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Nursing Services Directorate Competency Framework: Nursing Worked Examples of 36

Name & Surname Joanna Borg

ID Card: 100015M Registration No: 0001

Address: 2 Triq il kbira Mosta

Government Email Address:

[email protected]

Mobile Number: 79797979

Entity: MDH Place of Work: MW 20

Title: Staff Nurse

*personal details are fictitious

Competency Programme and Evaluation Framework for Senior Staff Nurse

4. Nursing Worked Examples

Nursing Services Directorate

The selected practice examples are provided to assist in the completion of the competency framework. They must not be copied in your framework.


Scope of Document

This document Competency Framework- Sample Worked Examples has been developed as a

sample of how a filled self-assessment booklet should resemble prior to its submission.


Domain 1: Professional and Ethical Practice

Competencies Insert the reference and

page number where

evidence is provided.

Competency 1.1: Demonstrates adherence with standards of

professional practice, scope of practice and code of ethics1.

Evidence 1 pg 8

Competency 1.2: Demonstrates ability to lead, supervise and monitor

care provided by junior registered nurses, enrolled nurses, nursing

students and support workers in accordance with the Scope of

Practice.

Evidence 2 pg 9

Competency 1.3: Promotes an environment that enables clients’

health, quality of life, independence, comfort and safety.

Evidence 3 pg 10

Competency 1.4: Provides evidence of continuous professional

development. Evidence 4 pg 11

1 1 Available from:

• The Scope of Professional Practice (2002). Retrieved from;

https://health.gov.mt/en/regcounc/cnm/Documents/scopeofpractice_cnm.pdf

• Health Care Professions Act (Chapter 464).To regulate the practice of health care

professions in Malta. Retrieved from ;

http://www.justiceservices.gov.mt/DownloadDocument.aspx?app=lom&itemid=8930&

l=1

• Maltese Code of Ethics for Nurses and Midwives (1997). Retrieved from:

https://health.gov.mt/en/phc/pdu/Documents/maltese_code_of_ethics_nurses.pdf

http://www.justiceservices.gov.mt/DownloadDocument.aspx?app=lom&itemid=8930&l

http://www.justiceservices.gov.mt/DownloadDocument.aspx?app=lom&itemid=8930&l


Domain 2- Provision of Nursing Care

Competencies

Insert the reference and

page number where


Competency 2.1: Undertakes a holistic and detailed assessment of

clients through observation, interview and examination in a variety of

settings.

Evidence 5 pg 12

Competency 2.2: Ensures that the clients have been provided with the

necessary information to make informed decisions and remains in

control of their health.

Evidence 6 pg14

Competency 2.3: Carries out nursing care in a responsible, safe and

accountable manner.

Evidence 7 pg15

Competency 2.4: Facilitates reintegration and/or empowers client to

remain in the community by providing timely and effective continuity of

care (if applicable).

Evidence 8 pg 16

Competency 2.5: Demonstrates the ability to tackle complaints and

queries independently and professionally.

Evidence 9 pg17

Competency 2.6: Takes charge of ward/section/unit, in the absence of

Charge Nurse, and / or Deputy Charge Nurse (if applicable).

Evidence 10 pg 18

Competency 2.7: Demonstrates ability to respond effectively to

unexpected or rapidly changing circumstances. Evidence 11 pg 19


Domain 3: Interpersonal and Therapeutic Relationships

Competencies


page number where


Competency 3.1: Demonstrates the ability to establish, maintain, and

conclude therapeutic relationships with clients and their informal

carers.

Evidence 12 pg 20

Competency 3.2: Communicates effectively with clients, informal

carers, and members of the interdisciplinary team using verbal, non-

verbal and written communication as needed.

Evidence 13 pg 21

Competency 3.3: Always provides and requests handover from

colleagues and other health care professionals to ensure continuity of

care.

Evidence 14 pg 22

Competency 3.4: Demonstrates respect and sensitivity for diversity in

beliefs, values, and cultural practices. Evidence 15 pg 23


Domain 4: Interprofessional Collaboration and Quality Management

Competencies


page number where


Competency 4.1: Collaborates effectively with different members of

the interdisciplinary team to promote teamwork and to facilitate and

coordinate care.

Evidence 16 pg 24

Competency 4.2: Recognises and respects the different roles and

skills of all members of the health care team and support services.

Evidence 17 pg 25

Competency 4.3: Participates in the planning and/or implementation

of quality improvement initiatives such as evaluation and improvement

of practice, clinical audits, and development of policies/standards.

