Standards of Competency for Entry to the Register

Transcription

1 Department of Nursing and Midwifery Standards of Competency for Entry to the Register Adult Programme Year 3 110

2 Student Orientation to Placement: Year Three (Student to complete) * If you have responded with a YES on day one, you do not need to repeat this in Week 1 Placement 5 DAY ONE Placement 5 During First Week Placement 6 DAY ONE Placement 6 During First Week Name Of Placement Mentor Identified Please Circle YES / NO YES / NO YES / NO YES / NO Induction Pack Available/Given Please Circle YES / NO YES / NO YES / NO YES / NO Emergency Equipment/Procedures Please Circle YES / NO YES / NO YES / NO YES / NO Layout Of Area Please Circle YES / NO YES / NO YES / NO YES / NO Profile Of Learning Opportunities Please Circle YES / NO YES / NO YES / NO YES / NO Introduction To Relevant Personnel Please Circle Access To Local Policies E.G Manual Handling, Infection Control, Child Protection, Vulnerable Adults, Violence At Work, and appropriate others. Please Circle YES / NO YES / NO YES / NO YES / NO YES / NO YES / NO YES / NO YES / NO 111

3 LEARNING CONTRACT: YEAR THREE PLACEMENT FIVE ACTION PLAN TO MEET INDIVIDUAL OUTCOMES AGREED BY STUDENT AND MENTOR: PLACEMENT FIVE Individual outcomes as identified by the student Action Target Date Evaluation 112

4 ACTION PLAN TO MEET INDIVIDUAL OUTCOMES AGREED BY STUDENT AND MENTOR: PLACEMENT FIVE (Cont) Individual outcome as identified by the student Action Target Date Evaluation Mentor s Name: Mentor s signature: Date: Student s Name: Student s signature: Date: 113

5 MID-POINT SUMMARY PLACEMENT FIVE Student Overall Comments: Print name: Signature: Date: Mentor overall comments - Please provide specific comments in relation to the competencies and skills as below. Service user/carer involvement Communication Professionalism/team working Clinical ability Print name: Signature: Date: 114

6 ACTION PLAN TO MEET INDIVIDUAL OUTCOMES AGREED BY STUDENT AND MENTOR: PLACEMENT FIVE (Cont) Outcomes that are causing concern Agreed activities to address areas of concern Target Date Evaluation of Student Performance Mentor s Name: Mentor s signature: Date: Student s Name: Student s signature: Date: 115

7 END OF PLACEMENT SUMMARY PLACEMENT FIVE Student Overall Comments: Print name: Signature: Date: Mentor overall comments - Please provide specific comments in relation to the competencies and skills as below. Service user/carer involvement Communication Professionalism/team working Clinical ability Print name: Signature: Date: CARBONATE IN DUPLICATE White sheet submitted with sheets, student to retain (yellow) copy in booklet. 116

8 LEARNING CONTRACT: YEAR THREE PLACEMENT SIX ACTION PLAN TO MEET INDIVIDUAL OUTCOMES AGREED BY STUDENT AND MENTOR: PLACEMENT SIX Individual outcomes as identified by the student Action Target Date Evaluation 117

9 ACTION PLAN TO MEET INDIVIDUAL OUTCOMES AGREED BY STUDENT AND MENTOR: PLACEMENT SIX (Cont) Individual outcome as identified by the student Action Target Date Evaluation Mentor s Name: Mentor s signature: Date: Student s Name: Student s signature: Date: 118

10 MID-POINT SUMMARY PLACEMENT SIX Student Overall Comments: Print name: Signature: Date: Mentor overall comments - Please provide specific comments in relation to the competencies and skills as below. Service user/carer involvement Communication Professionalism/team working Clinical ability Print name: Signature: Date: 119

11 ACTION PLAN TO ADDRESS ANY AREAS FOR FURTHER DEVELOPMENT FOLLOWING MID-POINT REVIEW. Outcomes that are causing concern Agreed Activities to address areas of concern Target Date Evaluation of Student Performance Mentor s Name: Mentor s signature: Date: Student s Name: Student s signature: Date: 120

