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Transition to Advanced Practice and Specialist Practice Integrated Portfolio

Specialist Practice - Community Children’s Nursing and Community Nursing

in the Home (District Nursing) Pathways

2013 - 2015

Contents

Personal details 2Introduction 3Aims/ Learning outcomes 3 Summary of syllabus content 4 Summary of teaching and learning methods 4Summary of assessment methods 5The Portfolio 5Attendance in practice record 7 Analysis of your strengths, weaknesses, opportunities and threats 8Personal Development Plan 10 Suggestions for developing your portfolio 12

Appendix 1 13

Section 1 14On-going record of achievement statement 14 Introduction 15Roles and Responsibilities 16

Section 2 18 Progress records and verification of competence 18Initial Interview 19Interim Review of progress 20Final Interview 21Initial reflection by student at commencement of practice experience 22Interim student reflection on progress 23Self-Assessment Guide: To Domains 24Learning Contract / Progression Record Template 27Reflection 28

Section 3 30Introduction 30Domain A Clinical Nursing Practice 31Domain B Leading Complex Care Co-ordination 33Domain C Proactively Manage Complex Care 35Domain D Managing Cognitive Impairment and Mental Well Being 37Domain E Supporting Self Care, Self- Management and Enabling Independence 39Domain F Professional Practice and Leadership 41Domain G Identifying High Risk People, Promoting Health and Preventing Ill Health 43Domain H Managing Care at the End of Life 45Domain I Interagency and Partnership Working 47Domain J Community Children’s Nursing 49

Patient and family/carer involvement in practice 51

Section 4 52Elective Placement 53Key Texts / References 57

Annex 1 NMC Mapping 59

2TAP 2013-15 SP M Rawlinson © University of Southampton 2013 April 15th

Personal Details

NAME: __________________________ ACADEMIC YEAR: _______________

PROFESSIONAL QUALIFICATION/S:

Work base Address: Home Address:

Tel: Tel:

Email: Email:Fax: mobile:

Practice Teacher/ Mentor

Name: ______________________________

Work address:

Tel: Email

Mobile: ________________________________

Module Leader

Name: ___Francine O'Malley______________________________

Tel: ____02380597627_____________________________ Email: F.O’[email protected]

Pathway Leader

Name: Dr mark Rawlinson

Tel : 01983534112 Email: [email protected]

Name : Margaret Fergus Email : [email protected]

Tel : 02380 597979


mailto:[email protected]


IntroductionFor practitioners on longitudinal programmes, process development is important so that you can integrate individual modules and experiences to specific situations in a different way. The Transition to Advanced Practice Module -Specialist Practice is the provision of structured experiences and opportunities, fostering a developmental approach, to enable you to achieve confidence and competence in advancing your professional role and making the transition toward advanced practice.

The portfolio forms the basis of the Transition to Advanced Practice - Specialist Practice Module and will demonstrate your acquisition of evidence-based knowledge from academic components of the programme and its application to your practice. It may also enable you to demonstrate the attainment of the skills / competencies required for advanced practice.

In conjunction with your practice teacher, you will negotiate your own learning for this module through the use of a personal development plan; this will enable you to individualise your learning and the ways in which you plan to meet the module learning outcomes. The portfolio will provide evidence of your knowledge and skills acquisition, your personal learning and development, and evidence of continuous critical reflection in and on your own clinical practice (Wilkinson et al, 2002). All of which will demonstrate your transition toward advanced practice; as well as being able to demonstrate your ability to meet the NMC (2001) Standards for Specialist Education and Practice and the NMC (2006) Standards of Proficiency for Nurse and Midwife Prescribers (see appendix 1).

Aims This module will enable you to navigate and articulate your transition towards advanced clinical practice. This will be underpinned by the integration of your personal, professional and academic development, gained as a result of your study within the MSc Advanced Clinical Practice.

Learning outcomesOn completion of the module you will have shown the ability to:

1. Critically reflect on your role transition towards advanced practice through personal, professional and academic development.

2. Demonstrate the integration of best evidence when undertaking health assessment, diagnostic reasoning, decision making, therapeutic intervention and evaluation within the context of advanced clinical practice.

3. Demonstrate leadership, collaboration and risk management in contexts that are challenging, complex and /or unpredictable.

4. Critically evaluate the contribution of your profession, and underpinning health and social policy, to the health of the specified client group.

5. Demonstrate advanced interpersonal skills including those of negotiation, referral, consultation, case presentation, mentorship and education.

6. Critically evaluate how your advanced practice role can improve health outcomes.


Summary of syllabus content

This module has been specifically designed to enable integration of the learning and personal/professional development that occurs during study of the MSc Advanced Clinical Practice (Specialist Practice Community Nursing pathway). The module content is designed to allow you to critically explore and debate both national and international perspectives on advanced clinical practice, and their underpinning evidence base. It recognises that there are a multitude of different definitions and conceptualisations of advanced practice, ranging from those that are focused on very specific practitioner roles through to those that are much broader articulations of practice at a senior or expert level. It also recognises that there are marked regional, national and international variations in how advanced practice roles are articulated and enacted, as well as variations across the different healthcare professions. Associated with these variants are also differing levels of professional autonomy. The module will thus enable you to explore and identify what advanced practice means within the context of your own professional practice role, and equip you to further develop your advanced clinical practice beyond the end of the module. It will also allow you to demonstrate your ability to meet the required Standards for Specialist Practice Community Nursing (appendix 1).

Core content will include: Analysis of the concept and scope of advanced practice, and its interface with

accountability, clinical governance, autonomy, specialist practice and expert practice.

Integration of communication and assessment skills, decision making, management and speciality specific knowledge and skills acquired during the MSc Advanced Clinical Practice programme.

Role transition and professional identity in advanced practice Legal and ethical issues underpinning advanced/autonomous practice Leadership within advanced practice Advanced practitioner roles in the context of the multi-disciplinary/multi agency

team. UK and international health and social care policy in relation to advanced practice.

