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MPOM 101 Service learning 2015 Page 1

FACULTY OF HEALTH SCIENCES

SCHOOL OF MEDICINE

2015 MPOM 010 Service Learning

Student Workbook

LONGITUDINAL SERVICE LEARNING

THIS WORKBOOK BELONGS TO: NAME: ____________________________________________________________

STUDENT NUMBER: _________________________________________________

CONTACT NUMBER: _________________________________________________

E-MAIL ADDRESS: ___________________________________________________

LEARNING FACILITATOR: Name: ________________________________________

CLINIC: _______________________________

Compiled by Debbie Barnard Revised December 2014

SL Coordinator

Sefako Makgatho Health Sciences University

Faculty of HEALTH SCIENCES

School of MEDICINE Study field: MBChB

Course: Practice of Medicine

Year: 1

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PRACTICE OF MEDICINE SERVICE LEARNING

SCORING SHEET MPOM 101

STUDENT NAME AND NUMBER:

Marks achieved

Witness report: participation and behaviour while working on the project (Individual mark)

10

Health Education & Life skills Project (Group task) 20 Community Profile Power point Presentation (Group task)

20

Log sheet of skills - 4 patients 5 marks each (Individual task)

20

Completed Structured report regarding patient and family living with chronic disease. (Individual task)

20

Blood Pressure Measurement 10

TOTAL 100

Learning Facilitator ______________________________________ ______________________ Print Name and Surname Date ________________________________________ Signature

COMPULSORY STUDENT PHOTOGRAPH TO BE PASTED HERE

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THIS IS A

CRITICAL MESSAGE TO THE STUDENT

NO STUDENT MAY VISIT THE CLINIC IF THEY DO NOT HAVE THE

FOLLOWING EQUIPMENT WITH THEM:

A STETHOSCOPE

A BAUMANOMETER (BLOOD PRESSURE APPARATUS)

A THERMOMETER

A WATCH WITH A SECOND HAND (MAY NOT USE A CELL PHONE)

A CLEAN WHITE COAT

OWN SUPPLY OF GLOVES

HANDBOOKBOOK: Talley & O’Connor

The student also needs to take with:

- Own lunch - Water - Personal toiletries like toilet paper

If the student does not have the necessary equipment to perform practical procedures WITH them, their books will

and may not be signed by the facilitators!

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TABLE OF CONTENTS:

Page No

1 Organisational Component 5 2 Witness report 6

3 Report on health promotion workshop/talk presented in the community

8

4 Format for community profile power point presentation 10

5 Log sheet of patient examination at the clinic 12

6 Report on a family living with chronic disease 15

7 Blood pressure control 24

8 Clinic assessment 27

9 Student feedback and reflection 33

10 SL reflective diary 35

11 Conclusion and suggestions regarding the block 36

12 Checklist for documents handed in 38

Safety Guidelines and Rules of Conduct in the Community Find draft copy included in the “GENERAL GUIDELINES + YEAR SCHEDULE POME 105 OF 2013”

document as it was developed in December 2010.

You are representing Sefako Makgatho Health Sciences University and the Medical Profession.

Dress and act professionally!

WELCOME to the Service Learning program!

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1. ORGANISATIONAL COMPONENT

CONTACT DETAILS OF FACILITATORS/ACADEMIC HEADS INVOLVED IN THIS BLOCK

LEARNING FACILITATORS AT THE SITES Hebron Clinic: Sister Gontse Rampeng Cell: 082 701 2639 Mercy Clinic: Sister Monica Monaheng Cell: 083 3125 899 Lethlabile Clinic: Sister Robbie du Preez Cell:082 886 2901 Tlamelong Clinic: Sister Christel Rodgers Cell: 082 4967 437 KT Motubatsi Clinic: Sister Mercia Viktor Cell: 083 9883 185 Sister Mosidi Modingwane Cell No: 082 978 9943 Phedisong 4 Clinic: Sister Caroline Kotsokoane Cell: 079 985 2254 Maria Rantho Clinic: Sister Dawn Mosdell Cell: 082 254 7335 Kgabo Clinic: Sister Esther Modise Cell: 073 317 8294

Sister Anne Hide Cell: 082 4437 401

SL COORDINATOR Mrs. D. Barnard

Skills lab Basement room 16 Cell: 082 561 3234 Office 012-521 4416 E-mail:

POME 105 COURSE COORDINATOR

Dr. L.H. Mabuza Cell: 083 325 0580 / 083 680 3269 Tel No: 012-521 4314 / 4528 / 529 3108

honeymanyosi@gmail.com

ADMINISTRATIVE COORDINATORS (POME office)

