Introduction
This chapter will guide you through a series of activities designed to help you develop professional knowledge and expertise and meet the Nursing and Midwifery Council (NMC) outcomes for entry to your chosen branch of the professional register. If you choose to do the activities on a regular basis during your placement, you will develop your knowledge and understanding and so be in a strong position to complete your course assignments. Even more importantly, you will be learning how to learn in and from your practice as you progress through your placement and so improve your practice and patient care.
The ‘toolkit’ described in this chapter was designed to help you develop the independent learning skills that you need for the whole of your programme and your future career as a health care professional.
Making the most of the ‘toolkit’: what is it? and why?
You may be asking yourself various questions such as ‘What is this toolkit all about?’, ‘Do I have to use it?’ or ‘How is this going to help me with all the other work I have to do for my assignments and my practice placements?’
Throughout this chapter you will find activities designed to help you use your course theoretical material and to relate it to your practice when giving care. Of course, your learning should not stop there and we hope you will want to do some extra reading and develop a broader and deeper understanding about how to care for your patients/clients.
The activities will take you through the steps of planning your learning and your practice development while helping you to consider how you can demonstrate your progress. Depending on how much you already know before you start the placement, some activities will take approximately 10–20 minutes, whereas others can be done over a period of days. The activities will encourage you to work rather like a detective investigating a case, looking for clues and then finding supporting evidence to support your arguments.
Working like a detective
Before you start on your detective work, you will need to keep a small notebook in your uniform pocket so that you can make notes and review them when you have some free time both on your placement and when you are off duty. You will have the opportunity to write a report on your observations (see below). If you want, you could transfer your notes to an electronic file or data-base so you can use the information later when writing up your practice-based assignment or your portfolio. The kinds of things you might want to include are:
• The title of the investigation.
• The dates.
• The placement name and your name.
• An introduction to the activity.
• The NMC outcome(s) it relates to.
• A description of what took place (the event/s).
• Your discussion of the event, drawing on relevant course material and additional material from your reading.
• Your conclusions.
• What you have learned and how you will use this learning when giving care and working with practice colleagues.
Figure 6.1 (a) shows a form that can be used to report a practice experience; Figure 6.1 (b) is an example report of a typical practice experience.
 |
| Figure 6.1(a) A form that can be used to report a practice experience; (b) an example report of a typical practice experience. |
You will need to keep your reports in a safe place, so you may find it helpful to store them in a ring file, or write them up electronically and put them on a memory stick so you can use the information for your assignments.
If you choose to do these learning activities during each of your first-year foundation programme placements, you will develop your writing skills and assignments will become much easier to complete. Your knowledge and enjoyment will also increase as you become confident about what you are learning. This will be reflected in your placement and development of your practice skills. So, even though it may seem quite daunting at this point, working through the activities in the toolkit has lots of advantages.
When you start on a placement you will find it helpful to talk to your mentor about the kinds of patients you want to study and the related social and biological sciences and so benefit from your mentor’s experience of the placement and knowledge of the patients. This can save you a lot of time.
Preparing for your assignments and examinations
All your theoretical and practice-based assignments are designed to support your professional development. By using the toolkit you will be able to accumulate evidence for your assignments, including your practice-based assignments, and to develop the essential skills for your skills schedule.
So, in preparation for working through the toolkit, you will need copies of any related course/programme documents, such as:
• Learning outcomes for each placement experience.
• Skills schedule.
• Placement details.
• Assignment information.
• The welcome pack for your placement and any information about the learning opportunities available.
Meeting professional standards
NMC outcomes for entry to the branch programme
The Nursing and Midwifery Council of the United Kingdom (NMC) sets standards that all nursing and midwifery students must achieve before they progress from their foundation programme to the branch programme and from the branch programme to become a registered nurse or midwife. As a nursing student, you must demonstrate that you have achieved the outcomes for entry to the branch programme. All your assignments (including the practice-based assignment) and the skills schedule are designed to help you meet these requirements. For simplicity’s sake and because these requirements have been set by the NMC, we will call them either ‘NMC outcomes for entry to the branch’ or ‘NMC proficiencies for registration’.
