PRECEPTORSHIP PROGRAMME 2018 -2019 - UCC

 
PRECEPTORSHIP PROGRAMME 2018 -2019 - UCC
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.
PRECEPTORSHIP PROGRAMME 2018 -2019 - UCC
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
PRECEPTORSHIP PROGRAMME 2018 -2019 - UCC
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)
PRECEPTORSHIP PROGRAMME 2018 -2019 - UCC
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
PRECEPTORSHIP PROGRAMME 2018 -2019 - UCC
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
PRECEPTORSHIP PROGRAMME 2018 -2019 - UCC
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
PRECEPTORSHIP PROGRAMME 2018 -2019 - UCC
Allocation of students

 UCC - Allocations Officer
 BSc Allocations liaison officer on site
 Combination of internal and external placements
 Student numbers per ward/site
PRECEPTORSHIP PROGRAMME 2018 -2019 - UCC
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
PRECEPTORSHIP PROGRAMME 2018 -2019 - UCC
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
PRECEPTORSHIP PROGRAMME 2018 -2019 - UCC
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
REFLECTION
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 - 3.2.6.6)
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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