on-going record of achievement - university of suffolkon-going record of achievement: document that...

UNIVERSITY CAMPUS SUFFOLK

Faculty of Health and Science

Department of Nursing Studies

Pre-Registration Nursing Programmes: BSc (Hons) Adult Nursing

BSc (Hons) Mental Health Nursing BSc (Hons) Child Health Nursing

On-going Record of Achievement

Student Name: Programme: Cohort:

Contents

Content Page No.

Introduction ……………………………………………………………………………. 3

Glossary of terms ……………………………………………………………………... 4

Requirements for entering first practice placement.…………………………….… 6

Requirements for Mental Health Nursing students during the first practice placement……………………………………………………………………………….

9

Year 2 and 3 Record of mandatory training…………………………….................. 10

Generic guidelines for mentors to all pre-registration undergraduate Nursing programmes…………………………………………………………………..

11

The assessment process in practice flow-chart …………………………………… 12

Guidelines for students raising and escalating concerns in practice……………. 13

Year 1 documentation……. ………………………………………………………….. 17

• Mentor signature sheets……………………………………………………….. 19

• Simulated Practice Learning: Preparation for Practice Experience…..…… 23

• Short placement forms…………………………………………………………. 37

• Long placement forms …………………………………………………………. 51

Interview with Personal Tutor Forms………………………………………………... 101






Interview with Personal Tutor Forms………………..………………………………. 185






Final Placement documentation.…..………………………………………………… 239

• Sign-off Mentor signature sheet……………………………………………….. 240

• Final placement forms………………………………………………………….. 241

• Tri-partite meeting form………………………………………………………… 255

• Sign-off mentor end of programme declaration……………………………… 257

Interview with Personal Tutor Forms………………..………………………………. 258

Content Page No.

Absence record forms………………………………………………………………… 260

EU Directives…………………………………………………………………………... 263

Introduction The On-going Record of Achievement is the document that provides evidence of

your clinical progress throughout your programme.

The document must be completed in hand using black ink. Any alterations must be

clearly signed and dated – NO correction fluid is allowed in this document.

In line with the NMC (2015) ALL entries within this document MUST maintain the

anonymity and confidentiality of service users and their family/carer(s).

Students are expected to be familiar with those Values and Principles associated

with health care in the United Kingdom as enshrined in the NHS Constitution:

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/17065

6/NHS_Constitution.pdf

and to learn and practice in a way that is compatible with them.

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/170656/NHS_Constitution.pdf

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/170656/NHS_Constitution.pdf

Glossary of Terms Academic Lecturer: a member of UCS staff with academic

responsibilities

Action plan: Document that identifies development or learning needs

Associate mentor/ Stage 1 registrant:

a qualified nurse who has not undertaken/completed a NMC approved mentorship programme and therefore cannot sign to say that a student is competent.

Clinical Practice Facilitator/ Practice Educator:

a member of the clinical staff with specific responsibilities for the student experience

Direct contact: interaction with a service user

Facilitator: a member of staff that organises/enables a student experience

HEI: Higher Education Institution (UCS for example)

Indirect contact: simulation of an interaction with a service user

Link Lecturer: a member of academic staff responsible for liaising with specific clinical areas.

Long arm mentoring: the indirect supervision of a student whilst they are on visits or undertaking a practice learning opportunity in an area related to the student has been allocated.

Mentor/Stage 2 registrant: a qualified nurse who has successfully completed a NMC approved mentorship programme.

On-going Record of Achievement:

Document that demonstrates the student’s competency and their professional development throughout their programme of study.

Personal Tutor

A member of academic staff who is responsible for supporting the student, usually throughout their programme of study.

Practice Learning Opportunities: these are opportunities that students can engage in away from their allocated area that can enhance the student’s understanding of the service user’s experience (hubs and spokes).

Professional Lead: Senior academic and NMC registrant leading on health, welfare, disability and fitness to practice issues

Protected time: the one hour per week that the NMC (2008) identify should be allocated for sign-off mentors

Service user: anyone who uses the services of a nurse, or any other relevant service

Sign-off Mentor/Stage 2a registrant:

a qualified nurse who has successfully completed a NMC approved programme; able to sign to confirm that a student is competent and fit to be entered onto the professional nursing register.

