On-going Record of Achievement of... · The On-going Record of Achievement is the document that...
Transcript of On-going Record of Achievement of... · The On-going Record of Achievement is the document that...
UNIVERSITY of SUFFOLK
Faculty of Health and Science
Department of Health Sciences
Pre-Registration Nursing Programmes:
BSc (Hons) Adult Nursing BSc (Hons) Mental Health Nursing BSc (Hons) Child Health Nursing
On-going Record of Achievement
Student Name: Programme: Cohort:
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Contents Page
Content Page No.
Introduction and glossary of terms 3
Requirements for entering first practice placement 5
UK Core Skills training: year 1 8
Mental Health Nursing students mandatory training 12
Year 2 and 3 Record of mandatory training 13
UK Core Skills training: year 2 14
UK Core Skills training: year 3 16
Generic guidelines for mentors to all pre-registration undergraduate
Nursing programmes
18
The assessment process in practice flow-chart 19
Guidelines for students raising and escalating concerns in practice 20
Year 1 documentation 25
• Mentor signature sheets 26
• Simulated Practice Learning: Preparation for Practice Experience 30
• Dementia care checklist: AN Students year 1 43
• Short placement forms: 4 sets of forms 45
• Long placement forms: 4 sets of forms 58
Interview schedule with Personal Tutor Forms 1 and 2 107
Year 2 documentation 109
• Mentor signature sheets 110
• Simulated Practice Learning: Preparation for Practice Experience 114
• Dementia care checklist: AN Students year 2 125
• Short placement forms: 4 sets of forms 127
• Long placement forms: 4 sets of forms 140
Interview schedule with Personal Tutor Forms 3 and 4 189
Year 3 documentation 191
• Mentor signature sheets 192
• Simulated Practice Learning: Preparation for Practice Experience 204
• Dementia care checklist: AN Students year 3 205
• Short placement forms: 3 sets of forms 207
• Long placement forms: 2 sets of forms 217
Interview schedule with Personal Tutor Form 5 242
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Content Page No.
Final Placement documentation 243
• Sign-off Mentor signature sheet 244
• Final placement forms 245
• Tri-partite meeting form 258
• Sign-off mentor end of programme declaration 260
Interview schedule with Personal Tutor Form 6 261
Absence record forms 262
EU Directives 264
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Introduction The On-going Record of Achievement is the document that provides evidence of your clinical
progress throughout your programme.
The document must be completed in hand using black ink. Any alterations must be clearly
signed and dated – NO correction fluid is allowed in this document.
In line with the NMC (2015) ALL entries within this document MUST maintain the anonymity
and confidentiality of service users and their family/carer(s).
Students are expected to be familiar with those Values and Principles associated with health
care in the United Kingdom as enshrined in the NHS Constitution:
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/170656/NHS_
Constitution.pdf
and to learn and practice in a way that is compatible with them.
Glossary of Terms Academic Lecturer: a member of University of Suffolk staff with academic
responsibilities
Action plan: Document that identifies development or learning needs
Associate mentor/ Stage 1 registrant:
a qualified nurse who has not undertaken/completed a NMC approved mentorship programme and therefore cannot sign to say that a student is competent.
Clinical Practice Facilitator/ Practice Educator:
a member of the clinical staff with specific responsibilities for the student experience
Direct contact: interaction with a service user
Facilitator: a member of staff that organises/enables a student experience
HEI: Higher Education Institution (University of Suffolk for example)
Indirect contact: simulation of an interaction with a service user
Link Lecturer: a member of academic staff responsible for liaising with specific clinical areas.
Long arm mentoring: the indirect supervision of a student whilst they are on visits or undertaking a practice learning opportunity in an
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area related to the student has been allocated.
Mentor/Stage 2 registrant: a qualified nurse who has successfully completed a NMC approved mentorship programme.
On-going Record of Achievement:
Document that demonstrates the student’s competency and their professional development throughout their programme of study.
Personal Tutor
A member of academic staff who is responsible for supporting the student, usually throughout their programme of study.
Practice Learning Opportunities: these are opportunities that students can engage in away from their allocated area that can enhance the student’s understanding of the service user’s experience (hubs and spokes).
Professional Lead: Senior academic and NMC registrant leading on health, welfare, disability and fitness to practice issues
Protected time: the one hour per week that the NMC (2008) identify should be allocated for sign-off mentors
Service user: anyone who uses the services of a nurse, or any other relevant service
Sign-off Mentor/Stage 2a registrant:
a qualified nurse who has successfully completed a NMC approved programme; able to sign to confirm that a student is competent and fit to be entered onto the professional nursing register.
References used in this glossary of terms
Nursing and Midwifery Council (2010) Standards for pre-registration nursing education. London: NMC
Nursing and Midwifery Council (2008) Standards to support learning and assessment in practice. London: NMC (http://www.nmc-uk.org/Educators/Standards-for-education/Standards-to-support-learning-and-assessment-in-practice/)
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Requirements for entering the first practice placement
Agreement to abide by all policies and procedures
It is essential that you abide by all policies and policies of Practice Education Partners,
University of Suffolk relating to placement and the expectations of the NMC as enshrined in
The Code: Professional standards of practice and behaviour for nurses and midwives (NMC,
2015) http://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/revised-new-
nmc-code.pdf
I have read, understand and agree to abide by the above policies and procedures.
Signature of Student:
Date:
I have discussed this statement with the student
Signature of Personal Tutor:
Date:
Protecting the public through professional standards: Accepting appropriate
responsibility
There may be times when you are in a position where you may not be directly supervised by
your mentor, supervisor or another registered professional. As your skills, experience and
confidence develop, you will become increasingly able to deal with this situation. However,
throughout all clinical placements you must only participate in care interventions for which
you have been fully prepared or in which you are appropriately supervised, and which are in
keeping with Trust/Practice policy.
If you have any doubts, discuss them as quickly as possible with your mentor, clinical
practice facilitator or an academic lecturer.
I have read and understood the above statement
Signature of Student:
Date:
I have discussed this statement with the student
Signature of Personal Tutor:
Date:
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Access to information about progression in practice
The NMC (2008) stipulates that Mentors must have the opportunity to review your previous
practice achievements, experiences and learning. It is your responsibility to keep this
document safe, to take to each of your clinical placements and make it available to your
mentors.
Consent statement
I consent to allow the sharing of confidential data about me between successive mentors
and with the relevant representatives of the Department of Health Sciences at University of
Suffolk with regard to the assessment of my fitness for practice.
I understand that this is an NMC (2008) requirement and that it is essential to my
programme of study leading to registration with the NMC.
Signature of Student:
Date:
I have discussed this statement with the student
Signature of Personal Tutor:
Date:
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Mandatory Training required before entering first practice placement
Moving and Handling:
Year 1:Theory Year 1: Practice (1)
Date Trainer Signature Date Trainer Signature
Year 1: Practice (2)
Date Trainer Signature
Resuscitation Level 2: Paediatric Resuscitation Level 2: (for
Child Health Nursing Students)
Year 1: Practice Year 1: Practice
Date Trainer Signature Date Trainer Signature
Disclosure and Barring Service check completed
Year 1
Date Signature of authority
Occupational Health Clearance
Year 1
Date Signature of authority
All requirements for entering the first practice placement are complete
Signature of Course Leader/Personal Tutor:
Date:
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UK Core Skills training: year 1
The UK Core Skills Training Framework subjects for England are:-
1. Equality, diversity and human rights 3. Health, safety and welfare 4. NHS conflict resolution 5. Fire safety 6. Infection prevention and control 7. Moving and handling 8. Safeguarding adults 8a. Preventing Radicalisation 9. Safeguarding children 10. Resuscitation 11. Information governance http://www.skillsforhealth.org.uk/services/item/146-core-skills-training-framework
All of the above sessions are covered in year 1 (in either NP1; NT1 or NT2) and some are
developed in years 2 and 3
This section refers to the skills other than Moving and Handling and Resuscitation as these
are covered on the previous page as they MUST be completed before the first clinical
placement.
Students MUST sign to say they have attended sessions identified below and
Lecturer/Education Staff to verify attendance.
NB – these should be completed on the day of attendance or on the next possible
occasion
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Skills covered at University of Suffolk
Equality, diversity and human rights (to be signed after the NT1 session)
Date: Student Signature:
Attendance verified by - Name: Signature:
Health, safety and welfare (to be signed following Practice Prep session))
Date: Student Signature:
Attendance verified by - Name: Signature:
Fire safety – on Induction
Date: Student Signature:
Attendance verified by - Name: Signature:
Infection Prevention and Control (to be signed after the NT1 session)
Date: Student Signature:
Attendance verified by - Name: Signature:
Safeguarding Adults and Children – Introductory day (all fields of practice)
Date: Student Signature:
Attendance verified by - Name: Signature:
Safeguarding Adults and Children – Day 1 (all fields of practice)
Date: Student Signature:
Attendance verified by - Name: Signature:
Preventing Radicalisation – on Induction
Date: Student Signature:
Attendance verified by - Name: Signature:
Information Governance – Booklet signed by Personal tutor
Date: Student Signature:
Attendance verified by - Name: Signature:
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Core Skills covered in the Trust
Name of Trust:
Skills covered by Trust Induction/Mandatory Training
Title of Core Skill:
Date: Student Signature:
Attendance verified by - Name: Signature:
Title of Core Skill:
Date: Student Signature:
Attendance verified by - Name: Signature:
Title of Core Skill:
Date: Student Signature:
Attendance verified by - Name: Signature:
Title of Core Skill:
Date: Student Signature:
Attendance verified by - Name: Signature:
Title of Core Skill:
Date: Student Signature:
Attendance verified by - Name: Signature:
Title of Core Skill:
Date: Student Signature:
Attendance verified by - Name: Signature:
Title of Core Skill:
Date: Student Signature:
Attendance verified by - Name: Signature:
Title of Core Skill:
Date: Student Signature:
Attendance verified by - Name: Signature:
Title of Core Skill:
Date: Student Signature:
Attendance verified by - Name: Signature:
Title of Core Skill:
Date: Student Signature:
Attendance verified by - Name: Signature
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Core Skills covered in the Trust
Name of Trust:
Skills covered by Trust Induction/Mandatory Training
Title of Core Skill:
Date: Student Signature:
Attendance verified by - Name: Signature:
Title of Core Skill:
Date: Student Signature:
Attendance verified by - Name: Signature:
Title of Core Skill:
Date: Student Signature:
Attendance verified by - Name: Signature:
Title of Core Skill:
Date: Student Signature:
Attendance verified by - Name: Signature:
Title of Core Skill:
Date: Student Signature:
Attendance verified by - Name: Signature:
Title of Core Skill:
Date: Student Signature:
Attendance verified by - Name: Signature:
Title of Core Skill:
Date: Student Signature:
Attendance verified by - Name: Signature:
Title of Core Skill:
Date: Student Signature:
Attendance verified by - Name: Signature:
Title of Core Skill:
Date: Student Signature:
Attendance verified by - Name: Signature:
Title of Core Skill:
Date: Student Signature:
Attendance verified by - Name: Signature
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Mental Health Nursing Students: Mandatory Training
By the end of your first period of practice, you MUST achieve the following:
Trust Induction: Acute Base Site Trust Induction: NSFT
Year 1 Year 1
Date Signature (Trust) Date Signature (Trust)
Personal Safety Training:
Year 1: Theory Year 1: Practice
Date Trainer Signature Date Trainer Signature
Lorenzo Training:
Year 1
Date Trainer Signature
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Year 2 and 3 Record of Mandatory Training: all fields of practice
Moving and Handling: Year 2
Theory Practice
Date Trainer Signature Date Trainer Signature
Moving and Handling: Year 3:
Theory Practice
Date Trainer Signature Date Trainer Signature
Resuscitation Level 2:
Year 2 Year 3
Date Trainer Signature Date Trainer Signature
Paediatric Resuscitation Level 2: (for Child Health Nursing Students)
Year 2 Year 3
Date Trainer Signature Date Trainer Signature
Person Safety Training (for Mental Health Nursing Students)
Year 2 Year 3
Date Trainer Signature Date Trainer Signature
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UK Core Skills training: year 2
This section refers to the skills other than Moving and Handling and Resuscitation as these
are covered on the previous page as they MUST be completed before the first clinical
placement.
Students MUST sign to say they have attended sessions identified below and
Lecturer/Education Staff to verify attendance.
NB – these should be completed on the day of attendance or on the next possible
occasion
Skills covered at University of Suffolk
Infection Prevention and Control
Date:
Student Signature:
Attendance verified by - Name: Signature:
Information Governance
Date:
Student Signature:
Attendance verified by - Name: Signature:
Safeguarding Adults and Children – Day 2 (all fields of practice)
Date: Student Signature:
Attendance verified by - Name: Signature:
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Core Skills covered in the Trust
Name of Trust:
Skills covered by Trust Induction/Mandatory Training
Title of Core Skill:
Date: Student Signature:
Attendance verified by - Name: Signature:
Title of Core Skill:
Date: Student Signature:
Attendance verified by - Name: Signature:
Title of Core Skill:
Date: Student Signature:
Attendance verified by - Name: Signature:
Title of Core Skill:
Date: Student Signature:
Attendance verified by - Name: Signature:
Name of Trust:
Skills covered by Trust Induction/Mandatory Training
Title of Core Skill:
Date: Student Signature:
Attendance verified by - Name: Signature:
Title of Core Skill:
Date: Student Signature:
Attendance verified by - Name: Signature:
Title of Core Skill:
Date: Student Signature:
Attendance verified by - Name: Signature:
Title of Core Skill:
Date: Student Signature:
Attendance verified by - Name: Signature:
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UK Core skills training: year 3
This section refers to the skills other than Moving and Handling and Resuscitation as these
are covered on the previous page as they MUST be completed before the first clinical
placement.
Students MUST sign to say they have attended sessions identified below and
Lecturer/Education Staff to verify attendance.
NB – these should be completed on the day of attendance or on the next possible
occasion
Skills covered at University of Suffolk
Infection Prevention and Control
Date:
Student Signature:
Attendance verified by - Name: Signature:
Information Governance
Date:
Student Signature:
Attendance verified by - Name: Signature:
Safeguarding Adults and Children – Day 3 (all fields of practice)
Date: Student Signature:
Attendance verified by - Name: Signature:
Safeguarding Children – Day 4 (CHILD HEALTH STUDENTS ONLY)
Date: Student Signature:
Attendance verified by - Name: Signature:
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Core Skills covered in the Trust
Name of Trust:
Skills covered by Trust Induction/Mandatory Training
Title of Core Skill:
Date: Student Signature:
Attendance verified by - Name: Signature:
Title of Core Skill:
Date: Student Signature:
Attendance verified by - Name: Signature:
Title of Core Skill:
Date: Student Signature:
Attendance verified by - Name: Signature:
Title of Core Skill:
Date: Student Signature:
Attendance verified by - Name: Signature:
Title of Core Skill:
Date: Student Signature:
Attendance verified by - Name: Signature:
Name of Trust:
Skills covered by Trust Induction/Mandatory Training
Title of Core Skill:
Date: Student Signature:
Attendance verified by - Name: Signature:
Title of Core Skill:
Date: Student Signature:
Attendance verified by - Name: Signature:
Title of Core Skill:
Date: Student Signature:
Attendance verified by - Name: Signature:
Title of Core Skill:
Date: Student Signature:
Attendance verified by - Name: Signature:
Title of Core Skill:
Date: Student Signature:
Attendance verified by - Name: Signature:
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GENERIC GUIDELINES FOR MENTORS FOR ALL
PRE REGISTRATION UNDERGRADUATE NURSING PROGRAMMES
Progression and achievement of competencies in practice?
Raise concern with student at earliest opportunity and document
in the practice document with a clear action plan for achievement.
Contact CPF/Link Lecturer/Convenor as appropriate.
University of Suffolk to be contacted for support in action plan formulation if needed; contact link
tutor or personal tutor
Review action plan and document evidence of achievement.
Feedback to student. Personal tutor to be informed to feed
outcome into assessment board
Additional support, please contact Course Leader
Is there concern regarding fitness to practise (for example conduct, ability to meet requirements and
standards due to social or personal circumstance)
Raise concern with student and document in practice document.
Contact CPF/Link Lecturer/ Convenor as appropriate
Course Leader or Programme Director
Programme Director to assess urgency and address concern through University of Suffolk Fitness to Practise process
CAUSE FOR CONCERN RAISED
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The assessment process in practice flowchart
Prior to commencing practice placement
Practice Placement identify the mentor(s)
Student contact the placement and collects
off-duty
First day in practice placement
Student and mentor discuss learning
opportunities
Orientation to placement completed
End of first week – Initial Interview
Student and mentor complete initial interview;
Identify relevant visits
If relevant discuss Integrated practice
assessment and
Learning outcomes for the placement
Each week
Mentor completes record of meetings held with
student
Mid-point Interview
Student and mentor review and record the
student’s progress
Identify strengths and areas for improvement
Action plan completed if required
PASS REFER
Course Leader
Areas requiring
improvement identified
These should be raised
with the student at the
earliest opportunity.
