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Florence Nightingale School of Nursing & Midwifery King’s College London Practice Assessment Document (PAD) Mental Health Branch Degree S2011 –Final Year 6KNIPM3B Student name: Personal tutor: Programme Leader: Branch Leader:

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Florence Nightingale School of Nursing & Midwifery King’s College London

Practice Assessment Document (PAD) Mental Health Branch Degree S2011 –Final Year

6KNIPM3B

Student name:

Personal tutor:

Programme Leader:

Branch Leader:

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Contents Section Page Section Page

1.0 General guidelines 2 4.0 Placement 3 details 21 1.1 The initial interview (placements 1-3) 2 4.1 Orientation - placement 3 22

1.2 Midpoint review (placements 1-3) 2 4.2 Initial interview - placement 3 23

1.3 End of placement review (placements 1-2) 2 4.3 Midpoint review – placement 3 24

1.4 Summative assessment (placement 3) 2 4.4 Action plan following midpoint review - placement 3 25

1.5 Submission of the PAD 2 4.5 Summative assessment - placement 3 26

1.6 Monitoring point with personal tutor 2 4.6 Action plan following summative assessment- placement 3 27

1.7 Mentor responsibilities 3 4.7 Personal tutor feedback- placement 3 28

1.8 Summary of PAD submission dates and monitoring periods 4 5.0 Sign off mentor record sheet 29

2.0 Placement 1 details 5 6.0 Assessment in practice 33 2.1 Orientation - placement 1 6 6.1 Professional values 34

2.2 Initial interview - placement 1 7 6.2 Practice outcomes 36

2.3 Midpoint review - placement 1 8 6.3 Assessment of clinical skills 44

2.4 Action plan following midpoint review - placement 1 9 7.0 Additional skills 55 2.5 End of placement review – placement 1 10 8.0 Service user/carer involvement in practice assessment 56 2.6 Action plan following end of placement review - placement 1 11 9.0 Pre-registration nursing students risk assessment 58 2.7 Personal tutor feedback – placement 1 12 10.0 Attendance for clinical supervision 59

3.0 Placement 2 details 13 11.0 Attendance record for practice hours 60 3.1 Orientation - placement 2 14 12.0 Record of meetings/comment sheet 78 3.2 Initial interview - placement 2 15 13.0 Action Plan sheets 82 3.3 Midpoint review – placement 2 16

3.4 Action plan following midpoint review - placement 2 17

3.5 End of placement review - placement 2 18 3.6 Action plan following end of placement review - placement 2 19 3.7 Personal tutor feedback – placement 2 20

This Practice Assessment Document represents an important part of a formal assessment and examination procedure leading to a professional qualification. Irregularities in its

use by students may count as an examination offence. Examination and assessment offences are subject to specific academic regulations, details of which can be found on the College Policy Zone (search for ‘Regulations for Examinations’) http://www.kcl.ac.uk/college/policyzone/

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Guidelines for the completion of the Practice Assessment Document (PAD) for students and mentors 1.0 General guidelines Please read this document carefully and familiarise yourself with its contents.

For placements 1-2 the following must be completed: • Placement details • Orientation • Initial interview • Midpoint review • End of placement review • Assessment of professional values, practice outcomes and clinical skills • Service user feedback (placement 2) • Attendance record for practice hours

For placement 3 the following must be completed: • Placement details • Orientation • Initial interview • Midpoint review • Summative assessment • Assessment of professional values, practice outcomes and clinical skills • Service user feedback • Attendance record for practice hours

1.1 The initial interview (placements 1-3)

This is a formal interview between the student and mentor and should take place during the first week of placement. The following should be discussed: • Mentor comments and action plans from the previous placements including

years 1 and 2. • Individual student learning needs/objectives for the placement. • Learning opportunities on the placement and how they relate to the PAD. • How to demonstrate professional values. • Planned meeting times with mentor(s).

1.2 Midpoint review (placements 1-3) The midpoint review takes place half-way through the placement. Comments and action plans from this meeting should be documented. 1.3 End of placement review (placements 1-2) The end of placement review is completed in the final week of placements 1 and 2. Comments and action plans from this meeting should be documented. 1.4 Summative assessment (placement 3) The final assessment of proficiency draws on evidence of assessment over a sustained period of time. The sign-off mentor may use the previous PADs and other evidence to see if competence has been achieved and maintained previously, as well as demonstrated in the current placement. 1.5 Submission of the PAD It is the responsibility of the student to negotiate with their mentor to ensure that the PAD is completed and ready for submission by the submission dates indicated on page 4. The PAD constitutes an integral part of the formal assessment and examination process. Students should inform their programme or branch lead in the event of non-submission. 1.6 Monitoring point with personal tutor Students are required to discuss their PAD with their personal tutors on completion of placements 1 and 2. Professional values, practice outcomes, clinical skills and hours that were not achieved at the minimum required level will be clearly identified and documented on the personal tutor feedback sheet. An action plan will be formulated to monitor progress. Students should also arrange to see their personal tutor prior to submission of the PAD at the end of the year. This is to ensure that the PAD is completed satisfactorily and to answer queries/ concerns.

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1.7 Mentor responsibilities Mentors are required to meet the criteria stipulated by the NMC Standards (2008) to support learning and assessment in practice including:

• Successful completion of an NMC approved mentor preparation programme

• Participation in annual updating • Undertaking a triennial review

and are responsible for:

• Organising and co-ordinating student learning activities in practice. • Supervising students in learning situations and providing them with

constructive feedback on their achievements. • Setting and monitoring achievement of realistic learning objectives. • Assessing total performance – including skills, attitudes and behaviours. • Providing evidence of student achievement or lack of achievement. • Liaising with others (e.g. mentors, sign-off mentors, practice facilitators,

practice teachers, personal tutors, programme leaders) to provide feedback, identify any concerns about the student’s performance and agree action as appropriate.

• Providing evidence for, or acting as, sign-off mentors with regard to making decisions about achievement of proficiency at the end of a programme.

The flow chart opposite is a guide for students and mentors as to the process of assessment for each placement.

First day: Orientation to ward

Within 48 hours: Mentor allocated

End of first week: • Duty rota completed to achieve 40% of time working with mentor • Aims and objectives for the placement agreed with mentor at initial interview

Midpoint of placement: Arrange and complete midpoint review with MentorIf necessary, Mentor to complete Action Plan following midpoint review

Penultimate week : Arrange date with Mentor for end of placement review/summative assessment for final placementFinal week: Mentor will assess practice including:

• Professional values, practice outcomes and performance of clinical skills

Outcome 1

Required level achieved:no action to be taken

Outcome 2

Some values, outcomes or skillsnot achieved at the required level: complete ‘Action Plan’

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1.8 Summary of PAD submission dates and monitoring periods

Placement Student Administrator Personal tutor Branch leader Monitoring periods 1

BSc

150 hours

• Submit to JCMB G15 • BSc W/C 14 Oct 2013 • Meet with personal tutor

during monitoring period.

