clinical skills development booklet - university of bolton · to develop the student nurses ability...

Version 1.2 Mar16 JH/TH 1

Clinical Skills Development Booklet

Pre-Registration BSc (HONS) Adult Nursing

Programme

Name:

Trust:

Personal Tutor:

Clinical Tutor:


Please place in a file as you will need to take this skills log onto your clinical

placements

Please ensure to practice these skills under supervision (or simulation where

applicable).

Always read and adhere to local Trust polices at all times.

Above all enjoy your clinical skills development and work closely with your

mentors and clinical tutors


Clinical skills Log

This skills listed below are divided into three sections, one for each of the years on the

course. You will be required to demonstrate achievement of the skills listed for each year by

the end of that year. In exceptional circumstances some skills may be carried over into the

following year. All skills must be undertaken in keeping with local and national guidelines so

you will need to familiarise yourself with these prior to undertaking each skills. Skills will be

developed using a three-stage approach (Based on the Miller Pyramid), the descriptions

below offer guidance on when each of the stages should be signed.

Theorised Practice

This stage will be signed when the learner has demonstrated a clear understanding of the

knowledge underpinning the practice of the skills. This includes (where applicable) the

underpinning anatomy and physiology, best practice guidelines, local/national policy, potential

risks/complications, overriding purpose/goal and scope of professional practice. No skills

should be undertaken (even within a practice scenario) without first achieving this stage.


Supervised Practice

This stage should be signed when you are able to demonstrate consistent successful

implementation of the skill with direct supervision and prompting. This stage may be

achieved in clinical practice and/or simulation dependent upon the particular skill in

question. You will need to follow the guidance of a suitably qualified practitioner.

Competent Practice

This stage is signed when you are able to consistently demonstrate the undertaking of the

skill without requiring guidance or prompts. The length of time it takes you to get to this

stage will vary considerably between different skills and the opportunities you get to practice

them. Achieving this stage indicates that you are ready to practice that particular skill

without direct supervision. During your training however you will not be able to undertake all

of these skills without direct supervision. For some of these skills you will need to wait until

you have graduated and gained your registration. These skills are highlighted within the

skills log.


Core skills Framework

By adopting a shared approach to learning it is envisaged that mandatory training will be

standardised, reviewed and developed to ensure agreed standards and quality throughout

training within the Higher Educational Institutions and the Trusts. Core skills taught sessions

have been integrated into year 1 semester 1 and 2 timetables.

Once you have attended the taught session and you have reviewed the learning materials on

the Core Skills Framework site, you need to complete the accompanying test. The test will

need to be completed before you go on your second clinical placement. Please print your

completed test paper as evidence and record the date you completed the test in the table

below. Your completed test paper should be kept in your portfolio.

Core skill

Taught session Date test completed

Fire Safety

Trust Induction and e-learning

Moving and Handling

Clinical skills, Trust induction and e-learning

NHS Conflict resolution

Clinical skills, Trust Induction and e-learning

Equality diversity and human rights

University session and e-learning

Resuscitation – adult basic life support


Resuscitation – child basic life support


Health and Safety

Trust induction and e-learning

Infection prevention and control

Trust Induction, Clinical tutor, University and e-learning

Safeguarding children


Safeguarding vulnerable adults


Information governance

Trust induction and e- learning


Moving and Handling year 1 Copy to be kept in portfolio

MANUAL HANDLING

Aim: To enable the student nurse to perform

safe manual handling under supervision PRACTICED Tick when completed

INSTRUCTED Tick when completed

Outcomes:

Principles of moving a load

Principles of carrying

a. baby

b. child

c. Object

Palm to palm support standing

Managing falls

M & H unconscious and paralysed patients

Assisting patients on and off beds and chairs

Use of equipment

a. slide sheet

b. Pat slide

c. Hoist

d. Transfer board

e. Handling blocks

Date of skill session attendance

Is exposed to the skill and is able to observe

in practice

Taught under supervision

Performs under supervision

Signature of Registrant Signature of Registrant Signature of Registrant Signature of Registrant


Basic Life Support (BLS) Year 1 Copy to be kept in portfolio

INFANT, CHILD AND ADULT BASIC LIFE SUPPORT- CARDIO PULMONARY RESUSCITATION

Aim: To enable the student nurse to deliver effective basic life support

Outcomes:

Discuss importance of competency in basic life support

Demonstrate assessment of airway, breathing and circulation

Discuss/demonstrate effective ventilation technique

Discuss/demonstrate effective cardiac massage

Recall cardiac arrest procedure for the clinical environment.

PRACTICED Tick when completed

INSTRUCTED Tick when completed

Date of skills session

Is exposed to the skill and is able to observe

in practice

Taught under

supervision

Performs under

supervision

Signature of Skills Lecturer Signature of Registrant Signature of Registrant Signature of Registrant


1st Year Clinical Skills

Hand washing

Aim: to develop in the student nurse a knowledge base underpinning the practice of hand -washing and the ability to carry out a taught hand - washing technique.

Outcomes:

Define hand – washing

Identify what contaminates and patients most susceptible to infection

Identify solutions used for hand washing

Demonstrate effective hand – washing techniques in practice

Discuss reasons for non – compliance

Discuss the trust infection control policy

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed Signed Signed

Print Print Print

Measurement of Blood pressure Aim: To introduce the student nurse to the skill of physical observation and assessment.