An action plan MUST be
developed
End of practice experience – final interview
Student and mentor complete the final
interview
Achievements and unmet outcomes identified
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Faculty of Health and Science
Department of Health Sciences
Guidelines for students raising and escalating concerns in practice Introduction Students are subject to a variety of practice experiences and placements both within the
community, and acute trust settings. This is a guide for students who may witness clinical
practices in any of those environments, causing them concern. It gives the student a
process to raise that concern appropriately, and to escalate if they feel it is required. The
underlying principle is to safeguard the public. The following principles also apply;
Principles.
1. These guidelines are to be applied giving patient/carer and student safety as a
priority.
2. These guidelines are to be applied whenever, and however, there is a reasonable
belief that practice placement is not, compliant with NMC Standards.
3. These guidelines are to be employed in keeping with best education practice being
mindful of NMC Guidance on Escalating Concerns.
4. All persons involved should feel able to express their honest understanding of any
given situation without reserve.
Application.
These guidelines and based upon the NMC “Raising and Escalating Concerns: Guidance for
Nurses and Midwives” (NMC, 2015) and are to be applied when any reasonable concern
exists. The specifically relate to, and are aimed at students of nursing and midwifery who
may wish to raise or escalate a concern regarding clinical practice. They are to be used in
conjunction with any local placement policies relating to safeguarding, or whistle blowing.
The following are examples to establish an appropriate mental set only, to be considered if
the issue cannot be resolved when first raised. An expectation is that any person or authority
involved will exercise professional judgment at the time and in a proportional manner.
Immediate actions should be determined by the principles identified above. Examples of
situations where these guidelines may apply;
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- A concern is raised as a consequence of a complaint made by a patient, their carer
or a student to any person or authority about the standard of care delivered within a
placement
- An internal or external governance process or agency raises a concern about the
standard of care within a placement.
- The placement is not compliant with any aspect of NMC standards for placement
learning
Student guidance: Your role in raising concerns
As a student of Nursing or Midwifery, whilst not on the NMC register, you have a duty of care
to safeguard the public and report any concerns from practice placements which put the
safety of the people in your care or the public at risk. As outlined in the NMC (2015)
guidance on raising and escalating concerns, the expectation is;
• Action must be taken without delay if you believe that you, a colleague or anyone
else may be putting someone at risk
• You must inform someone in authority if you experience problems that prevent care
delivery from meeting standards
• Speaking up on behalf of people in your care and clients is an everyday part of your
role, and just as raising genuine concerns represents good practice, ‘doing nothing’
and failing to report concerns is unacceptable. Whilst it is often daunting to raise
concerns, you should feel you can do so without prejudice, and with the support of
both practice and academic staff.
Student guidance: Procedure for raising and escalating concerns If you have a concern about anything you have witnessed in practice it is recommended that
you raise this first and foremost with your mentor. In conjunction, you should inform your
personal tutor so that they can guide and support you through the process. If you feel that
your concern has not been recognized or appropriately acted upon, you have the right to
escalate this concern to the appropriate staff. As a student there are a number of people
available to you. You can again speak with your personal tutor, or a member of the
academic team, who can advocate for and support you. In addition, if you feel comfortable
you should raise your concern with the clinical manager of your placement area. If you are
in an acute trust, there are Clinical Practice Facilitators (CPFs) who can also support this
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process. In other clinical areas Link Lecturers and/or Clinical Learning Environment
Coordinators are available. If you are concerned at any point about who to approach, please
speak to a member of academic staff. Your concerns should be addressed through the
appropriate policies for the individual clinical area and the academic staff should be included
in all steps of the process. The role of the academic staff is to support you in raising your
concerns, escalating if required, supporting you in the process of any outcome (such as
investigation, or provision of statements) and to assist the feedback to you to ensure
resolution of your concern, at whichever level it has been escalated to. In some instances,
concerns may be escalated from the clinical areas, to the appropriate professional bodies
and you may be required to support this process. You will be supported by the academic
staff and we always ask that if a student raises a concern, that they do not submit any form
of statement, either written or verbal, without the presence of an appropriate member of
academic staff.
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Student guidance: Flow chart to summarise the process
Reference Nursing and Midwifery Council (2015) Raising concerns: Guidance for nurses and midwives. [Online]. Available at: http://www.nmc.org.uk/globalassets/siteDocuments/NMC-Publications/NMC-Raising-and-escalating-concerns.pdf
CONCERNED? Examples; standards of
care, conduct of a
member of staff, safety
Raise your concern firstly by
speaking to your mentor
IS YOUR CONCERN RESOLVED? YES; No further action but it is
recommended that you discuss with your personal tutor to debrief
NO; Escalate your concern to the clinical
manager and CPF/Link Lecturer/Convenor
Remember to include the academic staff for support.
IS YOUR CONCERN RESOLVED?
YES; No further action but it is
recommended that you discuss with your personal tutor to debrief
NO; It is rare that a concern is not addressed at this stage
however if you feel that this is the case, speak to the
CPF/Link Lecturer and academic staff who can support you in raising concerns further if required
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YEAR 1
Documentation
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Mentor/Registered Practitioner Signature Sheet: Year 1
All registered practitioners who sign the student’s documentation MUST complete the sheet below. This is a requirement of University of Suffolk as it allows for signatures to be checked and confirmed. Please read the following statement before signing this sheet. By signing this sheet mentors are signing to say they have attended a mentor update in the last 12 months and that their triennial review is up-to date as required by NMC (2008).
Name of Mentor/Registered
Practitioner (printed)
Signature Initials of Mentor/Registered
Practitioner
Name of placement
area
Contact telephone number for placement
area
Dates student attended clinical
placement
Name of Manager
verifying the signature
Manager’s signature
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Mentor/Registered Practitioner Signature Sheet: Year 1
All registered practitioners who sign the student’s documentation MUST complete the sheet below. This is a requirement of University of Suffolk as it allows for signatures to be checked and confirmed. Please read the following statement before signing this sheet. By signing this sheet mentors are signing to say they have attended a mentor update in the last 12 months and that their triennial review is up-to date as required by NMC (2008).
Name of Mentor/Registered
Practitioner (printed)
Signature Initials of Mentor/Registered
Practitioner
Name of placement
area
Contact telephone number for placement
area
Dates student attended clinical
placement
Name of Manager
verifying the signature
Manager’s signature
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Mentor/Registered Practitioner Signature Sheet: Year 1
All registered practitioners who sign the student’s documentation MUST complete the sheet below. This is a requirement of University of Suffolk as it allows for signatures to be checked and confirmed. Please read the following statement before signing this sheet. By signing this sheet mentors are signing to say they have attended a mentor update in the last 12 months and that their triennial review is up-to date as required by NMC (2008).
Name of Mentor/Registered
Practitioner (printed)
Signature Initials of Mentor/Registered
Practitioner
Name of placement
area
Contact telephone number for placement
area
Dates student attended clinical
placement
Name of Manager
verifying the signature
Manager’s signature
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Mentor/Registered Practitioner Signature Sheet: Year 1
All registered practitioners who sign the student’s documentation MUST complete the sheet below. This is a requirement of University of Suffolk as it allows for signatures to be checked and confirmed. Please read the following statement before signing this sheet. By signing this sheet mentors are signing to say they have attended a mentor update in the last 12 months and that their triennial review is up-to date as required by NMC (2008).
Name of Mentor/Registered
Practitioner (printed)
Signature Initials of Mentor/Registered
Pracitioner
Name of placement
area
Contact telephone number for placement
area
Dates student attended clinical
placement
Name of Manager
verifying the signature
Manager’s signature
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Simulated Practice Learning (SPL): Preparation for Practice Experience The Nursing and Midwifery Council (NMC, 2007; 2010) recognise that simulated practice learning within a simulation environment can enhance a student’s acquisition of direct care skills. Throughout your pre-registration programme clinical skills sessions have been identified as simulated practice learning. These sessions aim to introduce you to specific care and delivery which you can enhance and develop when out in practice.
• Attendances for these sessions need to be recorded and confirmed.
• A Simulated Practice Learning Evaluation & Feedback (SPLEF) sheet needs to be completed which should then be used in discussion with your mentor to help guide and develop direct care experiences within clinical practice placements.
Guidance for mentors and students The aim of SPL is to develop the student’s professional practice skills and build confidence within a safe environment, which can then help to support direct care given in clinical practice. During the SPL skills sessions the students will undertake scenario based learning opportunities that will incorporate a range of clinical and communication skills outlined through session aims and objectives which reflect the Essential Skills Clusters (NMC, 2010). There will be an opportunity for peer and facilitator feedback as well as personal reflection from the student before, during and after each session. The completed SPLEF sheets are to be utilised, through discussion between mentor and student, to help guide related learning objectives and action plans when in the practice placement as well as supporting any direct care the student is involved in. Nursing and Midwifery Council (2007) Simulation and practice learning project. London: NMC. Nursing and Midwifery Council (2010) Standards for pre-registration nursing education. London: NMC.
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Preparation for Practice Experience Forms
Session title Date of SPL session: Attendance verified by facilitator: Aims & Objectives of SPL session: Pre session activities undertaken: Feedback from peers and facilitator/s:
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Post session activities undertaken: Reflection of SPL opportunity facilitated through discussion with mentor (to include implications for your developing practice, relevant practice learning objectives and actions plans): Mentor signature: Student signature: Date:
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Preparation for Practice Experience Forms
Session title Date of SPL session: Attendance verified by facilitator: Aims & Objectives of SPL session: Pre session activities undertaken: Feedback from peers and facilitator/s:
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Post session activities undertaken: Reflection of SPL opportunity facilitated through discussion with mentor (to include implications for your developing practice, relevant practice learning objectives and actions plans): Mentor signature: Student signature: Date:
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Preparation for Practice Experience Forms
Session title Date of SPL session: Attendance verified by facilitator: Aims & Objectives of SPL session: Pre session activities undertaken: Feedback from peers and facilitator/s:
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Post session activities undertaken: Reflection of SPL opportunity facilitated through discussion with mentor (to include implications for your developing practice, relevant practice learning objectives and actions plans): Mentor signature: Student signature: Date:
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Preparation for Practice Experience Forms
Session title Date of SPL session: Attendance verified by facilitator: Aims & Objectives of SPL session: Pre session activities undertaken: Feedback from peers and facilitator/s:
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Post session activities undertaken: Reflection of SPL opportunity facilitated through discussion with mentor (to include implications for your developing practice, relevant practice learning objectives and actions plans): Mentor signature: Student signature: Date:
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Preparation for Practice Experience Forms
Session title Date of SPL session: Attendance verified by facilitator: Aims & Objectives of SPL session: Pre session activities undertaken: Feedback from peers and facilitator/s:
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Post session activities undertaken: Reflection of SPL opportunity facilitated through discussion with mentor (to include implications for your developing practice, relevant practice learning objectives and actions plans): Mentor signature: Student signature: Date:
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Preparation for Practice Experience Forms
Session title Date of SPL session: Attendance verified by facilitator: Aims & Objectives of SPL session: Pre session activities undertaken: Feedback from peers and facilitator/s:
Page 43
Post session activities undertaken: Reflection of SPL opportunity facilitated through discussion with mentor (to include implications for your developing practice, relevant practice learning objectives and actions plans): Mentor signature: Student signature: Date:
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Dementia care checklist: 1st year
The Government’s ‘Challenge on Dementia 2020’ campaign (Department of Health, 2015) and ‘Dementia Core Skills Education and Training Framework’ (Skills for Health & Health Education England, 2015) recognise the growing need to incorporate a substantial approach to dementia care education, in a direct response to the rising demand for specialist knowledge and skills to adequately meet the increasingly complex, physical and psychological, needs of people with dementia (World Alzheimer Report, 2015). University of Suffolk, is committed to deliver dementia care education in a meaningful way, in order to equip future practitioners with the knowledge and relevant skills needed to be competent and confident in practice. The approach to dementia care education will use links with practice by involving services users, carers and support groups as well as utilising simulation as a recognised form of learning, to develop evidence based practical skills (Department of Health, 2011). Guidance for mentors and students Each year students receive a collaboratively led theoretical study day, followed by a simulation skills session based on dementia care scenarios utilising role play, simulation equipment and contemporary practice tools and is developmental in linking with core curriculum themes. These skills sessions are recorded in the students’ Record of Achievement documentation and are to be utilised during discussions with mentors to develop individual skills during practice placement. Part of the development process will be to complete the following year specific check list, focussing on relevant areas of dementia care. Although these activities are not mandatory, the aim is to fulfil as many of the key tasks listed, during each year of practice, if possible, then discuss them and the experiences, during the field specific simulation skills session, as well as between the student and mentor. The activities can be completed as a student self-assessment or signed by both the student and the mentor References Department of Health (2011) A Framework for Technology Enhanced Learning. Available at: https://www.gov.uk/government/publications/a-framework-for-technology-enhanced-learning (Accessed: 30 January 2017) Department of Health (2015) Prime Minister’s challenge on dementia 2020. Available at: https://www.gov.uk/government/publications/prime-ministers-challenge-on-dementia-2020 (Accessed: 30 January 2017) Skills for Health and Health Education England (2015) Dementia Core Skills Education and Training Framework. Available at: http://www.skillsforhealth.org.uk/services/item/176-dementia-core-skills-education-and-training-framework (Accessed: 30 January 2017) World Alzheimer Report (2015) The Global Impact of Dementia: An analysis of prevalence, incidence, cost and trends. Available at: https://www.alz.co.uk/research/world-report-2015 (Accessed: 30 January 2017)
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Complete as many of the following, as possible, during your 1st year. The emphasis being contributing to care with the support of your mentor: COMMUNICATION: Use, or observe the use of, an appropriate communication framework e.g. VERA (Blackhall et al, 2011)
What tool/framework was used in the practice area? What do you think were the benefits of this tool? Were there any disadvantages to using this tool?
Sign & date when accomplished (this can be more than one time)
PERSON CENTRED CARE: Use, or observe the use of, a tool that enhances person centred care e.g. This is Me (Alzheimer’s society, 2013)
What tool/framework was used in the practice area? What do you think were the benefits of this tool? Were there any disadvantages to using this tool?
Sign & date when accomplished (this can be more than one time)
PAIN CONTROL: Use, or witness the use of, an observational pain assessment tool e.g. The Abbey Pain Scale (Abbey et al, 2004)
What tool/framework was used in the practice area? What do you think were the benefits of this tool? Were there any disadvantages to using this tool?
Sign & date when accomplished (this can be more than one time)
Abbey, J.A., Piller, N., DeBellis, A, Esterman, A., Parker, D., Giles, L. & Lowcay, B. (2004) ‘The Abbey Pain Scale. A 1-minute numerical indicator for people with late-stage dementia’, International Journal of Palliative Nursing, 10(1), pp. 6-13. Alzheimer’s society (2013) This is Me. Available at: https://www.alzheimers.org.uk/info/20113/publications_about_living_with_dementia/415/this_is_me (Accessed: 30 January 2017) Blackhall, A, Hawkes, D, Hingley, D & Wood, S (2011) ‘VERA framework: communicating with people who have dementia…Validation, Emotion, Reassure and Activity’, Nursing Standard, 26 (10), pp. 35-39
Page 46
Short Placement forms:
For placements that are 1 to 3 weeks long
Page 47
Short Placement: Orientation to the practice placement
This form is to be completed on the first day of the student’s placement. Aspects to be discussed
Registered Practitioners initials
Student Signature
Layout of the practice area.
Procedure in event of a fire.
Procedure for emergencies including resuscitation.
Moving and handling equipment.
Trust and local practice area policies
General information about the practice including shift times; procedure for reporting sickness; uniform policy and professional issues.
Practice learning outcomes and learning opportunities are identified and discussed – to be recorded on the initial interview form.
Personal learning needs are discussed - to be recorded on the initial interview form.
Date:
Page 48
Short Placement: Evaluation of student professional conduct
For each placement that the student attends the form below MUST be completed The REGISTERED PRACTITIONER should tick whether the student has demonstrated the ability to accept RESPONSIBILITY for their own action in the areas identified, PROVIDE COMMENTS, DATE AND SIGN the form
Demonstrates ability to accept
responsibility for their own actions in
relation to:
Yes No Comments
• Arriving on duty on time
• Wears uniform in line with Trust and University of Suffolk dress code policy
• Responds appropriately to constructive feedback
• Reports sickness/absence in line with University of Suffolk/Trust policy
• Adheres to current NMC Guidance on professional conduct
Number of hours sick/absent during the placement:
Registered Practitioner Signature:
Date:
Page 49
SHORT PLACEMENT MEETING FORM This form is to be used for placements that last less than four weeks Name of Practice Placement: On the First Day
Learning outcomes to be achieved during this placement
Date:
Registered Practitioner Signature:
Student Signature:
At the end of the practice placement
Registered Practitioner’s comments on the student’s performance during the placement
Date:
Registered Practitioner Signature:
Student Signature:
Page 50
Short Placement: Orientation to the practice placement
This form is to be completed on the first day of the student’s placement. Aspects to be discussed
Registered Practitioner initials
Student Signature
Layout of the practice area.