• Data entry of student hours/night duty/sickness.

• Return PAD to personal tutor.

• Report non-submissions to branch leads.

• Meet with student to review PAD during monitoring period.

• Complete action plan if required – cc branch lead, student file.

• Return PAD to student

• Monitors student progress in practice

• Monitors action plans. • Reports to exam

boards.

• BSc 28 Oct – 8 Nov 2013

2 BSc

187.5 hours

• Submit to JCMB G15 • BSc W/C 10 Feb 2014 • Meet with personal tutor

during monitoring period.

• Data entry of student hours/night duty/sickness.

• Return PAD to personal tutor.

• Report non-submissions to branch leads.

• Meet with student to review PAD during monitoring period.

• Complete action plan if required – cc branch lead, student file.

• Return PAD to student.

• Monitors student progress in practice

• Monitors action plans. • Reports to exam

boards.

• BSc 24 Feb – 7 March 2014

3

BSc 450 hours

• Submit to JCMB G15 on Monday – NOT W/C - 7 July 2014

• Meet with personal tutor during monitoring period.

• Final Hours – As soon as completed but no later than midday on 28 July 2014

• Data entry of student hours/night duty/sickness.

• Return PAD to Student Services.

• Report non-submissions to branch leads.

• Meet with student to review PAD during monitoring period.

• Check all elements of the PAD are complete before the student submits the PAD for the final time

• Monitors student progress in practice

• Monitors action plans. • Reports to exam

boards. • Completes registration

process

• BSc 23 June - 4 July 2014

TOTAL 787.5

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2.0 Placement 1 details Placement details to be completed by student:

Name of placement

Trust /organisation

Allocation date(s) From to

Personal Tutor Ext

Document to be submitted on

Placement details to be completed by mentor:

Mentor(s) Mentor’s signature Date

Professional qualification Mentorship qualification

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2.1 Orientation – placement 1

Orientation to practice area should take place during the first day of placement. Date ………………… The following issues must be discussed with the student on the first day of placement:

Issue Signature of student

Signature of staff member

Fire number

Fire procedure

Location of fire exits

Location of fire equipment: fire blankets, hose reels, extinguishers

Cardiac arrest number

Resuscitation trolley

Security number

Ward/department/school/community setting layout

Trust/placement policies – to include Manual Handling Policy and procedures for managing violent and aggressive patients

Specific local policies /guidelines i.e. COSH(H)

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2.2 Initial interview – placement 1

The initial interview should take place between the student and their mentor, during the first week of the placement. Please review together: 1. The student’s personal objectives for this placement. 2. The experiences available on this placement that will enable the student to achieve the professional values, practice outcomes and clinical skills.

1. My personal objectives for this placement are: 2. The experiences available on this placement that will enable me to achieve the professional values, practice outcomes and clinical skills are:

Mentor’s comments:

I have reviewed the mentor’s comments from the previous placements (in years 1 and 2) and any areas for development have been included in my comments above. Mentor’s signature ...................................................................... Student’s signature ...................................................... Date .......................................

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2.3 Midpoint review - placement 1

Student’s self-assessment Progress in achieving personal objectives: Progress in achieving competence in professional values, practice outcomes and clinical skills:

Mentor’s assessment Progress in achieving personal objectives: Progress in achieving competence in professional values, practice outcomes and clinical skills:

Mentor’s signature ...................................................................... Student’s signature ...................................................... Date .......................................

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2.4 Action plan following midpoint review – placement 1 (if required)

Following a meeting between mentor and student, the following action plan has been agreed:

Area for further development What needs to be demonstrated How can this be demonstrated Date for review

Mentor’s signature ...................................................................... Student’s signature ...................................................... Date .......................................

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2.5 End of placement review – placement 1

Student’s self-assessment Progress in achieving personal objectives : Progress in achieving competence in professional values, practice outcomes and clinical skills:

Mentor’s assessment Progress in achieving personal objectives : Progress in achieving competence in professional values, practice outcomes and clinical skills:

Mentor’s signature ...................................................................... Student’s signature ...................................................... Date .......................................

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2.6 Action plan following end of placement review – placement 1 (if required)

Following a meeting between mentor and student, the following action plan has been agreed:

Area for further development What needs to be demonstrated How can this be demonstrated Date for review

Mentor’s signature ...................................................................... Student’s signature ...................................................... Date .......................................

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2.7 Personal tutor feedback – placement 1

Professional values: Minimum level required: Consistently Able

Yes No Indicate any not completed or marked Unsafe (U)

Practice outcomes: Minimum level required: Consistently Able

Yes No Indicate any not completed or marked Novice(N)/Unsafe (U)

Clinical skills: Minimum level required: Consistently Able

Yes No Indicate any not completed or marked Novice (N)/Unsafe (U)

Hours: All required hours complete from this placement

Yes No If more than 1 week, action plan required

Hours: All required hours complete from previous year

Yes No

Personal tutor comments/action plan if required (cc action plan to Branch Lead and student file) Review date:………………………….. Student’s name:

Student’s signature:

Date: Personal tutor’s signature:

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3.0 Placement 2 details

Placement details to be completed by student

Name of placement

Trust /organisation

Allocation date(s) From to

Personal Tutor Ext

Document to be submitted on

Placement details to be completed by mentor

Mentor(s) name Mentor’s signature Date

Professional qualification Mentorship qualification

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3.1 Orientation – placement 2

Orientation to practice area should take place during the first day of placement. Date …………………

The following issues must be discussed with the student on the first day of placement:

Issue Signature of student

Signature of staff member

Fire number

Fire procedure

Location of fire exits

Location of fire equipment: fire blankets, hose reels, extinguishers

Cardiac arrest number

Resuscitation trolley

Security number

Ward/department/school/community setting layout

Trust/placement policies – to include Manual Handling Policy and procedures for managing violent and aggressive patients

Specific local policies /guidelines i.e. COSH(H)

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3.2 Initial interview – placement 2 The initial interview should take place between the student and their mentor, during the first week of the placement. Please review together: 1. The student’s personal objectives for this placement. 2. The experiences available on this placement that will enable the student to achieve the professional values, practice outcomes and clinical skills.

1. My personal objectives for this placement are: 2. The experiences available on this placement that will enable me to achieve the professional values, practice outcomes and clinical skills are:

Mentor’s comments:

I have reviewed the mentor’s comments from the previous placements and any areas for development have been included in my comments above. Mentor’s signature ...................................................................... Student’s signature ...................................................... Date .......................................