The NMC outcomes for entry to the branch programme are set out in the Appendix at the end of the book (an electronic version of the NMC outcomes can be obtained from the NMC website at www.nmc-uk.org). They are described under four headings (domains), all concerned with helping you develop your professional knowledge in preparation for your branch programme and promoting high standards of professional practice and good quality of patient care. It is essential that, by the end of your foundation course programme, you can demonstrate both in writing and in your nursing practice that you understand and use these attributes.
By reading through the information for your foundation course, you will find a list of the NMC outcomes that you have to achieve in order to successfully complete the foundation course programme and progress to your chosen branch programme. If you check the foundation course assignments against each NMC outcome, you will see that they are all based on these NMC outcomes.
As you read the various activities in the chapter, you will see specific NMC outcomes mentioned. Activity 6.1Activity 6.2Activity 6.3 and Activity 6.4 will help you gather evidence and increase your knowledge and understanding of the outcomes as they relate to your specific placement and NMC domains 2 and 3, and relate to care delivery and care management for individualized patient care. For Activity 6.11Activity 6.12 and Activity 6.13, rather than provide an activity for each outcome, you are invited to map your work against a number of NMC outcomes, which are all concerned with those in domain 1.
Activity 6.1
What makes a good nurse?
Allow 20 minutes for this activity
This activity relates to NMC outcomes in all the domains.
Make some notes in response to these questions (you may want to come back to these questions as you go through the activities in the toolkit and to add your ideas as you see other nurses giving care).
Spend a few minutes thinking about why you want to become a registered nurse.
What do you want to be like as a person and as a practitioner?
How do you see yourself caring for patients?
What do you think are the most important features of a good nurse?
Comment
Views of some first-year nursing students (from: Spouse J 2003 Professional learning in nursing. Blackwell Science, Oxford)
Nicola. Perhaps my view of general nursing, there’s some stereotyping I’m sure, there’s just as much basic chores in what there might be aspects of nursing as general – part of the job really. When I got back last week [from observation on a psychiatric ward], it made me think: ‘Yes I think this is what I want to do’. Sort of made it clear in my mind but I think that I do want to do it even more perhaps.… That scares me more than anything else, the actual physical, injecting, taking blood pressure, rather than like sitting down and talking to people. I’m sure you can do damage talking to people but it’s not like doing physical damage. I think it’s horrendous.… My mother, she was always the one who nursed me, when I had been ill at home, so I do think we do, carry on that sort of, ‘play the role-model’. I don’t know how I’d nurse actually, if it was me. I think sitting down and talking about it. You can’t talk about someone being sick; obviously you’ve got to do some practical.
Ruth. If you realize what makes you feel nice, if you were in a strange bed and things like that. Then that would help you to appreciate the little touches for a person, coming into a ward, so there is value in all those sort of reminders. I’ve always just thought a loving attitude, really, to actually like want to hold people’s hands and I think you need an element of toughness in you too, not to be pushed around by people… and in yourself. Well I think you need to know the workings of the body. You can learn all the theory in the world but really you’ve just gotta, to get on with people. They’re the main things.
Jack. But somehow this idea of sitting down talking to patients, getting to know them as individuals, not treating them as the appendix in bed 6. Not doing the back round at 3.00 p.m. Actually giving them the tablets when perhaps they want the tablets and not at 6.00 p.m. when perhaps they don’t need them. Giving them at 4.00 p.m. when they’ve got a pain. It just seemed so sensible to me then.
Activity 6.2
Working together
| Allow 10 minutes now and more time on your placement visit | |
|---|---|
| Role | Contribution to patient care |
| Cleaner | |
| Porter | |
| Physiotherapist | |
| Occupational therapist | |
| Ward clerk | |
| Pharmacist | |
| Radiographer | |
| Consultant | |
| Registrar | |
| House officer | |
| Bereavement officer | |
| Catering officer | |
| Social worker | |
Comment
You might discover that your placement setting is supported by only some of the people listed here, or you might find that several are missing from the list. Make a separate list in your notebook and find out about the roles of the people not identified here and then consider why there may be differences. Check your speculations with your mentor and see if you can get any further information.