Summary of teaching and learning methods

Teaching and learning methods are underpinned by constructivist theory (Piaget 1950).Students will use their experience and construct knowledge in order to achieve the learning outcomes. Although lectures by experts within the field of advanced practice and specialist practice community nursing will form a central component of the module, the greater emphasis will be on student centred debate, critical appraisal and action learning, to enable you to fully explore the meaning of advanced practice within the context of your own professional role and future career development. Assessment of competence to practice will be undertaken by a practice teacher.

Seminars Action learning sets Case presentations Lectures Critique of published papers and policies Group debate/critical discussion. Self -directed learning. Practice based learning


Key contributors to the module include active researchers and advanced/consultant practitioners as well as experts in the field of advanced clinical practice.

Piaget J (1950) The Psychology of Intelligence. London: Routledge & Kegan Paul

Summary of assessment methods

Formative assessmentFormative assessment will take the form of a short presentation to peers for which you will receive feedback which may be incorporated into the clinical portfolio.

Summative assessmentThe assessment of the module requires you to develop a clinical portfolio which demonstrates evidence of your transition to, or towards advanced practice.

This is in the form of a Portfolio of Learning Applied to Clinical Practice. A portfolio is a collection of various forms of evidence of achievement of the learning outcomes and, where appropriate, clinical competence. It is a compendium of material which together with reflective accounts enables you to identify strengths, weaknesses and areas for further development. It provides evidence of your ability to synthesise theory and practice. For your pathway, this includes evidence of successful completion of competencies required within the NMC (2001) Standards for Specialist Education and Practice and the NMC (2006) Standards of Proficiency for Nurse and Midwife Prescribers (appendix 1).

The PortfolioThe portfolio comprises a critical reflective report of 2,500 words and will also include the following supporting elements:

a) Learning contract /Personal development plan / SWOT analysisb) Evidence demonstrating that the learning outcomes and required professional/ clinical competencies (NMC 2001) have been addressed (appendix 1) including V100 Prescribing competencies (NMC 2006).c) Evidence of ‘User’ feedback.d) A record of attendance. d) An assessment of your progression and overall performance by your practice teacher

The portfolio will enable the assessment of your ability to discuss, critically appraise and evaluate your progress. It should enable you to integrate and apply your knowledge base to clinical practice to demonstrate your promotion of quality care provision and your transition towards advanced clinical practice.

Specific guidance regarding the approach you are required to take to your clinical portfolio will be given by your practice teacher and members of the university team. The required inclusion of assessment of clinical competence within the portfolio will depend on the nature of your clinical role (District Nurse or Community Children’s Nurse).

N.B.The module can only be successfully completed if a pass is attained in all required elements including the practice assessment in appendix 1.

You may be required to attend a viva voce examination if the examiners require clarification about some aspect of the portfolio or if it is deemed useful in helping the examiners decide


between a pass or refer outcome where the mark is borderline. Successful outcome of the viva voce will result in an uncapped mark and be viewed as a pass at the first attempt.


Attendance in practice record

Dates

If you are absent from a placement for any reason it is important that you notify both your PT and University Lecturer on the first day of absence. Lost practice time is required to be made up.

Agreed as a correct record: Student signature Dat

ePractice Teacher signature

Date

Analysis of your strengths, weaknesses, opportunities and threats


It is important for you to take control of your education and learning. A starting point is for you to reflect on, and analyse your strengths as well as areas that you need to develop, so that you recognise what opportunities are available and where you might have problems in the future. It can also be used to structure your first meeting with your practice teacher.

If this is to be of value you need to take an honest and critical view of yourself. One way of doing this is to undertake a SWOT analysis. The following is an example:

Strengths (current) Weaknesses (current)

Good interpersonal relationship skills

Reliable Organised Able to take initiative Plenty of work experience

Lack of self confidence Lack of experience in

studying at higher degree level

New to area – support system not in place

Poor timekeeperOpportunities (future) Threats (future)

Gain experience of working with others from a variety of backgrounds

Greater insight into my field of work

Gain a postgraduate degree Promotion potential

Lack of support at work Lack of time to undertake

course work Difficulty with timing of study

days due to family commitments

Utilise the chart provided undertake a SWOT analysis.

Strengths (Current) Weaknesses (current)


Opportunities (Future) Threats (future)


Personal Development Plan Identification of areas for improvement, personal development needs, how you are going to achieve them, over what time period, and how are you going to evidence that they have been met.Drawing on the reflection of your strengths, weaknesses, opportunities and threats, identify your personal goals. The following are some guidelines to assist you:

Areas for improvementThis section will include the weaknesses or opportunities that you identified through the SWOT analysis. You may also wish to develop skills in managing some of the threats that you have identified or maximising the opportunities.

What are your development needs?What exactly do you need to learn? What is your goal / target? e.g. in the example we identified poor time keeping as a weakness, what do you want to achieve / learn? This could include:

Time management strategies How to organise your workload more effectively Organising your personal life to create more personal time / space etc.

How are you going to achieve them?List the resources available to enable you to achieve each of your learning needs. Some of these resources will be through the modules you will be undertaking; others will include wider resources such as literature / experts / colleagues / Internet etc.

What is your timeline?How long will it take you to meet your development needs?They may be on-going or met throughout this module, or throughout the MSc programme

EvidenceHow are you going to know that you have achieved what you set out to achieve? For instance in the time keeping scenario, you may decide that your evidence is that you are able to submit assignments on time without having to write them at the last minute!

This is an important section to complete because it will enable you to look back on your achievements and take pride in the progress you have made. It is also important as it links with the evidence you will provide within your portfolio to verify your transition toward Advanced Practice.


Personal Development PlanDevelopment needs How I am going to achieve

themTimeline Evidence of achievement


Suggestions for developing your portfolio

Critical reflective report Critically review your learning activities and professional development using the

learning outcomes, and also using an advanced practice framework. This can be a conceptual framework(e.g. Manley 1997) or a competency based framework (e.g. DH 2010).