Mrs. Drienie Schoeman E-mail: Tel No: 012-521 3294 Skills Lab Basement POME office

OVERALL COURSE ACADEMIC DEPARTMENT HEADS & CONSULTANTS Family medicine & Primary

Health Care:

Community Health:

Environmental and

Occupational Health:

Dr. L.H. Mabuza Prof. Peet Rautenbach Prof. Daan Kocks Cell: 083 325 0580 / 083 680 3269 Tel No: 012-521 4314 / 4528 / 529 3108

Tel No: 012-521 4350 Tel No: (012) 521 4355

honeymanyosi@gmail.com

jfisher@ul.ac.za

Please do not phone any tutor/ facilitator or doctor after 17h00 or before 08h00. Do not phone on Saturdays, Sundays or Public Holidays

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2. WITNESS REPORT

PARTICIPATION AND BEHAVIOUR WHILE WORKING ON THE PROJECT

Mark sheet for the individual student: Submit after 4 weeks in your portfolio: This document is completed by the Learning Facilitator in charge of the students at the clinic:

Name and Surname of Student: ________________________________________________ Student Number: ___________________________ Group number: ___________________ Name of clinic and Community: ________________________________________________

DATES OF CONFIRMED CLINIC VISITS (MUST be completed and signed by BOTH parties!)

DATE STUDENT SIGNATURE FACILITATOR SIGNATURE

DATES OF ABSENTEEISM FROM CLINIC VISITS (MUST be completed and signed by BOTH parties!)

DATE STUDENT SIGNATURE FACILITATOR SIGNATURE

REASON FOR ABSENTEESIM

Sick certificate

YES / NO

YES / NO

YES / NO

YES / NO

SICK CERTIFICATE SUBMITTED TO POME ADMINISTRATION

Received by: _______________________________________

Signature of receiving person at the POME Admin office: __________________________________

General behaviour and attitude of student: __________________________________________________________________________ __________________________________________________________________________ General participation and involvement:

__________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________

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Ability to work in a team: __________________________________________________________________________ __________________________________________________________________________ Ability to build relationships with patient(s):

__________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Comments on the quality of work as performed by this student:

__________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________

Overall global score - Use as guideline 9-10 Student is excellent, CANNOT BE FAULTED at all, NO room for improvement!

6-8 Student has good abilities and all objectives & critical issues was acceptably addressed

5 Student is borderline, has abilities in at least half of the areas with no critical errors

3-4 Student’s performance is poor, only competent is some areas, but has major weaknesses

0-2 Student is incompetent, does not meet the objectives, critical errors

Recommendations / actions that student must take in order to improve: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________

Student : ________________________________________ Print Name and Surname

________________________________________ ______________________ Signature Date

Learning Facilitator in charge: ________________________________________ ______________________ Print Name and Surname Date

________________________________________ Signature

Final mark: _________

10

STUDENT MUST SIGN!!

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3. HEALTH PROMOTION WORKSHOP/ TALK

PRESENTED IN THE COMMUNITY

REPORT ON HEALTH PROMOTION WORKSHOP/TALK PRESENTED IN THE COMMUNITY

Specific topic: ________________________________________________________________ Content areas covered in the talk: What specifically did you talk about?

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Why and how did you decide to choose this topic?

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Specify your target audience (To whom did you present, how many people attended)?

__________________________________________________________________________________________________________________________________________________________________________________________ Where were the talk presented / which facilities were used? Was this sufficient?

__________________________________________________________________________________________________________________________________________________________________________________________ How did you present your talk and poster? E.g. only talked, talked and allowed discussion (which

questions/comments did you get), activities e.g. condom demonstration, role-plays etc.

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ______________________________________________________________ What materials did you develop to enhance the efficiency of your talk? E.g. pamphlet was develop and

handed to all who attended, or a poster was developed and put on the wall.

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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What were the outcomes of your talk? How did your talk contribute to developments in the community?

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Recommendations / comments from target audience:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Student : ________________________________________ Print Name and Surname ________________________________________ ______________________ Signature Date

Learning facilitator in charge: ________________________________________ ______________________ Print Name and Surname Date

________________________________________ Signature

Final mark: _________

20 -10% for poor participation of the student

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4. COM

MUNITY PROFILE POWER POINT

PRESENTATION

FORMAT FOR COMMUNITY PROFILE POWER POINT PRESENTATION

GROUP REPORT:

1. Each group of students attending a clinic/visiting the community must develop a power point

presentation of the students’ and community’s activities and findings that were witnessed during the

visits. 2. CONTENT: slides must cover the following information regarding the Community

Describe the geographical area (approximate size, boundaries)

Indicate the population numbers

Indicate the Ethnical group in dominance

Indicate the literacy levels amongst the community

Indicate the economic activities in the community and surrounding areas

Describe the disease profile (commonest diseases) patients present with

Indicate the governance of the community (e.g. chief vs. municipality etc.)

