Clinical Skills Book

CFP and Adult Branch

Name

……………………………..…………………………….…

Intake

……………………………………

Centre

……………………………………………………

Personal Tutor

……………………………………

Useful Contacts	Telephone Number	e-mail
School Reception
Student Services
Personal Tutor

Clinical Placements Undertaken

Placement	Speciality	Duration	Date

Introduction and Guidelines

This book focuses on skills for nursing practice. It includes a number of skills that are considered essential and your attainment of these must be assessed for you to become a registered nurse (NMC 2007).

Keep this book safe and accessible when in clinical

This book guides you towards a comprehensive range of skills that you should achieve during the course and in your future practice. Skills may not be acquired in a particular order however we have indicated those skills which should be considered as a priority with a

* sign.

The list is not exhaustive and other skills may be acquired depending upon the learning opportunities that arise.

This book will help you and your mentors identify the skills you already have or need to develop. This will enable you and your mentors to assess your progress and develop action plans.

This book should be used as part of your portfolio evidence towards your achievement of proficiencies.

· It is the students’ responsibility to liaise with their mentor to identify any skills (or use of equipment) that require specific training before being undertaken or can only be undertaken by a registered nurse with extended skills. Please note this will vary between trusts.

(see also http://www.medical-devices.gov.uk)

· ALWAYS FOLLOW LOCAL TRUST POLICIES / PROCEDURES

Except for the essential skills section it is your responsibility to sign and date the skills as acquired, however you can negotiate with your mentor to countersign these.

CONTENTS

Section – skills relating to	Page
Essential Skills Assessments	4
List of Mandatory Skills and OSCE’s undertaken	21
Health and Safety	22
Handling and Mobility	23
Management of Violence and Aggression	24
Infection Prevention and Control	25
Communication Skills	27
Record Keeping and Documentation	29
Patient Assessment	30
Breathing	31
Circulation	33
Temperature	35
Hydration and Nutritional	36
Elimination	39
Neurological Status	41
Hygiene, Comfort and Dignity	43
Palliative Care and Care of the Dying	45
Pain	47
Sleep and Rest	48
Individuality (including Spiritual Care)	49
Administration of Medications	50
Peri-operative Care	52
Wound Care	54
Public Health and Health Promotion	56
Working in an Inter-disciplinary Team	59
Management and Leadership	60
Teaching	62
Additional Skills Acquired	63

ESSENTIAL SKILLS ASSESSMENTS

Guidelines for mentors undertaking practical assessments

The NMC have introduced Essential Skills Clusters (ESCs Circular 07/2007) to complement the existing NMC pre-registration outcomes / proficiencies. The NMC require that some of these skills are specifically assessed in practice.

During the Common Foundation Programme students must be assessed in the following prior to moving to the Branch programme:

TPR and BP (assessed in School, OSCE) Measures/documents vital signs (assessed in school, OSCE) Aseptic/clean technique (assessed in School, simulation)

Accurate measurements of Height, weight and BMI (assessed in practice)

Fluid balance (assessed in practice) Dietary intake (assessed in practice) Medicine calculations (assessed in School.)

During the Branch programme, students must be assessed in the following prior to registration:

Nutritional assessment (assessed in practice) Dehydration (assessed in practice)

Medicines administration (assessed in practice)

Enteral feeding (Child, LD, Adult branch only, assessed in practice) Intravenous fluids (Child and Adult branch only, assessed in practice)

Patient group directions (assessed in School)

These assessments only have to be passed on one occasion but it is expected that the student will continue to demonstrate competence at a level appropriate to the semester in which they are practising and the corresponding level of the Bondy skills escalator.

Students can have as much formative learning/practise as they feel they require but only TWO summative attempts are allowed for each assessment.

The following brief guidelines are to assist you with these assessments. If you have any queries please don’t hesitate to contact your PLT educational representative.

During the preliminary interview, identify with the student if any assessments are to be carried out.

Should a student disclose a disability to you, contact your local School of Nursing Centre and ask for the Disability Liaison Officer for guidance.

Check the assessment criteria and ascertain whether the summative assessment will be possible in the placement.

Allow the student the opportunity to practise the skill prior to arranging the assessment.

During practise give the student clear and specific feedback on their strengths / weaknesses.

Mutually agree the opportunity/ or set a date to undertake the summative assessment/s.

Assess the student against the given criteria. Each criterion must be achieved for the student to be awarded a pass.

Give the student feedback and record the result of the assessment.

Where a fail is awarded, give the student specific reasons as to why they have failed, document on the assessment form and develop an action plan.

Mentors should use their discretion on the day of assessment in the event of any unexpected circumstances such as deterioration of the patient, the student becoming unwell, an emergency in the area or equipment failure. A note of events should be made in the action plan of the Assessment of Practice Record.

NB: It is expected that the assessment will be undertaken by the primary mentor. In exceptional circumstances, the assessment may be another mentor other than the primary mentor.

ESSENTIAL SKILLS ACHIEVED IN PRACTICE

CFP	Date Achieved
Measures Height, Weight, BMI
Monitors and records Fluid Balance
Monitors and records Dietary Intake
BRANCH
Nutritional assessment
Hydration / Dehydration assessment
Enteral feeding
Intravenous fluids
Medicines Administration

ESSENTIAL SKILLS ACHIEVED IN SCHOOL

CFP		Date Achieved
Measures / documents T,P,R, BP	OSCE
Aseptic technique	Classroom Simulation
Medicines calculations	Assessment
BRANCH
Patient Group Directions	Classroom assessment

Measures Height, Weight, BMI

Responds appropriately to findings outside normal range for weight and height.