As you work through this exercise you may wonder how the work of all these different teams of people is coordinated. This is a question you can work on during your placement by taking on your detective role, asking questions and more usefully observing what people are doing at different times during the 24-hour cycle of care. Don’t forget to make notes in your notebook as these will help you to formulate your questions.
Activity 6.3
Patient care and the ‘NMC Code of professional conduct’
Referring to the ‘NMC Code of professional conduct’, write short notes against each of the following areas of practice as to how the Code influences patient care.
Allow 20 minutes for this activity
Using your copy of the ‘NMC Code of professional conduct’ write short notes against each area of practice on how the Code influences patient care regarding:
Technical procedures
Care delivery
Care management
Physical, emotional and spiritual needs of patients
Comment
You will see that the ‘NMC Code of professional conduct’ is very comprehensive and is designed to make sure that patients receive care only from practitioners who are capable of delivering it at a safe and competent level. This means that practitioners have the responsibility for ensuring that patient care is only delegated to people who are capable of delivering it. Thus they need to assess students before they delegate patient care responsibilities to them. Managers have the responsibility of ensuring that the skill-mix of staff on duty will allow this to be possible.
Activity 6.4
Professional information you might require to prepare for placement experiences
Allow 5 minutes for this activity
The areas you may be interested in are:
• Student support available.
• Patient care.
• Clinical speciality.
• Patient-centred learning opportunities on and away from the placement.
• What I need to revise in preparation for the placement.
• What I need to do for my assignments.
Comment
Abraham developed the following list of questions when asking ‘What do I need to know about my placement?’
• How many patients are cared for in this setting?
• What is wrong with the patients nursed in this placement (kinds of diseases/conditions)?
• How is nursing care organized (team, primary nursing or task allocation)?
• What special information do I need to have before I arrive?
• Is there a recommended reading list to help me get started?
• Where can I find a copy of the menu of learning opportunities (visits, investigations, etc. to see and so on)?
• Which of my learning outcomes can I achieve here?
• Which skills can I develop here?.
• What would be good subjects for my practice-based assignment?
• What learning resources are available close by (e.g. library, computer, reading materials)?
• What is the name of the link lecturer, the times she/he comes to the placement and how can I contact her/him?
Activity 6.11
Discuss in an informed manner the implications of professional regulation for nursing practice
| Outcome and activity | Activity notes |
|---|---|
| Student demonstrates awareness of the role of the professional statutory body and its role in protecting the public. | |
| Activity | |
| Read the ‘NMC Code of professional conduct’ and drawing on your work for Activity 6.3 discuss how public protection is ensured. | |
| Student demonstrates awareness of the ‘NMC Code of professional conduct’: standards for conduct, performance and ethics, in everyday behaviour while on and off duty. | |
| Activity | |
| If a student was persistently late for duty or failed to notify the staff that they were having difficulties attending how might this contravene the ‘NMC Code of professional conduct’? | |
| Student demonstrates an awareness of, and can apply ethical principles to nursing practice. | |
| Activity | |
| Consider your responsibilities and actions if you discovered a member of your placement team was verbally and physically abusing a patient/client. | |
| Student demonstrates awareness of legislation relevant to nursing practice. | |
| Activity | |
| Describe what you would do if a patient/client told you they were using hard drugs and had some in their bedside locker. | |
| Drawing on your course materials and any further reading give an explanation for your proposed actions. | |
| Student demonstrates the importance of promoting equity in patient/client care by contributing to nursing care in a fair and anti-discriminatory way. | |
| Activity | |
| Describe your actions if your elderly and blind patient/client is incontinent because she has been unable to receive the necessary assistance to get to the toilet in time. |
Activity 6.12
Demonstration an awareness of the ‘NMC Code of professional conduct’
| Outcome and activity | Activity notes |
|---|---|
| Student demonstrates awareness of the ëNMC Co de of professional conduct’ whilst engaged | |
| in patient care and interactions with patients, their carers and colleagues. | |
| Activity | |
| Read the ëNMC Co de of professional conduct’ and using two examples from your practice discuss how to try to adhere to it. | |