12 END OF PLACEMENT SUMMARY PLACEMENT SIX Student Overall Comments: Print name: Signature: Date: Mentor overall comments - Please provide specific comments in relation to the competencies and skills as below. Service user/carer involvement Communication Professionalism/team working Clinical ability Print name: Signature: Date: CARBONATE IN DUPLICATE White sheet submitted with sheets, student to retain (yellow) copy in booklet. 121

13 ADDITIONAL OPPORTUNITIES ACCESSED DURING PLACEMENT Placement learning opportunity (student to complete) How did the additional learning opportunity contribute to achievement of learning outcomes or skills? (student to complete) Practitioner feedback Title, signature and date to verify visit Title, signature and date to verify visit Title, signature and date to verify visit 122

14 ADDITIONAL OPPORTUNITIES ACCESSED DURING PLACEMENT Placement learning opportunity (student to complete) How did the additional learning opportunity contribute to achievement of learning outcomes or skills? (student to complete) Practitioner feedback Title, signature and date to verify visit Title, signature and date to verify visit Title, signature and date to verify visit 123

15 ADDITIONAL OPPORTUNITIES ACCESSED DURING PLACEMENT Placement learning opportunity (student to complete) How did the additional learning opportunity contribute to achievement of learning outcomes or skills? (student to complete) Practitioner feedback Title, signature and date to verify visit Title, signature and date to verify visit Title, signature and date to verify visit 124

16 ADDITIONAL OPPORTUNITIES ACCESSED DURING PLACEMENT Placement learning opportunity (student to complete) How did the additional learning opportunity contribute to achievement of learning outcomes or skills? (student to complete) Practitioner feedback Title, signature and date to verify visit Title, signature and date to verify visit Title, signature and date to verify visit 125

17 ASSESSMENT OF STUDENT COMPETENCIES: YEAR THREE The NMC (2010 p.102) state students must demonstrate their ability to work as autonomous practitioners by the point of registration. Students are required to make safe and effective use of practice learning, which includes less direct supervision in the final part of the programme. This enables students to be confident and fit for practice by entry to the register. The Sign-off mentor, who has met additional NMC requirements, is responsible for making the judgement about whether a student has achieved the overall standards of competence required for entry to the register at the end of an NMC approved programme. 126

18 ASSESSMENT OF STUDENT COMPETENCIES: YEAR THREE In order to assist you in making decisions about the students competence, we have adopted the visual grading system that is used by all students in the faculty and which you may have some knowledge of from previous documents. As a visual reminder we have colour coded each section using a traffic light system. You must assign a colour to each competency using the criteria statements below to help you make an informed judgement about each student s ability across the range. These criteria statements could be included as part of the mid-point and final summative. In order to fulfil the NMC progression criteria students MUST have achieved a minimum of green across all the criteria below for each outcome and skill by the end of the final placement in year three. RED GREEN GRADE FAIL/REFER PASS KNOWLEDGE AND UNDERSTANDING Is not able to demonstrate an adequate knowledge base for the practice of safe care and has significant gaps in understanding. Demonstrates satisfactory knowledge and understanding underpinning safe practice. Demonstrates good knowledge and understanding underpinning safe and effective practice. Demonstrates in depth knowledge and understanding of evidence based practice to deliver safe care. APPLICATION OF CRITICAL THINKING IN THE PRACTICE CONTEXT Demonstrates minimal ability to recognise the service user/carer needs and is unsafe if not closely supervised. Confidently recognises the service user and plans care safely. Recognises the significance of service user carer data / information to design / update interventions / plans of care safely. Critically analyses and comprehensively evaluates care needs to design / update interventions / plans of care safely and independently. CRITICAL PROBLEM SOLVING In practice does not apply problem solving skills, and at times is unable to recognise situations that require this skill. Responds appropriately to defined complex patient care situations. Responds appropriately to defined complex patient care situations, and some unplanned problems. Responds flexibly, and effectively to defined and complex service user care situations and unplanned problems. MANAGER OF CARE TRANSFERABLE & PRACTICAL SKILLS Poor performance, lacks confidence, has not learnt from previous experience, not able to follow directions. Transfers previously acquired skills appropriately. Able to safely and competently follow directions and work independently or under guidance in more complex / unusual situations of care. Transfers previously acquired skills effectively and appropriately. In partnership with the service user/carer is able to work safely and competently in more complex / unusual care situations of care. In partnership with the service user practices competently and confidently in complex or unplanned situations of care, applying previously acquired skills flexibly and effectively. 127

