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FACULTY OF SOCIAL SCIENCE AND HEALTH CARE SCHOOL OF HEALTH SCIENCES (NURSING) BSc (HONS) NURSING YEAR 3 COHORT 2006 MENTOR HANDBOOK Work Based Learning 5 & 6 Date/s : 3rd November 2008-19th December 2008 And 4th May 2009- 26th June 2009 University Contact Eleanor Swift :School Administrator Queen Margaret University Musselburgh East Lothian EH21 6UU Tel .0131 474 0000 Introduction The BSc( Hons) in Nursing is a four-year honours degree course leading to registration on Part 1 of the NMC Register. The course philosophy values excellence in practice and prepares nurses able to lead, anticipate and respond to change. The educational foundations for these qualities form the core of the course aims and outcomes. These aims encourage a deep approach to learning and foster student autonomy. The curriculum also reflects the guiding principles of “Fitness For Practice” (UKCC 2000a). This requires that practice centred learning involves the integration of evidence based theory with nursing practice. The course is delivered in a modular pattern over two semesters per academic year. Theory and practice are integrated during two periods of Work –Based learning (WBL) per year . The students will undertake the following placements over the course of the programme. Table 1. Clinical placements Year 1 Year 3 Placement Experience WBL 1 Year 2 Placement Experience Community placement WBL 3 Acute surgical WBL 2 Care of the person in a residential setting WBL4 Acute medical Placement Experience Placement Experience WBL 5 Specialties WBL 7 Medical / surgical / community WBL 6 Medical / surgical / WBL 8 Medical / surgical / community Year 4 Clinical supervision by QMU Each student is allocated a university lecturer as a Clinical Supervisor. During the placement Clinical Supervisors will maintain regular contact with the students (normally 1 hour per week). The nature and frequency of this contact will be agreed at the beginning of each placement. Supervisors will vary during the summer period. Mentors are encouraged to contact Clinical Supervisors at an early stage should they have any queries about the placement or concerns about a student. We value any comments you may have regarding this period of clinical placement as this will enable us to improve the quality of student, client and clinical staff experiences. Contact details Clinical Supervisor: Name: email: …@qmu.ac.uk 2 STANDARDS There are standards for ensuring students have a quality learning experience within a placement area that has been quality assured (NES 2001). Equally, there are standards expected of students whilst they are on placement. Within the placement, students may legitimately expect the following: 1. Direct access to clinical supervisor in the event of any problem or uncertainty. Lecturers will ensure that students are given their contact details prior to placement. 2. Directly supervised group contact for a minimum of one hour per week of placement. This may be in the form of weekly tutorials. Arrangements will be communicated to mentors in advance of, or at the beginning of, the student placement. If students require to travel to supervisions, then time should be organised to allow them to do so. Supervisors will negotiate with mentors if specific arrangements have to be made with individual students. 3. Specific guidance from the clinical supervisor as to how the 37.5 hours will be made up for any specific placement. This will take into account: placement locality and nature of work; year of course; nature of outcomes; availability of clinical supervisor. Within the community the student will normally be working Monday to Friday. 4. Facilitation by the mentor to enable data collection/analysis in the clinical area. For example, this might include: assistance to select a patient for a particular activity e.g. assessment, teaching; providing the opportunity to consult patient documentation or attend a case conference; allowing time to write/collate notes, care plans etc. 5. The mentor to be familiar with specific QMU outcomes and assessment criteria. Clinical Supervisors may legitimately expect the following 1. Students and mentors will notify them if any problems occur. 2. Attendance of students at planned supervision sessions. Failure to attend without prior negotiation with the clinical supervisor will be viewed as absence and will contribute to a failed placement. 3. Students will produce evidence of work carried out during clinical hours. For example, contribution to supervision sessions, work produced in library, or clinical area. Mentors may legitimately expect the following 1. Notification from the clinical supervisor as to the general supervisory pattern for that placement, and specific dates and times of supervision sessions. 2. Consultation with the student and the clinical supervisor if an individual student's/mentor's needs require an amendment to the pattern of attendance. Provision of up-to-date mentor information booklet detailing QMU outcomes and assessment criteria before or at the beginning of each student's placement period. POLICY ON CLINICAL ATTENDANCE Fundamental principles All clinical experience should be driven by educational needs Experience should allow insight into the 24 hour nature of practice provision. To conform with national requirements, students should receive 37.5 hours of clinical practice education per week and be supernumerary. 3 The following activities can legitimately be described as clinical practice education: Involvement in direct patient care Involvement within clinical setting: e.g. attending medical rounds, case conferences, obtaining data from case notes, attendance in theatres/labs and so on. Analysing clinical data obtained from the above in order to produce evidence that learning outcomes have been met. This can be carried out in the clinical or academic setting. This would be the major activity in a clinical tutorial with the supervisor. Acquiring data to support analysis e.g. referring to research evidence, visiting an expert. This may be available in clinical or academic setting. The 37.5 clinical hours per week should thus comprise a mixture of these activities. This does NOT include time spent in formal assignment preparation. QMU POLICY ON WORKING SHIFT PATTERNS : Due to a number of factors the team has reviewed our policy on acceptable options for shift pattern working during work-based learning. Students should always discuss with their allocated QMU Clinical Supervisor their plans for working shift patterns other than core shifts before they confirm their off duty. If you have any queries about the changes please contact your QMU Clinical Supervisor. Year 1 (WBL 1: Community) – students will work the normal day time hours (09.0017.00hrs) as negotiated with their mentors Year 1 (WBL 2) - negotiate either core day shifts or 12hour day shift with mentor. No night duty. 12 hour shifts are permitted ONLY IF working with mentor on the same shifts. A combination of options may be appropriate depending on the learning outcomes at different stages of the placement. Year 2- work either core or 12 hour day shifts and some night duty. 12 hour shifts are permitted ONLY IF working with mentor on the same shifts. Their must be a sound educational reason for working night duty and students MUST be working with their mentor on the same shifts. It is expected that the majority of shifts worked over the duration of the placement would be on day duty. A combination of