Nursing Development Programme 2

(NDP2)

Critical Care DirectorateCardiff and Vale NHS Trust

Candidate; …………………………

Start date; …………………………

Important Notice;

All components of the Nursing Development Programme 2 (NDP2) must be successfully completed in order to claim this achievement and document it on your CV.

To claim successful completion and state this on your CV without fully completing the Programme is classed as fraud. Individuals can and will be investigated by the Cardiff and Vale NHS Trust if suspected of fraudulent activity.

For your own protection do not list this on your CV until you have passed all components and been certificated.

The components for successful completion of the NDP2 are;

1. Attendance at greater than or equal to 80% of the study sessions

2. Successful completion of the Reflective Assignments – see assignment guidelines for full criteria.

3. Inclusion in group activities and discussions throughout the Programme.

4. Pass written test.5. Pass scenario

Critical Care Directorate Revised April 2011

Nursing Development ProgrammePart 2 (NDP2)

Critical Care DirectorateCardiff & Vale NHS Trust

Reflective Practice Assessment

Start Date……………………Candidate……………………

IntroductionThe Critical Care Directorate and Cardiff and Vale NHS Trust are committed to the continual development of staff and life long learning. As a component of this strategy, the Nursing Development Programme 2 has been developed as part of an integrated Education Pathway.

Professionally Post Registration Education and Practice (NMC 2002) provides the standards set out by which nurses can present proof of development. The concept inherently merges the acquisition of clinical experience with the need to provide evidence of development through reflective practice and post registration education. The outcome of this standard is the provision of high quality and equitable evidence based care, which meets the minimum requirement for registration. However the complex nature of Critical Care requires a more comprehensive approach in the form of a pathway that provides in depth education and supervision far exceeding what is acceptable as a minimum standard. The process needs to provide structure for development over a prolonged period to develop staff competence from novice through to expert (Benner 1984).From a service provision perspective the National Report into the effectiveness of Critical Care provision (Audit Commission 1999) led to a re-evaluation of service provision. Comprehensive Critical Care (2000) which considered the Human resource issues and reiterated the need for highly skilled, knowledgeable individuals skilled in the discipline. From a corporate perspective, Clinical governance (1999) tempered the need for the use of evidence and audit by a skilled and knowledgeable workforce with the outcome of managing risk and quality of provision. This idea was further strengthened by the National Assembly for Wales document Improving Health in Wales (2001) and reiterated in Designed for Life (2005) with staff recruitment, retention, education and development as core principles.The political and professional demands place on the staff and the service have made it incumbent upon Trusts to ensure that adequate provision is made to foster an environment of continual staff development and that adequate resources are designated to accomplish this outcome.

Course AimsThe aim of the DP2 course is to enable staff develop within the Knowledge and Skills Framework, to function at Band five/six level. The process will ensure that staff are fit for purpose and able to take responsibility for individual and groups of patients requiring Critical Care intervention.The DP2 programme is typically aimed at the nurses that have completed a foundation programme in Critical Care nursing and have a level of Critical Care experience greater than eighteen months. It will provide staff with a structured learning experience that will encourage the use of Best Practice and evidence based care.

Knowledge and Skills FrameworkWorking within Critical Care Directorate staff will develop specialist Knowledge and Skills, through formal teaching sessions and supervision of clinical practice and the use of reflection. The KSF (2004) framework will be utilised to help develop staff within the Specific Critical Care and Core dimensions to the levels indicated at band six. The object of the course is to enable staff to pass the foundation gateway and aid in their long-term development, in parallel with the Personal Development Review process to satisfy the criteria for advancing through the second gateway. This will provide clarity to enable the individual to tailor their needs to meet both their professional obligations, service requirements and ultimately improve patient care.

