PRECEPTORSHIP PROGRAMME 2018 -2019 - UCC
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PRECEPTORSHIP PROGRAMME 2018 -2019 In collaboration with: Catherine McAuley School of Nursing and Midwifery, University College, Cork (UCC) Nurse Education Centre, Bons Secours Hospital Cork University Hospital Centre of Nurse Education Mercy University Hospital Centre of Nurse Education The Health Service Providers: HSE Southern, BSH, CUH,CUMH, MUH, SIVH, Cork MHS, COPE Foundation. Nursing & Midwifery Planning Development Unit.
Learning outcomes ■ At the end of this session the preceptor will be able to: - Outline the history of the undergraduate nursing/midwifery programme and the current programme outline - Describe the role of the preceptor/ associate preceptor - Identify supports they can use in their role of preceptor
Introduction & History of BSc Nursing ABA now NMBI have always set the national standards for education and registration for nursing and midwifery 2005 ■ Certificate apprenticeship until 1997 – PAF record of clinical placement achievements ■ 1997 - 3 year Diploma ■ 2002 BSc Nursing and Midwifery – each HEI developed their own document for recording student achievement on clinical placement ■ Nurses Act 2011 ■ European Union Standards for Nursing and Midwifery 2016 Directive 2013/55/EC direct the content broadly of the curriculum ■ 2016 New national curriculum – NMBI - implement 2018 ■ 2018 Introduction by NMBI the National Competency Document (CAD)
Modes of Entry to Nursing Programmes CAO applications 2018 CAO points Mature student entry methods General Nursing - 445 Mature Student application CAO – over 23 yrs old – Aptitude test Children's General Nursing - 501 DARE – Disability Access Route to Education Mental Health - 419 FETAC/QQI – College of Commerce, St Johns & Stiofan Naofa (Distinction) Intellectual Disability Nursing - 429 HEAR – Higher Education Access Route Maternity - 451
Student intake 200+ (approx.) General nursing = 113 CUH - 56 Bon Secours – 19 MUH -23 SIVUH – 15 General and Children CUH = 24 Mental Health Psychiatry Nursing = 31 HSE –Southern Area Mental Health Services Intellectual Disability = 21 COPE Foundation Midwifery - CUMH = 21
Theoretical content ■ Course is divided into modules – practice placement is also a module awarded credits Module Codes e.g NU1049, NU2086, NU3086, NU4053 ■ Shared modules among disciplines but discipline specific modules also
Allocation of students UCC - Allocations Officer BSc Allocations liaison officer on site Combination of internal and external placements Student numbers per ward/site
Clinical Placements Year Current Programme number of weeks From Sept 2018 number of weeks of of clinical placement clinical placement Year 1 7 weeks supernumerary 14 weeks supernumerary Year 2 21 weeks supernumerary 12 weeks supernumerary Year 3 16 weeks supernumerary 16 weeks supernumerary Year 4 1 week supernumerary 3 weeks’ supernumerary 36 weeks Internship finish sept each 36 weeks Internship finish sept each year year Integrated Children’s General finish in Integrated Children’s General finish in December of each year December of each year
Clinical time Supernumerary = 30 hours practice and 5 hours Reflection Internship - 39 hours including 4 hours reflection i.e. 8 hours in 2 weeks PREP (Protected Reflective Educational Practice) for 4th year while on Intern (rostered) placement ◦ CUH, MUH , COPE and Mental Health – 3 weeks based in UCC and parent hospital ◦ Bons and SIVH – weekly sessions based in parent site
Student assessment tools Year Current assessment booklet From 2018 CAD New booklet Until 2021 Year1 CLO Clinical Learning outcomes booklet Competency Assessment Document Year 2 CLO Clinical Learning outcomes booklet Competency Assessment Document Year 3 Competency Booklet Competency Assessment Document Year 4 Competency Booklet Competency Assessment Document
Code of Professional Conduct and Ethics 2014 ■ Code of Professional Conduct and Ethics for Registered Nurses and Registered Midwives (NMBI 2014). “You must support junior colleagues and nursing, midwifery and other healthcare students in the learning and on-going development of their professional values, practice and conduct” (Principle 5, Standard 5, NMBI 2014) “In your role of guiding and directing student nurses or midwives you must take responsibility for the care they provide. This involves supporting, learning, teaching, supervising, assessing practice and taking action to address concerns where they are identified” (Principle 5, Standard 6, NMBI 2014) “you should ensure that the patient understands the role of the student nurse or midwife and that the student is supervised by a registered nurse or midwife” Principle 5, Standard 7, NMBI 2014)
Who is a preceptor ? “A preceptor/associate preceptor is a registered nurse. He/she is responsible for orientating, supervising and assessing the candidate nurse. The role involves facilitating learning opportunities and assessing the competence of the candidate nurse on a continuing basis throughout the period of supervised practice. The preceptor/associate preceptor is an experienced registered nurse who acts as a role model and resource person for the candidate nurse assigned to him/her” (NMBI 2018, pg 27) Key elements: Short term (Gray 2014), teaching, supporting, supervising, role model, critical and problem skill development. It describes a working relationship between a qualified professional and a student.
