Preceptorship programme 2015 -2016

In collaboration with:

Catherine McAuley School of Nursing and Midwifery, University College, Cork (UCC)

Nurse Education Centre, Bons Secours Hospital

Cork University Hospital Centre of Nurse Education

Mercy University Hospital Centre of Nurse Education

The Health Service Providers: HSE Southern, BSH, CUH,CUMH, MUH, SIVH, Cork MHS, COPE Foundation.

Nursing & Midwifery Planning Development Unit.

Introduction to programme• Background to to-day’s programme

• all nurses who support students attend a teaching and assessing course.

• … each student whilst on clinical placement should be assigned a named preceptor who is a registered nurse.

( Government of Ireland, 2000)

Information on preceptorship • All information can be accessed on School of Nursing and

Midwifery website on the following link: http://www.ucc.ie/en/nursingmidwifery/allocations/preceptorinfo/

We strongly encourage you all to use this site as there is a new interactive guide called the On-Line Support Package for trained Preceptors (Registered Nurse/Midwife), Student Nurses and Student Midwives which Provides an Over-view of the Clinical Assessment Process

Introduction• Code of Professional Conduct and Ethics for Registered

Nurses and Registered Midwives (NMBI 2014).

• “You must support junior colleagues and nursing, midwifery and other healthcare students in the learning and on-going development of their professional values, practice and conduct” (Principle 5, Standard 5, NMBI 2014)

• “In your role of guiding and directing student nurses or midwives you must take responsibility for the care they provide. This involves supporting, learning, teaching, supervising, assessing practice and taking action to address concerns where they are identified” (Principle 5, Standard 6, NMBI 2014)

• “you should ensure that the patient understands the role of the student nurse or midwife and that the student is supervised by a registered nurse or midwife” Principle 5, Standard 7, NMBI 2014)

Who is a preceptor “A preceptor is a registered nurse/midwife who has

undertaken preparation for the role and who supports undergraduate nursing and midwifery students in their learning in the practice setting and assumes the role of supervisor and assessor of the students’ achievement of clinical learning outcomes and competence” (NMBI 2015, pg 104)

An associate preceptor is a delegated associate who

acts in the absence of the preceptor (An Bord Altranais, 2000)

Key elements: Short term, teaching, supporting, supervising, role model, critical and problem skill development.

“ A preceptor is a nurse, who teaches and supports the student and is seen as pivotal to student learning within the clinical setting” (Carlson, Wann Hansson, Pilhammar 2009).

“The preceptor acts as a role model, their behaviours are important for the enhancement of critical thinking and problem solving skills” (Myrick and Yonge 2001,Burns et al 2006)

Desired qualities of preceptors • RGN with expertise in the clinical area • Good communication skills• Decision making abilities• Interest in the professional growth of all nurses• Desire to teach and undertake the preceptorship role• Flexibility to provide an individual learning experience• Non-judgmental attitude • Assertive• Adaptability to meet individual teaching needs• Committed • Leadership skills

Procedural responsibilities of the Preceptor1. Assessment of students needsAssessment of students learning needs by referring to

appropriate learning outcomes/ objectives and through discussion with student.

May need to consult with CNM1/CNM2/CPC’s for further clarity

2. Planning• Collaborative planning of a teaching programme to suit

the student’s needs.

• Plan depends on the length of preceptorship relationship

3. ImplementationOrientation and socialisation of the student to the

ward

Acting as a teacher and a role model

Observation and evaluation the student throughout the preceptorship period

• Facilitating development of the student as he or she advances through the clinical placement by continuous feedback (formal and informal)

• Facilitating the achievement of the learning objectives

4. Evaluation• Ensuring that the goals that were set at the

beginning of the clinical placement have been met.

• Feedback on students performance to student.CNM1, CNM2, CPC.