Map your evidence to each of the domains in your chosen framework Signpost your evidence from the text of your critical reflective report Critically discuss what you understand by Advanced practice Make explicit how each of the Learning Outcomes of the module will be achieved e.g. map evidence to Learning Outcomes Demonstrate how each of the Individual intended outcomes identified in your personal development plan are addressed or reasons why not Demonstrate how you have developed in each of the chosen domains (eg use Benner)

Evidence to support claims made in Critical reflective report Use a variety of evidence – but be selective

E.g. clinical skill competencies (appendix 1) Case study and reflection in and on practice Use of benchmarking Competency log (appendix 1) E.g. transition toward Advanced Practice Diary of practice teacher /mentor meetings and reflection on actions Practice Teacher/ Mentor report (appendix 1) E.g. Development of teaching skills Overview of learning styles and PowerPoint presentation with student / peer evaluation and personal reflection E.g. Development of new skills / knowledge Visits to other organisations/departments who have implemented similar service improvement, with critical comparison Analysis/reflection of new learning gained from other MSc modules E.g. development of management/leadership ability Case study and critical reflection or critical incident- professional conversation E.g. development of communication skills / inter-professional working Annotated notes of meetings with critical reflection Critical incident analysis E.g. development of research skills Search strategy and critical appraisal of evidence to address a practice question Development of audit tool, including process as well as final documentation

Content of pages 2-12 adapted from: The standard TAP module.


Appendix 1

Assessment of Practice

Section 1: Introduction and practice context

Section 2:Progress records and verification of competence

Section 3: Practice competencies Patient and family/carer involvement in practice

Section 4:Gives details of the elective placement / References

Annex 1- Mapping of NMC (2001) Standards for Education and Practice


Section 1

On-going record of achievement statement

My Assessment of Practice document is my “on-going record of achievement” for practice. I consent to allow the processing of confidential data about me to be shared between successive Practice Teachers and with the relevant education providers.

Protecting the public through professional standardsAccepting appropriate responsibilityThere may be times when you are in a position where you are not directly accompanied by your Practice Teacher, supervisor or another registered colleague. As your skills, experience and confidence develop, you will become increasingly able to deal with these situations.However you must only participate in interventions for which you have been fully prepared or in which you are properly supervised and which are in keeping with Trust/practice policy. If you have any doubts, discuss them as quickly as possible with your Practice Teacher or academic tutor.

ConfidentialityEntries made in the portfolio must ensure the service users’ right to confidentiality is respected at all times.


Introduction

In order for you to record a community specialist practice qualification as a District Nurse (DN) or a Community Children’s Nurse (CCN) you must successfully complete an Nursing and Midwifery Council (NMC) validated pathway designed to prepare you for the role of specialist practitioner (NMC 2001 /06).

Specialist practice is according to the NMC (2001) the exercising of higher levels of judgment, discretion and decision making in clinical care that focuses on the four broad areas:

Clinical practice:

Care and programme management:

Clinical practice development:

Clinical practice leadership:

These four broad areas are represented through the following domains which represent the requirements of the standards for specialist practice articulated through a modified set of Department of Health (2006) competencies for case management of long term conditions. Additionally the competencies are referenced against NMC (2006) guidelines relating to Independent Prescribing V100, Children’s Workforce Development Council (2011) and Department of Health (2013).

Domain A Clinical nursing practice (including nurse prescribing: (V100))

Domain B Leading complex care co-ordination

Domain C Proactively managing complex care

Domain D Managing cognitive impairment and mental well being

Domain E Supporting self-care, self-management and enabling independence

Domain F Professional practice and leadership

Domain G Identifying high risk people, promoting health and preventing ill health

Domain H Managing care at the end of life

Domain I Interagency and partnership working

Domain J Community Children’s Nursing specific competences

Each domain is populated by competencies. All competencies need to be achieved and signed off by your practice teacher.


Roles and Responsibilities As a specialist practice student you will be allocated a Practice Teacher and a mentor to supervise and assess your practice against the prescribed competencies as set out in section 3 of this appendix.

Role of the practice teacher (PT)

A practice teacher is a registrant who normally will have previously fulfilled the NMC requirements to become a mentor, and who has received further preparation to achieve the knowledge, skills and competence required to meet the NMC defined outcomes for a practice teacher (NMC 2008 p27).

Practice teachers are responsible and accountable for:Organising and co-ordinating learning activities, primarily in practice learning environments for those intending to record a specialist practice qualifications.

Supervising students and providing them with constructive feedback on their achievements.

Setting and monitoring achievement of realistic learning objectives in practice.

Assessing total performance – including skills, attitudes and behaviours.

Providing evidence as required by programme providers of the student’s achievement or lack of achievement.

Liaising with others (e.g. mentors, sign-off mentors, supervisors, personal tutors, the programme leader, other professionals) to provide feedback and identify any concerns about the student’s performance and agree action as appropriate.

Signing off achievement of proficiency at the end of the final period of practice learning or a period of supervised practice.

The practice teaching role will be supported by appropriate professional and academic qualifications, and practice development activity, to provide an evidence-base for teaching. Practice teachers will have met the additional criteria for a sign-off mentor (section 2.1.3) as part of their preparation. The practice teacher role may vary according to the nature of the student they are supporting. (NMC 2008 P29)

The role of the designated prescribing mentor (DPM)Additionally a student may by be required to be taught and facilitated by a Designated Prescribing Mentor (DPM) in order to assess competence in Prescribing (Domain A). This will only be necessary if the practice teacher is not a nurse prescriber or non medical prescriber.

The role of the mentor Your mentor will act as a clinical facilitator and will be responsible for supervising and teaching you, under the guidance of a recognized practice teacher.

It is anticipated that the practice teacher and mentor will work closely together in planning and executing your programme. It is expected that the mentor will meet formally with the identified practice teacher at least once every four weeks in each semester to discuss your progress.The practice teacher and mentor will plan your teaching programme; manage the learning environment; provide appropriate experience; contribute to the integration of theory and practice and the development of a positive learning environment.

The practice teacher will assess and determine your competence to practice.


You, your practice teacher and mentor will be provided with an overview of the course and a competency based portfolio incorporating guidelines for practice and assessment.