To develop the student nurses ability to assess blood pressure.

Outcomes:

Recall anatomy and physiology of the cardiovascular system.

Define blood pressure.

Discuss rationale/indications for recording blood pressure.

Identify equipment: Manual and electronic

Prepare the patient for the intervention.

Demonstrate palpation of both radial and brachial pulses.

Collect and prepare equipment.

Assess measure and record blood

pressure both manually and

electronically.

Demonstrate knowledge of factors

affecting blood pressure variations

Theorised

Practice

Supervised

Practice

Competent

Practice


Standard Infection Control Precautions / Aseptic Non-Touch Technique Aim: To enable the student nurse to adopt and practice safe aseptic technique and

prevention of cross infection.

Outcomes:

Define asepsis

Discuss methods of preventing infection

Identify patients most vulnerable

Discuss safe principles that underpin practice i.e. hand-washing, dressing, trolley cleaning

Demonstrate ability to put on a pair of sterile surgical gloves

Demonstrate check and safe opening of sterile instrument packages/additional equipment

Participate in an aseptic technique for wound cleansing/dressing change

Carry out aseptic technique (under supervision)

Discuss how patient was prepared for the procedure physically and psychologically

Identify individual Trust/Clinical area policy and procedure

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed Signed

Print

Print Print

Measurement of Oxygen Saturation

Aim To introduce the student nurse to the skill of measurement and assessment and oxygen

saturation. To develop the student nurses ability to assess and record oxygen saturation

Outcomes:

Recall anatomy and physiology of the respiratory system.

Define what the measurement of oxygen saturation is.

Discuss rationale/indications for recording oxygen saturation.

Discuss what else is noted when observing and recording oxygen saturation

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed Signed

Print

Print Print


Measurement of Heart Rate

Aim: To introduce the student nurse to the skill of physical observation and assessment.

To develop the student nurses ability to assess pulse rate.

Outcomes:

Recall anatomy and physiology of the cardio-vascular system, in particular the heart.

Define what a pulse is.

Locate the major pulse points of the body.

Discuss what else is noted when palpating & recording pulse besides rate.


Locate, assess and record the radial pulse, the carotid pulse.

Discuss factors affecting variations in pulse rate

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed

Signed

Print

Print

Print

Measurement of Respiratory Rate


To develop the student nurses ability to assess respiration rate.

Outcomes:

Recall anatomy and physiology of the respiratory system.

Define what respiration is.

Discuss rationale/indications for recording respiration.

Discuss what else is noted when observing and recording respiration e.g. depth, rhythm and effort.

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed Signed

Print

Print Print


Measurement of Temperature


To develop the student nurses ability to assess and record temperature.

Outcomes:

Recall anatomy and physiology of the skin in relation to body temperature control.

Identify methods of recording temperature.

Discuss rationale for methods identified.


Identify and prepare equipment.

Measure and record body temperature at the axilla, in the oral cavity or tympanic membrane

Demonstrate knowledge of variations of the norm

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed Signed

Print

Print Print

Choking Aim: To enable the student nurse to deliver safe and effective first aid to a person who is choking by removing the obstruction and restoring normal breathing.

Outcomes:

Define choking

Recall physical signs and symptoms

Demonstrate first aid technique to remove an obstruction in an unconscious Adult/Child NB: Unconscious patient:

Ensure clear airway Keep checking response Think about other injuries

Identify physical symptoms of shocks and demonstrate appropriate first aid

Know about the importance of Tetanus Toxoid vaccination.

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed Signed

Print

Print Print


Pain Management Aim. To introduce the student the importance and management of pain

Outcomes

To discuss the different types and signs of pain

To discuss the factors that affect pain

Explain the assessment tools and select the appropriate assessment tool

Be able to use a pain assessment tool.

To safely and accurately record assessment of the patients pain

Demonstrate referral to clinical team reporting the patients pain

Understand the action of analgesia and side effects

Understand the need to repeat the pain assessment score post analgesia

Discuss non-pharmacological methods of reducing pain and promoting comfort.

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed Signed

Print

Print Print

Eating and Drinking

Aim: To develop a knowledge base relation to the nutritional requirement of the “client” across the

lifespan. To introduce the student nurse to the principles of undertaking a nutritional assessment and the identification of, and participation in appropriate nursing interventions.

Outcomes:

Describe basic anatomy and physiology of the gastro-intestinal tract

Identify factors influencing a clients nutritional intake

Assess potential nutritional requirements of the client using a nutritional assessment tool

Plan nutritional interventions

Demonstrate appropriate nutritional intervention i.e. assisting a dependent patient.

Promotes dignity at all times

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed Signed

Print

Print Print


Assisting with Nutritional Intake Aim To enable the student nurse to assist patients with nutritional record safely and effectively

Outcomes:

Explain / discuss the importance of monitoring and record fluid and nutrition intake

Identify methods of recording fluid and nutritional intake.

Discuss rationale for methods identified.

Monitor and record fluid and nutritional intake safely and effectively and report and concerns.

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed Signed

Print

Print Print

Personal Care – Bed making Aim: To enable the student nurse to make/change an occupied / unoccupied bed without increasing

risk of infection whilst enhancing the patient’s comfort.

