pilot trial report - rda northern rivers · pilot trial report december 2010. 2 ... for collating...

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Clinical Placement and Education Program

Pilot Trial Report December 2010

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ContentsAcknowledgements ..................... 3

About the Authors ....................... 3

Executive Summary ..................... 4

Introduction ................................. 6

The Learning Program ................. 8

Direct Outcome Measures and Evaluations ................................ 10

Results ....................................... 10

Direct Outcome Measures ................................... 11

Evaluations ................................ 12

Capability Maps ......................... 15

Outcomes and Discussion ....... 16

The Financial Cost of the Program ........................... 18

Implications for Recruitment and Retention in Aged Care ............. 21

Recommendations .................... 21

List of References ...................... 22

Appendix 1 ................................ 24

Appendix 2 ................................44

Appendix 3 ................................ 46

Appendix 4 ................................ 48

Appendix 5 ................................ 50

Appendix 6 ................................ 52

AcknowledgementsThe vision for the Clinical Placement and Education Program came about from discussion between Anne Moehead and Natalie Carter and encouragement from Northern Area Health Services Forum, North Coast Area Health Service and Uniting Care Ageing North Coast.

Funding to trial the program came from Regional Development Australia – Northern Rivers IDEAS Project.

The implementation and success of the trial would not have been possible without the enthusiasm, commitment and contribution from the registered nurses from Uniting Care Ageing, the Nurse Educators, Nurse Managers and Preceptors Lismore Base Hospital, and the Project Manager the IDEAS Project.

Thanks also must go to Dr John Stevens for collating all the information and writing the report.

About the AuthorsNatalie CarterNatalie has spent the last eleven years with Uniting Care Ageing North Coast Region in various leadership roles including advancing to the newly formed position of Residential Group Manager. In this role Natalie oversees the management of five residential aged care facilities which are home to three hundred residents. Natalie has also been the Clinical Care Manager responsible for the establishment of a Regional Clinical Centre of Excellence. During her tenure at Uniting Care Ageing, Natalie has continued her pursuit of clinical excellence in aged care through the Joanna Briggs Institute Aged Care Clinical Fellowship in 2008 and undertaking the Masters of Health Science/Gerontology through the University of Sydney.

Nicola ScanlonNicola is a part time Acting Nurse Educator and a part time Registered Nurse on the General Intensive Care unit at Lismore Base Hospital. As a member of the hospital education team Nicola designs, plans, implements, and evaluates the delivery of nursing education and staff development programs, and manages educational resources.

Cheryl MunroeCheryl is a Clinical Nurse Educator at Lismore Base Hospital whose role is teaching and guiding registered and student nurses both in the clinical and theoretical setting. As clinical nurse educator Cheryl has responsibilities such as designing curricula, developing programs of study and related courses, evaluating learning, and documenting all phases of the educational process.

Anne MoeheadAnne is the Nurse Practitioner Psychogeriatrics/Dementia for the northern sector of the NCAHS, working in the acute hospital settings, where she assists in the treatment and management of older people with delirium, dementia and related behavioural problems. Anne has led a number of innovative projects over the years in an attempt to improve the services and outcomes for older people living in the Northern Rivers. She continues to work closely with her contemporaries in researching and reviewing opportunities to pursue excellence in aged care service delivery.

The IDEAS Project is a regional workforce development initiative funded by the Australian and New South Wales governments under the Targeting Skills Needs in the Regions Program. Regional Development Australia – Northern Rivers manages this project on behalf of the Aged and Community Services Association of NSW and ACT. Our brief is to increase the capability and expertise of the aged services sector on the north coast, and raise and diversify the skills of the existing aged services workforce.

The IDEAS Project is funding the Clinical Placement and Education Pilot Program because we believe that this is a visionary initiative. We commend all of those people who are participating and are very pleased to be able to support this project.

Ollie HeathwoodIDEAS Project manager.

Christine PaulingFor her assistance in delivering and finalising this program for IDEAS.

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Executive SummaryThe North Coast Area Health Service and the Uniting Care Ageing North Coast Region collaborated to develop and trial a learning program for aged care registered nurses. A grant to pilot the project was offered from the IDEAS Project Regional Development Australia – Northern Rivers. This money provided an opportunity to trial the intervention called The Clinical Partnership Program.

The aim of the learning program was to provide the opportunity for clinical registered nurses in aged care settings to update their clinical practice, skills and knowledge in more advanced specialised acute areas. The pilot program was designed, produced and implemented by a clinical nurse educator (CNE) from Lismore Base Hospital. The CNE was informed and managed by a steering committee made from the collaborating organisations. The program provided the opportunity for three registered nurses from UCANCR to spend five days (supernumery) in the acute care setting of the Lismore Base Hospital under the guidance of a clinical nurse educator and supported by a preceptor within the ward setting.

OutcomesThe overall outcomes of the pilot program were:

1. the improvement of interagency collaborations and future strategic planning

2. the development of an effective learning program that does indeed develop and renew acute care skills and knowledge of aged care nurses

3. the development of an evidence-based hypothesis: that this Clinical Placement and Education Program will reduce unplanned hospital admissions and reduced lengths of stay for residents of aged care facilities. (This in turn will produce significant cost savings to the acute sector and increase income to RACFs derived from a reassessment based on the Aged Care Funding Instrument.)

There were specific outcomes achieved by those who participated in the program. These outcomes included:

• development, implementation and positive evaluation of the clinical placement program • delivery of the pilot phase of the clinical placement program• completion of the well-validated Positive Approach to Older People, Dementia E-learning program • consolidation of partnerships between Uniting Care Ageing North Coast, NCAHS and the Regional Development

Australia, Northern Rivers, IDEAS Project• sharing of educational resources, learning packages and clinical expertise and knowledge • opportunity for the registered nurses to observe and participate in complex clinical decision-making pathways, research

innovations and clinical placement• the implementation of a process that can improve client outcomes with a seamless transition between primary, acute

and residential care services• the opportunity to develop professional networks in the North Coast Area between acute and residential care providers• enhancement of the clinical assessment skills of the Registered Nurse workforce at Uniting Care Ageing North Coast region• improved understanding of the attributes and limitations of service providers across the continuum of care from acute to

residential aged care.

Implementation and operational issues summaryAs this was a pilot project, a number of operational and implementation issues were identified that could be worked on to improve future versions of this program. These include:

• Clinical Nurse Educator Availability: During the pilot the CNE was unable to exclusively devote full time to the participants for the four days of the clinical placement. This was due to NCAHS staffing availabilities. The participants were somewhat disadvantaged by this and the program would have been more successful if they had total access to the CNE. Future programs should consider quarantining the CNE position or at least developing a contingency plan in the absence of the CNE

• The Participating Nursing Unit Managers Availability: One of the permanent NUMs who had originally agreed to participate in this program was unavailable during the week of the placement. The support from the NUM is integral, supporting the program in regards to bed management, ward managerial issues, workload and ensuring appropriate skill mix and clinical preceptor support available for the participants. Future programs should consider that the usual ward NUMs be available at the time of the placement. Preliminary briefing, information packages for NUMs and how they can assist and support the process should be developed, outlining the expected resource demand and intended outcomes for the participant and the role of the CNE

• Holistic care and preceptorship: The preceptor model of knowledge transference is based on providing holistic care to the patient which would include meeting all patient needs such as bed making and personal care; this would be regardless of the clinical experience and knowledge of the participant.

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• Priorities in future program deliveries: If a modified program is to be undertaken that lacks resources it was noted through this study that skill development was primarily obtained through the workshops and practical skills development delivered under instruction of the CNE. The preceptors were able to reinforce and demonstrate these skills learned in the theory workshops

• The completed participants should act as mentors to their aged care colleagues and take on a clinical leadership role in their chosen area of specialty or within their clinical area

• Future programs should consider the importance of staggering the aged care nurses start day to provide one-to-one clinical facilitation.

Main RecommendationsThe following list emerged as recommendations from the data of this evaluation of the project:

1. Given the lessons learned during this pilot program, funds should be sourced to extend, improve and repeat the program

2. Clinical pathways between LBH and Uniting Care Ageing should be established that would:

• reduce admissions from RACF to LBH

• facilitate the efficient and appropriate return of residents to RACF directly from ED following triage resulting in avoidance of admission

• facilitate earlier discharge to RACF from ward areas

• determine reasons for delay of patient return to Uniting Care Ageing in a timely manner

3. Area Health Service should consider adding to medical records, information indicating if someone has been admitted from an aged care facility

4. That the ACTFI be adjusted to allow the resourcing of the management of acute care episodes within the RACF to reduce the frequency of hospital admissions

5. Uniting Care Ageing should assess equipment needs and purchase resources to facilitate the acute care management of residents, such as ECG machines, infusion pumps, defibrillators

6. An agreement should be developed to allow an advanced practice acute care nurse from NCAHS to assess UCA facilities, equipment and consult on skills required to meet these stated objectives

7. Uniting Care Ageing should consider contracting NCAHS educators to develop continuous professional development in acute care skills and practice

8. Uniting Care nurses should provide in-service to acute care nurses on a regular basis on clinical nursing of the older person whilst being managed in the acute care setting

9. Uniting Care Ageing should adopt NCAHS clinical policies and procedures on PICC, IV therapy, IV cannulation; by sharing these policies this will maintain standards and evidence-based practices

10. Uniting Care nurses should present to LBH ED/ASET/AARCS/Discharge Planner/NUMs regarding clinical pathways and patient flow back to Uniting Care

11. That the collaboration be added as a permanent agenda item for all future Northern Health Services Forums

12. This pilot and evaluation could be presented at a conference and Northern Services Health Forum. The pilot should be published in a peer-reviewed journal

13. Production of the program handbook and syllabus.

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IntroductionContextCommonwealth and state government reports as well as the academic literature of recent years clearly indicate a trend which shows the intersection of three phenomena that will be responsible for shaping health and aged care services in the very near future (AIHW 2009, NSW Dept Health 2008, Productivity Commission 2005, Happell 2002, 2007, Stevens 2010). These phenomena are:

• the ageing and ageing-related epidemiology of the population• the predicted workforce shortages in the health and aged care sectors• the diminishing resources, relative to growth, available to support the health of our ageing population.

