CONTENTS. Section 1 [Cream] Assessment of practice-guidance for mentors, students and lecturers. Section 2 [Pink] Outcomes for grading 13-32

Transcription

1 CONTENTS Section 1 [Cream] Assessment of practice-guidance for mentors, students and lecturers Table: guidance for supervision and assessment of students Pages Section 2 [Pink] Outcomes for grading OSCA: Handwashing OSCA: Physiological assessment Section 3 [Yellow] Assessment Documentation Induction [hub and spokes] 37 Initial interview [hub] 38 Intermediate Interview [hub] 40 Intermediate review: Academic advisor 45 Spoke/pathway documentation Visits documentation Final Interview [hub] Final interview [Academic advisor] 82 1

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3 Assessment of Practice Information and guidance for mentors, students and lecturers Practice comprises 50% of the nursing programme. Assessment of practice forms one part of the assessment of 2 modules in the first year: 'Essentials of Nursing Science and Practice' and 'Introduction to relationship-centred care, science and practice'. The NMC [2010] requires that evidence of the level and range of practice related learning should be documented within the student's Ongoing Achievement Record. This in turn will form a major part of the student nurse's Personal and Professional Development Portfolio (PPDP), which is the student's personal record of their learning through the programme. Completed documents should be stored in the PPDP. The Ongoing Achievement Record consists of 2 parts: Part A: The Competency Assessment Document Part B: The Record of Skills and Experience Part A contains assessment documentation that students MUST pass each year in order to progress, whilst part B provides evidence of the range of experiences and skills: a cumulative record of each student's development over the length of the programme. Competence The overall aim of assessment in practice is to ensure that students demonstrate the competence required for entry to the NMC Register. The NMC (2010, p11) suggests that 'competence' is a holistic concept that involves 'the combination of knowledge, skills and attitudes' along with 'values and technical abilities that underpin safe and effective nursing practice'. In the 'Standards for preregistration nursing education' (2010), the NMC identify standards for competence, describing the knowledge, skills and attitudes which students must acquire and demonstrate by the end of the degree programme. The competencies are organised into 4 domains: Domain 1: Professional Values Domain 2: Communication and interpersonal skills Domain 3: Nursing practice and decision making Domain 4: Leadership, management and team working This competency framework therefore forms the basis for the assessment of practice documentation. Within this framework are generic competencies that must be achieved by all nurses and field specific competencies which relate to either Mental Health nursing, Children's nursing or Adult nursing Therefore, each field of nursing has it's own individual Ongoing Achievement Record documentation, which has the generic and field specific competencies embedded within the practice learning outcomes to be achieved. 3

4 Assessing competence In order to achieve the judgement of 'competent', at this stage of the programme, under the close direction/supervision of a Health and Social Care practitioner, students will need to consistently perform the required skills safely and effectively, adhering to local policies. This also involves ensuring that professional values are maintained, so the student should gain consent, demonstrate sensitivity, respect and care for the person, maintain their dignity and privacy and document actions/omissions appropriately. Whilst meeting physical care needs, the students should also meet the individual's psychological needs, communicating effectively with the person. The mentor/supervising practitioner should also always ask appropriate questions to check that the student has knowledge and understanding of the evidence-base that underpins the skill. Progression Points In addition, the NMC (2010) emphasises that there must be 2 progression points within the programme. They identify minimum standards of practice relating to safety and values that students must achieve by the end of Year 1/stage 1 of the programme, before they can progress into stage 2. Then at the end of Year 2/stage 2, there is a further progression point where students must demonstrate that they can take more responsibility for their own learning and practice, work more independently with less supervision, before they progress into the last stage of the programme. Again, these minimum standards at progression points are embedded into the Competency Assessment Document, so that if students achieve the outcomes identified in this document, then they have met the NMC progression point requirements. Essential Skills Clusters (ESCs) Additional guidelines for practice development exist in the form of 'Essential Skills Clusters' (NMC, 2010). Some of these are encompassed by the NMC competencies and where this is the case, they have been mapped to the practice learning outcomes. Others are incorporated within part B of the Ongoing Achievement Record: the Record of Skills and Experience, to be accumulated over the length of the programme. Assessment of Numeracy/Calculation skills The NMC (2010) particularly emphasise the need for numeracy skills in nursing. They identify baseline skills needed to calculate medicines, nutrition, fluids and other areas where there is a need to use numbers. Whilst in University, as part of the development of knowledge and skills in relation to medicines management, students will undertake preparation for practice assessment which contributes to Part A of the OAR. This tests the student's ability to accurately calculate dosages for tablets, liquid medicines, injections, and IV infusions. In the first year, students will be expected to achieve 80% in this assessment, then 90% in the second year and 100% in the third year. Students are not allowed into the practice setting unless this has been achieved, but it is vital that numeracy is also assessed in practice. Numeracy skills appear in several Essential Skills Clusters which are marked with an asterisk *. In addition, they are assessed in practice as they are incorporated into both physiological measurement and medicine administration Objective Structured Clinical Assessments [OSCAs] in years 1 and 2 as well as in outcomes/skills contained in the Ongoing Achievement Record in either part A or B 4