References used in this glossary of terms Nursing and Midwifery Council (2010) Standards for pre-registration nursing education. London: NMC Nursing and Midwifery Council (2008) Standards to support learning and assessment in practice. London: NMC (http://www.nmc-uk.org/Educators/Standards-for-education/Standards-to-support-learning-and-assessment-in-practice/)

http://www.nmc-uk.org/Educators/Standards-for-education/Standards-to-support-learning-and-assessment-in-practice/

http://www.nmc-uk.org/Educators/Standards-for-education/Standards-to-support-learning-and-assessment-in-practice/

Requirements for entering the first practice placement Agreement to abide by all policies and procedures

It is essential that you abide by all policies and policies of Practice Education Partners, UCS relating to placement and the expectations of the NMC as enshrined in The Code: Professional standards of practice and behaviour for nurses and midwives (NMC, 2015) http://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/revised-new-nmc-code.pdf

I have read, understand and agree to abide by the above policies and procedures.

Signature of Student:

Date:

I have discussed this statement with the student

Signature of Personal Tutor:

Date:

Protecting the public through professional standards: Accepting appropriate responsibility There may be times when you are in a position where you may not be directly supervised by your mentor, supervisor or another registered professional. As your skills, experience and confidence develop, you will become increasingly able to deal with this situation. However, throughout all clinical placements you must only participate in care interventions for which you have been fully prepared or in which you are appropriately supervised, and which are in keeping with Trust/Practice policy.

If you have any doubts, discuss them as quickly as possible with your mentor,

clinical practice facilitator or an academic lecturer.

I have read and understood the above statement


Date:


Signature of Personal Tutor

Date:

http://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/revised-new-nmc-code.pdf

http://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/revised-new-nmc-code.pdf

Access to information about progression in practice The NMC (2008) stipulates that Mentors must have the opportunity to review your

previous practice achievements, experiences and learning. It is your responsibility to

keep this document safe, to take to each of your clinical placements and make it

available to your mentors.

Consent statement I consent to allow the sharing of confidential data about me between successive

mentors and with the relevant representatives of the Department of Nursing Studies

at UCS with regard to the assessment of my fitness for practice.

I understand that this is an NMC (2008) requirement and that it is essential to my

programme of study leading to registration with the NMC.


Date:


Signature of Personal Tutor:

Date:

Mandatory Training required before entering first practice placement Moving and Handling:

Year 1:Theory Year 1: Practice (1)

Date Trainer Signature Date Trainer Signature

Year 1: Practice (2)

Date Trainer Signature

Basic Life Support:

Year 1:Practice


Paediatric Basic Life Support (for Child Health Nursing Students)

Year 1: Practice


Disclosure and Barring Service check completed

Year 1

Date Signature of authority

Occupational Health Clearance

Year 1

Date Signature of authority

All requirements for entering the first practice placement are complete

Signature of Course Leader/Personal Tutor:

Date:

For Mental Health Nursing Students by the end of your first period of practice, you

MUST achieve the following:

Trust Induction: Acute Base Site Trust Induction: NSFT

Year 1 Year 1

Date Signature (Trust) Date Signature (Trust)

Personal Safety Training:

Year 1:Theory Year 1:Practice


Lorenzo Training:

Year 1


Year 2 and 3 Record of Mandatory Training Moving and Handling: Year 2

Theory Practice


Moving and Handling: Year 3:

Theory Practice


Basic Life Support

Year 2 Year 3


Paediatric Basic Life Support (for Child Health Nursing Students)

Year 2 Year 3


Person Safety Training (for Mental Health Nursing Students)

Year 2 Year 3


GENERIC GUIDELINES FOR MENTORS FOR ALL PRE REGISTRATION UNDERGRADUATE NURSING PROGRAMMES

Progression and achievement of competencies in practice?

Raise concern with student at earliest opportunity and document

in the practice document with a clear action plan for achievement.