Preceptor are supported by: • Colleagues• Clinical placement co-ordinators • Link Lecturers • http://www.ucc.ie/en/nursingmidwifery/

AllocationsInformation/preceptorinfo/ • An Bord Altranais documents • Guidelines on the key points that may be

considered when developing a quality clinical learning environment• Requirements and standards for nurse

registration education programmes (4th edition 2015)• Requirements and standards for the midwife

registration education programme (4th edition 2015)

Benefits to the StudentAssisted in integrating into the clinical environment

Learning and advancing clinical skills

Achievement of learning outcomes/ objectives

Develop clinical decision making skills

Linking theory to practice

Member of a patient care team

Gain confidence in caring for patient/s /clients/ service users

Benefits to the preceptor • Personal growth• Satisfaction• Challenge• Extension of existing role/stimulating• Additional experience and skills in facilitating staff

development

Benefit for the Patient/Management

Quality care delivered to a professional standard

As a registered nurse • Your role continues to be essential;• to retain the essence of nursing• to maintain clinical competence and

hence patient safety• support an environment which facilitates

learning• assess students suitability to progress

towards registration• to prepare students for entry to the

profession

Background to BScCommission on Nursing (1998)

“ … pre-registration nursing education be based on a four year degree programme … with structured clinical placement within the health service … fully integrated in within third level sector.

(Commission on Nursing, 1998, page 4)

Student intake 2015 = 200+ (approx.)

General nursing = 114 CUH - 54 Bon Secours –20

MUH -24 SIVUH – 16

General and Children CUH = 21

Psychiatry Nursing = 21HSE –Southern Area Mental Health Services

Intellectual Disability = 21 COPE Foundation

Midwifery CUMH = 21

Disability – Fitness to Practice UCC policy Flow chart re self declared or reported health concerns for fitness to practice

Upon acceptance of a programme in UCC, Student completes Health Declaration form and return to Student Health UCC

Health disclosure form completed by Student and Head of School -if identified following acceptance of place

Details of Health Disclosure reviewed by Student Health Department

Consultant Occupational Health Physician review required ?

NO YES

NO YES DSS Input High Level of

reasonable accommodations

Matter Addressed

through local

Fitness to Train Certificate issued (with recommended accommodations where deemed

appropriate

NO YES

Matter considered by School Fitness to

Practice Committee

Reasonable accommodations

implemented where appropriate

DSS input low level reasonable

accommodations

Disclosure of a Disability • Practice Placement agreement 2014 12. I understand that if I have (or if I develop) an

impairment or condition that may impact in any way on my ability to learn, perform safely in the clinical environment or affect the welfare of myself or others, that it is my responsibility to share this with an appropriate person in the clinical setting (e.g. Allocations Liaison Officer, Clinical Placement Coordinator, Staff Nurse, Staff Midwife). I accept that only through disclosure of this impairment/condition can an appropriate plan of support to reach the required clinical learning outcomes/competencies be explored.

Theoretical content

• Course is divided into modules – practice placement is also a module

• Each including clinical module awarded credits

• Shared modules among disciplines but discipline specific modules also

Allocation of students

UCC - Allocations Officer

BSc Allocations liaison officer on site

Combination of internal and external placements

Student numbers per ward/site

For the 2012 Intake onwards Clinical Placements

Supernumerary◦ Year 1 - 7 weeks, ◦ year 2 - 21 weeks◦ Year 3 - 16 weeks◦ Year 4 - 1 week

To include all specialisms

Internship; last 36 weeks year 4 ◦ programme to finish in September (Integrated finish in December)

Clinical timeSupernumerary = 30 hours practice and 5

hours Reflection

Intern (Rostered): 37.5 hours including 4 hours reflection i.e. 8 hours in 2 weeks

PREP (Protected Reflective Educational Practice) for 4th year while on Intern (rostered) placement◦ CUH, MUH , COPE and Mental Health – 3 weeks based in

UCC and parent hospital◦ Bons and SIVH – weekly sessions based in parent site

Student assessment tools

• Year one and Year two• Achievement of learning outcomes booklet (CLO

Booklet)

• Year three and Year four • achievement of competency booklet

Summary

• 4 year programme (children’s and general 4.5yr)

• Collaboration HSP and UCC

• Student placements - • Supernumerary and rostered • Supported by preceptors• Assessment utilising booklets

Facilitating learning - The clinical environment

What is a quality clinical learning environment?

An environment with : Good communication Friendly, welcoming and inclusive (Walsh 2011)Positive attitude and allocated time for teaching (Walsh 2011)

Team members with up to date knowledge of the latest researchLearning resources on each clinical placementEnthusiasm of the teamConstructive comments on skill performance Clinical staffs’ openness to new ideas and share learning from courses (Gopee 2011) Preceptors create a feeling of trust, of security which is seen as critical to enhance student learning.