options may be appropriate depending on the learning outcomes at different stages of the placement. Year 3 work either core or 12 hour day shifts and some night duty. 12 hour shifts are permitted ONLY IF working with mentor on the same shifts. Their must be a sound educational reason for working night duty and students MUST be working with their mentor on the same shifts. It is expected that the majority of shifts worked over the duration of the placement would be on day duty. A combination of options may be appropriate depending on the learning outcomes at different stages of the placement. Year 4 - work either core or 12 hour day shifts and some night duty.12 hour shifts are permitted ONLY IF working with mentor on the same shifts. A combination of options may be appropriate depending on the learning outcomes at different stages of the placement. MOVING AND HANDLING POLICY QMU nursing students undertake a programme in moving and handling skills for undergraduate students provided by a trainer in Queen Margaret University . Manual Handling training is delivered, in house, to all the students in the School of Health Sciences at 4 QMU. Students are trained using the same principles and practices of OHSAS which is the Occupational Health & Safety Advisory Service for the NHS in Scotland. This means that students receive the same level of training as an NHS employee. In their first year, nursing students have to attend an introductory lecture which aims to highlight the issues related to manual handling, addresses the related legislation, introduces ergonomics, risk assessment and efficient handling and lifting techniques so that students are encouraged to adopt safe and efficient practice. The students also attend, in small groups, two practical workshops. The first workshop focuses on efficient movement and handling of objects. In the workshops students have to complete risk assessments related to a variety of scenarios. The second workshops deals with the moving and handling of patients. There are a large variety of moving and handling aids that the students can use including active and passive movers and hoists. Students attend these three sessions prior to going out on clinical placement. In addition, during the academic year, students have to complete and pass an online assessment related to all aspects of manual handling. Nursing students will receive refresher and update training in each subsequent year of their studies. All students have the support of a dedicated Manual Handling module as an online resources through WebCT. Students have been made aware of the history of nursing in relation to injury, the current legislation, and of the latest Royal College of Nursing 'Code of Practice in Moving and Handling “ (2000) which states “You have a responsibility to make staff aware of your own limitations. You must not to co-operate with unsafe practice and in particular to refuse to participate in any practice which has been condemned by the Royal College of Nursing. This is in line with your professional responsibilities as outlined in the current NMC Code of Professional Conduct (2008), and with the assurance that your workplace has Safe Handling Policies in place. “ The Programme Team supports students in these actions . However ,if you as a mentor have any particular problems relating to a student’s capacity to move and handle safely, please contact the relevant clinical supervisor. Sickness and absence Students are required to complete specified hours of clinical experience in order to Register as qualified nurses at the end of their course. Therefore, any episodes of sickness must be compensated for before the student can be recommended for registration. Students have been instructed that if they are sick and unable to attend placement they must notify placement staff and the school office administrator at QMU. Students are responsible for ensuring that the record of attendance in their Practice Record is completed. Their Mentor will sign to confirm the accuracy of this record. The completed form is to be returned to: School Administrator School of Health Sciences: Nursing Queen Margaret University Edinburgh EH22 6UU NU 3 Clinical Skills Relating to Clinical Practice on WBL 5 and 6 5 Students entering Year 3 will have met the standards of proficiency (NMC 2004) and achieved the essential skills clusters (NMC 2007) for entering the Branch programme. Clinical skills and nursing procedures achieved in year 2 are tabled below. Clinical skills and nursing procedures learnt in the third year integrate theory and practice within the educational approach of problem–based learning .They are grouped in the table below as essential skills clusters (NMC 2007) Skills have been taught using a variety of learning approaches , which in addition to practical learning individually in the clinical simulation suite ,include :o Experiential learning & reflection o Problem-based learning using clinical scenarios o Working in groups All students are given the opportunity to practice taught skills independently and receive formative assessment by self, peer, and lecturer . Skills are tested summatively through Objective Structured Clinical Assessment (OSCE) : Following each period of work-based learning , students are encouraged to reflect on and self-assess their skills development using e-portfolio : Problem-based learning (PBL) Is the process of working towards the identification and understanding of the knowledge which is required but not currently known in order to proceed with clinical reasoning. PBL provides students with the opportunity to learn, practice and develop self and peer assessment , team working skills, adaptation and inter dependent critical thinking. Over the third year, students examine and explore 5 clinical scenarios/case studies based on real-life situations . This encourages them to identify, explore and reflect on relevant care management and nursing skills , clinical reasoning, ethical and professional issues, communication issues , health care provision, psychosocial issues, and related anatomy and physiology : Nursing skills are therefore not taught discretely , but as part of the consideration of specific clinical scenarios, consistent with holistic care. There are two periods of work-based learning in year 3 , which encompass three hospital placements:- medical and surgical settings , and specialties : During the year students will undertake all three types of placement. Semester 1 Essential skills cluster Care, Compassion & Communication Achieved in year 1 and 2 Communication: non verbal behaviour ,listening & responding ,questioning ,exploratory skills: inter-professional, giving information, older people, Skills/Procedures explored in case studies (CS) and practised in simulated or lab learning CS1.1Communicating with patients and family during emergency situations 6 Infection Prevention Control & sensory deficits, dementia :Last Offices.Pre-operative information giving. Transcultural assessment, understanding loss and , grief and bereavement, end of life care. Hand washing & Infection control (Standard Precautions) Aseptic technique/wound care: Prevention of health care acquired infection. Wound dressing. Organisational Aspects of Care Blood Pressure measurement, TPR , Personal Hygiene: washing, bed bathing, hair care, assistance with dressing, bed making (unoccupied and occupied bed) Basic Life Support, First Aid Care planning and assessment : CP resuscitation , use of laerdal masks: Pre and Post