Outcomes:

Assess the need for linen change and choice of appropriate method (occupied or unoccupied)

Prepares the patient physically & psychologically obtaining consent

Prepares linen and equipment

Demonstrates a metered corner

Demonstrates pillowcase change

Make/change a bed

Change bed linen while the patient is in bed

Discuss reasons/benefits of bed making in relation to patient care

Disposes of linen in accordance with the Trust policy (for laundering)

Disposes of clinical waste as per Trust policy

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed

Signed

Print

Print

Print


Personal Care - Bed bathing Aim: To enable the student nurse to assist a bedfast patient to maintain personal hygiene

Outcomes:

Assess patients need for bathing and other personal hygiene activities.

Assess patients ability to contribute to own care

Assess patient safety

Recognise physical and psychological barriers for this nursing practice and prepare the patient appropriately.

Obtain patient consent

Identify and prepare equipment

Demonstrate a bed bath

Identify positive outcomes for the practice of bed bathing

Disposes of clinical waste in line with Trust policy

Disposes of bed linen in line with Trust policy (for laundering)

Demonstrates dignity and respect at all times

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed

Signed

Print Print Print

Personal Care - Oral Hygiene Aim: To enable the student nurse to perform oral hygiene according to the individual needs of the

patient

Outcomes:

Recall anatomy and physiology of the mouth cavity – including the tongue and teeth (or dentures).

Identify the need for this nursing

Intervention or assisting the patient

with this intervention

Prepare the patient and obtain consent

Able to discuss evidence based policy for mouth care and the equipment or products required

Able to discuss assessment for oral care and what underpins regularity of assessment and the performing of oral care

Identify, collect and prepare equipment

Demonstrate safe and effective oral hygiene technique.

Able to use educational strategies with the patient if appropriate

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed Signed

Print

Print Print


Personal Care- Eye Care

Aim: To enable the student nurse to perform eye care (swabbing / irrigation)

Outcomes:

Identify the need for this intervention

Prepare equipment

Prepare the patient (or carer) for the procedure and obtain consent

Demonstrate effective eye care

Adhere to infection control procedures

Adhere to individual Trust Policy

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed Signed Signed

Print Print Print

Continence Care

Aim: The student nurse will be able to assist and support the patient with the process of elimination

Outcomes:

Discuss the process of elimination

Define continence

Explain the conditions necessary for elimination to occur

Discuss nursing care of a patient suffering with altered bladder/bowel function

Demonstrate provision of facilities necessary for elimination

Discusses the use of a variety of continence products and their use

Promotes dignity and compassion at all times during continence care

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed Signed

Print

Print Print


Urinary Catheterisation and catheter Care Aim: To facilitate safe practice in the skill of urinary catheterisation and care of the indwelling catheter

Outcomes:

Discuss rationale for urinary catheterisation related to the patient’s condition

Prepare equipment and discuss rationale for catheter choice

Prepare patient physically and psychologically for the procedure obtaining consent

Observe the steps of the procedure for urinary catheterisation (female)

Undertake catheterization under supervision according to Trust Policy and ANTT principles

Discuss choice of drainage systems

Discuss associated risks and nursing care which will prevent/reduce these risks

Discuss patient education in relation to this intervention

Demonstrates accurate record keeping and documentation

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed Signed

Print

Print Print

**Please note – some Trusts have a policy that this skill must not be practiced by

student nurses until the 2nd year of the programme. Please discuss this with your

clinical tutor**


Urinalysis

Aim To enable the students to develop safe and effective skill in urinalysis

Outcomes:

Able to discuss the need for urinalysis

Able to discuss the principles of collecting an MSU, CSU and 24 hour collection of urine

Understand the principles of infection control for the safety of the patient and staff

Able to check patient identity, prepare the patient and obtain consent

Able to prepare the equipment in accordance with local Trust policy

Performs relevant checks of urinalysis strips prior to urinalysis

Undertake urine specimen whilst maintaining privacy and dignity / cultural attitudes at all times

Prevent cross infection during specimen collection during procedure

Undertake urinalysis, interpret results, document, act upon and communicate results to clinical team

Dispose of the urine specimen and clinical waste appropriately.

Identify clear rationale for repeat urine testing

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed Signed

Print

Print Print


Oxygen Therapy

Aim: To enable the student nurse to participate in the care of a patient requiring/receiving oxygen

therapy.

Outcomes:

Review/describe the respiratory system

Identify reasons why patients require oxygen therapy

Discuss methods of assessing respiratory function

Demonstrate/discuss preparation of a patient to receive oxygen therapy physically and psychologically

Identify equipment

Discuss rationale for low, medium and high flow rates

Administer (under supervision) prescribed oxygen to a patient

Identify methods to maintain patient comfort

Identify hazards

Assist with accurate documentation

Understand the need for oxygen to be prescribed and administered by a qualified healthcare professional

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed

Signed

Print Print Print

Injection Technique Aim: To enable the student nurse to develop safe and effective skills in the delivery of intramuscular

(IM) and subcutaneous (SC) injections

Outcomes:

Discuss patient preparation for the procedure physically and psychologically

Identify safe anatomical sites for IM and SC infections and explain rationales for use

Discuss methods of skin preparation (to cleanse or not)

Identify equipment needed

Draw up medication as prescribed (under supervision)

Demonstrate safe injection technique Always under direct supervision

Demonstrate safe sharps disposal

Discuss policy/procedure should needle stick injury occur

Demonstrate accurate record/documentation of drug given

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed Signed

Print

Print Print


Use of Automated External Defibrillator (AED)