(Carlson, Wann Hansson, Pilhammar 2009)

Good and Bad learning environments (Walsh 2014 pg 60 -61)

• Good • Consistency • Resources available • Flexibility• Staff approachable• Mentor enthusiasm• Mentor patient and

understanding • Identifiable learning

opportunities• Made them feel part of the

team• Sense of humour• Encouragement

• Bad• Not enough time to mentor• Not expected on placement• Being compared with

previous students • Too many students at the

one time• Staff shortages • Mentor not interested in

students • Critical rather than

constructive feedback• Used as a pair of hands • Not welcome to the team

Good and Bad learning environments continued • Good • Being respected • Mentor willing to listen • Given time to reflect • Teaching sessions on the

ward• Shift flexibility • Insight visits available • Multidisciplinary team

working opportunities • Peer support from other

students • Open minded staff

• Bad• Regarded as a healthcare

assistant • Clash of personalities• Staff unfamiliar with

paperwork • Mentor too busy to give time• Feeling of not belonging • Expectations too high/ too low• Ward politics / staff

disharmony• Being ignored because it was

not my field • No learning opportunities

identified

What is the role of a clinical placement?According to Elcock and Sharples (2013 pg 33) “practice placement is for

students to learn while they are with you, through practicing skills, increasing their knowledge and role modelling the professional behaviours of staff”

“It is not just a creation for student nurses. We are all students” (Walsh 2011pg 46)

“Each student requires practice placements in practice settings to learn patient care skills directly” (Gopee 2011, p 115)

Students opportunity to:◦ integrate theory and practice◦ to prepare for their future professional role by developing the

knowledge and skills required for competent practice(An Bord Altranais, 1994: Hodson, 1999)

◦ Work based learning – learning in practice settings (Gopee 2011, p 135)

Consider for a moment …

• … which factors helped you to learn in the ward while you were on placement as a student?

• … which factors blocked/impeded your learning on the ward as a student?

Student thoughts...Students strongly endorse the central nature of the ward placement

and preceptor support. Students recounted:“I think I lucked out. My preceptor is a good nurse.

She’s liked by the staff and they know she’s competent ….I guess ‘ cause the staff respect her and it actually amazingly rubs off on me . Because she’s treated me like a colleague, it seems like the people she’s friends with treat me like a colleague too.” (Myrick and Yonge 2001 pg465)

“I was made feel like a member of the team rather than another student (which I haven’t experienced anywhere else). The staff were more than happy to show me a range of procedures and explain why and point me towards the relevant literature to support it “ (Walsh 2011 pg 49)

Factors that hinder learning Difficulty in balancing practical work / clinical requirements Being in a clinical environment where there is a general disinterest in

having students (Walsh 2011) Being reprimanded by senior staff in front of other colleagues Critical rather than constructive feedback (Walsh 2011) Used as a pair of hands (Walsh 2011) Being compared to other students Expectations too high/low (Walsh 2011) Student nurses can feel obstructive, burdensome and a nuisance to

registered nurses (Hyde & Brady 2002)

Being ignored because it was not my branch (Walsh 2011) Poor leadership (Gopee 2011) Staff shortages Being in a clinical environment where some nurses show uncaring attitudes

towards patients e.g. lack of time to talk to patients despite their being time but “nurses choose to sit in the office and have a chat and a cig”

(Pearcey & Elliott 2004)

Group work• Form groups of 3 • one person is a student • one person is a preceptor• one person is a patient

• Preceptor teaches the student a skill e.g • tie a shoelace, put on a watch, put on a chain, • put on a jacket on a person with an arm paralysis

Domains of learning - Bloom’s

The student role• Timekeeping and other professional issues• Present robust evidence on a frequent basis• Keeping paperwork up dated • Flag any problems and issues as early as possible

(Walsh 2014)

• Take responsibility for own learning• Actively seek out opportunities• Ask questions• Learning from mistakes • Seek to recognise the gap between where they are and where

they want to be (Quinn,2007)

• Students have the opportunity to observe and then participate in nursing or midwifery activities in an environment of safety

• Students gain confidence in developing skills and demonstrating competence

• It is essential that students and staff clearly understand students’ role (A.B.A.)

