practice assessments guidance for midwife mentors · • developing confidence in abdominal...

2015

Practice Assessment Guidance for Sign off Mentors and Co-Mentors Edited by Sara Phillips and Hazel Inkster

The purpose of this booklet is to provide some informal guidance to support midwife mentors in the assessment of clinical practice. The booklet includes NMC standards for midwifery training and relevant information from the Practice Educator Midwife to support development. Information for mentors and co-mentors in all clinical areas will guide teaching and assessment in practice. This booklet has a direct focus on the pre registration, 3 year programme for ease of breakdown however this is easily transferrable to the 18 month course. The expectations are at the end of each year NOT each placement. These lists are for guidance only please see the PAD, Practice Educator and experienced colleagues for further support. This booklet has had contributions from experienced mentors from all clinical areas and senior student midwives. Thank you to the staff involved. Acknowledgements Charlotte Hudson Kirsty Gallagher Megan Brown Sarah Bailey Rebecca Edmonds Emma Glass Emma Frewin Hannah Kurz

2

Index

* Each section of this booklet is colour coded to an area

Title Page

Supporting our Student Midwives

3

Feedback and planned meetings

4

Relevant NMC Guidance 5 Student Journey 6 Community

Year 1 8 Year 2 9 Year 3 9

DAU/ANC Year 2 10/11 Year 3 10/11

Delivery Suite


Iffley Ward Year 2 15 Year 3 16

Marsh Ward Year 1 17 Year 2 18 Year 3 18

Rushey Birth Centre


Skills Drills/OSCE Support 22 Suggested Reading 23 Useful Contacts 24

3

Supporting our students Getting it Right for our students they are our midwives of the future Meet and Greet Carrying out initial interview ……..things to check

• Look at the student’s shifts to make sure they are working 40% with you and have consistency with the co-mentor.

• Making sure the students do not have more than 3 mentors. • Carry out orientation on first day - document it in the student

midwife PAD. The orientation page should be photocopied and a copy left on the ward.

• Make dates for midpoint and final interviews which are appropriate and convenient to all.

• Make sure up to date contact numbers are in student folder in your area.

• If asked to change shifts ask student midwife if she could also change. If unable to please ensure your student midwife has a mentor for that shift.

• If you have to hand over a student half way through placement ensure you liaise with the future mentor.

• Establish which competencies need to be achieved. This may mean not actually signing them off during the placement but having a good idea of what still needs to be done.

• Establish ground rules and what student needs are – make sure student has PAD and time sheet signed every day.

4

Giving Feedback

• Do this on a daily basis - 5 minutes at the end of a shift/during shift this will make a huge difference – document if necessary.

Carry out Midpoint when arranged

• Inform the midwife in charge that the midpoint interview needs to be done. If support required the mentor should see the student champion/practice educator midwife and contact UWL early in the placement. The student midwife must be informed that you have done this (contact details of UWL on student board).

Carry out Final meeting

• Inform midwife in charge that final meeting needs to be carried out. If UWL were required for midpoint then UWL staff should be present at the final interview.

5

Relevant NMC Documents Standards for pre-registration midwifery education (2011) Standards to support learning and assessment in practice (2008) Mentors are practice teachers. They are responsible and accountable for (NMC 2008):

• 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 as required by programme providers of student achievement or lack of achievement. It is recommended that the mentor keeps a log.

• 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.

