH 34
Specimen Collection (Non-Blood Based)
Aim To provide the student nurse with knowledge and skill to undertake specimen collections
accurately
Outcomes:
Able to define reasons for obtaining specimens.
Demonstrate understanding of basic anatomy and physiology relevant to the type of specimen collection
Discuss the procedures and techniques including specimen types, usual tests and possible adverse effects.
Prepare materials and equipment used within the Trust for collection of specimens.
Able to identify the patient, the specimen required and obtain consent from the patient
Discuss the need for the specimen with the patient
Obtains specimen in accordance with Trust guidelines respecting privacy and dignity
Demonstrates Infection Prevention and Control measures such as hand hygiene and use of Personal Protective Equipment (PPE) and safe disposal of equipment
Demonstrates effective labeling of specimen and timely transportation to relevant department.
Demonstrates accurate clinical record keeping and documentation including appropriate referral if required
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed Signed
Print Print
Version 1.2 Mar16 JH/TH 35
Principles of Wound Care
To provide the student nurse with knowledge and principles of wound care
Outcomes:
Has been assessed as competent to perform aseptic non touch / clean dressing technique
Can identify the 4 main phases of wound healing
Can carry out full wound assessment
Can state the clinical appearance of:
Epithelializing tissue
Granulation tissue
Slough
Maceration
Necrotic tissue
Infected wound
Can rationalise the use of various types of dressing:
hydrofilm
hydrocolloid
hydrofibre
hydrogel
alginates
antimicrobial
Records assessment findings on wound care template as per Trust Policy
Records evidence of ongoing assessment.
Can advise patients about principles of good nutrition, hygiene, mobility and elevation of limbs where this has an impact upon wound care.
Can correctly state the method used in taking a wound swab and when this should be done.
Disposes of clinical waste in accordance with local infection control guidelines.
Can recognise the need for wound debridement and can identify when this should and shouldn’t be done.
Recognises own limitations with the management of wounds and refers for further assessment by wound care/tissue viability specialists promptly
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed Signed
Print Print
Version 1.2 Mar16 JH/TH 36
Pressure Area Care Aim - To provide the student nurse with knowledge and skill to undertake Pressure area care
Outcomes:
Describes the structure of the skin and its function.
Recognises the structures involved in each stage of tissue breakdown
Discusses the need for regular positional changes, how these are performed and what underpins the regularity of positional changes
Performs a holistic assessment in relation to skin condition identifying areas at risk of pressure related damage.
At all times maintains the dignity and safety of the individual during the assessment.
Describes the factors that increase individuals risk of developing skin and tissue damage and undertakes the risk assessment in relation to pressure area care and the risk of skin breakdown
Describes the importance of a holistic risk assessment.
Performs risk assessment appropriate to the individuals risk and plans the care to minimise risk factors where appropriate with individuals and/or carers.
Identifies when a risk assessment should be performed.
Describe the categories of tissue pressure damage.
Performs reliable assessment of pressure areas with supervision.
Categorises tissue and skin damage in line with the local protocol with supervision
Reliably documents accurate findings of risk and skin assessments.
Reliably develops individual care/treatment plans to ensure consistency in care.
Performs rational reassessment of individual’s risk factors.
Refer individuals to specialist services for assistance if required.
CONT ………
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed Signed
Print Print
Version 1.2 Mar16 JH/TH 37
Monitor and assess individuals after treatment, reviewing and evaluating care/treatment plans.
Undertake treatments and dressings related to the care of wounds.
Demonstrate an understanding of the equipment options available for reducing an individual’s risk of developing pressure damage.
Assists with the ordering and return of equipment for individual patients
Fit appropriate equipment to reduce skin damage (for example, pressure relieving devices).
Safely use the equipment available for reducing the risk of skin damage
Identifies the need to reassess the needs of the individual in relation to equipment provision.
Demonstrates an understanding of the importance of accurate nursing records and their impact on nursing care
Can access resources to support decision making in relation to maintaining skin health and reducing risk of pressure damage.
Has the ability to access National and local guidelines, protocols and research articles in relation to maintaining skin health and reducing risk of pressure damage.
Identifies personal and professional responsibilities in the evaluation of the care prescribed.
Ensures professional competence in relation to the prevention of skin damage.