Aim: To enable the student nurse to understand the implications, use and safety of AED use

This can be completed in simulated scenarios or observed within clinical placements

Outcomes:

Discusses the need for defibrillation and recognition of basic ‘shock able’ arrhythmias

Demonstrates attaching electrodes in acceptable positions

Allows rhythm analysis without touching the or AED

Demonstrates rapid and safe delivery of a single shock (including visual check and verbal instruction to stand clear)

Resumes CPR immediately, as guided by the voice prompts, starting with chest compressions

Minimises interruptions in chest compressions

If observed in clinical practice to discuss with mentor and undertake critical reflection and debrief

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed Signed

Print

Print Print

Bleeding and Shock Aim: To introduce student nurses to the principles of first aid. To provide information / facilitate learning which will allow students to act appropriately giving immediate assistance to someone bleeding and or / shocked before the arrival of an ambulance, doctor or appropriately qualified person. (Remember safe approach and A - E)

Outcomes:

Recall the blood clotting process

Recognise types of wounds and identify

Recognise/identify types of bleeding

Define external bleeding and demonstrate appropriate first aid, pressure dressing, bandaging, and elevation.

Define internal bleeding and identify signs and symptoms

Identify physical symptoms of shock and demonstrate appropriate first aid

Know about the importance of Tetanus Toxoid vaccination.

Discuss rapid escalation

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed Signed

Print

Print Print


Empathy and rapport Aim: To enable the student nurse to demonstrate the ability to listen with empathy

Outcomes:

Demonstrates safe, effective, compassionate and respectful communication skills

Acts in a manner than is attentive, kind, sensitive, compassionate and non-discriminatory, that values diversity and acts within professional boundaries.

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed Signed

Print

Print Print


Second Year Clinical Skills


Moving and handling year 2 in addition to year 1 skills

Copy to be kelp in portfolio

MANUAL HANDLING

Aim: To enable the student nurse to perform safe manual handling under supervision

Outcomes:

Instructed Tick when completed

Practiced Tick when completed

STYLE (Assessment of Load)

Principles of Moving and Handling

Standing and walking person from chair (palm to palm)

Turning using Slide Sheet in bed

Transfer using PAT slide trolley to bed

Transfer using hoist bed to chair

Solving Problems from Practice/ Who to contact -discussion

Students signing here agree that: Student Signature: Print Name:

a. Instruction and practice has been undertaken

as indicated

b. They will re-read the University Moving and Handling booklet on the Clinical Skills are of Blackboard


Is exposed to the skill and is able to observe in

practice



Signature of Registrant Signature of Registrant Signature of Registrant Signature of Registrant


Moving and Handling skills year 2

In addition to year 1 competencies

Copy to be kept in portfolio

INFANT, CHILD AND ADULT BASIC LIFE SUPPORT CARDIO PULMONARY RESUSCITATION


Outcomes:

Reflect on experience in practice

Discuss the role of the cardiac arrest team

Identify and demonstrate common items of equipment used:-

Oral Airways Face masks Ambu bags Et tubes Mini-jets for drug administration Defibrillator

Demonstrate effective BLS procedure





practice



Signature of Registrant Signature of Registrant Signature of Registrant


Blood Glucose Monitoring Aim: To enable the student to develop safe and effective skills in taking and monitoring blood

glucose

Outcomes:

Be able to discuss the reason for the patient needing blood glucose monitoring.

Be able to discuss the limitations of using a blood glucose meter.

Be able to discuss the rationale for calibrating the meter, ensuring test strips are in date, performing internal Quality Control

Discusses the correct method to obtain blood sample.

Discusses the significance of test results and how to interpret.

Demonstrates the correct operation the meter (Trust equipment only)

Abe to check the patients identity and obtain consent

Offer reassurance to the patient

Discusses and demonstrates the correct procedure for skin preparation.

Discusses and demonstrates the correct method to obtain blood sample.

Practices in accordance with Trust Infection Control Policy and Sharps Disposal and Management Policy to avoid needle stick injury.

Practices in accordance with Trust Infection Prevention and Control Policy and Hand Hygiene Procedure and Standard Precautions Procedure to avoid contamination and cross infection.

Documents all care given in accordance with Trust policy & procedures.

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed Signed

Print

Print Print


Care of Patients in Isolation

Aim: To enable the student nurse to care for patients in isolation

Outcomes

Discuss the reason why patients need to be cared for in isolation

Discuss methods of preventing infection

Identify patients most vulnerable and would need to be cared for in isolation

Discuss safe principles that underpin practice this care

Discuss how patient was prepared for the care both physically and psychologically

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed Signed

Print

Print Print

Intravenous Therapy

Aim: To enable the student nurse to assist in the introduction of intravenous therapy, and to care

for a patient who is receiving intravenous fluid replacement therapy

Outcomes:

Discuss rationale for an intravenous infusion and relate this to the patient’s condition

Identify intravenous routes for peripheral intravenous therapy

Assist with accurate calculation of infusion rates for standard and blood infusion sets

Identify equipment necessary

Discuss the different fluids used in IV therapy

Prime infusion set and interpret fluid prescription sheet (under supervision)

Discuss practitioner responsibility in care of a cannula site

Demonstrates accurate record keeping

Demonstrates accurate fluid balance documentation

Understands the risk factors associated with IV therapy

Discuss/demonstrate care of a patient receiving fluid replacement therapy

Discuss methods which enable the nurse to maintain the intravenous infusion as prescribed and document accordingly.