McDonald (2007) specifically identified shortcomings in current models of care when residents were transferred to and from acute care facilities. McDonald showed both the human and financial cost of this nationally, generally mismanaged, arrangement and warned of a crisis of care and resources as the population ages.

At the Northern Health Services Forum in June 2009 strategies were considered for dealing with these developing constraints within the health and aged care services in the Northern NSW area. In order to meet the demand of the increasing ageing population in the North Coast and to achieve optimal outcomes for the older person when they present for acute care, it was considered imperative that acute and primary health services, generally provided by NCAHS, collaborate and co-operate with partner aged care providers. The forum developed a strategy to explore opportunities that strengthened and built on professional networks; as well it considered how the sharing of resources, knowledge and clinical expertise can be improved.

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Anne Moehead (NCAHS) and Natalie Carter (Uniting Care Ageing North Coast Region – UCANCR) were charged with the responsibility of developing a plan to enable the sharing of resources such as education, clinical knowledge and models of care between acute care services and RACF in the northern sector. It was during this planning process that the idea for the Clinical Placement and Education Aged Care Program (CPEACP) was formed.

The intention of the initiative was to design and pilot an intervention to enable clinical registered nurses working in residential aged care facilities (RACF) to gain new clinical skills and competencies, and update their current clinical practice, skills and knowledge in more advanced specialised acute care settings.

If the intervention did increase and improve skills and knowledge of the UCA RNs it was possible that it would also have knock-on effects in the:

• care of residents requiring increased acute interventions• number of unplanned transfers to acute care services• length of stay of residents who require acute care• cost of services• income to RACFS• job satisfaction, status and recognition of aged care nursing within the community• recruitment and retention of nurses in aged care• collegiality between aged care and acute care services and RNS.

ConsultationThe idea for the program was presented at the Northern Health Services Forum at the October 2009 meeting. A recommendation was made from the forum to put forward a brief to the executive of NCAHS and Uniting Care Ageing (UCA), to advance the proposal.

Anne Moehead took a lead role in the consultation process with the NCAHS Area Nursing & Midwifery Directorate, Director of Nursing Richmond Network and Lismore Base Hospital (LBH), NCAHS Area Aged Care Coordinator, members of the NCAHS Health Advisory Committee and the LBH Nurse Educator’s and the Project Manager IDEAS Project Regional Development Australia – Northern Rivers, Uniting Care Ageing Care Leadership Team, UCANCR Care and Governance Committee, service Managers and the three clinical Registered Nurses.

Project Funding A grant to pilot the project was offered from the IDEAS Project Regional Development Australia – Northern Rivers. This money provided an opportunity to trial the intervention called The Clinical Partnership Program, evaluate, adapt and modify the program. The recommendations of this pilot would inform the group and provide evidence for consideration of a larger trial of the program if feasible and if funding could be found.

The project was provided with $28,157.00.

These funds were used to resource the:

• participation and backfill of the three registered nurses in the five day clinical placement • participation of a NCAHS clinical nurse educator (CNE)• development and production of the learning program • in-service and briefing of the NCAHS preceptors• evaluation of the project• dispersement of findings.

The IDEAS ProjectThe IDEAS Project is a regional workforce development initiative funded by the Australian and New South Wales governments under the Targeting Skills Needs in the Regions Program. Regional Development Australia – Northern Rivers manages this project on behalf of the Aged and Community Services Association of NSW and ACT. Their brief is to increase the capability and expertise of the aged services sector on the north coast, and raise and diversify the skills of the existing aged services workforce.

What follows is a report on the project that describes the learning program and its implementation, the methods of data collection for evaluation, the results of the evaluation, outcomes and discussion of these results and final recommendations.

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The Learning ProgramDevelopment ProcessThe process of designing the learning intervention was a collaborative effort drawing on the literature as well as the expertise and experiences of the project team. A steering committee led the governance of the project, developed the ideas and learning outcomes and engaged a senior nurse educator at LHB to produce and implement the learning intervention package.

Uniting Care RNs had previously met as a group with the Clinical Practice Manager Uniting Care and identified a number of clinical barriers and inadequate staff skill bases that prevented the residents in the Uniting Care facilities from being cared for and managed within the facility. These clinical issues were highlighted when the residents presented with a functional decline or an acute exacerbation of their co-morbidities; the staff were committed to avoid transfer to hospital and expressed a desire to manage the acute presentations in the comfort of the residential care facility. The Clinical Practice Manager and the NP psycho geriatrics met to develop a strategy to address these issues and to design a clinical placement program in partnership with the Lismore Base Hospital that would ultimately improve the patient journey through the acute care system.

An opportunity then presented to combine with the IDEAS Project Regional Development Australia – Northern Rivers who supported the ideas of the project and generously offered some money to pilot the program. The time was right to proceed with further consultation of key stakeholders, develop a steering group and progress implementation and delivery of the program.

Overview of the Learning Program What follows is a brief summary of the learning package. The package and implementation are described and provided in full in the Program Handbook (Appendix 1).

The purpose of the NCAHS and the Uniting Care Ageing North Coast Region Clinical Placement and Education Program was to provide the opportunity for clinical registered nurses to update their clinical practice, skills and knowledge in more advanced specialised acute areas. The three-month pilot program was designed, produced and implemented by a senior nurse educator from Lismore Base Hospital, and informed and managed by a steering committee made from the project group. The program provided the opportunity for three registered nurses from UCANCR to spend five days (supernumery) in the acute care setting of the Lismore Base Hospital under the guidance of a clinical nurse educator and supported by a preceptor within the ward setting.

An orientation day program, clinical learning packages and demonstrations of clinical competency achieved by the registered nurses was included as the main components of the total package. Access to the NCAHS dementia online program was also provided and integrated into the learning package (Appendix 1). The nurses were required to identify their self-identified learning goals and how these will be achieved and implemented back in their workplace. These learning goals were used to develop the content of the orientation day and the clinical placement. A learning program handbook (Appendix 1) was developed that described the program aims and objectives, assessments and processes.

The AimThe aim of the learning program was to develop the confidence and competence of the aged care registered nurse so that it effectively facilitates the opportunity to progress enhanced learning and currency of practice within the acute care setting.

The ObjectivesOn completion of the program it was expected that the registered nurse should be able to:

• demonstrate competency in clinical nursing within the acute care setting• demonstrate excellence in clinical practice that progresses the aged care agenda within the North Coast• demonstrate a commitment to personal and professional development• demonstrate knowledge of, and compliance with, physical assessment, intravenous medication administration basic life

support, ECG intravenous cannulation management • demonstrate application of Richmond Network clinical practice guidelines • support others in learning situations• contribute positively to the profession of nursing• develop learning partnerships with NCAHS • share educational resources and clinical expertise and knowledge and apply this back in the aged care setting

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• improve client outcomes with a seamless transition between primary, acute and residential care services• develop professional networks in the North Coast area.

The Processes of the Learning ProgramThe main structure activities of the program included:

• A one-day program and LBH orientation with learning packages for: ❑ IV medication administration

❑ PICC line management

❑ Basic Life Skills

❑ Automated External Defibrillator

❑ Health documentation such as, the national inpatient medication chart, Standardised Adult General Observation (SAGO) chart and other relevant documents were also provided on the day

❑ Preparation for clinical practice

• A five-day supernumerary clinical placement with a preceptor ❑ A five-day clinical placement roster was drawn up to provide the clinical experience in the areas identified as

appropriate. These areas included rotation to orthopaedics, medical oncology, and general medicine. This ensured a broad learning experience for the nurses. They were supernumerary, allocated a preceptor and worked together with the preceptor managing a patient workload for the morning. Each afternoon the UCANCR nurses had ‘off the ward’ structured workshops and reflective practice sessions with the clinical nurse educator

• The Positive Approach to Care of the Older Person Dementia E-learning Program ❑ All UCANCR nurses were enrolled in the 12-week x 4-module Dementia E-learning program. This is a facilitated

online learning program. The syllabus includes person-centred care, a biomedical overview of dementia, differentiating dementia/delirium/depression, the importance of hydration, nutrition and mobility.

* The completion of the clinical placement program attracted 20 hours CPD plus completion of the dementia online program attracted 25 hours CPD.

The UCANCR nurses were orientated to the hospital and clinical areas and introduced to the ward Nurse Unit Manager and their clinical preceptors who would assist and support them throughout the clinical experience.

The nurses were required to identify their self-identified learning goals and how these will be achieved and implemented back in their workplace. These learning goals were used to develop the content of the orientation day and the clinical placement.

A program handbook (Appendix 1) was developed setting out the program details, learning outcomes to be achieved, aims and objectives, assessment of skills and demonstration of clinical competencies and evaluation. This was aligned with the ANMC continuing competency framework. Access was facilitated for the nurses to access the NCAHS four-module dementia online program.

In preparation to work in the clinical setting the UCANCR, nurses needed to be compliant with health screening, code of conduct, police clearance and all relevant documentation required by NSW health (Appendix 2).

Recruitment of ParticipantsUCA RNsThree registered nurses who were clinical leaders within UCANCR were purposefully selected and recruited by the regions executive leadership team to participate in the pilot.

LBH Clinical Nurse EducatorA clinical nurse educator from Lismore Base Hospital was assigned to the project to assist the nurses in the clinical area by providing a structured learning experience. Her role was to provide support, teach and assess clinical skills and assist the participants to work through the learning packages.

The PreceptorsThe CNE had allocated the clinical preceptor for each participant based on the availability, skill level and experience of the preceptor.

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Direct Outcome Measures and EvaluationsDirect Outcome MeasuresIn addition to the evaluation data described below, the main direct outcome measures included:

• the new and renewed competencies achieved during the program by the RACF nurses as measured by reports from the Nurse Educator

• the transfer of the practice development and competencies from the acute care setting to their RACF workplace and practices as measured by reports from the UCA RNs within the three-month trial time frame.

EvaluationsAn evaluation of the program was undertaken with a set of survey questionnaires administered by the steering committee to the key stakeholders. These stakeholders included the:

• Uniting Care Nurses (Appendix 2)• Clinical Nurse Educator (Appendix 3)• Ward Nurse Managers (Appendix 4)• Preceptors (Appendix 5).

The evaluation surveys aimed to describe outcomes and tap into the experiences and perceptions of the stakeholders. The evaluations were tailored to each stakeholder group and used statements linked to a 1–5 Likert scale (5 being highest positive score) and/or open-ended questions. See Appendices 2, 3, 4 and 5.

