Clinical Skills Book

CFP and Adult Branch

 

 

 

Name……………………………..…………………………….…Intake……………………………………

 

Centre

 

……………………………………………………

 

Personal Tutor

 

……………………………………

     

 

 

 

 

 

 

Useful ContactsTelephone Numbere-mail
School Reception  
Student Services  
Personal Tutor  
   

 

 

Clinical Placements Undertaken

PlacementSpecialityDurationDate
    
    
    
    
    
    
    
    
    
    
    
 
  

 

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 toPage
Essential Skills Assessments4
List of Mandatory Skills and OSCE’s undertaken21
Health and Safety22
Handling and Mobility23
Management of Violence and Aggression24
Infection Prevention and Control25
Communication Skills27
Record Keeping and Documentation29
Patient Assessment30
Breathing31
Circulation33
Temperature35
Hydration and Nutritional36
Elimination39
Neurological Status41
Hygiene, Comfort and Dignity43
Palliative Care and Care of the Dying45
Pain47
Sleep and Rest48
Individuality (including Spiritual Care)49
Administration of Medications50
Peri-operative Care52
Wound Care54
Public Health and Health Promotion56
Working in an Inter-disciplinary Team59
Management and Leadership60
Teaching62
Additional Skills Acquired63

 

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

 

CFPDate 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 techniqueClassroom Simulation 
Medicines calculationsAssessment 
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

 CRITERIA12
1Demonstrates a safe, professional, caring approach to the individual  
2Gains valid consent from the individual  
3Follows correct infection control procedures  
4Prepares equipment required  
5Accurately measures the height of the individual  
6Accurately weighs the individual  
7Accurately calculates the BMI  
8Records measurements and BMI  
9Identifies normal BMI parameters  

 

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

 

 

 

 

 

 

Summative attempt no. 2Result – Pass / FailDate
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

 CRITERIA12
1Demonstrates a safe, professional, caring approach to the individual  
2Gains valid consent from the individual  
3Follows correct infection control procedures  
4Enters 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)

  
7Disposes of equipment safely  
8Accurately calculates the 12/24 hour intake and output  
9Recognises whether this is a positive or negative balance for the individual  
10Explains the need for recording fluid intake and output on the individual.  

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Summative attempt no. 2Result – Pass / FailDate
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

 CRITERIA12
1Demonstrates a safe, professional, caring approach to the individual  
2Gains 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

  
4Is able to explain why the individual needs to have dietary intake recorded  

 

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

 

 

 

 

 

 

 

Summative attempt no. 2Result – Pass / FailDate
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

 CRITERIA12
1Demonstrates a safe, professional, caring approach to the individual  
2Gains valid consent from the individual  
3Communicates effectively to gain an accurate patient/client history  
4Accurately completes a nutritional risk assessment  
5

Recognises any actual or potential problem with the individual’s dietary

intake.

  
6Communicates the level of risk to other appropriate professionals  
7Identifies when reassessment needs to take place  
8Documents 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. 2Result – Pass / FailDate
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

 Criteria12
1Demonstrates a safe, professional, caring approach to the individual  
2Gains valid consent from individual  
3Follows correct infection control procedures  
4

Identifies signs and symptoms

shown by the individual which indicate that they are dehydrated

  
5Explains 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. 1Result – Pass / FailDate
Name of Assessor –Signature – 
Comments –  

 

 

 

 

 

 

 Summative attempt no. 2Result – Pass / FailDate
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

 CRITERIA12
1Demonstrates a safe, professional, caring approach to the individual  
2Gains valid consent from the individual  
3Follows correct infection control procedures  
4Selects the correct feed  
5Checks the expiry date and the condition of feed  
6Prepares equipment  
7Place the individual in an appropriate position for feeding  
8Ascertains the enteral feeding tube is correctly sited and is patent by agreed procedure.  
9Attaches feeding tube to the administration equipment  
10Delivers the feed at the correct rate according to the feeding regime  
11Monitors the individual appropriately during feeding  
12On completion of the feed flushes the enteral tube in accordance with the local policy  
13Caps the end of the enteral tube and positions the tube for safety and comfort  
14Disposes/maintains equipment safely  
15Documents the procedure accurately  
16Monitors the individual appropriately after feeding  

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Summative attempt no. 2Result – Pass / FailDate
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

 Criteria12
1Demonstrates a safe, professional, caring approach to the individual  
2Gains consent from patient and prepares them appropriately  
3Follows correct infection control procedures  
4Checks that correct infusion is in place  
5Checks that infusion is running to time  
6Monitors infusion site for signs of abnormality and pain  
7Checks date for IV giving set to be changed  
8Evaluate and discuss the individuals hydration status  
10Monitors and discuss possible contraindications e.g. fluid overload  
13Explains how patient should subsequently be monitored  
15Completes 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

 CRITERIA12
1Demonstrates a safe, professional, caring approach to the individual  
2Gains valid consent from the individual  
3Follows correct infection control procedures whilst preparing and administering medicines  
4Prepares equipment required (as appropriate)  
5Checks and confirms:
aThe identity according to local policy and procedures  
bAllergies or adverse effects  
cWeight if required  
6Checks the Patient Specific Direction (Prescription)
aDate  
bTime  
cStart and Review date as appropriate  
dName and form of the medicine to be given  
eLast time dose given  
fDose prescribed  
gRoute of administration  
hSigned by the prescriber/transcriber *  
iAny additional advice e.g. after food  
jAny once only or as required medicines needed  
7Reports 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)

  
10Checks the expiry date  
11Calculates the correct dose  
12Measures/dispenses the correct dose  
13Performs final check of the individuals identity  
14Administers medication and observes it is taken  
15Completes documentation accurately  
16

Demonstrate knowledge of monitoring, reporting and recording

side effects, allergic reactions, effectiveness of medicine

  
17Provides individual with appropriate information, advice and promotes concordance  
18Explains correct disposal of unwanted medicines  
19Disposes 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. 2Result – Pass / FailDate
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

OSCESemesterDate Passed
Hand washingSemester 1 / 2 

Temperature Pulse Respiration

Blood Pressure

 

Semester 2

 

Systematic assessment of an

acutely ill adult

Semester 5 

 

YEAR ONE Mandatory Sessions

 

SessionDate 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
Year
121234
* 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
Year
121234
*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
Year
121234
* 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

ObservedDirect supervision/ supervised practice
Year
121234

* 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 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
Year
121234

*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
Year
121234
*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
Year
121234

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
Year
121234
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
Year
121234

* 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
Year
121234
*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
Year
121234

*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
Year
121234
* 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

  1. 3 lead
  2. 4 lead
  3. 5 lead

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

Recognise rhythms on a 3 lead monitor

  1. Sinus rhythm
  2. Ventricular fibrillation
  3. Ventricular tachycardia
  4. Systole
  5. 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

  1. pallor
  2. presence of sweating
  3. peripheral temperature
  4. 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
Year
121234

* 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
Year
121234
*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
Year
121234

*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
Year
121234

*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
Year
121234

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
Year
121234

*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
Year
121234
*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
Year
121234

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
121234
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
Year
121234

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
Year
121234
*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
Year
121234
*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
Year
121234
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
Year
121234

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
Year
121234

*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
Year
121234
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
Year
121234

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
Year
121234

*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
Year
121234

*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
Year
121234
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
Year
121234
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
Year
121234