| Student demonstrates understanding of professional responsibilities to protect and serve society by acting in a thoughtful and considerate manner towards patients, their carers and colleagues. | |
| Activity | |
| Describe one situation from your recent experience where you feel you have worked in a thoughtful and considerate manner towards: | |
| (a) a patient and their carer (b) your colleagues in practice. | |
| Student demonstrates willingness to accept responsibility for personal actions and decisions, by ensuring that appropriate guidance and supervision have been sought and utilized. | |
| Activity | |
| Describe how you felt about the feedback you have received during this placement either if you sought feedback on your performance or where you have sought guidance on patient care. |
Activity 6.13
Demonstrate an awareness of, and apply ethical principles to, nursing practice
| Outcome and activity | Activity notes |
|---|---|
| Student demonstrates awareness of responsibility to behave with integrity, honesty and in the best interests of patients, their carers and colleagues. | |
| Activity | |
| Describe one situation from your recent practice where you can demonstrate that you have met this outcome. | |
| Student’s actions and speech demonstrate respect for patients, their carers and colleagues, and understanding of the importance of confidentiality when discussing or documenting aspects of patient care or practice. | |
| Activity | |
| Drawing on relevant programme material describe one situation where you gave care to a patient that demonstrates that you understand this outcome in your daily relationships with patients and colleagues. | |
| Student demonstrates willingness to consider ethical issues that challenge personal beliefs and values and to explore reasonable explanations whilst acting in the best interests of patients, their carers and colleagues. | |
| Activity | |
| Describe how Activity 6.1 has influenced your approach to patient care giving an example from your recent practice. |
Developing your portfolio of evidence
NMC outcome 4.1 (under the domain of personal and professional development) requires you to demonstrate responsibility for your own learning through the development of a portfolio of practice and to recognize when further learning may be required. You can accumulate different pieces of evidence for your portfolio by doing all the various activities and keeping your work in a folder.
The section titled ‘Learning from practice’ later in this chapter provides some advice on how to develop your portfolio and helps you to assess your development by giving you some questions to ask yourself and other people about your performance (such as colleagues including your mentor and even your patients). Many students have difficulty writing in an academic style, so this section also provides guidance about how to write a good assignment.
Reusing the activities in the toolkit
You can ‘recycle’ the toolkit for each of your placements as the activities have relevance throughout your course/programme and any placement in your foundation programme. You might therefore want to make copies of some of the pages so you can save them for your next placement. How extensively you use the toolkit is entirely up to you, but the work you do will help you with your revision and your assignments. Box 6.1 lists the learning outcomes you might be expected to achieve.
Box 6.1
Learning outcomes you could achieve by using the activities in the ‘toolkit’
• Develop a clear understanding of your beliefs and values about being a nurse and giving nursing care.
• Plan your placement experience according to your learning needs and in collaboration with your mentor.
• Demonstrate skills of self-management.
• Demonstrate knowledge and behaviour that reflect understanding of professional and ethical practice.
• Demonstrate the ability to take responsibility for your own learning.
• Seek and utilize supervision to support your professional development.
• Create an action plan for your development, based on self-assessment of competence and collaboration with your mentor and other clinical staff.
• Increase your capability in patient care delivery and management.
• Demonstrate integration and progression of knowledge concerned with different aspects of patient care and professional practice.
• Develop your skills and expertise as a reflective practitioner.
• Create a portfolio of evidence.
• Develop expertise as an action inquirer into your own professional practice.
• Demonstrate acquisition of essential nursing skills.
• Operate within the principles of confidentiality and professional practice.
• Develop your writing skills and skills of literature searching.
Please note: You will find blank copies of Figure 6.1 (a) and the templates in Activity 6.3Activity 6.2Activity 6.3Activity 6.11Activity 6.12Activity 6.13Activity 6.14Activity 6.15Activity 6.19 and Activity 6.20 at http://evolve.elsevier.com/spouse/commonfoundation.