Monitors level of stock to ensure accessibility of equipment
Version 1.2 Mar16 JH/TH 38
Pre-Operative Care & Preparation Aim To provide the student nurse with knowledge and skill to undertake Pre-operative care &
preparation (under supervision) accurately
Objectives:
Discuss the objectives of pre-operative assessment
Define when and where pre-operative assessment should take place and who performs the assessment
Discuss the principles of pre-operative care
Able to demonstrate an insight into the psychological care of the patient offering information and reassurance
Able to discuss the need for informed consent whilst observing this in practice
Able to discuss and assist with the physical preparation of the patient pre-operatively
Able to identify potential risks and hazards pre-operatively and how these are managed/avoided
Able to assist in accurate pre-operative checks in accordance with local Trust policy
Able to accurately document pre-operative checks including pre-operative patient pathway according to Trust policy (under supervision)
Escorts the patient to theatre (with supervision) and observes/assists with patient handover with the delivery of accurate information, using checklists according to policy
Demonstrates the caring and support of family/carers throughout the procedure if applicable
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed Signed
Print Print
Version 1.2 Mar16 JH/TH 39
Post-Operative Care Aim To provide the student nurse with knowledge and skill to undertake Post -operative care &
preparation (under supervision) accurately
Outcomes:
Discuss the principles of post operative care
Discusses and participates in post operative monitoring
Able to discuss post operative observations with mentor, including implications
Accurately records post operative physiological observations
Able to discuss and participate in total post operative care in accordance with relevant pathway and Trust protocol under supervision
Able to undertake accurate pain assessment and non pharmacological management (under supervision)
Discuss pain assessment score with clinical team member and assist with analgesia administration according to local Trust policy
Able to describe the analgesic ladder and classes of analgesia
Able to discuss post operative complications and management, including the importance of immediate referral to clinical team members
Offers patient reassurance and promotes comfort at all times
Theorised
Practice
Supervised
Practice
Competent Practice
Signed
Signed Signed
Print Print
Version 1.2 Mar16 JH/TH 40
Care of the deceased Aim: To enable the student nurse to participate/undertake the procedure of Last Offices for the
deceased patient, as appropriate.
Outcomes:
Discuss own attitudes to death and dying across the lifespan
Discuss the clinical situations in which you have encountered death
Identify physiological changes which can occur at death
Discuss how and who certifies a patients death
Respect religion and cultural difference
Identify needs of family/carers and the supportive measures which can be offered to them.
With support from mentor can assist with the support of families/carers
Be familiar with last offices policy/procedure
Identify/prepare equipment needed
Participate in the last office procedure (with the support of mentor)
Able to discuss what happens once the patient has been transferred to the mortuary
Able to discuss when and why a post mortem maybe required
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed
Signed
Print Print Print
Version 1.2 Mar16 JH/TH 41
3rd Year Clinical Skills
Manual Handling (Update) Year 3 (in addition to year 1 and 2 competencies) Copy to be kept in Portfolio
MANUAL HANDLING
Aim: To enable the student nurse to perform safe manual handling under supervision in year 3 Outcomes:
Instructed Tick when completed
Practiced Tick when completed
Mentor/registrant/ clinical tutor signature
Mentor/registrant/ clinical tutor signature
STYLE (Assessment of Load)
Principles of Moving and Handling
Standing and walking person from chair (palm to palm)
Turning using Slide Sheet in bed Print name Print name
Transfer using PAT slide trolley to bed
Transfer using hoist bed to chair
Solving Problems from Practice/ Who to contact –discussion
Students signing here agree that: Student Signature: Print Name:
a. Instruction and practice has been undertaken as indicated
b. They will re-read the Trust Moving and Handling policy
Date of skill session attendance
Is exposed to the skill and is able to observe in
practice
Signature of Registrant
Taught under supervision
Signature of Registrant
Performs under supervision
Signature of Registrant
Version 1.2 Mar16 JH/TH 42
Year 3 Basic life support in addition to years 1 and 2 competencies
INFANT, CHILD AND ADULT BASIC LIFE SUPPORT CARDIO PULMONARY RESUSCITATION
Aim: To enable the student nurse to deliver effective basic life support
Outcomes:
Demonstrate effective BLS procedure
Discuss cardiac arrest in special circumstances
Poisoning
Drowning
Electrocution
Pregnancy
Explore ventilation of a patient with a tracheostomy
Be familiar with drugs used
Instructed Tick when completed
Practiced Tick when completed
Date of skill session attendance
Is exposed to the skill and is able to observe in practice
Taught under supervision
Performs under supervision
Signature of Registrant Signature of Registrant Signature of Registrant
Version 1.2 Mar16 JH/TH 43
Venepuncture
Aim: To demonstrate the knowledge and techniques needed for safe venepuncture.