operative care, informed consent. Tissue viability, wound care, pressure area care, risk assessment /incident reporting Documentation and record keeping , preparing patients for transfer and investigations. Management of Oxygen therapy. CS 1:1 Triage, role of triage nurse. CS 1:1 .intro to management of arterial lines, Arterial Blood gases. Pulse oximetry Management of fractures. Preparation of patient for abdominal scanning.. Pain assessment tools. Acute pain management. CS1:2 Intubation/extubation/care of endotracheal tube : Suctioning. Chest drains, measurement of Peak Flow Expiratory respiratory care IV devices, CVP monitoring, arterial line monitoring, arterial blood gases. Care of epidurals Nutrition & Fluid Management Urine testing ,Specimen collection, Oral hygiene, Care of dentures, Assisting patients with eating & drinking: Elimination: Fluid Balance charts, assisting patients using urinal, bedpan & commode, catheter care, emptying catheter bags, catheter specimens of urine, caring for patients with constipation, diarrhoea & incontinence. Suppositories/enema administration , Female catherisation , passing NG tubes ,P.E.G feeding , Blood transfusion, Blood glucose monitoring Drug calculations and administration, drug groups. Intramuscular and sub-cutaneous injection administration Management of IV infusions : Oxygen therapy-delivery and management CS.1:1 Assessment of haemodynamic status , recognition of circulatory change, electrolyte imbalance Medicines Management CS1:1Management of hypoxaemia/ safety issues 7 Semester 2 : Essential skill cluster Care, Compassion & Communication Infection Prevention & Control Skill/Procedure CS2:1 health promotion and life-style change CS 2:2 Neurological assessment Communication with unconscious patients Cognitive assessments: Inter-professional communication Managing challenging behaviour CS 2 :3 Breaking bad news, patient education. Psychological support in altered body image Spiritual support Supporting the family Documentation, record systems CS 2 :3 Protective isolation of neutropoenic patients Organisational Aspects of Care CS 2:1 12 lead ECGs, recognition of life-threatening arrhythmias. Advanced life support Medical/nursing systems of assessment. Unitary Note system. CS 2:2 Glasgow Coma scale, purpose use and assessment. Care of tracheostomy tubes : Cognitive assessments. Discharge planning, neurological rehabilitation. Management of seizures CS 2:3:2 Diagnostic investigation relating to breast cancer: IV access and devices (e.g. Hickman), chemotherapeutic options and regimes, side effect and complications. Nutrition & Fluid Management C2:1Nutritional support and dietary change in prevention of and following cardiac disease Medicines Management C2:1 Knowledge of action of common cardiac drug groups. Removal of IV cannulae Students are expected to participate and gain experience in performing the above range of skills and clinical competence in those achieved in year 2. Initially students are advised to work under the direct supervision of their mentor until confidence is gained in carrying out the skills /procedures above. Following each placement they are expected to self-evaluate their skills learning and development using e-portfolio as a basis for identifying individual skills which they feel need improvement. Additionally, they will be formatively and summatively assessed by OSCE following WBL5/6. 8 PRINCIPLES OF ASSESSMENT: Clinical practice contributes to academic success. Students are unable to complete the course and register unless they successfully complete all practice placements. In the second year of the BSc (Hons) in Nursing course, clinical practice carries ten academic points which will also be awarded to their overall academic profile. Clinical progress is evaluated using the Practice Record. This tool specifies the clinical learning outcomes for each clinical placement. For each outcome students must submit evidence which demonstrates their achievement. The process for achieving outcomes can be found in the section Clinical Supervision. As a mentor, you are asked to provide a mid-way assessment of progress .At the end of the practice record you are asked to assess the student’s overall performance as ‘satisfactory’ or ‘unsatisfactory’ in your professional judgement. You are also asked to complete a professional attributes assessment. The forms for these assessments can be found in the student’s own practice record. Students entering the course from 2007 will maintain an ongoing record of all their mentor assessments as part of the requirement to be assessed by a ‘sign off’ mentor prior to successful registration. Evidencing outcomes Evidence will include: A student’s e-portfolio or ‘learning diary’ should be used to record clinical learning experiences. This diary/’blog’ is intended to facilitate reflection on practice and is a personal record. Students may opt to keep their diary/’blog’ as a confidential record. Students can access the E-portfolio via the QMU website at: https://eportfolio.qmuc.ac.uk/ The expertise of experienced nurses working in the practice area. Clinical documentation e.g. care pathways, care plans, assessment tools, patient/client records. Patient information sources e.g. websites, leaflets, support groups. Expertise of health care professionals e.g. clinical nurse specialists, occupational therapists, physiotherapists, chaplains, and pharmacists. Professional literature – up to date and clinically credible. The Process of Assessment: Self awareness and self-evaluation of a student’s progress in the acquisition and use of knowledge, caring skills and attitude is an integral part of the BSc (Hons) Nursing course. Students are therefore asked to make THREE written evaluations of their own needs, expectations, progress and performance in relation to anticipated opportunities for learning within each experience. They will use these evaluations in discussions with you and within clinical supervision sessions. Preliminary self assessment Students are expected to complete a self-assessment exercise before commencing placement. In this they are asked to identify their learning needs, their expectations of the placement, any anxieties they may have, and aspects of nursing practice with which they would like particular support. The information can be used as the basis for discussion at the first meeting with you. 9 Throughout the experience Throughout the practice placement students will have ongoing discussions with you. In order to be constructive, they are encouraged to use their learning experiences to inform this discussion. If there are any concerns about their achievements or conduct during the placement, you the mentor should draw this to their attention to give them an opportunity to remedy the situation. Clinical supervisors should be contacted as early as possible if there are any problems preventing you and the student meeting regularly to discuss progress or any other issues which may affect the student’s progress. Mid point of the experience You should discuss the student’s progress with them using the mid-way self-assessment as the basis for discussion. Mid-way discussion allows outstanding learning needs to be identified and a plan formulated to meet all the outcomes by the end of the placement. You will be required to complete a written mid way assessment within the student’s placement record. Final assessment At the end of the experience you should discuss the student’s achievements and areas for further development. Mentors