ResultsThis section describes the findings from the recruitment of participants, the implementation of the learning program, the direct outcome measures and the evaluations.

The ParticipantsThe 3 participants recruited from UCANCR were very senior, experienced registered nurses working at Deputy Director of Nursing level. Each of the participants brought unique skills and viewpoints to the program, together with an industry experience ranging from 15 to 40 years in the aged care services. Importantly they represented both high care and low care facilities with 2 of the participants managing 70- and 80-bed, high care facilities respectively and the third a manager in an 80-bed, low care facility with a 20-bed dementia specific unit and ageing in place. They each demonstrated a strong commitment to the program and to their personal clinical skill development. Significantly, each participant has been able to utilise the experience from this program to integrate important changes into the ever-evolving aged care industry. Changes such as the development of the necessary policies, procedures and clinical pathways and guidelines to support the implementation of IV therapy, ECG monitoring and PICC line management or mentoring clinical nurses to develop their physical assessment skills and provide complex clinical care.

Feedback from participants indicated that:

1. the successful completion of this course would upskill the RN workforce in clinical competencies such as IV line management, PICC line management, physical skills assessment and ECG monitoring and interpretation, enabling residents of RACF to be treated in the facility, or alternatively be discharged from the acute hospital earlier

2. this program would be valuable for all RNs to participate in, especially to update and refresh their skills and practice, which would lead to better assessment, more timely response to escalations in disease processes and better health outcomes for the older person in care.

Results of the ImplementationAll components of the learning program as described in the Handbook (Appendix 1) were delivered to the three UCA RNs in the time frames as intended. All three nurses completed:

• the orientation day and Lismore Base Hospital Orientation Day Learning Packages• the five-day supernumery placement • the Positive Approach to Care of the Older Person Dementia E-learning Program.

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Direct Outcome Measures1. During the learning program the three UCA

RNs were able to develop new or renew the following ANMC competencies and skills through successful demonstration to the Nurse Educator. All participants were assessed using LBH criteria and deemed competent in the following:

• Undertaking and basic interpretation of a 12 Lead ECG

• Delivery of intravenous medications and antibiotics

• Infusion pump management

• Care of the IV cannula and IV cannulation (theory only)

• Care of a PICC line

• Update and refresher on physical assessment skills

• Basic Life Support skills, cardio-pulmonary resuscitation and demonstration of Zoll automated external defibrillator

• Stages of shock

• Management of chemotherapy oral medication and management of cytotoxic spills and waste

• Introduction and application of the national inpatient medication chart and the standardised adult general observation charts.

2. The transfer of the practice development and competencies from the acute care setting to their RACF workplace and practices.

Physical Assessment of Residents The advanced physical assessment skills of the older person have been applied in all three RACFs with an identified positive outcome for a resident of Caroona Kalina and NCAHS. The resident in question was able to be cared for in the home, since as a result of communicating with the GP, increasing the observation of the person’s vital signs and reporting with him directly, the GP had confidence that the physical signs and symptoms were well monitored and their care needs were attended to by a skilled workforce. As a result of the renewed skills and competencies the RN was able to support the GP and the resident was able to remain in the home and not be transferred to the Lismore Base Hospital.

The full cost weight for the last episode of care for this patient was estimated at 10.76. At the current case weighted price of $3734 this equates to a total cost of $40,178 for the stay. It could be proposed that this amount was saved due to the management and renewed skill base of the RN.

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EvaluationsParticipant’s Evaluation of Clinical Exchange ProgramThe Uniting Care Nurses Clinical Experience

Two evaluations, one quantitative and one qualitative, were undertaken with the Uniting Care Nurses.

The quantitative survey is reported on as follows:

This mostly quantitative evaluation used seven Likert scale statements describing the three UCA RNs experiences in the program and one open-ended question asking for additional comments. The Likert scale measures were: strongly agree, agree, neither agree or disagree, disagree, strongly disagree. The evaluations were analysed and the findings are presented below for each

1. Support from the clinical nurse educator (CNE)?Likert scale rating = agree x 3

2. Support from the ward nursing staff?Likert scale rating = strongly agree x 2, agree x 1

3. Good communication with the multidisciplinary team?Likert scale rating = agree x 3

4. Opportunities to develop skills from the preceptors and apply these in the workplace?Likert scale rating = strongly agree x 1, agree x 2

5. Supported from the NUMS?

Likert scale rating = agree x 2, neither agree or disagree x 1

6. Increase in confidence in the clinical setting?Likert scale rating = strongly agree x 1, agree x 2

7. Achieving clinical competencies?Likert scale rating = agree x 3

Additional Comments Additional comments were provided on the evaluation forms (these have been paraphrased and re-interpreted rather than quoted directly in order to de-identify the participants):

• All three participants reported high levels of clinical support from the CNE. However it was recommended that more CNE one-on-one supervision and support be available on the first day of the clinical placement on the ward. This would have assisted with a more intensive exchange of knowledge and delivery of relevant clinical care.

• The CNE had allocated the clinical preceptor for each participant based on the skill base and experience of the preceptor. One participant experienced a reallocation of their preceptor by the NUM, which resulted in a reluctant preceptor on that particular ward. This emphasised the importance of a preceptor that is committed to the learning needs of the participant.

• The participants expressed the valued opportunity gained working alongside the medical and multidisciplinary teams.

• Skill development was primarily obtained through the workshops and practical skills development delivered under instruction of the CNE. The preceptors were able to reinforce and demonstrate these skills learned in the clinical environment.

• The preceptors supervised the practice and provided clinical feedback on the skills acquired by the participants whilst at the bedside.

• LBH clinical policies and procedures were provided and referenced within evidence-based practice. These policies could be adapted to provide clinical guidance back in the aged care setting.

• Overall the NUMS were welcoming and provided support and a positive learning environment for all the participants. However due to their workload they were not intimately involved in the process.

• A variety of clinical speciality areas were provided for each participant. This was embraced by some of the participants however it was also identified that five days was inadequate for a rotational placement and a preference for remaining on the one ward was suggested. The challenge was in adapting to a new environment and working with a new preceptor.

• The experience provided the opportunity to revisit and update clinical skills for these Uniting Care nurses in the acute care setting.

• It did significantly enhance clinical confidence in their specific identified learning objectives.

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The qualitative evaluation is described and reported on below:

1. The participants were asked to list the new clinical skills and competencies gained from the clinical experience. These were as listed.

• IV medication administration

• Management of Baxter IV pump

• PICC line management

• PICC line dressings

• ECG recording and basic ECG interpretation

• Updated patient physical assessment skills

• Basic Life Support and use of Zoll defibrillator

• Stages of shock

• IV cannulation (theory only).

2. Which of these skills have you been able to apply in the workplace?

All three candidates stated physical assessment skills with one participant stating that through communication with a GP, increasing the resident’s vital signs and closer observation, a resident was able to remain in the facility thus preventing a hospital admission.

3. Which skills have you not been able to apply in the workplace and why?

None of the other skills have been utilised due to:• lack of policy/procedures/clinical pathways

• lack of equipment/resources

• skill mix

• RN staffing levels

• Workforce that do not have the skills to be able to accept patients requiring these treatments back from acute hospital.

4. Would you recommend adopting this program for all RNs and why?

All three participants would recommend this program for other aged care RNs to: • update and refresh their clinical/assessment skills

and practice

• provide positive outcomes for residents in aged care facilities

• prevent admissions to hospital

• shorten length of stay if in hospital

• attract registered nurses into aged care by breaking down barriers between aged care and public hospital system

• retain skills

• have two way communication/conversations and exchange of information with the acute care hospital regarding what aged care nursing is about and in relation to the needs of the aged care residents.

With a more supported and structured program it would be a valuable update/refresher for all RNs clinical assessment skills which would ultimately lead to better outcomes for residents.

Providing the program is modified to ensure that at all times it provides a very supportive, safe and conductive learning environment.

5. Are there additional resources required to support the implementation of this program?

• Policy and procedure guidelines/manuals/clinical pathways to be implemented to facilitate safe, consistent practice

• Adequate equipment

• Ongoing education and support for all staff to support the retention of skills once gained

• PR/Liaison coordinator for all stakeholders to provide information on the program/to “sell” the program to Uniting Care Australia and NCAHS staff

• Infection control education to all staff

• Staffing RN review need to increase.

6. Are the skills you have gained transferrable to other staff? If so how would you implement these skills?

• Yes, once consolidated/refreshed at point of care as situation arises. Small group 1:1

• Skills such as PICC lines and IV therapy are transferrable on a 1:1 basis at the point of care as the need arises with the support of other staff such as Lismore Base Hospital educators to ensure competencies are consolidated and skills kept current and refreshed

• With 1:1 support from NCAHS as a resource person at the point of care once the process/paperwork and staff are in place

• Updated and refreshed clinical assessment skills transferrable through handovers to RNs/EENs and when the need arises with residents, for example increase in observations, oxygen saturations etc.

• Need support from LBH educator

• Adopting some of LBH guidelines e.g. ISBAR and the assessment tool.

The Clinical Nurse Educator EvaluationNine questions and responses from the CNE are reported on below:

1. Did you feel you were prepared for the clinical education and placement of the aged care nurses?

Yes – fully aware of the nurses learning needs.

2. How did the aged care nurses demonstrate skills and knowledge?

Through dialogue and practice as well as discussion on the orientation day and accumulation of their years of nursing experience.

3. How well did they integrate into the ward routine?

They worked within their scope of practice in a safe and confident manner. Treated patients and staff with respect.

4. What insights and benefits did they bring to the acute care setting?

They shared their clinical knowledge and practices from the residential aged care setting.

Enlightened the acute care nurses to the challenges of the residential aged care setting.

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5. What did you perceive to be the attitudes and beliefs of the aged care nurses practice?

Delivering holistic care. Ageing in place. Managing nutrition, skin integrity, chronic health,

mental health and wellness, maintaining patient dignity and quality of lifestyle.

Supporting their staff and maintaining a safe happy active environment.

6. Did your understanding about older people living in care change as a result of this experience?

No real change but a better appreciation is applied to ensure the dignity of older people is maintained.

7. Do you think this experience will improve relationships between acute and aged care?

Yes definitely.

8. Do you think this learning program will impact on patients returning to residential aged care facilities?

Yes.