• Students need to be able to negotiate aspects of learning needs

Role of the CNM• “Ward managers’ role is essential”

(O’Flanagan, 2002)• Act as team leaders (‘Team spirit’)

• Act as role models for nursing and midwifery practice

• Link student to an allocated preceptor and /or associate preceptor

Role of staff nurses and midwivesAre willing to give time and feedback both positive and

not so positiveInclusivenessEncourage questioning and involvementFoster self esteem and self confidence Are well informed about course/assessment processCan distinguish between different levels of students

Walsh( 2014 pg 63) suggests – possesses a vast array of skills and knowledge

List contd on next slide is not exhaustive

Role of staff nurses and midwives Health and safety Dignified and respectful care Communication skills Moving and handling MDT working Care of dying Discharge planning Nutrition Elimination Management of aggression Hygiene Aseptic technique Pre and post op care CPR First Aid Infection control Technical nursing skills and

knowledge Breaking bad news Confusion Emergency care Observations

Ethics & law Pain management Evidence based practice Research Budgeting Staff management Advocacy Clinical Supervision Care planning Mentor/ educator Assessment Stress &anxiety management Confidentiality Documentation Care of the dying Risk assessment Health promotion Counselling Medication management Liasion

Creating a ‘student friendly ‘ environment… Components of a learning environment according to Stuart

(2013) include the following: 1. The people • The leader of the team• The members of the team• The student/s• The practice educators

2. Learning opportunities and experiences “provided by” • Patient /client care • Other clinical activities

3. Staff commitment to teaching and learning • Support and supervision of learners• Continuing professional development

4. Material resources

Do • Establish what the student already knows

• Get the theory across to everyday life

• Break down practical demonstrations for students

• Ask more reflective questions, questions are much more powerful than answers

• Follow up

Reflection

Reflection“Reflection : in depth focused attention”

(Bolton 2014 p.)

‘Is a process of thinking and evaluating actions and feelings with the overall intent

of improving nursing practice’ (Lethbridge, 2006)

Reflective Practice “….. it is recognised as an essential tool for helping students to make the links between theory and practice” (Jasper, M 2003 p.1)

Outcomes of Reflection• Gaining new perspectives on experience

• Facilitating a change of behaviour

• Readiness for application

• Commitment to action(Bulman and Schutz 2009)

“Yet it makes the difference between 20 years of experience and merely one year of experience repeated 20 times” (Beaty 1997 p.8)

Why do we reflect? – the purpose • Identify learning needs• Identify new

opportunities for learning • To identify ways in

which we learn best • To identify new

courses of action • To explore alternative

ways of solving problems• For personal

development • To escape routine

practice

• To be aware of the consequences of our actions• To demonstrate our

competence to others• To build theory from

observations• To help us make decisions

to resolve uncertainty• To empower or

emancipate ourselves as individuals

• (Jasper 2013, pg. 6)

47

Research Findings Alarcon and Lyons (2011) claim that reflective

practice increases job satisfaction and work related stress will decrease. And it brings a greater empathy

between the client and the practitioner.

Reflection is necessary in order to achieve competence (Tate, 2004)

“Writing taps tacit knowledge: it brings into awareness that which we sensed but could not

explain” (Holly 1989 p 78)

GIBBS Reflective Cycle (1988)

There are 6 steps in the cycle:1. Description2. Thoughts & Feelings3. Evaluation4. Analysis5. Conclusion6. Action Plan

(See preceptorship pack on website http://www.ucc.ie/en/nursingmidwifery/allocations/preceptori

nfo/ )

Writing Reflective NotesMust be specific to a clinical experience

A reflective framework must be used - Gibbs Cycle is recommended.

Use references to support analysis section of reflective cycle

Confidentiality & Anonymity

Guidelines on reflective note writing available in CLO and Competency booklets

Preceptor to discuss, sign, date reflective notes.

Preceptor may also review reflective notes.

Conclusion• Importance of providing students with opportunities

to engage in reflective practice in a supportive learning environment for the development of attitudes, knowledge and skills

• Reflective Practice is an active and deliberate process whereby clinical practice is critically examined.

Competence in Nursing Practice

Definition of CompetenceNMBI (2015, pg 102) defines “competence as the attainment of

knowledge, intellectual capacities, practice skills, integrity required for safe, professional values and ethical values required for safe , accountable and effective practice as a Registered Nurse. Competence relates to the nurses’ scope of practice within a division of the register, is maintained through continuing professional development and the nurse may need to upskill, update or adapt competence if s/he works in a different practice setting or with a different profile of service user”.

“Competence applies to specific clinical skills which in nursing also include the associated knowledge and attitude components” (Gopee 2011)

Nurses & Midwife's Responsibilities • The nurse/midwife must develop and maintain their

competence necessary for professional practice

• Competence is not static – nurse/midwife must ensure knowledge and practice is up to date in order to maintain competence.