are required to write a brief summary about the student’s performance and indicate whether their performance during placement has been SATISFACTORY or UNSATISFACTORY. The focus of your role is to ensure that the student’s practice is proficient, competent and professional. Submission of record Please note that Programme Regulation NU4 states: “Students must submit the appropriate completed Practice Record documents by the agreed date as stipulated in the Practice Record document. Any student who submits a completed Practice Record after the submission date, without the agreement of the Course Leader, will normally be deemed to have failed the placement.” CLINICAL SUPERVISION: How will the process work to help students achieve learning outcomes? Students will achieve the work based outcomes by carrying out a number of learning activities. The activities are suggestions only (see principles of assessment). They are not exclusive. On discussion with you, students may decide that they can meet the outcomes by carrying out alternative or additional activities. The evidence of these activities should be gathered in their practice record and used to form the basis of discussions with you, both during the placement and at the time of assessment. The evidence will also assist them in clinical supervision sessions where they will be expected to bring the evidence to support discussions of particular care situations within placement. Learning process in supervision During clinical supervision sessions, clinical supervisors will be expecting students to actively engage with the outcomes and learning activities outlined in their practice records. 10 Students are expected to bring their practice record with them to every supervision meeting to assist in their discussions. Students will achieve all their outcomes through reflection by reflecting and analysing in depth on care situations that occur during their work based experiences, which will be discussed in supervision sessions. Students will be assessed formatively, using their contribution to the discussion and debate, during their clinical supervision sessions therefore attendance is mandatory and a record of attendance will be kept. A summative assessment will be submitted during the final Work-based learning period of the year, drawing on the evidence they have presented in supervision. Processes of assessment. Formative Each care situation and related outcomes will be formatively assessed for the quality of evidence which demonstrates applied learning. In other words, students will be demonstrating, what they did to achieve each outcome in the practice setting, and how this achievement informs and develops practice. Personal reflections can be included as evidence to base their discussions on. Students should select an incident from their ‘Blog’ in their eportfolio or from their own reflective diary. If the clinical supervisor supervisor assesses their evidence (see suggested learning activities) and discussion as satisfactory, the outcome will be signed off and the next outcome selected. Whether everyone undertakes the same or different outcomes each week, depends on the preferences of the group and the nature of the student’s clinical practice. Outcomes have been designed to cross-reference to the NMC proficiencies (see Appendix) , however a student may choose to directly select a clinical scenario which may also achieve some of these proficiencies. Summative During the student’s final clinical experience of the academic year, they will select one case scenario. This could be selected from any care situation they have presented during the past year. The student will write a critical account of the care given, identifying the appropriate learning. The care scenario will be based around the four NMC domains and evidence the student provides will reflect NMC proficiencies (this information will be issued to the student prior to submission). The account should include the nature of the student’s learning, its significance for improving the care of the patient/client, and its value for developing their personal and professional knowledge. Outline structure for supervision The outline is indicative. As a group the students can negotiate with the clinical supervisor how this structure will be rolled out each week. It is not meant to be rigid or prescriptive. The structure demonstrates what students can expect from supervision, and their responsibilities within this. Week 1 – as a group the students will discuss with their supervisor the overall outcomes of the work based experience and negotiate how they would like to achieve these using care situations. Week 2/3 – Bringing a care situation from practice with them; students will discuss with their group and supervisor, how the selected outcomes apply to the care situation. They will provide the evidence to support the meeting of the outcomes and discuss how this activity has informed their practice. The student’s peers in the group are expected to contribute to this process. Formative assessment through group discussion will help the student 11 understand how evidence is relevant to both the outcome and their personal experience. If the clinical supervisor is satisfied with the evidence and outcome of the discussion, the selected outcomes will be signed off by the supervisor in the completion matrix. The next outcomes and case scenario will be selected for the following week. Week 4/5 – As in weeks 2/3 Week 6/7 /8– As in weeks 2/3 STUDENT LEARNING OUTCOMES WITH SUGGESTED LEARNING ACTIVITIES YEAR 3 STUDENT LEARNING OUTCOMES WITH SUGGESTED LEARNING ACTIVITIES Please note the activities are suggestions only . The aim is to achieve the outcomes for each placement . These cross-reference to the NMC proficiencies and essential skills clusters (NMC 2007) tabled at the end of this record , which must all be achieved in order to obtain registration as a qualified nurse. When you satisfactorily achieve each outcome your clinical supervisor will record this on the form included in this practice placement record. WBL 5 AND 6 /OTHER Outcome 1 Practice in accordance with an ethical and legal framework that ensures the primacy of patient/client interest and wellbeing and respects confidentiality. Suggested Learning Activity: Select a vulnerable client group for discussion , that you have encountered in this placement. (e.g older person, disabled person, person with dementia, person with learning difficulties) 1. Explore related health and social policy aimed at supporting and protecting this client group. 2. Discuss an actual or potential ethical issue associated with this client group. 3. Reflect on how the process of ethical decision making is addressed in nursing practice. Proficiencies: B1,3 Outcome 2 Practise in a fair/anti-discriminatory way, acknowledging the difference in beliefs and cultural practices of individuals or groups. 