Evidence 18 pg 28

Competency 4.4: Contributes to the professional development of

peers and other healthcare professionals and promotes a culture of

learning.

Evidence 19 pg 29


Applicant’s Declaration

1. I declare that I have assessed myself against the Competency Framework for

Senior Staff Nurses and that I meet the required standards of competence.

2. I declare that any documentation and evidence presented is entirely my own

work, or whenever the work was part of a team due reference is made.

3. I certify that the documents referenced and submitted for evidence are authentic.

4. I understand that I will be called for an interview to verify submitted evidence,

demonstrate the competencies achieved and present original certifcates referred

to as part of the framework.

5. I understand that the board may ask for additional material or evaluation of

evidence.

By signing I declare that the information I have given is true and correct.

Applicant Signature

20/10/17


Evidence 1 – Competency 1.1

This evidence discusses a case of patient identification upon which a hospital policy exists.

On November 1st, in our unit we had two patients with the same name, surname and locality.

This is not uncommon in Malta especially with older generation. Furthermore, one of the patients

suffered from severe dementia and was not able to identify herself when asked. It is the hospital

policy that each patient should wear identification (id) bracelet during his/her stay. In this situation

it was essential that the id bracelet had 2 identifiers including the name & surname and the

medical record number. For local patients the national identification number is used. This is

essential to ensure that a correct match is made between the patient and the interventions; be it

drug administration, surgical intervention, phlebotomy, and blood transfusion amongst others.

The id bracelet proved useful to ensure a correct identifier in the above mentioned interventions

and therefore minimised potential errors.

This scenario was given its due importance. The whole nursing team took on the challenge to

ensure that it was handed over at every change of shift. We also made sure that the daily

phlebotomists were also informed on a daily basis. The respective medical teams especially the

on call doctors were also made aware in particular when ordering blood or any other

interventions and when carrying out any documentation to ensure that the appropriate file was

chosen. The consequences that could result are detrimental if one is not careful especially when

you have a patient with dementia. This case also shows the importance of handing over and

effective communication between the multidisciplinary team to minimise the risk of any

preventable errors.



Delegated Task: PCA Charting by a 3rd

year BSc Student.

I was a mentor for a 3rd

year student who had been with working with me on a surgical ward for

the last 2 weeks. Throughout these two weeks, we had a couple of patients who had PCA

infusion. We have discussed the reason for the PCA, the pros and cons of PCA, and how to use

the machine especially in extracting the data required for documentation. In addition, together

we have been through the parameters recorded, their frequency and the rationale behind. The

student had developed a good insight into the reason for a PCA and how to take readings from

the machine.

On her third week of placement, I delegated the PCA charting to the student during my lunch

break. She was told that Nurse X will be responsible for my patients during this time and

therefore she will come to supervise her during the task. Following handover of all patients to

nurse X, I also informed her that the student will be asking for supervision during the PCA

charting.

Following my break I went through the parameters with the student and ensured that

documentation was carried out. Together with the student we looked into different scenarios and

the actions that would need to be taken in accordance with the case. This exercise served two

purposes: as a reflective practice for myself and also enhanced further the student’s knowledge. I

also sought feedback from the nurse who had supervised the student.

Affirmation of Evidence by CN: As Charge Nurse of Mrs. Borg I would like to state that she

ensures that effective delegation is carried out with her colleagues as well as students. She

follows up on the delegated task and ensures that the person being delegated to is competent in

carrying out the task. She also ensures that the task is within the scope of practice of the

delegatee.

Sharon Camilleri Joanna Borg

Charge Nurse Staff Nurse

Medical Ward 20 Medical Ward 20



We had an admission for respite care which is not normal in our psychiatric unit. This client

had never been admitted despite having been diagnosed with mental illness for over 20

years. He was always managed in community, however his main carer needed to be

admitted to hospital for a surgical operation and the psychiatrist agreed to have him admitted

until his carer is back home since there is no other family member to take care of him and

the operation and rehabilitation were anticipated to be long.

During his admission assessment, his main carer informed us that he is helped with personal

hygiene. I found this strange as he seemed to be quite capable and physicaly independent. I

was day duty the following day and since he was my patient I took him to wash but he

seemed lost. I realised he has no idea how to do it on his own. I assisted him and started

giving him simple instructions to carry out whilst I was there. I spoke with him about this fact

and explained that our team can help him to relearn how to do it by himself. He was

reluctant at first but after a few attempts he agreed. I involved the Occupational therapist to

carry out a bathing assessment and together a plan was developed on the way forward. It

was very important that we do not put undue stress so as not to trigger an anxiety attack and

eventual relapse. Within 2 weeks the patient was capable of taking a shower alone.