Communications - Practice teacher and mentor (PT and M)Four times during the academic year the practice teacher and mentor will be invited to attend a meeting at the University to discuss areas of the syllabus to be covered by their student; to consider the progress of individual students and the reactions of the student group as a whole. Practice teachers will be asked to recommend other relevant subjects to discuss at the meetings and notes will be kept of each meeting.

In addition regular practice teacher/mentor/lecturer/student meetings will be held in work-base settings.

Contact will also be made by email and telephone when necessary and additional visits to practice made if required.

The outcome of assessment must be demonstrated by the practice teacher in the competency based portfolio and must be available for consultation and subsequent planning.

Where a student is failing to achieve a satisfactory standard, the practice teacher and mentor (if appropriate), student and academic tutor will meet together; the problem will be discussed and extra learning contracts drawn up to guide the student towards the required standard.


Section 2 Progress records and verification of competence

In this section you will find some self-assessment tools to assist you with planning and reflection.

Additionally there are pages that require signatures, please ensure all are completed by the end of your pathway; failure to do so may result in your placement being referred.

Any number of learning contracts/ progression records can be used.

Remember to produce some original evidence (6 -12 pieces) of your ability not only to meet the competencies but to meet the requirements for the module Please see guidance re Critical Reflection Report and Evidence suggestions.


Initial Interview

Preparation for the Taught Element of the Practice To be completed within 2 days of the start of the practice experience

Purpose:This initial interview is to establish the student’s current level of competence in relationship to the domains in section 3, but also to ascertain their understanding of the role (DN or CCN).

Guidance: Having completed the self-assessment guide to the Domains, PT/ M and student should carefully re-read the Domains and Competencies identified in Sections 3. Following this, a plan should be formulated which takes into account previous knowledge, skills, attitudes and experience as well as new knowledge, skills and experience required by the student in order to achieve competence. Furthermore the student’s capability to lead and manage the practice environment should also be discussed. It is suggested the Department of Health Leadership Framework (2012) could be used as a frame of reference.

The plan should include clearly stated goals and an outline of how these are to be achieved.

This page and all learning contracts created should be included as evidence


Summary of review Key areas for development identified for this practice experience

Student signature Date

Practice Teacher signature

Date

Proposed date of interim review

Interim Review of progress

Preparation for Consolidated Practice Purpose: This progress review should consider the degree to which the student is capable of taking increased responsibility in relation to independently leading and managing the practice environment. Any areas of concern (knowledge, skills or behaviour) should be discussed and documented and action plan formulated. Additional review points can be undertaken.

Guidance:An action plan should be developed which takes into account previous knowledge, skills, attitudes and experience as well as new knowledge, skills and experience required by the student in order to achieve the objective of independently leading and managing the practice environment. The plan should include clearly stated goals and an outline of how these are to be achieved.






Date


Final Interview

Purpose:This report should reflect on the overall performance of the student in order to determine if they have met the required standards set by the NMC 2001/06.

Guidance:Key questions to be addressed Y/N1) Has competence in the required domains been achieved?2) Is the student fit for practice?3) Is the student fit for purpose?4) Identify future development needs?5) Areas of practice to be commended?



Summary of final interview


Practice Teacher signature Date

Outcome of practice placement

Pass Refer Date

Initial reflection by student at commencement of practice experience

Purpose: To establish a personal understanding of your knowledge, skills and understanding of the role the DN or CCN and establish your current level of competence in regards to the Domains in Section 3.

Guidance:Revisit the SWOT analysis you undertook in the first part of the portfolio and draw out your strengths, weaknesses concerns and expectations.Undertake the self-assessment guide to the Domains.Summarise you learning needs and discuss them at your initial review meeting with your practice teacher.






Date


Interim student reflection on progress

Purpose:To identify the progress that you think you have made so far towards achieving fitness for purpose and practice.Guidance:Before discussion with your practice teacher and mentor, please summarise your views about your progress, including strengths, areas for development and identification of any issues affecting your performance. This reflection should inform your interim review with your practice teacher.






Date

Proposed date of final review

Self -Assessment Guide

To the Domains

Use the following framework to assess your current level of practice as a Community Nurse in each domain of the DH Community Matron and Case Manager Competencies.

Level of Competency Rating Scale

Level Descriptor0 Cannot not perform this activity1 Can perform part of activity with supervision and

guidance2 Can perform this activity satisfactorily with supervision

and guidance3 Can perform this activity without supervision or

guidance4 Can perform this activity satisfactorily without

supervision or guidance with more than acceptable speed and quality of work

5 Can perform this activity satisfactorily without supervision or guidance with more than acceptable speed and quality of work and with initiative and adaptability to special problem situations

6 Can perform this activity satisfactorily without supervision or guidance with more than acceptable speed and quality of work and with initiative and adaptability to special problem situations and can lead others in performing this activity

Adapted from: Fearon, M. 1998 Assessment and measurement of competence in practice, Nursing Standard, 12 (22), 43-47


Assessment of Competence

Domains Level of CompetenceA. Advanced Clinical Nursing Practice

Advanced ability to use information in undertaking assessments, clinical decision making and diagnosis

In depth knowledge and understanding of the presentation, progression, pathophysiology and prognosis of common long term conditions

In depth knowledge and understanding of therapeutic interventions, including relevant pharmacology and medicines management

0 1 2 3 4 5 6

B. Leading Complex Care Coordination Advanced skills in use of management of

knowledge In depth knowledge and understanding

of health and wellbeing issues for people with long term conditions

Knowledge and understanding of government policy and guidance on long term conditions

C. Proactively Manage Long Term Conditions Knowledge and understanding of the

impact of socio-economic and personal circumstances on people with long term conditions

Skills in managing clinical events, including risk assessment and appropriate management of risk

Advanced skills in managing and facilitating patient and carer education

D. Managing Cognitive Impairment and Mental Well Being

Skills in the assessment of mental health needs, including risk assessment

Knowledge and understanding of physical, behavioural, emotional and psychological indications of mental health needs

Skills in interpreting responses to long term conditions, including recognising the signs of depression


E. Supporting Self-Care, Self-Management and Enabling Independence

Advanced skills in empowering patients and enabling self-care

In depth knowledge and understanding of the impact of long term conditions on everyday living