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed

Signed

Print

Print

Print

**Please note – Student nurses must NOT attach infusion devices or commence/

replace any IV fluids with direct supervision**


Intravenous Therapy – Blood Transfusion Therapy

Aim: To enable the student nurse to observe, monitor and recognise adverse reactions to blood transfusion therapy in patients PLEASE REFER TO TRUST POLICY FOR STUDENT NURSES

Outcomes:

Identify the procedure for checking and administrating blood products utilising local trust guidelines (obtaining products from lab or blood fridge) N.B student are not competent to obtain blood products alone

Utilise correct checking procedure for patients receiving blood products prior to administration

Obtains patient consent

Observes qualified clinical staff administering blood products in line with local Trust and National policy

Discuss adverse reactions which may occur

Demonstrate knowledge of effective response to adverse patient reactions

Discuss necessity of 15 minute recording of vital signs

Demonstrates accurate documentation


Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed

Signed

Print

Print

Print


Percutaneous Feeding Aim To provide the student nurse with knowledge and skill to undertake the care of Percutaneous tubes and assist with feeding (under supervision)

Outcomes:

Able to link anatomy knowledge to practice

Able to discuss the need for percutaneous feeding

Able to discuss the impact upon a patients psychological state

Able to define gastrostomy, jejunostomy and percutaneous endoscopic gastrostomy

Able to discuss the need for monitoring the percutaneous site for signs of infection (including patient reported pain)

Discusses the need to observe stoma site for signs of swelling, leakage, redness, irritation, skin erosion or soreness.

Demonstrates the timely reporting to senior clinical staff

Demonstrates accurate documentation of site observation and actions taken

Able to swab the site and send sample for culture and sensitivity if infection is suspected, liaising with senior clinical staff

Adheres to local Trust infection control policy when managing and caring for the patient

Able to assist with nutritional input via percutaneous tube as prescribed by dietician under supervision of a qualified practitioner

Able to assist with the administration of prescribed medication under supervision of a qualified practitioner

Demonstrates accurate documentation of the above

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed Signed

Print

Print Print


Nasogastric Tube Insertion and Care

Aim: To familiarise the student nurse with the procedure and practice of nasogastric intubation.

Outcomes:

Review/Describe the gastrointestinal tract

Discuss indications for nasogastric intubation

Discuss the different NG tubes and their uses

Identify and prepare equipment required for the procedure

Demonstrate/discuss preparation of the patient physically and psychologically including consent for the procedure

Observe the procedure of passing a nasogastric tube and rationale for actions undertaken

Discuss the methods of checking the correct placement of the nasogastic tube

Discuss patient care and safety

Discuss indications for nasogastric feeding – relate to the patient’s condition

Identify and prepare equipment

Discuss associated complications with this intervention and nursing care which will help prevent/reduce these including the checking and documenting of tube placement at every shift

Discuss indications of tube displacement

Discuss actions required if tube displacement suspected

Discuss Trust policy and guidelines on techniques and procedures to ensure correct tube placement for patient safety

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed

Signed

Print

Print

Print

**Please refer to individual Trust Policy and discuss with Clinical tutors.

Many Trusts do not allow student nurses to pass nasogastic tubes

even under supervision**


Three & Twelve Lead ECG Measurement

Aim – To enable student to develop safe and effective skills in assisting in measuring and reading

three and twelve lead ECGs

Outcomes:

Able to describe the normal conduction pathway and associated events in the cardiac cycle.

Able to discuss the need for 3 or 12 lead ECG monitoring/procedure

Able to explain the need for ECG machine to be kept on charge, cleaned and checked in accordance with local Trust policy for infection control

Able to prepare and reassure the patient including obtaining consent

Demonstrate ability to position patients ensuring satisfactory recording.

Able to correctly place electrodes on the patient promoting dignity and comfort

Discuss Einthoven’s triangle

Able to discuss the factors associated with artifacts and how to troubleshoot these

Able to undertake a 12 lead ECG procedure under supervision

Demonstrates the safe disposal of clinical waste adhering to local Trust policy

Able to demonstrate the need for skin care and post procedural skin monitoring observing for any reactions to electrode adhesive products

Able to recognized normal sinus rhythm

Able to interpret 3 basic arrhythmias

Demonstrates immediate reporting to senior clinical staff if arrhythmias detected


Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed Signed

Print

Print Print


Neurological Observations Aim: To provide the student nurse with knowledge and skill to undertake neurological observations and to record and repeat them accurately

Outcomes:

Define what neurological observations are

Identify why they are carried out and who requires them

Identify equipment required to record neurological observations

Demonstrate the application of the Glasgow Coma Scale.

Demonstrate neurological observations under supervision

Document neurological observations accurately under the supervision of mentor

Discuss the implications of neurological observations

Discuss signs of neurological deterioration

Able to discuss escalation if deterioration suspected

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed

Signed

Print Print Print

Early Warning Scores (EWS) - (NEWS) National early warning score Aim – To enable student to develop skills to safely and effectively monitoring, record and report early warning scores

Outcomes:

To understand the importance of correctly using EWS and effective use of the monitoring and escalation plan

To demonstrate competence when using the Adult Observation Chart and Early Warning Scoring (EWS) tool as per Trust Policy and Guidelines

To discuss the outcome of the EWS for individual patients and possible actions to be taken in consultation with senior members of the clinical team

To achieve quality, safe and timely clinical care through proficient measurement, recording, and communicating of changes in observations and EWS score to senior members of the clinical team.