Takes and records accurate measurements of weight, height and body mass index, according to local policy

To be completed before entry to the Branch Programme All criteria must be passed to be awarded a pass mark

Please insert P=Pass or F=Fail in the appropriate attempt box.

SUMMATIVE ATTEMPT

	CRITERIA	1	2
1	Demonstrates a safe, professional, caring approach to the individual
2	Gains valid consent from the individual
3	Follows correct infection control procedures
4	Prepares equipment required
5	Accurately measures the height of the individual
6	Accurately weighs the individual
7	Accurately calculates the BMI
8	Records measurements and BMI
9	Identifies normal BMI parameters

Summative attempt no. 1	Result – Pass / Fail	Date
Name of Assessor –	Signature –
Comments –

Summative attempt no. 2	Result – Pass / Fail	Date
Name of Assessor –	Signature –
Comments –

Monitors and Records Fluid Balance

Accurately monitors and records fluid intake and output in accordance with local policy

To be achieved before entry to the Branch Programme. All criteria must be passed to be awarded a pass mark Please insert P=Pass or F=Fail in the appropriate box.

SUMMATIVE ATTEMPT

	CRITERIA	1	2
1	Demonstrates a safe, professional, caring approach to the individual
2	Gains valid consent from the individual
3	Follows correct infection control procedures
4	Enters fluid input and output accurately onto the appropriate record
5	Accurately measures and records as appropriate: a. Oral intake (if applicable) b. Intravenous intake (if applicable) c. Enteral intake (other than oral, if applicable)
6	Accurately measures and records fluid output: d. Urinary e. Other (if applicable)
7	Disposes of equipment safely
8	Accurately calculates the 12/24 hour intake and output
9	Recognises whether this is a positive or negative balance for the individual
10	Explains the need for recording fluid intake and output on the individual.

Summative attempt no. 1	Result – Pass / Fail	Date
Name of Assessor –	Signature –
Comments –

Summative attempt no. 2	Result – Pass / Fail	Date
Name of Assessor –	Signature –
Comments –

Monitors and Records Dietary Intake

Accurately monitors dietary intake and completes relevant documentation according to local policy.

To be achieved before entry to the Branch Programme All criteria must be passed to be awarded a pass mark

Please insert P=PASS or F=Fail in the appropriate attempt box.

SUMMATIVE ATTEMPT

	CRITERIA	1	2
1	Demonstrates a safe, professional, caring approach to the individual
2	Gains valid consent from the individual
3	Is able to accurately complete a food record to include: a. what is offered to the individual b. what is observed/reported to be consumed by the individual
4	Is able to explain why the individual needs to have dietary intake recorded

Summative attempt no. 1	Result – Pass / Fail	Date
Name of Assessor –	Signature –
Comments –

Summative attempt no. 2	Result – Pass / Fail	Date
Name of Assessor –Comments –	Signature –

Nutritional Assessment

Makes a comprehensive assessment of patient/client needs in relation to nutrition identifying, documenting and communicating level of risk in accordance with local policy

To be achieved during the Branch Programme.

All criteria must be passed to be awarded a pass mark Please insert P=Pass of F=Fail in the appropriate attempt box

SUMMATIVE ATTEMPT

	CRITERIA	1	2
1	Demonstrates a safe, professional, caring approach to the individual
2	Gains valid consent from the individual
3	Communicates effectively to gain an accurate patient/client history
4	Accurately completes a nutritional risk assessment
5	Recognises any actual or potential problem with the individual’s dietary intake.
6	Communicates the level of risk to other appropriate professionals
7	Identifies when reassessment needs to take place
8	Documents the assessment appropriately
9	Can explain the local support and reporting systems to deal with nutritional problems

Summative attempt no. 1 Result – Pass / Fail Date Name of Assessor – Signature –

Comments –

Summative attempt no. 2	Result – Pass / Fail	Date
Name of Assessor –	Signature –
Comments –

Hydration / Dehydration Assessment

Identifies signs of dehydration and acts to correct these

To be achieved during the Branch Programme

All criteria must be passed to be awarded a pass mark

Please insert P=Pass or F=Fail in the appropriate attempt box.

SUMMATIVE ATTEMPT

	Criteria	1	2
1	Demonstrates a safe, professional, caring approach to the individual
2	Gains valid consent from individual
3	Follows correct infection control procedures
4	Identifies signs and symptoms shown by the individual which indicate that they are dehydrated
5	Explains the possible reasons why the individual has become dehydrated
6	Take the appropriate actions to correct the dehydration and prevent any further dehydration according to local policy
7	Documents the assessment findings and adjusts the plan of care appropriately

Summative attempt no. 1	Result – Pass / Fail	Date
Name of Assessor –	Signature –
Comments –

Summative attempt no. 2	Result – Pass / Fail	Date
Name of Assessor –	Signature –
Comments –

Enteral Feeding

Where relevant to Branch, administers enteral feeds safely and maintains equipment in accordance with local policy.