9. How could this program be adapted/extended to provide mutual benefits to both facilities?

All nursing staff in aged care to become upskilled. Facilitate early return to aged care. Decrease acute care bed block. Provide continuity of care to patients. Both facilities not to be financially disadvantaged.

The NCAHS Ward Preceptors EvaluationNine questions were asked of the preceptors and their responses are collated below:


Yes – knew in advance that Uniting Care nurses were coming to the ward.

Yes, the visiting RN was very capable and not flustered in an acute setting.

Found out on day at handover. Yes, I knew the day before. Not prepared as only found out about the program in

the morning but felt confident and comfortable working with the nurse.


Planning care together. Able to apply theory to practice with IV drug

administration and patient assessment. Communicating knowledge and/or questioning

throughout shifts. Through performing all tasks involved in a patient’s

care.


Slight apprehensiveness. No problems adapting to ward routine. Worked within

scope of practice and asked advice.

Integrated well. No issues. Excellently. Integrated well into ward routine. Patient safety was

maintained throughout.


Knowledge and experience was a great help.

Excellent interpersonal and communication skills.

Great potential to provide insight with age-related issues.

By giving feedback about the patient within their “home” environment.

By providing feedback about returning patients to their home.


Here to learn more advanced care.

Improve care in the nursing home.

Did not explore this area.

Unsure.

Limited understanding.


No change. I understand they receive an excellent level of care. No, already had good understanding. No, as my knowledge has barely increased. Not really as did not talk about aged care facility.


Understand the pressures in acute care including paperwork, profiles and referrals.

Developed even more respect for aged care nurses after observing the excellent level of care they provide.

Clearer understanding of how each area works. It is an excellent program and I believe acute nurses

going to aged care would also benefit. It will benefit and free up acute care beds if we can

send patients back to the aged care facilities with PICC lines and requiring IV antibiotics.


More comprehensive care. Better management with understanding of acute care

nursing process and recognise acute changes quicker so patients requiring IV therapy or IV antibiotics could stay in their own environment.

Provides better communication between staff at both facilities therefore must improve patient outcomes.


No comment. More frequent exchanges.

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More aged care staff to participate to enable them to administer IV antibiotics so patients could leave hospital earlier.

Make sure all RNs from aged care facilities come through.

Regular exchange programs between acute care and aged care facilities.

The Nurse Unit Managers Evaluation

Nine questions were asked of the nursing unit managers and their responses are collated and presented below:


Yes, plenty of forewarning however would have preferred more info about what they specifically needed to learn.

Yes. Yes.


Ward preceptor would be better to answer this question.

Part of the team.

Actively involved in discussions regarding patients’ management.

Worked with the ward RN and cared for patients together.

Partnered with RN, discussed care issues and were actively involved in care.


Fabulous! Buddied with the ward RN and worked as a team. Very well. Aware of their own scope of practice and

boundaries. Probably needed to be prepared with LBH guidelines

re. OH&S prior to commencement of clinical placement.


Aged care perspective was good. Fresh eyes on our aged care patients. Brought perspective of other areas of nursing and

patient care to acute ward. Insight into aged care; some good conversations with

LBH staff. Networking.


Previously very good understanding as on an aged care network committee.

No comment.

Types of service they provide and some of the limitations they face.


Yes, enhanced a little regarding what happens.

No.

No.


Both facilities have better understanding of each other’s areas.

Better communication between nurses who provide different levels of care to patients.

Better understanding of each other’s skills and work load.

Good network, now when I ring this facility I generally speak to someone I’ve met.

The aged care nurses have developed an understanding of what we do and our limitations, especially bed blockages!


Better relationships will improve communication between acute and aged care.

RACF would phone us if they don’t get discharge summary etc.

Better prepared transfers.

Should facilitate a quicker return.


They should come with own educator.

Have longer in the one clinical place.

Acute nurses going into aged care facilities.

Capability MapsA tool called a capability map was used to identify key practice development areas prior to the placement and then to evaluate outcomes on completion. Each participant was requested to complete the exercise at culmination of the placement and on return to Uniting Care.

The capability maps measure practice development that resulted from the program on five core skill areas: 1) Interpersonal development; 2) Infection control; 3) Observation/assessment; 4) Hygiene; and 5) Nutritional status.

The capability maps of the three participants can be found in Appendix 6. They show that most of the practice development was within the core skills development of interpersonal development and observation/assessment.

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Outcomes and Discussion This section recaps with a synopsis of the program. The outcomes of the program are presented and then the implications of the outcomes discussed.

SynopsisThe North Coast Area Health Service and the Uniting Care Ageing North Coast Region Clinical Placement and Education Program collaborated to develop and trial a learning program for aged care registered nurses. The aim of the learning program was to provide the opportunity for clinical registered nurses in aged care settings to update their clinical practice, skills and knowledge in more advanced specialised acute areas. The pilot program was designed, produced and implemented by a clinical nurse educator (CNE) from Lismore Base Hospital. The CNE was informed and managed by a steering committee made from the collaborating organisations. The program provided the opportunity for three registered nurses from UCANCR to spend five days (supernumery) in the acute care setting of the Lismore Base Hospital under the guidance of a clinical nurse educator and supported by a preceptor within the ward setting. There were three main direct outcomes of this project as well a list of operational issues that were encountered and suggestions for the program’s improvement and these are presented below:

Outcomes1. Established and Improved Interagency Collaboration

The NCAHS and UCA Northern Rivers were able to develop a process to meet and collaborate on strategies for staff practice development and improving the health and wellbeing of older people and the rationalisation of health and aged care resources.

The collaboration was able to develop a rigorous project proposal, and submit for and be successful in attracting funding from the IDEAS Project.

The collaboration was able to construct governance and communication pathways in order to manage the overall project, the staff and the funds from the grant.

The evaluations showed that staff from both organisations had an improved perception and respect for each other’s role and practice.

2. A Program of Learning that Achieves its Aims

The funding allowed for allocated Clinical Nurse Educator time for the project. The CNE managed the development, implementation and evaluation of the program of learning.

The program aimed to provide staff from UCA RCFs the opportunity to develop new or renew skills and knowledge in caring for acutely ill people.

The pilot and evaluation of this learning program with three UCA RNs indicates that this aim was met within the time frame and teaching and learning resources were available to them.

The evidence from evaluations and direct observation showed that:

• there was a high level of satisfaction with the program from all stake holders• the program was well planned and communicated throughout the organisations• new or renewed competencies and knowledge were developed in:

❑ undertaking and basic interpretation of a 12 Lead ECG

❑ delivery of intravenous medications and antibiotics

❑ infusion pump management

❑ care of the IV cannula and IV cannulation (theory only)

❑ care of a PICC line

❑ physical assessment skills

❑ Basic Life Support skills, cardio-pulmonary resuscitation and demonstration of Zoll automated external defibrillator

❑ knowledge of the stages of shock

❑ the management of chemotherapy oral medication and management of cytotoxic spills and waste

❑ the application of the national inpatient medication chart and the standardised adult general observation charts

• as a result of the program the UCA RNs felt more confident in working in an acute care environment and believed they would be able to transfer this confidence in their normal aged care work setting

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• as a result of the program the UCA RNs felt that they were indeed able to apply the new or renewed knowledge and skills in their RACF workplace. The ability to fully implement all new learnt skills appeared to be limited due to lack of resources at their respective workplaces. The UCA RNs believed that the full benefit of their new knowledge and skill is dependent on Uniting Care Ageing North Coast Region purchasing and providing clinical resources, such as ECG machines, infusion pumps and defibrillators

• as a result of the program an unplanned hospital admission was prevented. Within a week of returning to the RACF one of the UAC RNs reported having been able to use the skills gained through the program to circumvent an unplanned transfer from the RACF to Lismore Based Hospital.

3. The development of an evidence-based hypothesis: that this Clinical Placement and Education Program will reduce unplanned hospital admissions and reduced lengths of stay for residents of aged care facilities. (This in turn will produce significant cost savings to the acute sector and increase income to RACFs derived from a reassessment based on the Aged Care Funding Instrument.)

Implementation and Operational Issues As this was a pilot project a number of operational and implementation issues were identified that could be worked on to improve future versions of this program. These include:

• Clinical Nurse Educator Availability: During the pilot the CNE was unable to exclusively devote full time to the participants for the four days of the clinical placement. This was due to NCAHS staffing availabilities. The participants were somewhat disadvantaged by this and the program would have been more successful if they had total access to the CNE. Future programs should consider quarantining the CNE position or at least developing a contingency plan in the absence of the CNE

• The Participating Nursing Unit Managers Availability: One of the permanent NUMs who had originally agreed to participate in this program was unavailable during the week of the placement. The support from the NUM is integral, supporting the program in regards to bed management, ward managerial issues, workload and ensuring appropriate skill mix and clinical preceptor support available for the participants. Future programs should consider that the usual ward NUMs be available at the time of the placement. Preliminary briefing, information packages for NUMs and how they can assist and support the process should be developed outlining the expected resource demand and intended outcomes for the participant and the role of the CNE

• Holistic care and preceptorship: The preceptor model of knowledge transference is based on providing holistic care to the patient which would include meeting all patient needs such as bed making and personal care; this would be regardless of the clinical experience and knowledge of the participant

• Priorities in future program deliveries: If a modified program is to be undertaken that lacks resources it was noted through this study that skill development was primarily obtained through the workshops and practical skills development delivered under instruction of the CNE. The preceptors were able to reinforce and demonstrate these skills learned in the theory workshops

• The completed participants should act as mentors to their aged care colleagues and take on a clinical leadership role in their chosen area of specialty or within their clinical area

• Future programs should consider the importance of staggering the aged care nurses start day to provide one-to-one clinical facilitation.

Other Program Improvement SuggestionsIn addition to the implementation issues discussed above, the stakeholders offered four suggestions that could improve the Learning Program:

• The aged care RNs could come with their own educator • Have longer in the one clinical place• Acute nurses should go into aged care facilities as an extension of the program• A longer clinical practicum. 17

The Financial Cost of the ProgramThis section shows the calculations of the cost of developing and implementing this learning program.

Cost to NCAHSThe estimated cost of the program for NCAHS was $17,029. Calculations are shown below in Table 1.