5 Continuous Assessment and Objective Structured Clinical Assessments (OSCAs) Within the competency assessment document are Objective Structured Clinical Assessments (OSCAs). These provide a 'snapshot' of particular elements of competence and are designed to add 'rigour' to the assessment process. Detailed standard criteria are provided for mentors to use to evaluate the student's performance throughout the placement. The first OSCA, relating to handwashing, should be performed within the first 2 weeks of placement as this is a key skill in practice and is essential to ensure safety of service users and staff. This observation enables the mentor to quickly and accurately identify strengths and weaknesses, provide specific feedback and if performance is unsatisfactory, the opportunity to provide focused coaching. This process can be repeated and if the required standard has not been achieved by the intermediate review, then this should be documented and remedial action incorporated within an action plan. The second OSCA, to be achieved before the end of the first placement, will relate to physiological assessment. Again, physiological assessment is a core skill which is vital for safe practice, in all fields of nursing. The evidence from these observations will contribute to the mentor's decision in the final assessment. However, it is important to note that assessment of practice is continuous in nature and although competence may have been demonstrated in an OSCA, students are expected to consistently maintain this level of competence in order to pass the final assessment. Clinical Placement 'The clinical placement' means the whole of the planned clinical experiences identified for the student during the year/stage. This will consist of a 'hub', several 'spokes' and some 'visits'. The hub is the primary placement: the 'base', which may be a person or an area, where students will spend the majority of the placement. The 'hub' will provide a qualified mentor who will be responsible for the overall assessment of the student's clinical progress and achievements during this year/stage. In addition, to broaden their experience, students will undertake a number of spokes: pathway placements [each lasting between 1-3 weeks] as well as a number of visits [lasting up to a week]. During these experiences, students will be allocated another mentor/supervisor who will contribute to the assessment process by providing evidence in the form of testimonies and by signing appropriate sections in the Record of Skills and Experience to record the student's achievements. NB: If there is a lack of opportunity to achieve the learning outcomes/competencies, the link lecturer should be involved early, to ensure appropriate opportunities can be provided. 5

6 Practice Learning and Assessment: Student responsibilities Prior to placement. As adults, students are responsible for their own learning and, to facilitate this, they need to prepare for placements. They should Identify the nature of the placement [including hubs and spokes] and contact placement areas Familiarise themselves with outcomes/competencies to be achieved Familiarise themselves with Objective Structured Clinical Assessments due to be achieved Identify priorities in skills/experiences in part B of the Ongoing Achievement Record Identify and document goals for development during the placement Complete name, dates, placement details [including hubs and spokes] in the document During the placement. In order to develop competence, students need to fully engage with experiences available in practice, through Observing and participating in practice, wherever appropriate 1 Asking relevant questions at appropriate times Reflecting upon experiences and reading related literature in order to understand the needs of the client group and rationale for actions, thus linking theory and practice. At least 4 written reflections are required relating to clinical placements in the first year. These should be at least 500 words long, referenced and demonstrate the linking of theory and practice, as they comprise part of the evidence for achievement of some specific outcomes/competencies. In addition, there are specific materials relating to medicines management [eg: drug diary] which students should complete during the placement Actively seeking feedback on their performance Collecting appropriate evidence from practitioners with whom they work 2, in the form of at least 2 testimonies and completion of the Record of Skills and Experience. It is vital that this is maintained as it will provide essential evidence for the 'sign off' mentor in year 3, that the range of skills and experience which the NMC state is required for entry to the register has been achieved. To facilitate this, the student must ensure that both parts of the Ongoing Achievement Record are available at all times on placement. Prior to the intermediate interview, the student should obtain at least one testimony and use reflection hours to complete self-review section, log of experiences and at least 2 pieces of reflection Prior to the final interview, the student should obtain at least one more testimony and use the allocated reflective hours to complete the self assessment section, log of experiences and the remaining 2 pieces of reflection. If at any time, concerns are expressed about student progress, the student should contact the link lecturer, their academic advisor and student support officer. Following clinical placement. The student must attend an interview with their academic advisor when in University half way through placement A and after completing placement A. It is the student's responsibility to arrange mid term and final appointments. The final interview with academic advisor should normally occur within 5 working days of the end of the student s placement (or designated assessment date - see your assessment schedule). Failure to arrange this may mean that the results of the assessment of practice are not presented at the appropriate Assessment Board and recorded as a 'failure to submit'. Students should contact Student Support Officer if there are difficulties. 1 NB: Students should always ensure that patients/clients are aware of their student status and gain consent for care. However, patients/clients have the right to refuse care from an unqualified practitioner 2 NB: Students are reminded that fraudulent entry of assessment outcomes or signatures by a student in any document is a serious disciplinary matter that will be investigated by the University and may result in exclusion of the student from the programme. 6