To be achieved during Branch Programme

All criteria to be passed to be awarded a pass mark

Please insert P=Pass or F=Fail in the appropriate attempt box.

SUMMATIVE ATTEMPT

	CRITERIA	1	2
1	Demonstrates a safe, professional, caring approach to the individual
2	Gains valid consent from the individual
3	Follows correct infection control procedures
4	Selects the correct feed
5	Checks the expiry date and the condition of feed
6	Prepares equipment
7	Place the individual in an appropriate position for feeding
8	Ascertains the enteral feeding tube is correctly sited and is patent by agreed procedure.
9	Attaches feeding tube to the administration equipment
10	Delivers the feed at the correct rate according to the feeding regime
11	Monitors the individual appropriately during feeding
12	On completion of the feed flushes the enteral tube in accordance with the local policy
13	Caps the end of the enteral tube and positions the tube for safety and comfort
14	Disposes/maintains equipment safely
15	Documents the procedure accurately
16	Monitors the individual appropriately after feeding

Summative attempt no. 1	Result – Pass / Fail	Date
Name of Assessor –	Signature –
Comments –

Summative attempt no. 2	Result – Pass / Fail	Date
Name of Assessor –	Signature –
Comments –

Intravenous Fluids

Where relevant to the branch monitors and assesses patients / clients receiving IV fluids.

Documents progress against prescription and markers of hydration according to local policy

To be achieved during Branch Programme.

All criteria to be passed to be awarded a pass mark

Please insert P=Pass or F=Fail in the appropriate attempt box

SUMMATIVE ATTEMPT

	Criteria	1	2
1	Demonstrates a safe, professional, caring approach to the individual
2	Gains consent from patient and prepares them appropriately
3	Follows correct infection control procedures
4	Checks that correct infusion is in place
5	Checks that infusion is running to time
6	Monitors infusion site for signs of abnormality and pain
7	Checks date for IV giving set to be changed
8	Evaluate and discuss the individuals hydration status
10	Monitors and discuss possible contraindications e.g. fluid overload
13	Explains how patient should subsequently be monitored
15	Completes documentation accurately

Summative attempt no. 1 Result – Pass / Fail Name of Assessor – Signature –

Comments / Action Plan– Date

Summative attempt no. 2 Result – Pass / Fail Name of Assessor – Signature –

Comments – Date

Medicines Administration

Accurately calculates medicines frequently encountered within Branch
Safely manages drug administration and monitors
Safely and effectively administers medicines via routes and methods commonly used within Branch and maintains accurate records.

For an individual or a small group of patients depending on setting In accordance with the local policy and NMC standards for medicine administration (NMC 2007)

To be achieved during the Branch Programme

All criteria to be passed to be awarded a pass mark

Please insert P=Pass or F=Fail in the appropriate attempt box.

SUMMATIVE ATTEMPT

	CRITERIA	1	2
1	Demonstrates a safe, professional, caring approach to the individual
2	Gains valid consent from the individual
3	Follows correct infection control procedures whilst preparing and administering medicines
4	Prepares equipment required (as appropriate)
5	Checks and confirms:
a	The identity according to local policy and procedures
b	Allergies or adverse effects
c	Weight if required
6	Checks the Patient Specific Direction (Prescription)
a	Date
b	Time
c	Start and Review date as appropriate
d	Name and form of the medicine to be given
e	Last time dose given
f	Dose prescribed
g	Route of administration
h	Signed by the prescriber/transcriber *
i	Any additional advice e.g. after food
j	Any once only or as required medicines needed
7	Reports any errors or concerns about the prescription

8	Demonstrate knowledge of the therapeutic use, dose, routes, side effects, precautions and contraindications of the medicine with reference to the BNF, BNFC or pharmacist as appropriate
9	Selects the correct medication, checks the label and dose carefully against the prescription (including any dilutent)
10	Checks the expiry date
11	Calculates the correct dose
12	Measures/dispenses the correct dose
13	Performs final check of the individuals identity
14	Administers medication and observes it is taken
15	Completes documentation accurately
16	Demonstrate knowledge of monitoring, reporting and recording side effects, allergic reactions, effectiveness of medicine
17	Provides individual with appropriate information, advice and promotes concordance
18	Explains correct disposal of unwanted medicines
19	Disposes of equipment used safely (if appropriate)

*NB: Applicable only where there is a Transcribing Policy in place

Summative attempt no. 1 Result – Pass / Fail Date Name of Assessor – Signature –

Comments –

Summative attempt no. 2	Result – Pass / Fail	Date
Name of Assessor –	Signature –
Comments –

Additional guidelines for Patient Specific Directions assessment (medicine management)

The assessment should involve a range of medications for 4 individuals.