12 Suggested Learning Activity: Identify a patient/client or a client group with specific beliefs and cultural practices Discuss the way in which nursing care in your area responds to the values and customs of this individual/group OR Discuss the processes in place that would be actioned should this situation be encountered. Identity the ways in which care given demonstrated sensitivity to cultural diversity Proficiencies: C1,2,3,4 Outcome 3 Based on best available evidence, apply knowledge and an appropriate repertoire of skills indicative of safe nursing practice. Suggested Learning Activity: Select an aspect of patient care ( e.g nutrition, pain management, wound care , infection control ) Explore current research which informs nursing practice and critically reflect on how this is applied in practice Proficiencies: H1,2,6, K1 Outcome 4 Create/utilise opportunities to promote the health and well-being of patients/clients/groups. Suggested Learning Activity: Discuss how you would assess the information needs of a selected patient at a particular point in their care . e.g on admission, during specific treatment/interventions or in preparation for discharge Proficiencies: E 1,3 H 5 Outcome 5 Undertake and document a comprehensive , systematic and accurate nursing assessment of the physical, psychological, social, and spiritual needs of patients/clients/communities. Suggested Learning Activity: Select a patient/client.(e.g on admission, or referral, or transfer) and undertake a nursing assessment. Critically examine the documentation used in this process, giving consideration to a holistic approach Comment on available tools to assist in this process. 13 Proficiencies: F1,2 Outcome 6 Formulate and document a plan of nursing care, where possible in partnership with patient/clients /carer(s) significant others within framework of informed consent. Produce a care plan for one individual patient/client. Suggested Learning Activity: Discuss how priorities of care were established .(e.g in partnership with patient, relative, professional colleagues) Select one nursing intervention and provide a detailed rationale for its implementation . Proficiencies;G1,2 Outcome 7 Evaluate and document the outcomes of nursing and other interventions. Suggested Learning Activity: Select a patient/client who you have cared for. Examine the expected care outcomes and discuss any changes made to these in response to e.g. change in patients condition, home circumstances, resources, Comment on how this process is monitored and documented. Proficiencies G3 J1,2 Outcome 8 Contribute to public protection by creating and maintaining a safe environment of care through the use of quality assurance and risk management strategies. Suggested Learning Activity: Select an environmental hazard or nursing action which has the potential to compromise the safety of patients/clients/communities in your care: identify risk management measures associated with maintaining individual or collective safety in relation to your selection 14 discuss the responsibilities of the registered nurse in implementing risk management measures. Proficiencies: L2,3,4,5 Outcome 9. Demonstrate an ability to respond competently in emergency situations or unexpected events. Identify a situation in practice, which has been demanding in that outcomes were unpredictable. This could include (for example) a situation which:1. Was life threatening for your patient; Suggested Learning Activity: OR 2. Identified a rapid change in your patient’s condition; OR 3. Compromised the safety of yourself and others; OR 4. Demanded rigorous and critical decision making. OR 5. Required prioritisation of manpower and resources to effectively resolve the situation . Evaluate your competence in dealing effectively with this situation. Reflect on your personal learning and development needs in managing this potential or actual crisis Describe the communication processes you used to record salient events and which outline your legal and professional obligations. Proficiencies; J2 K3,O4 Outcome 10 (Medical) Suggested Learning Activity Contribute to the decision making of the Multi-disciplinary team Conduct two handover reports relating to one patient or a group of patients. Participate in a medically led ward round OR case conference Discuss how patient care is reviewed, evaluated and documented by TWO members of the multi-disciplinary team Proficiencies: M1,2,3 15 Outcome 11 (surgical) Suggested Learning Activity Participate in information giving, aimed at promoting patients’ health and independence. Prepare a patient pre-operatively for theatre: Discuss the consideration you made when explaining procedures to this patient (You should support your discussion with appropriate evidence from literature). Proficiencies: D1,D2 H4 MENTOR’S ASSESSMENT OF STUDENT ‘S PROFESSIONAL PERFORMANCE: 1. MENTOR DECLARATION: I (PLEASE PRINT NAME )----------------------------------- AM A GRADE REGISTERED NURSE AND A REGISTERED STUDENT NURSE MENTOR. I AM THE MENTOR / CO MENTOR / APPROPRIATE CATEGORY) OTHER QUALIFIED NURSE (PLEASE TICK OF STUDENT NURSE (PLEASE PRINT NAME )------------------------------------THE FOLLOWING ASSESSMENT TOOK PLACE ON WARD /UNIT-----------------------------------------HOSPITAL ----------------------------------DATE:-------------------------------------------------- FOLLOWING A PERIOD OF PRACTICE OF ………………. WEEKS SIGNED: (MENTOR’S SIGNATURE)-------------------------------------NAME (PLEASE PRINT)---------------------------- 16 NAME OF STUDENT PROFESSIONAL ASSESSMENT: A grade of SATISFACTORY should be given when the student has completed at least 80% of the designated placement experience. Demonstrated the following professional attributes: Maintains patient safety, as evidenced by for example: appropriately seeking and acting on advice appropriately notifying senior staff of changes in patient condition Yes NO Demonstrates respect for persons, as evidenced by for example Showing sensitivity in communicating with patients Respects privacy and dignity when providing care Yes NO Works as a team member, as evidence by, for example: Punctuality reporting for shifts Reliability in carrying out assigned duties Communicating appropriately with other team members Yes NO Provides high quality care as evidenced by, for example: Observing infection control policies Carrying out technical procedures with appropriate skill care for level of training Yes NO Recognises and works within the boundaries of the professional caring relationship as evidenced by, for example: Accepting comment and constructive criticism from qualified staff. Sharing appropriate non- personal information with staff and patients Maintaining a professional demeanour in times of challenge Yes NO Conforms to QMU standard of self presentation, as evidenced By for example: Uniform worn correctly, with ID visible Grooming, taking account of need for safety; i.e. short nails, removal of jewellery, hair tied back NO Yes 17 A grade of UNSATISFACTORY should be given if the student does not achieve ALL of these components. MENTOR: (PLEASE PRINT NAME) MENTOR’S SIGNATURE---------------------- Mentor’s statement : On the basis of the above professional assessment, this student has received a grade of: SATISFACTORY (circle as appropriate) Signature : ____________________________ UNSATISFACTORY Date : _________________ Name: (please print)______________________ Student’s comments : 18 Signature : ______________________________ Date : _________________ TO BE COMPLETED BY CLINICAL SUPERVISOR _________________ (Name) Signature _________________________ Date : _________________ Appendix 1 YEAR 3 WBL 5/6/ The Standards of Proficiency for Entry to the Register (NMC 2004) 19 Mentors assessmen t Met in clinical tutorial process or University teaching Can be/is Met in year 4 LEARNING OUTCOMES MAY BE ACHIEVED ACROSS ALL CLINICAL PLACEMENTS Essential skills clusters (ESC’S) Domain 1 : Professional/Ethical Practice A. Manage self, one's practice, and that of others, in accordance with the NMC Code of Professional Conduct, recognising one's own abilities and limitations. 