Preceptor/ associate preceptor ■ Hughes & Frazer (2011) suggest that the relationship that a student has with their preceptor has a major effect on how they work and their confidence about their achievement of competence in knowledge, skills and professional behaviours A preceptor is not a crutch and must not remain a dependant relationship or become an excuse just for a chat (McKimm et al 2007)
Desired attributes of preceptors Approachable – has interest in others ■ Honest, trusting ■ Empathetic, compassionate and caring ■ Non-judgmental attitude ■ Competent ■ Committed -enjoys the profession ■ Knowledgeable ■ Good communication skills ■ Decision making abilities ■ Provides feedback ■ Encourages feeling of belonging to the team ■ Promotes equity and mutual respect - leads by example
Role of the Preceptor ■ Build confidence and self esteem of a student nurse ■ Encourage reflective practice ■ Guide and support ■ Interest in the professional growth of all nurses ■ Desire to teach and undertake the preceptorship role ■ Flexibility to provide an individual learning experience ■ Adaptability to meet individual teaching needs ■ Leadership skills ■ RGN with expertise in the clinical area ■ Facilitate the application of theory to practice ■ Role model, coach, supervise
Preceptor are supported by: ■ Colleagues (Staff Nurses/Midwives, CNM1, CNM2) ■ Clinical placement co-ordinators (CPC’s) ■ Link Lecturers (LL’s) ■ http://www.ucc.ie/en/nursingmidwifery/AllocationsInformation/precept orinfo/ ■ An Bord Altranais documents: • Recording clinical practice. Professional guidance (2015) • Quality clinical learning environment. Professional guidance (2015) • Requirements and standards for nurse registration education programmes (4th edition 2016) • Requirements and standards for the midwife registration education programme (4th edition 2016)
Benefits to the Student Assisted in integrating into the clinical environment Learning and advancing clinical skills Achievement of learning outcomes/ objectives Develop clinical decision making skills ■ Linking theory to practice Member of a patient care team Gain confidence in caring for patient/s /clients/ service users
Summary ■ 4 year programme (children’s and general 4.5yr) ■ Collaboration HSP and UCC ■ Student placements - – Supernumerary and internship – Supported by preceptors – Assessment utilising booklets – CLO, Comp, CAD
Information on preceptorship ■ All information can be accessed on School of Nursing and Midwifery website on the following link: http://www.ucc.ie/en/nursingmidwifery/allocations/preceptorinfo/ We strongly encourage you all to use this site as there is a new interactive guide called the On-Line Support Package for trained Preceptors (Registered Nurse/Midwife), Student Nurses and Student Midwives which Provides an Over-view of the Clinical Assessment Process
FACILITATING LEARNING - THE CLINICAL ENVIRONMENT
Learning Outcomes ■ At the end of this presentation the preceptor will be able to: – Outline the role of clinical placement – Determine what makes a good clinical placement – Understand how competence can be achieved and lost – Experience teaching a skill – Develop an understanding of Blooms taxonomy – Appreciate Peyton's stages in teaching a skill – Develop an understanding of adult learning through Race's Ripple Model of adult learning – Understand the importance and value in facilitating problem solving
What is the role of a clinical placement? “Practice placement according to NMBI (2018 p.2) represents 50% of the undergraduate nursing programme and the development of skills, knowledge, professional behaviour, and attitudes represents a key component in the undergraduate nursing students attainment of competence to practice as a registered nurse”. According to Elcock and Sharples (2013 pg 33) “practice placement is for students to learn while they are with you, through practicing skills, increasing their knowledge and role modelling the professional behaviours of staff” “It is not just a creation for student nurses. We are all students” (Walsh 2011pg 46) “Each student requires practice placements in practice settings to learn patient care skills directly” (Gopee 2011, p 115) ◦ Work based learning – learning in practice settings (Gopee 2011, p 135)
Consider for a moment … ■ …which factors helped you to learn in the ward while you were on placement as a student? ■ … which factors blocked/impeded your learning on the ward as a student?
Good and Bad learning environments can enhance or hinder student learning (Walsh 2014 pg 60 -61) • Good ■ Not so good (Bad) • Consistency ■ Not enough time to mentor • Resources available ■ Not expected on placement • Flexibility ■ Being compared with previous students • Staff approachable ■ Too many students at the one time • Mentor enthusiasm ■ Staff shortages • Mentor patient and ■ Mentor not interested in students understanding ■ Critical rather than constructive • Identifiable learning feedback opportunities ■ Used as a pair of hands • Made them feel part of the team ■ Not welcome to the team • Sense of humour • Encouragement
Good and Bad learning environments continued ■ Good ■ Not so good (Bad) ■ Being respected ■ Regarded as a healthcare assistant ■ Mentor willing to listen ■ Clash of personalities ■ Given time to reflect ■ Staff unfamiliar with paperwork ■ Teaching sessions on the ward ■ Mentor too busy to give time ■ Shift flexibility ■ Feeling of not belonging ■ Insight visits available ■ Expectations too high/ too low ■ Multidisciplinary team working ■ Ward politics / staff disharmony opportunities ■ Being ignored because it was not my ■ Peer support from other students field ■ Open minded staff ■ No learning opportunities identified
Students perspectives of a good placement (Gray and Smith 2000, Sharp et al 2006) ■ Support the student rather than breath down their neck ■ Encourage and allow involvement and participation in patient/client rather than just observation ■ Show confidence in students ability and trust them to do things unsupervised ■ Form a relaxed (within reason) relationship with the student ■ Take time every day to let the student do or observe something and do not assume that because they were in a certain semester they would already seen or performed ■ Regardless of the students stage in the programme, have an initial discussion, preferably on the first day to determine the students abilities and their intended learning outcomes
Students perspectives of a good placement (Gray and Smith 2000, Sharp et al 2006) contd. ■ Ascertain what the student requires as an individual to meet the required learning outcomes ■ Clarify ground rules on both sides and discuss the opportunities available to meet the desired learning outcomes ■ Allow the student some independence by giving more guidance at the beginning of the placement and then stand back to let the student show some initiative and self motivation ■ If you are off duty when your student is on duty, make arrangements with other members of staff to look out for them rather than have the student feel abandoned.