7 Practice Learning and Assessment: Long arm Mentor responsibilities on Hub 3 Prior to placement. The mentor should Check student allocation and identify mentees, noting the level/cohort of the student Ensure they have been updated within the last year and that they have had a triennial review within last 3 years if more than 3 years since their mentor preparation. If not, arrangements must be made to achieve these NMC requirements before mentoring students Check their availability to work with the student, particularly during the first week, when the initial interview will be required. Also, that they are available throughout the placement. NB: The NMC (2010) state that every student must be assigned a mentor at the beginning of a practice learning experience, who will need to be available to students for at least 40% of the time. Careful negotiation of the student's off duty is required to facilitate this. During the placement. The mentor should Ensure that an appropriate induction is given Conduct the initial interview, formulating an action plan for student development Work alongside the student, demonstrating and teaching evidence-based practice Directly observe and supervise the student's practice Ensure that any relevant OSCA's are conducted Provide feedback for the student on their progress Give feedback to student, document, liaise with LEM and link lecturer when students are a cause for concern However, when the mentor is not available to work with the student, in order to safeguard patients/clients and aid the student's learning, the mentor may delegate some day-to-day supervision to other registered professionals, provided the 40% time requirement is achieved. The student must always be supervised either directly or indirectly, appropriate to the nature of the placement and ability of the student. Therefore, during the placement, a number of practitioners may supervise the student and facilitate their development and supervisors should provide regular feedback about the student's progress to the assigned mentor (NMC, 2010). The mentor will need to adopt a team approach by gathering evidence from colleagues about the student's performance and encourage the student to do the same. Whilst students should be proactive in evidence collection, mentors need to: Ensure written testimonies are available from other practitioners/service users, which provide evidence of the student's abilities and constructive feedback in relation to the outcomes/competencies. Ensure relevant sections within the Record of Skills and Experience are completed. Ultimately the mentor's role is to assess the student. This evidence from others adds 'rigour' to the assessment, helps to ensure the reliability of the assessment and reduces subjectivity in the assessment process as it is not based on a single person's viewpoint. However, it is important to note that the mentor remains responsible and accountable for all the student's learning and assessment (NMC, 2010). Therefore, direct observation of the student by the mentor, remains an important aspect of assessment. The mentor must make the final judgement about whether there is sufficient evidence that the student has achieved the required level of competence. 3 Students and mentors should access the following web site regularly for up to date information. 7

8 Practice Learning and Assessment: Learning Environment Manager responsibilities Prior to placement. On receipt of allocation list Learning Environment Managers [LEMs] should Check that they have sufficient appropriate mentors who will be available for the students allocated. NB: Mentors must have been updated within the last year and had a triennial review within the last 3 years if more than 3 years since their mentor preparation Contact placements if any problems are anticipated. Assign appropriately qualified mentors to students and make them aware of this. Specifically check mentor availability during the first week, when the initial interview is required. If the mentor is not available during the first week, a suitably prepared supervisor should be identified to support the student and complete this interview and induction. During the placement. The LEM should Support the mentor and student as required Support the assessment process when there are concerns about a student's progress in clinical practice [involving link lecturer] Make contingency arrangements for student support if mentor becomes unavailable Provide guidance and feedback to ensure quality of learning, supervision and assessment. Ongoing responsibilities Learning Environment Managers [LEMs] should Oversee the placement to ensure it provides a positive learning environment Identify learning opportunities available on the placement Formulate and update placement profile, welcome packs as appropriate Support or direct mentors to appropriate opportunities for annual updating and triennial review Work in partnership with the link lecturer to complete the audit and maintain an up to date live register of mentors Monitor and respond to student evaluation, supporting action plans for development of the learning environment Practice Learning and Assessment: Link lecturer responsibilities Ongoing responsibilities: Link lecturers should Audit practice learning environments to ensure the required standards are met. Provide opportunities to update staff, to meet NMC requirements for mentorship, to ensure mentors and supervisors understand the programme, assessment processes and criteria, expectations of students and their role. Visit/contact designated practice link areas to increase understanding of the nature of the placements and current issues which may impact on student learning Provide guidance and support for LEMs, mentors and students. Respond to any concerns expressed by students/ LEMs/mentors and provide appropriate support and guidance. During student placements: If a student is identified as 'not progressing', this can be very stressful for all involved. Link lecturers should provide appropriate support to the mentor, whilst taking a quality control role: ensuring assessment processes are adhered to and that documentation is completed accurately. In addition, they should provide support to the student, to ensure that they understand the assessment processes and have a clear action plan which includes support strategies. Lastly, they should inform the student's academic advisor, relevant module leaders and level manager of any student who is not achieving the learning outcomes. 8