When his sister recovered and he was ready to go home, we told her to keep encouraging

him to take a shower alone so he will strengthen his confidence and continue to gain some

independence. We told his sister that this was beneficial for both especially more so for her

since she was still physically recovering.

This scenario is quite common within the mental health care. It is very important that we as

nurses understand the complexities that mental illness has on the individual. Mental health

sufferers tend to lose their social skills like cleanliness and patients who have no support

often end up suffering from self-neglect. Nurses must identify such problems through

assessment, and can educate and empower the patient to regain social skills so that they

can cope in the community. This also follows with the national strategy of integrating people

with mental illness in the community. It is important that other health care professionals are

also involved and as a team work together to help the patient. Involving the family members

is also important. This case study illustrates the importance of proper nursing assessment to

identify patient needs; the establishment of a good therapeutic relationship built on trust; and

finally working together with the multidiscliplinary team to improve patient outcome.



2016 – Safe Practices within the Clinical Environment: Short Summary

Include a list of CPD – certificates to be presented during the interviews.

The following is a short summary of what is expected on a CPD activity.

2016 – Safe Practices within the Clinical Environment: Short Summary

I had the opportunity to attend a one day Conference on Safe Practices within the clinical

environment. A brief introduction to patient safety issues including the physical, social, emotional

and economic costs was presented. This was followed by a description of the PASQIT project

currently being implemented in Mater Dei Hospital. A number of initiatives associated with this

project were also presented including thermoregulation of the newborn, pressure sores, and the

importance of discharge planning to reduce potential safety issues.

Most of the topics on patient safety were not new however I was not aware of some of the

initiatives that were taking place. Also the importance of the reporting and its positive impact at

organisational level was presented. This facilitated my understanding of the whole concept. The

lack of reporting by all professionals was also debated. During the presentation I could relate to

a number of incidents including near misses that I could have reported but did not know.

The importance of reporting is an issue that I will be working more upon. Reporting provides a

means for the organisation to analyse the processes and improve upon them. It has also

widened my perspective on other areas which are considered as part of the patient safety alert.

These areas will aid as a reminder in my every day practice.



Nursing Home Visit Report

NB: All the names used and personal information are fictitious to maintain anonymity

Source, Date &

Reason of Referral

Mr Grech was referred for assessment from the CommCare Call

Center

Date of Visit 12th March 2012

Client’s Name and

Surname

Mr Joe Grech

Address 20, Triq Santa Tereza, Qormi.

I.D 012352M

Tel. No: 21223344

Next of Kin & Contact

No:

Niece Ms Mary Attard

General Practitioner Dr Caruana Tel : 21998877

Present during visit The house was crowded with relatives, his sister, brother, niece

and nephews. Mr Joe Grech (patient) and Joanna Borg (nurse)

Diagnosis / Medical

Information

Mr Grech is a known case of diabetes on insulin and suffers from

heart problems. He was discharged from hospital a week ago

following aspiration pneumonia and uncontrolled diabetes.

His Treatment is being prepared by his sister as per chart.

Social Situation Mr Grech lives with his sister and her family and has a lot of family

support. In fact his brother in law and niece attend to his personal

hygiene and also check his glucose regularly.

General Information;

ADL’s / IADL’s

Mr Grech seemed very lethargic throughout the home visit. He is

semi dependent in most activities of daily living. He succeeds to

mobilise with the use of frame.

They have purchased a height adjustable bed so as to aid in

mobilising in and out of bed.

His relatives assist him in his personal hygiene. He is still continent

however, relatives claimed that he sometimes has accidental

incontinence.

Services Utilised District nurses visit twice a day for insulin administration.


It was agreed to send carer for personal hygiene twice a week as

well to help the relatives.

He has physiotherapy outpatient’s referral and is being followed

by social worker.

Problems Identified His sister claimed that last night he fell whilst trying to go to the

toilet. Parameters were checked and his Blood glucose was 16

mmols whilst his blood pressure was very low 90/50 (on no anti-

hypertensive drugs). The symptoms presented required urgent

reviewing so as to prevent the possibility of develop ketoacidosis.

He has also high risks of falls as well due to uncontrolled diabetes

and mobility problems.

