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Hong Kong College of Medical Nursing

Advanced Practice Nursing (Medicine) Certification Program

Fellow Membership Examination (Sub-Specialty Module – Advanced Medicine Nursing)

Clinical Log Book

Endorsed on 16 May 2016

Amended on 4 July 2016

Name of the Candidate

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Advanced Practice Nursing (Medicine) Certification Program

Fellow Membership Examination (Sub-Specialty Module- Advanced Medicine

Nursing) Clinical Log Book

Table of Contents:

1 GENERAL INSTRUCTION FOR CANDIDATE ………………………………………..3

2 PURPOSE OF THE LOG BOOK ……………………………………….………………….3

3 RESPONSIBILITIES OF THE CANDIDATE…………………………………………3-4

4 RESPONSIBILITIES OF THE MENTOR…………………………………………………4

5. PERSONAL DATA OF THE CANDIDATE.………………………………………………5

6 RECORD OF EXPERIENCES…………………………………………………………..6-10

7 RECORD OF CASE STUDY AND/OR PRESENTATION…………………………10

8 DEVELOP NURSE LED CLINIC…..………………………………………………………10

9 PATIENT ADVOCACY & END-OF-LIFE CARE…………………..…………………10

10 FACILITATE CHANGE & EVIDENCE-BASED PRACTICE………………………11

11 INITIATE IMPROVEMENT STRATEGIES………………………………….…………11

12 CLINICAL LOG SHEET………………………………………………………..……………12

13 EVALUATION FORM ………………………………………………………………………13

14 REFERENCE – COMPETENCE FRAMEWORK………………………………14-16

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1. General Instructions for Candidate

The Candidate should regularly read and access information related to Specialty

Training published by the Hong Kong College of Medical Nursing as updated on

website.

2. The Purpose of the Log Book

1. To assist the Candidate in reflecting the learning opportunities in clinical

practices

2. To facilitate the Mentor to assess the clinical competence of the Candice and

provide support and guidance to accomplish the Certification Program

3. Responsibilities of the Candidate

1 Each Candidate, upon enrollment, will be issued with the Log Book at the

commencement of Advanced Practice Nursing (Sub-Specialty - Advanced

Medicine) Certification Program training. It will be the property of the

Candidate.

2 The Candidate should record the followings:

– All supervised assessment on the patients

– All supervised interventions on the patients

– All special encounters with the patients/families

– Case conferences

– Research activity

– Journal reading and reflection

– Continuous Professional Activities – Attending Mortality and Morbidity Meetings

– Attending/ leading Continuous Nursing Education activities

– Case presentations

– Nurses rounds

– Attending/presentation in conferences, seminars – Leading Patient Safety activity

– Leading Staff Occupational Safety activities

– Leading Risk Management and Quality improvement activities The above list is not exhaustive as the log book serves as a means that demonstrate

reflective learning of the Candidate.

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3 The Candidate is strongly advised to keep the Log Book with him/her at all

times and to fill in relevant information on a regular basis. Patient(s) MUST

NOT be identified by names or Hong Kong Identity Card numbers. Cases

should be recorded using patients’ initials and /or hospital numbers.

4 The Candidate should discuss his/her progress as documented in the Log

Book with his/her mentor at regular intervals. This dialogue serves an

opportunity for the Candidate to reflect on the learning and growth in the

nursing profession. This regular assessment allows deficiencies in

experience to be remedied early in the course of the training. Evaluation

Form must be signed by the mentor and endorsed by the Chairman of

Examination Panel before recommendation to the Hong Kong Academy of

Nursing for admission to Fellow Member.

5. The Candidate should seek the Mentor’s endorsement of the Training

Program before submission to the Examination Panel.

6 The Candidate should complete at least 70% of the Log Book before final

assessment.

4. Responsibilities of the Mentor

1 The Mentor facilitates the Candidate to map learning opportunities in the

clinical practices to the competence framework

2 The Mentor has the responsibility to guide the Candidate to reflect on

encounters in the clinical areas by asking what has happened, why and

what is the learning point?

3 The Mentor is to facilitate the Candidate to identify opportunities to

develop the leadership abilities to lead the team.

4 The Mentor is to polish the Candidate’s presentation and writing skills and

encourage him/her to present cases and papers.

5 The Mentor is to encourage the Candidate to be active team players in

clinical rounds.

6 The Mentor should not take more than three Candidates at the same work

place.