9 The Assessment of Practice Process: Hub placement To fulfil the required assessment of practice process, a minimum of 3 progress interviews must take place between the mentor and student: the initial, intermediate and final interview. Initial Interview This should take place within the first week of the Hub placement and involves discussion between student and the long arm mentor. Goals and an action plan to achieve them should be agreed, documented and signed. In addition, the student should complete 'placement information' and the mentor must complete 'mentor information' and sign the specimen signature. Intermediate Interview At least one intermediate interview should take place, approximately midway through the placement. However, mentors will need to plan the timing of this carefully, taking account of the pattern of the hubs and spokes. If the student is leaving the hub for a significant period of time, it is recommended that their progress should be formally reviewed and documentation completed before they move. In this interview, the mentor and the student review progress towards achieving the practice learning outcomes and the mentor should provide appropriate feedback. The mentor should make their judgement using a variety of evidence [further guidance is given later]. An action plan to focus development in the spoke placements and/or second part of the placement should be agreed. The documentation for intermediate progress review should be completed and signed Additional review of progress It is advisable to undertake a further review of progress when the student returns to the hub after a significant period of time away, or if the mentor has been changed, or when there have been concerns about a student's progress. The action plan should be reviewed and, if required, another action plan formulated to focus development in the last part of the placement should be agreed. The documentation for additional progress review should be completed and signed. Final Interview Here the long arm mentor on the Hub placement and the student review and discuss the learning achieved during the placement. The mentor awards a final grade and ensures all the documentation is completed. Concerns about student progress If at any time, there are any concerns about a student, the link lecturer should be notified as soon as possible. Concerns may relate to attendance, knowledge, progress, ability, behaviour, health etc. The Hub mentor should not wait until the intermediate/final review to raise concerns. Any concerns should be documented in the appropriate section and an action plan developed to address these. Review of achievement with academic advisor Following the placement, the student and academic advisor meet to review progress. At this interview the academic advisor and student review both parts of the completed Ongoing Achievement Record so that the academic advisor can verify the assessment outcome. The student and the academic advisor should also use this opportunity to review the student s portfolio and discuss the student s plan for future development. 9

10 Assessment of practice: Link to the modules This Competency Assessment Document contains the practice assessment for 2 modules to be achieved during Placement A. The 'Introduction to relationship-centred care, science and practice' module contains the following module learning outcome: 'Demonstrate NMC competencies to meet the requirements of progression part 1 and essential care skills required for practice, against the NMC Domains: 'Communication and Interpersonal skills' and 'Leadership, Management and Team working'' Domain 2 'Communication and Interpersonal skills', contain practice learning outcomes for grading which link implicitly to this module. Embedded in this domain are outcomes related to relationshipcentred care: developing a therapeutic relationship with services users, which is at the heart of nursing, as well as relationships with their family, significant others and carers. Domain 4 'Leadership, Management and Team working' contains outcomes which emphasise the development of self-management and collaborative working within the nursing team and wider multidisciplinary team, where again relationships are vital to delivery of quality care. The 'Essentials of nursing science and practice' module also contains a module learning outcome which is practice based: 'Demonstrate NMC competencies to meet the requirements of progression part 1 and essential care skills required for practice, against the NMC Domains: 'Professional Values' and 'Nursing Practice and Decision Making'' Domain 1 'Professional values' includes practice learning outcomes for grading relating to professional values/ behaviour and the underpinning ethical and legal frameworks which guide nursing. Evidence-based practice is intrinsic within these values and so the theory-practice connection between the module content and practice assessment is strong. Domain 3 'Nursing practice and decision making' contains outcomes and competencies which encompass the vast scope of nursing knowledge and skills: the everyday nursing actions and interventions which nurses need to practice safely. Underpinning these are life and social sciences and the science of nursing to enable holistic care, so again the theory-practice link is overt. In order to streamline the assessment and help mentors, the practice assessment documentation for both these modules have been combined into one booklet. The document has clearly separate domains within it and the final assessment grading is separated into domains, so that the result for each domain and therefore for each module, is clear and unambiguous. The following offers explanation about grading and progression: 10