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3.3 Midpoint review - placement 2

Student’s self-assessment Progress in achieving personal objectives: Progress in achieving competence in professional values, practice outcomes and clinical skills:

Mentor’s assessment Progress in achieving personal objectives: Progress in achieving competence in professional values, practice outcomes and clinical skills:

Mentor’s signature ...................................................................... Student’s signature ...................................................... Date .......................................

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3.4 Action plan following midpoint review – placement 2 (if required)

Following a meeting between mentor and student, the following action plan has been agreed:

Area for further development What needs to be demonstrated How can this be demonstrated Date for review

Mentor’s signature ...................................................................... Student’s signature ...................................................... Date .......................................

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3.5 End of placement review – placement 2

Student’s self-assessment Progress in achieving personal objectives : Progress in achieving competence in professional values, practice outcomes and clinical skills:

Mentor’s assessment Progress in achieving personal objectives : Progress in achieving competence in professional values, practice outcomes and clinical skills:

Mentor’s signature ...................................................................... Student’s signature ...................................................... Date ........................................

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3.6 Action plan following end of placement review – placement 2 (if required)

Following a meeting between mentor and student, the following action plan has been agreed:

Area for further development What needs to be demonstrated How can this be demonstrated Date for review

Mentor’s signature ...................................................................... Student’s signature ...................................................... Date .......................................

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3.7 Personal tutor feedback – placement 2

Professional values: Minimum level required: Consistently Able

Yes No Indicate any not completed or marked Unsafe (U)

Practice outcomes: Minimum level required: Consistently Able

Yes No Indicate any not completed or marked Novice (N)/Unsafe (U)

Clinical Skills: Minimum level required: Consistently Able

Yes No Indicate any not completed or marked Novice (N)/Unsafe (U)

Hours: All required hours complete from this placement

Yes No If more than 1 week, action plan required

Hours: All required hours complete from previous placement

Yes No

Personal tutor comments/action plan if required (cc action plan to Branch Lead and student file) Review date:………………………….. Student’s name:

Student’s signature:

Date: Personal tutor’s signature:

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4. Placement 3 details Placement details to be completed by student

Name of placement

Trust /organisation

Allocation date(s) From to

Personal Tutor Ext

Document to be submitted on

Placement details to be completed by mentor

Mentor(s) name Mentor’s signature Date

Professional qualification Mentorship qualification

Placement details to be completed by Sign Off mentor

Sign off Mentor(s) name Sign off Mentor’s signature Date

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4.1 Orientation – placement 3

Orientation to practice area should take place during the first day of placement. Date …………………

The following issues must be discussed with the student on the first day of placement:

Issue Signature of student

Signature of staff member

Fire number

Fire procedure

Location of fire exits

Location of fire equipment: fire blankets, hose reels, extinguishers

Cardiac arrest number

Resuscitation trolley

Security number

Ward/department/school/community setting layout

Trust/placement policies – to include Manual Handling Policy and procedures for managing violent and aggressive patients

Specific local policies /guidelines i.e. COSH(H)

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4.2 Initial interview – placement 3

The initial interview should take place between the student and their mentor, during the first week of the placement. Please review together: 1. The student’s personal objectives for this placement. 2. The experiences available on this placement that will enable the student to achieve the professional values, practice outcomes and clinical skills.

1. My personal objectives for this placement are: 2. The experiences available on this placement that will enable me to achieve the professional values, practice outcomes and clinical skills are:

Mentor’s comments:

I have reviewed the mentor’s comments from the previous placements and any areas for development have been included in my comments above. Mentor’s signature ...................................................................... Student’s signature ...................................................... Date .......................................

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4.3 Midpoint review - placement 3

Student’s self-assessment Progress in achieving personal objectives: Progress in achieving competence in professional values, practice outcomes and clinical skills:

Mentor’s assessment Progress in achieving personal objectives: Progress in achieving competence in professional values, practice outcomes and clinical skills:

Mentor’s signature ...................................................................... Student’s signature ...................................................... Date .......................................

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4.4 Action plan following midpoint review – placement 3 (if required)

Following a meeting between mentor and student, the following action plan has been agreed:

Area for further development What needs to be demonstrated How can this be demonstrated Date for review

Mentor’s signature ...................................................................... Student’s signature ...................................................... Date .......................................

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4.5 Summative assessment – placement 3 Student’s self-assessment Progress in achieving personal objectives : Progress in achieving competence in professional values, practice outcomes and clinical skills:

Mentor’s assessment Progress in achieving personal objectives : Progress in achieving competence in professional values, practice outcomes and clinical skills:

Mentor’s signature ...................................................................... Student’s signature ...................................................... Date ........................................

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4.6 Action plan following summative assessment – placement 3 (if required)

Following a meeting between mentor and student, the following action plan has been agreed:

Area for further development What needs to be demonstrated How can this be demonstrated Date for review

Mentor’s signature ...................................................................... Student’s signature ...................................................... Date .......................................

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4.7 Personal tutor feedback – placement 3

Professional values: Minimum level required: Consistently Able

Yes No Indicate any not completed or marked Unsafe (U)

Practice outcomes: Minimum level required: Consistently Able

Yes No Indicate any not completed or marked Novice (N)/Unsafe (U)

Clinical Skills: Minimum level required: Consistently Able

Yes No Indicate any not completed or marked Novice (N)/Unsafe (U)

Service user/carer feedback Yes No

Clinical supervision (minimum 4 sessions) Yes No

Sign off mentor verification Yes No

Hours: All required hours complete from this placement

Yes No If more than 1 week, action plan required

Hours: All required hours complete from previous placement

Yes No

Personal tutor comments/action plan if required (cc action plan to Branch Lead and student file) Review date:………………………….. Student’s name:

Student’s signature:

Date: Personal tutor’s signature:

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5.0 Sign-off mentor record sheet

The NMC identify that sign-off mentors must have time allocated to reflect, give feedback and keep records of student achievements in their final period of practice learning. This will be the equivalent of an hour per student per week, in addition to the 40% time working with the mentor. The time allocated may need to be greater earlier in the placement and reduced as they become more confident and competent (NMC 2007). The first meeting should include a discussion of the student’s on-going record of achievement from years 1 and 2 and final year’s placements.

Name of Sign-off Mentor

Name of Trainee Sign-off Mentor

Date and time Time spent on reviewing evidence, discussions and documentation should all be recorded Signature of sign-off mentor and student and time spent in activity

Signed mentor…………………………………

Signed student ………………………………..

Time spent …………………………………

Signed mentor ……………………………… Signed student ……………………………… Time spent ……………………………………

Signed mentor ……………………………… Signed student ………………………………

Time spent ……………………………………

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Sign-off mentor record sheet continued

Date and time Time spent on reviewing evidence, discussions and documentation should all be recorded Signature of sign-off mentor and student and time spent in activity

Signed mentor………………………………… Signed student ……………………………….. Time spent ……………………………………

Signed mentor ………………………………… Signed student ……………………………… Time spent …………………………………….

