Download Hints and Tips for achieving Practice Learning

Hints and Tips for achieving Practice Learning Outcomes in Mental Health Nursing
Practice 3 92551 (Semester 2, year 1)
In the CAP Document for all years undertaking the BSc(Hons)Nursing programme the
Practice Learning Outcomes [PLOs] are skills based and match the Essential Skills
Clusters that the Nursing and Midwifery Council [NMC] state must be achieved at the
different progression points in programmes they validate. The NMC have identified that
ALL nurses need to achieve these as they progress, whatever their field of practice.
As you are aware this represents a change in culture for our students and mentors and
at first glance it is difficult to see how they can be achieved in many mental health
practice settings, particularly those in the community. To try to help students and
mentors understand how these may be interpreted in various practice environments I
have made some suggestions below. Some of this is based on recent discussions with
students and mentors. This is a new challenge and we hope to add to this resource in
future. All questions, suggestions and feedback is therefore most welcome, please don’t
hesitate to get in touch.
Neil Burton; Lecturer, Module Leader Mental Health Practice 3 Module 92551
[email protected] 01482 464679
Hints and Tips for interpretation of specific PLO activities
Page numbers refer to the CAP Document : a pdf of this is available to everyone from the
following URL (cut and paste it into your browser)
http://www2.hull.ac.uk/fhsc/placementlearningunit/moduledocuments/mentalhealthf
ielddocuments.aspx
If you are looking for a specific PLO activity number (e.g. 1.5), type this number into the
‘find’ field in the ‘edit’ menu above.
Level of performance
Please remember at this level to achieve the outcomes the student is required to observe
others undertaking the activity, accurately describe it and/or act as a helper
demonstrating acceptable performance under direct supervision as a knowledgeable
observer (page 10). This competency level (4) allows some flexibility in the way it is
written as there are two possible levels of performance. This suggests students should
ideally practice the skill under supervision but if the opportunity to do this is not
available there is the scope to ‘accurately describe it’.
Please note: There is nothing here to prevent the activity being simulated if necessary
and/or described. Many clinical skills can be observed using the resources available to
students via the University VLE eBridge. For example using ClinicalSkillsNet or, for
intramuscular injection practice the videos and elearning package via
http://www.reach4resource.co.uk . It is also very appropriate for students at this level
to explore the resources and policy documents available in the Trust to support safe
practice (e.g. for infection control). Many Trusts now have access to equipment to
simulate clinical skills and these can be borrowed by teams and mentors (e.g. a injection
site model). The student can be asked to talk through a procedure or asked questions
about what they would do in a certain practice situation or scenario.
1.5 Demonstrate an ability to engage effectively with a range of people and build
caring professional (p65)
This PLO provides a list of the full range of people the student has engaged where all
types must be achieved by the end of Year 1. This does not mean individually on
separate occasions. For example maybe the student will visit a patient at home where
there are children and/or young people in the family they interact with. A person with a
diagnosis of schizophrenia has a long-term condition. There may need to be some
thought given to how the student can achieve the PLO in relation to ‘Pregnant and/or
Postnatal Women’. This may require facilitation of a visit to an antenatal clinic but could
involve a visit to the perinatal mental health service. It would be better if some students
achieved this in semester 2 to avoid clinics becoming overwhelmed with requests in
Semester 3. Please liaise with the PLF if you are not sure how to go about this.
3.3 Adjust ways of communicating where a person's hearing, vision or speech is
compromised. (page 67)
Think creatively about this one. A person senses may be compromised because they are
experiencing hallucinations that are distracting or because they have difficulty attending
to stimuli.
9.2 Respond appropriately when faced with an emergency or sudden
deterioration in a person's physical or psychological condition (e.g. abnormal
vital signs, collapse, cardiac arrest, self-harm, extremely challenging behaviour,
attempted suicide) (Page 73)
The key phrase here is ‘sudden deterioration’. The examples given are just examples,
any sudden deterioration in a persons physical or psychological condition is appropriate
as an example. If not witnessed during this placement, discussing and answering
question about how to respond to a given scenario described by the mentor and taken
from his/her previous practice would be appropriate.
9.3 Seek the assistance of appropriate others in such a situation (page 74)
See 9.2, the same applies.
10.1 Participate in aspects of care planned to keep people safe by:
These all need to be signed off but don’t have to be taken too literally and again
scenarios could be used.
Consider how you would minimise the risk of falls when administering an injection in a
patient’s home, when there is a risk of sedation from medication (or postural
hypotension), when agitation or insomnia impacts on function increasing the risk of
accidents.
How do you make sure pain is not the cause when assessing levels of anxiety and
agitation in any patient
Signs and symptoms of infection may be observed in all settings.
dysfunction
Constipation is a potential anticholinergic effect of many medications and GI
disturbances are also common from both prescribed medicines and substances of abuse,
The increased prevalence of bowel cancer in people with serious mental illness provides
a rational for asking questions about bowel function and exchanging information about
when to act, the impact of poor diet or fluid intake as a result of mood or delusions may
require intervention.
ers
Think about interpreting this one relating to skin integrity, personal hygiene, obesity,
sedation.