• Competence is developmental – if appropriate the nurse/midwife must take measures to gain competence for new clinical situations.

• According to Stuart (2014) “the educational and professional outcome of pre- registration education is a competent practitioner who is fit to practice”

Nurses & Midwife's Responsibilities

• Nurses/midwives are responsible and personally accountable for own actions and omissions

• Nurse/midwife should decline to perform duties unless able to do so in a safe and skilled manner

Competency Attributes

• Perform practical and technical skills• Implement research within effective clinical practice• Utilise a critical thinking and a problem solving approach • Accept responsibility • Being accountable• Practise interpersonal and communication skills,

organisational and managerial skills (Scope of Practice, ABA, 2000)

Competence for Student Nurses/Midwives

Students may learn a specific skill, but the knowledge underpinning that skill changes over time Competence is not static

Practice is necessary to maintain competence (Edwards et al., 2004)

See e.Learning programme on competency assessment at www.nursingboard.ie

Five Domains of Competence

Framework for entry to the Register of Nurses

1. Professional and ethical practice2. Holistic approaches to care and the

integration of knowledge3. Interpersonal relationships4. Organisation and management of care5. Personal and professional

development (ABA, 2002)

+ Clinical Skills

Domains of Competence• Each domain has a number of: • Clinical learning outcomes (Years 1 & 2)• Competencies (Years 3 & 4) • Performance criteria

• Each learning outcome/competency/performance criteria has a number of indicators• Emphasis is on completing the learning outcome or

competency/ performance criteria rather than the individual indicators

A supportive learning environment is necessary for

the achievement of competence

(Farrand, 2004)

Conclusion

• “The competency movement is about creating a more flexible and mobile labour force to increase productivity and it does so by redefining work as a set of transfer- able or ‘soft’ generic skills that is transportable and is the possession of the individual”

(Windsor et al. 2012)

Assessment in Clinical Practice

Why be assessed?

• Ensure that those who become registered nurses are safe and competent practitioners• (An Bord Altranias, 2003)

• Competence is required to qualify for admission to the register• (An Bord Altranais, 2000)

Assessment• Integral part of teaching and learning • Assess performance in relation to stated learning outcomes• Encourages self-assessment and reflection• Provides data regarding the effectiveness of the educational

programme• Is it a motivator or does it dominate the curriculum?

The main method of assessing competence by observing the student’s performance and asking questions.

(Quinn,2007)

Variety of methods of assessment

• Interviews• Questioning• Problem solving• Discussion• Direct Observation• Assessment of documentation• Any other evidence considered relevant

Assessment of clinical practice is also performed and documented using the following tools : • ABA Domains – Assessment of competence • Taxonomy of learning – Steinaker & Bell (1979)• Clinical learning outcomes booklet• Competency booklets • Performance criteria (Midwifery)

Assessment Tool – booklets and series of interviews

• Years 1 & 2 Clinical Learning Outcome Booklet • Years 1, 2 & 3 Clinical Learning Outcome Booklet (Integrated

Children’s & General)• Years 3 & 4 Competency Booklet• Each Domain has specific Learning Outcomes, Performance

criteria or Competencies • Each of the Learning Outcomes, Performance Criteria or

Competencies have specific indicators (critical elements) which are assessed

First InterviewPreceptor and Student identify :• Specific learning outcomes, performance criteria or

competencies to be achieved within the agreed time frame• Specific skills to be achieved within the agreed time frame• Learning opportunities and resources available in the

clinical environment• Requirements in relation to reflective notes (Gibbs Cycle)

Mid Placement Interview

• This occurs in placement longer than 3 weeks• The Preceptor & student review and discuss agreed outcomes,

performance criteria, competencies and skills• Preceptor gives non-judgemental constructive feedback• Self-assessment is encouraged• Reflective notes (Gibbs Cycle) are referred to and reviewed if

applicable

Additional Support Interviews

If required, an additional interview is completed by the preceptor and student to highlight areas of concern in relation to the students progress or unprofessional behaviour – CPC, CNM and Link Lecturer are informed.

A Supportive Learning Plan (SLP) isimplemented if learning outcomes, performance criteria or competencies are not achieved

(See algorithm in Assessment Booklet)

End of Placement Interview • Student and Preceptor discuss the learning which has taken

place and overall placement experience

• Reflective notes are reviewed and discussed, signed and dated.