Signed mentor ……………………………….. Signed student ………………………… Time spent …………………………………….

Signed mentor ……………………………….. Signed student ………………………… Time spent …………………………………….

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Sign-off mentor record sheet continued

Date and time Time spent on reviewing evidence, discussions and documentation should all be recorded Signature of sign-off mentor and student and time spent in activity

Signed mentor……………………………… Signed student ………………………………. Time spent …………………………………

Signed mentor ……………………………… Signed student ……………………………… Time spent …………………………………….

Signed mentor ……………………………… Signed student ……………………………… Time spent …………………………………….

Signed mentor ……………………………… Signed student ……………………………… Time spent …………………………………….

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Sign-off mentor record sheet continued

Date and time Time spent on reviewing evidence, discussions and documentation should all be recorded Signature of sign-off mentor and student and time spent in activity

Signed mentor……………………………… Signed student ………………………………. Time spent …………………………………

Signed mentor ……………………………… Signed student ……………………………… Time spent …………………………………….

Sign-off Mentor Verification Statement: I verify that this student [give name] ________________________________________________meets the proficiencies required for Nursing and Midwifery Council registration. Sign-off mentor’s name (please print)____________________________________________________ NMC PIN No _____________________________ Signature____________________________________________________________________________ Date ____________________________________

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6.0 Assessment in practice

Assessment in practice consists of three domains: professional values, practice outcomes and clinical skills.

The performance rating scale below is used to assess practice.

Quality of Performance Outcome Level

• The student is unable to follow instructions or guidance from the mentor. • The student has a lack of understanding of the rationale for the activity. • The student spends excessive time on the activity placing little focus on the patient.

The student has demonstrated unsafe practice through the inability to discuss, perform and/or follow instructions despite repeated guidance.

Unsafe (U)

• The student is dependent on guidance and clear prompts to undertake the activity. • The student has some understanding of the rationale for the activity. • The student may lack confidence, spending considerable time on the activity with

some attempt to focus on the patient.

The student is able to perform the activity safely under direct supervision and guidance.

Expectation in CFP

Novice (N)

• The student is able to perform the activity under moderate supervision within a controlled scenario.

• The student is skilful in some aspects and demonstrates an understanding of the rationale for the activity.

• The student has some degree of confidence in the activity, some efficiency in the use of time with some focus on the patient.

The student can discuss and perform elements of the activity safely with moderate supervision and guidance, but may not always achieve this.

Expectation in Year 2

Sometimes Able (SA)

• The student is competent in performing the activity under minimal supervision. • The student demonstrates a clear understanding of the rationale for the activity. • The student is skilful and coordinated with economical use of time and is able to focus

on the patient.

The student is able to demonstrate competent, safe practice with minimal supervision. The student is able to apply relevant knowledge and evidence to practice and discuss the transfer of this knowledge to more complex situations.

Expectation in Year 3

Consistently Able (CA)

The required level of achievement that needs to be obtained: Professional values: the level of achievement in this domain is consistently able (CA) for each practice placement in year three. Practice outcomes: must be assessed in each placement in year three. The level of achievement in this domain is consistently able (CA) by the end of year three. Clinical skills: must be assessed across a range of placements and achieved to consistently able (CA) by the end of year three .

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Professional Values

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6.1 Professional values

Key to Levels: Consistently Able = CA, Unsafe = U

Placement 1 Placement 2 Placement 3 Midpoint review

End of placement review

Midpoint review

End of placement review

Midpoint review

Summative assessment

Minimum level required

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

1. At all times demonstrates behaviour in accordance with the NMC Standards of Conduct, Performance and Ethics for nurses and midwives.

• Maintains a professional attitude through presentation of self in accordance with the dress code policy in the workplace.

• Acts in a professional manner with all patients, clients, visitors, and health care team members.

• Demonstrates consistent punctuality and time keeping.

• Recognises unsafe practice and consults appropriately.

CA

2. Demonstrates respect for the individual

• Awareness in community settings that you are a guest in that person’s home.

• Asks the patient or client how they wish to be addressed.

• When communicating with patients, clients, visitors and health care team members gives individual attention.

• Acknowledges that individuals have choices and rights.

• Gains permission before undertaking care procedures ie obtains consent.

• Gives appropriate information to inform choice. • Respects individual’s culture, age, gender,

sexuality, religion, impairment or disability.

CA

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Key to Levels: Consistently Able = CA, Unsafe = U

Placement 1 Placement 2 Placement 3 Midpoint review

End of placement review

Midpoint review

End of placement review

Midpoint review

Summative assessment

Minimum level required

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

3. Acknowledges and respects the rights, values, customs and beliefs of individuals and groups

• Identifies how own beliefs and values may impact on patients’ and clients’ care.

• Understands how values, customs and beliefs may impact on health and social care needs.

• Avoids labels which stigmatise individuals. • Understands and follows the equality and

diversity policies of the workplace.

CA

4. Maintains privacy and dignity

• Ensures privacy when carrying out personal care.

• Ensures privacy when discussing intimate or personal information. Demonstrates sensitivity when maintaining dignity for patients and clients.

CA

5. Maintains confidentiality

• Practices in accordance with confidentiality policies.

• Maintains patient and client confidentiality when using practice experience for own learning.

CA

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Practice Outcomes

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6.2 Practice outcomes NMC Standards of proficiency for entry to the register. Practice outcomes for placements 1, 2, 3 (Branch – Year 3)

Placement 1 Placement 2 Placement 3 Midpoint review

End of placement review

Midpoint review

End of placement review

Midpoint review

Summative assessment

1. Handover Minimum level required

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

The student is able to:

1a. Identify and record relevant information for patient care.

CA

1b. Identify additional sources of information required prior to patient assessment, particularly if there are concerns about risk.

CA

1c. Consult with mentor/supervisor if unsure of own level of competency.

CA

1d. Demonstrate understanding and/or need to refer to local and national policies, evidence base/protocol for care.

CA

1e. Recognise and consider equality and diversity issues for individual patients.

CA

1f. Handover patient caseload clearly and concisely and identify key issues for patients and healthcare team.

CA

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NMC Standards of proficiency for entry to the register. Practice outcomes for placements 1, 2, 3 (Branch – Year 3)

Placement 1 Placement 2 Placement 3 Midpoint review

End of placement review

Midpoint review

End of placement review

Midpoint review

Summative assessment

2. Assessment Minimum level required

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

The student is able to:

2a. Select and use a relevant assessment tool in relation to patient and staff safety:

1. Lone worker (for community settings)

2. Environment 3. Patient safety 4. Safety of others

CA

2b. Establish rapport with patient/ family to identify bio psychosocial needs and appropriate interventions.

CA

2c. Acknowledge and support the right of individuals /groups respecting individual choices and the right to confidentiality.