Action Taken His general practitioner was contacted and notified of the

parameters and agreed to visit immediately. He arrived in few

minutes time and administered another dose of insulin. He

reviewed his treatment and advised to keep the patient well

hydrated. Brother in law was advised to check and record the

glucose levels more regularly in the next few days and inform the

GP immediately of any drastic changes.

Information regarding diet, complications and actions to be taken

in case of hypoglycaemia or hyperglycemias was given to the

relatives present.

District carer service started twice a week in view of his personal

hygiene.

Recommendations Check HGT regularly; take oral fluids regularly, to follow diabetic

diet.

Further actions/Plans Follow up call this afternoon from our offices

To visit patient in one week time.

Date of Report 12th March 2012

Signature J. Borg

Follow up Report Date - 12th March 2012

Review by phone was carried out; his sister claimed that the blood

glucose remained within normality. His general practitioner (Dr

Caruana) has visited again to review his condition. Mr Grech was

much better and will be followed for his diabetes at diabetic clinic

at Qormi Health Center. They were advised to contact CommCare

should they require any other assistance.



A 22 year old female was admitted to the Day Care Unit (Surgery) for laying open of anal

fistula. During the pre-operative preparation, I have assessed what she knew regarding the

procedure and whether she required any other information. Factually, she informed me that

she was a nursing student and had a good idea of what the procedure entailed. She also

stated that the consultant had already explained a lot during the outpatient appointment.

However she seemed terrified that anyone of her colleagues might be present during the

operation and did not seem to remember whether the consultant had informed her or not

regarding size of scar and aftercare post op. I have immediately contacted the theatre staff

and stressed the fact that the patient did not wish to have any healthcare students during the

procedure. Moreover, I have asked one of the doctors to come and explain in more detail

regarding the laying open of the fistula and follow up care. Once I reassured her that no

students would be present during the procedure, she was more relaxed and able to

understand the information given and sign the consent form accordingly. I have also

explained how to relieve pain and speed up the heeling process with the use of sitz baths

and use of bethadine. I made sure that the client and her mother who was accompanying

her had understood all the information and I have answered all their queries and concerns.

Moreover, I have written all the instructions and provided a contact number, should she

require any other clarification.



3 skills:

1. Intravenous Drug Administration – successfully achieved the certificate in

Intravenous Drug administration – July 2016 and is valid for 5 years. (Certificate to be

presented during the interview)

2. Basic Life Support – successfully completed the Certificate of basic life support for

Health Care Professionals – November 2016. (Certificate to be presented during the

interview)

3. Removal of Redivac Drain:

This is to certify that I have witnessed Ms. Borg in carrying out Removal of redivac drain.

The following were all demonstrated:

• Procedure explained to patient to gain consent and ensure cooperation. Ensured that

patient is placed in a comfortable position.

• Followed and adhered to infection control principles – in terms of hand hygiene and use

of hand rub, sterile techniques in opening of packs.

• Equipment to be used checked for sterility, expiry and placed on previously cleaned

trolley.

• Dressing removed and discarded in yellow bag. Site observed for any signs of infection

or inflammation.

• Drain site cleansed and dried to visualise suture knot. Suture removed and checked it

was complete.

• Swab placed under tubing. Patient advised to inhale and exhale slowly during removal

of drain. Drain slowly pulled out and pressure applied to drain site until bleeding stopped.

Drain site covered with sterile dressing. Patient informed that procedure was ready.

• Correct disposal of sharps and equipment carried out.

• Ensured proper documentation of procedure, site and output in drain charted on output

chart and nursing report.

Sharon Camilleri Joanna Borg Charge Nurse Staff Nurse Medical Ward 20 Medical Ward 20



A 77 year old lady has been admitted to our ward with shortness of breath. Her relatives

were very agitated and immediately claimed that she cannot cope anymore alone and

should be admitted in a nursing home. After the acute phase has passed and she was

stabilised, I have spoken to Ms Zammit (the patient) and tried to gather more information

about her situation at home and level of dependence. She claimed that she did not wish to

go in a nursing home but was not coping anymore on her own to prepare meals, clean her

house and wash by herself, and was ending up always with shortness of breath. She did not

want to be a burden on her family. During the ward round I took the opportunity to discuss

her case with her consultant who agreed to refer her to an OT to assess her home situation

and the discharge liaison team so as to try to support her before discharging her home. In

the meantime I have discussed the different services available with both the patient and her

relatives and they were willing to try to use them. The unit social worker was also consulted

who started the process for the referral for Telecare, Meals on Wheels and Homehelp.