Table 1 Cost Estimate for the Learning Program

Task Description Amount Total

Staff costs

(12 weeks of the pilot plus evaluation and preparatory writing up of the project)

Clinical Nurse Educator @ $38 per hour x 100 hours $3800.00

Nurse Educator @ $ 44 per hour x 95hrs $4136.00

Total educator costs $7936.00

10% consumables $793.60

121/2% oncost $992.00 $9721.60

Nurse Practitioner @ $52 per hour × 50hrs donated in kind. Included facilitation of the Dementia e-learning program $2600.00

Total staff costs for the 12-week pilot $9721.60

Dementia E-learning program

Facilitation and access to the 12-week Dementia online program for three Uniting Care staff

$1260.00 $1260.00

Evaluation Evaluation and write up of the program – John Stevens $2000.00 $2000.00

Printing Printing of the manual and the report $1000.00 $1000.00

Conference costs Conference attendance and presentation of pilot outcomes

$1500.00 $1500.00

Total other costs $5760.00

Costs exclusive of GST $15,481.60

Plus GST $1548.16

Total budget allocated and acquitted $17,029.76

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Cost to UCA NRCost to UCANCR

The estimated cost of the program to UCANCR was $10,115.28. The calculation is provided below in Table 2.

Table 2 UCANCR cost estimates for the learning program

Task Description Amount Total

Total funding

Staff costs 3 x registered nurse wages

1 x day orientation 8hrs @ $32.87 per hr x 3 = $789.00

5 x day clinical placement 38 hrs @ $32.87/hr x 3 = $3750.00 $4539.00

Contribution in kind clinical practice manager 50hrs @ $50.20 $2510.00

Replacement staff costs Cost of replacement of staff (18 shifts x 8 hour shifts )

144hrs @ $32.87 = $4733.28 $4733.28

On costs 10% on costs $927.72 $927.72

GST $927.27 $927.27

Total budget allocation $11,127.27

Total Cost The total cost of the pilot program (this excluded evaluation and information dispersement costs) was $28,157.03.

The cost per participant then was approximately $9385 each.

Potential Cost of RepeatsIf the program was repeated then based on current figures more than $13,000 of this expenditure was due to program and process development.

With development cost accounted for, the cost of repeats of this program would be significantly reduced to less than $5000 per participant.

Cost BenefitThe potential cost benefits to health service and RACFs resulting from this program are discussed in the following sub-section.

Implications of the Learning Program on Unplanned Admissions and Shortened Length of StaySkilled and knowledgeable clinical RNs who are able to conduct thorough clinical assessments, monitoring of vital signs, and managing PICC and IV lines would be hugely beneficial in the residential aged care setting. Their improved skill set would enable timely identification of physical deterioration and swift intervention and treatment to reduce the numbers of clients transferred to hospital. And by having the registered nurses with these improved skill sets for the acute services to discharge to could also reduce the length of stay for those who have been admitted to hospital.

In addition, the increased level of acuity of a resident cared for in the facility rather in an acute care service could also increase the funding derived from the Aged Care Funding Instrument (ACFI). As well, by having fewer unplanned and shortened lengths of stay less income is lost to the RACFs because of the resultant empty beds. Further analysis of this cost benefit is recommended.

A Hypothetical Cost Benefit Calculation Modelling Local and National StatisticsAs can be seen in Figure 1, since August 2009 there has been a steady increase in the number of unplanned transfers from residential aged care to acute care in the North Coast region. This is indicative of the national picture according to the Australian Institute of Health and Welfare (2008), McDonald (2007) and NSW Dept of Health (2008). These increases place demands on the resources of the acute care services of accident and emergency and the ambulance services.

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Figure 1 Unplanned Transfers from RACFs and Admissions to Acute Care Services in the North Coast Region

While the numbers of admissions to North Coast acute services from RACFs continues to increase, the average length of stay is also increasing: from 4.7 days in 2008 to 5.4 days in 2009 for high care clients and 6.9 days for low care clients. This increase is also indicative of the national trend (AIHW 2008, Karmel et al. 2008).

Hypothetical Sums

If by providing three Registered Nurses in each RACF with access to a practice development learning program such as the one described in this report (at approximately $5000 per participant = $15,000), unplanned admissions could be reduced just 10% and length of stay by one day then:

Unplanned Transfers in the Lismore Area

Admissions data from just six residential aged care facilities in Lismore to LBH for the twelve-month period July 2009 to June 2010 showed 300 unplanned transfers to hospital.

If the average length of stay was between 5.4 and 6.9 days then the savings would be between $149,850 and $191,475.

Lismore Hypothetical Calculations

30 residents x 5.4 x 925 = $149,850OR30 residents x 6.9 x 925 = $191,475

*As of June 2010 the average cost of an acute care bed = $925 per day (minimum cost)

Length of Stay in the Lismore Area

If the length of stay could be reduced by one day then the savings would be over $277,500.

(300 residents x 925 per day = $277,500)

Unplanned Transfers Nationally

At a national level there were potentially 52,000 unplanned transfers in 2001–2 (Karmel et al. 2008).

A 10% reduction in transfers would = between $26 and 33 million.

National Hypothetical Calculations for Unplanned Transfers

5200 x 5.4 x 925 = $25,974,000OR5200 x 6.9 x 925 = $33,189,000

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Length of Stay Nationally

If length of stay could be reduced by one day then the savings would be over $48 million.

(52000 x 925 = $48,100,000)

Implications for Recruitment and Retention in Aged CareAged care nursing, whilst being a specialty clinical area, suffers an image problem within the community and the nursing industry itself. The literature consistently argues that the poor image of aged care nursing is due to the ‘caring’ and ‘low-tech’ nature of the nursing practice as opposed to the ‘curative’ or ‘high tech’ nature of acute care nursing (Jackson, Mannix and Daly 2003, Happell 2007, Stevens 2010). Aged care nurses themselves feel that they are seen as less skilled and many are concerned that if they work in aged care that they will clinically de-skill and get stuck in the industry.

There is an image and a reality that RACFs are isolated from the acute care services and that collegial support and opportunities is reduced. This has a detrimental effect on the aged care nurses sense of self as a clinician, their job satisfaction, the perceptions of nurses in acute care of the skills and knowledge of the aged care industry and a lack of continuity of care for the older person in their disease process. The aged care industry is therefore considered by most new graduates as the least desired career option (Stevens and Crouch 1995, Happell 2002, 2007 and Stevens 2010) and the ability of the industry to attract highly skilled and effective clinicians is diminished.

Nazarko (1997) identified that job satisfaction and workplace values within the aged care sector were enhanced when partnerships with learning institutes were established and conjoint staffing exchanges were fostered.

RecommendationsThe recommendations emerging from these data are tabled as follows:

1. Given the lessons learned during this pilot the program funds should be sourced to repeat and extend the size of the trial

2. Clinical pathways between LBH and Uniting Care Ageing should be established that would aim to:

• reduce admissions from RACF to LBH

• facilitate the efficient and appropriate return of residents to RACF directly from ED following triage resulting in avoidance of admission

• facilitate earlier discharge to RACF from ward areas

• determine reasons for delay of patient return to Uniting Care Ageing in a timely manner

3. Area Health Service should consider adding to medical records, information indicating if someone has been admitted from an aged care facility

4. That the ACTFI be adjusted to allow the resourcing of the management of acute care episodes within the RACF to reduce the frequency of hospital admissions

5. Uniting Care Ageing should assess equipment needs and purchase resources to facilitate the acute care management of residents, such as ECG machines, infusion pumps, defibrillators

6. An agreement should be developed to allow an advanced practice acute care nurse from NCAHS to assess UCA facilities, equipment and consult on skills required to meet these stated objectives

7. Uniting Care Ageing should consider contracting NCAHS educators to develop continuous professional development in acute care skills and practice

8. Uniting Care nurses should provide in-service to acute care nurses on a regular basis on clinical nursing of the older person whilst being managed in the acute care setting.

9. Uniting Care Ageing should adopt NCAHS clinical policies and procedures on PICC, IV therapy, IV cannulation; by sharing these policies this will maintain standards and evidence-based practices

10. Uniting Care nurses should present to LBH ED/ASET/AARCS/Discharge Planner/NUMs regarding clinical pathways and patient flow back to Uniting Care

11. That the collaboration be added as a permanent agenda item for all future Northern Health Services Forums

12. This pilot and evaluation could be presented at a conference and Northern Services Health Forum. The pilot should be published in a peer-reviewed journal

13. Produce a handbook of the program and syllabus.

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List of ReferencesAIHW 2009, Australia’s Health 2008, AIHW, Canberra.

Byles, J, Wylie, K, Alle, M, Hellier, G, Penning, C, Nair, K, Sanson-Fisher, R, Kucera, B, Higgins, I & Parkinson, L 2004, ‘Recommendations for Implementation of dementia-specific education and training for hospital staff in the care of people with dementia in acute care settings’, Unpublished report to the NSW Department of Health.

Happell, B 2002, ‘Nursing home employment for nursing students: valuable experience or a harsh deterrent?’, Journal of Advanced Nursing, vol. 39, no. 6, pp. 529–36.

Happell, B 2007, ‘The older I get the more I worry: Attitudes of mental health nurses to working with older people’, Journal of Mental Health Nursing, vol. 16, no. 6, p. 371.

Jackson, D, Mannix, J & Daly, J 2003, ‘Nursing staff shortages: Issues in Australian residential aged care’, Australian Journal of Advanced Nursing, vol. 21, no. 1, pp. 42–45.

Karmel, R, Lloyd, J & Anderson, P 2008, ‘Movement from Hospital to Residential Care’, Data linkage series no. 6 cat no. CS16, AIHW, Canberra.

McDonald, T 2007, ‘For their sake. Can we improve the quality and safety of resident transfers from acute hospitals to residential aged care?’, report Commissioned by Aged Care Association Australia.

Nazarko, L 1997, ‘Staffing the homes’, Nursing Management, vol. 4, no. 3, pp. 22–23.

NSW Department of Health 2008, ‘Special commission of inquiry: Acute care services in NSW Public Hospitals’, (the Garling Report), NSW Dept of Health, Sydney.

Productivity Commission 2005, ‘Economic Implications of an Ageing Australia’, Research Report, Canberra.

Stevens, JA & Crouch, M 1995, ‘Who cares about care in nursing education?’, The International Journal of Nursing Studies, vol. 32, no. 3, pp. 233–242.