Student thoughts... Students strongly endorse the central nature of the ward placement and preceptor support. Students recounted: “I think I lucked out. My preceptor is a good nurse. She’s liked by the staff and they know she’s competent ….I guess ‘ cause the staff respect her and it actually amazingly rubs off on me . Because she’s treated me like a colleague, it seems like the people she’s friends with treat me like a colleague too.”(Myrick and Yonge 2001 pg465) “I was made feel like a member of the team rather than another student (which I haven’t experienced anywhere else). The staff were more than happy to show me a range of procedures and explain why and point me towards the relevant literature to support it “ (Walsh 2011 pg 49)
Ascent to Competence conceptual framework by (Levett – Jones and Lathlean 2009)
Burch (1970’s) Conscious Competence training model
Group work ■ Form groups of 3 – one person is a student – one person is a preceptor – one person is a patient ■ Preceptor teaches the student a skill e.g – tie a shoelace, put on a watch, put on a chain, – put on a jacket on a person with an arm paralysis
Domains of learning - Bloom’s Cognitive
Blooms psychomotor taxonomy (Reynolds 1965)
Bloom's Affective Domain Kratwohl, Bloom,& Masia 1964)
Peyton (1998) 4 stage approach to teaching a skill ■ Stage 1 - Demonstrate the skill at normal speed, with little or no explanation. This is to give the student an overall picture of what is involved from start to finish ■ Stage 2 - You repeat the skill demonstration but include a full explanation as well as encourage the student to ask questions ■ Stage 3 - You demonstrate the skill again but this time, ask the student to explain each step while providing rational for each step. This may need to be repeated until you are satisfied that the student fully understands the how and why of the skill ■ Stage 4 - The student performs and practices the skill under direct supervision, describing each step before it is taken. Again, you should correct any imperfections. This stage is repeated until you consider the student proficient in the skill
Race’s Ripple Adult Model of Learning (1993)
Do ■ Establish what the student already knows ■ Get the theory across to everyday life ■ Break down practical demonstrations for students ■ Ask more reflective questions, questions are much more powerful than answers ■ Follow up
Learning Outcomes ■ At the end of this presentation the preceptor will be able to: – Define reflection – Understand the purpose of reflection – Outline the steps of the Gibbs Reflective cycle – Appreciate its application to the student's clinical placement recording booklet (CLO/competency or Competency Assessment Document (CAD))
Reflection “Reflection : in depth focused attention” (Bolton 2014 p.) ‘Is a process of thinking and evaluating actions and feelings with the overall intent of improving nursing practice’ (Lethbridge, 2006) Reflective Practice “….. it is recognised as an essential tool for helping students to make the links between theory and practice” (Jasper, M 2003 p.1)
Why do we reflect ? – the purpose • Identify learning needs • To be aware of the consequences of our actions • Identify new opportunities for learning • To demonstrate our competence to • To identify ways in which we learn best others 42 • To build theory from observations • To identify new courses of action • To help us make decisions to resolve • To explore alternative ways of solving uncertainty problems • To empower or emancipate ourselves • For personal development as individuals • To escape routine practice • (Jasper 2013, pg. 6)
Outcomes of Reflection ■ Gaining new perspectives on experience ■ Facilitating a change of behaviour ■ Readiness for application ■ Commitment to action (Bulman and Schutz 2009) “Yet it makes the difference between 20 years of experience and merely one year of experience repeated 20 times” (Beaty 1997 p.8)
GIBBS Reflective Cycle (1988) There are 6 steps in the cycle: 1. Description 2. Thoughts & Feelings 3. Evaluation 4. Analysis 5. Conclusion 6. Action Plan
Writing Reflective Notes Must be specific to a clinical experience A reflective framework must be used - Gibbs Cycle is recommended and included in the CAD Use references to support analysis section of reflective cycle Confidentiality & Anonymity Guidelines on reflective note writing available in CLO and Competency booklets and CAD booklet Preceptor to discuss, sign, date reflective notes. Preceptor may also review reflective notes
Conclusion ■ Importance of providing students with opportunities to engage in reflective practice in a supportive learning environment for the development of attitudes, knowledge and skills ■ Reflective Practice is an active and deliberate process whereby clinical practice is critically examined.