Objectives to be achieved

C1-Communication – Level (3) C2-Personal and People development - Level (3) C3-Health, Safety and Security - Level (1) C4-Service Improvement – Level (2) C5-Quality – Level (2) C6-Equality and Diversity – Level (2) HWB2-Assessment and Care Planning to Meet Health and Wellbeing Needs –

Level (3) HWB5-Provision of Care to Meet Health and Wellbeing Needs - Level (4) HWB7-Interventions and Treatments – Level (3) HWB8-Biomedical Investigation and Intervention – Level (3) G6-People Management – Level (2)

Definition of levels and assessmentAll practice outcomes will be assessed against the KSF dimensions and levels as fixed for the band 6 post outline. Students should seek support from their preceptors and the Practice Education Team for supervision and utilise a recognised theoretical framework to demonstrate reflection when completing the Reflective Journal. Students will be expected to have completed the Reflective Practice Journal within the six month duration of the course.

Core dimensionsC1-Level 3: The student must demonstrate the ability to develop and maintain communication with people about difficult matters and or in difficult situations.

C2-Level 3: Develop oneself and contribute to the development of others.

C3-Level 1: Assist in maintaining own and others health, safety and security.

C4-Level 2: Contribute to the improvement of services.

C5-Level 2: Maintain quality in own work and encourage others to do so.

C6-Level 2: Support equality and value diversity.N.B. The core dimensions should be applied to all aspects of the assessment process where possible.

Health and wellbeing

HWB2-level 3: Assess health and wellbeing needs and develop, monitor and review care plans to meet specific needs.

HWB5-Level 4: Plan deliver and evaluate care to meet peoples health and wellbeing needs. This should encompass the utilisation of evidence and best practice for specific care delivery. Working within the multidisciplinary team and monitoring the effectiveness of interventions.

HWB7-Level 3: Plan deliver and evaluate interventions and or treatments. Scrutinising goals for overall treatment plans, guideline and model use.

HWB8-Level 3: To plan, undertake, evaluate and report biomedical investigations and or interventions. The nurse should demonstrate the ability to carry out the appropriate procedure safely and able to respond effectively within the multidisciplinary team based on the findings of the interventions.

People Management

G6-Level 2 Plan allocate and supervise the work of a team. Is able to supervise, effectively and support junior members of staff within their proximity. To utilise good communication skills in order to provide constructive feedback and facilitate development of staff within the clinical area.

(NHS Knowledge and Skills Framework 2004)

Initial Self assessmentPrevious relevant experienceStrengths

Weaknesses

Threats

Expected outcomes following the course

Student sign/date……………/…….Preceptor sign/date……………/…….

Adapted for the All Wales initiative/Fitness for Practice (2005)

Clinical Reflections

This schedule contains a series of clinical reflection questions.

During the course of this programme you will be expected to complete four of these clinical reflections.

It will be expected that these clinical reflections will be submitted and a ‘Pass’ obtained in each one in order to complete the NDP2 Programme.

Candidates may present a draft copy of the work in line with the dates provided within this schedule.

Each piece of work will be double marked and written comments will be provided. The work will be returned via the internal post. Candidates will receive either a ‘PASS’ or ‘REFER’ on first submission of the final assignment work. On second submission of work a ‘PASS’ or ‘FAIL’ will be received.

Each clinical reflection must contain the following;o Wordage of 1000 excluding reference and quotes/tables.o All pieces of work are to be typedo 12 font to be usedo Name, word count and page numbers must be clearly

identifiedo Harvard referencing to be followedo A recognised model of reflection must be used, stated and

followedo KSF criteria must be included as outlined in each given

reflective questiono Work to be E mailed

Clinical reflection: 1 Respiratory

DimensionLevel

Carry out a clinical assessment of a patient with respiratory failure and Acute Lung Injury (ALI) /Adult Respiratory Distress Syndrome (ARDS).

Document your findings. Identify the pathophysiology of the underlying

illness. What were the essential issues influencing the

assessment? What was the diagnosis and how was the diagnosis

made? State was the initial plan following assessment. Was an evidence based approach utilised and if so

what was this? Were you able to instigate care in an expedient

manner and what dimensions influenced provision? Evaluate the initial response to the interventions. Evaluate the outcome. Was the outcome as expected,

give reasons for this What might have improved the care provision and

why?

HWB 2 (3)HWB 5 (4)HWB 7 (3)

Core C1 (3)Core C2 (3)Core C5 (2)

Latest date for draft submission;

Final submission date;

Clinical Reflection 2: Cardiovascular Care Dimension Level

Work with a patient requiring either;a. Inotropic therapy orb. Cardiac Output (CO) Monitoring

What observations might indicate the need to utilise CO monitoring / or inotropic support?