6

Student Journey

Year Pre-registration Programme

3 year

Part Post-registration Short course

18 month Area Weeks Area Weeks

1 Community including 1 week of clinic if no bookings undertaken in the community

8

1 Community 6

Delivery Suite or Birth Centre

8 ANC 1

Postnatal 4 Delivery Suite/ Birth

Centre

8

Gynaecology 3 Antenatal/Postnatal Wards

2/2

2 ITU 1 2 DAU 1 ANC/DAU 3 ANC 1

Antenatal Ward 4 Antenatal ward

2

Postnatal/ Community

4 Postnatal/ Community

2

Delivery Suite 8 Elective 1 Neonatal/Iffley 2 Delivery Suite 8

3 Delivery Suite/ Birth Centre

8 - Neonatal 2

Antenatal Ward

2 HDU/High Risk

1

Postnatal/Community

4

Elective 1 Reflective Placement

8

7

40th Births

This is a constant worry for all our student midwives. Please reassure your student that they will achieve their births. It is suggested that student midwives witness a minimum of 5 normal births before they start delivering. The mentor must remain hands on for the first 5 deliveries but you may need to do this for the first 10. Please use your professional discretion whilst remembering you remain accountable. Student midwives need experience in hands on and hands poised. Senior mentors have given a very approximate guide for the number of births to anticipate per year.

KEEP CALM

YOU WILL GET 40 BIRTHS

Pre-registration Programme 3years

Year 1 10 Births Year 2 15 Births Year 3 15 Births

Post-registration Short Course 18months

Part 1 10-15 Births Part 2 25-30 Births

8

Community Year 1

• Demonstrates good communication skills (both verbal and body).

• Confidentiality skills. • Start to learn the skills of palpation. • Auscultation of the fetal heart with a pinnard and sonicaid. • Has an understanding of the hormones of pregnancy and

effect on the woman. • Understand medical terms ie. prefix's hyper, hypo ie

hyperemesis, hypotension. • Newborn blood spot screening. • Awareness of screening tests offered, why they are offered

and when (e.g. Nuchal). • Able to recall the AN care schedule and be aware of what is

needed at each appointment. • Is able to undertake a routine postnatal check. • Is knowledgeable about physiological jaundice. • Basic observations. • Case loading. • Awareness of routine antenatal bloods and which sample

bottles to use. • Becoming familiar with trust guidelines. • Is developing a logical approach to tasks.

9

Community Year 2

• A good understanding of medical conditions that effect pregnancy (diabetes, epilepsy) and associated medication.

• Interpretation of blood results. • Knows when and how to refer to MDT (GP’s, obstetricians,

Poppy, social care). Can effectively communicate the referral to the family.

• Advanced palpation skills, understands the different lies and positions.

• Documentation, using the correct terminology. • Good understanding of CMIS, Intranet etc. • Actively participates in booking appointments. • Able to accurately discuss the different screening tests

offered with women. • Recognisees deviation from normal in postnatal woman. • Can support women with feeding difficulties.

Community Year 3

• Lead antenatal and postnatal clinics. • Recognising the abnormal and referring both in a timely

manner and to the correct department. • Delegation of workload and planning appointment times. • Preparation for a home birth or BBA. • Advanced communication, prepared for a difficult

conversation, bad news etc. • Discharging the woman to the Health visitor. • Ability to assess infant feeding in the PN period at home, in

particular BF and baby friendly care plan writing to support the infant feeding advice given.

• Participates in parent craft.

10

DAU/ANC - All placements

• Meet and greet women in a professional and welcoming

manner. • Answer the phone willingly and in a professional manner.

Take accurate details on the triage form, discuss with a midwife regarding the advice to give (with common queries e.g. decreased foetal movements/ raised BP be beginning to recognise who to invite in/ advise to stay at home etc. and simply look to the midwife for confirmation of this), then relay this advice back to the woman.

• Be able to document accurately and concisely regarding the care they have given the women using the SBAR format. There is a guide given to each student on good documentation when they arrive on DAU.

• Ensure electronic documentation is completed. • Under direct/indirect supervision as appropriate complete the

cycle of seeing admissions. • After discussion with a midwife regarding what is necessary,

begin to take the lead in caring for all the women under one midwife’s supervision.

• Time management and prioritisation skills and triage of patient needs/situation.

• Adopt a timely manner in seeing women, recognising the need to balance building up a rapport/ taking accurate histories and being available at the desk to answer the phone/ discuss situations with colleagues/ admit women etc.