11 Grading and progression: Placement A Pass grade awarded If ALL the practice learning outcomes are graded as 'Achieved' in placement A, then a PASS grade is awarded for all 4 domains by the mentor. The student can progress to Year 2 and placement B. In University, the Academic Advisor enters a PASS grade in the Assessment of practice sections of both the 'Essentials of nursing science and practice' and the 'Introduction to relationship-centred care, science and practice' modules in grade centre Refer grade awarded If ANY of the practice learning outcomes are graded as 'Not Achieved' in placement A, then a REFER grade is awarded for the specific domain[s] which contains the outcome[s] not achieved, by the mentor and the specific outcomes/elements not achieved should be identified. In University, the academic advisor identifies which Domains the student has passed and which they have not. Domains 1 and 3, constitute the assessment of practice for Essentials of nursing science and practice and Domains 2 and 4 are the assessment of practice for the Introduction to relationshipcentred care, science and practice module. The appropriate grade of PASS/REFER is entered in the relevant modules in grade centre. The student may be Referred in one module or both, depending on their grading for each. However, if the student has not achieved ALL the outcomes/competencies identified for Year 1, then they have not achieved the minimum standard identified by the NMC (2010) for progression to Year 2. In this situation, a student cannot progress to year 2, placement B until the outcomes have been achieved, but another [final] attempt can be made by referred students before the end of the first year. The academic advisor should inform the module leader and level manager where a refer grade has been awarded. The student will need to return to the Hub placement for an additional 4 weeks, in order to undertake another attempt to achieve the outstanding outcomes. Any practice learning outcomes not achieved during placement A should be documented appropriately in the 'Initial Interview' section of the refer placement documentation in order that an appropriate action plan can be developed with the mentor [who will also have access to placement A documentation]. The appropriate link lecturer will be involved in supporting the mentor and student during this 'refer' placement. If the student achieves ALL the outstanding practice learning outcomes in the refer placement, then a PASS grade is awarded for the refer [final] attempt at the specified domains by the mentor and the student can progress to Year 2. The academic supervisor records a PASS grade in the appropriate module on grade centre. If the student is unsuccessful at this second attempt the outcomes not achieved will be graded as FAIL and this should be recorded on grade centre according to relevant domain/module as described previously. Where a student has had 2 attempts and failed, they are unable to progress and they will need to withdraw from the programme. The modules are exempt from re-registration regulations. 11

12 Assessing a student s achievement: the following can be used for guidance 4 alongside Year 1/Stage 1 outcomes to be graded Academic and experiential level Degree of supervision expected. Mentor role For student to be graded as Achieved For student to be graded as Not Achieved Year 1, Level 4, Exposure Initially, close and direct supervision for all activities. facilitates orientation to the activity provides instruction or delegates this to others facilitates reflection observes the student s performance offers frequent feedback. asks the student questions to check for understanding. shows interest in practice actively takes up opportunities to observe activities are keen to participate can accurately describe the care given. can describe the evidence base for care [has read something] recognises own limitations asks for help when appropriate shows little interest in practice needs prompting to observe activities reluctant to participate cannot describe care that they have seen cannot describe the evidence base for care does not ask questions does not ask for help Year 1, Level 4, Identification and Participation Gradually reducing level of supervision for routine and predictable activities. Close, direct supervision continues for new, more complex or less routine activities. observes the student s practice and offers feedback occasionally prompts the student for routine predictable care liaises with others to obtain feedback about the student s performance prompts student to obtain written testimonies. participates effectively, follows instructions appropriately starts to take the initiative to perform routine and predictable activities needs only occasional prompting for single tasks demonstrates safe and effective practice related to expected outcomes can describe the evidence base for care [has read something] recognises their limitations asks for help when appropriate recognises and reports safety issues takes responsibility for learning and collection of evidence is reluctant to participate still requires close supervision for routine and predictable activities requires repeated prompting for routine and predictable activities does not demonstrate required level of competence demonstrates lack of awareness of safety issues has little awareness of knowledge underpinning practice does not ask for help when appropriate does not take responsibility for own learning and collection of evidence either acts outside their role boundaries/ limitations, or does not try to develop 4 Adapted from work by Stuart CC (2007) Assessment, supervision and support in clinical practice 2 nd edition, Edinburgh, Churchill Livingstone 12