Activity 6.14
Demonstrate an awareness of legislation relevant to nursing practice
| Outcome and activity | Activity notes |
|---|---|
| Student demonstrates observation and utlilzation of health and safety regulations in practice activities and general conduct and has attended relevant mandatory training days (please include list of dates). | |
| Activity | |
| Make list of the health and safety regulations that relate to your practice. | |
Against each regulation write a short paragraph describing how the regulation influences each of the following. • your nursing care (e.g. moving and handling) • your own health and safety (i.e. what could happen to you if you did not follow the regulation) • your patients and their carers • your colleagues. | |
| Student demonstrates observation and utilization of employers’ policies in everyday practice. | |
| Activity | |
| Make a list of placement and school policies that affect you in the clinical placement and check that you have identified ones with your mentor. | |
| Discuss the relevance of the school and placement policies for your everyday behaviour in your placement. | |
| Drawing on two placement policies and examples from your own placement experiences, discuss how they influence your nursing care and membership of the clinical team. | |
| Student demonstrates observation and awareness of relevant legislation relating to mental health, children, data protection etc. in everyday practice. | |
| Activity | |
| Choosing a patient in your placement, identify two pieces of relevant legislation and explore how they influence health care provision. |
Activity 6.15
Self-awareness checklist
Allow 20 minutes for this activity
The checklist is made up four different types of abilities or attributes. Consider each pair of statements, decide where you fit between them and circle the appropriate number.
| Circle the number that reflects your strengths and weaknesses 1 = I need help, 5 = I feel strong about this | ||||||
|---|---|---|---|---|---|---|
| Self-management | ||||||
| I am poorly organized | 1 | 2 | 3 | 4 | 5 | I am well organized |
| I rarely feel good about myself | 1 | 2 | 3 | 4 | 5 | I feel good about myself most of the time |
| I rarely get the most out of new situations | 1 | 2 | 3 | 4 | 5 | I get the most out of new situations |
| I am poor at coping with stress | 1 | 2 | 3 | 4 | 5 | I am good at coping with stress |
| I find it difficult to describe what I feel | 1 | 2 | 3 | 4 | 5 | I am good at describing what I feel |
| I am not clear about what is important | 1 | 2 | 3 | 4 | 5 | I am clear about what is important |
| Confidence | ||||||
| I find it difficult to identify my own professional needs and development | 1 | 2 | 3 | 4 | 5 | I feel confident about looking at my professional needs and development |
| I find it difficult to take responsibility for my own learning | 1 | 2 | 3 | 4 | 5 | I am committed to my own empowerment and learning |
| I am not very good at seeking help from others | 1 | 2 | 3 | 4 | 5 | I feel comfortable seeking help to develop |
| I feel self-conscious when I work with colleagues in one-to-one situations | 1 | 2 | 3 | 4 | 5 | I enjoy working with colleagues in one-to-one situations |
| Skills | ||||||
| I am not confident about (skill) | 1 | 2 | 3 | 4 | 5 | I am reasonably confident about this skill |
| I am finding it difficult to study while I am on duty | 1 | 2 | 3 | 4 | 5 | I can negotiate time to study while on duty |
| I find it difficult to talk about my own experience as a student | 1 | 2 | 3 | 4 | 5 | I am able to talk about my own experiences as a student |
| I am not good at problem-solving | 1 | 2 | 3 | 4 | 5 | I am good at problem-solving |
| Support | ||||||
| I don’t feel confident to talk to my mentor about my professional development | 1 | 2 | 3 | 4 | 5 | I have support from my mentor about my own professional development |
| I don’t know who to go to for support | 1 | 2 | 3 | 4 | 5 | I know who to go to for help if I have a problem outside my scope |
Activity 6.19
Self-review template
Chapter section title or activity numbers: _________________
Date of completion: _________________
Now that I have completed this section of the chapter, what have I learned and what do I want to record?
What have I learned about myself?
What have I learned about my strengths and shortcomings?
What information do I have that could be used for my portfolio?
Identifying the next steps of my learning
As a result of working through this section of the chapter, is there anything further I would like to find out about:
1. My practice?
2. Knowledge related to my specialist practice?
Have I checked through the placement learning outcomes and the NMC outcomes for entry to the branch?
Have I reviewed each section of the chapter and identified what help I might need to develop my skills further?
What skills and knowledge do I want to concentrate on next?
What help do I need?
How am I going to record this information in my portfolio?
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