Together with the discharge liaison team, we have also referred her to CommCare

Assessment Unit and district nursing to assist her in washing and prepare her medications

once a week. All the assessments and actions taken were documented. (Please find the

COCF form pg 1 and pg 2 attached in Appendix 1 as evidence).


Evidence 9 - Competency 2.5

During a day duty one of the relatives of a 75 year old lady who was in our ward approached

the nursing desk shouting and asking for the nurse in charge so as to make a complaint. The

charge nurse was not on duty and being the most senior in the ward, I have approached the

gentlemen and invited him to come in the office so that he could vent out his concerns.

His mother was admitted due to uncontrolled diabetes and necrotic toe. He was really angry

and agitated as he claimed that his mum told him that they were going ‘to cut out’ (amputate)

her toe and they asked her to sign a form without telling them to be present during the

explanation/ ward round. After trying to calm him down, I promised him that I was going to

ask the nurses who were on duty and to check her file and get back to him immediately. I

came to know that in reality, the nurse allocated to the patient was caught by surprise during

the ward round with the news of amputation and had immediately tried to call the relatives

(knowing how involved in her care) without any reply and all was documented in the file. I

have explained all this to the relative and made sure to find a doctor who could explain the

need of the procedure and related information. Indeed he checked his mobile and found a

number of missed calls to which he had not replied. We confirmed that they were from the

hospital.

I tried to deal with the complaint at source of origin, he seemed much calmer and

appreciated a lot that I listened to him and took the necessary actions without taking any

parts. Nevertheless, I still asked him whether he wanted to make the complaint formal, which

he refused.

I have documented the occurrence in the file and after discussing the case with my charge

nurse we decided to emphasize more with the consultants and the nursing staff in the ward

to make sure to include the family in the care if the patient consents. Upon reflection and

discussion with the charge nurse I also realised that it would have been ideal if I had asked

for a colleague to be present with me in the office primarily as a witness and as a safety

measure. Also, as a team we taught that it may be more appropriate to have more than one

contact number, when available, so that if one relative is not reachable we can contact

another one.



To whom it may concern,

Ms Joanna Borg has formed part of this unit since its initial phases and thus was one of the

members who participated in the setting up and training and mentoring of new staff during its

expansion. Ms Borg was one of the senior qualified nurses and has acted as deputy nurse,

in the last three years when I was responsible for the Unit taking charge of the unit in my

absence. She has systematically demonstrated the ability to be flexible, prioritise work and

willing to share her knowledge and expertise with patients, families and other members of

staff. She is a very responsible, organised and accountable person. She is able to work

independently, out of own initiative and/or within a team. She has always demonstrated

ability to acknowledge her limitations and liaise with her senior management as needed. Ms

Borg has strong communication and interpersonal skills and is a valued team member.

Yours Sincerely




The daughter of a 70 year old gentleman has phoned CommCare for assistance as she

suspected that her father was not taking his medications properly. She claimed that he was

behaving strangely and he still had pills in the pill box from previous days. He suffered from

heart problems and was a known case of epilepsy. During the home visit his daughter was

present and Mr Ellul was sitting comfortable on the sofa. He admitted that he was finding

difficulties in preparing his medications and forgetting to take them at the correct time. I have

advised Mr Ellul and his daughter to inform their GP regards these new changes in memory

process so as to review his condition. However in the meantime I have informed them that I

would be referring him to district nursing to prepare the medications and apply for Telecare

plus so that they would remind him to take the medications. I was still explaining when all of

a sudden, Mr Ellul started jerking his limbs and had facial twitching. Fortunately he was

sitting on the sofa and therefore I removed the furniture which was near and putted cushions

and pillows on the floor and around him to keep him safe. I have reassured his daughter who

was terrified and started taking the time to assess duration of the seizure. The seizure lasted

more than 5 minutes (almost 12 mins) therefore I asked his daughter to call for an

ambulance. As soon as it ended I rolled him onto his side and made sure the airway was

patent and he was breathing well. Mr Ellul had lost control of his bladder and therefore to

avoid any drastic change in temperature, we covered him with a blanket and kept him warm.