**Please note – the use of NEWS was advocated by the Royal College of physicians in May 2015. It is vital you adhere to your individual local Trust policy**

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed Signed

Print

Print Print


Unconscious Patients

Aim To provide the student nurse with knowledge and skill to care for the unconscious patient

Outcomes:

Define consciousness and have an understanding of the related anatomy and physiology.

Discuss the various levels of impaired consciousness.

List the causes of unconsciousness.

Able to assess the conscious level of patients documenting accurately

Able to identify and discuss the total needs of the unconscious patient

Prioritise patient care, recognising the skills required for the assessment, planning and implementation of nursing care.

Demonstrates timely referral to senior clinical staff when changes are detected

Able to offer support and reassurance to family/carers

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed Signed

Print

Print Print

Wound Drainage To provide the student nurse with knowledge and skill to undertake monitor and record wound drainage accurately

Outcomes:

Able to discuss the need for wound drains applying anatomy and physiology knowledge

Able to identify and discuss the various types wound drainage systems

Able to discuss the management of wound drainage systems reducing the risk of mechanical injury

Able to discuss the management of wound drainage systems adhering to local Trust infection control guidelines

Able to identify types of/measure wound drainage adhering to local Trust infection control guidelines

Able to accurately record wound drainage/puncture site and refer to senior clinical staff if detecting signs of infection and/or bleeding

Able to educate the patient on the care of wound drainage system

Monitor patient for pain and comfort

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed Signed

Print

Print Print


Suture/Clip Removal

To provide the student nurse with knowledge and skill to undertake suture and clip removal (under Supervision) accurately

Outcomes:

Able to describe the anatomy and physiology of the skin

Able to discuss the process of wound healing

Discusses the need for suture/clip removal and describes the procedure

Able to discuss signs of wound infection and action to be taken including obtaining a wound swab

Able to prepare equipment for procedure

Identifies patient, explains procedure and obtains consent.

Positions patient in a position so that sutures/staples/clip are accessible and without undue tension – ensuring privacy and dignity at all times

Assess wound edges prior and post.

Performs suture/clip removal under supervision according to local Trust policy using ANTT using correct technique whilst monitoring patient comfort

Understands when to stop procedure and consult senior clinical staff if drainage or dehiscence of wound detected .

Performs wound care as per protocol

Documents procedure and appearance of wound site accurately.

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed Signed

Print Print


MRSA Screening Aim To provide the student nurse with knowledge and skill to undertake MRSA Screening accurately

Outcomes:

Able to define MRSA and its management/treatment

Able to discuss the local Trust policy for MRSA screening

Able to assemble the equipment required for MRSA screening

Able to identify the patient and obtain consent offering reassurance

Able to perform MRSA screening using the correct swab procedure according to Trust policy ensuring dignity and respect at all times

Adheres to Trust policy for infection control and the use of universal precautions

Labels swabs and microbiology forms accurately ensuring samples are transported to the relevant department in a timely manner

Is able to access microbiology results discussing implications and management

Able to discuss microbiology results with patients and family/carers

Able to discuss care of the patient with MRSA and minimize hospital acquired infection across the clinical area

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed Signed

Print

Print Print


Specimen Collection (Non-Blood Based)

Aim To provide the student nurse with knowledge and skill to undertake specimen collections

accurately

Outcomes:

Able to define reasons for obtaining specimens.

Demonstrate understanding of basic anatomy and physiology relevant to the type of specimen collection

Discuss the procedures and techniques including specimen types, usual tests and possible adverse effects.

Prepare materials and equipment used within the Trust for collection of specimens.

Able to identify the patient, the specimen required and obtain consent from the patient

Discuss the need for the specimen with the patient

Obtains specimen in accordance with Trust guidelines respecting privacy and dignity

Demonstrates Infection Prevention and Control measures such as hand hygiene and use of Personal Protective Equipment (PPE) and safe disposal of equipment

Demonstrates effective labeling of specimen and timely transportation to relevant department.

Demonstrates accurate clinical record keeping and documentation including appropriate referral if required

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed Signed

Print

Print Print


Principles of Wound Care

To provide the student nurse with knowledge and principles of wound care

Outcomes:

Has been assessed as competent to perform aseptic non touch / clean dressing technique

Can identify the 4 main phases of wound healing

Can carry out full wound assessment

Can state the clinical appearance of:

Epithelializing tissue

Granulation tissue

Slough

Maceration

Necrotic tissue

Infected wound

Can rationalise the use of various types of dressing:

hydrofilm

hydrocolloid

hydrofibre

hydrogel

alginates

antimicrobial

Records assessment findings on wound care template as per Trust Policy

Records evidence of ongoing assessment.

Can advise patients about principles of good nutrition, hygiene, mobility and elevation of limbs where this has an impact upon wound care.

Can correctly state the method used in taking a wound swab and when this should be done.

Disposes of clinical waste in accordance with local infection control guidelines.

Can recognise the need for wound debridement and can identify when this should and shouldn’t be done.