If necessary, the assessment may take place over a number of days, for example in a community setting

The student should have knowledge of the therapeutic use of all medications that they administer

Please refer to the Clinical Skills book to ensure that the student has administered medications via frequently encountered routes, as appropriate to the setting, prior to carrying out the assessment

OSCES

OSCE	Semester	Date Passed
Hand washing	Semester 1 / 2
Temperature Pulse Respiration Blood Pressure	Semester 2
Systematic assessment of an acutely ill adult	Semester 5

YEAR ONE Mandatory Sessions

Session

Date Attended

Basic Life Support 1 (Adult)

Basic Life Support 2 (Child / Baby) Introduction to COSHH Introduction to Risk Management

Responding to Violence & Aggression 1 Fire Safety 1

Infection Control: An Introduction Infection Control: Application of principles

Hospital acquired infection and an introduction to food hygiene

Numeracy 1

Moving & Handling 1 Moving & Handling 2 Moving & Handling 3 Moving & Handling 4 Moving & Handling 5 Moving & Handling 6

Administration of medication (Theory) Administration of medication Practice (Oral) Administration of medication by injection Numeracy 2

Basic life support in the institutional setting Principles of Asepsis

Mother and Baby Booklet Child Protection Package

Health and Safety

I have demonstrated appropriate skills related to:

Skill	Introduced in School	Observed		Direct supervision/ supervised practice
		Observed		Year
		1	2	1	2	3	4
* Fire procedure awareness
Basic Life Support
First Aid skills, including a) ABCDE assessment b) The unconscious / unresponsive patient c) Airway obstruction d) Acute bleeding
Resuscitation in an institution
Aware of COSHH regulations
Aware of RIDDOR regulations
Reporting of untoward incidents
Observe/contribute to a Health and Safety risk assessment of a clinical area / department
Safe transport of specimens
Able to access health and safety policies, procedures and protocols
*Safe use and disposal of sharps
Safe use of and disposal of medical devices
Teach and advise patients on safe use of medical devices
Use of radiation protection
Notes: Health and Safety

Handling and Mobility

I have demonstrated appropriate skills related to:

Skill	Introduced in School	Observed		Direct supervision/ supervised practice
		Observed		Year
		1	2	1	2	3	4
*Moving and Handling risk assessment
*Developing moving and handling care plans. a) Assessment b) Planning c) Implementation d) Evaluation
*Beds – operating, instructing a) b)
*Sliding Systems a) b)
*Hoists a) b) c)
*Standing Aids a) b)
*Walking a patient and walking aids a) Walking with handhold b) Zimmer frame c) Walking stick
*Wheelchairs a) Manual b) Electric
*Bathing aids a) b)
Falls risk assessment / plan

Violence and Aggression

I have demonstrated appropriate skills related to:

Skill	Introduced in School	Observed		Direct supervision/ supervised practice
		Observed		Year
		1	2	1	2	3	4
* Recognising triggers and cues of challenging behaviour
* Appropriate use of body language in conflict situations
*Common strategies aimed at defusing aggression
Verbal preventative strategies
Assertiveness
Stimulus change
Mood matching
Distraction
Low arousal techniques
Verbal response techniques
* Maintenance of safe distance

Infection Prevention and Control

I have demonstrated appropriate skills related to:

Skill	Introduced in School	Observed		Direct supervision/ supervised practice
		Observed		Year
		1	2	1	2	3	4
* Effective hand hygiene a) Social hand washing b) Hygienic hand washing c) Use of Alcohol gels d) ‘Scrubbing’ for surgical procedures
* Waste and Linen Disposal a) Household waste b) Clinical Waste c) Body fluids
*Appropriate use of gloves and protective clothing
*Ensuring a clean and tidy environment for patients and visitors
*Decontamination / cleaning of multi use equipment egg beds
Prevention and management of sharps injuries
*Applying principles of infection control
*Applying principles of asepsis
Care of a patient in isolation a) Protective b) Source
Care of a patient in isolation a) Protective b) Source
Care of a patient with an infection on an open ward
Safe management of hazardous specimens
Able to access expert infection control advice

Skill	Introduced in School	Observed		Direct supervision/ supervised practice
		Observed		Year
		1	2	1	2	3	4
Microbial sampling a)Recognises when microbial samples required b) Identifies equipment to take samples c) Obtains samples in accordance with local policy*
Contributes to an infection control risk assessment.
Using an infection control risk assessment is able to plan appropriate care
Can teach / advise patients / visitors / staff about infection control risk, prevention and management of infection
Takes appropriate action if exposure to infection occurs egg TB, HIV

Notes: Infection Prevention and Control

* Sepsis protocol identifies the need for microbial sampling prior to commencement of antibiotics, within 6 hours of onset of sepsis (ref).

Communication Skills

I have demonstrated appropriate skills related to:

Skill	Introduced in School	Observed		Direct supervision/ supervised practice
		Observed		Year
		1	2	1	2	3	4
*Presents oneself in a professional manner
*‘Customer Services’ reception and telephone skills
*Initiates appropriate communication
* Terminates a conversation in an appropriate manner
*Interprets non-verbal cues
* Utilises non-verbal skills effectively egg touch
*Demonstrates accurate reporting of information a) Patient handover b) Reporting to team members c) Conveys clinical urgency when required
*When a patient deteriorates recognises the need to inform a) Primary responder, or patients doctor to initiate a review/ escalation of treatment b)Patients’ family / significant others

*Utilises appropriate skills when communicating with a) Visually impaired b) Hearing impaired c) speech impairment

Skill	Introduced in School	Observed		Direct supervision/ supervised practice
		Observed		Year
		1	2	1	2	3	4
Shows sensitivity to cross cultural aspects of communication
Can access interpreting services
Can access support when dealing with complex situations egg Macmillan Nurse

Notes: Communication skills and Record Keeping

* Primary responder is the term used by NICE (2007) to reflect the role of the critical care outreach team or equivalent. Not all trusts or wards have this service.