He slept for few more minutes than he started gaining consciousness. I stayed with his

daughter till the ambulance came and helped to change his clothes and transfer him to the

ambulance for further review at hospital. I gave hand over and explained the occurrence to

the ambulance nurse and gave her my contact details for further clarifications if needed. I

have documented everything on his assessment sheet once back in the office and informed

the rest of the team at Commcare. He was admitted for few days in hospital for more

investigations. Upon discharge we were notified and we booked another day to reassess the

situation and revaluate his care plan.



One of our patients sent me a friend request on face book whilst still hospitalised. I had a

very good rapport with this patient having nursed her both pre and post operatively. She

trusted and preferred to discuss certain matters with me. I had started noticing that she

would only share concerns with me rather than with the allocated nurses. If I was not on duty

she would wait until I’m back to work to ask major issues.

I was taken back when I saw a friend request sent by her on face book as I had never

encountered such circumstances before. I did not feel it was right to accept her as this would

compromise our relationship. I saw the friend request on my off day. When I returned to work

on my first day, the patient came by and asked if I saw her friend request. I told her that I

had not seen it yet since I don’t use it that often. I took the opportunity to go through some

literature and foreign policies with regards to social media so as to make sure that I was

taking the right decisions. It took me a lot of courage to talk to her and explain the reason

why I was not accepting her friend request. I tried to reassure her that this will not change

our relationship in any way whilst she is in hospital. At first the patient did not talk to me at

all, however I made sure that I would continue as if she never sent the request. I knew that

she felt awkward with my presence in the beginning but the fact that I showed her my

support all along minimised this uneasiness. I wanted to ensure that the professional

boundaries were respected. Following this episode I discussed the case with my Charge

Nurse and other colleagues to check if the patient had sent them facebook requests as well.

As a unit we realised that this is not the first time that this situation presented and together

we started discussing the best way to tackle it. We agreed to follow and refer to the Policy on

the Use of Social Media in the Public Services so as to establish guidelines for future

reference.



A patient of mine was discharged and required community referral for stoma care. The

patient had undergone an emergency intestinal obstruction and the stoma was unplanned.

During hospitalisation, the patient was seen and followed by the stoma nurse specialists.

The patient had coped relatively well with the situation and her relatives were very

supportive. They were present during the educational sessions organised by the stoma

nurses. During the sessions the patient had refused any psychological support in view of

altered body image but said that she will take the number and call should she feels the

need. On day of discharge I ensured that the stoma nurses were involved and a discharge

note for community nurses was filled and completed. The appointment with the stoma

nurses to review was also in place. Although the stoma nurses had given all the paper work

and also handed over that the patient can be discharged from a stoma care point of view I

contacted them again just in case they had some other input.

Finally the following issues were ensured:

1. The family had picked up all the consumables required for management of stoma at

home.

2. Any other prescriptions and schedule V papers were duly signed and handed over by the

surgical team.

3. Discharge letter was ready.

4. Referral to the community services form filled and contacted.

Due to the number of papers, appointments and referrals, I planned some time to go through

them with the client and her family to ensure that they understood the process. I also used

the hospital discharge checklist to ensure that I had gone through all the important criteria

(discharge checklist criteria - Appendix 2)

The family was asked to go through the papers themselves and explain their purpose to

verify that they have understood the information given. The ward contact details were

provided again to the relatives. Both relatives and the patient were advised to call the ward

should they think of any other questions that they may have forgotten to ask before

discharge. This number also gave some form of reassurance as it was a contact number of a

place which knew about their situation.



The evidence provided is of a handover and discharge of a case of a client who had an

amputee and was being transferred to the Rehab Hospital.

Actual discharge process:

1. Telephone call with detailed handover done with the nurse in charge at the Rehab Ward.

During this telephone conversation, I ensured that the bed was available so that I can

book the transport.

2. Transfer handover document (COCF Residential - Appendix 3)

3. The file together with a Copy of Discharge letter, and COCF given to the porter who was

accompanying the patient.

4. Documentation handed over to the patient and his relatives included - Discharge letter,

Schedule V papers signed, appointment dates for follow up.



During one of the admission assessment, the client expressed the wish that all information is

provided to the husband. The lady revealed that she held Islam belief and her request was

odd for us since our first duty is to inform the client. As a team we discussed how best to go

about this since the operation was a delicate one. Together with the husband, we agreed

that the information is discussed with both of them together. We gave the couple time to

decide on the treatment options, and as a team we met and agreed upon a plan of action.

We gained both husband and wife’s trust which helped in the recovery phase as both

husband and wife did not insist that the husband must be present at all times. This would

have been a problem since it is an only female ward, and therefore the presence of the

husband at all times might have created problems. We did encourage the presence of the

husband during all delicate information giving and especially if a male doctor was present.