Procedure in event of a fire.
Procedure for emergencies including resuscitation.
Moving and handling equipment.
Trust and local practice area policies
General information about the practice including shift times; procedure for reporting sickness; uniform policy and professional issues.
Practice learning outcomes and learning opportunities are identified and discussed – to be recorded on the initial interview form.
Personal learning needs are discussed - to be recorded on the initial interview form.
Date:
Page 51
Short Placement: Evaluation of student professional conduct
For each placement that the student attends the form below MUST be completed The REGISTERED PRACTITIONER should tick whether the student has demonstrated the ability to accept RESPONSIBILITY for their own action in the areas identified, PROVIDE COMMENTS, DATE AND SIGN the form
Demonstrates ability to accept
responsibility for their own actions in
relation to:
Yes No Comments
• Arriving on duty on time
• Wears uniform in line with Trust and University of Suffolk dress code policy
• Responds appropriately to constructive feedback
• Reports sickness/absence in line with University of Suffolk/Trust policy
• Adheres to current NMC Guidance on professional conduct for nursing and midwifery students
Number of hours sick/absent during the placement:
Registered Practitioner Signature:
Date:
Page 52
SHORT PLACEMENT MEETING FORM This form is to be used for placements that last less than four weeks Name of Practice Placement: On the First Day
Learning outcomes to be achieved during this placement
Date:
Registered Practitioner Signature:
Student Signature:
At the end of the practice placement
Registered Practitioner’s comments on the student’s performance during the placement
Date:
Registered Practitioner Signature:
Student Signature:
Page 53
Short Placement: Orientation to the practice placement
This form is to be completed on the first day of the student’s placement. Aspects to be discussed
Registered Practitioner initials
Student Signature
Layout of the practice area.
Procedure in event of a fire.
Procedure for emergencies including resuscitation.
Moving and handling equipment.
Trust and local practice area policies
General information about the practice including shift times; procedure for reporting sickness; uniform policy and professional issues.
Practice learning outcomes and learning opportunities are identified and discussed – to be recorded on the initial interview form.
Personal learning needs are discussed - to be recorded on the initial interview form.
Date:
Page 54
Short Placement: Evaluation of student professional conduct
For each placement that the student attends the form below MUST be completed The REGISTERED PRACTITIONER should tick whether the student has demonstrated the ability to accept RESPONSIBILITY for their own action in the areas identified, PROVIDE COMMENTS, DATE AND SIGN the form
Demonstrates ability to accept
responsibility for their own actions in
relation to:
Yes No Comments
• Arriving on duty on time
• Wears uniform in line with Trust and University of Suffolk dress code policy
• Responds appropriately to constructive feedback
• Reports sickness/absence in line with University of Suffolk/Trust policy
• Adheres to current NMC Guidance on professional conduct for nursing and midwifery students
Number of hours sick/absent during the placement:
Registered Practitioner Signature:
Date:
Page 55
SHORT PLACEMENT MEETING FORM This form is to be used for placements that last less than four weeks Name of Practice Placement: On the First Day
Learning outcomes to be achieved during this placement
Date:
Registered Practitioner Signature:
Student Signature:
At the end of the practice placement
Registered Practitioner comments on the student’s performance during the placement
Date:
Registered Practitioner Signature:
Student Signature:
Page 56
Short Placement: Orientation to the practice placement
This form is to be completed on the first day of the student’s placement. Aspects to be discussed
Registered Practitioner initials
Student Signature
Layout of the practice area.
Procedure in event of a fire.
Procedure for emergencies including resuscitation.
Moving and handling equipment.
Trust and local practice area policies
General information about the practice including shift times; procedure for reporting sickness; uniform policy and professional issues.
Practice learning outcomes and learning opportunities are identified and discussed – to be recorded on the initial interview form.
Personal learning needs are discussed - to be recorded on the initial interview form.
Date:
Page 57
Short Placement: Evaluation of student professional conduct
For each placement that the student attends the form below MUST be completed The REGISTERED PRACTITIONER should tick whether the student has demonstrated the ability to accept RESPONSIBILITY for their own action in the areas identified, PROVIDE COMMENTS, DATE AND SIGN the form
Demonstrates ability to accept
responsibility for their own actions in
relation to:
Yes No Comments
• Arriving on duty on time
• Wears uniform in line with Trust and University of Suffolk dress code policy
• Responds appropriately to constructive feedback
• Reports sickness/absence in line with University of Suffolk/Trust policy
• Adheres to current NMC Guidance on professional conduct for nursing and midwifery students
Number of hours sick/absent during the placement:
Registered Practitioner Signature:
Date:
Page 58
SHORT PLACEMENT MEETING FORM This form is to be used for placements that last less than four weeks Name of Practice Placement: On the First Day
Learning outcomes to be achieved during this placement
Date:
Registered Practitioner Signature:
Student Signature:
At the end of the practice placement
Registered Practitioner comments on the student’s performance during the placement
Date:
Registered Practitioner Signature:
Student Signature:
Page 59
Page 60
Long Placement forms: For placements that are more
than 4 weeks long
Page 61
Long Placement: Orientation to the practice placement
This form is to be completed on the first day of the student’s placement. Aspects to be discussed
Mentor initials Student Signature
Layout of the practice area.
Procedure in event of a fire.
Procedure for emergencies including resuscitation.
Moving and handling equipment.
Trust and local practice area policies
General information about the practice including shift times; procedure for reporting sickness; uniform policy and professional issues.
Practice learning outcomes and learning opportunities are identified and discussed – to be recorded on the initial interview form.
Personal learning needs are discussed - to be recorded on the initial interview form.
Date:
Page 62
Initial Interview form To be completed by the end of the first week of the student’s practice placement
Placement: I have read the Student’s On-going Record of Achievement and discussed any issues with the student Mentor Signature: Date: Learning Opportunities available in the practice placement: Specific Learning Outcomes for the placement: Link these to the objectives the student has identified in their preparation for practice form in their PAD. Discussion on Integrated Practice Assessment: Is this relevant to this placement – Yes No If answer is yes please record details below Student signature: Date: Mentor signature: Date:
Page 63
Mid-point Interview
At the mid-point the mentor and student must meet to discuss their progress and development. The discussion should focus on the student’s achievement of generic and field specific competencies; progress in achieving competency with the relevant essential skills and feedback on the specific learning outcomes identified at the initial interview. Mentor comments: Mentor signature: Date: Student signature: Date:
Page 64
Service User Feedback Sheet
The opinions of Service Users are an integral part of the assessment of student’s in practice settings. Registered Nurses working in an appropriate area can select a Service User and request their opinion on the care they have received from the student. These opinions are to be recorded by the Registered Nurse. The student is required to have the opinions of two service users for each of their four week or longer placements, except for the final placement when the opinions of three service users must be sought. There is no expectation of service user feedback for placements shorter than four weeks N.B. The Service User’s anonymity must be maintained Areas for Service User comment
• Maintain privacy and dignity • Polite, courteous and respectful • Provide adequate information • Listen attentively • Made them feel welcome
1. Aspects of the student’s care that is commendable.
2. Aspects of this student’s care that could be further developed. This is an accurate representation of the Service User’s feedback and has been discussed with the student. Signature of Registered Nurse: Date: Print name
Page 65
Service User Feedback Sheet
The opinions of Service Users are an integral part of the assessment of student’s in practice settings. Registered Nurses working in an appropriate area can select a Service User and request their opinion on the care they have received from the student. These opinions are to be recorded by the Registered Nurse. The student is required to have the opinions of two service users for each of their four week or longer placements, except for the final placement when the opinions of three service users must be sought. There is no expectation of service user feedback for placements shorter than four weeks N.B. The Service User’s anonymity must be maintained Areas for Service User comment
• Maintain privacy and dignity • Polite, courteous and respectful • Provide adequate information • Listen attentively • Made them feel welcome
1. Aspects of the student’s care that is commendable.
2. Aspects of this student’s care that could be further developed. This is an accurate representation of the Service User’s feedback and has been discussed with the student. Signature of Registered Nurse: Date: Print name
Page 66
Record of visits/Practice learning opportunities away from the allocated practice placement
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Page 67
Record of visits/Practice learning opportunities relevant to the allocated practice placement
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Page 68
Record of Meetings between student and mentor These schedules are to be used to record a student’s progress/any issues that arise during the placement
Date
Details of meeting Outcome
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Page 69
Record of Meetings between student and mentor
Date
Details of meeting Outcome
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Page 70
Action Plan To be completed if there is an area that the student needs to develop Area of practice that requires development: Plan: Resources and support required: Date for review of action plan:
Action plan agreed: Yes No
Student signature: Date:
Mentor signature:
Date:
Outcome of action plan: Student signature: Date:
Mentor signature:
Date:
Page 71
Long Placement: Evaluation of student professional conduct
For each placement that the student attends the form below MUST be completed The MENTOR should tick whether the student has demonstrated the ability to accept RESPONSIBILITY for their own action in the areas identified, PROVIDE COMMENTS, DATE AND SIGN the form
Demonstrates ability to accept
responsibility for their own actions in
relation to:
Yes No Comments
• Arriving on duty on time
• Wears uniform in line with Trust and University of Suffolk dress code policy
• Responds appropriately to constructive feedback
• Reports sickness/absence in line with University of Suffolk/Trust policy
• Adheres to current NMC Guidance on professional conduct for nursing and midwifery students
Number of hours sick/absent during the placement:
Mentor Signature:
Date:
Page 72
Final Interview
At the end of the practice placement the mentor and student must meet to how the student has progressed and developed during the placement. The discussion should focus on the student’s achievement of generic and field specific competencies; progress in achieving competency with the relevant essential skills and achievement of the specific learning outcomes identified at the initial interview.
Mentor comments: Areas to develop in future practice placements: Is the student achieving at the required level of performance YES/NO (please delete as applicable) If answer is no please see the assessment process in practice flowchart Overall this student is safe to progress: YES/NO (please delete as applicable) Please provide below the rationale for these decisions: Mentor signature: Date: Student signature: Date:
Page 73
Long Placement: Orientation to the practice placement
This form is to be completed on the first day of the student’s placement. Aspects to be discussed
Mentor initials Student Signature
Layout of the practice area.
Procedure in event of a fire.
Procedure for emergencies including resuscitation.
Moving and handling equipment.
Trust and local practice area policies
General information about the practice including shift times; procedure for reporting sickness; uniform policy and professional issues.
Practice learning outcomes and learning opportunities are identified and discussed – to be recorded on the initial interview form.
Personal learning needs are discussed - to be recorded on the initial interview form.
Date:
Page 74
Initial Interview form To be completed by the end of the first week of the student’s practice placement
Placement: I have read the Student’s On-going Record of Achievement and discussed any issues with the student Mentor Signature: Date: Learning Opportunities available in the practice placement: Specific Learning Outcomes for the placement: Link these to the objectives the student has identified in their preparation for practice form in their PAD. Discussion on Integrated Practice Assessment: Is this relevant to this placement – Yes No If answer is yes please record details below Student signature: Date: Mentor signature: Date:
Page 75
Mid-point Interview
At the mid-point the mentor and student must meet to discuss their progress and development. The discussion should focus on the student’s achievement of generic and field specific competencies; progress in achieving competency with the relevant essential skills and feedback on the specific learning outcomes identified at the initial interview. Mentor comments: Mentor signature: Date: Student signature: Date:
Page 76
Service User Feedback Sheet
The opinions of Service Users are an integral part of the assessment of student’s in practice settings. Registered Nurses working in an appropriate area can select a Service User and request their opinion on the care they have received from the student. These opinions are to be recorded by the Registered Nurse. The student is required to have the opinions of two service users for each of their four week or longer placements, except for the final placement when the opinions of three service users must be sought. There is no expectation of service user feedback for placements shorter than four weeks N.B. The Service User’s anonymity must be maintained Areas for Service User comment
• Maintain privacy and dignity • Polite, courteous and respectful • Provide adequate information • Listen attentively • Made them feel welcome
3. Aspects of the student’s care that is commendable.
4. Aspects of this student’s care that could be further developed. This is an accurate representation of the Service User’s feedback and has been discussed with the student. Signature of Registered Nurse: Date: Print name
Page 77
Service User Feedback Sheet
The opinions of Service Users are an integral part of the assessment of student’s in practice settings. Registered Nurses working in an appropriate area can select a Service User and request their opinion on the care they have received from the student. These opinions are to be recorded by the Registered Nurse. The student is required to have the opinions of two service users for each of their four week or longer placements, except for the final placement when the opinions of three service users must be sought. There is no expectation of service user feedback for placements shorter than four weeks N.B. The Service User’s anonymity must be maintained Areas for Service User comment
• Maintain privacy and dignity • Polite, courteous and respectful • Provide adequate information • Listen attentively • Made them feel welcome
3. Aspects of the student’s care that is commendable.
4. Aspects of this student’s care that could be further developed. This is an accurate representation of the Service User’s feedback and has been discussed with the student. Signature of Registered Nurse: Date: Print name
Page 78
Record of visits/Practice learning opportunities away from the allocated practice placement
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Page 79
Record of visits/Practice learning opportunities relevant to the allocated practice placement
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Page 80
Record of Meetings between student and mentor These schedules are to be used to record a student’s progress/any issues that arise during the placement
Date
Details of meeting Outcome
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Page 81
Record of Meetings between student and mentor
Date
Details of meeting Outcome
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Page 82
Action Plan To be completed if there is an area that the student needs to develop Area of practice that requires development: Plan: Resources and support required: Date for review of action plan:
Action plan agreed: Yes No
Student signature: Date:
Mentor signature:
Date:
Outcome of action plan: Student signature: Date:
Mentor signature:
Date:
Page 83
Long Placement: Evaluation of student professional conduct
For each placement that the student attends the form below MUST be completed The MENTOR should tick whether the student has demonstrated the ability to accept RESPONSIBILITY for their own action in the areas identified, PROVIDE COMMENTS, DATE AND SIGN the form
Demonstrates ability to accept
responsibility for their own actions in
relation to:
Yes No Comments
• Arriving on duty on time
• Wears uniform in line with Trust and University of Suffolk dress code policy
• Responds appropriately to constructive feedback
• Reports sickness/absence in line with University of Suffolk/Trust policy
• Adheres to current NMC Guidance on professional conduct for nursing and midwifery students
Number of hours sick/absent during the placement:
Mentor Signature:
Date:
Page 84
Final Interview
At the end of the practice placement the mentor and student must meet to how the student has progressed and developed during the placement. The discussion should focus on the student’s achievement of generic and field specific competencies; progress in achieving competency with the relevant essential skills and achievement of the specific learning outcomes identified at the initial interview.
Mentor comments: Areas to develop in future practice placements: Is the student achieving at the required level of performance YES/NO (please delete as applicable) If answer is no please see the assessment process in practice flowchart Overall this student is safe to progress: YES/NO (please delete as applicable) Please provide below the rationale for these decisions: Mentor signature: Date: Student signature: Date:
Page 85
Long Placement: Orientation to the practice placement
This form is to be completed on the first day of the student’s placement. Aspects to be discussed
Mentor initials Student Signature
Layout of the practice area.
Procedure in event of a fire.
Procedure for emergencies including resuscitation.
Moving and handling equipment.
Trust and local practice area policies
General information about the practice including shift times; procedure for reporting sickness; uniform policy and professional issues.
Practice learning outcomes and learning opportunities are identified and discussed – to be recorded on the initial interview form.
Personal learning needs are discussed - to be recorded on the initial interview form.