• Achievement of agreed learning outcomes, performance criteria, competencies and skills are recorded

• Areas for future learning are identified

ConclusionFeedback is important

◦ As soon as possible◦ Balanced approach ◦ Indicating positive aspects◦ Acknowledge achievement/improvement◦ Clear indications of areas needing attention◦ Listen to contribution from student

encourage self awareness

◦ Future plan and recommendations

Feedback must be conducted in a way that facilitates learning (Freet and Fry, 2005)

Learning from Clinical Experience

Steinaker and BellExperiential Learning Taxonomy (1979)

Consider Experience• Think of some personal experience that

you are very familiar with.

• Is there a sequence of steps through which you have progressed from initial exposure through to dissemination of that experience?

Can you see a continuum of your learning?

From initial awareness . . . . . . moving sequentially . . . .

. . with increasing familiarity . . . . . to dissemination?

What is meant by experience?

• This generally implies having lived through an event

• But what about vicarious experiences?

• Can you think of something that you have learnt vicariously?

Experiences• Not isolated events, generally set in

specific context or may be linked together

• Are often quite complex and have many dimensions

• Probably to each new experience we bring the sum total of all our previous experiences

Experience?Can be positive or negative?

Can be internalised or discarded?

But all experiences are ‘real’ for the individual - even where they are vicarious

Steinaker and Bell 1979)

Steinaker and Bell Taxonomy

At exposure level the person is conscious of the experience

At participation, the person makes a decision to engage in the experience

Later they may identify with the experience by asking relevant questions or by emotionally getting involved

The experience changes from one of being an observer to being an enquirer

At internalisation the person is able to express the experience

(Nicklin and Kenworthy 2000)

Competency ModelYear 1 and 2:

◦By end of Year 2 the student should reach level of Participation

◦Clinical Learning Outcomes Booklet

Year 3 and 4:◦By Completion of the Programme the student is

required to reach competence at the level of Internalisation

◦Competence Booklet

Exposure The student observes a competent practitioner

carry out aspects of care

Student becomes consciousness of the experience.

External motivation can be used to:◦gain and focus attention ◦reduce anxiety and◦establish in the student a willingness to participate

further

Examples

The student is able to - discuss with the practitioner how certain aspects of care are carried out, and identifies sources and types of information required to enhance further application of knowledge to the observed practice

Participation, the student:

Is able to participate under supervision of a competent practitioner in carrying out aspects of care

Decides to become physically a part of the experience or

Becomes an active participant (replicates in some way the experience to which they have been exposed)

End of Year 2 the student:

Can discuss aspects of care and its rationale, including decision-making, practical skills, and means of acquiring further information and opportunities for practice.

Is able to engage in psychomotor and interpersonal skills, and is able to execute communication and problem solving skills with guidance

Identification, the student:

• Can participate in the delivery of care under supervision on more sustained basis with less prompting and greater confidence.

• Actively participates in the experience indicating that initial learning has been achieved

• Organisational, emotional and intellectual context of a learning experience are combined

During Year 3 the student begins to:

• Identify personally with the experience, recognises the organisation of the experience, gains a deeper insight into its value, and is able to express recognition of their own achievement

• Shows greater ability to communicate effectively

• Demonstrates a wish to acquire further information and ability to analyse and interpret information

• Applies problem solving skills and knowledge base to meet different situations

Internalisation, the student is:

• Can explain the rationale for nursing/midwifery activity• Is viewed as active and self-directive in the learning

experience, progression no longer controlled from outside• Experiences are incorporated and further reinforced

and the student begins to problem solve unconsciously• The highest level of internalisation has been achieved

when an experience touches and continues to influence the lifestyle

IDENTIFICATION LEVEL

CUES:• Active participation with less prompting for the preceptor• More developed communication skills • Hunger for more information • Analyse/breakdown information• Interpret/ explain meaning of this information • Demonstrate problem solving skills • The student’s ability to reflect on the experience- emotional,

intellectual, organizational and value

INTERNALISATION LEVEL

CUES:• Self-directed • Progress comes from within the student• Problem solving becomes an unconscious ability • Experience influences/ impacts upon the student’s learning

By the end of Year 4 the student:

• Requires less supervision whilst caring for a group of patients/ clients

• Is able to transfer knowledge to new situations

• Seeks and applies new knowledge and research findings, demonstrates ability to use problem solving skills, critical analysis and evaluation