This agreement was documented in the nursing report and handed over from shift to shift in

order to ensure continuity of care.



To be part of an effective team each member needs to value and understand the

contribution of all the other members. Teamwork is a process and one has to work towards

enhancing it through different pathways including teambuilding activities, enhancing an

environment of respect, tolerance and continuous collaboration.

In our unit, we admit very sick patients who need complex and different levels of care.

Particular complex cases which we see in our ward are patients admitted with

cerebrovascular accident (CVA). CVA causes physical, psychological and cognitive changes

and emotional turmoil for the patient and his family. In order to meet all the needs of our

patients a multidisiclipinary team approach is needed. In the acute phase, the consultant and

nurses focus on minimising the brain damage caused by stroke. When the acute phase is

over, assessment from various specialties is needed to help the patient work on his/her

disabilities to improve prognosis and to cope with disability. From admission a detailed

history is taken so as to get a better idea of the patient’s condition and living arrangements

prior admission and start working to enhance recovery and faciliate discharge. As a result

the consultant and nurse start sending referrals and requests for consultation to health

professionals including:

• the physiotherapist who works on regaining mobility and strength,

• the speech language pathologist who assesses speech and swallowing problems,

• the occupational therapist who helps the patient and relatives adapt their

environment to this new disability,

• the discharge liaison nurse who facilitates discharge and return in the community and

• The psychologist who helps the patient and relatives cope with emotional problems.

This is done according to need.

It is quite a challenge to co-ordinate care with all these professionals, however with good

communication, collaboration and mutual respect; we tend to work very well together in the

best interest of the patients and his/her relatives. As nurses, we are present when these

professionals come to assess, plan and work with the patient. Each professional provides a

plan of care and it is often nurse who have to ensure continuity of care in their absence.

Apart from feedback in the patient’s notes, we provide information about care plans and the

patient’s progress to the rest of the team and facilitate co-ordination of care. This team effort

has always proved to facilitate care, improve outcome and help the patient return back into

the community despite disabilities he/she experiences.



Whilst working in the treatment room at the Health Centre, I often encounter elderly informal

carers taking care of their spouses or loved ones. I try to take the opportunity to discuss with

them and provide information about the available local services Health and Community Care

services. Recently, I came across an elderly lady who was taking care of her wheelchair

bound husband who required daily change of dressing on his lower limb. I noted that this

was adding several stress on this elderly lady as she had to bring him by pace to the centre

every day which was physically challenging for her. He was incontinent and they used to

spend a large amount of their pension in buying of diapers. Moreover she had become

homebound herself and never leaves the house due to fear that something would happen to

her husband whilst she is not there. I discussed their situation with my charge nurse who

supported my idea of involving the commcare assessment unit and to inform them regards

the incontinence and Telecare Plus services. The CommCare Assessment Unit were

contacted and briefed about the situation, who in turn agreed to schedule a home visit so as

to assess the situation and devise a care plan accordingly.

Below please find the information provided to this elderly couple in the meantime.

Commcare

A unit comprised of nurses, a physiotherapist, an occupational therapist, a social worker,

personal carers and administrative staff who strive to ensure that all individuals who receive

care in the community are appropriately cared for, whilst also acting as a bridge between the

health and social care services in the community. Their contact details are :

Address: CommCare Unit, St Luke’s Hospital, Gwardamangia

Telephone Number: 22589393

E-mail: [email protected]

Incontinence Service

The aim of the Continence Service is to alleviate the psychological problem(s) to which a

person may, as a result of incontinence, be subjected.

General Information

Scheme A: The person must be in possession of a valid special identity card issued by

the Commission for the Rights of Persons with Disability (CRPD) and suffers from

incontinence as certified by the respective General Practitioner (GP). Those under Scheme

mailto:[email protected]


A are entitled to free nappies. A monthly amount of nappies fully subsidised and free of

charge

Scheme B: Applicant must be over sixty years of age and suffers from incontinence as

certified by the respective General Practitioner (GP). Those under Scheme B are entitled to

subsidised nappies. A monthly amount (unlimited) of subsidised nappies (that is a

government subsidy of €0.07 per nappy) Fees per nappy: Small: 16c each, Medium: 23c

each, Large: 27c each, Extra Large: 34c each.

In order to apply one needs a completed application form, a special Identity Card (Scheme

A), a Medical Report signed by the respective General Practitioner and a Signed Declaration

Form.