What led to its instigation?

How did the observations affect the planning of treatment?

What parameters and observations were recorded and why?

How did the observations effect the use of drugs or fluid as a treatment option and why?

Was the resultant treatment effective? If yes, why? If not, why not? Give the rationale for your answer.

HWB 2 (3)HWB 5 (4)HWB 7 (3)

Core C1 (3)Core C2 (3)Core C5 (2)

Latest date for draft submission;

Final submission date;

Clinical Reflection 3: Communication

DimensionLevel

Reflect on an issue involving an area where communication was challenging. This may include:

An ethical dilemma.

Dealing with a clinical incident.

Dealing with an agitated patient or challenging relative.

Briefly describe the situation. Identify which of the KSF Core Dimensions were involved and why?

Was the matter dealt with efficiently, were there quality of service issues?

Was there any policy instigated that influenced the approach to solving the issue.

Could the issues have been dealt with more efficiently or the outcome improved?

Core C1 (3)Core C2 (3)Core C5 (2)Core C6 (2)

Latest date for draft submission;

Final submission date;

Interim Self assessment 3Months

Experience that has improved practice

Experience that has threatened achievement of initial objectives

Areas still considered Weaknesses

Objectives set for the next 3 months

Threats to achieving the objectives

Student sign/date………………Preceptor sign/date…………….

Clinical reflection 4: Sepsis Dimension Level

Carry out an assessment of a patient in severe sepsis. How is the septic process defined? What led to the illness? How did the patients past and present history

influence initial assessment and care planning? Was the evidence practice paradigm/guidelines

utilised? What body systems were affected by the illness

and how did this influence care planning. Were the goals of instigated protocols met and

did the patient achieve the goals set for the shift? If not why not.

HWB 2 (3)HWB 5 (4)HWB 7 (3)

Core C1 (3)Core C2 (3)Core C5 (2)

Latest date for draft submission;

Final submission date;

Clinical Reflection 5: Renal CareDimension Level

Work with a patient requiring CVVH and reflect on:- Why was the patient Haemofiltered and what

blood parameters led to its instigation?

Carry out an assessment of the patient’s fluid balance utilising both the balance sheet and a clinical patient assessment.

What issue influenced the choice of filtration rate and hourly fluid removed?

What was recorded each hour and why?

What method of anticoagulation was utilised and why. What were the alternatives and why were they not used.

What were the psychological and physical issues raised?

Were the goals set for the shift met?

HWB 2 (3)HWB 5 (4)HWB 7 (3)

Core C1 (3)Core C2 (3)Core C5 (2)

Latest date for draft submission;

Final submission date;

Clinical Reflection 6: Neurological Care DimensionLevel

HWB2-level 3HWB5-Level 4HWB7-Level 3:C1-Level 3:C3-Level 1C4-Level 2C5-Level 2

Choose one of the following to answer. Please indicate clearly which question you have chosen.

1. Care for a level 3 patient with a head injury that requires an extra ventricular drain (EVD) or lumbar drain.o State the patients history which lead to the injuryo Identify the Pathophysiology of the injury and state why,

in relation to this, the EVD / lumbar drain was insertedo Identify the specific care and management of the EVD/

Lumbar drain giving the rationale.o State the evidence to support this.o Clearly identify the assessment of this patient

2. Care for a level 3 patient with an altered level of consciousness (which is not a result of elective sedation therapy)

o State the patients history which lead to this evento Identify the Pathophysiology of the injury and relate

this to their Glasgow Coma Score (GCS) providing a succinct account.

o Identify the specific care and management of this patient. State the evidence to support this in relation to a patient with reduced GCS

o Clearly identify the assessment of this patientCriteria for assessment will be matched against the KSF

Dimension levels1

Latest draft submission;

Final submission date;

Final Self assessmentExperiences that have been most useful

Strengths

Weaknesses

Expected outcomes/objectives to be set following the course.