The registered nurse or midwife

Advises others

Shows ability to teach junior colleagues

Has a personal management style and shows ability to manage care delivery by junior staff

Critical analysis, evaluation and decision-making skills demonstrated

And finally Dissemination

• An individual plans, implements and evaluates care for a group/clients under minimal supervision • Involves a voluntary outward expression

and reflects the degree of motivation achieved

It is not necessary for the students to reach this level

References and further reading• An Bord Altranais (2004) E.Learning programme introducing

competency assessment. www.nursingboard.ie

• Nicklin and Kenworthy (2000) Teaching and Assessing in Nursing Practice London: Bailliere Tindall

• Steinaker, N. and Bell, R., (1979) The Experiential Taxonomy: A New Approach to Teaching and Learning. New York. Academic Press.

Introduction to the BSc Students’ Assessment of Practice Booklet

Workshop

Assessment BookletClinical Learning Outcome Booklet (CLO) Students in 1st and 2nd year (General/Midwifery/Psych/ID)

Note-Students in the General Integrated pathway have 2 separate booklets ie a General Booklet and Children’s Booklet for 2006 Intake only).This group has one combined booklet for 2007 Intake onwards

Assessment of Competence Booklet Students in 3rd and 4th year have a Competency Booklet

Children’s and General IntegratedBSc Nursing Pathway

4.5 years duration 20 students per intakeModules: shared modules with General

nursing students & pathway specific children’s nursing modules

Children’s & General placements each yearLeads to dual professional qualifications/

registration - RCN & RGNLeads to award of BSc degree

The Assessment Booklet For General Nursing, Midwifery,

ID, Psych and Integrated Children's General

DomainsA. Professional / Ethical practiceB. Holistic approaches to care and the integration of KnowledgeC. Interpersonal relationshipsD. Organization and management of careE. Personal and professional development Clinical skills (Psych do not have this section within booklets)

ASSESSMENT FRAMEWORK LEVELS BSc Nursing Programme

Steinaker & Bell’s Experiential Learning Taxonomy (1979)1. Exposure (Year 1 and 2)2. Participation (Year 1 and 2 )3. Identification (Year 3 and 4 ) 4. Internalisation (Year 3 and 4)

Note: Integrated pathway Exposure & Participation completed in Yr 3. Identification & Internalization completed over years 4 & 5(Programme duration is 4.5years ending in December Year 5

Domains, Outcomes, Indicators

Domains Each domain has a number of learning outcomes or competencies

Each learning outcome/competency has a number of indicators

Emphasis on completing the learning outcome/competency rather than individual indicators

CLINICAL SKILLS Domain F

(General, ID & Integrated)

• Essential Skills -these skills must be achieved in order for a student to progress

Opportunistic Skills –students may have the opportunity to achieve these skills but if they do not a student will not be penalised for not achieving them Performing CPR

Miscellaneous Skills -these skills are clinical area specific for example cast care in the ED or SMOH

The Emphasis in Year One

Students familiarise themselves with the world of nursing

Nursing skills, procedures, techniques are learned and practised in defined parts through guidance from, and under the supervision of, experienced practitioners, until confidence in each element is acquired

Pass & Progression in Year 1

Completion of scheduled clinical hours prior to Summer Examination Board

Completion of scheduled clinical hours prior to Summer Examination Board, NU 1049 clinical placement is now 7 supernumerary weeks.

It is expected that the student will achieve approximately one learning outcome per week of clinical placement.

A student will need to achieve a minimum of 5 learning outcomes at exposure or 3 learning outcomes at exposure level and 2 at participation level to pass year one.

Students are expected to complete the relevant sections of the clinical learning outcomes (Interviews, reflective notes, student declaration).

The Emphasis in Year Two

The student begins to link and integrate knowledge and skills

The student begins to identify and appreciate the relationships between different areas of knowledge

Students will still need guidance and support in prioritising and identifying salient aspects of specific

nursing situations

Pass & Progression in Year 2 Clinical placement is now 21 supernumerary weeks

Completion of scheduled hours prior to Autumn Examination Board

The student must achieve all remaining clinical learning outcomes and clinical skills at exposure level and all clinical learning outcomes and clinical skills at participation level as a requirement, at the end of Year 2, in order to pass NU2063

Students are expected to complete the relevant sections of the clinical learning outcomes booklet (Interview pages, reflective notes, student declaration, etc.)