Stevens, J 2010, ‘Student nurses’ career preferences for working with older people: A replicated longitudinal survey’, International Journal of Nursing Studies (inpress).

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Appendices

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Appendix 1Exchange Program Handbook

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Welcome to the North Coast Area Health Service

Our VisionNorth Coast nurses and midwives work respectfully together harnessing energy to create person-centred care.

Welcome to the Richmond Network Clinical Placement and Education Aged Care Program. This new and innovative program is a partnership between NCAHS and Uniting Care Ageing North Coast which aims to provide the opportunity for clinical registered nurses to update their clinical practice, skills and knowledge by participating in a specially designed program to accommodate registered nurses working in the residential aged care environment

The program provides access to learning packages, clinical placement, preceptorship, mentoring and access to the NCAHS dementia online programme. You will be required to identify self-identified learning goals and how these will be achieved and implemented back in your workplace.

We are delighted to welcome you and hope that you will have a rewarding learning experience with us.

This handbook is designed to support you throughout the programme and to help you keep a record of your learning as you go. It can become the beginning of your portfolio.

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Table of Contents

Introduction 27

Context 27

Purpose 27

Duration 27

Responsibility of Assessment 27

Using Registered nurse Program Resources 27

Guide Icons 27

Learning Outcomes 28

Aim 28

Objectives 28

Program Details 28

Course Structure 28

Clinical Placement 29

Orientation 29

Lismore Base Ward orientation 29

Professional Development 29

During the program 29

Clinical Resources & Support 29

Draft Clinical Placement Program 29

Reflective Practice 29

NCAHS Internet e-Learning packages 30

Clinical Nurse Educators 30

Clinical Preceptorship 30

Helpful Hints 30

Practice Development 31

Completion of Registered Nurse Program 31

Evaluating the Program 31

Ward orientation check list 32

Draft Clinical Placement Program 34

Professional Development Plan – Forms ( A and B ) 35

Evaluating the Program form 36

Capability Map 39

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IntroductionContextThe North Coast Area Health Service Clinical Placement and Education Aged Care Programme provides the clinical environment and theoretical framework within which the registered nurse is able to strengthen clinical competencies, consolidate currency of nursing practice and enhance clinical assessment skills within the hospital acute care setting.

PurposeThe purpose of the program is to assist and support the professional development of the registered nurse working within the aged care sector who is seeking an opportunity to maintain currency of practice.

DurationThe Clinical Placement and Education Aged Care Program runs over 12 weeks.

Responsibility of AssessmentThe onus of responsibility for professional development remains with the registered nurse. As registered nurses, it is assumed they are safe nurse practitioners.

Using Clinical Placement and Education Aged Care Program ResourcesAs well as the Clinical Placement and Education Aged Care Program Handbook, you will also be provided with a number of other resources to support your learning throughout the program. As you use these resources you will encounter a number of icons that have a standard meaning.

Guide Icons

t Key Point

A significant item/statement that you may find useful for future reference.

r References

Direction to page, book, intranet etc where further information can be found. Journal articles are available through the Clinical Library.

a Activities

An individual or group exercise that facilitates the reinforcement of learning outcomes.

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Learning OutcomesAimTo provide a program, which develops the confidence and competence of the aged care registered nurse and effectively facilitates the opportunity to progress enhanced learning and currency of practice within the acute care setting. The engagement in the program commits to lifelong personal and professional development

ObjectivesOn completion of the Clinical Placement and Education Aged Care Program, the registered nurse will be able to:

• Demonstrate competency in clinical nursing within the acute care setting.• Demonstrate excellence in clinical practice that progresses the aged care agenda within the

North Coast• Demonstrate a commitment to personal and professional development• Demonstrate knowledge of, and compliance with, physical assessment, Intravenous

medication administration basic life support , ECG Intravenous cannulation management • Demonstrate application of Richmond Network clinical practice guidelines • Undertake the support of others in learning situations• Contribute positively to the profession of nursing• Develop learning partnerships with NCAHS • Share educational resources and clinical expertise and knowledge and apply this back in

the aged care setting• Improve client outcomes with a seamless transition between primary, acute and residential

care services• Develop professional networks in the North Coast Area

Program DetailsCourse Structure

t The Clinical Placement and Education Aged Care Program is 12 weeks in duration

During the program the registered nurse will be required to meet various practical assessments. It is expected that the registered nurse will demonstrate ongoing professional development in the areas of theoretical knowledge, problem solving, teamwork, documentation and communication.

The program will provide an opportunity for the registered nurse to review and complete a capability map based on the ANMC performance standards as listed:

• Professional and Ethical Practice• Critical Thinking and Analysis• Management of Care• Enabling

Clinical Placement – SupernumeryThe clinical placement aims to provide the registered nurse with the opportunity to gain clinical experience in different nursing practice settings. The length of placement is five days.

During the clinical placement a clinical nurse educator will be allocated to provide theoretical and clinical support

A preceptor will be allocated from the nursing team on the ward.

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Clinical Placement and Education Aged Care Program

Orientation

t The North Coast Area Health Service Clinical Placement and Education Aged Care Program commences in June 2010

Lismore Base Ward OrientationYou will be provided with the Lismore Base Hospital survival kit which includes:

• The health service environment• Key issues• Occupational health and safety issues• Emergency procedures• Manual Handling protocols• Infection Control• Security• Fire safety

During this time you will also be introduced to:

• Rapid Response procedures and Cardiac Arrest Procedures and the ‘Between the Flags’ protocol

Professional DevelopmentDuring the Program

a One day preliminary theory - to undertake and complete the “Safe Intravenous Medication Administration” learning package with the clinical nurse educator from Lismore Base Hospital.

1/2 day preparation for clinical placement

Intravenous Cannulation and Venepuncture Management and PICC line management – Learning Package may be completed by participants during the program with theoretical assistance from the CNE if the participant wishes to progress this.

5day clinical placement

Dementia online 4 modules

Clinical Resources and SupportsClinical Placement Program

a Program included on page 12

Reflective Practice

a You will be encouraged as an adult learner to undertake regular reflective practice activities.

The program will include a formal de-briefing sessions

An optional opportunity to keep a reflective journal on your experience throughout the program.

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NCAHS Internet E-learning Packages

a Access to the “Positive Approach to Care of the Older Person” Dementia online program will be provided as part of the program

You will receive information and access to the site.

http://elearning.ncahs.health.nsw.gov.au

Other packages which may be included are:

r http://int.ncahs.nsw.gov.au/learning/index (NCAHS ,E- Learning)

www.bloodsafelearning.org.au

Clinical Nurse EducatorsThe Clinical Nurse Educator will assist you by providing a structured learning experience for you during your clinical placement.

Clinical Preceptorship A preceptor is a Registered Nurse who is able to facilitate and support you during the clinical placement on the allocated wards.

Helpful Hints

a Below are some helpful hints for you in getting started in the clinical placement program:

• Identify your learning needs.• Develop relevant and achievable objectives that will enhance your clinical practice• Develop and maintain communication with staff• Communicate with your preceptor/ Clinical Nurse Educator if having difficulties.• Regularly evaluate your progress with your preceptor (on an informal basis)• Identify who your preceptor is and introduce yourself• Let staff know how you learn best• Clarify with your preceptor what the expectations of the ward are.• Request feedback from your:

❑ Preceptor

❑ Person in Charge

❑ Clinical Nurse Educator

On a daily basis…

• Introduce yourself to the nursing team• Ensure the other nurses around you are aware of your level of experience (scope of

practice) when they are delegating activities to you.• Ensure that you are supervised when performing new activities unless you have already

completed the relevant competency.• Update the rest of the nursing team regularly throughout the shift and immediately if there

are changes in your patients’ condition.• Consult MIMS prior to administering drugs and consult the IV Medications handbook

before giving IV medications.• Do not hesitate to ask for help if needed• Write new things down and look them up later.

In General …

• Arrange to meet with your preceptor regularly.• Keep in touch with the Clinical Nurse Educator and update them with your progress. Ask

for assistance from them if required.• Reflect on feedback from staff during the day – keep your reflective log, this helps!

http://int.ncahs.nsw.gov.au/learning/index

http://www.bloodsafelearning.org.au

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• Work on strategies with your preceptor in areas that you need improvement• Recognise your own limitations• Recognise how you deal with stress – utilise useful stress management strategies.

Feedback …

• Comes in various forms and from different people. You will receive feedback from: ❑ Preceptors

❑ Other nursing staff

❑ Patients

❑ Relatives

❑ Doctors,

❑ Clinical Nurse Educator.

Feedback …

• Encourages professional development, including development of clinical expertise• Provides information about behaviour• Identifies strengths and weaknesses• Helps give direction• If you ask for feedback – ask for concrete examples.• When receiving either formal or informal feedback, give yourself time to consider the

information and develop strategies to deal with the situation.• Together with your preceptor, set realistic daily goals or objectives for each item of

feedback.• Organise follow-up time with your preceptor to review your progress

Don’t stress – it is all part of your development – feedback never ends and it is part of everyone’s career.

Practice DevelopmentThis program been designed with the specific needs of the registered nurse working in the aged care setting in mind. It is based on the domains of the ANMC National Nursing Competencies for Registered Nurses.

The ANMC performance standards divide nursing practice into 4 domains:

• Professional and Ethical Practice• Critical Thinking and Analysis• Management of Care• Enabling

It is proposed that the program will be accredited by the NCAHS APEC Accreditors.

Completion of Clinical Placement and Education Aged Care Program

t At the completion of the program, a NCAHS Clinical Placement and Education Aged Care Program Statement of Completion ( including CNE points approximately 25 points) is awarded to all nurses who have completed the program (or part thereof) of clinical experience, including a transcript of participation in study opportunities and any of the Core Competencies.

Evaluating the ProgramOne of the final requests we will ask of you is that you give us feedback on the NCAHS Clinical Placement and Education Aged Care Program. We are continually looking to improve our program to ensure it meets the clinical and learning needs of the participants.

Good luck and enjoy your new journey!

32

Clinical/Ward OrientationThe following questions and activities are designed to help orient you to the ward. This is not a conclusive list of questions; in fact, you may have some of your own to ask. Please make sure you ask them too! Make notes as you go as this will help you remember what you are told. It will also give you some information to revise.

• Introduce yourself to the Nursing Unit Manager. Record their name below.