Date:
Page 86
Initial Interview form To be completed by the end of the first week of the student’s practice placement
Placement: I have read the Student’s On-going Record of Achievement and discussed any issues with the student Mentor Signature: Date: Learning Opportunities available in the practice placement: Specific Learning Outcomes for the placement: Link these to the objectives the student has identified in their preparation for practice form in their PAD. Discussion on Integrated Practice Assessment: Is this relevant to this placement – Yes No If answer is yes please record details below Student signature: Date: Mentor signature: Date:
Page 87
Mid-point Interview
At the mid-point the mentor and student must meet to discuss their progress and development. The discussion should focus on the student’s achievement of generic and field specific competencies; progress in achieving competency with the relevant essential skills and feedback on the specific learning outcomes identified at the initial interview. Mentor comments: Mentor signature: Date: Student signature: Date:
Page 88
Service User Feedback Sheet
The opinions of Service Users are an integral part of the assessment of student’s in practice settings. Registered Nurses working in an appropriate area can select a Service User and request their opinion on the care they have received from the student. These opinions are to be recorded by the Registered Nurse. The student is required to have the opinions of two service users for each of their four week or longer placements, except for the final placement when the opinions of three service users must be sought. There is no expectation of service user feedback for placements shorter than four weeks N.B. The Service User’s anonymity must be maintained Areas for Service User comment
• Maintain privacy and dignity • Polite, courteous and respectful • Provide adequate information • Listen attentively • Made them feel welcome
5. Aspects of the student’s care that is commendable.
6. Aspects of this student’s care that could be further developed. This is an accurate representation of the Service User’s feedback and has been discussed with the student. Signature of Registered Nurse: Date: Print name
Page 89
Service User Feedback Sheet
The opinions of Service Users are an integral part of the assessment of student’s in practice settings. Registered Nurses working in an appropriate area can select a Service User and request their opinion on the care they have received from the student. These opinions are to be recorded by the Registered Nurse. The student is required to have the opinions of two service users for each of their four week or longer placements, except for the final placement when the opinions of three service users must be sought. There is no expectation of service user feedback for placements shorter than four weeks N.B. The Service User’s anonymity must be maintained Areas for Service User comment
• Maintain privacy and dignity • Polite, courteous and respectful • Provide adequate information • Listen attentively • Made them feel welcome
5. Aspects of the student’s care that is commendable.
6. Aspects of this student’s care that could be further developed. This is an accurate representation of the Service User’s feedback and has been discussed with the student. Signature of Registered Nurse: Date: Print name
Page 90
Record of visits/Practice learning opportunities away from the allocated practice placement
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Page 91
Record of visits/Practice learning opportunities relevant to the allocated practice placement
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Page 92
Record of Meetings between student and mentor These schedules are to be used to record a student’s progress/any issues that arise during the placement
Date
Details of meeting Outcome
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Page 93
Record of Meetings between student and mentor
Date
Details of meeting Outcome
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Page 94
Action Plan To be completed if there is an area that the student needs to develop Area of practice that requires development: Plan: Resources and support required: Date for review of action plan:
Action plan agreed: Yes No
Student signature: Date:
Mentor signature:
Date:
Outcome of action plan: Student signature: Date:
Mentor signature:
Date:
Page 95
Long Placement: Evaluation of student professional conduct
For each placement that the student attends the form below MUST be completed The MENTOR should tick whether the student has demonstrated the ability to accept RESPONSIBILITY for their own action in the areas identified, PROVIDE COMMENTS, DATE AND SIGN the form
Demonstrates ability to accept
responsibility for their own actions in
relation to:
Yes No Comments
• Arriving on duty on time
• Wears uniform in line with Trust and University of Suffolk dress code policy
• Responds appropriately to constructive feedback
• Reports sickness/absence in line with University of Suffolk/Trust policy
• Adheres to current NMC Guidance on professional conduct for nursing and midwifery students
Number of hours sick/absent during the placement:
Mentor Signature:
Date:
Page 96
Final Interview
At the end of the practice placement the mentor and student must meet to how the student has progressed and developed during the placement. The discussion should focus on the student’s achievement of generic and field specific competencies; progress in achieving competency with the relevant essential skills and achievement of the specific learning outcomes identified at the initial interview.
Mentor comments: Areas to develop in future practice placements: Is the student achieving at the required level of performance YES/NO (please delete as applicable) If answer is no please see the assessment process in practice flowchart Overall this student is safe to progress: YES/NO (please delete as applicable) Please provide below the rationale for these decisions: Mentor signature: Date: Student signature: Date:
Page 97
Long Placement: Orientation to the practice placement
This form is to be completed on the first day of the student’s placement. Aspects to be discussed
Mentor initials Student Signature
Layout of the practice area.
Procedure in event of a fire.
Procedure for emergencies including resuscitation.
Moving and handling equipment.
Trust and local practice area policies
General information about the practice including shift times; procedure for reporting sickness; uniform policy and professional issues.
Practice learning outcomes and learning opportunities are identified and discussed – to be recorded on the initial interview form.
Personal learning needs are discussed - to be recorded on the initial interview form.
Date:
Page 98
Initial Interview form To be completed by the end of the first week of the student’s practice placement
Placement: I have read the Student’s On-going Record of Achievement and discussed any issues with the student Mentor Signature: Date: Learning Opportunities available in the practice placement: Specific Learning Outcomes for the placement: Link these to the objectives the student has identified in their preparation for practice form in their PAD. Discussion on Integrated Practice Assessment: Is this relevant to this placement – Yes No If answer is yes please record details below Student signature: Date: Mentor signature: Date:
Page 99
Mid-point Interview
At the mid-point the mentor and student must meet to discuss their progress and development. The discussion should focus on the student’s achievement of generic and field specific competencies; progress in achieving competency with the relevant essential skills and feedback on the specific learning outcomes identified at the initial interview. Mentor comments: Mentor signature: Date: Student signature: Date:
Page 100
Service User Feedback Sheet
The opinions of Service Users are an integral part of the assessment of student’s in practice settings. Registered Nurses working in an appropriate area can select a Service User and request their opinion on the care they have received from the student. These opinions are to be recorded by the Registered Nurse. The student is required to have the opinions of two service users for each of their four week or longer placements, except for the final placement when the opinions of three service users must be sought. There is no expectation of service user feedback for placements shorter than four weeks N.B. The Service User’s anonymity must be maintained Areas for Service User comment
• Maintain privacy and dignity • Polite, courteous and respectful • Provide adequate information • Listen attentively • Made them feel welcome
1. Aspects of the student’s care that is commendable.
2. Aspects of this student’s care that could be further developed. This is an accurate representation of the Service User’s feedback and has been discussed with the student. Signature of Registered Nurse: Date: Print name
Page 101
Service User Feedback Sheet The opinions of Service Users are an integral part of the assessment of student’s in practice settings. Registered Nurses working in an appropriate area can select a Service User and request their opinion on the care they have received from the student. These opinions are to be recorded by the Registered Nurse. The student is required to have the opinions of two service users for each of their four week or longer placements, except for the final placement when the opinions of three service users must be sought. There is no expectation of service user feedback for placements shorter than four weeks N.B. The Service User’s anonymity must be maintained Areas for Service User comment
• Maintain privacy and dignity • Polite, courteous and respectful • Provide adequate information • Listen attentively • Made them feel welcome
1. Aspects of the student’s care that is commendable.
2. Aspects of this student’s care that could be further developed. This is an accurate representation of the Service User’s feedback and has been discussed with the student. Signature of Registered Nurse: Date: Print name
Page 102
Record of visits/Practice learning opportunities away from the allocated practice placement
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Page 103
Record of visits/Practice learning opportunities relevant to the allocated practice placement
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Page 104
Record of Meetings between student and mentor These schedules are to be used to record a student’s progress/any issues that arise during the placement
Date
Details of meeting Outcome
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Page 105
Record of Meetings between student and mentor
Date
Details of meeting Outcome
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Page 106
Action Plan To be completed if there is an area that the student needs to develop Area of practice that requires development: Plan: Resources and support required: Date for review of action plan:
Action plan agreed: Yes No
Student signature: Date:
Mentor signature:
Date:
Outcome of action plan: Student signature: Date:
Mentor signature:
Date:
Page 107
Long Placement: Evaluation of student professional conduct
For each placement that the student attends the form below MUST be completed The MENTOR should tick whether the student has demonstrated the ability to accept RESPONSIBILITY for their own action in the areas identified, PROVIDE COMMENTS, DATE AND SIGN the form
Demonstrates ability to accept
responsibility for their own actions in
relation to:
Yes No Comments
• Arriving on duty on time
• Wears uniform in line with Trust and University of Suffolk dress code policy
• Responds appropriately to constructive feedback
• Reports sickness/absence in line with University of Suffolk/Trust policy
• Adheres to current NMC Guidance on professional conduct for nursing and midwifery students
Number of hours sick/absent during the placement:
Mentor Signature:
Date:
Page 108
Final Interview
At the end of the practice placement the mentor and student must meet to how the student has progressed and developed during the placement. The discussion should focus on the student’s achievement of generic and field specific competencies; progress in achieving competency with the relevant essential skills and achievement of the specific learning outcomes identified at the initial interview.
Mentor comments: Areas to develop in future practice placements: Is the student achieving at the required level of performance YES/NO (please delete as applicable) If answer is no please see the assessment process in practice flowchart Overall this student is safe to progress: YES/NO (please delete as applicable) Please provide below the rationale for these decisions: Mentor signature: Date: Student signature: Date:
Page 109
INTERVIEW SCHEDULE WITH PERSONAL TUTOR (1)
End of Semester 1 Assessment Comments Practice Assessment Document discussed
Yes/No
Ongoing Record of Achievement discussed
Yes/No
EU Directives Achieved: � general and specialist medicine
� general and specialist surgery
� child care and paediatrics
� maternity care
� mental health and psychiatry
� care of the older person
� home nursing
Yes/No
Overall comments by Personal Tutor Signature of Personal Tutor: _________________________________ PRINT NAME: _____________________________________________ Signature of Student: _________________________________ Date: _______________
Page 110
INTERVIEW SCHEDULE WITH PERSONAL TUTOR (2)
End of Semester 2: end of year 1 Assessment Comments Practice Assessment Document for year 1 complete
Yes/No
Ongoing Record of Achievement discussed
Yes/No
EU Directives Achieved: � general and specialist medicine
� general and specialist surgery
� child care and paediatrics
� maternity care
� mental health and psychiatry
� care of the older person
� home nursing
Yes/No
Overall comments by Personal Tutor Result Pass Refer
Signature of Personal Tutor: _________________________________ PRINT NAME: _____________________________________________ Signature of Student: _________________________________ Date: _______________
Page 111
NURSING PRACTICE 1 MODERATION SHEET
Moderator Name _______________________________ Moderator Signature _______________________________ Date _______________________________
Assessment
Y/N Comments
All signatures retrieved and verified
All Service User Feedback Completed
All interview paperwork completed
Overall comments by Moderator
Page 112
YEAR 2
Documentation
Page 113
Mentor/Registered Practitioner Signature Sheet: Year 2
All registered practitioners who sign the student’s documentation MUST complete the sheet below. This is a requirement of University of Suffolk as it allows for signatures to be checked and confirmed. Please read the following statement before signing this sheet. By signing this sheet mentors are signing to say they have attended a mentor update in the last 12 months and that their triennial review is up-to date as required by NMC (2008).
Name of Mentor/Registered
Practitioner (printed)
Signature Initials of Mentor/Registered
Practitioner
Name of placement
area
Contact telephone number for placement
area
Dates student attended clinical
placement
Name of Manager
verifying the signature
Manager’s signature
Page 114
Mentor/Registered Practitioner Signature Sheet: Year 2
All registered practitioners who sign the student’s documentation MUST complete the sheet below. This is a requirement of University of Suffolk as it allows for signatures to be checked and confirmed. Please read the following statement before signing this sheet. By signing this sheet mentors are signing to say they have attended a mentor update in the last 12 months and that their triennial review is up-to date as required by NMC (2008).
Name of Mentor/Registered
Practitioner (printed)
Signature Initials of Mentor/Registered
Practitioner
Name of placement
area
Contact telephone number for placement
area
Dates student attended clinical
placement
Name of Manager
verifying the signature
Manager’s signature
Page 115
Mentor/Registered Practitioner Signature Sheet: Year 2
All registered practitioners who sign the student’s documentation MUST complete the sheet below. This is a requirement of University of Suffolk as it allows for signatures to be checked and confirmed. Please read the following statement before signing this sheet. By signing this sheet mentors are signing to say they have attended a mentor update in the last 12 months and that their triennial review is up-to date as required by NMC (2008).
Name of Mentor/Registered
Practitioner (printed)
Signature Initials of Mentor/Registered
Practitioner
Name of placement
area
Contact telephone number for placement
area
Dates student attended clinical
placement
Name of Manager
verifying the signature
Manager’s signature
Page 116
Mentor/Registered Practitioner Signature Sheet: Year 2
All registered practitioners who sign the student’s documentation MUST complete the sheet below. This is a requirement of University of Suffolk as it allows for signatures to be checked and confirmed. Please read the following statement before signing this sheet. By signing this sheet mentors are signing to say they have attended a mentor update in the last 12 months and that their triennial review is up-to date as required by NMC (2008).
Name of Mentor/Registered
Practitioner (printed)
Signature Initials of Mentor/Registered
Practitioner
Name of placement
area
Contact telephone number for placement
area
Dates student attended clinical
placement
Name of Manager
verifying the signature
Manager’s signature
Page 117
Simulated Practice Learning (SPL): Preparation for Practice Experience The Nursing and Midwifery Council (NMC, 2007; 2010) recognise that simulated practice learning within a simulation environment can enhance a student’s acquisition of direct care skills. Throughout your pre-registration programme clinical skills sessions have been identified as simulated practice learning. These sessions aim to introduce you to specific care and delivery which you can enhance and develop when out in practice.
• Attendances for these sessions need to be recorded and confirmed.
• A Simulated Practice Learning Evaluation & Feedback (SPLEF) sheet needs to be completed which should then be used in discussion with your mentor to help guide and develop direct care experiences within clinical practice placements.
Guidance for mentors and students The aim of SPL is to develop the student’s professional practice skills and build confidence within a safe environment, which can then help to support direct care given in clinical practice. During the SPL skills sessions the students will undertake scenario based learning opportunities that will incorporate a range of clinical and communication skills outlined through session aims and objectives which reflect the Essential Skills Clusters (NMC, 2010). There will be an opportunity for peer and facilitator feedback as well as personal reflection from the student before, during and after each session. The completed SPLEF sheets are to be utilised, through discussion between mentor and student, to help guide related learning objectives and action plans when in the practice placement as well as supporting any direct care the student is involved in. Nursing and Midwifery Council (2007) Simulation and practice learning project. London: NMC. Nursing and Midwifery Council (2010) Standards for pre-registration nursing education. London: NMC.
Page 118
Preparation for Practice Experience Forms
Session title Date of SPL session: Attendance verified by facilitator: Aims & Objectives of SPL session: Pre session activities undertaken: Feedback from peers and facilitator/s:
Page 119
Post session activities undertaken: Reflection of SPL opportunity facilitated through discussion with mentor (to include implications for your developing practice, relevant practice learning objectives and actions plans): Mentor signature: Student signature: Date:
Page 120
Preparation for Practice Experience Forms
Session title Date of SPL session: Number of equivalent practice hours: Attendance verified by facilitator: Aims & Objectives of SPL session: Pre session activities undertaken: Feedback from peers and facilitator/s:
Page 121
Post session activities undertaken: Reflection of SPL opportunity facilitated through discussion with mentor (to include implications for your developing practice, relevant practice learning objectives and actions plans): Mentor signature: Student signature: Date:
Page 122
Preparation for Practice Experience Forms
Session title Date of SPL session: Number of equivalent practice hours: Attendance verified by facilitator: Aims & Objectives of SPL session: Pre session activities undertaken: Feedback from peers and facilitator/s:
Page 123
Post session activities undertaken: Reflection of SPL opportunity facilitated through discussion with mentor (to include implications for your developing practice, relevant practice learning objectives and actions plans): Mentor signature: Student signature: Date:
Page 124
Preparation for Practice Experience Forms
Session title Date of SPL session: Attendance verified by facilitator: Aims & Objectives of SPL session: Pre session activities undertaken: Feedback from peers and facilitator/s:
Page 125
Post session activities undertaken: Reflection of SPL opportunity facilitated through discussion with mentor (to include implications for your developing practice, relevant practice learning objectives and actions plans): Mentor signature: Student signature: Date:
Page 126
Preparation for Practice Experience Forms
Session title Date of SPL session: Attendance verified by facilitator: Aims & Objectives of SPL session: Pre session activities undertaken: Feedback from peers and facilitator/s:
Page 127
Post session activities undertaken: Reflection of SPL opportunity facilitated through discussion with mentor (to include implications for your developing practice, relevant practice learning objectives and actions plans): Mentor signature: Student signature: Date:
Page 128
Dementia care checklist: 2nd year
The Government’s ‘Challenge on Dementia 2020’ campaign (Department of Health, 2015) and ‘Dementia Core Skills Education and Training Framework’ (Skills for Health & Health Education England, 2015) recognise the growing need to incorporate a substantial approach to dementia care education, in a direct response to the rising demand for specialist knowledge and skills to adequately meet the increasingly complex, physical and psychological, needs of people with dementia (World Alzheimer Report, 2015). University of Suffolk, is committed to deliver dementia care education in a meaningful way, in order to equip future practitioners with the knowledge and relevant skills needed to be competent and confident in practice. The approach to dementia care education will use links with practice by involving services users, carers and support groups as well as utilising simulation as a recognised form of learning, to develop evidence based practical skills (Department of Health, 2011). Guidance for mentors and students Each year students receive a collaboratively led theoretical study day, followed by a simulation skills session based on dementia care scenarios utilising role play, simulation equipment and contemporary practice tools and is developmental in linking with core curriculum themes. These skills sessions are recorded in the students’ Record of Achievement documentation and are to be utilised during discussions with mentors to develop individual skills during practice placement. Part of the development process will be to complete the following year specific check list, focussing on relevant areas of dementia care. Although these activities are not mandatory, the aim is to fulfil as many of the key tasks listed, during each year of practice, if possible, then discuss them and the experiences, during the field specific simulation skills session, as well as between the student and mentor. The activities can be completed as a student self-assessment or signed by both the student and the mentor References Department of Health (2011) A Framework for Technology Enhanced Learning. Available at: https://www.gov.uk/government/publications/a-framework-for-technology-enhanced-learning (Accessed: 30 January 2017) Department of Health (2015) Prime Minister’s challenge on dementia 2020. Available at: https://www.gov.uk/government/publications/prime-ministers-challenge-on-dementia-2020 (Accessed: 30 January 2017) Skills for Health and Health Education England (2015) Dementia Core Skills Education and Training Framework. Available at: http://www.skillsforhealth.org.uk/services/item/176-dementia-core-skills-education-and-training-framework (Accessed: 30 January 2017) World Alzheimer Report (2015) The Global Impact of Dementia: An analysis of prevalence, incidence, cost and trends. Available at: https://www.alz.co.uk/research/world-report-2015 (Accessed: 30 January 2017)
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Complete as many of the following 2nd year tasks as possible. The emphasis should be on assessing, planning, implementing & evaluating care with the support of your mentor: COMMUNICATION: Use, or observe the use of, an assessment model, to analyse and help manage distressed behaviour e.g. DisDat (Regnard et al, 2007); Antecedent-Behaviour-Consequence tool (South West Yorkshire Mental Health NHS Trust, 2008)
What tool/framework was used in the practice area? What do you think were the benefits of this tool? Were there any disadvantages to using this tool?