PRECEPTORSHIP EDUCATION PROGRAMME 2018 – 2019 National Competency Assessment Document (CAD) & Clinical Learning Outcomes (CLO) and Competency Booklets 27.8.18
Learning Outcomes ■ Gain an overview of Clinical Assessment Document (CAD) ■ Become aware of the 6 domains of competence as outlined by NMBI (2018) ■ Outline the teaching methods suggested by NMBI ■ Understand the levels of supervision outlined by NMBI ■ Acknowledge the responsibilities of the student including self-assessment ■ Acknowledge the responsibilities of the preceptor and CPC ■ Understand the assessment of clinical achievement by the student ■ Become aware of questions that a preceptor may ask when assessing a student ■ Recognize the importance of feedback to students ■ Appreciate some of the reasons why a student may not achieve a clinical placement.
What is the National Competency Assessment Document (CAD) ? ■ “Requirements of the Nursing and Midwifery Board of Ireland (NMBI), the Competency Assessment Document acts as the record of continuous achievements by the Undergraduate Nursing Student that is NMBI’s requirement for registration. It is also a fundamental component for the successful progression through the undergraduate nursing programme” (NMBI 2018 p. 2) ■ Competence according to NMBI (2018 p.2) “ is the attainment of knowledge, intellectual capacities, practice skills, integrity and professional and ethical values required for safe accountable and effective practice as a Registered Nurse”. ■ Competence according to Eraut (2004) is a moving target. If the learner can do it once, it is an event, twice may be coincidence, and three times may show that a consistent pattern is emerging.
Requirements to enter NMBI register ■ There are 6 Domains of Competence that an undergraduate nursing student must reach upon completion of the education programme for entry to the NMBI Register. ■ The above applies to a placement length of 4 weeks or more ■ There is a shorter version of the competence CAD for a placement length of 3 weeks or less
Domains of Competence Domain 1: Professional values and conduct of the nurse competences Knowledge and appreciation on the virtues of caring, compassion, integrity, honesty, respect and empathy as a basis for upholding the professional values of nursing and identity as a nurse. Domain 2: Nursing practice and clinical decision-making competences Knowledge and understanding of the principles of delivering safe and effective nursing care through the adoption of a systematic and problem solving approach to developing and delivering a person centred plan of care based on an explicit partnership with the person and his/her primary carer. Domain 3: Knowledge and cognitive competences Knowledge and understanding of the health continuum, life and behavioural sciences and their underlying principles that underpin a competence knowledge base for nursing and healthcare practice. Domain 4: Communication and interpersonal competences Knowledge, appreciation and development of empathic communication skills and techniques for effective interpersonal relationships with people and other professionals in healthcare settings. Domain 5: Management and team competences Using management and team competences in working for the person’s well-being, recovery, independence and safety through recognition of the collaborative partnership between the person, family and multidisciplinary health care team. Domain 6: Leadership potential and professional scholarship competences Developing professional scholarship through self-directed learning skills, critical questioning/reasoning skill and decision-making skills in nursing and the foundation for lifelong professional education, maintaining competency and career development.
Teaching methods that can be utilised by preceptor Teaching method Description Modelling The preceptor demonstrates the object to be learned. Coaching Involves delegating and guiding the student’s activity and observation of the performance, The preceptor provides ongoing appropriate feedback. Scaffolding Accesses what level the student is at and plans activities to progress the student along the learning continuum Articulation Preceptor questions the students to illicit their problem solving skills. It involves the preceptor questioning the student on their rationale for care and why they have chosen one action over the other or indeed challenge them with “what if” scenarios to access what action the student may have taken if the practice situation became more complex. Reflection Accesses the students’ cognition. The preceptor at the end of the shift or following a learning opportunity encourages the student’s self-reflection or assesses their performance; that is their strengths and weaknesses (1 written reflection per placement) Exploration Preceptor encourages the student to set their future learning goals and practice more independently.
Levels of competence for the CAD ■ To assist in determining if a student has achieved the required level of competence NMBI have included under each domain performance criteria and indicators: E.g. ■ DOMAIN 1 PROFESSIONAL VALUES AND CONDUCT OF THE NURSE 1.1 Demonstrates safe, person centred care (performance criteria) (previously called Learning outcome) a. Clarifies with Preceptor/Associate/ Registered Nurse instructions that s/he does not understand b. Applies principles of moving and handling c. Adheres to principles of safe hand hygiene d. Adheres to principles of infection prevention and control (a - d are indicators) DOMAIN 1 has 3 performance criteria - 1.1, 1.2, 1.3 - (previously Domain 1 had 3 learning outcomes)
Supervision for Undergraduate Nursing Students ■ Supervision is defined by NMBI as “the provision of oversight, direction, guidance or support by a nurse or midwife to nursing students. Supervision may be direct or indirect” (NMBI, 2015). “Direct supervision means that the supervising nurse or midwife is actually present and works with the nursing student undertaking a delegated role or activity. Indirect supervision implies that the nurse or midwife does not directly observe the nursing student undertaking a delegated role or activity. Both direct and indirect supervision can include oversight, direction, guidance and support and evaluation” (NMBI, 2015).