One can apply for the service Online, download an application form from the site

activeageing.gov.mt or alternatively, one can also call at Ċentru Servizz Anzjan, 3, Old Mint

Street Valletta and apply there.

Telecare Plus

The aim of this service is to provide peace of mind to older persons when assistance is

required at their homes, thus encouraging the elderly to continue living in their own home

and in the community. Persons under 60 years of age who suffer from a chronic illness can

also apply for this service.

· General information

Persons over sixty years of age who have no one living with them in the same residence

under sixty years of age are eligible for the service. The applicant must have: a valid Pink

form issued by the Department of Social Security which is to be renewed yearly; or a valid

Yellow Card issued by the Department of Health proving that applicant is diabetic (the

schedule V or the SLH 145 form). Persons under sixty years who suffer from a chronic

illness can also apply for the service. Applicants must have a fixed land line with GO plc.

The required documents to apply are a completed application form, a Copy of a Valid Pink

form or Copy of a valid Yellow Card proving that applicant is diabetic; a Medical report

signed by the General Practitioner (applies to persons under sixty years only and a Signed

Declaration Form.

Fees and Charges

Payment for the Telecare+ Service is as follows:


o €25 deposit is paid upon installation by technician, which is refundable if the set

is returned and service is no longer required; and

o €4 rent every month for the service payable on the GO Bill.

o No Rent is paid for this service by Pink Form holders, Yellow Card holders and

those suffering from diabetes.

One can apply for the service Online, download an application form from the site

activeageing.gov.mt or alternatively, one can also call at Ċentru Servizz Anzjan, 3, Old Mint

Street Valletta and apply there.



We were noticing an increase in pressure ulcers within our unit and in turn decided to investigate

the occurrence. We started by looking into our nursing practice in relation to pressure sores in

particular nutrition & hydration, and mobility including lifting and handling. We also looked into all

the equipment available which could be used. We kept a register with all the patients name,

diagnosis, pressure sore, and the presence of predisposing factors and presence of pressure

sore on admission and / or developed during admission. We needed to differentiate between the

two to implement both a preventive as well as management strategy.

We revised our care and as a team we identified a number of strategies that we could implement.

Our priority area was nutrition, and the lack of documentation about it. Our assessment revealed

that we knew very little about the nutritional state of our client on a daily basis. For a successful

implementation of this strategy the carers were also involved. They were explained the

importance of what we are doing, and they were asked to report back if clients were eating or

not. This enabled us to advise medical team on any additional nutritional supplementation that

was needed to prevent pressure sore and enhance recovery. We are still in the implementation

phase and therefore cannot state whether we have any reductions or not. A positive thing about

this initiative is the fact that all nurses worked together to try to analyse the problem and together

managed to come up with solutions.

Affirmation of Evidence by CN

I affirm that Ms. Borg has participated in the initiative to reduce pressure sores within our unit.

She collaborated and worked with the team so that together they come up with focused

strategies to minimise the occurrence of pressure sores.




A new depot injection has been introduced in the government non-formulary list. This injection

has well founded benefits and the hsoptial staff were all anticipating its introduction to evaluate

whether the claimed benefits would be seen in our patients as well. However, the administration

of this depot injection was to be done only following training and becoming certified competent.

The hospital management sent two delegates from all acute wards for the course that was

organized by the company. Being one of the most senior nurses in the ward, I attended the

training together with the charge nurse. During the training, we were taught about the

preparation and administration technique and made aware of the extra care needed to avoid

post injection syndrome. Factually, we were informed that the patient needs to stay under

observation for 3 hours while he is monitored for signs and symptoms of post injection

syndrome. It was agreed that the training would permit us to train others and certify them

competent.

Following the training, the charge nurse and I developed a plan to provide the necessary

training to our ward’s staff so they could administer the injection themselves. We met with

every shift and delivered a tutorial on how to give the injection and the importance to monitor

for post injection syndrome. We also gave them some literature that was provided to us by

the company so they can do further reading. After all the shifts were given the tutorial, a staff

meeting was organised where we reflected and discussed any queries about the new

treatment and the way forward to maintain competence in this new skill. A boxfile with all the

information was also compiled and placed in the nursing station where it will be available for

everyone.

.



Appendix 1: COCF - Competency 2.4


Appendix 2: Discharge Checklist Criteria – Competency 3.2


Appendix 3: COCF Residential – Competency 3.3