NMC ref http://www.nmc-uk.org Record keeping [PDF] – Updated July 2007

Record Keeping and Documentation (Note: this links to all other sections)

I have demonstrated appropriate skills related to:

Skill	Introduced in School	Observed		Direct supervision/ supervised practice
		Observed		Year
		1	2	1	2	3	4
In accordance with local and NMC guidelines
Records are: factual, accurate and clearly written
Written consecutively and as soon as possible after an event has occurred, providing current information on the condition of the patient and the care given / action taken
Records are dated, timed and signed, (signature printed alongside the first entry) and counter signed by mentor
Any alterations or additions are dated, timed and signed in such a way that the original entry can still be read clearly
Records are professional and do not include abbreviations, jargon, meaningless phrases etc
Records are written, wherever possible, with the involvement of the patient or their carer in terms that the patient can understand
All charts / documentation completed accurately. Labelled with min 2 patient identifiers.
Patient confidentiality to be maintained regarding records

Generic Patient Assessment

I have demonstrated appropriate skills related to:

Skill	Introduced in School	Observed		Direct supervision/ supervised practice
		Observed		Year
		1	2	1	2	3	4
* Demonstrates a structured approach to assessment a) Emergency b) Planned

*Able to undertake an initial patient admission
*Utilises a person centred, holistic approach
* Able to orientate a patient to a new environment
*Recognises the importance of observations made on patients
Is able to use and interpret specific assessment tools;
a)Early warning score/ track and trigger scores
b)ABCDE algorithm
c)
d)
Recognises abnormal measurements / clinical deterioration and adjusts a) Frequency of observations b) Level of monitoring
Initiates appropriate actions / management plan as per local policy

Breathing

I have demonstrated appropriate skills related to:

Skill	Introduced in School	Observed		Direct supervision/ supervised practice
		Observed		Year
		1	2	1	2	3	4
*Able to assess airway
* Able to observe, record and interpret respiratory rate, depth and rhythm
*Measures and interprets oxygen saturation levels using pulse oximetry
*Recognises abnormal respiratory measurements and breathlessness
*Accurately assigns early warning trigger scores
*Responds to measurements in accordance with local protocols including oxygen therapy and airway support (under supervision)
Record and interpret Peak Expiratory Flow Rate
*Holistically evaluates the patients’ breathing and oxygenation
*Can assess cough and sputum
Can obtain a sputum sample
*Sets up oxygen equipment as prescribed using: a) Nasal cannula b) Venturi mask c) Humidification d) Non/partial rebreathing
*Administers prescribed oxygen, provides appropriate care and records O₂ flow / %

Skill	Introduced in School	Observed		Direct supervision/ supervised practice
		Observed		Year
		1	2	1	2	3	4
*If using portable oxygen, ensure there is adequate oxygen in the cylinder for the duration of the journey
Uses a nebuliser as prescribed a) Air compressor b) Oxygen driven
Demonstrates how to use an inhaler and can assess the patient’s technique
Tracheostomy care a) b)
Assess need for and insert oropharyngeal airway
*Suction Sets up and checks suction equipment a)wall b)portable
Undertakes suction using the correct procedure and equipment b) Oropharyngeal –catheter c) Oral with yankeur suction d) Tracheal e) Tracheostomy
Maintain an open airway using the triple airway manoeuvre
Undertake care of a patient having a chest drain inserted or with a chest drain in situ
Notes: Breathing* you may have the opportunity to learn how to listen / ausculate the chest if you work with a physiotherapist, specialist nurse or doctor

Circulation

I have demonstrated appropriate skills related to:

Skill	Introduced in School	Observed		Direct supervision/ supervised practice
		Observed		Year
		1	2	1	2	3	4
* Measure and record, rate, rhythm and volume of the pulse
*Recognises abnormal pulse measurement and responds appropriately
*Measure and record blood pressure a) Manual b) Electronic
*Recognises abnormal BP measurement and responds appropriately
Assigns EWS for BP and pulse
Locates and records peripheral pulses
Assess limb perfusion a) Temperature b) Pallor c) Vascular doppler
Perform and interpret capillary refill test
Adjusts frequency of observations as local protocol
Undertakes Care of a patient with a Central Venous catheter a) recognises risks / complications b) monitors patient and provides care required c) measures, records and interprets CVP measurement

Skill

Undertake arterial pressure measurement

Cardiac monitoring

3 lead
4 lead
5 lead

Assist in recording a 12 lead E.C.G.