19 EXAMPLE PAGE YEAR THREE ADULT PROGRAMME COMPETENCY CRITERIA COMPETENCY DOMAIN 1: Professional Values RED = Fail/Refer Placement 5 GREEN = Pass Placement 6 Competency Grade Initials Grade Initials Grade Initials Grade Initials 1. Practise with confidence, managing self and others in accordance with NMC code of professional conduct: standards for conduct, performance and ethics, recognising one s own abilities and limitations. Green Green Red Green Supporting Examples: Demonstrates knowledge and application of professional standards; demonstrates a good understanding of personal scope of practice and available support; seeks advice appropriately; acts as a role model in promoting a professional image through adherence to dress code. Indicate types of evidence provided: PO, R, SoLD 2. Practise in accordance with an ethical and legal framework which ensures the primacy of service users interests and wellbeing and respects confidentiality. Red Red Red Green Supporting Examples: With increasing confidence demonstrates knowledge of ethical issues, nursing policies and legislation, including the rationale for sharing information with others when the interests of safety and protection override the need for confidentiality. Indicate types of evidence provided: SoLD, SUCT Key: Types of evidence that may be used to support verification of achievement: PO Practice Observed, SUCT Service User/Carer Testimony N Narrative, Q&A Question and Answer SDS Skills Development Sheet, SoLD Supervision of Learning Days Activity, R Reflection 128

20 COMPETENCY DOMAIN 1: Professional Values RED = Fail/Refer Placement 5 GREEN = Pass Placement 6 Competency Grade Initials Grade Initials Grade Initials Grade Initials 1. Practise with confidence, managing self and others in accordance with NMC code of professional conduct: standards for conduct, performance and ethics, recognising one s own abilities and limitations. Supporting Examples: Demonstrates knowledge and application of professional standards; demonstrates a good understanding of personal scope of practice and available support; seeks advice appropriately; acts as a role model in promoting a professional image through adherence to dress code. Indicate types of evidence provided: 2. Practise in accordance with an ethical and legal framework which ensures the primacy of service users interests and wellbeing and respects confidentiality. Supporting Examples: Demonstrates knowledge and application of ethical issues, nursing policies and legislation, including the rationale for sharing information with others when the interests of safety and protection override the need for confidentiality. Indicate types of evidence provided: Key: Types of evidence that may be used to support verification of achievement: PO Practice Observed, SUCT Service User/Carer Testimony N Narrative, Q&A Question and Answer SDS Skills Development Sheet, SoLD Supervision of Learning Days Activity, R Reflection 129

21 COMPETENCY DOMAIN 1: Professional Values RED = Fail/Refer Placement 5 GREEN = Pass Placement 6 Competency Grade Initials Grade Initials Grade Initials Grade Initials 3. Safeguard vulnerable people, including those with complex needs in accordance with current legislation. Supporting Examples: Demonstrates proactive safeguarding of vulnerable and at risk groups; e.g. those who are ageing, have long term conditions, cognitive impairment and/or at the end of life. Indicate types of evidence provided: 4. Practise in a holistic, non-judgemental, caring and sensitive manner, promoting choice, and the cultural practices of service users. Supporting Examples: Shows awareness of prejudices and biases in self and others; demonstrates spirituality and culturally appropriate care for service users; preserves dignity and compassion in care; challenges inequalities, discrimination and exclusion from access to care. Indicate types of evidence provided: Key: Types of evidence that may be used to support verification of achievement: PO Practice Observed, SUCT Service User/Carer Testimony N Narrative, Q&A Question and Answer SDS Skills Development Sheet, SoLD Supervision of Learning Days Activity, R Reflection 130