Contact CPF/Link Lecturer/Convenor as appropriate.

UCS to be contacted for support in action plan formulation if needed; contact link tutor or personal tutor

Review action plan and document evidence of achievement.

Feedback to student. Personal tutor to be informed to feed

outcome into assessment board

Additional support, please contact Course Leader

Is there concern regarding fitness to practise (for example conduct, ability to meet requirements and

standards due to social or personal circumstance)

Raise concern with student and document in practice document.

Contact CPF/Link Lecturer/ Convenor as appropriate

Course Leader or Programme Director

Programme Director to assess urgency and address concern

through UCS Fitness to Practise process

CAUSE FOR CONCERN RAISED

The assessment process in practice flowchart

Prior to commencing practice placement• Practice Placement identify the mentor(s)• Student contact the placement and collects

off-duty

First day in practice placement• Student and mentor discuss learning

opportunities• Orientation to placement completed

End of first week – Initial Interview• Student and mentor complete initial interview;• Identify relevant visits • If relevant discuss Integrated practice

assessment and • Learning outcomes for the placement

Each weekMentor completes record of meetings held with student

Mid-point Interview• Student and mentor review and record the

student’s progress• Identify strengths and areas for improvement• Action plan completed if required

PASS REFER

Course Leader

Areas requiring improvement identified

These should be raised with the student at the earliest opportunity.

An action plan MUST be developed

End of practice experience – final interview• Student and mentor complete the final

interview• Achievements and unmet outcomes identified

Faculty of Health and Science

Department of Nursing Studies

Guidelines for students raising and escalating concerns in practice Introduction Students are subject to a variety of practice experiences and placements both within the

community, and acute trust settings. This is a guide for students who may witness clinical

practices in any of those environments, causing them concern. It gives the student a

process to raise that concern appropriately, and to escalate if they feel it is required. The

underlying principle is to safeguard the public. The following principles also apply;

Principles.

1. These guidelines are to be applied giving patient/carer and student safety as a

priority.

2. These guidelines are to be applied whenever, and however, there is a reasonable

belief that practice placement is not, compliant with NMC Standards.

3. These guidelines are to be employed in keeping with best education practice being

mindful of NMC Guidance on Escalating Concerns.

4. All persons involved should feel able to express their honest understanding of any

given situation without reserve.

Application.

These guidelines and based upon the NMC “Raising and Escalating Concerns: Guidance for

Nurses and Midwives” (NMC, 2015) and are to be applied when any reasonable concern

exists. The specifically relate to, and are aimed at students of nursing and midwifery who

may wish to raise or escalate a concern regarding clinical practice. They are to be used in

conjunction with any local placement policies relating to safeguarding, or whistle blowing.

The following are examples to establish an appropriate mental set only, to be considered if

the issue cannot be resolved when first raised. An expectation is that any person or authority

involved will exercise professional judgment at the time and in a proportional manner.

Immediate actions should be determined by the principles identified above. Examples of

situations where these guidelines may apply;

A concern is raised as a consequence of a complaint made by a patient, their carer

or a student to any person or authority about the standard of care delivered within a

placement

- An internal or external governance process or agency raises a concern about the

standard of care within a placement.

- The placement is not compliant with any aspect of NMC standards for placement

learning

Student guidance: Your role in raising concerns

As a student of Nursing or Midwifery, whilst not on the NMC register, you have a duty of care

to safeguard the public and report any concerns from practice placements which put the

safety of the people in your care or the public at risk. As outlined in the NMC (2015)

guidance on raising and escalating concerns, the expectation is;

• Action must be taken without delay if you believe that you, a colleague or anyone

else may be putting someone at risk

• You must inform someone in authority if you experience problems that prevent care

delivery from meeting standards

• Speaking up on behalf of people in your care and clients is an everyday part of your

role, and just as raising genuine concerns represents good practice, ‘doing nothing’

and failing to report concerns is unacceptable. Whilst it is often daunting to raise

concerns, you should feel you can do so without prejudice, and with the support of

both practice and academic staff.