CA

2d. Refer to appropriate patient care records /documentation to inform ongoing assessment.

CA

Conduct and document a holistic assessment with regard to the individual’s (or local community’s):

2e. Emotional, physical, psychological, spiritual and social well-being.

CA

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NMC Standards of proficiency for entry to the register. Practice outcomes for placements 1, 2, 3 (Branch – Year 3)

Placement 1 Placement 2 Placement 3 Midpoint review

End of placement review

Midpoint review

End of placement review

Midpoint review

Summative assessment

2. Assessment (cont) Minimum level required

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

2f. Patient/family/carer/local community needs.

CA

2g Discharge plan/need for alternative care setting.

CA

2h. Promoting health and well being.

CA

2i. Analyse information gathered, identify and record patient needs/problems.

CA

2j. Prioritise interventions based on caseload and acuteness of need.

CA

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NMC Standards of proficiency for entry to the register. Practice outcomes for placements 1, 2, 3 (Branch – Year 3)

Placement 1 Placement 2 Placement 3 Midpoint review

End of placement review

Midpoint review

End of placement review

Midpoint review

Summative assessment

3. Care delivery Minimum level required

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

The student is able to:

3a. Work collaboratively with patients/ families and carers as part of the team in planning care.

CA

3b. Demonstrate an understanding of informed consent for patients and how it is applied.

CA

3c. Discuss and negotiate interventions with patients/ carers/family and the team members.

CA

3d. Review and compile a care plan that is specific, measurable, achievable and reflects current needs.

CA

3e. Provide a rationale for nursing interventions taking account of equality and diversity, privacy and dignity, spiritual care, acuteness of health and well-being needs, social needs and risk.

CA

3f. Provide care with skill and sensitivity relevant to patient, family and carer needs.

CA

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NMC Standards of proficiency for entry to the register. Practice outcomes for placements 1, 2, 3 (Branch – Year 3)

Placement 1 Placement 2 Placement 3 Midpoint review

End of placement review

Midpoint review

End of placement review

Midpoint review

Summative assessment

3. Care delivery (cont) Minimum level required

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

3g. Document care effectively in accordance with professional, ethical and legal requirements.

CA

3h. Refer the patient to other health and social care professionals as appropriate.

CA

3i. Recognise the need to adapt care plans and interventions when circumstances change.

CA

3j. Take the opportunity for informal teaching with patients/family, carers, other health professionals and students.

CA

3k. Utilise clinical information systems and/or the Patient Electronic Record (PER) to order and/or obtain information/results.

CA

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NMC Standards of proficiency for entry to the register. Practice outcomes for placements 1, 2, 3 (Branch – Year 3)

Placement 1 Placement 2 Placement 3 Midpoint review

End of placement review

Midpoint review

End of placement review

Midpoint review

Summative assessment

4. Evaluation Minimum level required

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

The student is able to:

4a. Evaluate and record patient progress with reference to care provided in the appropriate documentation.

CA

4b. Identify whether care provided met the patient/family/carer expectations.

CA

4c. Critically discuss the evidence base for interventions used relevant to the allocated caseload.

CA

4d. Identify recommendations for improving the patient’s/ family’s/ carer’s experience (service improvement).

CA

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NMC Standards of proficiency for entry to the register. Practice outcomes for placements 1, 2, 3 (Branch – Year 3)

Placement 1 Placement 2 Placement 3 Midpoint review

End of placement review

Midpoint review

End of placement review

Midpoint review

Summative assessment

5. Management of self and others

Minimum level required

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

The student is able to:

5a. Critically reflect on own patient workload planning and prioritisation for management of simple patient caseload or complex patient caseload.

CA

5b. Demonstrate understanding of the impact of unexpected events (eg staff sickness, untoward incidents) on the workforce for the shift.

CA

5c. Critically reflect how feedback from patient/carers/family influences own learning.

CA

5d. Demonstrate ability to recognise when issues of conflict or challenge arise in team working.

CA

5e. Critically reflect on how own mood and physical health impacts on their ability to provide care for patients.

CA

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NMC Standards of proficiency for entry to the register. Practice outcomes for placements 1, 2, 3 (Branch – Year 3)

Placement 1 Placement 2 Placement 3 Midpoint review

End of placement review

Midpoint review

End of placement review

Midpoint review

Summative assessment

5. Management of self and others (cont)

Minimum level required

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

5f. Delegate activities appropriately to others in the healthcare team.

CA

5g. Co-ordinate the delivery of nursing and healthcare for the patient caseload.

CA

5h. Demonstrate effective leadership in the maintenance of safe nursing practice.

CA

5i. Respond to constructive feedback from mentors/supervisors and demonstrate how this contributes to personal development.

CA

5j. Identify personal strengths and areas for development and how to act on these.

CA

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Clinical Skills

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6.3 Assessment of clinical skills Care delivery For entry to the register, under supervision, the student is able to:

Placement 1 Placement 2 Placement 3 Midpoint review

End of placement review

Midpoint review

End of placement review

Midpoint review

Summative assessment

Engagement and psychosocial skills

Minimum level required

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

1. Make and maintain working relationships with patients and/or

carers

CA

2. Describe practice of enhanced observation

CA

3. Use a solution-focused approach with patients during one to one sessions/individual time

CA

4. Identify and/or use interventions related to cognitive behaviour

therapy

CA

5. Apply psychodynamic concepts in their understanding of complex

situations with patients and staff

CA

6. Identify ways to help a patient maintain or find work or other meaningful activities

CA

7. Involve patients in their care

CA

8. Acknowledge spiritual needs and respond to these

CA

9. Work collaboratively with carers

CA

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Care delivery For entry to the register, under supervision, the student is able to:

Placement 1 Placement 2 Placement 3 Midpoint review

End of placement review

Midpoint review

End of placement review

Midpoint review

Summative assessment

Medication administration Minimum level required

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

10. Safely and effectively administer medication following the steps outlined below:

a) Checks that prescription written legibly in the approved drug name

b) Identifies patient, history and allergies

c) Checks drug (strength, dose and formulation)

d) Checks route, date, time and frequency

e) Completes calculations accurately and independently

f) Prepares any relevant equipment

g) Describes the use, side effects and

contraindications of the administered drug

h) Communicates with patient during administration: assessing side effects and giving information

i) Identifies whether informed consent has been given

j) Administers medication in accordance with Infection Control procedures

k) Disposes of sharps in accordance with local policy

l) Describes the procedure for reporting errors or near misses without consent

CA

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Care delivery For entry to the register, under supervision, the student is able to:

Placement 1 Placement 2 Placement 3 Midpoint review

End of placement review

Midpoint review

End of placement review

Midpoint review

Summative assessment

Medication administration Minimum level required

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

11. Apply principles of motivational interviewing to medication management

a) Asks the patient their view of the

good and bad things about their medication

b) Acknowledges that patient may be ambivalent about medication

c) Adopts a neutral attitude towards medication

CA

12. Demonstrate understanding of local policy for ECT

a) Describes the rationale for ECT

b) Describes nursing procedures for preparing patient for ECT and for recovery after treatment