22 COMPETENCY DOMAIN 1: Professional Values RED = Fail/Refer Placement 5 GREEN = Pass Placement 6 Competency Grade Initials Grade Initials Grade Initials Grade Initials 5. Be accountable and responsible for continuing professional development to enhance knowledge, skills, values and attitudes. Supporting Examples: Has increasing insight of own learning needs, proactively seeks learning opportunities; enhances safety and quality through evaluation, supervision and appraisal. Indicate types of evidence provided: Key: Types of evidence that may be used to support verification of achievement: PO Practice Observed, SUCT Service User/Carer Testimony N Narrative, Q&A Question and Answer SDS Skills Development Sheet, SoLD Supervision of Learning Days Activity, R Reflection 131

23 COMPETENCY DOMAIN 2: Communication and Interpersonal Skills RED = Fail/Refer Placement 5 GREEN = Pass Placement 6 Competency Grade Initials Grade Initials Grade Initials Grade Initials 6. Initiate, develop and disengage from partnerships and therapeutic relationships using appropriate non discriminatory communication and interpersonal skills. Supporting Examples: Confidently demonstrates accurate and comprehensive written and verbal communication; demonstrates effective inter personal skills, including an awareness of non-verbal skills; shows development of assertiveness with self and others, respecting professional boundaries. Indicate types of evidence provided: 7. Able to use a range of communication strategies including verbal, non verbal and documentation, taking account of people with a variety of specific communication needs. Supporting Examples: In more complex and challenging situations demonstrates warmth, empathy, active listening skills, compassionate and respectful non discriminatory language; obtains, interprets and provides information to service users to inform choices, recognises the impact of service users emotions and health on communication E.g. Braille, sign language, images, audio and IT etc. Indicate types of evidence provided: Key: Types of evidence that may be used to support verification of achievement: PO Practice Observed, SUCT Service User/Carer Testimony N Narrative, Q&A Question and Answer SDS Skills Development Sheet, SoLD Supervision of Learning Days Activity, R Reflection 132

24 COMPETENCY DOMAIN 2: Communication and Interpersonal Skills RED = Fail/Refer Placement 5 GREEN = Pass Placement 6 Competency Grade Initials Grade Initials Grade Initials Grade Initials 8. Promote the concept of self care for service users where appropriate, using effective communication skills and strategies. Supporting Examples: Demonstrates effective partnership working and negotiation skills in complex decision-making processes promoting self care; encourages health promoting behaviour through education, role modelling and effective communication strategies. Indicate types of evidence provided: 9. Maintains accurate, clear and complete records, including the use of electronic formats using appropriate and plain language. Supporting Examples: Completes effective documentation and competent record keeping to support service user care plan, accesses information from a variety of sources including inter-professional and inter-agency working. Indicate types of evidence provided: Key: Types of evidence that may be used to support verification of achievement: PO Practice Observed, SUCT Service User/Carer Testimony N Narrative, Q&A Question and Answer SDS Skills Development Sheet, SoLD Supervision of Learning Days Activity, R Reflection 133

25 COMPETENCY DOMAIN 2: COMMUNICATION AND INTERPERSONAL SKILLS RED = Fail/Refer Placement 5 GREEN = Pass Placement 6 Competency Grade Initials Grade Initials Grade Initials Grade Initials 10. Acknowledging professional boundaries, practises in a safe and assertive manner that recognises and contributes to conflict resolution. Supporting Examples: Knows how to make referrals for advocacy, mediation or arbitration in line with current policies and legislation, keeps information secure and confidential. Key: Types of evidence that may be used to support verification of achievement: PO Practice Observed, SUCT Service User/Carer Testimony N Narrative, Q&A Question and Answer SDS Skills Development Sheet, SoLD Supervision of Learning Days Activity, R Reflection 134