Supervision Explanation DIRECT SUPERVISION YEAR 1 - Direct supervision is defined as the Student is exposed and participates in all aspects of preceptor being present and working continuously with the practice. undergraduate student whilst s/he provides delegated nursing care to The student will have a basic understanding of the broad patients/service users concepts underpinning person centred care. Student may require continuous prompting and considerable direction identifying their learning needs. CLOSE SUPERVISION YEAR 2 - Close supervision is defined as the Frequent prompting may be required to support the student presence or close proximity to the undergraduate student whilst s/he in the provision of person centred care and identification of provides delegated nursing care to patient’s /service users and underpinning evidence. The student begins to identify their supports family members. learning needs through discussion with preceptor INDIRECT SUPERVISION YEAR 3 - Indirect supervision is defined as the Student identifies needs of persons and primary careers in preceptor being accessible to the undergraduate student for guidance practice and begins to adopt a problem solving approaching and support whilst s/he provides delegated nursing care to provision of safe care. Actively participates in assessment, patients/service users and supports family members planning, delivery & evaluation of person centred care and provides rational for actions. It may be difficult for students to prioritise care in particular complex situations DISTANT SUPERVISION YEAR 4/4.5 - is defined as the undergraduate Competently apply a systematic approach to the provision of person nursing student providing safe and effective delegated nursing care to centred practice to an allocation of 4 -6 patients under distant supervision. The student must demonstrate evidence based patients/service users and supporting family members. The practice and critical thinking. Must demonstrate collaborative work undergraduate nursing student accepts responsibility for the provision with professional colleague. The student possesses many attributes of delegated care and recognises when s/he requires the guidance including practical and technical skills, communication and and support of the preceptor and Registered Nurse and seeks such interpersonal skills, organisational and managerial skills and the assistance in a timely manner. ability to perform as part of the health care team, demonstrating a professional attitude, accepting responsibility and being
Year Benner (1984) Steinaker & Bell (1979) Supervision Explanation 1 Novice - nursing student has no/limited Exposure – the nursing student has the Direct supervision - Direct supervision is defined as Student is exposed and participates in all aspects experience and understanding of the opportunity to observe a situation taking the preceptor being present and working continuously of practice. clinical situation, therefore they are cognisance of the learning objectives of the with the undergraduate student whilst s/he provides The student will have a basic understanding of taught about the situation in terms of programme and the practice placement delegated nursing care to patients/service users the broad concepts underpinning person centred tasks or skills taking cognisance of the Participation – the nursing student care. Student may require continuous prompting theory taught in the classroom. The becomes a participant rather than an and considerable direction identifying their nursing student is taught rules to help observer with the support of the preceptor learning needs. them apply theory to clinical situations where learning opportunities are identified and to perform tasks in partnership 2 Novice - nursing student has no/limited Participation - the nursing student Close Supervision - Close supervision is defined as the Frequent prompting may be required to support experience and understanding of the becomes a participant rather than an presence or close proximity to the undergraduate the student in the provision of person centred clinical situation, therefore they are observer with the support of the preceptor student whilst s/he provides delegated nursing care to care and identification of underpinning evidence. taught about the situation in terms of where learning opportunities are identified patient’s /service users and supports family members. The student begins to identify their learning needs tasks or skills taking cognisance of the in partnership through discussion with preceptor theory taught in the classroom. The nursing student is taught rules to help them apply theory to clinical situations and to perform tasks 3 Advanced Beginner – the nursing Identification – the nursing student takes Indirect supervision - Indirect supervision is defined as Student identifies needs of persons and primary student demonstrates acceptable more responsibility for their own learning the preceptor being accessible to the undergraduate careers in practice and begins to adopt a problem performance based on previous and participation and initiates appropriate student for guidance and support whilst s/he provides solving approaching provision of safe care. experience gained in real clinical action and evaluates same delegated nursing care to patients/service users and Actively participates in assessment, planning, situations supports family members delivery & evaluation of person centred care and provides rational for actions. It may be difficult for students to prioritise care in particular complex situations 4/4.5 Competent – a nursing student who has Internalisation - the nursing student makes Distant supervision - is defined as the undergraduate Competently apply a systematic approach to the gained experience and therefore can informed decisions based on the nursing student providing safe and effective delegated provision of person centred practice to an plan actions with a view to achieving information available and works as an nursing care to patients/service users and supporting allocation of 4 -6 patients under distant efficiency and long term goals. S/he has autonomous practitioner family members. The undergraduate nursing student supervision. The student must demonstrate the ability to manage the complexity of Dissemination – the nursing student uses accepts responsibility for the provision of delegated evidence based practice and critical thinking. clinical situations critical analysis to determine the outcomes care and recognises when s/he requires the guidance Must demonstrate collaborative work with of their actions and can give rationale for and support of the preceptor and Registered Nurse professional colleague. The student possesses their action to others and seeks such assistance in a timely manner. many attributes including practical and technical skills, communication and interpersonal skills, organisational and managerial skills and the ability to perform as part of the health care team, demonstrating a professional attitude, accepting responsibility and being accountable for one’s own practice
Student responsibilities in relation to completion of CAD ■ Accurate completion of the CAD and submit to HEI for assessment process ■ Prior to placement commencement complete the self –evaluation of learning needs and reviews clinical placement outcomes (the unit/ward learning outcomes) ■ Familiarise him/herself with the local HEI and Health Care Providers guidelines, policies and procedures relevant to undertaking practice placement. ■ Follow the local HEI attendance policies and processes ■ Take advantage of every opportunity to engage with the Preceptor/Associate Preceptor and to avail of the learning opportunities. ■ Regularly seek feedback from the Preceptor/Associate Preceptor to help make a realistic self - assessment of the experience and achievement.