Advanced change management skills

F. Professional Practice and Leadership Highly developed reflective practice

skills In depth knowledge and understanding

of relevant clinical governance skills In depth knowledge and understanding

of the issues relating to personal and professional competence

G. Identifying High Risk People, Promoting Health and Preventing Ill Health.

Skills in analysing, interpreting and presenting public health data

Knowledge and understanding of evaluation methodologies and associated ethics

H. Managing Care at the End of Life Knowledge and understanding of life

changes and losses associated with long term conditions

Knowledge and understanding of how individuals respond to stress

I. Interagency and Partnership Working In depth knowledge and understanding

of collaborative and interagency working Advanced Communication and

interpersonal skills

J. Child specific knowledge and skills In-depth knowledge of children’s and

young people’s development In depth knowledge and understanding of

partnership and inter agency working A comprehensive understanding of the

concept of risk and vulnerability

Developed by Gemma Smith (Community Matron) 2007 and adapted by Mark Rawlinson 2013


Learning Contract / Progression Record Template (Adapted from Quinn, 2000) Copy as many as required

Your Name:Student Number

Practice Teacher /Mentor's Name:

Practice Experience

Objectives Learning Resources/Strategies

Time scales Evaluate achievement of goal together

Renegotiate or complete contract



ReflectionThis is an example of one tool and is for illustrative purposes only: others should be critically considered for use.

1. A description of the event

WHAT? Trigger questions:

• Is the purpose of returning to this situation?• Happened?• Did I see/do?• Was my reaction to it?• Did other people do who were involved in this?

2. An analysis of the event

SO WHAT? Trigger questions:

• How did I feel at the time of the event?• Were those feelings I had any different from other people who were also involved at the time?

• Are my feelings now, after the event, any different from what I experienced at the time?• Do I still feel troubled, if so, in what way?• What were the effects of what I did (or did not do)?• What positive aspects now emerge for me from the event that happened in practice?• What have I noticed about my behaviour in practice by taking a more measured look at it?

• What observations does any person helping me to reflect on my practice make of the way I acted at the time?

3. Proposed actions following the event

NOW WHAT? Trigger questions:

• What are the implications for others and me in clinical practice based on what I have described and analysed?• What difference does it make if I choose to do nothing?• Where can I get more information to face a similar situation again?• How can I modify my practice if a similar situation were to happen again?• What help do I need to help me ‘action’ the results of my reflections?• Which aspect should be tackled first?• How will I notice that I am any different in clinical practice?• What is the main learning that I take from reflecting on my practice in this way?

Student’s record of reflectionTo reflect on practice means exploring one’s own skills, knowledge, beliefs and values as a practitioner by thinking about:• What was done?• Why it was done?• What was one’s own involvement in the event?• What are one’s own feelings and understandings of the event?




Date

• What are the implications for the safety and well-being of the client(s) involved?• Should a similar situation occur again, would you handle events in a different way?The examples used do not need to be dramatic - they are often ‘everyday’ situations – but nevertheless, something that made you think about your practice or that of your colleagues. They could also be events that were rewarding, interesting, challenging or disturbing. Whatever subject is selected, reflection helps to identify what has been learned and what still needs to be learned. However, since the memory of events can fade quickly, it is advisable to complete this activity as soon as possible.There is no ‘right’ way to reflect. Pages have been provided for you to summarise the key points of the reflection. You are expected to share with your practice teacher/mentor a more comprehensive reflection that integrates evidence and theory to demonstrate how you attempted to ‘make sense’ of the experience and you may use any form that is meaningful for you. Two of these reflections can form the basis of your formative and summative professional conversations

Student summary record of reflection

Date of event

What happened?

Why it happened?

My involvement in the event

My feelings during the event

Implications for those involved (safety well-being)

What would I do next time?

Student signature

Practice teacher/mentor Date31

TAP 2013-15 SP M Rawlinson © University of Southampton 2013 April 15th

signature


Section 3

Introduction

The specialist practice standards and a modified set of competencies for case management are represented through the individual competencies that are clustered under each domain. The title of the domain indicates the general theme of the competencies; each competency is made up of a context, performance and knowledge and skills section.

The reference code e.g. CM.A1–identifies the case management domain and competencies which have been modified for the specialist practice practitioner.

Competence in a domain is achieved when a nurse has successfully demonstrated to his/her practice teacher that they have met the required competencies for each domain.


Domain A Clinical Nursing Practice

This domain refers to the community nurse specialist practitioner who is providing nursing care in the home (or other environment); this might include care that is more usually associated with care offered in an acute setting but not necessarily. This type of care involves assessing and managing risks associated with working in isolation. The nurse must work in an autonomous manner, being able to assess, plan, implement, evaluate, prescribe and carry out treatments taking into account the risks that are associated with working in this type of environment. The nurse will need to be competent in history taking and clinical nursing practice. He/she will be responsible for recognising the need for diagnostic tests, exercising critical reasoning and decision-making in addition to making appropriate and timely referrals. The nurse must also be competent in prescribing to manage episodes of care and minimise the impact of compounding co-morbidities to maximise the patient's quality of life. It is expected that the nurse will also combine the competences of managing cognitive impairment and mental well being within the overall clinical care they provide.

Domain A Clinical Nursing PracticeCollect collate and analyse information

Verification of Competence

Reference code

Competencies PT Signature

StudentSignature

Date

CM.A1 Obtain information to inform the assessment of an individual

CM.A2 Establish an individual’s functional capabilities with their presenting conditions

CM.A3 Investigate and assess an unwell individual as part of clinical management

CM.A4 Plan, implement, monitor and review therapeutic interventions with individuals and their carers

CM.A5 Assess individual needs and preferencesCM.A6 Enable individuals to manage their medicinesCM.A7 Prescribe medication for individuals within your sphere of

responsibility


DomainA

Identify key aspects of personal and professional learning through the application of theory to practice in achieving this domain.

Required Exam results + MCQ Drug Calculation Results and Practice Prescriptions.