26 COMPETENCY DOMAIN 3: Nursing practice and decisionmaking RED = Fail/Refer Placement 5 GREEN = Pass Placement 6 Competency Grade Initials Grade Initials Grade Initials Grade Initials 11. Applies a broad knowledge of the structure and functions of the human body in the context of the practice setting. Supporting Examples: Has in depth knowledge of physical and mental health and ill health, impairment, long term conditions, ageing and death and related treatments; Facilitates and teaches service users about their condition to optimise their health and wellbeing. Indicate types of evidence provided: 12. Must assess and meet the essential physical, psychological, social and spiritual needs of service users. Supporting Examples: in partnership with service users and others is confident to carry out comprehensive systematic nursing s paying special attention to changing health needs during different life stages including progressive illness and death, loss and bereavement, recognises; interprets signs of deterioration and refers appropriately for more complex care needs. Indicate types of evidence provided: Key: Types of evidence that may be used to support verification of achievement: PO Practice Observed, SUCT Service User/Carer Testimony N Narrative, Q&A Question and Answer SDS Skills Development Sheet, SoLD Supervision of Learning Days Activity, R Reflection 135

27 COMPETENCY DOMAIN 3: Nursing practice and decisionmaking RED = Fail/Refer Placement 5 GREEN = Pass Placement 6 Competency Grade Initials Grade Initials Grade Initials Grade Initials 13. In partnership with service users formulate, document, deliver and evaluate a personcentred plan of nursing care. Supporting Examples: Autonomously identifies and prioritises service user centred goals; reviews and evaluates planned care in partnership with the service users and carers inclusive of end of life care; shows awareness of informed consent and patient choice; provides a rationale for the nursing care delivered in increasingly complex and unplanned situations. Indicate types of evidence provided: 14. Contribute to public and personal protection by creating and maintaining a safe environment of care through the use of quality assurance and managing risk effectively. Supporting Examples: Practises safely recognising when a person is at risk and take action accordingly; contributes to the collection of local and national data, has knowledge and understanding of clinical audit, and effectively reports environmental and clinical risks. Indicate types of evidence provided: Key: Types of evidence that may be used to support verification of achievement: PO Practice Observed, SUCT Service User/Carer Testimony N Narrative, Q&A Question and Answer SDS Skills Development Sheet, SoLD Supervision of Learning Days Activity, R Reflection 136

28 COMPETENCY DOMAIN 3: Nursing practice and decisionmaking RED = Fail/Refer Placement 5 GREEN = Pass Placement 6 Competency Grade Initials Grade Initials Grade Initials Grade Initials 15. Uses health promotion and public health strategies to advocate for and empower individuals, communities and populations. Supporting Examples: Teaches health promotion and public health strategies to advocate for and empower individuals, communities and populations; including people with ill health, impairment, ageing and death and dying, to facilitate the development of others competence. Indicate types of evidence provided: 16. Applies relevant theory and research to practice, based on the best available evidence. Supporting Examples: Confidently incorporates and disseminates current evidence into practice and identifies areas for further investigation; teaches and shares best practice with other staff members. Indicate types of evidence provided: Key: Types of evidence that may be used to support verification of achievement: PO Practice Observed, SUCT Service User/Carer Testimony N Narrative, Q&A Question and Answer SDS Skills Development Sheet, SoLD Supervision of Learning Days Activity, R Reflection 137

29 COMPETENCY DOMAIN 4: Leadership, management and team working RED = Fail/Refer Placement 5 GREEN = Pass Placement 6 Competency Grade Initials Grade Initials Grade Initials Grade Initials 17. Enhance the professional development and safe practice of others through peer support, evaluation and teaching. Supporting Examples: Facilitates others to develop their competence, ability to give and receive constructive feedback, identifies service improvement; manages complaints appropriately. Indicate types of evidence provided: 18. Provide leadership to enhance service users wellbeing and experiences of health care. Supporting Examples: Demonstrates effective leadership skills including self, time, human and resource management; has the potential to act as a change agent ; provides leadership through quality improvement and service development. Indicate types of evidence provided: Key: Types of evidence that may be used to support verification of achievement: PO Practice Observed, SUCT Service User/Carer Testimony N Narrative, Q&A Question and Answer SDS Skills Development Sheet, SoLD Supervision of Learning Days Activity, R Reflection 138