Recognises own limitations with the management of wounds and refers for further assessment by wound care/tissue viability specialists promptly

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed Signed

Print

Print Print


Pressure Area Care Aim - To provide the student nurse with knowledge and skill to undertake Pressure area care

Outcomes:

Describes the structure of the skin and its function.

Recognises the structures involved in each stage of tissue breakdown

Discusses the need for regular positional changes, how these are performed and what underpins the regularity of positional changes

Performs a holistic assessment in relation to skin condition identifying areas at risk of pressure related damage.

At all times maintains the dignity and safety of the individual during the assessment.

Describes the factors that increase individuals risk of developing skin and tissue damage and undertakes the risk assessment in relation to pressure area care and the risk of skin breakdown

Describes the importance of a holistic risk assessment.

Performs risk assessment appropriate to the individuals risk and plans the care to minimise risk factors where appropriate with individuals and/or carers.

Identifies when a risk assessment should be performed.

Describe the categories of tissue pressure damage.

Performs reliable assessment of pressure areas with supervision.

Categorises tissue and skin damage in line with the local protocol with supervision

Reliably documents accurate findings of risk and skin assessments.

Reliably develops individual care/treatment plans to ensure consistency in care.

Performs rational reassessment of individual’s risk factors.

Refer individuals to specialist services for assistance if required.

CONT ………

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed Signed

Print

Print Print


Monitor and assess individuals after treatment, reviewing and evaluating care/treatment plans.

Undertake treatments and dressings related to the care of wounds.

Demonstrate an understanding of the equipment options available for reducing an individual’s risk of developing pressure damage.

Assists with the ordering and return of equipment for individual patients

Fit appropriate equipment to reduce skin damage (for example, pressure relieving devices).

Safely use the equipment available for reducing the risk of skin damage

Identifies the need to reassess the needs of the individual in relation to equipment provision.

Demonstrates an understanding of the importance of accurate nursing records and their impact on nursing care

Can access resources to support decision making in relation to maintaining skin health and reducing risk of pressure damage.

Has the ability to access National and local guidelines, protocols and research articles in relation to maintaining skin health and reducing risk of pressure damage.

Identifies personal and professional responsibilities in the evaluation of the care prescribed.

Ensures professional competence in relation to the prevention of skin damage.

Monitors level of stock to ensure accessibility of equipment


Pre-Operative Care & Preparation Aim To provide the student nurse with knowledge and skill to undertake Pre-operative care &

preparation (under supervision) accurately

Objectives:

Discuss the objectives of pre-operative assessment

Define when and where pre-operative assessment should take place and who performs the assessment

Discuss the principles of pre-operative care

Able to demonstrate an insight into the psychological care of the patient offering information and reassurance

Able to discuss the need for informed consent whilst observing this in practice

Able to discuss and assist with the physical preparation of the patient pre-operatively

Able to identify potential risks and hazards pre-operatively and how these are managed/avoided

Able to assist in accurate pre-operative checks in accordance with local Trust policy

Able to accurately document pre-operative checks including pre-operative patient pathway according to Trust policy (under supervision)

Escorts the patient to theatre (with supervision) and observes/assists with patient handover with the delivery of accurate information, using checklists according to policy

Demonstrates the caring and support of family/carers throughout the procedure if applicable

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed Signed

Print

Print Print


Post-Operative Care Aim To provide the student nurse with knowledge and skill to undertake Post -operative care &

preparation (under supervision) accurately

Outcomes:

Discuss the principles of post operative care

Discusses and participates in post operative monitoring

Able to discuss post operative observations with mentor, including implications

Accurately records post operative physiological observations

Able to discuss and participate in total post operative care in accordance with relevant pathway and Trust protocol under supervision

Able to undertake accurate pain assessment and non pharmacological management (under supervision)

Discuss pain assessment score with clinical team member and assist with analgesia administration according to local Trust policy

Able to describe the analgesic ladder and classes of analgesia

Able to discuss post operative complications and management, including the importance of immediate referral to clinical team members

Offers patient reassurance and promotes comfort at all times

Theorised

Practice

Supervised

Practice

Competent Practice

Signed

Signed Signed

Print

Print Print


Care of the deceased Aim: To enable the student nurse to participate/undertake the procedure of Last Offices for the

deceased patient, as appropriate.

Outcomes:

Discuss own attitudes to death and dying across the lifespan

Discuss the clinical situations in which you have encountered death

Identify physiological changes which can occur at death

Discuss how and who certifies a patients death

Respect religion and cultural difference

Identify needs of family/carers and the supportive measures which can be offered to them.

With support from mentor can assist with the support of families/carers

Be familiar with last offices policy/procedure

Identify/prepare equipment needed

Participate in the last office procedure (with the support of mentor)

Able to discuss what happens once the patient has been transferred to the mortuary

Able to discuss when and why a post mortem maybe required

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed

Signed

Print Print Print


3rd Year Clinical Skills

Manual Handling (Update) Year 3 (in addition to year 1 and 2 competencies) Copy to be kept in Portfolio

MANUAL HANDLING

Aim: To enable the student nurse to perform safe manual handling under supervision in year 3 Outcomes:



Mentor/registrant/ clinical tutor signature

Mentor/registrant/ clinical tutor signature

STYLE (Assessment of Load)

Principles of Moving and Handling

Standing and walking person from chair (palm to palm)