CA

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Care delivery For entry to the register, under supervision, the student is able to:

Placement 1 Placement 2 Placement 3 Midpoint review

End of placement review

Midpoint review

End of placement review

Midpoint review

Summative assessment

Physical health care Minimum level required

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

13. Carry out assessment of physical health

a) Temperature (orally and per axilla)

CA

b) Rate and quality of respirations CA

c) Pulse CA

d) Blood pressure, including lying and standing measure

CA

e) Urinalysis CA

f) Blood sugar level CA

g) Neurological observations CA

h) Weight CA

i) Height CA

j) Calculate BMI CA

k) Measure and record fluid input and output

CA

l) Measure and record dietary intake CA

m) Identify any need for assessment of skin integrity

CA

n) Screen mobility and identify need for referral to physiotherapist/OT

CA

o) Screen for swallowing difficulties and identify need for referral to Speech Therapist

CA

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Care delivery For entry to the register, under supervision, the student is able to:

Placement 1 Placement 2 Placement 3 Midpoint review

End of placement review

Midpoint review

End of placement review

Midpoint review

Summative assessment

Physical health care Minimum level required

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

14. Demonstrate ability to provide appropriate physical health care

a) Helps patient maintain their personal hygiene sensitively and

safely b) Identifies any need for assistance

with eating or drinking c) Recognises any problems with

elimination (e.g. constipation, incontinence) and takes appropriate action

d) Recognises need for oral care and, where appropriate, carries this out safely

e) Understands principles of asepsis as applied to minor wounds and burns

CA

15. Enable a patient to develop a plan to improve their physical health/lifestyle

a) Helps the patient to identify lifestyle factors affecting physical

health b) Helps the patient identify motivation to change health c) Helps the patient identify appropriate goals and steps to achieve

these d) Helps the patient evaluate progress

and reformulate plan

CA

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Care Delivery For entry to the register, under supervision, the student is able to:

Placement 1 Placement 2 Placement 3 Midpoint review

End of placement review

Midpoint review

End of placement review

Midpoint review

Summative assessment

Physical health care Minimum level required

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

16. Demonstrate ability to identify Early Warning Signs in potentially worsening medical conditions and take appropriate action

a) Identifies normal limits of physical observations and acts on any changes

b) Identifies any other critical abnormalities and appropriate action (Examples may include: shortness of breath, altered level of consciousness, confusion, chest pain, ataxia, low urinary output, haematemesis, melaena)

c) Identifies different types of shock and action to take

d) Identifies hypo- and hyperglycaemic states and indicates appropriate action

CA

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Care Delivery For entry to the register, under supervision, the student is able to:

Placement 1 Placement 2 Placement 3 Midpoint review

End of placement review

Midpoint review

End of placement review

Midpoint review

Summative assessment

Physical health care Minimum level required

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

17. Apply the principles of infection control to practice

a) Identifies potential sources of infection

b) Is aware of basic precautions in food handling

c) Washes hands correctly

d) Identifies means of disposing of waste products

e) Assembles sharps bins correctly, uses and disposes of it appropriately

f) Uses retractable needles and blood lancets appropriately

g) Describes what to do in event of needlestick injury

CA

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Care delivery For entry to the register, under supervision, the student is able to:

Placement 1 Placement 2 Placement 3 Midpoint review

End of placement review

Midpoint review

End of placement review

Midpoint review

Summative assessment

Managing emergencies Minimum level required

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

18. Identify strategies to safely and effectively manage anger and violence

a) Identifies factors which can improve communication and minimise aggression from first point of contact

b) Identifies increasing risk of aggression

c) Identifies steps to reduce likelihood of aggression

d) Helps the patient to identify means to manage own aggressive feelings

e) Reflects on own/service’s role in relation to patient aggression

CA

19. Identify role in emergency situations and has awareness of how to contribute to their

management a) Accurately identifies emergency or potential emergency situations

b) Takes prompt and effective action in first instance

c) Summons appropriate help

d) Works as a calm, effective team member during emergency

e) Contributes appropriately to post-incident analysis

f) Participates in documentation and reporting of incident

CA

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Care delivery For entry to the register, under supervision, the student is able to:

Placement 1 Placement 2 Placement 3 Midpoint review

End of placement review

Midpoint review

End of placement review

Midpoint review

Summative assessment

Legal procedures Minimum level required

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

20. Correctly identify nurse’s role with regard to Mental Health Act (1983) as Amended by the MHA (2007), the Mental Capacity Act (2005) and the Deprivation of Liberty safeguards

a) Identifies indications for referral for section assessment

b) Demonstrates knowledge of conditions for application of Nurses’ Holding Power

c) Describes the process for accepting section papers accurately and legally

d) Explains rights to patients and checks understanding

e) Identifies the psychological effects on the patient who is detained under MHA

f) Observes the preparation of a nursing report for MHA appeal hearing

g) Understands the role of a nurse in ensuring good practice for agreed leave

CA

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Care delivery For entry to the register, under supervision, the student is able to:

Placement 1 Placement 2 Placement 3 Midpoint review

End of placement review

Midpoint review

End of placement review

Midpoint review

Summative assessment

Legal procedures Minimum level required

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

21. Correctly identify nurse’s role with regard to Care Programme Approach

a) Identifies role of care co-ordinator for CPA

b) Accurately completes needs assessment

c) Contributes to the formulation of a MDT care plan

d) Aware of procedures and administration of the Supervised Community Treatment and CTOs.

CA

22. Correctly identify nurse’s role in safeguarding children

a) Identifies limits of confidentiality with respect to safeguarding children

b) Aware of procedures for assessment of child safety

c) Describes local procedures for referral to Local Authority children’s services or to police

CA

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Care delivery For entry to the register, under supervision, the student is able to:

Placement 1 Placement 2 Placement 3 Midpoint review

End of placement review

Midpoint review

End of placement review

Midpoint review

Summative assessment

Legal procedures Minimum level required

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

Level achieved

Level achieved

Mentor’s signature and date

23. Describe nurse’s role in Protection of Vulnerable Adults (POVA):

a) Identifies different potential types of neglect or abuse

b) Describes action to be taken if neglect or abuse suspected

CA

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7.0 Additional skills List any opportunities to practise additional skills

Skills

Comments on performance Mentor’s signature and date

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8.0 Service user/carer involvement in practice assessment for nursing students These sheets must be completed in three different placements during the branch programme: one in the final placement of year 2, and in the final two placements of year 3. Consent must be gained from the service user/carer with the mentor present to participate in this exercise. If the service user/carer only wishes to discuss this with the student rather than complete the form below, the mentor could record the points raised below.