Sign & date when accomplished (this can be more than one time)
DELIRIUM ASSESSMENT: Use, or observe the use of, an appropriate assessment framework, to help diagnose delirium e.g. Confusion Assessment Method (NICE, 2010)
What tool/framework was used in the practice area? What do you think were the benefits of this tool? Were there any disadvantages to using this tool?
Sign & date when accomplished (this can be more than one time)
Regnard C, Reynolds J, Watson B, Matthews D, Gibson L, Clarke C. (2007) Understanding distress in people with severe communication difficulties: developing and assessing the Disability Distress Assessment Tool (DisDAT). Journal of Intellectual Disability Research, 51(4): 277-292. National Institute for Heath and Care Excellence (2010) Delirium: prevention, diagnosis, and management. Available at: https://www.nice.org.uk/guidance/cg103 (Accessed: 31 January 2017). South West Yorkshire Mental Health Trust. (2008) The Dementia Toolkit. Available at: http://www.southwestyorkshire.nhs.uk/documents/832.pdf (Accessed: 31 January 2017)
Page 130
Short Placement forms:
For placements that are 1 to 3 weeks long
Page 131
Short Placement: Orientation to the practice placement
This form is to be completed on the first day of the student’s placement. Aspects to be discussed
Registered Practitioner initials
Student Signature
Layout of the practice area.
Procedure in event of a fire.
Procedure for emergencies including resuscitation.
Moving and handling equipment.
Trust and local practice area policies
General information about the practice including shift times; procedure for reporting sickness; uniform policy and professional issues.
Practice learning outcomes and learning opportunities are identified and discussed – to be recorded on the initial interview form.
Personal learning needs are discussed - to be recorded on the initial interview form.
Date:
Page 132
Short Placement: Evaluation of student professional conduct
For each placement that the student attends the form below MUST be completed The REGISTERED PRACTITIONER should tick whether the student has demonstrated the ability to accept RESPONSIBILITY for their own action in the areas identified, PROVIDE COMMENTS, DATE AND SIGN the form
Demonstrates ability to accept
responsibility for their own actions in
relation to:
Yes No Comments
• Arriving on duty on time
• Wears uniform in line with Trust and University of Suffolk dress code policy
• Responds appropriately to constructive feedback
• Reports sickness/absence in line with University of Suffolk/Trust policy
• Adheres to current NMC Guidance on professional conduct
Number of hours sick/absent during the placement:
Registered Practitioner Signature:
Date:
Page 133
SHORT PLACEMENT MEETING FORM This form is to be used for placements that last less than four weeks Name of Practice Placement: On the First Day
Learning outcomes to be achieved during this placement
Date:
Registered Practitioner/Facilitator Signature:
Student Signature:
At the end of the practice placement
Registered Practitioner comments on the student’s performance during the placement
Date:
Registered Practitioner Signature:
Student Signature:
Page 134
Short Placement: Orientation to the practice placement
This form is to be completed on the first day of the student’s placement. Aspects to be discussed
Registered Practitioner initials
Student Signature
Layout of the practice area.
Procedure in event of a fire.
Procedure for emergencies including resuscitation.
Moving and handling equipment.
Trust and local practice area policies
General information about the practice including shift times; procedure for reporting sickness; uniform policy and professional issues.
Practice learning outcomes and learning opportunities are identified and discussed – to be recorded on the initial interview form.
Personal learning needs are discussed - to be recorded on the initial interview form.
Date:
Page 135
Short Placement: Evaluation of student professional conduct
For each placement that the student attends the form below MUST be completed The REGISTERED PRACTITIONER should tick whether the student has demonstrated the ability to accept RESPONSIBILITY for their own action in the areas identified, PROVIDE COMMENTS, DATE AND SIGN the form
Demonstrates ability to accept
responsibility for their own actions in
relation to:
Yes No Comments
• Arriving on duty on time
• Wears uniform in line with Trust and University of Suffolk dress code policy
• Responds appropriately to constructive feedback
• Reports sickness/absence in line with University of Suffolk/Trust policy
• Adheres to current NMC Guidance on professional conduct for nursing and midwifery students
Number of hours sick/absent during the placement:
Registered Practitioner Signature:
Date:
Page 136
SHORT PLACEMENT MEETING FORM This form is to be used for placements that last less than four weeks Name of Practice Placement: On the First Day
Learning outcomes to be achieved during this placement
Date:
Registered Practitioner Signature:
Student Signature:
At the end of the practice placement
Registered Practitioner comments on the student’s performance during the placement
Date:
Registered Practitioner Signature:
Student Signature:
Page 137
Short Placement: Orientation to the practice placement
This form is to be completed on the first day of the student’s placement. Aspects to be discussed
Registered Practitioner initials
Student Signature
Layout of the practice area.
Procedure in event of a fire.
Procedure for emergencies including resuscitation.
Moving and handling equipment.
Trust and local practice area policies
General information about the practice including shift times; procedure for reporting sickness; uniform policy and professional issues.
Practice learning outcomes and learning opportunities are identified and discussed – to be recorded on the initial interview form.
Personal learning needs are discussed - to be recorded on the initial interview form.
Date:
Page 138
Short Placement: Evaluation of student professional conduct
For each placement that the student attends the form below MUST be completed The REGISTERED PRACTITIONER should tick whether the student has demonstrated the ability to accept RESPONSIBILITY for their own action in the areas identified, PROVIDE COMMENTS, DATE AND SIGN the form
Demonstrates ability to accept
responsibility for their own actions in
relation to:
Yes No Comments
• Arriving on duty on time
• Wears uniform in line with Trust and University of Suffolk dress code policy
• Responds appropriately to constructive feedback
• Reports sickness/absence in line with University of Suffolk/Trust policy
• Adheres to current NMC Guidance on professional conduct for nursing and midwifery students
Number of hours sick/absent during the placement:
Registered Practitioner Signature:
Date:
Page 139
SHORT PLACEMENT MEETING FORM This form is to be used for placements that last less than four weeks Name of Practice Placement: On the First Day
Learning outcomes to be achieved during this placement
Date:
Registered Practitioner Signature:
Student Signature:
At the end of the practice placement
Registered Practitioner comments on the student’s performance during the placement
Date:
Registered Practitioner Signature:
Student Signature:
Page 140
Page 141
Short Placement: Orientation to the practice placement
This form is to be completed on the first day of the student’s placement. Aspects to be discussed
Registered Practitioner initials
Student Signature
Layout of the practice area.
Procedure in event of a fire.
Procedure for emergencies including resuscitation.
Moving and handling equipment.
Trust and local practice area policies
General information about the practice including shift times; procedure for reporting sickness; uniform policy and professional issues.
Practice learning outcomes and learning opportunities are identified and discussed – to be recorded on the initial interview form.
Personal learning needs are discussed - to be recorded on the initial interview form.
Date:
Page 142
Short Placement: Evaluation of student professional conduct
For each placement that the student attends the form below MUST be completed The REGISTERED PRACTITIONER should tick whether the student has demonstrated the ability to accept RESPONSIBILITY for their own action in the areas identified, PROVIDE COMMENTS, DATE AND SIGN the form
Demonstrates ability to accept
responsibility for their own actions in
relation to:
Yes No Comments
• Arriving on duty on time
• Wears uniform in line with Trust and University of Suffolk dress code policy
• Responds appropriately to constructive feedback
• Reports sickness/absence in line with University of Suffolk/Trust policy
• Adheres to current NMC Guidance on professional conduct for nursing and midwifery students
Number of hours sick/absent during the placement:
Registered Practitioner Signature:
Date:
Page 143
SHORT PLACEMENT MEETING FORM This form is to be used for placements that last less than four weeks Name of Practice Placement: On the First Day
Learning outcomes to be achieved during this placement
Date:
Registered Practitioner Signature:
Student Signature:
At the end of the practice placement
Registered Practitioner comments on the student’s performance during the placement
Date:
Registered Practitioner Signature:
Student Signature:
Page 144
Long Placement forms: For placements that are more
than 4 weeks long
Page 145
Long Placement: Orientation to the practice placement
This form is to be completed on the first day of the student’s placement. Aspects to be discussed
Mentor initials Student Signature
Layout of the practice area.
Procedure in event of a fire.
Procedure for emergencies including resuscitation.
Moving and handling equipment.
Trust and local practice area policies
General information about the practice including shift times; procedure for reporting sickness; uniform policy and professional issues.
Practice learning outcomes and learning opportunities are identified and discussed – to be recorded on the initial interview form.
Personal learning needs are discussed - to be recorded on the initial interview form.
Date:
Page 146
Initial Interview form To be completed by the end of the first week of the student’s practice placement
Placement: I have read the Student’s On-going Record of Achievement and discussed any issues with the student Mentor Signature: Date: Learning Opportunities available in the practice placement: Specific Learning Outcomes for the placement: Link these to the objectives the student has identified in their preparation for practice form in their PAD. Discussion on Integrated Practice Assessment: Is this relevant to this placement – Yes No If answer is yes please record details below Student signature: Date: Mentor signature: Date:
Page 147
Mid-point Interview
At the mid-point the mentor and student must meet to discuss their progress and development. The discussion should focus on the student’s achievement of generic and field specific competencies; progress in achieving competency with the relevant essential skills and feedback on the specific learning outcomes identified at the initial interview. Mentor comments: Mentor signature: Date: Student signature: Date:
Page 148
Service User Feedback Sheet
The opinions of Service Users are an integral part of the assessment of student’s in practice settings. Registered Nurses working in an appropriate area can select a Service User and request their opinion on the care they have received from the student. These opinions are to be recorded by the Registered Nurse. The student is required to have the opinions of two service users for each of their four week or longer placements, except for the final placement when the opinions of three service users must be sought. There is no expectation of service user feedback for placements shorter than four weeks N.B. The Service User’s anonymity must be maintained Areas for Service User comment
• Maintain privacy and dignity • Polite, courteous and respectful • Provide adequate information • Listen attentively • Made them feel welcome
7. Aspects of the student’s care that is commendable.
8. Aspects of this student’s care that could be further developed. This is an accurate representation of the Service User’s feedback and has been discussed with the student. Signature of Registered Nurse: Date: Print name
Page 149
Service User Feedback Sheet
The opinions of Service Users are an integral part of the assessment of student’s in practice settings. Registered Nurses working in an appropriate area can select a Service User and request their opinion on the care they have received from the student. These opinions are to be recorded by the Registered Nurse. The student is required to have the opinions of two service users for each of their four week or longer placements, except for the final placement when the opinions of three service users must be sought. There is no expectation of service user feedback for placements shorter than four weeks N.B. The Service User’s anonymity must be maintained Areas for Service User comment
• Maintain privacy and dignity • Polite, courteous and respectful • Provide adequate information • Listen attentively • Made them feel welcome
7. Aspects of the student’s care that is commendable.
8. Aspects of this student’s care that could be further developed. This is an accurate representation of the Service User’s feedback and has been discussed with the student. Signature of Registered Nurse: Date: Print name
Page 150
Record of visits/Practice learning opportunities away from the allocated practice placement
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Page 151
Record of visits/Practice learning opportunities relevant to the allocated practice placement
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Page 152
Record of Meetings between student and mentor These schedules are to be used to record a student’s progress/any issues that arise during the placement
Date
Details of meeting Outcome
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Page 153
Record of Meetings between student and mentor
Date
Details of meeting Outcome
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Page 154
Action Plan To be completed if there is an area that the student needs to develop Area of practice that requires development: Plan: Resources and support required: Date for review of action plan:
Action plan agreed: Yes No
Student signature: Date:
Mentor signature:
Date:
Outcome of action plan: Student signature: Date:
Mentor signature:
Date:
Page 155
Long Placement: Evaluation of student professional conduct
For each placement that the student attends the form below MUST be completed The MENTOR should tick whether the student has demonstrated the ability to accept RESPONSIBILITY for their own action in the areas identified, PROVIDE COMMENTS, DATE AND SIGN the form
Demonstrates ability to accept
responsibility for their own actions in
relation to:
Yes No Comments
• Arriving on duty on time
• Wears uniform in line with Trust and University of Suffolk dress code policy
• Responds appropriately to constructive feedback
• Reports sickness/absence in line with University of Suffolk/Trust policy
• Adheres to current NMC Guidance on professional conduct for nursing and midwifery students
Number of hours sick/absent during the placement:
Mentor Signature:
Date:
Page 156
Final Interview
At the end of the practice placement the mentor and student must meet to how the student has progressed and developed during the placement. The discussion should focus on the student’s achievement of generic and field specific competencies; progress in achieving competency with the relevant essential skills and achievement of the specific learning outcomes identified at the initial interview.
Mentor comments: Areas to develop in future practice placements: Is the student achieving at the required level of performance YES/NO (please delete as applicable) If answer is no please see the assessment process in practice flowchart Overall this student is safe to progress: YES/NO (please delete as applicable) Please provide below the rationale for these decisions: Mentor signature: Date: Student signature: Date:
Page 157
Long Placement: Orientation to the practice placement
This form is to be completed on the first day of the student’s placement. Aspects to be discussed
Mentor initials Student Signature
Layout of the practice area.
Procedure in event of a fire.
Procedure for emergencies including resuscitation.
Moving and handling equipment.
Trust and local practice area policies
General information about the practice including shift times; procedure for reporting sickness; uniform policy and professional issues.
Practice learning outcomes and learning opportunities are identified and discussed – to be recorded on the initial interview form.
Personal learning needs are discussed - to be recorded on the initial interview form.