Student responsibility in relation to CAD ■ Make the National Competency Assessment Document available to the Preceptor/Associate Preceptors, CNM, and CPC’s upon request. ■ Submit the National Competency Assessment Document to the designated School/Department office of the HEI by the required submission date. As with all work submitted it is the nursing students responsibility to keep a copy of all work submitted.
APPENDIX 1: SELF-EVALUATION OF LEARNING NEEDS AND EXPECTATIONS A Guide to help you with your Self-Evaluation Critical and Analytical Skills “What questions arise from practice for myself and others?” “How can these questions be answered?” Intrinsic Motivation “How can I generate evidence “What do I and others value?” for or from practice?” “What is the caring response?” “What knowledge, skills and attitudes do I need to develop?” SELF-EVALUATION OF Awareness of Others LEARNING NEEDS AND Care, Compassion, EXPECTATIONS Commitment, Courage & Resilience Awareness of Self Self-Belief and Self-Efficacy “What are the barriers to my learning?” “What is stopping me being the practitioner I want to be?” “Do I have the self-belief to make a difference?”
Preceptor/Associate preceptor responsibilities for completion of CAD ■ Be a Registered Nurse with NMBI. ■ Have experience in the area of clinical practice ■ Have completed a teaching and assessing course approved by NMBI and updates in line with local policy ■ Maintain undergraduate nursing students’ supernumerary status. ■ Provide orientation to the practice placement area and discuss practice placement learning outcomes. ■ Supervise, organise, coordinate and evaluate appropriate nursing student learning activities in the practice placement area and provide feedback as required. ■ Provide learning opportunities that will fulfil the requirements of the six domains of competence. ■ Conduct preliminary, mid-placement (where applicable) and final interviews.
Preceptor/Associate preceptor responsibilities for completion of CAD contd. ■ Guide reflective practice with the undergraduate nursing students. ■ Ensure the implementation of protected time for reflective practice every week. ■ Ask questions to determine the nursing student’s ability to link theory to practice towards the provision of safe and effective evidence based care, using the six domains of competency ■ Provide evidence of nursing student achievement or the lack of achievement as required by the HEI. ■ Provide nursing students, if required, with additional learning supports in a timely manner, in line with HEI policy. ■ Ensure that the National Competency Assessment Document is completed in line with the HEI policy.
Preliminary Interview – short discussion ■ How did the student get on in their last placement ? - Any particular problems? - What went well and why? ■ What is the student hoping to get out of this placement ? – What are their learning outcomes - self assessment ? – Have they any personal learning outcomes – self assessment – Are their learning outcomes realistic? Negotiate – Have they any anxieties or issues they would like to discuss – Is there anything that may affect their learning ? – Do they need any adjustments to be made ?
■ Discuss how and when feedback should be given – Immediately after performance of a skill/care delivered – Summarised after a shift and provided at the end of a shift ■ Raise the issue of reflection and its importance to learning process – Ask what reflective model they use – Discover the process they use to reflect – end of shift or after a week on placement ■ Discuss and agree in advance how best to handle any problems that may occur. This is important as it sets a marker for an agreed process – You may wish to state that if there is an immediate concern with their patient care, you will sensitively intervene so as not to alarm the patient – Once there is no patient concern, then you may wish to provide feedback at earliest convenience (Gray 2014)
CPC responsibilities ■ The CPC provides guidance, support, facilitation and monitoring of practice based learning of undergraduate nursing students during their practice placement. The CPC ensures that all the requirements of the education programme are met by the practice placement in accordance with local policy. ■ Regularly liaises with the Preceptor/Associate Preceptors to discuss progress of nursing students ■ Provide support and guidance to the Preceptor/Associate Preceptor as required. ■ Ensure that the nursing student has been assigned a Preceptor, in line with NMBI requirements and standards. ■ Liaise with Link Academic Staff, as required, in line with HEI policies and procedures. Adapted from Nurse Registration Programmes Standards and Requirements (NMBI, 2016:124 - 184.108.40.206)
Assessment decision of the preceptor ■ The Preceptor/Associate Preceptor should remember as both a registered nurse and as a Preceptor, although it is a nursing student’s responsibility to learn, the Preceptor/Associate Preceptor is responsible for the assessment process and will need to have confidence in their judgement. ■ Please ensure that the undergraduate nursing student has achieved the appropriate level of competence. ■ Comments should be written by the nursing students and the Preceptor/Associate Preceptor at every stage of the assessment process, preliminary, mid-point and final interview ■ If the Preceptor/Associate Preceptor is concerned that the nursing student may not be able to achieve the required level of competence during or by the end of the placement, please ensure that the CPC and Link Academic Staff are informed as per local policy.