We would like to hear your views about the way nursing students have contributed to the care you have received. You do not need to disclose your name. The feedback you give will not affect the care you receive and there is no requirement for you to participate (if a carer, this relates to care given to the service user). Please comment on (student name): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ’ s strengths and weaknesses. Please state what you feel they have done well. Please state what they could do to improve their nursing care. Please add any other information you think would be helpful. Placement name: Date: Mentor’s signature (witness): Service

user’s/carer’s initials:

Student’s initials:

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Service user/carer involvement in practice assessment for nursing students (continued) Consent must be gained from the service user/carer with the mentor present to participate in this exercise. If the service user/carer only wishes to discuss this with the student rather than complete the form below, the mentor could record the points raised below.

We would like to hear your views about the way nursing students have contributed to the care you have received. You do not need to disclose your name. The feedback you give will not affect the care you receive and there is no requirement for you to participate (if a carer, this relates to care given to the service user). Please comment on (student name): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ’ s strengths and weaknesses. Please state what you feel they have done well. Please state what they could do to improve their nursing care. Please add any other information you think would be helpful. Placement name: Date: Mentor’s signature (witness): Service

user’s/carer’s initials:

Student’s initials:

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9.0 Pre-registration nursing students’ risk assessment The following form must be completed when pre-registration nursing students are visiting patients/clients in their own homes, unaccompanied by Trust staff. The form must be stored in the student’s Practice Assessment Document. Name of student ............................................................................................. Name of clinical placement ............................................................................. Dates: From ........................................................................................................................ To ............................................................................................... . Identifying the hazard Please indicate any hazards the student may be exposed to in the patient’s/client’s home

Identifying control measures to reduce risk Please indicate action taken for controlling hazards and risks identified

Additional information Please indicate any additional information such as prohibited activities or other hazards that may affect the student

I have discussed the above with the student. I have assessed the student as competent to undertake identified nursing care with identified patients in an unaccompanied capacity. Signature of mentor ................................................................................................................. Date ..................................................................................... I have had the opportunity to discuss the above with my mentor. I feel competent to visit identified patients unaccompanied and know what action to take in the event of an emergency.

Signature of student ............................................................................................................... Date .........................................................................................

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10.0 Attendance for clinical supervision sessions

All third year students must attend a minimum of six clinical supervision sessions within year 3 and have each of these signed and dated in the PAD. Please note that attendance is mandatory and that clinical supervision is supported and recognised by the NMC. Ground rules for clinical supervision will be given to students prior to commencing year 3 and these should be shared with mentors. Please list below the dates on which you have attended clinical supervision so that we can see how many you have attended.

If you attend a clinical supervision session when you are on shift, this cannot be claimed as extra clinical hours. If your clinical supervision takes place when you are not on shift, you may claim this as clinical time but you must record it on the weekly timesheet page and it must be signed off. Date attended clinical supervision Signature of supervisor

1

2

3

4

5

6

7

8

9

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Timesheets

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11.0 Attendance record for practice hours Completing your record of placement hours • Trust inductions count as clinical hours and must be recorded and signed off at the time of induction • No more than 48 hours may be worked in any one week • No more than 11.5 hours may be worked per shift (this excludes breaks) • If you work more than the above stipulated hours per shift or per week, the excess hours will not be counted in the total for the placement. Completing your weekly timesheets • Record the hours you have been rostered to work each week. Then, in the appropriate column, indicate the actual shift times you worked,

and the total number of hours this equates to. • For each shift worked you must obtain the signature of your supervisor ie qualified nurse or mentor (or other professional), who can verify

the hours worked. Shifts that have not been signed will not be included in your total. • Ensure you indicate, using ‘N’, if the shift was a night shift. • If you are sick, and did not work the rostered hours, you must indicate this using ‘S’ against the relevant shift. You must also complete the

on-line notification: https://www.kcl.ac.uk/teares/nmvc/prereg/absence/student/index.php • If you are sick/absent and make up hours, these should be recorded in the separate section at the end (page 76), and added to the overall

placement total. • Record the total hours for each WEEK. • Write the TOTAL number of hours worked on the placement in the box at the end. • All changes to written information must be verified with a new signature and date. One line through a mistake and no tippex.

PADs that are filled in incorrectly, or where the weekly or overall totals have not been completed, will be returned for correction before being processed.

Please see the example on the following pages, and ensure your document is completed in the same manner.

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EXAMPLE Placement 1, Week 1 Date Rostered hours Actual hours

completed Indicate if night shift (N). If you did not work the shift, indicate if sick (S)

Total hours

Supervisor’s signature

M 13 Sept 2010 07.30 – 15.30 07.30 – 15.30 7.5 D S Jones T 14 Sept 2010 07.30 – 15.30 07.30 – 15.30 7.5 D S Jones W 15 Sept 2010 07.30 – 15.30 07.30 – 15.30 7.5 D S Jones T 16 Sept 2010 07.30 – 15.30 07.30 – 15.30 7.5 D S Jones F 17 Sept 2010 07.30 – 15.30 07.30 – 15.30 7.5 D S Jones S S

Total practice hours this week 37.5 Placement 1, Week 2 Date Rostered hours Actual hours

completed Indicate if night shift (N). If you did not work the shift, indicate if sick (S)

Total hours

Supervisor’s signature

M 4 October 2010 07.30 – 15.30 07.30 – 15.30 7.5 D S Jones T W 6 October 2010 20.15 – 07.45 20.15 – 07.45 N 10.5 D S Jones T 7 October 2010 20.15 – 07.45 20.15 – 07.45 N 10.5 D S Jones F 8 October 2010 20.15 – 07.45 None S S S

Total practice hours this week 28.5

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Placement 1, Week 3 Date Rostered hours Actual hours

completed Indicate if night shift (N). If you did not work the shift, indicate if sick (S)

Total hours

Supervisor’s signature

M 11 October 2010 07.30 – 15.30 07.30 – 16.00 8 D S Jones T W 13 October 2010 20.15 – 07.45 20.15 – 07.45 N 10.5 D S Jones T 14 October 2010 20.15 – 07.45 20.15 – 07.45 N 10.5 D S Jones F 15 October 2010 20.15 – 07.45 20.15 – 07.45 N 10.5 D S Jones S S

Total practice hours this week 39.5

Summary of Placement 1: Total hours for placement 105.5 Number of night duty shifts 5 shifts Number of shifts not worked because of sickness 1 shift

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Record of Hours Placement 1 Placement 1, Week 1 Date Rostered Hours Actual Hours

completed Indicate if Night Shift (N). If you did not work the shift, indicate if Sick (S)

Total hours

Supervisor’s signature

M T W T F S S

Total hours week 1 Placement 1, Week 2 Date Rostered Hours Actual Hours

completed Indicate if Night Shift (N). If you did not work the shift, indicate if Sick (S)