Date:
Page 158
Initial Interview form To be completed by the end of the first week of the student’s practice placement
Placement: I have read the Student’s On-going Record of Achievement and discussed any issues with the student Mentor Signature: Date: Learning Opportunities available in the practice placement: Specific Learning Outcomes for the placement: Link these to the objectives the student has identified in their preparation for practice form in their PAD. Discussion on Integrated Practice Assessment: Is this relevant to this placement – Yes No If answer is yes please record details below Student signature: Date: Mentor signature: Date:
Page 159
Mid-point Interview
At the mid-point the mentor and student must meet to discuss their progress and development. The discussion should focus on the student’s achievement of generic and field specific competencies; progress in achieving competency with the relevant essential skills and feedback on the specific learning outcomes identified at the initial interview. Mentor comments: Mentor signature: Date: Student signature: Date:
Page 160
Service User Feedback Sheet
The opinions of Service Users are an integral part of the assessment of student’s in practice settings. Registered Nurses working in an appropriate area can select a Service User and request their opinion on the care they have received from the student. These opinions are to be recorded by the Registered Nurse. The student is required to have the opinions of two service users for each of their four week or longer placements, except for the final placement when the opinions of three service users must be sought. There is no expectation of service user feedback for placements shorter than four weeks N.B. The Service User’s anonymity must be maintained Areas for Service User comment
• Maintain privacy and dignity • Polite, courteous and respectful • Provide adequate information • Listen attentively • Made them feel welcome
9. Aspects of the student’s care that is commendable.
10. Aspects of this student’s care that could be further developed. This is an accurate representation of the Service User’s feedback and has been discussed with the student. Signature of Registered Nurse: Date: Print name
Page 161
Service User Feedback Sheet
The opinions of Service Users are an integral part of the assessment of student’s in practice settings. Registered Nurses working in an appropriate area can select a Service User and request their opinion on the care they have received from the student. These opinions are to be recorded by the Registered Nurse. The student is required to have the opinions of two service users for each of their four week or longer placements, except for the final placement when the opinions of three service users must be sought. There is no expectation of service user feedback for placements shorter than four weeks N.B. The Service User’s anonymity must be maintained Areas for Service User comment
• Maintain privacy and dignity • Polite, courteous and respectful • Provide adequate information • Listen attentively • Made them feel welcome
9. Aspects of the student’s care that is commendable.
10. Aspects of this student’s care that could be further developed. This is an accurate representation of the Service User’s feedback and has been discussed with the student. Signature of Registered Nurse: Date: Print name
Page 162
Record of visits/Practice learning opportunities away from the allocated practice placement
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Page 163
Record of visits/Practice learning opportunities relevant to the allocated practice placement
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Page 164
Record of Meetings between student and mentor These schedules are to be used to record a student’s progress/any issues that arise during the placement
Date
Details of meeting Outcome
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Page 165
Record of Meetings between student and mentor
Date
Details of meeting Outcome
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Page 166
Action Plan To be completed if there is an area that the student needs to develop Area of practice that requires development: Plan: Resources and support required: Date for review of action plan:
Action plan agreed: Yes No
Student signature: Date:
Mentor signature:
Date:
Outcome of action plan: Student signature: Date:
Mentor signature:
Date:
Page 167
Long Placement: Evaluation of student professional conduct
For each placement that the student attends the form below MUST be completed The MENTOR should tick whether the student has demonstrated the ability to accept RESPONSIBILITY for their own action in the areas identified, PROVIDE COMMENTS, DATE AND SIGN the form
Demonstrates ability to accept
responsibility for their own actions in
relation to:
Yes No Comments
• Arriving on duty on time
• Wears uniform in line with Trust and University of Suffolk dress code policy
• Responds appropriately to constructive feedback
• Reports sickness/absence in line with University of Suffolk/Trust policy
• Adheres to current NMC Guidance on professional conduct for nursing and midwifery students
Number of hours sick/absent during the placement:
Mentor Signature:
Date:
Page 168
Final Interview
At the end of the practice placement the mentor and student must meet to how the student has progressed and developed during the placement. The discussion should focus on the student’s achievement of generic and field specific competencies; progress in achieving competency with the relevant essential skills and achievement of the specific learning outcomes identified at the initial interview.
Mentor comments: Areas to develop in future practice placements: Is the student achieving at the required level of performance YES/NO (please delete as applicable) If answer is no please see the assessment process in practice flowchart Overall this student is safe to progress: YES/NO (please delete as applicable) Please provide below the rationale for these decisions: Mentor signature: Date: Student signature: Date:
Page 169
Long Placement: Orientation to the practice placement
This form is to be completed on the first day of the student’s placement. Aspects to be discussed
Mentor initials Student Signature
Layout of the practice area.
Procedure in event of a fire.
Procedure for emergencies including resuscitation.
Moving and handling equipment.
Trust and local practice area policies
General information about the practice including shift times; procedure for reporting sickness; uniform policy and professional issues.
Practice learning outcomes and learning opportunities are identified and discussed – to be recorded on the initial interview form.
Personal learning needs are discussed - to be recorded on the initial interview form.
Date:
Page 170
Initial Interview form To be completed by the end of the first week of the student’s practice placement
Placement: I have read the Student’s On-going Record of Achievement and discussed any issues with the student Mentor Signature: Date: Learning Opportunities available in the practice placement: Specific Learning Outcomes for the placement: Link these to the objectives the student has identified in their preparation for practice form in their PAD. Discussion on Integrated Practice Assessment: Is this relevant to this placement – Yes No If answer is yes please record details below Student signature: Date: Mentor signature: Date:
Page 171
Mid-point Interview
At the mid-point the mentor and student must meet to discuss their progress and development. The discussion should focus on the student’s achievement of generic and field specific competencies; progress in achieving competency with the relevant essential skills and feedback on the specific learning outcomes identified at the initial interview. Mentor comments: Mentor signature: Date: Student signature: Date:
Page 172
Service User Feedback Sheet
The opinions of Service Users are an integral part of the assessment of student’s in practice settings. Registered Nurses working in an appropriate area can select a Service User and request their opinion on the care they have received from the student. These opinions are to be recorded by the Registered Nurse. The student is required to have the opinions of two service users for each of their four week or longer placements, except for the final placement when the opinions of three service users must be sought. There is no expectation of service user feedback for placements shorter than four weeks N.B. The Service User’s anonymity must be maintained Areas for Service User comment
• Maintain privacy and dignity • Polite, courteous and respectful • Provide adequate information • Listen attentively • Made them feel welcome
1. Aspects of the student’s care that is commendable.
2. Aspects of this student’s care that could be further developed. This is an accurate representation of the Service User’s feedback and has been discussed with the student. Signature of Registered Nurse: Date: Print name
Page 173
Service User Feedback Sheet
The opinions of Service Users are an integral part of the assessment of student’s in practice settings. Registered Nurses working in an appropriate area can select a Service User and request their opinion on the care they have received from the student. These opinions are to be recorded by the Registered Nurse. The student is required to have the opinions of two service users for each of their four week or longer placements, except for the final placement when the opinions of three service users must be sought. There is no expectation of service user feedback for placements shorter than four weeks N.B. The Service User’s anonymity must be maintained Areas for Service User comment
• Maintain privacy and dignity • Polite, courteous and respectful • Provide adequate information • Listen attentively • Made them feel welcome
1. Aspects of the student’s care that is commendable.
2. Aspects of this student’s care that could be further developed. This is an accurate representation of the Service User’s feedback and has been discussed with the student. Signature of Registered Nurse: Date: Print name
Page 174
Record of visits/Practice learning opportunities away from the allocated practice placement
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Page 175
Record of visits/Practice learning opportunities relevant to the allocated practice placement
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Page 176
Record of Meetings between student and mentor These schedules are to be used to record a student’s progress/any issues that arise during the placement
Date
Details of meeting Outcome
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Page 177
Record of Meetings between student and mentor
Date
Details of meeting Outcome
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Page 178
Action Plan To be completed if there is an area that the student needs to develop Area of practice that requires development: Plan: Resources and support required: Date for review of action plan:
Action plan agreed: Yes No
Student signature: Date:
Mentor signature:
Date:
Outcome of action plan: Student signature: Date:
Mentor signature:
Date:
Page 179
Long Placement: Evaluation of student professional conduct
For each placement that the student attends the form below MUST be completed The MENTOR should tick whether the student has demonstrated the ability to accept RESPONSIBILITY for their own action in the areas identified, PROVIDE COMMENTS, DATE AND SIGN the form
Demonstrates ability to accept
responsibility for their own actions in
relation to:
Yes No Comments
• Arriving on duty on time
• Wears uniform in line with Trust and University of Suffolk dress code policy
• Responds appropriately to constructive feedback
• Reports sickness/absence in line with University of Suffolk/Trust policy
• Adheres to current NMC Guidance on professional conduct for nursing and midwifery students
Number of hours sick/absent during the placement:
Mentor Signature:
Date:
Page 180
Final Interview
At the end of the practice placement the mentor and student must meet to how the student has progressed and developed during the placement. The discussion should focus on the student’s achievement of generic and field specific competencies; progress in achieving competency with the relevant essential skills and achievement of the specific learning outcomes identified at the initial interview.
Mentor comments: Areas to develop in future practice placements: Is the student achieving at the required level of performance YES/NO (please delete as applicable) If answer is no please see the assessment process in practice flowchart Overall this student is safe to progress: YES/NO (please delete as applicable) Please provide below the rationale for these decisions: Mentor signature: Date: Student signature: Date:
Page 181
Long Placement: Orientation to the practice placement
This form is to be completed on the first day of the student’s placement. Aspects to be discussed
Mentor initials Student Signature
Layout of the practice area.
Procedure in event of a fire.
Procedure for emergencies including resuscitation.
Moving and handling equipment.
Trust and local practice area policies
General information about the practice including shift times; procedure for reporting sickness; uniform policy and professional issues.
Practice learning outcomes and learning opportunities are identified and discussed – to be recorded on the initial interview form.
Personal learning needs are discussed - to be recorded on the initial interview form.
Date:
Page 182
Initial Interview form To be completed by the end of the first week of the student’s practice placement
Placement: I have read the Student’s On-going Record of Achievement and discussed any issues with the student Mentor Signature: Date: Learning Opportunities available in the practice placement: Specific Learning Outcomes for the placement: Link these to the objectives the student has identified in their preparation for practice form in their PAD. Discussion on Integrated Practice Assessment: Is this relevant to this placement – Yes No If answer is yes please record details below Student signature: Date: Mentor signature: Date:
Page 183
Mid-point Interview
At the mid-point the mentor and student must meet to discuss their progress and development. The discussion should focus on the student’s achievement of generic and field specific competencies; progress in achieving competency with the relevant essential skills and feedback on the specific learning outcomes identified at the initial interview. Mentor comments: Mentor signature: Date: Student signature: Date:
Page 184
Service User Feedback Sheet
The opinions of Service Users are an integral part of the assessment of student’s in practice settings. Registered Nurses working in an appropriate area can select a Service User and request their opinion on the care they have received from the student. These opinions are to be recorded by the Registered Nurse. The student is required to have the opinions of two service users for each of their four week or longer placements, except for the final placement when the opinions of three service users must be sought. There is no expectation of service user feedback for placements shorter than four weeks N.B. The Service User’s anonymity must be maintained Areas for Service User comment
• Maintain privacy and dignity • Polite, courteous and respectful • Provide adequate information • Listen attentively • Made them feel welcome
1. Aspects of the student’s care that is commendable.
2. Aspects of this student’s care that could be further developed. This is an accurate representation of the Service User’s feedback and has been discussed with the student. Signature of Registered Nurse: Date: Print name
Page 185
Service User Feedback Sheet The opinions of Service Users are an integral part of the assessment of student’s in practice settings. Registered Nurses working in an appropriate area can select a Service User and request their opinion on the care they have received from the student. These opinions are to be recorded by the Registered Nurse. The student is required to have the opinions of two service users for each of their four week or longer placements, except for the final placement when the opinions of three service users must be sought. There is no expectation of service user feedback for placements shorter than four weeks N.B. The Service User’s anonymity must be maintained Areas for Service User comment
• Maintain privacy and dignity • Polite, courteous and respectful • Provide adequate information • Listen attentively • Made them feel welcome
1. Aspects of the student’s care that is commendable.
2. Aspects of this student’s care that could be further developed. This is an accurate representation of the Service User’s feedback and has been discussed with the student. Signature of Registered Nurse: Date: Print name
Page 186
Record of visits/Practice learning opportunities away from the allocated practice placement
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Page 187
Record of visits/Practice learning opportunities relevant to the allocated practice placement
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Page 188
Record of Meetings between student and mentor These schedules are to be used to record a student’s progress/any issues that arise during the placement
Date
Details of meeting Outcome
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Page 189
Record of Meetings between student and mentor
Date
Details of meeting Outcome
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Page 190
Action Plan To be completed if there is an area that the student needs to develop Area of practice that requires development: Plan: Resources and support required: Date for review of action plan:
Action plan agreed: Yes No
Student signature: Date:
Mentor signature:
Date:
Outcome of action plan: Student signature: Date:
Mentor signature:
Date:
Page 191
Long Placement: Evaluation of student professional conduct
For each placement that the student attends the form below MUST be completed The MENTOR should tick whether the student has demonstrated the ability to accept RESPONSIBILITY for their own action in the areas identified, PROVIDE COMMENTS, DATE AND SIGN the form
Demonstrates ability to accept
responsibility for their own actions in
relation to:
Yes No Comments
• Arriving on duty on time
• Wears uniform in line with Trust and University of Suffolk dress code policy
• Responds appropriately to constructive feedback
• Reports sickness/absence in line with University of Suffolk/Trust policy
• Adheres to current NMC Guidance on professional conduct for nursing and midwifery students
Number of hours sick/absent during the placement:
Mentor Signature:
Date:
Page 192
Final Interview
At the end of the practice placement the mentor and student must meet to how the student has progressed and developed during the placement. The discussion should focus on the student’s achievement of generic and field specific competencies; progress in achieving competency with the relevant essential skills and achievement of the specific learning outcomes identified at the initial interview.
Mentor comments: Areas to develop in future practice placements: Is the student achieving at the required level of performance YES/NO (please delete as applicable) If answer is no please see the assessment process in practice flowchart Overall this student is safe to progress: YES/NO (please delete as applicable) Please provide below the rationale for these decisions: Mentor signature: Date: Student signature: Date:
Page 193
INTERVIEW SCHEDULE WITH PERSONAL TUTOR (3)
End of Semester 3: end of semester 3 Assessment Comments Practice Assessment Document for year 1 complete
Yes/No
Ongoing Record of Achievement discussed
Yes/No
EU Directives Achieved: � general and specialist medicine
� general and specialist surgery
� child care and paediatrics
� maternity care
� mental health and psychiatry
� care of the older person
� home nursing
Yes/No
Overall comments by Personal Tutor Result Pass Refer
Signature of Personal Tutor: _________________________________ PRINT NAME: _____________________________________________ Signature of Student: _________________________________ Date: _______________
Page 194
INTERVIEW SCHEDULE WITH PERSONAL TUTOR (4)
End of Semester 4: End of year 2 Assessment Comments Practice Assessment Document for year 1 complete
Yes/No
Ongoing Record of Achievement discussed
Yes/No
EU Directives Achieved: � general and specialist medicine
� general and specialist surgery
� child care and paediatrics
� maternity care
� mental health and psychiatry
� care of the older person
� home nursing
Yes/No
Overall comments by Personal Tutor Result Pass Refer
Signature of Personal Tutor: _________________________________ PRINT NAME: _____________________________________________ Signature of Student: _________________________________ Date: _______________
Page 195
NURSING PRACTICE 2 MODERATION SHEET
Moderator Name _______________________________ Moderator Signature _______________________________ Date _______________________________
Assessment
Y/N Comments
All signatures retrieved and verified
All Service User Feedback Completed
All interview paperwork completed
Overall comments by Moderator
Page 196
YEAR 3
Documentation
Page 197
Mentor/Registered Practitioner Signature Sheet: Year 3
All registered practitioners who sign the student’s documentation MUST complete the sheet below. This is a requirement of University of Suffolk as it allows for signatures to be checked and confirmed. Please read the following statement before signing this sheet. By signing this sheet mentors are signing to say they have attended a mentor update in the last 12 months and that their triennial review is up-to date as required by NMC (2008).
Name of Mentor/Registered
Practitioner (printed)
Signature Initials of Mentor/Registered
Practitioner
Name of placement
area
Contact telephone number for placement
area
Dates student attended clinical
placement
Name of Manager
verifying the signature
Manager’s signature
Page 198
Mentor/Registered Practitioner Signature Sheet: Year 3
All registered practitioners who sign the student’s documentation MUST complete the sheet below. This is a requirement of University of Suffolk as it allows for signatures to be checked and confirmed. Please read the following statement before signing this sheet. By signing this sheet mentors are signing to say they have attended a mentor update in the last 12 months and that their triennial review is up-to date as required by NMC (2008).
Name of Mentor/Registered
Practitioner (printed)
Signature Initials of Mentor/Registered
Practitioner
Name of placement
area
Contact telephone number for placement
area
Dates student attended clinical
placement
Name of Manager
verifying the signature
Manager’s signature
Page 199
Simulated Practice Learning (SPL): Preparation for Practice Experience The Nursing and Midwifery Council (NMC, 2007; 2010) recognise that simulated practice learning within a simulation environment can enhance a student’s acquisition of direct care skills. Throughout your pre-registration programme clinical skills sessions have been identified as simulated practice learning. These sessions aim to introduce you to specific care and delivery which you can enhance and develop when out in practice.
• Attendances for these sessions need to be recorded and confirmed.
• A Simulated Practice Learning Evaluation & Feedback (SPLEF) sheet needs to be completed which should then be used in discussion with your mentor to help guide and develop direct care experiences within clinical practice placements.
Guidance for mentors and students The aim of SPL is to develop the student’s professional practice skills and build confidence within a safe environment, which can then help to support direct care given in clinical practice. During the SPL skills sessions the students will undertake scenario based learning opportunities that will incorporate a range of clinical and communication skills outlined through session aims and objectives which reflect the Essential Skills Clusters (NMC, 2010). There will be an opportunity for peer and facilitator feedback as well as personal reflection from the student before, during and after each session. The completed SPLEF sheets are to be utilised, through discussion between mentor and student, to help guide related learning objectives and action plans when in the practice placement as well as supporting any direct care the student is involved in. Nursing and Midwifery Council (2007) Simulation and practice learning project. London: NMC. Nursing and Midwifery Council (2010) Standards for pre-registration nursing education. London: NMC.