NB Indicate the risk areas and situations in the community (risk to mental and physical health)

NB Show/indicate resources in the area e.g. water supply, transport, health care, education,

housing, religion, sanitation, economic activities etc. (how many and type of schools, crèches, churches, clinics etc.).

Show/indicate resources in the health care facility you visited (sponsors, equipment, facilities,

building, beds, staff, medicines, storeroom etc.) Show/indicate services offered to the community by the health care facility (e.g. describe and

provide photographs of home based care programme, types of clinic, outreach activities such as

mobile clinics, food gardens, sewing/baking programmes, computer literacy etc.)

Show/indicate strengths and weaknesses of the facility and the environment

Show what the students did during their visit.

Indicate what you have done and learnt during the block (NB! Action photographs speak a

thousand words! – do NOT include a group of students posing, rather take a photograph of a student interacting with a patient!)

Present your recommendations to better health related services to the community – be realistic!

3. The mark that the student group will be given will be used as a TEST MARK for exam admission – no

re-do’s will be allowed 4. Try to restrict the written slides to below 20 and the photographs to 20 as well. 5. Do NOT use photographs or slides from other groups/year groups! You will get NO MARK

for your assignment as it is plagiarism!

6. Indicate the group and the year clearly on the cover of the CD.

Remember:

MARKS: 20

THIS POWER POINT PRESENTATION IS AN

EXTREMELY IMPORTANT DOCUMENT! Give a lot of

attention to it!

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-10% for students not participating in the activity!

Example of how to mark the CD. ______________________________________________________________

A classification of Blood Pressure readings according to Talley & O’Connor :

Clinical Examination – A systematic guide to physical diagnosis.

CATEGORY SYSTOLIC (mmHg)

DIASTOLIC (mmHg)

Optimal <120 <80

Normal 120 - 129 80 - 84

High Normal 130 - 139 85 - 89

Mild Hypertension (grade 1) 140 - 159 90 - 99

Moderate Hypertension (grade 2) 160 - 179 100 - 109

Severe Hypertension (grade 3) >180 >110

POME 105 GROUP 4

January 2015

CLINIC AREA:

HEBRON

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5. PATIENT EXAMINATIONS AT CLINIC

LOG SHEET OF PATIENT EXAMINATIONS AT CLINIC

Example: Mrs Y visits the clinic with the presenting complaint of an abscess on the right arm. She has a fever. Her vital signs and observations are recorded in the table below:

Patient 1: __________________________________________________________________ __________________________________________________________________________ Patient 2: __________________________________________________________________ __________________________________________________________________________ Patient 3: __________________________________________________________________ __________________________________________________________________________ Patient 4: __________________________________________________________________ __________________________________________________________________________

Example Patient 1 Patient 2 Patient 3 Patient 4 File no

Y 007

BP

125

80 (Normal)

Pulse

102 beats/min (Fast heart rate / regular)

Respiratory rate

14 per min (Normal)

Temperature

38.2 ᵒ C Axillary

(Fever)

Height

1.72m

Weight

82 kg

BMI*

27.7 (Grade 1

obesity)

Blood sugar

5.4 mmoll/L

Urine test

Ketones ++

Glucose +++ pH 7

SG 1020

NB! See information in Talley & O’Connor for values

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BODY MASS INDEX: How to calculate body mass index (BMI):

BMI = weight/ height² = 82 / (1.72 x 1.72)

= 82/ 2.96 = 27.7

Interpretation of BMI:

Below 18.5: Underweight 18.5 – 24.9: Normal

25 -29.9: Grade 1 obesity 30 – 39.9: Grade 2 obesity

40 +: Grade 3 obesity

STUDENT INTERPRETATION OF ABOVE FINDINGS:

Example The patient’s diabetes is not well controlled. She has a fever. She has repeated infections like

urinary tract infections. Leg ulcers that do not want to heal. Lifestyle advice needed as she is

also overweight according to her BMI.

Patient 1

Patient 2

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Patient 3

Patient 4

Ask your mentor to assist you in this learning.