7 The Mentor should not hold Trainer status in more than 2 specialties.

8 The Mentor has the responsibility to guide the Candidate to prepare for

the Training Program

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5. Personal Data of the Candidate

Candidate’s Name Sex

Chinese Name

Registration Number of the Candidate

Date of entry into the training program

Address

Email Telephone

Mentor Name Title

Institution/Department/Unit

Supervising period

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6. Record of Experience

* Mandatory Items

* 6.1 Patient Assessment Skills ( not less than 5 scenarios )

Date Experience Mentor’s

sign

*6.2 Symptomatic based assessment and assessment tools ( not less than 3 scenarios)

Date Experience Mentor’s

sign

*6.3 Screening of the infectious disease but not limiting to TB, HIV, H1N1, MDRA, CRE,

VRE, MERS

Date Experience Mentor’s

sign

6.4 Screening of Patients according to updated Government supported programs such

as Dementia; Colorectal screening ( not less than 3 scenarios)

Date Experience Mentor’s

sign

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*6.5 Establishment of Patient Centered Care Therapeutic relationship (not less than 3

scenarios)

Date Experience Mentor’s

sign

*6.6 Management of patients with Cardio pathological conditions (not less than 3

scenarios)

Date Experience Mentor’s

sign

*6.7 Management of patients with Respiratory pathological conditions ( not less than

3 scenarios)

Date Experience Mentor’s

sign

*6.8 Management of patients with Critical respiratory conditions required

non-invasive ventilations (NIV) or Invasive mechanical ventilations (not less than 2

scenarios)

Date Experience Mentor’s

sign

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*6.9 Management of patients with Respiratory complications with chest drain or

pigtail drain ( not less than 2 scenarios )

Date Experience Mentor’s

sign

6.10 Management of patients with Acute kidney shutdown requires Renal

Replacement Therapy (not less than 2 scenarios)

Date Experience Mentor’s

sign

*6.11 Management of patients with Emergency condition with hypoglycemia or

diabetic ketoacidosis ( not less than 2 scenarios)

Date Experience Mentor’s

sign

*6.12 Management of patients with Epilepsy (not less than 2 scenarios)

Date Experience Mentor’s

sign

*6.13 Management of patients with Central Venous Cather Insertion ( not less than 2

scenarios)

Date Experience Mentor’s

sign

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*6.14 Management of patients with infectious disease such as TB, HIV, H1N1, MDRA,

CRE, VRE, MERS ( not less than 4 scenarios)

Date Experience Mentor’s

sign

*6.15 Management of patients with hepatitis, complications of liver cirrhosis and

gastrointestinal bleed (not less than 4 scenarios)

Date Experience Mentor’s

sign

*6.16 Management of patients with nutritional problems ( not less than 2

scenarios)

Date Experience Mentor’s

sign

*6.17 Management of patients with Grade 4 Pressure ulcer ( not less than 2

scenarios )

Date Experience Mentor’s

sign

*6.18 Management of patients with Dementia ( not less than 2 scenarios)

Date Experience Mentor’s

sign

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6.19 Management of patients Receiving Biological therapy; Chemotherapy;

radiotherapy and management of complications. ( not less than 2 scenarios)

Date Experience Mentor’s

sign

6.20 Management of patients receiving organ or marrow transplant. ( not less than 1

scenarios)

Date Experience Mentor’s

sign

7. Case Study and / or Presentation (not less than 2 cases, please refer to Clinical Log

Sheet at the back as a reference format)

8. Nurse Led Clinics – planning, development and operation (not less than 1

activity)

date Activity Mentor’s

Sign

9. * Patient advocacy and End-of-Life Care (not less than 2 activities )

Date Activity Mentor’s

Sign

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10. Facilitate change and adopt evidenced based practice in nursing care (not

less than 3 activities)

date Activity Mentor’s

Sign

11. *Initiate improvement strategies in quality and risk management (not less

than 2 activities)

date Activity Mentor’s

Sign

- END –

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12. Clinical Log Sheet

This is a suggested format to facilitate mentor mentee discussion.