• Find the Nurse Call Bell, Nurse Presence button, Nurse Assist Bell and the Medical Emergency Bell.

• How do you find out what changes and orders were made on Doctor’s rounds?

• What should you do if you notice that the ward is running low on a particular stores item?

• What is the system for acquiring medications for patients on the ward?

• How do you get medications after hours and at weekends, when the pharmacy is closed?

• Where would you leave messages for the medical officers about medication charts to be re-written and other tasks to be completed

• What should you do if you receive a telephone enquiry?

• What do you do when you receive pathology results over the telephone?

33

• What tasks/information must be attended or checked in preparing for and taking a patient to Operating Theatres?

• Now check the Resuscitation Trolley for today

• What happens when something is missing or expired on the Resuscitation Trolley?

• Find the roster, timesheets and leave forms.

• Who do you contact if you are sick and cannot report for duty?

• If you would like to request a special shift or days off, what must you do?

• Where are patient’s medications kept?

• What type of information should you be passing on to the Nursing Unit Manager or the RN in charge?

• What do you do if you find faulty equipment?

34

Clinical Placement and Education Aged Care Program with Uniting Care North Coast – Caroona Nursing Home – Pilot Program July 5 2010 • 5 days clinical placement at Lismore Base Hospital, working 07.00 – 15.30 Monday to

Friday

Monday 5th

Tuesday 6th

Wednesday 7th

Thursday 8th

Friday 9th Comments

Orthopaedic – C6 Susan Clark

Susan Clark

Debbie Smith

Debbie Smith

Margaret Simpson

Medical – A7 Debbie Smith

Debbie Smith

Susan Clark

Susan Clark

Susan Clark

Medical – C7 Margaret Simpson

Margaret Simpson

Margaret Simpson

Margaret Simpson

Debbie Smith

14.00 – 15.30

14.00 – 15.30

14.00 – 15.30

14.00 – 15.30

14.00 – 15.30

Reflective practice Practice Clinical/Theory Workshop - ECG

Reflective practice Practice BLS/AED Education 2.30 on ward C6

Reflective practice Practice Clinical/Theory Workshop - IVC

Reflective practice Practice Informal presentation to the wards by the Caroona RN’s

Reflective practice Practice Clinical/Theory Workshop - PICC ??

Margaret Simpson - [email protected]

Debbie Smith – [email protected]

Susan Clark – [email protected]

mailto:[email protected]

mailto:[email protected]

35

Name: Ward/Unit: Preceptor: Date:

Section A: Professional Development Plan - Self appraisal this section to be completed by the registered nurse

OBJECTIVES: (To be completed by the registered nurse at commencement of each clinical rotation)

STRATEGIES PLANNED TO ACHIEVE THESE OBJECTIVES:

EVALUATION/REVISION OF OBJECTIVES: (Half way through each clinical rotation) Date:

EVALUATION OF OBJECTIVES: (At completion of rotation, where your objectives achieved) Date:

36

Section B – Evaluation of Professional Development completed by the Registered nurse and Clinical Nurse Educator

Scoring: Performance must be scored against each performance statement according to the following scale:

1 2 3 4

Below Average Average Above Average Excellent

When scoring and making comments, please consider the experience level of the registered nurse, i.e. Which rotation is this? Where were they placed prior to this?

Domain: Professional & Ethical Practice SCORE

Competency CNE notes: Registered Nurse

CNE

Functions in accordance with legislation and common law affecting nursing practice

Comment on compliance with Poisons Act, OH & S Act, consent requirements, peri-operative counting requirements and awareness of duty of care:

Conducts nursing practice in a way that can be ethically justified

Comment on compliance with nursing code of ethics, ability to maintain confidentiality, awareness of ethical issues relevant to ward/unit:

Protects the rights of individuals and groups in relation to health care

Comment on willingness to explain procedures to patients, attitude and ability to respect values, dignity, customs, spiritual beliefs and practices of others:

Accepts accountability for own actions and nursing practice

Comment on accountability for own actions, including punctuality, appearance, respect for peers:

Domain: Critical Thinking and Analysis SCORE

Competency CNE notes: Comment on willingness to learn from both formal and informal sources and to share their knowledge:

Graduate NUM/ Preceptor

Acts to enhance the professional development of self and others

Graduate to list in-services and learning packages completed on ward/unit:

Values research in contributing to developments in nursing and improved standards of care

Comment on willingness to research areas that they are unfamiliar with, to seek out evidence to support or modify practice:

37

Domain: Management of Care SCORE

Competency CNE notes: Comment on assessment skills, particularly skills pertinent to clinical area:

Graduate NUM/ Preceptor

Carries out a comprehensive and accurate nursing assessment of individuals and groups in a variety of settings

Formulates a plan in collaboration with individuals and groups

Comment on development of clinical outcomes plans, discharge planning and liaison with other health professionals:

Implements planned nursing care to achieve identified outcomes within scope of competency

Comment on organisational skills, adaptability, time management and clinical skills competence:

Evaluates progress toward expected outcomes and reviews and revises plans in accordance with evaluation data

Comment on initiative to seek review of patients, alter clinical outcomes plans, document variances and revise planned care:

Domain: Enabling

Competency Registered Nurse / CNE notes:

Contributes to the maintenance of an environment which promotes safety, security and personal integrity of individuals and groups

Comment on awareness of clinical risks, use of appropriate lifting equipment, awareness of patient dignity and respect of patients and families:

Communicates effectively with individuals and groups

Comment on verbal skills with patients, relatives, visitors, peers and other health professionals, non-verbal skills, phone techniques, reliability passing on information, and written communication:

Manages effectively the nursing care of individuals and groups

Comment on ability to prioritise, rational planning, recognition of time limitations, flexibility:

Collaborates with other members of the health care team

Comment on ability to liaise with other health professionals, exchange patient information to facilitate health outcomes, refer to more experienced health professionals:

38

What parts of the rotation or experiences did the registered nurse really enjoy?

What parts of the rotation or experiences did the registered nurse find frustrating or difficult?

Identify any previous goals/objectives that were not achieved, establish why and how they could be achieved in the future:

Registered nurse’s comments:

Signature: Date:

Clinical Nurse Educator’s comments :

Signature: Date:

39

LISMORE BASE HOSPITAL

Capability MapPosition Title: Registered Nurse Date Updated: 14/4/2010 Date to be reviewed: April 2011

0 = No experience theory only

1 = I would like supervision/tuition

2 = Comfortable performing with resources available

3 = Competent to perform safely and independently

4 = Highly proficient performed frequently

Core Skill

Skills/ attributes

Link to ANMC

Examples/ Cues

0 1 2 3 4 Comments/ Plan of action

Inte

rper

sona

l Dev

elop

men

t

Communication skills

2, 4, 6, 7 8, 9, 10

• Able to give clear concise nursing hand over and verbal reports.

• Completes documentation, writes complete nursing reports.

• Communicates well at an appropriate professional and interpersonal level within teams/health care staff/allied health staff.

• Able to communicate appropriately with patients/carers.

Management of care, time management

1, 2, 3, 5, 6, 7, 8, 10

• Plans patient care for individuals and for their allocated patients.

• Able to accomplish required interventions within adequate time frame.

• Prioritises according to patient, resources, and unit needs.

• Timely with planned procedures, medications etc.

• Discharge planning processes.

Team work 4, 6, 7, 10

• Understands and complies within personal and role limitations.

• Aware of roles of other members of health care team.

• Understands and follows appropriate referral processes to internal and external agencies.

Leadership 7, 10

• Assists others to plan and implement care.

• Organises resources for self and within team to ensure workload accomplished.

• Supports colleagues with their work.

40

Core Skill

Skills/ attributes

Link to ANMC

Examples/ Cues


Inte

rper

sona

l Ski

lls C

ontin

ued

Ethical values 2 • Practices ethically, e.g. non-judgmental approach to others.

• Able to demonstrate knowledge of ethical issues in relation to nursing practice in the ward or unit.

• Able to seek assistance where there is confusion around ethical matters.

• Ensures confidentiality in all situations.

Empathy 2, 7, 9

• Provides appropriate education and support for patient/family/carers needs.

• Respects individual’s rights and needs.

• Able to identify own strengths and weaknesses in managing extended needs, e.g. grief issues.

Managing aggressive situations/patients

1-3 5-10

• Able to manage self in relation to aggressive situations/patients.

• Understands policy relating to “Zero tolerance to violence”, has attended required workshops.

• Seeks assistance with situations beyond their recognised scope.

• Ensures safety of self and others in relation to aggressive situations.

Flexibility/ innovation. Reflective practice

1, 2, 3, 4, 7

• Able to identify situations which allow for innovation.

• Follows protocols and employs reflective practice to identify own learning needs.

• Able to practice within a range of situations.

• Able to identify personal, professional difficulties and seek resources to overcome difficulties.

• Able to recognise limitations in scope of practice.

41

Core Skill

Skills/ attributes

Link to ANMC

Examples/ Cues


Infe

ctio

n C

ontr

ol

Standards for Infection control are adhered to

1, 2, 3

• Understands and demonstrates correct hand washing procedures for the level of task to be performed.

• Understand the need for policies pertaining to and implements the use of Personal Protective Equipment.

• Able to demonstrate clear understanding of the appropriate management of waste.

• Able to discuss and demonstrate to correct procedures for Exposure management.

• Able to interpret microbiology results.

• Aware of ward unit requirements for general and specific specimen collection.

• Able to demonstrate correct procedure relating to asepsis/sterility.

• Able to describe or demonstrate the implementation of levels of precautions.

Obs

erva

tion/

Ass

essm

ent

Able to assess physical aspects of patients health and functional status

5, 7, 10

• Able to accurately complete, identify deviations from normal and act on the following:

• Temperature, pulse, respiration

• Blood pressure• Electronic

sphygmomanometer• Neurological

observations• Circulatory observations• Alcohol & Other Drugs

Withdrawal Scale• Patient weight• Glucometer reading• Fluid Balance Chart• Mental state• Red Dot Mobility.• Other…….

Conducts Nursing assessment

5, 6, 7, 8

• Uses a structured approach in the process of assessment.

• Utilises appropriate tools and strategies.

• Involves social, physical, emotional, spiritual, psychological needs into assessment.