Achievement of Competence Year 1 It is important that the student fulfil all the requirements of the six domains as elucidated by their indicators appropriate to the year of study. Competence is not achieved, if the student does not meet the minimal level required/appropriate e.g. exposure in year one in one or more indicators in any of the six domains. Assessment decision Criteria The undergraduate nursing student has consistently demonstrated achievement of Achieved all of the Domains of Competence as per NMBI and demonstrates safe practice. The undergraduate nursing student has not consistently demonstrated achievement Not achieved of all the Domains of Competence as per NMBI and/or demonstrates unsafe practice.
Sign off by preceptor Key point to remember: Only the preceptor who signs off can decide whether a student is fit for This student is practice capable of safe, accountable and effective practice The university decides whether a student is fit for the award
Feedback & Assessment ■ Feedback is the lifeblood of learning (Rowntree 1987) ■ Learning without feedback is like archery in the dark (Cross, 1996) ■ Eraut (2004) and Heaslip and Scammell (2012) suggest that feedback has a powerful effect on the learning process and therefore the development of competence ■ Gray (2014) states that giving feedback needs to be done constructively and sensitively, otherwise it can have a negative impact on student learning ■ Molloy & Boud (2013, p. 228) “claim that feedback is not telling… it is a process whereby students obtain information about their work in order to appreciate the similarities and differences between appropriate standards for any given work and the qualities of the work itself in order to generate improved work”.
Benefits & Barriers to feedback (Gray 2014) ■ Benefits ■ Barriers ■ Increased student motivation ■ Student non receptive to feedback confidence and self –esteem ■ Mentor with limited or poor training/ ■ Improved interpersonal skills education in the process of giving and sense of accomplishment feedback for preceptors ■ Poor learning environment ■ Enhanced quality of patient ■ Strong emotional bond between the care preceptor and student can place ■ Enhances the learning difficulties in the path of delivering experience negative feedback
Critical principles of assessing students in practice (Price, 2007, 2012, Fisher & Webb 2008, Hyatt et al 2008) • Listening to student explain their work and their reasoning. • Does the student understand why they are performing care? Involves • How well does the student apply their questioning of knowledge to practice • Observe verbal and non verbal skills as well as practice skill and attitudes knowledge • Builds on your previous formative feedback Focused and deliberate process Principles • Continuing feedback to student rather than leave it to the end underpinning your of placement. assessment of • Forming an impression of performance towards learning students outcomes as you work/observe students in practice • Should hold no surprise for the student, because you give feedback regularly.
What is it that I need to observe and question the student about today ? ■ Performance in general – Is the student professional ? – How well did they communicate with others? – Depending on their stage in the programme did they exhibit appropriate organisational and interpersonal skills with patients/clients and team members? – What was their decision making process like? Do they make valid decisions based on available information ? – How do they organise patient/ client care? Are they able to prioritise? Is their sequencing of work logical and appropriate?
What is it that I need to observe and question the student about today ? Contd ■ Performance of a skill - how well was this done in terms of the correct preparation, process and self – evaluation ■ Underpinning knowledge – Is the students depth of knowledge of theory and evidence- based practice in line with their stage of their programme ■ Functioning as a member of a team – Is their performance as expected ?
Key points to consider when questioning across the years of study during clinical placement Year Suggested open questions 1 Can you describe …? What is the difference between X and Y? Why did you do it that way ? How do you know that? What evidence is there to support that position ? Can you give me examples of …? How would you identify …? How would you select …? Can you summarise the key factors to consider when…? 2 Why should we do it this way ? If you had a choice of X or Y which would you choose and why? How could you ….? If the patients observations were X, Y and Z what might this mean ? What action would you take as a result? How would you evaluate the effectiveness of …? If you came across X problem, how would you go about solving it?
Suggested questions to consider Year contd:open questions Suggested 3 What would you anticipate if X happened ? What would happen if ...? How would you adapt or modify care for this patient/ client ? Why? Can you differentiate between X and Y ? Is there a connection between what you have just said and what X said earlier? 4 How would you design X for the patient/ client ? How would you organise X? What did you observe about X? What do you think this means? How does this idea support/ challenge what we explored earlier in the session ?