The challenge is that you have to read and ask as much as possible regarding the patients seen. We

want you to learn what you can!. Do not sit back and wait for learning to occur. Actively search for knowledge and skills and make the best of this opportunity.

If you are finished with your 4 patients and there is time left, then you see more patients.

COMMENTS ABOUT THE STUDENT BY THE LEARNING FACILITATOR: _________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________

Signature Learning Facilitator: _______________________________

Date: _________________

Final mark: _________

20

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6. FAMILY LIVING WITH CHRONIC DISEASE

PATIENT INFORMATION Initials: ___________ Gender: _________ Date of birth: _________ Age: _____ Clinic file no: _______________ Chronic medical illness: ____________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________________________ Brief history of the current illness you are studying, in the example it was diabetes. When was it diagnosed, has the patient been admitted to hospital, any complications such as kidney failure:

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Previous medical history (briefly):

Example: patient was admitted to hospital for kidney infection in 2001 and had malaria in 2003.

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Family history regarding hereditary/chronic diseases. E.g. two brothers also has diabetes:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Hobbies and interests ______________________________________________________________

____________________________________________________________________________________________________________________________

Educational history: ________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________________________

Habits (smoking, drinking and recreational drugs): _________________________________________

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____________________________________________________________________________________________________________________________ Health promotion and/or awareness: (Exercise, healthy food, hygiene):

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Medicine allergies:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

The following section on Current treatment should be seen as a challenge for the student and part of active learning. After the student has seen the patient, he/she should read up about the medication and declare if the reason that the patient gave the student why he/she is taking the medication is correct or not. Then look up and describe the general information that you would give the patient regarding the use of medicine.

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CURRENT TREATMENT (PRESCRIPTION, OVER THE COUNTER AND HERBAL MEDICINES):

Name of medication Indication (Why is the patient taking the medicine?) Patient’s knowledge of the medication (what used for, how to drink)

Example: Glucophage 500mg tablets

According to the patient, for what reason is the pt taking the medication? How is the patient drinking the medication (dosage) To manage his Diabetes, Used for high sugar, drink one tablet every day, same time, cannot drink 2 if skipped

1.

According to the patient, for what reason is the pt taking the medication? How is the patient drinking the medication (dosage)

2.

According to the patient, for what reason is the pt taking the medication? How is the patient drinking the medication (dosage)

3.

According to the patient, for what reason is the pt taking the medication? How is the patient drinking the medication (dosage)

4.

According to the patient, for what reason is the pt taking the medication? How is the patient drinking the medication (dosage)

5.

According to the patient, for what reason is the pt taking the medication? How is the patient drinking the medication (dosage)

6.

According to the patient, for what reason is the pt taking the medication? How is the patient drinking the medication (dosage)

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Describe the general education regarding medicine use that you would give a patient:

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

_________________________________________________________________________________

Insert extra page if the above space is not sufficient.

What difficulties does the patient face in dealing with his disease? (implications on lifestyle) Example: The diabetes has affected her eyesight so she cannot read. This leads to big frustration as it was her only pastime. Or the patient has to rely on her neighbour for transport to the clinic for repeat prescriptions...

__________________________________________________________________________________________________________________________________________________________________________________________

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____________________________________________________________________________________________________________________________ Describe the family and community’s attitude and the support of the patient:

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ If possible a family member can be interviewed to hear about their frustrations in dealing with the patient’s illness. How has it affected their lives?

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Family Profile – who forms part of the family Patient Patient

partner or spouse

Person sharing

Person sharing

Person sharing

Person sharing

Male/ female

Age

Highest level of education

Diseases or conditions

What needs does the member have in order to cope with the pt e.g. support,

income, transport, wheelchair

Employment

Source of income (including grant)

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Surroundings This differs from an Ecomap. Do not indicate the relationship (energy flow).

Please give a detailed description. Listen to the community’s needs.

DESCRIPTION Housing (Number of rooms, ventilation, bathroom(s), toilet, type of structure (e.g. brick building)

Property (fencing, water, energy source, roads etc.)

Schools

Churches

Nearby shops e.g. spaza, supermarket. What don’t they sell

Municipal offices or other local authorities

Police station and Magistrates office Medical clinic

Private doctor(s)

Traditional healers

Places that sell alcohol or other recreational Drugs

Welfare organizations including places that render services such as food parcels

Social clubs and recreational facilities for adults and children

Sports facilities

Put yourself in the family’s position. Are there any other systems that impact on the family? Elaborate

Ask the patient and family to identify their health needs

Comments

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GENOGRAM

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CLINICAL EXAMINATION OF YOUR PATIENT

Result Interpretation (What does this mean?)