Recognise rhythms on a 3 lead monitor

Sinus rhythm
Ventricular fibrillation
Ventricular tachycardia
Systole
Arial fibrillation

Introduced in School

Observed 1 2

Direct supervision/ supervised practice Year

1 2 3 4

Measure / record blood loss Performs systematic cardiovascular assessment

pallor
presence of sweating
peripheral temperature
level of consciousness

See hydration for urine output

Notes: Circulation

*Be aware of and follow local escalation protocols when abnormal measurements are identified

Temperature

I have demonstrated appropriate skills related to:

Skill	Introduced in School	Observed		Direct supervision/ supervised practice
		Observed		Year
		1	2	1	2	3	4
* Able to measure, record and interpret a patients temperature a) Orally b) Tympanic c) Other	OSCE
Recognises an abnormal temperature
Care for a hypothermic patient
Utilises appropriate methods of cooling a hyperthermic patient
Care for a hyperthermic patient
Administers and monitors the effectiveness of prescribed antipyretics

Hydration and Nutritional Needs

I have demonstrated appropriate skills related to:

Skill	Introduced in School	Observed		Direct supervision/ supervised practice
		Observed		Year
		1	2	1	2	3	4
*Perform a comprehensive assessment of hydration status, identifies needs and plan care
*Perform a comprehensive assessment of nutritional status identifies needs and plan care
*Makes referral to a dietician when required
*Measure a patient’s height and weight and calculate the BMI
*Accurately records a) urine output b) food intake
*Records and collates fluid balance over 24hours and recognises fluid imbalance
*Apply Principles of food hygiene
*Assist with / feed a client safely and with dignity
Monitor a patients ability to swallow effectively
Inserts a Ryles nasogastric tube (only in a conscious patent) for a) Enteral feeding b) Monitoring / drainage of gastric contents
Perform Enteral feeding
Care of and feeding a patient with a Percutanious Endoscopic Gastrostomy tube

Skill	Introduced in School	Observed		Direct supervision/ supervised practice
		Observed		Year
		1	2	1	2	3	4
*Care of a patient with an intravenous infusion; a) Monitors cannula site b) Identifies any extravastation c) Identifies infection /inflammation d) Selects and Primes IV sets e) Manages an IV infusion (inc changing the administration set) f) Assists with cannulation g) Manages an IV fluid regime (inc checking, recording and calculations h) Removes an IV cannula
Specific medical devices training (pumps and controllers) a) b)
Contributes as policy to safety checks prior to administering a blood transfusion
Monitors a patient during a blood transfusion for reactions
Performs and records capillary blood glucose measurement
Supervise patients self monitoring blood glucose levels
*Recognise and report a) hypoglycaemia b) hyperglycaemia

Elimination Needs

I have demonstrated appropriate skills related to:

Skill	Introduced in School	Observed		Direct supervision/ supervised practice
		Observed		Year
		1	2	1	2	3	4
*Assessment of continence a) Urinary b) Faecal
*Collect and measure urine output
*Perform, interpret and record routine urinalysis
Collect and manage a MSSU
Collect stool sample
*Maintains dignity when meeting a patients’ toileting needs
Plan, implement and evaluate a management plan for elimination needs a) Urinary problems b) Faecal problems
Apply (after full assessment) a) continence pads / underwear b) Sheaths
Care of a patient with a urinary catheter a) Routine care b) Bag emptying c) Specimen collection
Safely performs a rectal examination considering patient dignity
Demonstrates effective and safe use of a bladder scanner

Skill	Introduced in School	Observed		Direct supervision/ supervised practice
		Observed		Year
		1	2	1	2	3	4
Undertakes / assists with urinary catheterisation a) female b) Male (See below)
Recognises urinary tract infection
Assess constipation
Assess diarrhoea
Care of a patient with a colostomy

Altered Neurological Status

I have demonstrated appropriate skills related to:

Skill	Introduced in School	Observed		Direct supervision/ supervised practice
		Observed		Year
		1	2	1	2	3	4
*Is able to assess a patient using the AVPU system Alert, responds to Voice, responds to Pain Unresponsive and recognise abnormal responses
*Undertake, record and interpret Glasgow Coma Score
Assess and interpret pupil size and response to light
Assess and interpret sensory and motor response
Recognises abnormal neurological observations
Responds as local protocol to EWS trigger
Recognises confused state as a marker of acute illness / deterioration
*Care for an unconscious patient in relation to; a) Positioning b) Simple Airway control
Care of patient who has a seizure. a) During a seizure (airway) b) Following a seizure Recording the length, frequency and nature of the seizures
Assists with lumbar puncture

Notes: Neurological Status

Hygiene, Comfort and Dignity

I have demonstrated appropriate skills related to:

Skill	Introduced in School	Observed		Direct supervision/ supervised practice
		Observed		Year
		1	2	1	2	3	4
*Assess a patients ability to undertake self care
*Develop individualised plans of care to meet hygiene needs promoting independence
Assess a patients a) skin b) nails c) hair
Implement care for specific skin conditions a) dry skin b)
* Oral Hygiene a) Assess lips / mouth b) Undertake oral care c) Assist with oral care
* Provides hygiene care for a dependant patient’s a) skin b) nails c) hair
* Able to prepare a comfortable bed
* Following an episode of care, ensures that a patient is comfortable, dignified, can reach belongings and has nurse call button if required

Palliative Care and Care of the Dying

I have demonstrated appropriate skills related to:

Skill	Introduced in School	Observed		Direct supervision/ supervised practice
		Observed		Year
		1	2	1	2	3	4
Undertake an assessment of the patients and carers needs a) Physical b) Psychological c) Social d) Spiritual
Plan, implement and evaluate care to: a) Manage distressing symptoms e.g. dry mouth, pain, agitation b) Promote optimal comfort c) Provide psychological, social and spiritual support d) Refer to appropriate palliative care services
Utilise the end of life care pathway
Implement appropriate care of the patient after an expected death (last offices)
Provide support and information for the bereaved
Communicate sensitively and compassionately when talking with the patient / family and when giving distressing information
Assist with a complex discharge from hospital for a palliative/dying patient