42

Core Skill

Skills/ attributes

Link to ANMC

Examples/ Cues


Hyg

iene

Assist with personal hygiene

6, 7, 9

• Sponge/bed bath• Showering patient• Hair wash/care• Mouth/teeth care• Pressure Area Care• Post-operative wash• Nail care• Care of hearing aids• Bed making

Nurses personal hygiene

• Personal cleanliness evident

• Hand washing protocols adhered to

• Hair neatly groomed• Appearance neat and

professional

Nut

ritio

nal S

tatu

s

Assists with dietary needs

5, 6, 7, 10

• Assesses weight and height as appropriate

• Arranges Dietician as required

• Ensures adequate dietary intake

• Ensures patient is able to access food or feeds patient as required

• Ensures adequate fluid intake

This mapping document developed by Sue Creech

This document is suitable for all Registered Nurses.

The IDEAS Project is a regional workforce development initiative funded by the Australian and New South Wales governments under the Targeting Skills Needs in the Regions Program. Regional Development Australia -Northern Rivers manages this project on behalf of the Aged and Community Services Association of NSW and ACT. Our brief is to increase the capability and expertise of the aged services sector on the north coast, and raise and diversify the skills of the existing aged services workforce.

The IDEAS Project is funding the Clinical Exchange and Education Pilot Program because we believe that this is a visionary initiative. We commend all of those people who are participating and are very pleased to be able to support this project.

Ollie Heathwood Ideas project

44

Appendix 2Evaluation form: Uniting Care Aged Care Nurses

45

and

Nurse Education Department Level 2 Crawford house

RNs in the Clinical Placement & Education Aged Care Program Evaluation

Did you feel that you were prepared for the clinical placement and education of the aged care nurses?

How could this be improved?

How did the uniting care nurses demonstrate their skills & knowledge?

How well did they integrate to the ward routine? (Bring in pt. safety/scope of practice)

What insight/benefits do you think they brought to the clinical area?

Having now worked with the aged care nurses what is your understanding of the care provided in aged care facilities? Please List:

Has your understanding about older people living in residential care changed following this experience? Please List:

How do you think this exchange programme might improve relationships between acute care and aged care facilities?

Based on this pilot how do you think it will impact on the well being of patients returning to residential care facilities?

How could this programme be adapted/extended to provide mutual benefits to both facilities?

46

Appendix 3Evaluation form: Clinical Nurse Educator

47

and


Clinical Nurse Educator in the Clinical Placement & Education Aged Care Program Evaluation











48

Appendix 4Evaluation form: Nurse Unit Manager

49

and


NUM of ward in Clinical Placement & Education Aged Care Program Evaluation











50

Appendix 5Evaluation form: Preceptor

51

and


Preceptors of RNs in the Clinical Placement & Education Aged Care Program Evaluation











52

Appendix 6Capability Maps

53


Capability MapPosition Title: Debbie Smith RN Date Updated: 05/072010 Date to be reviewed: April 2011






Core Skill

Skills/ attributes

Link to ANMC

Examples/ Cues


Inte

rper

sona

l Dev

elop

men

t


2, 4, 6, 7 8, 9, 10


* Pre-existing


*

• Communicates well at an appropriate professional and interpersonal level within teams/health care staff/allied health staff

*


*

Management of care, time management.

1, 2, 3, 5, 6, 7, 8, 10

Plans patient care for individuals and for their allocated patients.

* Pre-existing

Able to accomplish required interventions within adequate time frame.

*

Prioritises according to patient, resources, and unit needs.

*

Timely with planned procedures, medications etc

*

Discharge planning processes.

*

Team work. 4, 6, 7, 10


*

• Aware of roles of other members of health care team

*


*

Leadership 7, 10


*


*


*

54

Core Skill

Skills/ attributes

Link to ANMC

Examples/ Cues


Inte

rper

sona

l Ski

lls C

ontin

ued

Ethical values 2 • Practices ethically, e.g. non-judgmental approach to others

*


*


*


*

Empathy. 2, 7, 9

• Provides appropriate education and support for patient/family/carers needs

*


*


*


1-3 5-10


* Reasonable pre-existing skill level. Did not experience any aggression during placement


*


*

• Ensures safety of self and others in relation to aggressive situations

*

Flexibility/ innovation. Reflective practice.

1, 2, 3, 4, 7


* Some pre-existing skill. Did not have opportunity to expand during placement• Follows protocols and

employs reflective practice to identify own learning needs.

*


*


*

• Able to recognise limitations in scope of practice

*

55

Core Skill

Skills/ attributes

Link to ANMC

Examples/ Cues


Infe

ctio

n C

ontr

ol

Standards for Infection control are adhered to.

1, 2, 3


* Pre-existing skills. Did not have opportunity to look at NCAHS policies & procedures


*


*

• Able to discuss and demonstrate to correct procedures for Exposure management

*

• Able to interpret microbiology results

*

• Aware of ward unit requirements for general and specific specimen collection

*

• Able to demonstrate correct procedure relating to asepsis/sterility

*


*

Obs

erva

tion/

Ass

essm

ent


5, 7, 10

Able to accurately complete, identify deviations from normal and act on the following

Did not have opportunity to attend all of listed observations during placement.Some pre-existing skills


*

• Blood pressure *• Electronic

sphygmomanometer*

• Neurological observations

*

• Circulatory observations *• Alcohol & Other Drugs

Withdrawal Scale*

• Patient weight *• Glucometer reading *• Fluid Balance Chart *• Mental state *• Red Dot Mobility. *• Other……. *


5, 6, 7, 8


*

• Utilises appropriate tools and strategies

*


*

56

Core Skill

Skills/ attributes

Link to ANMC

Examples/ Cues


Hyg

iene

Assist with personal hygiene.

6, 7, 9

• Sponge/bed bath * Had more than enough practice in basic PC!• Showering patient *

• Hair wash/care *

• Mouth/teeth care *

• Pressure Area Care *

• Post-operative wash *

• Nail care *

• Care of hearing aids *

• Bed making *



*


*

• Hair neatly groomed *

• Appearance neat and professional

*

Nut

ritio

nal S

tatu

s


5, 6, 7, 10


* Pre-existing skills


*


*


*


*

57


Capability MapPosition Title: Margaret Simpson RN Date Updated: 05/072010 Date to be reviewed: April 2011






Core Skill

Skills/ attributes

Link to ANMC

Examples/ Cues


Inte

rper

sona

l Dev

elop

men

t


2, 4, 6, 7 8, 9, 10


* Pre-existing


*


*


*


1, 2, 3, 5, 6, 7, 8, 10


*


*


*


*


*

Team work. 4, 6, 7, 10


*


*


*

Leadership 7, 10


*


*


*

58

Core Skill

Skills/ attributes

Link to ANMC

Examples/ Cues


Inte

rper

sona

l Ski

lls C

ontin

ued


*


*


*


*

Empathy. 2, 7, 9


*


*


*


1-3 5-10


*


*


*


*


1, 2, 3, 4, 7


*


*


*


*


*

59

Core Skill

Skills/ attributes

Link to ANMC

Examples/ Cues


Infe

ctio

n C

ontr

ol


1, 2, 3


*


*


*


*


*


*


*


*

Obs

erva

tion/

Ass

essm

ent


5, 7, 10

Able to accurately complete, identify deviations from normal and act on the following• Temperature, pulse,

respiration*

• Blood pressure *• Electronic

sphygmomanometer*


*

• Circulatory observations *• Alcohol & Other Drugs

Withdrawal Scale*

• Patient weight *• Glucometer reading *• Fluid Balance Chart *• Mental state *• Red Dot Mobility. *• Other……. *


5, 6, 7, 8


*


*


*

60

Core Skill

Skills/ attributes

Link to ANMC

Examples/ Cues


Hyg

iene


6, 7, 9

• Sponge/bed bath *

• Showering patient *

• Hair wash/care *

• Mouth/teeth care *

• Pressure Area Care *

• Post-operative wash *

• Nail care *

• Care of hearing aids *

• Bed making *



*


*

• Hair neatly groomed *


*

Nut

ritio

nal S

tatu

s


5, 6, 7, 10


*


*


*


*


*

61


Capability MapPosition Title: Susan Clarke RN Date Updated: 05/072010 Date to be reviewed: April 2011






Core Skill

Skills/ attributes

Link to ANMC

Examples/ Cues


Inte

rper

sona

l Dev

elop

men

t


2, 4, 6, 7 8, 9, 10


/ Able to perform communication within the scope of practice whilst on placement.• Completes

documentation, writes complete nursing reports.

/


/


/


1, 2, 3, 5, 6, 7, 8, 10


/ Felt competent in same but always had a buddy during these tasks


/


/


/


/

Team work. 4, 6, 7, 10


/


/


/

Leadership 7, 10


/ Felt competent but due to the nature of the placement it was difficult to fully accomplish same


/


/

62

Core Skill

Skills/ attributes

Link to ANMC

Examples/ Cues


Inte

rper

sona

l Ski

lls C

ontin

ued


/ Very supportive staff on the ward when looking for assistance


/


/


/

Empathy. 2, 7, 9


/


/


/


1-3 5-10


/


/


/


/


1, 2, 3, 4, 7


/


/


/


/


/

63

Core Skill

Skills/ attributes

Link to ANMC

Examples/ Cues


Infe

ctio

n C

ontr

ol


1, 2, 3


/


/


/


/


/


/


/


/

Obs

erva

tion/

Ass

essm

ent


5, 7, 10

Able to accurately complete, identify deviations from normal and act on the following

Certain areas did not have the opportunity to attend


/

• Blood pressure /• Electronic

sphygmomanometer/


/

• Circulatory observations /• Alcohol & Other Drugs

Withdrawal Scale• Patient weight /• Glucometer reading /• Fluid Balance Chart /• Mental state /• Red Dot Mobility.• Other…….


5, 6, 7, 8


/


/


/

64

Core Skill

Skills/ attributes

Link to ANMC

Examples/ Cues


Hyg

iene


6, 7, 9

• Sponge/bed bath /

• Showering patient /

• Hair wash/care /

• Mouth/teeth care /

• Pressure Area Care /

• Post-operative wash /

• Nail care /

• Care of hearing aids /

• Bed making /



/


/

• Hair neatly groomed /


/

Nut

ritio

nal S

tatu

s


5, 6, 7, 10


/ Certain areas there was not the opportunity to attend same.• Arranges Dietician as

required


/


/


/

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