O

BS

ER

VA

TIO

NS

BP

Pulse

Respiratory Rate

Temp

Blood glucose

M

EA

SU

RE

ME

NT

S

Waist

Hip

Height

Waist to hip ratio (Talley & O’Connor)

Estimated weight

BMI

General appearance e.g. gait, looks healthy (Talley & O’Connor)

Fully conscious /stable/unstable

Do you think that the patient’s illness has an impact on the rest of the family? Explain.

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Do you think that the community, with its limited resources, has an effect on the patient? Explain.

__________________________________________________________________________________________________________________________________________________________________________________________

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____________________________________________________________________________________________________________________________ In your opinion, what could be done by the community and other partners involved to improve the activities

of daily living for your patient and family.

Example: My diabetic patient can be educated to grow fresh vegetables to improve his diet. I could also give advice on other hobbies after consulting with occupational therapy. The patient can also be motivated to start, or join a support group for people with Diabetes.

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ What lessons have you learnt from spending time with your family living with chronic illness?

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ How did you contribute in the wellbeing of your family living with chronic illness?

__________________________________________________________________________________________________________________________________________________________________________________________

Student : ________________________________________ Print Name and Surname ________________________________________ ______________________ Signature Date

Learning facilitator in charge: ________________________________________ ______________________ Print Name and Surname Date

________________________________________ Signature

Final mark: _________

20

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7. BLOOD PRESSURE MONITORING

VITAL SIGN OBSERVATIONS

MEASURING A BLOOD PRESSURE

STUDENT NAME: _____________________________ DATE: ________________

SECTION A – Knowledge MARKS

1. Give the definition of Blood pressure

- it is the pressure or force of the blood against the walls of the arteries

/1

2. Give the definition of Systolic Blood pressure

- it is the pressure or force of the blood against the walls of the arteries during the

CONTRACTION of the heart

/0.5

3. Give the definition of Diastolic Blood pressure

- it is the pressure or force of the blood against the walls of the arteries when the heart is at rest/relaxed/not contracting

/0.5

4 Give the definition of Hypotension

- it is a low blood pressure

/0.5

Give the definition of Hypertension

- it is a high blood pressure

/0.5

5. Name 4 factors that could affect the blood pressure reading

- Cardiovascular disorders - Neurological disorders

- Kidney and urological disorders - Pre-eclampsia in pregnant woman

- Psychological factors- stress, anger

- Medication - White coat hypertension

/0.5

6. How would you determine if the BP cuff is the right size? - it should cover 2/3 of the upper arm

/0.5

SUBTOTAL /4

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PROCEDURE: BLOODPRESSURE MEASUREMENT

SECTION B – Skill evaluation MARKS

1. Wash hands

Why? – to prevent cross infection

/0.5

2. Explain procedure to the pt

Why? – a well-informed patient is better prepared and less fearful.

/0.5

3. Have the pt sit or lie down with arm supported on pillow, table or side of the bed

- the room should be quiet and the patient must not talk

- If the pt is exerted/ walked a distance let the pt sit for + 5 minutes before commencing

Why? – exertion can influence the BP

/0.5

4. Position the pt’s arm so that it is + level to the pt’s heart

Expose the upper arm and remove restrictive clothing to avoid obstruction

/0.5

5. Squeeze the BP cuff to expel any air /0.5

6. Wind the BP cuff around the upper arm

- Use appropriate size cuff - the bottom ridge of the cuff should be + 2,5 cm above the bend of the arm (cover 2 thirds of the upper arm)

- Undersized cuff- overestimated BP, oversized cuff – underestimated BP

- the inflating part should be directly over the brachial arteries at the inner aspect of the arm, or as indicated on the cuff of the apparatus

- turn the pt’ palm upwards - keep the arm straight and relaxed

*

/0.5

7. Locate the radial pulse with finger tips

- While feeling the radial pulse with the one hand, inflate the apparatus very slowly until the radial pulse disappears

- note this reading as the estimated systolic blood pressure - cuff must not be hyper inflated – it may be painful for the patient

- deflate the cuff completely Why this procedure?

To determine the estimated systolic blood pressure

Student should be informed to indicate to the examiner what the reading was at which the pulse disappeared and the facilitator should confirm this by palpating the

radial pulse

/0.5

8. Locate the brachial artery to determine where the stethoscope should be placed NB – correct placement of the stethoscope!