1.Practise in accordance with the NMC Code of Professional Conduct; 1,8,15,21,38,39 2.Use professional standards of practice to self assess performance 1,5,11 3.Consult with a registered nurse when nursing care requires expertise beyond own current scope of competence; 1,9,23,28,29 4.Consult other health care professionals when individual or group needs fall outside the scope of nursing practice; 1,7,9,10,12,14,16,18, 23,28,29,35 5.Identify unsafe practice and respond appropriately to ensure a safe outcome; 1,11,14,18,22,24,30, 34 6.Manage the delivery of care services within sphere of own accountability. 1,9,12,17,21,24,31,3 4 B. Practise in accordance with an ethical and legal framework that ensures the primacy of patient/client interest and wellbeing and respects confidentiality. 1.Demonstrate knowledge of legislation and health and social policy relevant to nursing practice; LO 1 1,5,11 2.Ensure confidentiality and security of written and verbal information acquired in a professional capacity; 3.Demonstrate knowledge of contemporary ethical issues and their impact on nursing and healthcare; LO 1 1,9,23,28,29 1,7,9,10,12,14,16,18, 23,28,29,35 4.Manage the complexities arising from ethical and legal dilemmas; 5.Act appropriately when seeking access to caring for patients/clients in their own homes. 1,8,15,21,38,39 COMMUNITY 1,11,14,18,22,24,30, 34 20 Mentors assessmen t Met in clinical tutorial process or University teaching Can be/is Met in year 4 LEARNING OUTCOMES MAY BE ACHIEVED ACROSS ALL CLINICAL PLACEMENTS ESC’S C .Practise in a fair/anti-discriminatory way, acknowledging the difference in beliefs and cultural practices of individuals or groups. 1.Maintain, support and acknowledge the rights of individuals or groups in the healthcare setting; LO2 4,8,27,30 2.Act to ensure that rights of individuals and groups are not compromised; LO 2 4,8,11,12,26,27 3.Respect the values, customs and beliefs of individuals and groups; LO2 2,4,5,9,27, 40 4.Provide care that demonstrates sensitivity to patients'/clients' diversity. LO2 1,3,4,5,6,9,27,40 Domain 2 :Care Delivery D. Engage in, develop and disengage from therapeutic relationships through the use of appropriate communication and interpersonal skills. 1.Utilise a range of effective and appropriate communication and engagement skills; SURG OUTCOME (LO 11) 2,5,6,12,13,16,17,18, 19,29 35 7,13,18,19,29 2.Maintain, and where appropriate, disengage from professional caring relationships that focus on meeting the patient's/client's needs within professional therapeutic boundaries E. Create/utilise opportunities to promote the health and wellbeing of patients/ clients and groups. 1.Consult with patients/clients and groups to identify their needs and desires for health promotion advice; LO 4 2,6,9,27,40,41 21 2.Provide relevant and current health information to patients/clients and groups in a form which facilitates their understanding and acknowledges choice/individual preference; 3.Provide support/education in the development and/or maintenance of independent living skills; SURG OUTCOME (LO 11) LO 4 Met in clinical tutorial process or University teaching Can be/is Met in year 4 3,9,10,20,27, 40 9,18,21,23,27 4.Seek specialist/expert advice as appropriate Mentors assessmen t 4,5,6,8,9,10,11,12,13 ,21,27,40,41 LEARNING OUTCOMES MAY BE ACHIEVED ACROSS ALL CLINICAL PLACEMENTS ESC’S F. Undertake and document a comprehensive, systematic and accurate nursing assessment of the physical, psychological, social and spiritual needs of patients / clients / communities. 1.Select valid and reliable assessment tools for the required purpose; 2.Systematically collect data regarding the health and functional status of individuals/clients/communities through appropriate interaction, observation and measurement. LO 5 LO 5 6,13,18,28 9,13,18,19,28,36 6,9,10,13,18, 3 .Analyse and interpret data accurately to inform nursing care and take appropriate action 21,28,36 G. Formulate and document a plan of nursing care, where possible in partnership with patients / clients / carer(s) / significant others within a framework of informed consent. 1.Establish priorities for care based on individual or group needs; LO 6 2,7,10,16,17,23 2.Development and document a plan of care to achieve optimal health, habilitation, rehabilitation based on assessment and current nursing knowledge; LO 6 2,23,28,32,38,39,40 22 3.Identify expected outcomes including a time frame for achievement and/or review in consultation with patients / clients / carer(s) / significant others and members of the health and social care team. LO 7 2,6,9,10,13,14,16,17,2 3,35, 40 H . Based on best available evidence, apply knowledge and an appropriate repertoire of skills indicative of safe nursing practice. 1.Ensure that current research findings and other evidence are incorporated in practice; 2.Identify relevant changes in practice or new information and disseminate it to colleagues; LO3 LO3 9,16,18,22,31,35 9,16,18,22,23,25,31 3.Contribute to the application of a range of interventions to support patients/clients that optimise their health and wellbeing; WBL 12,18,25,28,31,35 4.Demonstrate safe application of the skills required to meet the needs of patients/clients within the current sphere of practice; SURG OUTCOME 5,6,13,18,21,25,28,31, 38,42 5.Identify and respond to patients'/clients' ongoing learning and care needs; 6.Engage with, and evaluate, the evidence base that underpins safe nursing practice. Mentors assessmen t Met in clinical tutorial process or University teaching Can be/is Met in year 4 (LO 11) LO 4 LO3 LEARNING OUTCOMES MAY BE ACHIEVED ACROSS ALL CLINICAL PLACEMENTS 9,18,27,41 9,14,16,18,25,35 ESC’S I. Provide a rationale for the nursing care delivered that takes account of social, cultural, spiritual, legal, political and economic influences. 16,17 1.Identify, collect and evaluate information to justify the effective utilisation of resources to achieve planned outcomes of nursing care. J . Evaluate and document the outcomes of nursing and other interventions . 1.Collaborate with patients/clients and when appropriate, additional carers to review and monitor the progress of individuals or groups towards planned outcomes; LO 7 3,6,10,13,23,27,29, 32,38,40 23 2.Analyse and revise expected outcomes, nursing interventions and priorities in accordance with changes in individual's condition, needs or circumstances. LO 7, LO9 10,13,19,32, 36 K. Demonstrate sound clinical judgement across a range of differing professional and care delivery contexts. 1,9,13,16,17, 1.Use evidence based knowledge from nursing and related disciplines to select and individualise nursing interventions; 2.Demonstrate the ability to transfer skills and knowledge to a variety of circumstances and settings; 4,6,7,8,9,12,13,16, 17,19,25,31 3.Recognise the need for adaptation and adapt nursing practice to meet varying and unpredictable circumstances; LO 9 4,7,8,9,13,17,18,19 ,22,31 4,7,8,9,11,12,14,17 ,18,30, 4.Ensure that practice does not compromise the nurse's duty of care to individuals or safety of the public. 31,35 Domain 3: Care Management L. Contribute to public protection by creating and maintaining a safe environment of care through the use of quality assurance and risk management strategies. 