10.2 Accurately measures and records weight, height, temperature, pulse,
respirations and blood pressure using manual and electronic devices. (page 74)
Equipment should be available for this in all settings. If no patient is available or willing
to consent, practice on the staff. Staff themselves may have become deskilled through a
lack of opportunity to practice and welcome an update from the student. Students can
share the resources on ClinicalSkills.net via eBridge and the Trust training or clinical
development departments should be able to help.
10.3 Participate in maintaining a person's personal hygiene where they have
identified they are unable to carry this out for themselves (page 74)
This may involve supporting a patient to improve their self-care skills.
14.2 Engage in communication with a range of members of the team (page 78)
To achieve this you MUST include evidence recorded on the INTER PROFESSIONAL
LEARNING LOG on page 32.
18.3 Demonstrate safe manual handling techniques (page 82)
This does not just apply to people, maybe there is a box or item of furniture that has to
be moved.
25.1 Apply principles of asepsis to aspects of patient care where there is actual or
potential danger of infection being introduced
Consider how you would prepare an injection in dirty a home environment. Or advise a
carer how to store and prepare medication for self-administration by a child or older
person (e.g. liquids, inhaler, eye drops).
26.2 Ensure dignity is preserved when collecting and disposing of bodily fluids
and soiled linen (page 90)
This may require a scenario but consider how bodily fluid is present on used needles
and gloves when administering an injection and the patient may bleed post injection.
Any patient in any given service or situation may vomit, what would you do about it’s
disposal?
27.1 Assist people to maintain independence in choosing what they eat and drink
27.2 Report any information gained from discussion with the person or their
carers about food preferences/requirements/difficulties (both page 91)
These two activities are about the overarching PLO about meeting needs for an adequate
nutrition and diet. There are many issues to do with poor nutrition in all sorts of client
groups and situations in mental health services. For example where there is weight gain
and obesity, in eating disorders, where delusions or compulsions impact on diet and
fluid intake.
29.1 Participate in accurately monitoring and recording fluid intake and output
29.2 Identify indicators of dehydration and fluid overload (page 93)
These are similar to 27.1 and 2 above but are likely to require a scenario discussion and
questions . For example if a patient discloses to you they think the water in their flat is
being poisoned, what signs of dehydration would you look out for and what would you
advise the patient was a reasonable fluid intake a day and how many times a day would
you expect them to pass urine. How could you convert what they report to you as having
drunk into an assessment of an adequate fluid intake and output. At what point would
you become concerned about the safety of the patient and what would you do next?
31.1 Recognise and report when people have difficulty eating and/or swallowing;
31.2 Observe and seek out information on alternative methods of maintaining
adequate nutrition (page 95)
Think about situations where people’s dietary and fluid intake is restricted due to
substance or alcohol use, where it is impacted on by their behaviour, symptoms or mood
(e.g. in hypomania or mania, in depression, in an eating disorder, delusions) or where
medication, poverty, life skills and lifestyle leads to an inappropriate diet and weight
gain or loss.
32.1 Observe infusion sites for signs of inflammation/infection and report
findings;
32.2 Observe the process of administering intravenous fluids and describe their
specific role within that process (page 96)
NB: Please note; as a change to the previous document these outcomes are not allowed
to be taught and assessed in simulated practice in the clinical skills unit at the University
nor signed off by a member of the academic staff. (THE NMC SAYS IT MUST HAPPEN
OUT IN PRACTICE) we are negotiating with the trusts how this might best be addressed
but please make all efforts possible to address this if you can.
33.1 Demonstrate competency in
(page 97)
I suggest you devise some of these from the BNF using the information available in the
main CNS medicines sections as well as different product entries e.g. identifying how
many tablets of a certain dose and frequency will be dispensed from the pharmacy for 7
days, calculating a certain dose in millilitres where the concentration of a liquid is given
in the BNF, similarly calculating how much to draw up for an injection in millilitres
where the concentration is known, converting tablets to liquid or drops, demonstrating
how to use drug equivalence tables when switching IM medication or when calculating
the maximum dose of a prescribed oral medication plus prn of the same class. The BNF
can be accessed online at http://www.bnf.org using an Athens username and password.
37.1 Demonstrate knowledge of local and national policies governing ordering,
receiving, safe storage and disposal of medicines; 37.2 Demonstrate safe disposal
of medicines (page 101)
If medicine administration does not take place in the placement, talk through the
process and answer questions about the policy as this activity says ‘demonstrate
knowledge of’.
38.1 Use prescription charts correctly and maintain accurate records; 38.2 Utilise
and safely dispose of equipment needed to administer medicines e.g. needles,
syringes, gloves; 38.3 Demonstrate competency in medicines administration
Injections
38.4 Reports any adverse reactions to medicines administered (all Page 102)
For these try to facilitate access to an area where the student can undertake medicines
administration. If some of these are impossible in Semester 2, please make sure this
feeds through into the action plan for the placement in Semester 3 and use simulated
practice and scenarios in Semester 2. Jacquie has a number of scenarios mentors can
use, should they need to (send an email) and make use of any available equipment for
simulation in your Trust.