• By their second week of placement be able to articulate clearly what a standard plan should be for common admissions, e.g. decreased fetal movements, PET screen, ?PROM.

• Be able to interpret a reassuring CTG accurately. Begin to troubleshoot suspicious CTGs, eg. Changing positions without prompting.

11

DAU/ANC - All placements

• Clinical skills- basic observations done accurately, be able to

perform an accurate palpation, auscultation of the fetal heart and commence CTG, venepuncture-successful on most occasions, accuracy of VE findings improving. – report and refer any deviations in a timely manner.

• By the end of their placement have a basic understanding of the physiology surrounding common conditions, e.g. PET, obstetric cholestasis. Be starting to articulate this to the women in their care.

12

Delivery Suite Year 1

• Demonstrates good communication skills. • Shows initiative. • Competent in completing the partogram unprompted. • Knowledge of the mechanisms of labour. • Observations in labour and correctly calculates the MOWS.

Aware of normal limits and reports findings. • Developing confidence in abdominal palpations. • Auscultation and documentation of the fetal heart as per

NICE guidelines. • Some contribution to the main notes. • Developing competence with venepuncture. • Understands the rationale for urine analysis and relevant

actions required. • Start undertaking VE’s. Suggested – initially mentor to do 1st

and then explain findings to the student. • Checking emergency equipment. • Infection control –Is aware of policies and correct hand

washing. • Safe moving and handling. • Confident with postnatal checks. • Breastfeeding support. • Understanding of the mechanisms of labour. • Knowledge of how to check a placenta. • Able to use the bleep system.

13


• Competent in aseptic technique. • Skilled in catheterisation. • Handover using SBAR. • Care planning for normal birth. • Developing confidence with VE’s. • Developing confidences in ARM’s. • Record keeping in the main notes to meet standards. • Understanding of high dependency care. • Confident in routine post op care. • Admission assessments and care planning. • Good understanding of CTG’s. • Checking the perineum and can classify the type of trauma. • Able to take cord gases. • Data entry on EPR/CMIS/pathology. • Communication lead. • Assist with epidurals. • Start K2 on line learning.

14


• Completes all records unprompted. • Competence at adult and neonatal resuscitation. • Able to manage obstetric emergencies. • Confident handover using SBAR. • 1 in charge shift with senior midwife- demonstrating

understanding of the role, organisation skills and impact of team working.

• Confidence with CTG interpretation/ finish K2 learning. • Demonstrates decision making and care planning. • Extended skills and PTP. • Has experience in Willow/ Bereavement care. • Intrapartum care of a twin pregnancy. • Be confident in high risk cases including

Diabetes/PET/MOH/HDU Care/IOL. • Confident with VE’s. • Confidence case for midwife care women only – see PTP for

guidance.

15

Iffley Ward Year 2

• Care planning for an Antenatal admission, orientation of

women. • CTG- understanding, take immediate actions if concerned

and know how to escalate concerns. • Understanding of physiology of pre-eclampsia, able to

recognise abnormal PET bloods. • Understanding complex medical conditions and how they

affect pregnancy. (Diabetes, OC, APH – placental abnormalities).

• Transitional care- able to implement a care plan for a transitional and discuss with parents.

• Breastfeeding- dealing complex feeding problems and implementing plans.

• Able to assist in Emergencies, confidently use the 2222 system, requesting correct team.

• Be involved on ward round/drug round. • Confidently refer to multi-disciplinary team. • Uses SBAR in transfers to delivery suite and Buscot. • Risk assessment- be able to assess workload and determine

priorities. • Record keeping – be able to maintain records.

16

Iffley Ward Year 3

• Be confident to plan care for antenatal women, in partnership

with women and partners taking into consideration any relevant history and involve appropriate team members with minimal support.

• Care independently for PN/AN women with minimal support from midwife. Work using own initiative and is able to risk assess work load.