**Whilst you may undertake venepuncture as a skill in the clinical simulation area this is NOT a skill you will be performing as a student nurse. You should, however be able to prepare the
patient, the equipment and assist with the location of viable veins for venepuncture. Please refer to individual Trust Polices**
Outcomes:
Describe relevant anatomy and physiology of the peripheral venous system.
Demonstrate familiarity of the equipment to meet the goals of venepuncture and blood sample collection.
Prepare the equipment required for the procedure, including the labeling of bottles and forms
Identify the patient, obtain consent and prepare the patient psychologically for the procedure.
Identify the peripheral veins suitable for venepuncture.
Perform venepuncture (clinical simulation only) in line with local Trust policy.
Demonstrate and describe infection prevention measures.
Dispose of clinical waste and sharps safely
Identify measures to minimize and address difficulties encountered during venepuncture.
List complications associated with venepuncture, their prevention, management strategies
Identify the action required in the event of a needle stick injury or blood and blood fluid exposure.
Completes accurate documentation following the procedure
Gives psychological to the patient checking puncture site regularly, particularly if the patient is prescribed anticoagulants
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed Signed
Print Print
Version 1.2 Mar16 JH/TH 44
Cannulation: Be able to assist with the preparation of the patient for a cannulation procedure and
demonstrate the safe assessment, monitoring and documentation of venous cannulas
**Whilst you may undertake cannulation as a skill in the clinical simulation area this is NOT a skill you will be performing as a student nurse. You should, however be able to prepare the patient, the
equipment and assist with the location of viable veins for cannulation. Please refer to individual Trust Polices**
Outcome:
KNOWLEDGE
Identify local policies and national guidelines regarding peripheral venous cannulation
Describe the anatomy and physiology of the venous and arterial circulatory systems.
Differentiate between a vein and an artery
Identify the physiological need for performing the procedure
Identify and describe the following potential hazards relating to peripheral venous cannulation:
o Air embolism o Infection o Haematoma o Extravasation o Infiltration o Phlebitis o Faulty equipment o Incorrect cannula fixation
PROCEDURE
Understands the importance of:
Checking the name of the patient against the patient’s wristband.
Confirming the name of the patient verbally.
If verbal identification of identity is not possible, checking the patient’s identity with a second practitioner.
Assessing the individual needs of the patient.
Preparing and demonstrating the correct and appropriate use of equipment.
Identifying a suitable vein and positioning the patient appropriately. CONT ……
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed Signed
Print Print
Version 1.2 Mar16 JH/TH 45
Where appropriate, the preparation and use of local anaesthesia as prescribed.
Insert a peripheral cannula correctly (simulation only) using ANTT
Flush the cannula with 0.9% saline using at least a 10ml syringe (simulation only)
Fixate the cannula using the appropriate dressing
Safely dispose of all equipment according to Trust policies.
Identify the action required in the event of a needle stick injury or blood and blood fluid exposure.
Document the procedure correctly MONITORING – PATIENT SAFETY
Understands the importance of monitoring the cannulation site and documenting any signs of:
Pain
Infection
Haematoma
Extravasation
Infiltration
Phlebitis According to local Trust policy
Immediately refers any of the above to mentor or other qualified member of the clinical team
REMOVAL OF PERIPHERAL CANNULA
Checks the identity of the patient
Accurate checking that cannula/correct site of cannula for removal
Obtains consent from the patient
Discusses and demonstrates infection control
Removes the cannula under supervision according to local Trust policy
Applies pressure to the cannula site with sterile gauze for 2- 3 minutes (or until the bleeding has stopped)
Covers the puncture site with sterile dressing
Safe disposal of clinical waste and plastic cannula
Discusses management if signs of infection are seen including the swabbing of the site/cannula tip to microbiology for C & S
Version 1.2 Mar16 JH/TH 46
Oral Suctioning: For the student nurse to perform this skill safely and competently
PLEASE REFER TO TRUST POLICY
Outcome:
Can explain the basic anatomy of the upper airway and buccal area
Understands the indications for oral cavity suctioning
Can identify general reasons for oral suctioning
Shows a clear understanding of contra- indications and complications in oral suctioning
Can explain all parts of the oral suctioning equipment and demonstrates correct set up procedure
Gains consent and explains procedure
Positions patient in comfortable and effective position
Uses correct PPE and infection control technique
Demonstrates safe oral suctioning technique under the supervision of qualified healthcare professional
Theorised
Practice
Supervised
Practice
Competent
Practice
Signed
Signed Signed
Print Print