Emphasis in Year 3 and 4• Students are required to achieve competencies for entry to the

ABA Register of Nurses • To pass 4th Year the student must successfully complete all

mandatory competencies at Internalisation Level

(Focus on competencies is from Year 4 for Integrated students)

Pass & Progression Year 3 • 3rd year• Completion of scheduled hours• A minimum of 8 competencies at Identification

level by the Summer Examination Board as part requirements for passing NU3082• A minimum of 40 skills at either identification or

internalisation level• Completion of relevant sections of the assessment

of competence booklet e.g. (placement details, reflective accounts, interviews)

Pass & Progression Year 4• Completion of scheduled hours• Remaining competencies and skills (at both

identification and internalisation level) by the fourth year Autumn Examination Board as part requirements for passing NU4051• Completion of relevant sections of the

assessment of competence booklet e.g. placement details, reflective accounts, interviews)

Assessment

• A learning outcome or competency can be achieved using the indicators as a guide to the assessment A preceptor can consider a number of indicators together• Methods used to assess learning outcomes may

include observation of practice, interview, discussion, and assessment of documentation • The preceptor is required to make some concluding

objective comments at the end of the assessment

Preceptors Responsibilities in the Assessment Process Act as a Role Model Have knowledge and information about the students

programme Identify Specific learning Opportunities that are available in the

clinical area Identify with the student their learning needs and plan the

achievement of learning outcomes/Competencies Ensure that time is identified for interviews Provide feedback that will assist and improve student

performance Liaise with CPC/CDC/LL concerning student issues Read and review reflective Notes

Students Responsibilities in the Assessment Process

Read and understand the Assessment Booklets Be familiar with the course objectives Have identified specific goals for each clinical experience Be proactive in seeking out learning opportunities Ensure the booklet is available every day of the clinical placement Keep the booklet neat during the two years of use Ensure the reflective notes are completed prior to the final

interview-signed at the final interview Ensure the outcomes/competencies are completed and signed at

final interview Develop and maintain effective communication with preceptor Seek assistance if required from CNM/CPC/CDC/LL/LP Return the book to the School of Nursing and Midwifery when

required

What if I’m concerned a student is not achieving?

• Ascertain why outcomes/skills are not being achieved.• Student may need to be given direction on what to achieve and

how to achieve it.• The concerns must be ‘flagged’ as soon as possible with the

CPC/LL.• Document in detail in the mid interview or if more frequent

interviews needed use the Additional interview section• Agree ways for the student to progress• If lack of achievement persists,– a meeting is arranged between

student, preceptor, CPC and/or Link lecturer, and a Supportive Learning Plan is instigated

When might I need to use a supportive learning Plan?

• If the student has not achieved the agreed learning outcomes/competencies

• If there is lack of achievement at a reasonable rate• If there is an apparent loss of as students earlier level of

achievement• Placement duration should have no bearing on initiating an SLP• The outcome of this meeting is documented in the Supportive

Learning Plan (SLP) (in booklet)• Confidentiality is maintained but a copy is required by the module

leader

Practical Guide for Preceptors for Students on Clinical Placement Day one meet, greet and orientate student to clinical placement (Unit/ ward/ setting)

Cl.Placement length

1week 2 week 3 week 4 week and longer

Interviews Interview on day 1/2 and final day Total 2 interviews

Interview on day 1/2 and final day Total 2 interviews

Interview on day 1/2 and final day Total 2 interviews

1. 1st Interview week 12.Mid interview – mid way 3.Final interview – final day Total 3 interviews

Reflective Notes 1 reflection 1 reflection 1 reflection 1 reflection per 3 weeks

CLO (Yr 1 & Yr 2) to achieve

Approx 1 per week Approx 1 per week

Approx 1 per week

Approx 1 per week

Competency (Yr3 & Yr4)to achieve

As per pass and progression document

Preceptor must sign upon student completion of Clinical Placement at final interview

*Interview 1 and 2 *Reflection*Signature on page 1 *May be additional preceptor notes

*Interview 1 and 2 *Reflection*Signature on page 1*May be additional preceptor notes

*Interview 1 and 2 *Reflection*Signature on page 1*May be additional preceptor notes*May be additional interview *May be SLP (Supportive learning plan)

*Interviews – 1st, mid and final*Reflection*Signature on page 1 *May be additional preceptor notes*May be additional interview *May be SLP (Supportive learning plan)

Today’s students are tomorrows work colleagues !!