Skill	Introduced in School	Observed		Direct supervision/ supervised practice
				Year
		1	2	1	2	3	4
UNEXPECTED/SUDDEN DEATH
a) Instigate appropriate First Aid/Resuscitation/Emergency care b) Assist with contacting family and other professionals c) Provide support when bad news is given d) Make appropriate referrals to support services / chaplaincy bereavement centre e) Work co-operatively with the police/coroners office g) Provide detailed documentation of events

Pain

I have demonstrated appropriate skills related to:

Skill	Introduced in School	Observed		Direct supervision/ supervised practice
		Observed		Year
		1	2	1	2	3	4
Perform and document pain assessment using different tools * a) b) c)
*Identify appropriate pharmacological interventions and their side effects a) b) c)
*Undertake non-pharmacological interventions a) b) c) d)
*Evaluate the effectiveness of pain control measures

Sleep and Rest

I have demonstrated appropriate skills related to:

Skill	Introduced in School	Observed		Direct supervision/ supervised practice
		Observed		Year
		1	2	1	2	3	4
*Assess a patient’s sleep and rest pattern and needs
*Plan a patient’s day taking into account of the need for sleep and rest.
*Identify measures that promote sleep
*Implement care that promotes sleep a) b)

Patient Individuality (including Spiritual and Culturally Sensitive Care)

I have demonstrated appropriate skills related to:

Skill	Introduced in School	Observed		Direct supervision/ supervised practice
		Observed		Year
		1	2	1	2	3	4
*Considers a patient spirituality and beliefs when planning care
*Shows sensitivity to patients a) spiritual needs b) cultural needs
Participates in collaboration with others (eg chaplain, interpreting service) to meet patients a) spiritual needs b) cultural needs
*Evaluates care related to a) spiritual needs b) cultural needs
Care delivery is based on an understanding of individual need rather than assumptions derived from patient characteristics (eg age and gender)

Administration of Medications Please see Essential Skills Criteria

I have demonstrated appropriate skills related to:

Skill	Introduced in School	Observed		Direct supervision/ supervised practice
		Observed		Year
		1	2	1	2	3	4
UNDER DIRECT SUPERVISION and IN ACCORDANCE WITH NMC and LOCAL GUIDELINES
* interprets / check’s a patient specific directive (prescription)
*Checks name, form, time, date and route of medicine to be given
* Accurately calculates dose a) Tablets b) Solutions c) IV rate
* Checks patients identity
*Administers prescribed medication safely; a) Oral b) NG / gastrostomy c) Rectal d) Vaginal (pessaries) e) Sub-cutanous f) Intra-muscular g) Inhaler h) Topical i) Ophthalmic j) Aural k) Nasal
*Checks and administers controlled drugs as policy
Demonstrates an understanding of the process of ordering, receiving, storing and disposal; a) IV fluids b) Stock Drugs c) Individual patient drugs d) Medications to take home e) Controlled drugs

Notes: Medications

NMC ref http://www.nmc-uk.org Standards for medicines management – summary booklet / full content [PDF]

Published: February 2008

We suggest you keep a record of medications you have learnt about

Peri-operative Care

I have demonstrated appropriate skills related to:

Skill	Introduced in School	Observed		Direct supervision/ supervised practice
		Observed		Year
		1	2	1	2	3	4
Prepare a patient for a anaesthetic a) General i fasting ii hygiene iii specific preparation b) Regional i fasting ii hygiene iii specific preparation c) Local i fasting ii hygiene iii specific preparation
Take / Receive a patient into the theatre area
Be able to put on surgical gloves and surgical gown
Care for a post-anaesthetised patient a) Observations b) Laryngeal mask airway c) LMA removal
Hand over a post-operative patient to ward staff
Receive a post operative patient and safely escort back to a ward

Notes: Peri-operative Care

Wound Care

I have demonstrated appropriate skills related to:

Skill	Introduced in School	Observed		Direct supervision/ supervised practice
		Observed		Year
		1	2	1	2	3	4
*Assess for pressure ulcer risk using the following assessment tools; a) b) c)
*Undertake a skin assessment
*Plans preventative care using a) pressure relieving beds b) seat cushions c) positioning d) education
Assess a pressure ulcer using a grading score a) b)
Plan, implement and evaluate care to promote pressure sore healing
*Assess and record progress of wound healing a) tracing b) photography
*Assess a a) chronic wound b) acute wound
*Cleanse a a) chronic wound b) acute wound
*Choose and apply appropriate wound dressings
Obtain a wound swab

Manage wound drainage systems a) b) c)
Close an acute wound with closure tapes
Assist with the suturing of a wound
Effectively apply a simple supporting bandage a) b)
Provide health education to a patient with a wound
Evaluate the healing of a wound a) Acute b) Chronic
Removal of sutures
Removal of clips

Public Health and Health Promotion

I have demonstrated appropriate skills related to:

Skill	Introduced in School	Observed		Direct supervision/ supervised practice
		Observed		Year
		1	2	1	2	3	4
Assess the client’s/carer’s current health need
Identify the factors that are, or could, impact on the clients/carer’s health within the care environment
Identify the factors that are, or could, influence the clients/carer’s health within their own ‘home’ environment
Report and record relevant factors influencing the clients/carer’s health
Communicate with the client/carer appropriately whilst assessing and meeting the clients health need a) verbal and non verbal face to face b) by telephone c) written d) other …
Provide appropriate information to clients/carers a) verbally b) utilising written information
Provide appropriate health education to meet client/carer needs

Skill	Introduced in School	Observed		Direct supervision/ supervised practice
		Observed		Year
		1	2	1	2	3	4
Choose and utilise an appropriate approach to meeting the clients needs 1.medical 2.behavioural 3.educational 4.client centred 5. harm reduction 6. risk reduction 7. signposting to other services 8. referral to other services 9. liaise with other services to formulate and deliver appropriate care packages 10. other
Provide appropriate supportive care to meet the clients physical, psychological and social needs
Evaluate the effectiveness of the intervention to meet the clients/carers needs
Assess factors risks which will/could influence your own health in the care environment
Assess factors/risks which will/could determine the health status of staff in the care environment
Demonstrate the ability to maintain a safe working/ care environment a) identify, report and record factors according to policy b)act appropriately to reduce risk

Notes: Public Health and Health Promotion

Reference: Public Health and Health Promotion: linking Theory to Nursing Practice 2005 Curriculum Advisory document (internal).

Working in an Inter-disciplinary Team

I have demonstrated appropriate skills related to:

Skill	Introduced in School	Observed		Direct supervision/ supervised practice
		Observed		Year
		1	2	1	2	3	4
*Able to identify the roles of IDT members a) b) c)
*Initiates and makes direct referrals to; a) Medical staff b) Specialist nurses / teams i) ii) iii) c) Physiotherapist d) Occupational Therapist e) Speech and Language Therapist f) Clinical Nutritionist g)
*Actively participates in a clinical hand over
Actively participates in clinical case conferences
Actively participates in a ward round

Management

I have demonstrated appropriate skills related to:

Skill	Introduced in School	Observed		Direct supervision/ supervised practice
		Observed		Year
		1	2	1	2	3	4
*Manages the overall care of an a) Individual patient b) 2-3 patients c) A group of patients for a period of time
Aware of the process of ordering, receiving and storing, a) Routine Supplies b) Emergency Supplies
Able to delegate appropriately
Able to instigate the complaints policy

Leadership

I have demonstrated appropriate skills related to:

Skill	Introduced in School	Observed		Direct supervision/ supervised practice
		Observed		Year
		1	2	1	2	3	4
Acts as role model/buddy to junior students
Leads a team to care for a group of patients
Able to provide constructive feedback to peers and junior students
Organisational awareness and management of policy initiatives a) b) c)

Teaching

I have demonstrated appropriate skills related to:

Skill	Introduced in School	Observed		Direct supervision/ supervised practice
		Observed		Year
		1	2	1	2	3	4
Assessing learning needs
Developing a teaching plan
Teaching a a) Skill b) Knowledge
Assessing learning achieved
Evaluating effectiveness of teaching approach

Additional Skills Acquired

I have demonstrated appropriate skills related to:

Skill	Introduced in School	Observed		Direct supervision/ supervised practice
		Observed		Year
		1	2	1	2	3	4

CFP and Adult Branch

This book focuses on skills for nursing practice. It includes a number of skills that are considered essential and your attainment of these must be assessed for you to become a registered nurse (NMC 2007).

· It is the students’ responsibility to liaise with their mentor to identify any skills (or use of equipment) that require specific training before being undertaken or can only be undertaken by a registered nurse with extended skills. Please note this will vary between trusts.

· ALWAYS FOLLOW LOCAL TRUST POLICIES / PROCEDURES

Guidelines for mentors undertaking practical assessments

These assessments only have to be passed on one occasion but it is expected that the student will continue to demonstrate competence at a level appropriate to the semester in which they are practising and the corresponding level of the Bondy skills escalator.

ESSENTIAL SKILLS ACHIEVED IN PRACTICE

Measures Height, Weight, BMI

SUMMATIVE ATTEMPT

Monitors and Records Fluid Balance

SUMMATIVE ATTEMPT

Monitors and Records Dietary Intake

SUMMATIVE ATTEMPT

Nutritional Assessment

SUMMATIVE ATTEMPT

Hydration / Dehydration Assessment

SUMMATIVE ATTEMPT

Enteral Feeding

SUMMATIVE ATTEMPT

Intravenous Fluids

SUMMATIVE ATTEMPT

Medicines Administration

SUMMATIVE ATTEMPT

Additional guidelines for Patient Specific Directions assessment (medicine management)

OSCES

YEAR ONE Mandatory Sessions

Handling and Mobility

Violence and Aggression

Infection Prevention and Control

Communication Skills

Generic Patient Assessment

Breathing

Circulation

Temperature

Hydration and Nutritional Needs

Elimination Needs

Altered Neurological Status

Hygiene, Comfort and Dignity

Palliative Care and Care of the Dying

Pain

Sleep and Rest

Administration of Medications Please see Essential Skills Criteria

Peri-operative Care

Wound Care

Public Health and Health Promotion

Working in an Inter-disciplinary Team

Management

Leadership

Teaching

Additional Skills Acquired

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