30 COMPETENCY DOMAIN 4: Leadership, management and team working RED = Fail/Refer Placement 5 GREEN = Pass Placement 6 Competency Grade Initials Grade Initials Grade Initials Grade Initials 19. Works effectively across professional and agency boundaries. Supporting Examples: Demonstrates an understanding of the challenges of inter professional working; respects others contributions to integrated person centred care, promotes shared decision making ; co ordinates effective transition within and between services and agencies. Indicate types of evidence provided: 20. Able to identify priorities and manage time and resources to ensure quality of care. Supporting examples: Effectively plans own time; shows application of clinical governance procedures, responds appropriately to planned and uncertain situations ensuring quality of care is maintained or enhanced, systematically evaluates care and ensure that findings improve experiences and outcomes. Indicate types of evidence provided: Key: Types of evidence that may be used to Support Verification of Achievement PO Practice observed, SUCT Service User/Carer Testimony N Narrative, Q&A Question and answer SDS Skills Development Sheet, SoLD Supervision of Learning Days activity, R Reflection 139

31 COMPETENCY DOMAIN 4: Leadership, management and team working RED = Fail/Refer Placement 5 GREEN = Pass Placement 6 Competency Grade Initials Grade Initials Grade Initials Grade Initials 21. Must work independently as well as in teams to coordinate, delegate and supervise care safely. Supporting Examples: Takes the lead in co-ordinating, delegating and supervising care safely, managing risk, self and others while remaining accountable. Indicate types of evidence provided: Key: Types of evidence that may be used to support verification of achievement: PO Practice Observed, SUCT Service User/Carer Testimony N Narrative, Q&A Question and Answer SDS Skills Development Sheet, SoLD Supervision of Learning Days Activity, R Reflection 140

32 MIDPOINT MENTOR AND STUDENT REVIEW (TO BE COMPLETED AT THE END OF PLACEMENT FIVE) Competency Outcome- Indicate Colour Number of passed skills: Online Numeracy Test: Achieved/Not Achieved Mentor s Name: Mentor s signature: Date: Student s Name: Student s signature: Date: CARBONATE IN DUPLICATE- White sheet to be sent to module leader, student to retain a carbon copy (yellow) in booklet. 141

33 MID POINT (END OF PLACEMENT FIVE) PERSONAL TUTOR/ GDP FACILITATOR REVIEW Personal Tutor / GDP Facilitator Comments I have reviewed the above student s Ongoing Achievement Record and portfolio of evidence and given advice and support and informed the module leader of the students progress. Personal tutor name: Personal tutor signature: Date: I have reviewed my progress with my personal tutor and received advice and support from them. I have completed the practice evaluation form. Student name: Student signature: Date: 142

34 EXAMPLE PAGE: FINAL SUBMISSION OF PRACTICE: YEAR THREE Student Name P A NOTHER Student Number Title of Programme, Site and Field: (e.g. MSc, BSc(Hon) OR Grad Dip Adult Nursing, L/D nursing, M/H nursing, Children s nursing etc) BSc (Hons) ADULT NURSING, Glenside Module Title Practice 1 Module Code UZU Module Leader D A NOTHER Personal Tutor/GDP Facilitator R A NOTHER Name: Placement 5 Community Nurses Mentor Name K A NOTHER Name: Placement 6 (final placement) Intensive Care Mentor Name (sign off) L A NOTHER TO BE COMPLETED AT THE END OF THE FINAL PLACEMENT YEAR THREE Please grade the numbered NMC competency boxes with the relevant colour codes and sign as confirmation of accuracy NMC Grading (Colour) Mentor NMC Grading (Colour) Mentor Competency Signature and Date Competency Year 3 skills passed? Signature and Date YES / NO 1 GREEN L A Nother I can confirm that the year three competencies and skills have been successfully passed Mentor Name: Signature: Date: Practice evaluation forms completed (student signature).. CARBONATE IN DUPLICATE Attach front white copy of all feedback sheets to this sheet and submit these in nominated box for programmes. Yellow copies to be retained in the student passport DO NOT TEAR OUT failure to retain copies could result in your referral in the programme, see module handbook for further details 143