Domain BLeading Complex Care Co-ordinationThe aim of this domain is to ensure that the Community Nurse Specialist Practitioner is competent in proactively co-ordinating and organising complex care packages to support personalised care plans being delivered efficiently, effectively and to the highest quality standard ensuring the desired outcome is achieved. They must monitor the care provided to those people who are on their case load with particular regard for those who are most at risk of deterioration, which may result in a hospital admission and readmission, the focus needed is about managing for health.

Domain B Leading Complex Care Co-ordination Collect collate and analyse information


Reference code


StudentSignature

Date

CM.B1 Plan, implement, monitor and review individualised care plans with individuals and their carers

CM.B2 Co-ordinate and review the delivery of care plans to meet the needs of individuals

CM.B3 Develop risk management plans to support individual’s independence and daily living within their home

CM.B4 Use and develop methods and systems to communicate, record and report

CM.B5 Present individuals needs and preferences

CM.B6Procure services for individuals

CM.B7Manage the use of physical resources

CM.B8Support the protection of individuals, key people and others


DomainB



Domain CProactively Manage Complex Care The aim of this domain is to ensure the Community Nurse Specialist Practitioner is competent in enabling people with complex care requirements make informed choices regarding their own plan of care. The Specialist Community Nurse will be able to identify and support the risks associated with caring for people with complex problems in their own home.

Domain C Proactively Manage Complex Conditions Collect collate and analyse information


Reference code


StudentSignature

Date

CM.C1Plan, implement, monitor and review individualised care plans with individuals who have complex care needs and their carers

CM.C2Assess the healthcare needs of individuals and agree care plans

CM.C3Enable individuals to make informed choices concerning their health and well-being

CM.C4Support individuals to live at home

CM.C5Build a partnership between the team, patients and carers

CM.C6Promote, monitor and maintain health, safety and security in the working environment


DomainC



Domain DManaging Cognitive Impairment and Mental Well BeingThe aim of this domain is to ensure the Community Nurse Specialist Practitioner is competent in carrying out a basic assessment of mental health, identifying and assessing deterioration in cognitive function, recognising deterioration in mental well being so as to be able to refer to an appropriate Specialist and to co-ordinate and support the delivery of the appropriate care.

Domain D Managing Cognitive Impairment and Mental Well Being

Collect collate and analyse information


Reference code


StudentSignature

Date

CM.D1 Identify mental health needs and related issuesCD.D2 Refer individuals to mental health and/or other servicesCD.D3 Contribute to the assessment of needs and the planning,

evaluation and review of individualised programmes of care for individuals

CD.D4 Implement specific parts of individualised programmes of care

CD.D5 Enable patients to access psychological support

CD.D6 Empower families, carers and others to support individualsCD.D7 Empower individuals with long term conditions to represent

their views and organise their own support, assistance or action

CD.D8 Promote the social inclusion of individuals by enabling them to participate in social, economic and cultural activities and networks

CD.D9Challenge injustice and inequalities in access to mainstream provision for individuals


DomainD


Domain ESupporting Self Care, Self Management and Enabling IndependenceThe aim of this domain is to ensure the Community Nurse Specialist Practitioner is competent in providing care to vulnerable people within the overall philosophy of enabling and promoting independence, dignity and choice to maximise independence.

Domain E Supporting Self Care, Self Management and Enabling Independence



Reference code


StudentSignature

Date

CD.E1 Help individuals to change their behaviour to reduce the risk of complications and improve their quality of life

CD.E2 Assist individuals to evaluate and contact support networks

CD.E3Assist individuals to use assistive devices and technology

CD.E4Provide information and advice to support individuals in undertaking desired occupational and non-occupational activities

CD.E5Enable people to cope with changes to their health and wellbeing

CD.EL11Enable learning through demonstrations and instruction

CD.E L12Enable individual learning through coaching

CD.E L13 Enable group learning


DomainE



Domain FProfessional Practice and LeadershipThe aim of this domain is also to ensure that the Community Nurse Specialist Practitioner is competent in taking responsibility for their learning to ensure continuing competent practice. It also includes the ability to lead and facilitate service improvements. Effective leadership behaviours are an integral part of the clinical role. This requires the individual to lead others from a base of clinical credibility in order to model and support improved practice and interagency and partnership working.

Domain F Professional Practice and LeadershipCollect collate and analyse information


Reference code


StudentSignature

Date

CM.F1Provide clinical leadership and take responsibility for the continuing professional development of self and others

CM.F2Promote the values and principles underpinning best practice

CM.F3Act within the limits of your competence and authority

CM.F4

Provide leadership to facilitate the development of organisational policy and practice

CM.F5Develop, sustain and evaluate collaborative work with others


DomainF



Domain GIdentifying High Risk People, Promoting Health and Preventing Ill HealthThe aim of this domain is also to ensure that the Community Nurse Specialist Practitioner is competent in taking responsibility for their learning to ensure continuing competent practice. It also includes the ability to lead and facilitate service improvements. Effective leadership behaviours are an integral part of the clinical role. This requires the individual to lead others from a base of clinical credibility in order to model and support improved practice and interagency and partnership working.

Domain G Identifying High Risk People, Promoting Health and Preventing Ill Health



Reference code

PT Signature

StudentSignature

Date

CM.G1Work collaboratively with Public Health practitioners to analyse and interpret data and information about health and wellbeing and/or stressors to health and wellbeing

CM.G2Communicate information about health and wellbeing and/or stressors to health and wellbeing in a defined caseload

CM.G3Communicate information about health and wellbeing and/or stressors to health and wellbeing in a defined caseload

CM.G4Communicate with individuals, groups and communities about promoting their health and wellbeing

CM.G5Work in partnership with others to promote health and wellbeing and reduce risks within settings.

CM.G6Work in partnership with communities to improve their health and wellbeing


DomainG



Domain HManaging Care at the End of LifeThe aim of this domain is to ensure the Community Nurse Specialist Practitioner is competent in working with people and their families in planning for the future and making choices about end of life care.