Total hours

Supervisor’s signature

M T W T F S S

Total hours week 2

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Placement 1, Week 3 Date Rostered Hours Actual Hours

completed Indicate if Night Shift (N). If you did not work the shift, indicate if Sick (S)

Total hours

Supervisor’s signature

M T W T F S S

Total hours week 3 Placement 1, Week 4 Date Rostered Hours Actual Hours

completed Indicate if Night Shift (N). If you did not work the shift, indicate if Sick (S)

Total hours

Supervisor’s signature

M T W T F S S

Total hours week 4 If you are sick or absent and make up a shift, this should be recorded on page 76. Please complete summary overleaf

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Attendance summary for Placement 1: Total hours for placement (including any shifts made up, recorded on page 76)

Number of night duty shifts

Number of shifts not worked because of sickness

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Record of Hours Placement 2 Placement 2, Week 1 Date Rostered Hours Actual Hours

completed Indicate if Night Shift (N). If you did not work the shift, indicate if Sick (S)

Total hours

Supervisor’s signature

M T W T F S S

Total hours week 1 Placement 2, Week 2 Date Rostered Hours Actual Hours

completed Indicate if Night Shift (N). If you did not work the shift, indicate if Sick (S)

Total hours

Supervisor’s signature

M T W T F S S

Total hours week 2

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Placement 2, Week 3 Date Rostered Hours Actual Hours

completed Indicate if Night Shift (N). If you did not work the shift, indicate if Sick (S)

Total hours

Supervisor’s signature

M T W T F S S

Total hours week 3 Placement 2, Week 4 Date Rostered Hours Actual Hours

completed Indicate if Night Shift (N). If you did not work the shift, indicate if Sick (S)

Total hours

Supervisor’s signature

M T W T F S S

Total hours week 4

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Placement 2, Week 5 Date Rostered Hours Actual Hours

completed Indicate if Night Shift (N). If you did not work the shift, indicate if Sick (S)

Total hours

Supervisor’s signature

M T W T F S S

Total hours week 5

If you are sick or absent and make up a shift, this should be recorded on page 76. Please complete the summary box below:

Attendance summary for Placement 2: Total hours for placement (including any shifts made up, recorded on page 76)

Number of night duty shifts

Number of shifts not worked because of sickness

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Record of Hours Placement 3 Placement 3, Week 1 Date Rostered Hours Actual Hours

completed Indicate if Night Shift (N). If you did not work the shift, indicate if Sick (S)

Total hours

Supervisor’s signature

M T W T F S S

Total hours week 1 Placement 3, Week 2 Date Rostered Hours Actual Hours

completed Indicate if Night Shift (N). If you did not work the shift, indicate if Sick (S)

Total hours

Supervisor’s signature

M T W T F S S

Total hours week 2

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Placement 3, Week 3 Date Rostered Hours Actual Hours

completed Indicate if Night Shift (N). If you did not work the shift, indicate if Sick (S)

Total hours

Supervisor’s signature

M T W T F S S

Total hours week 3 Placement 3, Week 4 Date Rostered Hours Actual Hours

completed Indicate if Night Shift (N). If you did not work the shift, indicate if Sick (S)

Total hours

Supervisor’s signature

M T W T F S S

Total hours week 4

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Placement 3, Week 5 Date Rostered Hours Actual Hours

completed Indicate if Night Shift (N). If you did not work the shift, indicate if Sick (S)

Total hours

Supervisor’s signature

M T W T F S S

Total hours week 5 Placement 3, Week 6 Date Rostered Hours Actual Hours

completed Indicate if Night Shift (N). If you did not work the shift, indicate if Sick (S)

Total hours

Supervisor’s signature

M T W T F S S

Total hours week 6

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Placement 3, Week 7 Date Rostered Hours Actual Hours

completed Indicate if Night Shift (N). If you did not work the shift, indicate if Sick (S)

Total hours

Supervisor’s signature

M T W T F S S

Total hours week 7 Placement 3, Week 8 Date Rostered Hours Actual Hours

completed Indicate if Night Shift (N). If you did not work the shift, indicate if Sick (S)

Total hours

Supervisor’s signature

M T W T F S S

Total hours week 8

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Placement 3, Week 9 Date Rostered Hours Actual Hours

completed Indicate if Night Shift (N). If you did not work the shift, indicate if Sick (S)

Total hours

Supervisor’s signature

M T W T F S S

Total hours week 9 Placement 3, Week 10 Date Rostered Hours Actual Hours

completed Indicate if Night Shift (N). If you did not work the shift, indicate if Sick (S)

Total hours

Supervisor’s signature

M T W T F S S

Total hours week 10

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Placement 3, Week 11 Date Rostered Hours Actual Hours

completed Indicate if Night Shift (N). If you did not work the shift, indicate if Sick (S)

Total hours

Supervisor’s signature

M T W T F S S

Total hours week 11 Placement 3, Week 12 Date Rostered Hours Actual Hours

completed Indicate if Night Shift (N). If you did not work the shift, indicate if Sick (S)

Total hours

Supervisor’s signature

M T W T F S S

Total hours week 12 If you are sick or absent and make up a shift, this should be recorded on page 76. Please complete the summary boxes overleaf:

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Attendance summary for Placement 3: Total hours for placement (including any shifts made up, recorded on page 76)

Number of night duty shifts

Number of shifts not worked because of sickness

Attendance summary for year three: Total Hours Total Night duty shifts Total shifts not worked due to

sickness Placement 1

Placement 2

Placement 3

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Record of dates when shifts missed through sickness/absence have been made up: Date Rostered hours Actual hours completed Indicate if night shift

(N).

Total hours Supervisor’s signature

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Record of dates when shifts missed through sickness/absence have been made up (continued): Date Rostered hours Actual hours completed Indicate if night shift

(N).

Total hours Supervisor’s signature

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12.0 Record of Meetings/Comment Sheet

Date and Time Record of Meetings/Comment Sheet Persons Present (signature and designation)

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Date and Time Record of Meetings/Comment Sheet Persons Present (signature and designation)

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Date and Time Record of Meetings/Comment Sheet Persons Present (signature and designation)

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Date and Time Record of Meetings/Comment Sheet Persons Present (signature and designation)

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13.0 Action Plan sheets Area for further development What needs to be demonstrated How can this be demonstrated Date for

review

Mentor’s signature ...................................................................... Student’s signature ...................................................... Date .......................................

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Area for further development What needs to be demonstrated How can this be demonstrated Date for review

Mentor’s signature ...................................................................... Student’s signature ...................................................... Date .......................................

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Area for further development What needs to be demonstrated How can this be demonstrated Date for review

Mentor’s signature ...................................................................... Student’s signature ...................................................... Date .......................................