35 FINAL SUBMISSION OF PRACTICE: YEAR THREE Student Name Student Number Title of Programme, Site and Field: (e.g. MSc, BSc(Hon) OR Grad Dip Adult Nursing, L/D nursing, M/H nursing, Children s nursing etc) Module Title Module Leader Name: Placement 5 Name: Placement 6 (final placement) Module Code Personal Tutor/GDP Facilitator Mentor Name Mentor Name (sign off) TO BE COMPLETED AT THE END OF THE FINAL PLACEMENT YEAR THREE Please grade the numbered NMC competency boxes with the relevant colour codes and sign as confirmation of accuracy NMC Grading (Colour) Mentor NMC Grading (Colour) Mentor Competency Signature and Date Competency Year 3 skills passed? Signature and Date 1 12 YES / NO I can confirm that the year three competencies and skills have been successfully passed Mentor Name: Signature: Date: Practice evaluation forms completed (student signature).. CARBONATE IN DUPLICATE Attach front white copy of all feedback sheets to this sheet and submit these in nominated box for programmes. Yellow copies to be retained in the student passport DO NOT TEAR OUT failure to retain copies could result in your referral in the programme, see module handbook for further details. 144

36 LEARNING CONTRACT: RETRIEVAL PLACEMENT MODULE CODE AND TITLE:.. ACTION PLAN TO MEET INDIVIDUAL OUTCOMES AGREED BY STUDENT AND MENTOR: RETRIEVAL PLACEMENT Individual outcomes as identified by the student Action Target Date Evaluation 145

37 ACTION PLAN TO MEET INDIVIDUAL OUTCOMES AGREED BY STUDENT AND MENTOR: RETRIEVAL PLACEMENT (Cont) Individual outcome as identified by the student Action Target Date Evaluation Mentor s Name: Mentor s signature: Date: Student s Name: Student s signature: Date: CARBONATE IN TRIPLICATE White sheet submitted with sheets, student to retain a carbon copy (yellow) in booklet, mentor to retain (pink) copy. 146

38 RETRIEVAL MID-POINT SUMMARY Student Overall Comments: Print name: Signature: Date: Mentor overall comments- please provide specific comments in relation to the competencies and skills as below: Service user/carer involvement Communication Professionalism/team working Clinical ability Print name: Signature: Date: CARBONATE IN DUPLICATE White sheet submitted with sheets, student to retain (yellow) copy in booklet. 147

39 ACTION PLAN TO ADDRESS ANY AREAS FOR FURTHER DEVELOPMENT FOLLOWING MID-POINT REVIEW Outcomes that are causing concern Agreed Activities to address areas of concern Target Date Evaluation of Student Performance Mentor s Name: Mentor s signature: Date: Student s Name: Student s signature: Date: Identify number of additional sheets used: 148

40 RETRIEVAL END OF PLACEMENT SUMMARY Student Overall Comments: Print name: Signature: Date: Mentor overall comments- please provide specific comments in relation to the competencies and skills as below: Service user/carer involvement Communication Professionalism/team working Clinical ability Print name: Signature: Date: CARBONATE IN DUPLICATE White sheet submitted with sheets, student to retain (yellow) copy in booklet. 149

41 RETRIEVAL OF PRACTICE ASSESSMENT: BRANCH PROGRAMME - YEAR THREE Student Name Student Number Title of Programme, Site and Field: (e.g. MSc, BSc(Hon) OR Grad Dip Adult Nursing, L/D nursing, M/H nursing, Children s nursing etc) Module Title Module Leader Name: Placement 5 Name: Placement 6 (final placement) Module Code Personal Tutor/GDP Facilitator Mentor Name Mentor Name (sign off) TO BE COMPLETED AT THE SUMMATIVE ASSESSMENT POINT OF THE FINAL PLACEMENT: YEAR THREE Please grade the NMC competency boxes with the relevant colour codes and sign as confirmation of accuracy NMC Grading (Colour) Mentor NMC Grading (Colour) Mentor Competency Signature and Date Competency Year 3 skills passed? Signature and Date 1 12 YES / NO I can confirm that the year three competencies and skills have been successfully passed Mentor Name: Signature: Date: CARBONATE IN DUPLICATE Attach front white copy of all feedback sheets to this sheet and submit these in nominated box for programmes. Yellow copies to be retained in the student passport DO NOT TEAR OUT failure to retain copies could result in your referral in the programme, see module handbook for further details. 150