Session date:

Level of care the Candidate provided:

Observation only Primarily mentor managed Independent care with

presentation to mentor agreement

Client information:

Initial Sex/Age Occupation

Social background

Resource / support network

Diagnosis / medications

Relevant medical, mental conditions and other parameters

Physical psycho-social problems identified

Intervention and education

Management and education provided

Reflection / learning

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13. Evaluation form to be completed by the Mentor for recommending to attend

assessment leading to award of HKAN Fellow Member

Name of Mentee

Supervising

Period

EVALUATIOM

Subject areas Grading

Pass Needs

improvement

Borderline

Fail

Fail

Professional judgment

Meeting the domain of competence

Managed patient with complex clinical profile

Established therapeutic relationship with

patient/family

Led CQI activity

Assisted to/ Developed clinical practice guidelines

Led nursing team and demonstrated leadership

abilities

Overall rating

recommendation

recommended as qualified and competent

not recommended

Additional comments (use additional sheet if necessary)

Name of Mentor Signature

Fellow number Date :

endorsed

not endorsed

Chairman of Examination & Accreditation Committee Signature

Date :

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REFENCE – COMPETENCE FRAMEWORK

Subject areas Domains

1 2 3 4 5 6 7 5.1. Health Assessment 5.1.1 Patient

assessment skills

All 1,2,3,4,8 1,2,3 2,3,5

5.1.2 Symptomatic based

assessment and assessment

tools

All 1,2,3,4,8 1,2,3 2,3,5,7

5.1.3 Focused assessment

for patients with common

acute medical conditions

All 1,2,3,4,8 1,2,3 2,3,5,6,7 1

5.1.4 Screening of

infectious disease including

All 1,2,3,4,8 1,2,3 1,2,3,5 1

MDRA; CRE; VRE; MERS 5.1.5 Screening of patients

according to updated

Government supported

programs like Dementia

screening ; Colorectal

screening

All 1,2,3,4,8 1,2,3 1,2,3,5 1

5.2 Establishment of

Patient Centered Care

Therapeutic relationship

All All 1,3,4,5 2 1

5.3 Management of

patients with complex

medical conditions:

All All 1,3,4,5 2 1

a) Cardio pathological

conditions such as

Acute coronary

syndrome, congestive

heart failure with

Cardiac interventions

All All 1,3,4,5 1,2,4 1,2,3,7 2,3,4,5,9 1

b) Respiratory

pathological

conditions such as

asthma ; chronic

obstructive

pulmonary disease or

sleep apnoea

All All 1,3,4,5 1,2,4 1,2,3,7 2,3,4,5,9 1

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c) Critical respiratory

conditions required

non-invasive

ventilations (NIV)

or Invasive mechanical

ventilations

All All 1,3,4,5 1,2,4 1,2,3,7 2,3,4,5,9 1

d) Respiratory

complications with

chest drain or

pigtail drain

All All 1,3,4,5 1,2,4 1,2,3,7 2,3,4,5,9 1

e) Acute kidney

shutdown requires

Renal Replacement

Therapy

All All 1,3,4,5 1,2,4 1,2,3,7 2,3,4,5,9 1

f) Emergency condition

with hypoglycemia or

diabetic ketoacidosis

All All 1,3,4,5 1,2,4 1,2,3,7 2,3,4,5,9 1

g) Epilepsy All All 1,3,4,5 1,2,4 1,2,3,7 2,3,4,5,9 1

h) Central venous

catheter insertion ;

monitoring and

management

All All 1,3,4,5 1,2,4 1,2,3,7 2,3,4,5,9 1

i) Infectious disease

such as TB, HIV, H1N1.

All All 1,3,4,5 1,2,4 1,2,3,7 2,3,4,5,9 1

j) receiving blood

products transfusion

All All 1,3,4 1,2,3 1,2,3 2,3,4,5, 9,10,11

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k) Common liver

diseases – hepatitis

and complications of

liver cirrhosis;

gastrointestinal bleed,

functional

gastroesophageal

disease; Crohn’s

disease

All All 1,3,4 1,2,4 1,2,3,7 1,2,3,4,5 1

l) with nutritional

problems

All 1,2,3,4,6,8 2 2 1

m) Pressure ulcer All 1,2,3,4,6,8 2 2 1

n) Receiving

Biol

ogical therapy;

Chemotherapy;

radiotherapy

and management of

complications.

All 1,2,3,4,6,8 1,3,4,5 1,2,4 1,2,3 2,3,4,5,9 1

o) Pre and post Organ or

marrow transplant

care

All All 1,2,3,4,5 1,2,4 1,2 2,3 1

5.4 Development of nurse-

led clinics

all all 5,6 1,2,3,4,5,6 2,5 1,2

5.5 Patient Advocacy and

End of life care in medical

nursing

All 1,2,3,4,5,8 1 3 1,4 2,5,9 1

5.6 Facilitate change and

adopt evidence based

practice in nursing care

1,2,3,5 2,3,7 3,4,5,9,10

5.7 Develop and foster

patient safe environment

and initiate improvement

strategies in quality and risk

management

3 2,3,4,8 3,4 1,2,3, 4,5,6

1,2,3,7 4,5,6,7,9 10,11

12,13

1,2