- student should know where to locate the brachial artery

/0.5

9. Place the stethoscope earpieces in ears and test if it is working by tapping the bell

- position the stethoscope over the brachial artery – do not occlude the opening of the bell with fingers

- inflate the cuff to 20mmHg higher than your estimated systolic blood pressure

/0.5

10. Release the valve and deflate the cuff at 3-4mm/sec and listen for the first consecutive

sound of pulsations - note the reading as the systolic blood pressure.

- the sound is called Karotkoff 1

- it should be near the reading of the estimated systolic blood pressure. - continue to deflate the cuff slowly and note the point at which the sound disappears

- note the reading as the diastolic blood pressure

*

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- the sound is called Karotkoff 5 - deflate completely NB!

- the student may repeat the BP measurement to ensure a correct reading, but only after

complete deflation and movement of the pt's arm and fingers to re-establish circulation

- avoid slow and repeated inflation of the cuff, as it can cause the blood flow to become inadequate and lead to incorrect readings

- document the blood pressure as systolic reading over diastolic reading

Student’s deflation and measuring method should be evaluated as a whole. Correct method is important. Student should show competence and confidence.

/0.5

11. Remove the cuff and ensure the pt’s comfort

- interpret findings and give the patient feedback

/0.5

12. Record the findings

The reading should be correct **** ****

/0.5

SUBTOTAL /6 TOTAL /10

* - 10% if not done/done incorrectly **** - fail if not done/done incorrectly

Student: ________________________________________ Print Name and Surname ________________________________________ ______________________ Signature Date

Learning facilitator in charge: ________________________________________ ______________________ Print Name and Surname Date

________________________________________

Final mark: _________

10

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8. ASSESSMENT OF CLINIC FUNCTION

CLINIC INFRASTRUCTURE Does the clinic have electricity? Yes No

Does the clinic have running water? Yes No

Does the clinic have warm running water? Yes No

Is there a patient waiting area that provides shelter from the Yes No

weather?

Is there sufficient seating for patients in the waiting area? Yes No

What happens to the weak/bedridden patients waiting for the doctor – wheelchairs? ________________________________________________________________________________________

________________________________________________________________________________________________________________________________________________________________________________

Does the clinic have a working telephone? Yes No

If NO, how do they communicate?

________________________________________________________________________________________________________________________________________________________________________________

________________________________________________________________________________________

Does the clinic have a link to the internet? Yes No

Does the clinic have transport? Yes No

If YES, describe the transport available and what it is used for:

________________________________________________________________________________________________________________________________________________________________________________

________________________________________________________________________________________

How do very ill or emergency patients get to hospital?

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

Does the clinic have a refrigerator? Yes No

If YES, what is stored in the refrigerator? LOOK!

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

Clinic transport Taxi

Emergency services Own transport

Other means ( Specify)

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________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

What happens if the electricity goes off? ________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

Is the refrigerator temperature recorded daily? Yes No

Is the facility (clinic) clean and tidy? Yes No

Does the clinic have toilet facilities for the public? Yes No

If Yes, describe the toilet facilities. ________________________________________________________________________________________________________________________________________________________________________________

________________________________________________________________________________________

Does the toilets have lids and seats? Yes No

Amount of toilets for the public/patients? ______________________________________________________

Amount of patients seen per day? ____________________________________________________________

Are there enough toilets for the public/patients? Motivate your answer.

________________________________________________________________________________________________________________________________________________________________________________

________________________________________________________________________________________ ________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

Are hand-washing facilities available at the toilets? Yes No

Does the clinic have separate toilet facilities for the staff? Yes No

If YES, describe these facilities. Are hand-washing facilities available? ________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________ ________________________________________________________________________________________

________________________________________________________________________________________

Is clinic cleaning carried out daily? Yes No

Is the clinic in need of repairs or maintenance? Yes No

If YES, list the repairs or maintenance required. ________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________ ________________________________________________________________________________________

________________________________________________________________________________________

Describe the ventilation of the clinic. Is it compliant with the requirements?

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________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________ ________________________________________________________________________________________

________________________________________________________________________________________________________________________________________________________________________________

Conclusions / comments on the clinic infrastructure

________________________________________________________________________________________

________________________________________________________________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________________________________________________________________

________________________________________________________________________________________

HEALTH CARE SERVICE PROVISION

Are the Batho Pele Principles displayed in the clinic? Yes No

Is the patient charter displayed in the clinic? Yes No

Is there a clear list of the services available posted in the Yes No

clinic?

If YES, are the times that the services are provided posted as well? Yes No

Is there a patient complaints mechanism in place at the clinic? Yes No

If YES, how are complaints handled?