Domain H Managing Care at the End of LifeCollect collate and analyse information


Reference code

PT Signature

StudentSignature

Date

CM.H1Ensure individuals and groups are supported appropriately when experiencing significant life events and transitions

CM.H2Support individuals through bereavement

CH.H3Support individuals through the process of dying


DomainH



Domain IInteragency and Partnership WorkingThe aim of this domain is to ensure the Community Nurse Specialist Practitioner is competent in leading and working across organisational and professional boundaries to enable personalised care to be delivered to the highest standards. It also includes the ability to provided leadership to facilitate service improvement in multiple settings with multiple stakeholders.

Domain I Interagency and Partnership Working



Reference code

PT Signature

StudentSignature

Date

CM.I1Manage a patient caseload which achieves the best possible outcomes for the individual

CM.I2Work with teams and agencies to review progress and performance and identify next steps

CM.I3Plan and implement transfer of care and discharge with individuals and their carers


DomainI


Domain J

Community Children’s Nursing – specific competencies reflecting the common core of skills and knowledge for the children’s and young people workforce – Children’s workforce development council (2011)

Domain J Child specific knowledge and skills



PT Signature

StudentSignature

Date

To be able to communicate effectively with children, young people and their families to assess, plan, provide and evaluate care.

Demonstrate knowledge of children’s and young people’s development and how this influences their understanding of health and illness.

Using knowledge of children and young people’s development of their understanding of health and illness to interpret why children and young people think and act as they do and to make appropriate responses to positively influence health behavioursTo work in partnership with children, young people and their families to assess and to monitor the health and wellbeing of children and young people.

To be able to identify risk factors and to initiate action using local policy and processes to protect children and young people from actual or potential harm.

To work in partnership with other health disciplines and other agencies to assess; to monitor and to implement plans to manage potential or actual risk of harm to children and young people.

Support young people and their families/carers to prepare for the transition from child to adult servicesWork with other agencies to plan the transition of young people to adult services.


Patient and family/carer involvement in practice

Consent must be gained from the patient or family/carer to participate in this exercise. We would like to hear from you about your views of the way the student District Nurse/ Community Children’s Nurse has contributed to the care that you have received. You do not need to disclose your name and the feedback that you give will not affect the care you receive. There is no requirement for you to participate in this exercise.

Please comment on strengths and weaknesses(student name)Please state what you feel they have done well

Please stPlease state what they could do to improve their care


DomainJ


Please add any other information you think would be helpful

Student signature to confirm consent given

Date

Other types of feedback can be used e.g. a letter of thanks / a drawing etc.

This has been developed from the Specialist Community Public Health Nursing Programme


Section 4

Elective Placement

Key Texts / References

Annex 1 Mapping NMC (2001) Competencies

Elective Placement

Introduction

As a student you are required to spend the equivalent of a one week period of observation in a practice setting which is in several respects different from your existing placement. This is regarded by practice teachers and academic tutors as a very valuable experience as it provides a different perspective to practice, and allows students to observe, without pressure and responsibility, the practice of colleagues in many spheres of their work. You will also able to see the differing priorities and policies in contrasting organisations. The experience contributes to the flexible approach to practice which it is desirable to encourage.

A programme for the week’s experience must be included in this section of documentation.

Guidelines for the visit

At the end of the elective experience week it is expected that you will have an understanding of and be able to:

Compare and contrast different health care management systems in relation to:

The setting of the service/the configuration of the host organisation and their sub-groups;Professional support systems, formal and informal;Priorities of work;Community resources;Environmental and socio-economic differences.

Compare and contrast differences in health policy in relation to:

The implementation of significant and current Government Acts/Report;


Domestic violence, child, adult and elderly;Health surveillance policies/identification of health/social needs/health improvement programme;Involvement of practitioners with all age groups;Record keeping and frameworks for practiceStatistical returns, audit etc.

Be aware of and gain understanding of any innovative developments peculiar to the health management system


Aim

To disseminate and promote discussion of the elective placement experiences undertaken.

Key Objectives

To provide information on the elective placement experienced and subsequently to enter into a discussion about the experience and the experiences of your fellow students

To promote a wider discussion of elective experiences

To provide evidence of learning for the your portfolio

To demonstrate the value of the elective placement to:

StudentsPTs / MsCourse lecturersNHS sponsorsHost organisationsExternal examiners

To develop individual IT skills


INSTRUCTIONS FOR STUDENTS

Re: Elective Placements Feedback

I have set out some directions which I hope will help guide you through this activity. If you are not sure about the information you have been asked to share please don't hesitate to contact me on: [email protected] [email protected] [email protected]

Information Required

Your name, discipline and University email address

Details of the nature of your Elective Placement (But not its name)For example:A Community Team, or a Private Sector Health Provider or a Voluntary Organisation.

Details of why you decided to undertake that placementFor example:It contrasted with my current placement …It provided a community outreach service that is not currently available to the client group I work with … etc

The value of the experienceA brief summary (6-10 lines) about what was of most value to you and potentially to your patient/client group about your Elective experience.Other details could include information that could be beneficial to others.

For example:The placement was located in a centre of excellence for carers' needs. A useful web site to find out more is … The web site has details of current research in the area of ...

NBIt is your responsibility to place the information about your Elective Placement on Black Board in the designated discussion area. You are required to read and give feedback to a minimum of 2 other accounts, one from your own discipline and one from another

Please remember that this (and any published) information is subject to NMC (2008) regulations and University policy with regards to confidentiality and anonymity. Information published on Web pages is also subject to the Data Protection Act 1998.





Figure 1: Elective Placement Flowchart


Instructions to students Plus

Verbal and Web guidance

Student checks with host organisation

(letter from Faculty if outside of own Trust

area)

Students check with employer

Student completes elective placement form

2 months prior to placement

form

Completed form returned to Faculty

1 month before placement email

reminderData base created

(admin/clerical)

Student attends placement

Students evaluate experience via

blackboard

Students make arrangements with

practice teacher

Key Texts / References

Advanced practice

Association of Advanced Nursing Practice Educators (2010) (website constantly updated) http://www.aanpe.org/DocumentsPublications/InternationalNationalRegionalStrategicDocs/tabid/1051/language/en-US/Default.aspx.

Chan, S. and Wai-Tong, C. (2000) Implementing contract learning in a clinical context: report on a study, Journal of Advanced Nursing, 31, 298-305.