Page 200
Preparation for Practice Experience Forms
Session title Date of SPL session: Attendance verified by facilitator: Aims & Objectives of SPL session: Pre session activities undertaken: Feedback from peers and facilitator/s:
Page 201
Post session activities undertaken: Reflection of SPL opportunity facilitated through discussion with mentor (to include implications for your developing practice, relevant practice learning objectives and actions plans): Mentor signature: Student signature: Date:
Page 202
Preparation for Practice Experience Forms
Session title Date of SPL session: Attendance verified by facilitator: Aims & Objectives of SPL session: Pre session activities undertaken: Feedback from peers and facilitator/s:
Page 203
Post session activities undertaken: Reflection of SPL opportunity facilitated through discussion with mentor (to include implications for your developing practice, relevant practice learning objectives and actions plans): Mentor signature: Student signature: Date:
Page 204
Preparation for Practice Experience Forms
Session title Date of SPL session: Attendance verified by facilitator: Aims & Objectives of SPL session: Pre session activities undertaken: Feedback from peers and facilitator/s:
Page 205
Post session activities undertaken: Reflection of SPL opportunity facilitated through discussion with mentor (to include implications for your developing practice, relevant practice learning objectives and actions plans): Mentor signature: Student signature: Date:
Page 206
Preparation for Practice Experience Forms
Session title Date of SPL session: Attendance verified by facilitator: Aims & Objectives of SPL session: Pre session activities undertaken: Feedback from peers and facilitator/s:
Page 207
Post session activities undertaken: Reflection of SPL opportunity facilitated through discussion with mentor (to include implications for your developing practice, relevant practice learning objectives and actions plans): Mentor signature: Student signature: Date:
Page 208
Preparation for Practice Experience Forms
Session title Date of SPL session: Attendance verified by facilitator: Aims & Objectives of SPL session: Pre session activities undertaken: Feedback from peers and facilitator/s:
Page 209
Post session activities undertaken: Reflection of SPL opportunity facilitated through discussion with mentor (to include implications for your developing practice, relevant practice learning objectives and actions plans): Mentor signature: Student signature: Date:
Page 210
Dementia care checklist: 3rd year
The Government’s ‘Challenge on Dementia 2020’ campaign (Department of Health, 2015) and ‘Dementia Core Skills Education and Training Framework’ (Skills for Health & Health Education England, 2015) recognise the growing need to incorporate a substantial approach to dementia care education, in a direct response to the rising demand for specialist knowledge and skills to adequately meet the increasingly complex, physical and psychological, needs of people with dementia (World Alzheimer Report, 2015). University of Suffolk, is committed to deliver dementia care education in a meaningful way, in order to equip future practitioners with the knowledge and relevant skills needed to be competent and confident in practice. The approach to dementia care education will use links with practice by involving services users, carers and support groups as well as utilising simulation as a recognised form of learning, to develop evidence based practical skills (Department of Health, 2011). Guidance for mentors and students Each year students receive a collaboratively led theoretical study day, followed by a simulation skills session based on dementia care scenarios utilising role play, simulation equipment and contemporary practice tools and is developmental in linking with core curriculum themes. These skills sessions are recorded in the students’ Record of Achievement documentation and are to be utilised during discussions with mentors to develop individual skills during practice placement. Part of the development process will be to complete the following year specific check list, focussing on relevant areas of dementia care. Although these activities are not mandatory, the aim is to fulfil as many of the key tasks listed, during each year of practice, if possible, then discuss them and the experiences, during the field specific simulation skills session, as well as between the student and mentor. The activities can be completed as a student self-assessment or signed by both the student and the mentor References Department of Health (2011) A Framework for Technology Enhanced Learning. Available at: https://www.gov.uk/government/publications/a-framework-for-technology-enhanced-learning (Accessed: 30 January 2017) Department of Health (2015) Prime Minister’s challenge on dementia 2020. Available at: https://www.gov.uk/government/publications/prime-ministers-challenge-on-dementia-2020 (Accessed: 30 January 2017) Skills for Health and Health Education England (2015) Dementia Core Skills Education and Training Framework. Available at: http://www.skillsforhealth.org.uk/services/item/176-dementia-core-skills-education-and-training-framework (Accessed: 30 January 2017) World Alzheimer Report (2015) The Global Impact of Dementia: An analysis of prevalence, incidence, cost and trends. Available at: https://www.alz.co.uk/research/world-report-2015 (Accessed: 30 January 2017)
Page 211
Complete as many of the following 3rd year tasks as possible. The emphasis should be on leading and managing care with the support of your mentor: DISCHARGE PLANNING:
Activity Review the discharge planning of a service user with dementia:
• Has the Dementia Intensive Support Team (DIST) been involved in the discharge?
• If the service user has had delirium, how has discharge been facilitated?
• What supportive interventions/agencies/other healthcare professionals are available to help the service user or their carer and how have these been sign posted? Have any referrals been made e.g. SALT?
Comment, sign & date when accomplished (this can be more than one time)
DECISION MAKING: Activity
Have you been involved with any of the following considerations? Reflect on your input and that of others involved? Was the decision making easily reached? If not, why not?
• Safeguarding
• Mental Capacity Act (MCA)
• Deprivation of Liberty Safeguards (DoLS)
• Advanced Care Planning
Comment, sign & date when accomplished (this can be more than one time)
Page 212
Short Placement forms:
For placements that are 1 to 3 weeks long
Page 213
Short Placement: Orientation to the practice placement
This form is to be completed on the first day of the student’s placement. Aspects to be discussed
Registered Practitioner initials
Student Signature
Layout of the practice area.
Procedure in event of a fire.
Procedure for emergencies including resuscitation.
Moving and handling equipment.
Trust and local practice area policies
General information about the practice including shift times; procedure for reporting sickness; uniform policy and professional issues.
Practice learning outcomes and learning opportunities are identified and discussed – to be recorded on the initial interview form.
Personal learning needs are discussed - to be recorded on the initial interview form.
Date:
Page 214
Short Placement: Evaluation of student professional conduct
For each placement that the student attends the form below MUST be completed The REGISTERED PRACTITIONER should tick whether the student has demonstrated the ability to accept RESPONSIBILITY for their own action in the areas identified, PROVIDE COMMENTS, DATE AND SIGN the form
Demonstrates ability to accept
responsibility for their own actions in
relation to:
Yes No Comments
• Arriving on duty on time
• Wears uniform in line with Trust and University of Suffolk dress code policy
• Responds appropriately to constructive feedback
• Reports sickness/absence in line with University of Suffolk/Trust policy
• Adheres to current NMC Guidance on professional conduct
Number of hours sick/absent during the placement:
Registered Practitioner Signature:
Date:
Page 215
SHORT PLACEMENT MEETING FORM This form is to be used for placements that last less than four weeks Name of Practice Placement: On the First Day
Learning outcomes to be achieved during this placement
Date:
Registered Practitioner Signature:
Student Signature:
At the end of the practice placement
Registered Practitioner comments on the student’s performance during the placement
Date:
Registered Practitioner Signature:
Student Signature:
Page 216
Short Placement: Orientation to the practice placement
This form is to be completed on the first day of the student’s placement. Aspects to be discussed
Registered Practitioner initials
Student Signature
Layout of the practice area.
Procedure in event of a fire.
Procedure for emergencies including resuscitation.
Moving and handling equipment.
Trust and local practice area policies
General information about the practice including shift times; procedure for reporting sickness; uniform policy and professional issues.
Practice learning outcomes and learning opportunities are identified and discussed – to be recorded on the initial interview form.
Personal learning needs are discussed - to be recorded on the initial interview form.
Date:
Page 217
Short Placement: Evaluation of student professional conduct
For each placement that the student attends the form below MUST be completed The REGISTERED PRACTITIONER should tick whether the student has demonstrated the ability to accept RESPONSIBILITY for their own action in the areas identified, PROVIDE COMMENTS, DATE AND SIGN the form
Demonstrates ability to accept
responsibility for their own actions in
relation to:
Yes No Comments
• Arriving on duty on time
• Wears uniform in line with Trust and University of Suffolk dress code policy
• Responds appropriately to constructive feedback
• Reports sickness/absence in line with University of Suffolk/Trust policy
• Adheres to current NMC Guidance on professional conduct for nursing and midwifery students
Number of hours sick/absent during the placement:
Registered Practitioner Signature:
Date:
Page 218
SHORT PLACEMENT MEETING FORM This form is to be used for placements that last less than four weeks Name of Practice Placement: On the First Day
Learning outcomes to be achieved during this placement
Date:
Registered Practitioner Signature:
Student Signature:
At the end of the practice placement
Registered Practitioner comments on the student’s performance during the placement
Date:
Registered Practitioner Signature:
Student Signature:
Page 219
Short Placement: Orientation to the practice placement
This form is to be completed on the first day of the student’s placement. Aspects to be discussed
Registered Practitioner initials
Student Signature
Layout of the practice area.
Procedure in event of a fire.
Procedure for emergencies including resuscitation.
Moving and handling equipment.
Trust and local practice area policies
General information about the practice including shift times; procedure for reporting sickness; uniform policy and professional issues.
Practice learning outcomes and learning opportunities are identified and discussed – to be recorded on the initial interview form.
Personal learning needs are discussed - to be recorded on the initial interview form.
Date:
Page 220
Short Placement: Evaluation of student professional conduct
For each placement that the student attends the form below MUST be completed The REGISTERED PRACTITIONER should tick whether the student has demonstrated the ability to accept RESPONSIBILITY for their own action in the areas identified, PROVIDE COMMENTS, DATE AND SIGN the form
Demonstrates ability to accept
responsibility for their own actions in
relation to:
Yes No Comments
• Arriving on duty on time
• Wears uniform in line with Trust and University of Suffolk dress code policy
• Responds appropriately to constructive feedback
• Reports sickness/absence in line with University of Suffolk/Trust policy
• Adheres to current NMC Guidance on professional conduct for nursing and midwifery students
Number of hours sick/absent during the placement:
Registered Practitioner Signature:
Date:
Page 221
SHORT PLACEMENT MEETING FORM This form is to be used for placements that last less than four weeks Name of Practice Placement: On the First Day
Learning outcomes to be achieved during this placement
Date:
Registered Practitioner Signature:
Student Signature:
At the end of the practice placement
Registered Practitioner comments on the student’s performance during the placement
Date:
Registered Practitioner Signature:
Student Signature:
Page 222
Long Placement forms: For placements that are more
than 4 weeks long
Page 223
Long Placement: Orientation to the practice placement
This form is to be completed on the first day of the student’s placement. Aspects to be discussed
Mentor initials Student Signature
Layout of the practice area.
Procedure in event of a fire.
Procedure for emergencies including resuscitation.
Moving and handling equipment.
Trust and local practice area policies
General information about the practice including shift times; procedure for reporting sickness; uniform policy and professional issues.
Practice learning outcomes and learning opportunities are identified and discussed – to be recorded on the initial interview form.
Personal learning needs are discussed - to be recorded on the initial interview form.
Date:
Page 224
Initial Interview form To be completed by the end of the first week of the student’s practice placement
Placement: I have read the Student’s On-going Record of Achievement and discussed any issues with the student Mentor Signature: Date: Learning Opportunities available in the practice placement: Specific Learning Outcomes for the placement: Link these to the objectives the student has identified in their preparation for practice form in their PAD. Discussion on Integrated Practice Assessment: Is this relevant to this placement – Yes No If answer is yes please record details below Student signature: Date: Mentor signature: Date:
Page 225
Mid-point Interview
At the mid-point the mentor and student must meet to discuss their progress and development. The discussion should focus on the student’s achievement of generic and field specific competencies; progress in achieving competency with the relevant essential skills and feedback on the specific learning outcomes identified at the initial interview. Mentor comments: Mentor signature: Date: Student signature: Date:
Page 226
Service User Feedback Sheet
The opinions of Service Users are an integral part of the assessment of student’s in practice settings. Registered Nurses working in an appropriate area can select a Service User and request their opinion on the care they have received from the student. These opinions are to be recorded by the Registered Nurse. The student is required to have the opinions of two service users for each of their four week or longer placements, except for the final placement when the opinions of three service users must be sought. There is no expectation of service user feedback for placements shorter than four weeks N.B. The Service User’s anonymity must be maintained Areas for Service User comment
• Maintain privacy and dignity • Polite, courteous and respectful • Provide adequate information • Listen attentively • Made them feel welcome
11. Aspects of the student’s care that is commendable.
12. Aspects of this student’s care that could be further developed. This is an accurate representation of the Service User’s feedback and has been discussed with the student. Signature of Registered Nurse: Date: Print name
Page 227
Service User Feedback Sheet
The opinions of Service Users are an integral part of the assessment of student’s in practice settings. Registered Nurses working in an appropriate area can select a Service User and request their opinion on the care they have received from the student. These opinions are to be recorded by the Registered Nurse. The student is required to have the opinions of two service users for each of their four week or longer placements, except for the final placement when the opinions of three service users must be sought. There is no expectation of service user feedback for placements shorter than four weeks N.B. The Service User’s anonymity must be maintained Areas for Service User comment
• Maintain privacy and dignity • Polite, courteous and respectful • Provide adequate information • Listen attentively • Made them feel welcome
11. Aspects of the student’s care that is commendable.
12. Aspects of this student’s care that could be further developed. This is an accurate representation of the Service User’s feedback and has been discussed with the student. Signature of Registered Nurse: Date: Print name
Page 228
Record of visits/Practice learning opportunities away from the allocated practice placement
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Page 229
Record of visits/Practice learning opportunities relevant to the allocated practice placement
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Page 230
Record of Meetings between student and mentor These schedules are to be used to record a student’s progress/any issues that arise during the placement
Date
Details of meeting Outcome
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Page 231
Record of Meetings between student and mentor
Date
Details of meeting Outcome
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Page 232
Action Plan To be completed if there is an area that the student needs to develop Area of practice that requires development: Plan: Resources and support required: Date for review of action plan:
Action plan agreed: Yes No
Student signature: Date:
Mentor signature:
Date:
Outcome of action plan: Student signature: Date:
Mentor signature:
Date:
Page 233
Long Placement: Evaluation of student professional conduct
For each placement that the student attends the form below MUST be completed The MENTOR should tick whether the student has demonstrated the ability to accept RESPONSIBILITY for their own action in the areas identified, PROVIDE COMMENTS, DATE AND SIGN the form
Demonstrates ability to accept
responsibility for their own actions in
relation to:
Yes No Comments
• Arriving on duty on time
• Wears uniform in line with Trust and University of Suffolk dress code policy
• Responds appropriately to constructive feedback
• Reports sickness/absence in line with University of Suffolk/Trust policy
• Adheres to current NMC Guidance on professional conduct for nursing and midwifery students
Number of hours sick/absent during the placement:
Mentor Signature:
Date:
Page 234
Final Interview
At the end of the practice placement the mentor and student must meet to how the student has progressed and developed during the placement. The discussion should focus on the student’s achievement of generic and field specific competencies; progress in achieving competency with the relevant essential skills and achievement of the specific learning outcomes identified at the initial interview.
Mentor comments: Areas to develop in future practice placements: Is the student achieving at the required level of performance YES/NO (please delete as applicable) If answer is no please see the assessment process in practice flowchart Overall this student is safe to progress: YES/NO (please delete as applicable) Please provide below the rationale for these decisions: Mentor signature: Date: Student signature: Date:
Page 235
Long Placement: Orientation to the practice placement
This form is to be completed on the first day of the student’s placement. Aspects to be discussed
Mentor initials Student Signature
Layout of the practice area.
Procedure in event of a fire.
Procedure for emergencies including resuscitation.
Moving and handling equipment.
Trust and local practice area policies
General information about the practice including shift times; procedure for reporting sickness; uniform policy and professional issues.
Practice learning outcomes and learning opportunities are identified and discussed – to be recorded on the initial interview form.
Personal learning needs are discussed - to be recorded on the initial interview form.