Gray (2014) Framework for giving constructive Negative feedback 1. Backdrop 2. Prepare for discussion 3 Begin discussion 4. Share the information 5. Action plan and support
Reasons why a student may not achieve competence on a placement ■ Lack of insight, poor self-awareness and unresponsive to feedback ■ Lack of interest, motivation enthusiasm or commitment ■ Poor communication/ interpersonal skills ■ Frequently late or absent ■ Poor professional behaviour /boundaries ■ Preoccupation with personal issues ■ Under – or - over confident ■ Preceptor leaves it too late to identify issues
NMBI National Competency Assessment Document – YEAR ONE: Six Domains of Competence for 3 weeks or less YEAR 1: NOVICE Domain 1: Professional values and conduct of the nurse competences Knowledge and appreciation on the virtues of caring, compassion, integrity, honesty, respect and empathy as a basis for upholding the professional values of nursing and identity as a nurse. Domain 2: Nursing practice and clinical decision-making competences Knowledge and understanding of the principles of delivering safe and effective nursing care through the adoption of a systematic and problem solving approach to developing and delivering a person centred plan of care based on an explicit partnership with the person and his/her primary carer. Domain 3: Knowledge and cognitive competences Knowledge and understanding of the health continuum, life and behavioural sciences and their underlying principles that underpin a competence knowledge base for nursing and healthcare practice. Domain 4: Communication and interpersonal competences Knowledge, appreciation and development of empathic communication skills and techniques for effective interpersonal relationships with people and other professionals in healthcare settings. Domain 5: Management and team competences Using management and team competences in working for the person’s well-being, recovery, independence and safety through recognition of the collaborative partnership between the person, family and multidisciplinary health care team. Domain 6: Leadership potential and professional scholarship competences Developing professional scholarship through self-directed learning skills, critical questioning/reasoning skill and decision-making skills in nursing and the foundation for lifelong professional education, maintaining competency and career development.
GUIDELINES FOR COMPLETING THE NMBI NATIONAL COMPETENCY ASSESSMENT DOCUMENT (CAD) FLOWCHART
• The nursing student completes all details on the front cover of the CLO / Comp booklet - their name , HEI details, and clinical placement details 1 • The preceptor/ associate preceptor will conduct orientation within the first 2 days of placement, and decide on the CLO/Comp and skills (goals)to be achieved while documenting this information at the first interview 2 (preliminary interview). • The student will manage their time sheet, in line with HEI policies and procedures. 3 • The preceptor/ associate preceptor will conduct the mid interview with the student. If completing a short placement 3 weeks or less is not necessary. If student has achieved CLO/Comp then revisit or set new goal/s. Document achievements to date and if necessary use notes pages to document achievements other that the 4 CLO/Comp. • Identify problems/ issues early - may use mid interview and /or additional interview and proceed to SLP if • required In advance of the final interview, nursing student will complete reflection/s as required: 3 weeks or less 1 5 reflection, 6 weeks or less 2 reflections, 6 weeks or more 1 reflection every 3 weeks. • The preceptor/associate preceptor will conduct the final interview and will review the domains, CLO/Competencies, skills agreed and reflective note/s before signing off the student achievement of the agreed goals. • If an SLP is in progress, if achieved it can be signed off. If it has not been achieved it can be carried to the next placement provided it is within the current academic year.
Comparison of Clinical Learning Outcomes Booklet (CLO) & Competency Assessment Document (CAD) Yr 1 Clinical Learning Outcomes Booklet (CLO) Competency Assessment Document Aim is to document the achievement of clinical knowledge, skills, professional behaviours and Aim is to document the achievement of competence in clinical knowledge, skills, professional attitudes of a student nurse behaviours and attitudes of a student nurse 5 Domains of competence 6. Domains of competence A. Professional and ethical practice 1. Professional values and conduct of the nurse competences B. Holistic approaches to care and the integration of knowledge 2. Nursing practice and clinical decision – making competences C. Interprofessional relationships 3. Knowledge and cognitive competences D. Organisation and management of care 4. Communication and Interprofessional competences E. Personal and professional development 5. Management and team competences F. Clinical Skills 6. Leadership potential and professional scholarship competences Clinical learning outcomes Performance criteria Indicators Indicators - must achieve all and preceptor must tick and initial all achieved Skills – achieved separate from the CLO, indicators and domains (not a requirement from Skills – implicit within the indicators, performance criteria and domains NMBI) Achievement of CLO – number dependant on placement length – promotes task achievement. Achievement - all indicators of all performance criteria on each placement - promotes holistic Once CLO achieved student did not revisit, “I have achieved it so I do not have to do it again” - patient centred care. Only time they did revisit is if they lost their earlier achievement or failed to achieve. This Have to achieve all indicators on each placement so the student must consistently maintain implies that the student could pass and progress to the next year of the programme based on a their overall level of competence to progress from one year to the next of the programme. once off achievement of CLO/Comp. Preceptor only signed what was achieved Preceptor must tick level and initial all indicators achieved Achievement of CLO and Skills at exposure and participation levels Achievement of indicators, performance criteria and domains at exposure and participation levels CLO Booklet does not follow an order – it requires a lot of turning of pages to sign CLO , skills, CAD Booklet follows an order – each placement record is independent within the booklet – interviews, reflection, additional notes and SLP if required Preceptor signature sheet, practice placement record, Student self –evaluation of learning needs, first, mid and final interviews, reflection, reflection time record sheet, additional notes (progress notes), Performance criteria and indicators sign sheet, additional interview and SLP No requirement for the student to document their learning needs through a self-evaluation Student self-evaluation of learning needs for each placement- student must have this complete at preliminary interview (commencement of placement interview) Reflection – Gibbs reflective cycle - pages included Reflection – Gibbs reflective cycle – structure included Language - described as “flowery” Language – plain English - “easy to understand”
Reference ■ NMBI (2018) Guidelines for completing the national competency assessment document. Dublin, NMBI.
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