Threats

Student sign/date………………Preceptor sign/date……………………

A Nursing Development Programme 2 (NDP2)MARKING GRID

Candidate Name; ……………………………………………..

Reflective Assignment Number………………………………

Hand in date; …………………………………………………

Topic Title; ………………………………………………………………………………………

……………………………………………………………………………………...

Pass Amend Fail

Evidence of reflective model use:

Evidence of literature review:

Evidence of session use:

Analysis and synthesis:

Content and grammar:

Markers; 1. ……………………………………

2. ……………………………………

Pass / Amend / Fail Comments:

Date; ……………………………………….

Assessed shift: Date…………Assessor………………

Patient history

Past medical history:

Presenting condition:

Hospital history:

Critical Care history:

I st AssessmentSYSTEM Indicators Shift Plan Rationale Sign

CNS GCSPupils

Agitation scoreRestraint/protocol

PainAnalgesia

Sleep

Sedation

CVS ECG BP

InotropesLactate

PeripheriesCI

SVIBlood Chemistry

RespiratorySystem

System

Vent modeVent settingsCuff pressure

P/F ratio AuscultationSecretions

SBTF/Vt

Vt / mls kg(Ventilation care

bundle)Sedation break

Head >30˚DVT prophylaxisGut prophylaxis

Ideal body weightPharyngeal suction

Shift Plan Rationale Sign

IndicatorsGI Feed route

Feed typeTube type / length

SecurityPosition check

SwallowGlucose controlBowels soundsBowel output

StomaDrains

Intra Abdominal Pressure

RENALPh

Urine output/hrPrevious 24 hrsFluid balance

actualFluid balance aim

CVVHDiureticsU&E’s

Catheter care

INFECTION TempWBCCRP

Microbes identifiedLactate measured

Fluid requirementsSite infection

Lines assessment and duration

VIP score

SYSTEM Indicators Shift Plan Rationale Sign

MOBILITY Actual body weightChest

Limb / joint integrity

Pressure soresWounds

Drains / linesPat-e-bac / Waterlow

End of life decision making

Section 1 / 2Mental Capacity

Fundamentals Respect / DignityNutrition

SkinHydrationOral care

Medication Pre admission medication

Critical Care medication

End of course assessment

Course objectives met

Reflective journal Personal goals metPreceptor signature…………………Date…………..Student signature…………………...Date…………..

Course assessment criteria met against KSF dimensions/Levels

Course assessor signature…………………….Date…………..Student signature………………….Date……………

Assessed shiftPersonal goals metPreceptor signature…………………Date…………..Student signature…………………...Date…………..

Course assessment criteria met against KSF dimensions/LevelsCourse assessor signature…………………….Date…………..Student signature………………….Date……………

References

Bloom B (1956). Taxonomy of Educational Objectives, Handbook I: The Cognitive Domain. New York: David McKay Co Incwww.nwlink.com/~donclark/hrd/bloom.html

Benner P (1984). From novice to expert. Excellence and power in clinical nursing Addison Wesley.www.ntrg.unet.com/html/skills_acquisition_in_clinical.htmlpractice.

Clinical Governance (1999)

Comprehensive Critical Care (2000)

Curzon L (1990) Teaching further education Holt Rinehart and Winston New York

Designed for Life (2005)

DOH (2004) Agenda for Change www.dh.gov.uk/PolicyAndGuidance/HumanResourcesAndTraining/ModernisingPay/AgendaForChange/fs/en

DOH (2005) The Knowledge Skills Framework Agenda for Change Project Team Welsh Assembly Government

Gibbs, G. (1988) learning by doing: a guide to teaching and learning methods FEU, London.

Merrill, M (1983). Component Display Theory. In C. Reigeluth (ed.), Instructional Design Theories and Models. Hillsdale, NJ: Erlbaum Associatestip.psychology.org/merrill.html

Oliver & Endersby (1994) Teaching and assessing nurses. Balliere Tindall

Rogers, C (1983) Freedom to Learn for the 80’s Merrill, Columbus

Appendices

Appendix 1Gibbs (1988) reflective learning cycle. This may be applied to as a whole or in part however the student would have to demonstrate analysis and synthesis in each portion of the cycle to demonstrate level 3 knowledge.