Date:
Page 236
Initial Interview form To be completed by the end of the first week of the student’s practice placement
Placement: I have read the Student’s On-going Record of Achievement and discussed any issues with the student Mentor Signature: Date: Learning Opportunities available in the practice placement: Specific Learning Outcomes for the placement: Link these to the objectives the student has identified in their preparation for practice form in their PAD. Discussion on Integrated Practice Assessment: Is this relevant to this placement – Yes No If answer is yes please record details below Student signature: Date: Mentor signature: Date:
Page 237
Mid-point Interview
At the mid-point the mentor and student must meet to discuss their progress and development. The discussion should focus on the student’s achievement of generic and field specific competencies; progress in achieving competency with the relevant essential skills and feedback on the specific learning outcomes identified at the initial interview. Mentor comments: Mentor signature: Date: Student signature: Date:
Page 238
Service User Feedback Sheet
The opinions of Service Users are an integral part of the assessment of student’s in practice settings. Registered Nurses working in an appropriate area can select a Service User and request their opinion on the care they have received from the student. These opinions are to be recorded by the Registered Nurse. The student is required to have the opinions of two service users for each of their four week or longer placements, except for the final placement when the opinions of three service users must be sought. There is no expectation of service user feedback for placements shorter than four weeks N.B. The Service User’s anonymity must be maintained Areas for Service User comment
• Maintain privacy and dignity • Polite, courteous and respectful • Provide adequate information • Listen attentively • Made them feel welcome
13. Aspects of the student’s care that is commendable.
14. Aspects of this student’s care that could be further developed. This is an accurate representation of the Service User’s feedback and has been discussed with the student. Signature of Registered Nurse: Date: Print name
Page 239
Service User Feedback Sheet
The opinions of Service Users are an integral part of the assessment of student’s in practice settings. Registered Nurses working in an appropriate area can select a Service User and request their opinion on the care they have received from the student. These opinions are to be recorded by the Registered Nurse. The student is required to have the opinions of two service users for each of their four week or longer placements, except for the final placement when the opinions of three service users must be sought. There is no expectation of service user feedback for placements shorter than four weeks N.B. The Service User’s anonymity must be maintained Areas for Service User comment
• Maintain privacy and dignity • Polite, courteous and respectful • Provide adequate information • Listen attentively • Made them feel welcome
13. Aspects of the student’s care that is commendable.
14. Aspects of this student’s care that could be further developed. This is an accurate representation of the Service User’s feedback and has been discussed with the student. Signature of Registered Nurse: Date: Print name
Page 240
Record of visits/Practice learning opportunities away from the allocated practice placement
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Page 241
Record of visits/Practice learning opportunities relevant to the allocated practice placement
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Page 242
Record of Meetings between student and mentor These schedules are to be used to record a student’s progress/any issues that arise during the placement
Date
Details of meeting Outcome
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Page 243
Record of Meetings between student and mentor
Date
Details of meeting Outcome
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Student signature: Date:
Mentor signature:
Date:
Page 244
Action Plan To be completed if there is an area that the student needs to develop Area of practice that requires development: Plan: Resources and support required: Date for review of action plan:
Action plan agreed: Yes No
Student signature: Date:
Mentor signature:
Date:
Outcome of action plan: Student signature: Date:
Mentor signature:
Date:
Page 245
Long Placement: Evaluation of student professional conduct
For each placement that the student attends the form below MUST be completed The MENTOR should tick whether the student has demonstrated the ability to accept RESPONSIBILITY for their own action in the areas identified, PROVIDE COMMENTS, DATE AND SIGN the form
Demonstrates ability to accept
responsibility for their own actions in
relation to:
Yes No Comments
• Arriving on duty on time
• Wears uniform in line with Trust and University of Suffolk dress code policy
• Responds appropriately to constructive feedback
• Reports sickness/absence in line with University of Suffolk/Trust policy
• Adheres to current NMC Guidance on professional conduct for nursing and midwifery students
Number of hours sick/absent during the placement:
Mentor Signature:
Date:
Page 246
Final Interview
At the end of the practice placement the mentor and student must meet to how the student has progressed and developed during the placement. The discussion should focus on the student’s achievement of generic and field specific competencies; progress in achieving competency with the relevant essential skills and achievement of the specific learning outcomes identified at the initial interview.
Mentor comments: Areas to develop in future practice placements: Is the student achieving at the required level of performance YES/NO (please delete as applicable) If answer is no please see the assessment process in practice flowchart Overall this student is safe to progress: YES/NO (please delete as applicable) Please provide below the rationale for these decisions: Mentor signature: Date: Student signature: Date:
Page 247
INTERVIEW SCHEDULE WITH PERSONAL TUTOR (5)
End of Semester 5: end of semester 5 Assessment Comments Practice Assessment Document discussed
Yes/No
Ongoing Record of Achievement discussed
Yes/No
EU Directives Achieved: � general and specialist medicine
� general and specialist surgery
� child care and paediatrics
� maternity care
� mental health and psychiatry
� care of the older person
� home nursing
Yes/No
Overall comments by Personal Tutor Signature of Personal Tutor: _________________________________ PRINT NAME: _____________________________________________ Signature of Student: _________________________________ Date: _______________
Page 248
YEAR 3
Final Placement documentation
Page 249
Sign-off Mentor Signature Sheet
The Sign-off Mentor MUST complete the sheet below. This is a requirement of University of Suffolk as it allows for signatures to be checked and confirmed. Please read the following statement before signing this sheet. By signing this sheet Signoff mentors are signing to say they have attended a mentor update in the last 12 months
and that their triennial review is up-to date as required by NMC (2008)
Nam
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-Off
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Page 250
Final Placement: Orientation to the practice placement
This form is to be completed on the first day of the student’s placement. Aspects to be discussed
Mentor initials Student Signature
Layout of the practice area.
Procedure in event of a fire.
Procedure for emergencies including resuscitation.
Moving and handling equipment.
Trust and local practice area policies
General information about the practice including shift times; procedure for reporting sickness; uniform policy and professional issues.
Practice learning outcomes and learning opportunities are identified and discussed – to be recorded on the initial interview form.
Personal learning needs are discussed - to be recorded on the initial interview form.
Date:
Page 251
Initial Interview form To be completed by the end of the first week of the student’s practice placement
Placement: I have read the Student’s On-going Record of Achievement and discussed any issues with the student Sign-Off Mentor Signature: Date: Learning Opportunities available in the practice placement: Specific Learning Outcomes for the placement: Link these to the objectives the student has identified in their preparation for practice form in their PAD. Discussion on Integrated Practice Assessment: Is this relevant to this placement – Yes No If answer is yes please record details below Student signature: Date: Sign-Off Mentor signature: Date:
Page 252
Mid-point Interview
At the mid-point the Sign-Off Mentor and student must meet to discuss their progress and development. The discussion should focus on the student’s achievement of generic and field specific competencies; progress in achieving competency with the relevant essential skills and feedback on the specific learning outcomes identified at the initial interview. Sign-Off Mentor comments: Sign-Off Mentor signature: Date: Student signature: Date:
Page 253
Service User Feedback Sheet
The opinions of Service Users are an integral part of the assessment of student’s in practice settings. Registered Nurses working in an appropriate area can select a Service User and request their opinion on the care they have received from the student. These opinions are to be recorded by the Registered Nurse. The student is required to have the opinions of two service users for each of their four week or longer placements, except for the final placement when the opinions of three service users must be sought. There is no expectation of service user feedback for placements shorter than four weeks N.B. The Service User’s anonymity must be maintained Areas for Service User comment
• Maintain privacy and dignity • Polite, courteous and respectful • Provide adequate information • Listen attentively • Made them feel welcome
1. Aspects of the student’s care that is commendable.
2. Aspects of this student’s care that could be further developed. This is an accurate representation of the Service User’s feedback and has been discussed with the student. Signature of Registered Nurse: Date: Print name
Page 254
Service User Feedback Sheet
The opinions of Service Users are an integral part of the assessment of student’s in practice settings. Registered Nurses working in an appropriate area can select a Service User and request their opinion on the care they have received from the student. These opinions are to be recorded by the Registered Nurse. The student is required to have the opinions of two service users for each of their four week or longer placements, except for the final placement when the opinions of three service users must be sought. There is no expectation of service user feedback for placements shorter than four weeks N.B. The Service User’s anonymity must be maintained Areas for Service User comment
• Maintain privacy and dignity • Polite, courteous and respectful • Provide adequate information • Listen attentively • Made them feel welcome
1. Aspects of the student’s care that is commendable.
2. Aspects of this student’s care that could be further developed. This is an accurate representation of the Service User’s feedback and has been discussed with the student. Signature of Registered Nurse: Date: Print name
Page 255
Service User Feedback Sheet
The opinions of Service Users are an integral part of the assessment of student’s in practice settings. Registered Nurses working in an appropriate area can select a Service User and request their opinion on the care they have received from the student. These opinions are to be recorded by the Registered Nurse. The student is required to have the opinions of two service users for each of their four week or longer placements, except for the final placement when the opinions of three service users must be sought. There is no expectation of service user feedback for placements shorter than four weeks N.B. The Service User’s anonymity must be maintained Areas for Service User comment
• Maintain privacy and dignity • Polite, courteous and respectful • Provide adequate information • Listen attentively • Made them feel welcome
1. Aspects of the student’s care that is commendable.
2. Aspects of this student’s care that could be further developed. This is an accurate representation of the Service User’s feedback and has been discussed with the student. Signature of Registered Nurse: Date: Print name
Page 256
Record of visits/Practice learning opportunities away from the allocated practice placement
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Page 257
Record of visits/Practice learning opportunities relevant to the allocated practice placement
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Date
Hours/days spent
Details of visit/ Practice Learning Opportunity
Student reflection on their learning: Supervisor’s comments on the student’s performance: Supervisor Name: Signature: Contact telephone number:
Page 258
Record of Meetings between student and Sign-off Mentor These schedules are to be used to record a student’s progress/any issues that arise during the placement
Date
Details of meeting Outcome
Student signature: Date:
Sign-off Mentor signature:
Date:
Student signature: Date:
Sign-off Mentor signature:
Date:
Student signature: Date:
Sign-off Mentor signature:
Date:
Student signature: Date:
Sign-off Mentor signature:
Date:
Page 259
Record of Meetings between student and Sign-off Mentor
Date
Details of meeting Outcome
Student signature: Date:
Sign-off Mentor signature:
Date:
Student signature: Date:
Sign-off Mentor signature:
Date:
Student signature: Date:
Sign-off Mentor signature:
Date:
Student signature: Date:
Sign-off Mentor Sign-Off signature:
Date:
Page 260
Action Plan To be completed if there is an area that the student needs to develop Area of practice that requires development: Plan: Resources and support required: Date for review of action plan:
Action plan agreed: Yes No
Student signature: Date:
Mentor signature:
Date:
Outcome of action plan: Student signature: Date:
Sign-off Mentor signature:
Date:
Page 261
Final Placement: Evaluation of student professional conduct
For each placement that the student attends the form below MUST be completed The Sign-Off Mentor should tick whether the student has demonstrated the ability to accept RESPONSIBILITY for their own action in the areas identified, PROVIDE COMMENTS, DATE AND SIGN the form
Demonstrates ability to accept
responsibility for their own actions in
relation to:
Yes No Comments
• Arriving on duty on time
• Wears uniform in line with Trust and University of Suffolk dress code policy
• Responds appropriately to constructive feedback
• Reports sickness/absence in line with University of Suffolk/Trust policy
• Adheres to current NMC Guidance on professional conduct for nursing and midwifery students
Number of hours sick/absent during the placement:
Sign-off Mentor Signature:
Date:
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Final Interview
At the end of the practice placement the sign-off mentor and student must meet to how the student has progressed and developed during the placement. The discussion should focus on the student’s achievement of generic and field specific competencies; progress in achieving competency with the relevant essential skills and achievement of the specific learning outcomes identified at the initial interview.
Mentor comments: Has the student achieved the required level of performance? YES/NO (please delete as applicable) If answer is no please see the assessment process in practice flowchart Overall this student is safe?: YES/NO (please delete as applicable) Please provide below the rationale for these decisions: Sign-off Mentor signature: Date: Student signature: Date:
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RECORD OF TRIPARTITE MEETING TO BE COMPLETED BY THE OBSERVER Name of Personal Tutor: Name of Observer (if different to Personal Tutor): Name of Student: Name of Sign-off Mentor: Date of Tripartite Meeting: Placement/site: Cohort: SIGN OFF MENTOR to complete:
1. Date of Sign-off Mentor training ………………..
2. Date of Triennial review ………………………………..
3. Is there a record of meeting 1 hour per week / equivalent in the PAD? YES / NO
If the answer is No – Has it been reported to CPF / Link Lecturer/Convenyor YES / NO Has it been reported to the Pre Assessment Board? YES / NO
4. Has the student been involved in the process of achieving the PAD during practice?
5. Is there evidence of discussion leading to the final grades being awarded? Give example
6. Has the student been involved in the decision making of the final grades awarded? Give examples
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Tripartite meeting summary (to be completed by University of Suffolk Observer): Following tripartite meetings with a sample of students (maximum 10% or minimum of 2 per base site) a summary form should be completed and presented to the Pre-Assessment Board for completing students. Cohort of students sample taken from: Number of tripartite meetings: Number of meetings per base site: Ipswich= West Suffolk= Great Yarmouth= Any issues raised form tripartite meetings (include details of actions and action plans): Signature of Student: Date Signature of Sign off Mentor: Date Signature of Observer: Date Date
Signature of Student: Date: Signature of Sign-off Mentor: Date: Signature of Observer: Date:
Have Sign-off Mentor verified signature and has this been cross matched by the Observer? Yes No Summary of meeting: In the context of the previous question, how was validity, reliability and objectivity of assessments ensured (i.e. use of assessment tools, feedback with peers)?
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SIGN-OFF MENTOR
END OF PROGRAMME DECLARATION
This is to certify that _________________________________ (print name of student nurse) Has successfully achieved the required level and number of skills; generic and field specific competencies required by the Nursing and Midwifery Council. The conclusion of this summative assessment has been made in consideration of service user evaluations of the student and the professional opinions of appropriate members of the multi professional team. They are fit to practice and are deemed competent to be entered onto the professional register as a registered nurse. I also confirm that I am registered on the same field of nursing that the student aims to enter. Signature of Sign-off Mentor ………………………………………………… Print Name …………………………………………………………………….. Date of Signature……………………………………………………………… Clinical Area……………………………………………………………………
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INTERVIEW SCHEDULE WITH PERSONAL TUTOR (6)
End of Semester 6: end of year 3 Assessment Comments Practice Assessment Document for year 1 complete
Yes/No
Ongoing Record of Achievement discussed
Yes/No
EU Directives Achieved: � general and specialist medicine
� general and specialist surgery
� child care and paediatrics
� maternity care
� mental health and psychiatry
� care of the older person
� home nursing
Yes/No
Overall comments by Personal Tutor Result Pass Refer
Signature of Personal Tutor: _________________________________ PRINT NAME: _____________________________________________ Signature of Student: _________________________________ Date: _______________
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Absence Record
This is provided as an aid memoire to assist students in planning any clinical recovery.
DATES
Placement area
No. of hours missed
Type of absence; i.e. sickness or personal To From
Please note: all absence time must be made up
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NURSING PRACTICE 3 MODERATION SHEET
Moderator Name _______________________________ Moderator Signature _______________________________ Date _______________________________
Assessment
Y/N Comments
All signatures retrieved and verified
All Service User Feedback Completed
All interview paperwork completed
Overall comments by Moderator
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Meeting EU requirements Article 31 of the EU directive 2005/36/EC specifies that students undertaking adult nursing programmes demonstrate that they have had clinical instruction related to the following specific aspects of care:-
• general and specialist medicine • general and specialist surgery • child care and paediatrics
• maternity care • mental health and psychiatry • care of the old and geriatrics
• home nursing
The students on the BSc. (Hons) Adult Nursing must complete the following forms. It has been agreed that it is good practice for students on the BSc. (Hons) Mental Health Nursing and BSc. (Hons) Child Health Nursing to also undertake this work. Evidence to support the achievement of these aspects of care can be collected throughout the entire programme both through direct care of a patient; completion of the insight work and indirectly (i.e. through simulation in the clinical skills laboratory).
General and specialist medicine Evidence of experiences in which you have had clinical instruction with regard to service users who have required general and specialist medical support.
Evidence of instruction/experience Placement details if relevant Mentor/Facilitator/Personal Tutor Signature
Date
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General and specialist surgery Evidence of experiences in which you have had clinical instruction with regard to service users who have required general and specialist surgery.
Evidence of instruction/experience Placement details if relevant Mentor/Facilitator/Personal Tutor Signature
Date
Child care and paediatrics Evidence of experiences in which you have had clinical instruction with regard to paediatric service users.
Evidence of instruction/experience Placement details if relevant Mentor/Facilitator/Personal Tutor Signature
Date
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Maternity care Evidence of experiences in which you have had clinical instruction with regard to maternity care.
Evidence of instruction/experience Placement details if relevant Mentor/Facilitator/Personal Tutor Signature
Date
Mental health and psychiatry Evidence of experiences in which you have had clinical instruction with regard to service users with mental health care needs
Evidence of instruction/experience Placement details if relevant Mentor/Facilitator/Personal Tutor Signature
Date
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Care of the old and geriatrics Evidence of experiences in which you have had clinical instruction with regard to care of the old and geriatric service users.
Evidence of instruction/experience Placement details if relevant Mentor/Facilitator/Personal Tutor Signature
Date
Home nursing Evidence of experiences in which you have had clinical instruction with regard to service users requiring home nursing.
Evidence of instruction/experience Placement details if relevant Mentor/Facilitator/Personal Tutor Signature
Date
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