• Refer women to other team members as appropriate. • Be confident to interpret CTG – take immediate measures

required. • Keep accurate records of care provided – make sure

everything is countersigned. • Be able to undertake an in charge shift– with support. • Confident to delegate work and follow up. • Being aware of everyone’s roles. Able to react to changing

situations ie staff being transferred to other areas. • In depth knowledge of all medicines given and

contraindications. Keep accurate records regarding medication given. Also aware of how to report drug errors and reactions.

• Actively involved in emergency procedures until help arrives – allocating help appropriately.

• Care planning for antenatal admissions to the ward. • Understanding of safeguarding issues and aware of referral

systems. • Risk assessing and planning work load appropriately.

17

Marsh Ward Year 1

• Mum and baby daily checks/observations under direct supervision.

• Assist with drug round. • Developing the skills of assisting with breastfeeding support

and expressing. • Keep feeding charts up to date. • Familiar with emergency equipment and procedures. • Able to remove catheters + complete VIP' charts. • Good time keeping. • Appropriate uniform. • Good communication with staff/patients/visitors. • Answer call bells and door buzzer. • Answer phone - take out of area discharges. • Able to use bleep system. • Refer women to other team members as appropriate. • Keep accurate records of care provided – make sure

everything is countersigned. • Uses SBAR in transfers to delivery suite, Buscot and Iffley • Record keeping – be able to maintain records • Involvement of physios as required

18

Marsh Ward Year 2

• Mum and baby daily checks/observations with minimal supervision.

• Assist with drug round. • Breastfeeding support and advice - becoming familiar with

formulating feeding plans under supervision. • Able to carry out discharge discussion under supervision. • Minimal prompts for record keeping required. • Be confident to plan postnatal care in partnership with

women, taking into consideration any relevant history. • Being aware of everyone’s roles. Able to react to changing

situations ie staff being transferred to other areas. • Knowledge of neonatal IVs and follow up required with

midwives and neonatal team.

19

Marsh Ward Year 3

• Mum + baby checks/observation with indirect supervision,

reporting and then making a action plan for any deviations. • Able to give postnatal advice on phone where appropriate,

supported by mentor. • Lead drug round under supervision. • Put feeding plans in place. • Complete discharges using indirect supervision. • Confidently plan and provide safe care for a bay of women. • Consolidate skills. • Supported in charge of ward for a minimum of 1 shift. • Confident to delegate work and follow up. • In depth knowledge of all medicines given and

contraindications. Keep accurate records regarding medication given. Also aware of how to report drug errors and reactions.

• Actively involved in emergency procedures until help arrives – allocating help appropriately.

• Care independently for PN women with minimal support from MW. Work using own initiative.

• Risk assessment- be able to assess workload and determine priorities.

• Confidently refer to multi-disciplinary team.

20

Rushey Year 1

• Observing and participating in initial assessments of women

in spontaneous labour or have ruptured their membranes. • Familiarising themselves with EPR and the pathways for

labour and participating in completing them. • Knowledge of the mechanisms of labour. • Undertaking observations and correctly calculating MOWs. • Learning to do palpations and auscultation of the fetal heart

using sonicaid and pinnards. • Learning how to take a history from women. • Communicate with women in triage and in labour. Be caring

and compassionate as well as using professional language. • Complete a partogram. • Undertake first VEs. • Learn to do and undertake speculums. • Witness births and then start to gain personal births including

care of women in water. • Observe and undertake both active and physiological third

stages. • Learning about aromatherapy. • Observe emergencies/scribe during emergencies. • Learning how to do and undertake first neonatal checks,

weights and observations immediately following birth. • Learning how to check a placenta. • Learning about maternal care immediately postpartum

including checking perineum, checking lochia and uterus tone.

• Assist in mothers having skin to skin and support with first feed of baby.

• 2 In charge shifts- Allocating work load and ensuring all daily checks completed.