Department of Health (2006) Caring for people with long term conditions; an educational framework for community matrons and case managers. DH, London.

Department of Health (2010) Advanced Level Nursing: a position statement. DH, London.

Council for Healthcare Regulatory Excellence (2009) Advanced Practice: Report to the Four UK Health Departments, http://www.chre.org.uk/_img/pics/library/090709_Advanced_Practice_report_FINAL.pdf

Department of Health (2010) Front Line Care: The Prime Minister’s Commission on the Future of Nursing and Midwifery in England, London, The Prime Minister’s Commission. http://webarchive.nationalarchives.gov.uk/20100331110400/http://cnm.independent.gov.uk/the-report/

Department of Health (2010). Advanced Level Nursing: A Position Statement, London, DH.http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_121739

Department of Health (2011) Enabling Excellence: Autonomy and Accountability for Health and Social Care Staff, London, DH. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_124359

Department of Health (2011). Government Response to the Recommendations in Front Line Care. London, DH. http://www.dh.gov.uk/en/MediaCentre/Pressreleases/DH_125996

Department of Health (2013) Care in local communities: a new vision and model for District Nursing. TSO. London.

Hinchcliffe,R and Rogers, R (2008). Competencies for Advanced Nursing Practice, London, Edward Allan.

International Council of Nurses (2008) The Scope of Practice, Standards and Competencies of the Advanced Practice Nurse, Geneva, ICN.

Lloyd Jones, M. (2005) Role Development and Effective Practice in Specialist and Advanced Practice Roles in Acute Hospital Settings: Systematic Review and Meta Analysis, Journal of Advanced Nursing, 49, 2, 191-209.

Lorenzton M Hooker J C (2005) Advanced nursing practice: an emerging global phenomenon. Journal of Advanced Nursing 24, 649-651.

Manley,K (1997) A conceptual framework for advanced practice: An action research project operationalising an advanced nurse practitioner/consultant nurse role, Journal of Clinical Nursing, 6, 179-190.

Mantzoukas,S. and Watkinson,S. (2006). Review of Advanced Nursing Practice: The International Literature and Developing the Generic Features. Journal of Clinical Nursing, 16, 28-37.


McGee P (2009) Advanced practice in nursing and allied health Professions, (3rd Edition) Chichester, Wiley Blackwell.

National Leadership and Innovation Agency for Healthcare (2010) Framework for Advanced Nursing, Midwifery and Allied Health Professional Practice in Wales, NHS Wales, http://www.wales.nhs.uk/sitesplus/documents/829/NLIAH%20Advanced%20Practice%20Framework.pdfNursing and Midwifery Council (2001) Standards for Specialist Education and Practice, London: NMC.

Nursing and Midwifery Council (2005) The Proposed Framework for the Standard of Post Registration Nursing London, NMC. http://www.nmc-uk.org/Get-involved/Consultations/Past-consultations/By-year/The-proposed-framework-for-the-standard-for-post-registration-nursing---February-2005/ (NB: Also follow links on the bottom of the page).

Nursing and Midwifery Council (2006) Standards of proficiency for nurse and midwife prescribers, London: NMC.

Nursing and Midwifery Council (2008) Standards to support learning and assessment in practice. NMC: London

Nursing and Midwifery Council (2008) The Code: Standards of conduct, performance and ethics for nurses and midwives. NMC: London

RCN (2012) Advanced Nurse Practitioners: An RCN Guide to the Advanced Nurse Practitioner Role, Competencies and Programme Accreditation. London, RCN. http://www. rcn .org.uk/__data/assets/pdf_file/0003/146478/003207.pdf

Schober, M. and Affara, F. (2006), International Council of Nurses: Advanced Nursing Practice, Oxford, Blackwell Publishing.

Smith,R., Leap,N, Homer,C. (2010) Advanced Midwifery Practice or Advancing Midwifery Practice, Women and Birth, 23, 3, 117-120.

Children’s Workforce Development Council (2011) The common core of skills and knowledge for the children and young people’s workforce. London.

The Scottish Government (2008) Supporting the Development of Advanced Nursing Practice: A Toolkit Approach. Edinburgh, NHS Scotland. Available at http://www.advancedpractice.scot.nhs.uk/home.aspx

Portfolio development

McCready T (2007) Portfolios and the assessment of competence in nursing: a literature review. International Journal of Nursing Studies, Volume 44, Issue 1, January 2007, Pages 143-151

Webb C et al (2002). Models of portfolios. Medical Education 36 (10)897-89

Wilkinson TJ et al (2002). The use of portfolios for assessment of the competence and performance of doctors in practice. Medical Education 36(10)918-24.


Annex 1


Portfolio Domains

Mapping of Specialist Practice Community Nursing Standards for Community Children’s Nursing and Community Nursing in the home (District Nursing) to the Practice Portfolio.

Specialist Practice Standard

Domain A

Domain B

Domain C

Domain D

Domain E

Domain F

Domain G

Domain H

Domain DomainI J

13.1 √ √ √ √13.2 √ √ √13.3 √ √ √ √ √13.4 √ √ √ √13.5 √ √ √ √13.6 √ √ √ √13.7 √13.8 √ √ √ √ √13.9 √ √ √ √ √ √ √

13.10 √ √ √ √ √ √ √13.11 √ √ √ √ √ √ √ √13.12 √ √ √ √ √13.13 √ √ √ √ √ √13.14 √ √ √ √ √ √13.15 √ √ √ √13.16 √ √ √ √13.17 √ √ √ √ √13.18 √ √

13.19 √ √ √ √ √ √13.20 √ √ √13.21 √ √13.22 √13.23 √ √ √13.24 √ √ √ √ √ √13.25 √13.26 √ √13.27 √CCN22.1 √ √ √ √22.2 √ √ √22.3 √ √ √ √ √ √22.4 √ √ √ √ √ √ √ √22.5 √ √ √ √ √DN28.1 √ √ √ √ √28.2 √ √28.3 √ √ √ √28.4 √ √ √ √ √28.5 √ √ √28.6 √ √ √ √ √