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

Are waiting times at the clinic tracked periodically? Yes No

Is the facility accessible to disabled persons? Yes No

Does the clinic have at least one member of staff that has Yes No

completed a recognised PHC course?

Can any problem be seen at any time at the clinic? Yes No

(i.e. the supermarket approach)

Does the clinic have a visiting doctor? Yes No

Does the clinic make use of a standardised referral form for Yes No

patients being referred elsewhere?

If YES, what details are captured on the referral form?

________________________________________________________________________________________

________________________________________________________________________________________________________________________________________________________________________________

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________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

How are patient records kept?

Hand written file Computer records

Patient retained record Other (Specify)

Does the clinic have a health committee with representatives Yes No

from the community?

If YES, who all serve on the committee?

________________________________________________________________________________________

________________________________________________________________________________________________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________________________________________________________________________________________________

Does the clinic make use of community health workers? Yes No

If YES, do these CHW receive in-service training Yes No

Is there privacy for consultations (auditory privacy)? Yes No

If not, describe: ________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________ ________________________________________________________________________________________

________________________________________________________________________________________________________________________________________________________________________________

Is there privacy for examination (visual privacy)? Yes No

If not, describe:

________________________________________________________________________________________________________________________________________________________________________________

________________________________________________________________________________________ ________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

Is there privacy for the patients visiting the VCT/HIV/AIDS section? ________________________________________________________________________________________

________________________________________________________________________________________________________________________________________________________________________________

Does the clinic make use of standard treatment guidelines? Yes No

If YES, are these guidelines (STGs) readily available for staff? Yes No

How is patient treatment statistics kept at the clinic?

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Comments:

________________________________________________________________________________________

________________________________________________________________________________________________________________________________________________________________________________

Is there a mechanism in place for reporting of notifiable Yes No

medical conditions.

If Yes, describe how this is done?

________________________________________________________________________________________

________________________________________________________________________________________________________________________________________________________________________________

List the services that are provided by the clinic: What services, and when?

________________________________________________________________________________________________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________________________________________________________________________________________________

________________________________________________________________________________________

Conclusions / Comments on health care provision

________________________________________________________________________________________________________________________________________________________________________________

________________________________________________________________________________________ ________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

HEALTH AND SAFETY

Is an organogram listing staff and duties available for the clinic? Yes No

Is there a copy of the Occupational Health and Safety Act in Yes No

the clinic?

Does the clinic have an occupational health and safety policy? Yes No

Has a risk assessment been done for all the clinic activities? Yes No

Do clinic staff get a pre-employment medical examination? Yes No

Is any form of medical surveillance carried out for occupational Yes No

diseases in staff?

Is a mechanism in place for the reporting of occupational Yes No

diseases and injuries?

If YES, describe the procedure.

Manual registers Electronic registers

Not kept Other (Specify)

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________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

Is there a plan available for clinic evacuation in case of a fire or Yes No

other hazardous situation?

Is personal protective equipment (PPE) such as gloves, masks Yes No

and goggles readily available for use by staff?

Does the clinic deal with TB patients? Yes No

If YES, what measures / precautions are taken to avoid transmission the disease to staff and other patients.

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

Are appropriate containers available for the disposal of medical Yes No

waste?

If YES, are the containers sealed and stored properly before Yes No

disposal?

How is medical waste disposed of at the clinic?

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

Is HIV post-exposure prophylaxis available at the clinic? Yes No

Conclusions / comments on health and safety.

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________ ________________________________________________________________________________________

________________________________________________________________________________________________________________________________________________________________________________

Collected by medical waste Incinerated (in incinerator)

company Burnt on open fire

Buried Other (Specify)

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9. STUDENT FEEDBACK AND REFLECTION

INTRODUCTION TO SERVICE LEARNING:

Group number: _____________

Community/Clinic visited: _______________________________________

Dates on which communities/clinics were visited: _______________________________________________

Were these visits worthwhile? (tick)

Give a rating mark for this CSL block or section of the block out of 10:

Mark to choose from

1 2 3 4 5 6 7 8 9 10

Mark given (tick)

Very poor mark

Excellent mark

List the 3 most important things that made the visits and learning successful:

a._________________________________________________________________________________________________________________________________________________________________________________________________________ b.___________________________________________________________________________________________________________________________________________ c.___________________________________________________________________________________________________________________________________________ What did not work? List the 3 biggest problems with these visits and learning.

a.___________________________________________________________________________________________________________________________________________ b.___________________________________________________________________________________________________________________________________________ c.______________________________________________________________________________

______________________________________________________________ How did you apply knowledge from previous lectures and/or textbooks in a practical way during this block?