1.Apply relevant principles to ensure the safe administration of therapeutic substances; YEAR 2 10,20,21,22,26,31 2.Use appropriate risk assessment tools to identify actual and potential risks; LO 8 11,14,17,18,19,21, 23,26,32,35 3.Identify environmental hazards and eliminate and/or prevent where possible; LO 8 17,18,26,37 LO 8 11,17,18,20, 4.Communicate safety concerns to a relevant authority; 21,35 5.Manage risk to provide care that best meets the needs and interests of patients / clients and the public. LO 8 11,12,14,17,18,19, 20,21,35 24 Mentors assessmen t Met in clinical tutorial process or University teaching Can be/is Met in year 4 LEARNING OUTCOMES MAY BE ACHIEVED ACROSS ALL CLINICAL PLACEMENTS ESC’S M. Demonstrate knowledge of effective inter-professional working practices that respect and utilise the contributions of members of the health and social care team. 1.Establish and maintain collaborative working relationships with members of the health and social care team and others; 2.Participate with members of the health and social care team in decision making concerning patients/clients; 3.Review and evaluate care with members of the health and social care team and others. MEDICAL OUTCOME (10) 6,7,9,14,18,30,35 MEDICAL OUTCOME (10) 7,9,11,14,16, MEDICAL OUTCOME (10) 7,9,10,12,14, 17,28,29,35 18,,28,29,35 N.Delegate duties to others, as appropriate, ensuring they are. supervised and monitored. 1.Take into account the role and competence of staff when delegating work; 6,14,15,17,30 2.Maintain own accountability and responsibility when delegating aspects of care to others; 6,14,15,17,30 3.Demonstrate the ability to co-ordinate delivery of nursing/health care ,14,15,16,17,22,24,,25, 30 O. Demonstrate key skills 1.Literacy - interpret and present information that is comprehensible; 11,21 2.Numeracy - accurately interpret numerical data and their significance for safe delivery of care; 27,28,29,31,32,33,36,3 8,39 3.Information technology and management - interpret and utilise data/technology, taking account of legal, ethical and safety considerations, in the delivery and enhancement of care; 4 .Problem solving - demonstrate sound clinical decision making that can be justified even when made on the basis of limited information. 26 See domain 2:8 14,19,25,30 LO 9 25 Mentors assessmen t Met in clinical tutorial process or University teaching MET IN COMM UNITY LEARNING OUTCOMES MAY BE ACHIEVED ACROSS ALL CLINICAL PLACEMENTS ESC’S PLACEMEN T Domain 4. Personal/Professional Development P. Demonstrate a commitment to the need for continuing professional development and personal supervision activities in order to enhance knowledge, skills, values and attitudes needed for safe and effective nursing practice. 1.Identify own professional development needs by engaging in activities such as reflection in and on practice and lifelong learning; 12 2. Develop a personal development plan that takes into account personal, professional and organisational needs; 5,25 3.Share experiences with colleagues and patients/clients to identify additional knowledge / skills needed to manage unfamiliar or professionally challenging situations; 1,5,12,20,25,27, 30 4.Take action to meet any identified knowledge and skills deficit likely to affect the delivery of care within current sphere of practice. 7,8,12,33,36,42 Q. Enhance the professional development and safe practice of others through peer support, leadership, supervision and teaching. 1.Contribute to creating a climate conducive to learning; 2.Contribute to the learning experiences and development of others by facilitating the mutual sharing of knowledge and experience; 3.Demonstrate effective leadership, in the establishment and maintenance of safe nursing practice. 9,25,27 6,9,22,24,25,27 9,19,24,25,30 YEAR 3 WBL 5/6/ The Standards of Proficiency for Entry to the Register (NMC 2004) 26 Mentors assessmen t Met in clinical tutorial process or University teaching Can be/is Met in year 4 LEARNING OUTCOMES MAY BE ACHIEVED ACROSS ALL CLINICAL PLACEMENTS Essential skills clusters (ESC’S) Domain 1 : Professional/Ethical Practice A. Manage self, one's practice, and that of others, in accordance with the NMC Code of Professional Conduct, recognising one's own abilities and limitations. 1.Practise in accordance with the NMC Code of Professional Conduct; 1,8,15,21,38,39 2.Use professional standards of practice to self assess performance 1,5,11 3.Consult with a registered nurse when nursing care requires expertise beyond own current scope of competence; 1,9,23,28,29 4.Consult other health care professionals when individual or group needs fall outside the scope of nursing practice; 1,7,9,10,12,14,16,18, 23,28,29,35 5.Identify unsafe practice and respond appropriately to ensure a safe outcome; 1,11,14,18,22,24,30, 34 6.Manage the delivery of care services within sphere of own accountability. 1,9,12,17,21,24,31,3 4 B. Practise in accordance with an ethical and legal framework that ensures the primacy of patient/client interest and wellbeing and respects confidentiality. 1.Demonstrate knowledge of legislation and health and social policy relevant to nursing practice; LO 1 1,5,11 2.Ensure confidentiality and security of written and verbal information acquired in a professional capacity; 3.Demonstrate knowledge of contemporary ethical issues and their impact on nursing and healthcare; LO 1 1,9,23,28,29 1,7,9,10,12,14,16,18, 23,28,29,35 4.Manage the complexities arising from ethical and legal dilemmas; 5.Act appropriately when seeking access to caring for patients/clients in their own homes. 1,8,15,21,38,39 COMMUNITY 1,11,14,18,22,24,30, 34 27 Mentors assessmen t Met in clinical tutorial process or University teaching Can be/is Met in year 4 LEARNING OUTCOMES MAY BE ACHIEVED ACROSS ALL CLINICAL PLACEMENTS ESC’S C .Practise in a fair/anti-discriminatory way, acknowledging the difference in beliefs and cultural practices of individuals or groups. 1.Maintain, support and acknowledge the rights of individuals or groups in the healthcare setting; LO2 4,8,27,30 2.Act to ensure that rights of individuals and groups are not compromised; LO 2 4,8,11,12,26,27 3.Respect the values, customs and beliefs of individuals and groups; LO2 2,4,5,9,27, 40 4.Provide care that demonstrates sensitivity to patients'/clients' diversity. LO2 1,3,4,5,6,9,27,40 Domain 2 :Care Delivery D. Engage in, develop and disengage from therapeutic relationships through the use of appropriate communication and interpersonal skills. 1.Utilise a range of effective and appropriate communication and engagement skills; SURG OUTCOME (LO 11) 2,5,6,12,13,16,17,18, 19,29 35 7,13,18,19,29 2.Maintain, and where appropriate, disengage from professional caring relationships that focus on meeting the patient's/client's needs within professional therapeutic boundaries E. Create/utilise opportunities to promote the health and wellbeing of patients/ clients and groups. 1.Consult with patients/clients and groups to identify their needs and desires for health promotion advice; LO 4 2,6,9,27,40,41 28 2.Provide relevant and current health information to patients/clients and groups in a form which facilitates their understanding and acknowledges choice/individual preference; 3.Provide support/education in the development and/or maintenance of independent living skills; SURG OUTCOME (LO 11) LO 4 Met in clinical tutorial process or University teaching Can be/is Met in year 4 3,9,10,20,27, 40 9,18,21,23,27 4.Seek specialist/expert advice as appropriate Mentors assessmen t 4,5,6,8,9,10,11,12,13 ,21,27,40,41 LEARNING OUTCOMES MAY BE ACHIEVED ACROSS ALL CLINICAL PLACEMENTS ESC’S F. Undertake and document a comprehensive, systematic and accurate nursing assessment of the physical, psychological, social and spiritual needs of patients / clients / communities. 