Turning using Slide Sheet in bed Print name Print name

Transfer using PAT slide trolley to bed

Transfer using hoist bed to chair

Solving Problems from Practice/ Who to contact –discussion

Students signing here agree that: Student Signature: Print Name:

a. Instruction and practice has been undertaken as indicated

b. They will re-read the Trust Moving and Handling policy



practice

Signature of Registrant






Year 3 Basic life support in addition to years 1 and 2 competencies

INFANT, CHILD AND ADULT BASIC LIFE SUPPORT CARDIO PULMONARY RESUSCITATION


Outcomes:

Demonstrate effective BLS procedure

Discuss cardiac arrest in special circumstances

Poisoning

Drowning

Electrocution

Pregnancy

Explore ventilation of a patient with a tracheostomy

Be familiar with drugs used




Is exposed to the skill and is able to observe in practice



Signature of Registrant Signature of Registrant Signature of Registrant


Venepuncture

Aim: To demonstrate the knowledge and techniques needed for safe venepuncture.

**Whilst you may undertake venepuncture as a skill in the clinical simulation area this is NOT a skill you will be performing as a student nurse. You should, however be able to prepare the

patient, the equipment and assist with the location of viable veins for venepuncture. Please refer to individual Trust Polices**

Outcomes:

Describe relevant anatomy and physiology of the peripheral venous system.

Demonstrate familiarity of the equipment to meet the goals of venepuncture and blood sample collection.

Prepare the equipment required for the procedure, including the labeling of bottles and forms

Identify the patient, obtain consent and prepare the patient psychologically for the procedure.

Identify the peripheral veins suitable for venepuncture.

Perform venepuncture (clinical simulation only) in line with local Trust policy.

Demonstrate and describe infection prevention measures.

Dispose of clinical waste and sharps safely

Identify measures to minimize and address difficulties encountered during venepuncture.

List complications associated with venepuncture, their prevention, management strategies

Identify the action required in the event of a needle stick injury or blood and blood fluid exposure.

Completes accurate documentation following the procedure

Gives psychological to the patient checking puncture site regularly, particularly if the patient is prescribed anticoagulants

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed Signed

Print

Print Print


Cannulation: Be able to assist with the preparation of the patient for a cannulation procedure and

demonstrate the safe assessment, monitoring and documentation of venous cannulas

**Whilst you may undertake cannulation as a skill in the clinical simulation area this is NOT a skill you will be performing as a student nurse. You should, however be able to prepare the patient, the

equipment and assist with the location of viable veins for cannulation. Please refer to individual Trust Polices**

Outcome:

KNOWLEDGE

Identify local policies and national guidelines regarding peripheral venous cannulation

Describe the anatomy and physiology of the venous and arterial circulatory systems.

Differentiate between a vein and an artery

Identify the physiological need for performing the procedure

Identify and describe the following potential hazards relating to peripheral venous cannulation:

o Air embolism o Infection o Haematoma o Extravasation o Infiltration o Phlebitis o Faulty equipment o Incorrect cannula fixation

PROCEDURE

Understands the importance of:

Checking the name of the patient against the patient’s wristband.

Confirming the name of the patient verbally.

If verbal identification of identity is not possible, checking the patient’s identity with a second practitioner.

Assessing the individual needs of the patient.

Preparing and demonstrating the correct and appropriate use of equipment.

Identifying a suitable vein and positioning the patient appropriately. CONT ……

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed Signed

Print

Print Print


Where appropriate, the preparation and use of local anaesthesia as prescribed.

Insert a peripheral cannula correctly (simulation only) using ANTT

Flush the cannula with 0.9% saline using at least a 10ml syringe (simulation only)

Fixate the cannula using the appropriate dressing

Safely dispose of all equipment according to Trust policies.

Identify the action required in the event of a needle stick injury or blood and blood fluid exposure.

Document the procedure correctly MONITORING – PATIENT SAFETY

Understands the importance of monitoring the cannulation site and documenting any signs of:

Pain

Infection

Haematoma

Extravasation

Infiltration

Phlebitis According to local Trust policy

Immediately refers any of the above to mentor or other qualified member of the clinical team

REMOVAL OF PERIPHERAL CANNULA

Checks the identity of the patient

Accurate checking that cannula/correct site of cannula for removal

Obtains consent from the patient

Discusses and demonstrates infection control

Removes the cannula under supervision according to local Trust policy

Applies pressure to the cannula site with sterile gauze for 2- 3 minutes (or until the bleeding has stopped)

Covers the puncture site with sterile dressing

Safe disposal of clinical waste and plastic cannula

Discusses management if signs of infection are seen including the swabbing of the site/cannula tip to microbiology for C & S


Oral Suctioning: For the student nurse to perform this skill safely and competently

PLEASE REFER TO TRUST POLICY

Outcome:

Can explain the basic anatomy of the upper airway and buccal area

Understands the indications for oral cavity suctioning

Can identify general reasons for oral suctioning

Shows a clear understanding of contra- indications and complications in oral suctioning

Can explain all parts of the oral suctioning equipment and demonstrates correct set up procedure

Gains consent and explains procedure

Positions patient in comfortable and effective position

Uses correct PPE and infection control technique

Demonstrates safe oral suctioning technique under the supervision of qualified healthcare professional

Theorised

Practice

Supervised

Practice

Competent

Practice

Signed

Signed Signed

Print

Print Print