__________________________________________________________________________________________________________________________________________________________________________________________

Yes No

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____________________________________________________________________________________________________________________________ Did your team become stronger through the experience of working in the community – elaborate on your statement

__________________________________________________________________________________________________________________________________________________________________________________________ Has your presence in the community made a difference in terms of the growth/ development in this community – elaborate on your statement

__________________________________________________________________________________________________________________________________________________________________________________________ What problems did you face that may have awakened your curiosity or made you search for answers?

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ How did this block prepare you for involvement in rural communities in future?

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Do you think you made a difference in your patients Health orientation and lifestyle – elaborate on your

statement

__________________________________________________________________________________________________________________________________________________________________________________________ What did you enjoy most?

__________________________________________________________________________________________________________________________________________________________________________________________ Have you any suggestions for the facilitators on how we could improve this experience for you as a student?

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Student :

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______________________________________ ________________________ Print Name and Surname Date

________________________________________ Signature

10. SERVICE LEARNING - REFLECTIVE DIARY Dear student For your learning to be really effective, you need to think a moment and reflect on what you have gained

from the learning experience (close the loops, so to say). Please therefore at the end of each day after you have visited a community/clinic (HIV block, Primary Health Care block, Introduction to SL block) think about

the visit and complete the following questions:

Student name and surname: ____________________________________________ Student number: _______________________ Group number: ________ Block: _______________________________ Block session and date: _______ What was my purpose in the community/clinic today?

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ What have I learnt today that I did not know before? (You can reflect on new knowledge that you have

acquired, any new skills that you have learnt and applied competently, any values/beliefs that have

expanded your vision about yourself or medicine)

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ How did I live my social responsibility towards the community today? Or how have I behaved ethically and

professionally?

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ What is the most important message I want to take home/back to campus?

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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If the space provided is not enough, you are welcome to write at the back of this page. You are also

welcome to add photos or pictures in order to illustrate the points that you have made above.

11. CONCLUSION AND SUGGESTIONS

REGARDING THE BLOCK How did you apply knowledge from previous lectures and/or textbooks in a practical way during this block?

__________________________________________________________________________________________________________________________________________________________________________________________

How did your team become stronger through the experience of working in the community?

__________________________________________________________________________________________________________________________________________________________________________________________ How has your presence in the community made a difference in terms of the growth/ development in this

community?

__________________________________________________________________________________________________________________________________________________________________________________________ What problems did you face that may have awakened your curiosity or made you search for answers?

__________________________________________________________________________________________________________________________________________________________________________________________ How did this block prepare you for involvement in rural communities in future?

__________________________________________________________________________________________________________________________________________________________________________________________ What did you enjoy most?

____________________________________________________________________________________________________________________________ What frustrated you?

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Have you any suggestions for the facilitators on how we could improve this experience for you as a student?

______________________________________________________________

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________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Student: ______________________________________ ________________________ Print Name and Surname Date ________________________________________ Signature

Learning Facilitator in charge: ______________________________________ ________________________ Print Name and Surname Date ________________________________________ Signature

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12. CHECKLIST FOR HANDING IN POME 105

SL ASSIGNMENTS

ASPECTS TO BE INCLUDED Witness report as completed by your Mentor

Report on Health Education as completed by you and your group.

Remember to attach a copy of your poster / leaflet / Brochures and all other documents which you have used to develop and present your talk.

Community profile Power Point presentation (Print black and white copies of your power point

presentation, 2 slides per page) as developed by you and your group.

Electronic copy (CD) of Power Point presentation handed in at the POME office, together

with a hard copy Both clearly marked with the group number and student names

Log sheet of patient examinations at clinic. At least 4 documented patients as completed by

yourself with feedback from your mentor.

Report about Family living with Chronic disease as completed by yourself after having visited

your patient in his/her home.

Student Feedback form (you tell us what we can do to improve your learning) as completed by

yourself.

Clinic assessment form

All reports and feedback forms must be completed and filed in a learning portfolio on Service Learning and submitted to your Learning Facilitator on

the last Friday of the block.

Please hand in your reflective diaries to POME Administrative lady at the end

of the block. She will send a copy of your diary to your facilitator for note-taking and comments (if any). You will have to collect your original

reflection sheets from her again and file it in your portfolio on SL.

Good luck and enjoy! Debbie Barnard

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See Blackboard for the SL lectures for POME 105 – information to be included in the examinations.