21

Rushey Year 2

• Risk assessments of women in labour and initial assessment in triage .

• Use SBAR for safe communication and handover of care. • Begin to do triage phone calls and logging them on computer

with a mentor. • Complete relevant clinical and administrative documentation. • Care planning. • Undertaking fetal heart auscultation by pinard and sonicaid.

Recognising when CEFM is needed instead. • Undertake VEs and attempt ARM if opportunity arises. • Undertake speculums. • Participate in emergency situations. • Show an understanding about commonly used midwife

administration drugs and give them under direct supervision. Learn about contraindications and side effects.

• Learn about aromatherapy and uses for different oils/applications.

• Participate in checking the perineum and estimation of blood loss.

• Undertake postnatal paperwork and CIMIS. • Demonstrates knowledge and confidence in feeding support. • Discussing possible scenarios when episiotomies are needed

with the option of undertaken the skill of episiotomy with guidance and supervision of sign off mentor.

• Undertaking water births.

22

Rushey Year 3

• Lead carer for triage assessment and women in labour under direct or indirect supervision as per confidence case guidance.

• Able to write a clear care plan in conjunction with patient and guidelines/policies.

• Take triage phone calls and log them on computer with mentor support as required.

• Correctly complete all recording keeping documents • Demonstrates confidence in midwifery skills and knowledge • Taking a history from women independently and provide

individualised advice. • Communicate with women in triage and in labour. Be caring

and compassionate as well as using professional language. • Participate in emergency situations and can take lead role if

own patient. • Confident in both active and physiological third stages. • Do initial newborn checks, weights, and observations

immediately following birth. • Begin to suture (once study day complete). • Cannulate if opportunity arises (once study day complete). • Working alongside the maternity coordinator, to gain

understanding of managing the unit as a whole.

23

Skills Drills/OSCE Support

Su

PPH on Marsh Ward

Cord Porlapse on DAU

Neonatal Resuscitation on Marsh ward

Eclamptic Fit on Iffley Ward

Homebirth Transfer

Vaginal Breech Delivery on Rushey

Category 1 GA LSCS

MOH

Neonatal Resus in theatre (requiring intubation, drugs and blood)

Neonatal Resuscitation at home

Shoulder Dystocia on Rushey ward

DKA DAU

24

Suggested Reading

Brookhart, S.M. (2008) How to give effective feedback to your students. ASCD [Online]. Available at: http://www.ascd.org/publications/books/chapters/[email protected]. Fry, H. Ketteridge, S. and Marshall, S. (eds.) A Handbook for Teaching and Learning in Higher Education. Enhancing Academic Practice. 4th ed. Oxon: Routledge. Middleton, J. Giving Constructive Feedback. [Online]. Available at: http://www.nursingtimes.net/giving-constructive-feedback/215184.article. Mohanna, K. Cottrell, E., Wall, D. and Chambers, R. (2001) Teaching Made Essay. A Manual for Health Professionals. 3rd ed. Oxon: Radcliffe Publishing. Royal College of Nursing (RCN)). 2007. Guidance for mentors of nursing student and midwives. An RCN Toolkit. RCN: London. Samples, J. and Marshall, J. (2014) Midwifery Basics: Mentorship. 2. Skills to facilitate learning in clinical practice. The Practising Midwife 17 (10), p. 33-37. Stewart, C. ed. (2007) Assessment, Supervision and Support in Clinical Practice. A guide for nurses, midwives and other health professionals. 2nd ed. Edinburgh: Churchill Livingstone. 25

Useful Contacts Hazel Inkster (Practice Educator) Ext 8198 [email protected] Jancis Shepherd (LME): [email protected] Jenny Brewster (UWL Senior Lecturer): [email protected] Cathy Rowan (UWL Senior Lecturer): [email protected] [email protected]. 07909004693 Practise Education Portal (PEP): https://uwlhealth.arcwebonline.com/

26

mailto:[email protected]

mailto:[email protected]