1.Select valid and reliable assessment tools for the required purpose; 2.Systematically collect data regarding the health and functional status of individuals/clients/communities through appropriate interaction, observation and measurement. LO 5 LO 5 6,13,18,28 9,13,18,19,28,36 6,9,10,13,18, 3 .Analyse and interpret data accurately to inform nursing care and take appropriate action 21,28,36 G. Formulate and document a plan of nursing care, where possible in partnership with patients / clients / carer(s) / significant others within a framework of informed consent. 1.Establish priorities for care based on individual or group needs; LO 6 2,7,10,16,17,23 2.Development and document a plan of care to achieve optimal health, habilitation, rehabilitation based on assessment and current nursing knowledge; LO 6 2,23,28,32,38,39,40 29 3.Identify expected outcomes including a time frame for achievement and/or review in consultation with patients / clients / carer(s) / significant others and members of the health and social care team. LO 7 2,6,9,10,13,14,16,17,2 3,35, 40 H . Based on best available evidence, apply knowledge and an appropriate repertoire of skills indicative of safe nursing practice. 1.Ensure that current research findings and other evidence are incorporated in practice; 2.Identify relevant changes in practice or new information and disseminate it to colleagues; LO3 LO3 9,16,18,22,31,35 9,16,18,22,23,25,31 3.Contribute to the application of a range of interventions to support patients/clients that optimise their health and wellbeing; WBL 12,18,25,28,31,35 4.Demonstrate safe application of the skills required to meet the needs of patients/clients within the current sphere of practice; SURG OUTCOME 5,6,13,18,21,25,28,31, 38,42 5.Identify and respond to patients'/clients' ongoing learning and care needs; 6.Engage with, and evaluate, the evidence base that underpins safe nursing practice. Mentors assessmen t Met in clinical tutorial process or University teaching Can be/is Met in year 4 (LO 11) LO 4 LO3 LEARNING OUTCOMES MAY BE ACHIEVED ACROSS ALL CLINICAL PLACEMENTS 9,18,27,41 9,14,16,18,25,35 ESC’S I. Provide a rationale for the nursing care delivered that takes account of social, cultural, spiritual, legal, political and economic influences. 16,17 1.Identify, collect and evaluate information to justify the effective utilisation of resources to achieve planned outcomes of nursing care. J . Evaluate and document the outcomes of nursing and other interventions . 1.Collaborate with patients/clients and when appropriate, additional carers to review and monitor the progress of individuals or groups towards planned outcomes; LO 7 3,6,10,13,23,27,29, 32,38,40 30 2.Analyse and revise expected outcomes, nursing interventions and priorities in accordance with changes in individual's condition, needs or circumstances. LO 7, LO9 10,13,19,32, 36 K. Demonstrate sound clinical judgement across a range of differing professional and care delivery contexts. 1,9,13,16,17, 1.Use evidence based knowledge from nursing and related disciplines to select and individualise nursing interventions; 2.Demonstrate the ability to transfer skills and knowledge to a variety of circumstances and settings; 4,6,7,8,9,12,13,16, 17,19,25,31 3.Recognise the need for adaptation and adapt nursing practice to meet varying and unpredictable circumstances; LO 9 4,7,8,9,13,17,18,19 ,22,31 4,7,8,9,11,12,14,17 ,18,30, 4.Ensure that practice does not compromise the nurse's duty of care to individuals or safety of the public. 31,35 Domain 3: Care Management L. Contribute to public protection by creating and maintaining a safe environment of care through the use of quality assurance and risk management strategies. 1.Apply relevant principles to ensure the safe administration of therapeutic substances; YEAR 2 10,20,21,22,26,31 2.Use appropriate risk assessment tools to identify actual and potential risks; LO 8 11,14,17,18,19,21, 23,26,32,35 3.Identify environmental hazards and eliminate and/or prevent where possible; LO 8 17,18,26,37 LO 8 11,17,18,20, 4.Communicate safety concerns to a relevant authority; 21,35 5.Manage risk to provide care that best meets the needs and interests of patients / clients and the public. LO 8 11,12,14,17,18,19, 20,21,35 31 Mentors assessmen t Met in clinical tutorial process or University teaching Can be/is Met in year 4 LEARNING OUTCOMES MAY BE ACHIEVED ACROSS ALL CLINICAL PLACEMENTS ESC’S M. Demonstrate knowledge of effective inter-professional working practices that respect and utilise the contributions of members of the health and social care team. 1.Establish and maintain collaborative working relationships with members of the health and social care team and others; 2.Participate with members of the health and social care team in decision making concerning patients/clients; 3.Review and evaluate care with members of the health and social care team and others. MEDICAL OUTCOME (10) 6,7,9,14,18,30,35 MEDICAL OUTCOME (10) 7,9,11,14,16, MEDICAL OUTCOME (10) 7,9,10,12,14, 17,28,29,35 18,,28,29,35 N.Delegate duties to others, as appropriate, ensuring they are. supervised and monitored. 1.Take into account the role and competence of staff when delegating work; 6,14,15,17,30 2.Maintain own accountability and responsibility when delegating aspects of care to others; 6,14,15,17,30 3.Demonstrate the ability to co-ordinate delivery of nursing/health care ,14,15,16,17,22,24,,25, 30 O. Demonstrate key skills 1.Literacy - interpret and present information that is comprehensible; 11,21 2.Numeracy - accurately interpret numerical data and their significance for safe delivery of care; 27,28,29,31,32,33,36,3 8,39 3.Information technology and management - interpret and utilise data/technology, taking account of legal, ethical and safety considerations, in the delivery and enhancement of care; 4 .Problem solving - demonstrate sound clinical decision making that can be justified even when made on the basis of limited information. 26 See domain 2:8 14,19,25,30 LO 9 32 Mentors assessmen t Met in clinical tutorial process or University teaching MET IN COMM UNITY LEARNING OUTCOMES MAY BE ACHIEVED ACROSS ALL CLINICAL PLACEMENTS ESC’S PLACEMEN T Domain 4. Personal/Professional Development P. Demonstrate a commitment to the need for continuing professional development and personal supervision activities in order to enhance knowledge, skills, values and attitudes needed for safe and effective nursing practice. 1.Identify own professional development needs by engaging in activities such as reflection in and on practice and lifelong learning; 12 2. Develop a personal development plan that takes into account personal, professional and organisational needs; 5,25 3.Share experiences with colleagues and patients/clients to identify additional knowledge / skills needed to manage unfamiliar or professionally challenging situations; 1,5,12,20,25,27, 30 4.Take action to meet any identified knowledge and skills deficit likely to affect the delivery of care within current sphere of practice. 7,8,12,33,36,42 Q. Enhance the professional development and safe practice of others through peer support, leadership, supervision and teaching. 1.Contribute to creating a climate conducive to learning; 2.Contribute to the learning experiences and development of others by facilitating the mutual sharing of knowledge and experience; 3.Demonstrate effective leadership, in the establishment and maintenance of safe nursing practice. 9,25,27 6,9,22,24,25,27 9,19,24,25,30 33