Student guidance: Procedure for raising and escalating concerns If you have a concern about anything you have witnessed in practice it is recommended that

you raise this first and foremost with your mentor. In conjunction, you should inform your

personal tutor so that they can guide and support you through the process. If you feel that

your concern has not been recognized or appropriately acted upon, you have the right to

escalate this concern to the appropriate staff. As a student there are a number of people

available to you. You can again speak with your personal tutor, or a member of the

academic team, who can advocate for and support you. In addition, if you feel comfortable

you should raise your concern with the clinical manager of your placement area. If you are

in an acute trust, there are Clinical Practice Facilitators (CPFs) who can also support this

process. In other clinical areas Link Lecturers and/or Clinical Learning Environment

Coordinators are available. If you are concerned at any point about who to approach, please

speak to a member of academic staff. Your concerns should be addressed through the

appropriate policies for the individual clinical area and the academic staff should be included

in all steps of the process. The role of the academic staff is to support you in raising your

concerns, escalating if required, supporting you in the process of any outcome (such as

investigation, or provision of statements) and to assist the feedback to you to ensure

resolution of your concern, at whichever level it has been escalated to. In some instances,

concerns may be escalated from the clinical areas, to the appropriate professional bodies

and you may be required to support this process. You will be supported by the academic

staff and we always ask that if a student raises a concern, that they do not submit any form

of statement, either written or verbal, without the presence of an appropriate member of

academic staff.

Student guidance: Flow chart to summarise the process Reference Nursing and Midwifery Council (2015) Raising concerns: Guidance for nurses and midwives. [Online]. Available at: http://www.nmc.org.uk/globalassets/siteDocuments/NMC-Publications/NMC-Raising-and-escalating-concerns.pdf

CONCERNED? Examples; standards of

care, conduct of a member of staff, safety

Raise your concern firstly by speaking to your mentor

IS YOUR CONCERN RESOLVED? YES; No further action but it is

recommended that you discuss with your personal tutor to debrief

NO; Escalate your concern to the clinical manager and CPF/Link

Lecturer/Convenor Remember to include the academic staff

for support. IS YOUR CONCERN RESOLVED?

YES; No further action but it is recommended that you discuss with

your personal tutor to debrief

NO; It is rare that a concern is not addressed at this stage however if you feel that this is the case, speak to the

CPF/Link Lecturer and academic staff who can support you in raising concerns further if required

http://www.nmc.org.uk/globalassets/siteDocuments/NMC-Publications/NMC-Raising-and-escalating-concerns.pdf

http://www.nmc.org.uk/globalassets/siteDocuments/NMC-Publications/NMC-Raising-and-escalating-concerns.pdf

YEAR 1 Documentation

Mentor Signature Sheet: Year 1

All registered practitioners who sign the student’s documentation MUST complete the sheet below. This is a requirement of UCS as it allows for signatures to be checked and confirmed. Please read the following statement before signing this sheet. By signing this sheet mentors are signing to say they have attended a mentor update in the last 12 months and that their triennial review is up-to date as required by NMC (2008). Name of Mentor

(printed)

Signature Name of placement

area

Contact telephone number for placement

area

Dates student attended clinical

placement

Name of Manager

verifying the Mentor’s signature

Manager’s signature

Simulated Practice Learning (SPL): Preparation for Practice Experience The Nursing and Midwifery Council (NMC, 2007; 2010) recognise that simulated practice learning within a simulation environment can enhance a student’s acquisition of direct care skills. Throughout your pre-registration programme clinical skills sessions have been identified as simulated practice learning. These sessions aim to introduce you to specific care and delivery which you can enhance and develop when out in practice.

• Attendances for these sessions need to be recorded and confirmed. • A Simulated Practice Learning Evaluation & Feedback (SPLEF) sheet needs to be

completed which should then be used in discussion with your mentor to help guide and develop direct care experiences within clinical practice placements.

Guidance for mentors and students The aim of SPL is to develop the student’s professional practice skills and build confidence within a safe environment, which can then help to support direct care given in clinical practice. During the SPL skills sessions the students will undertake scenario based learning opportunities that will incorporate a range of clinical and communication skills outlined through session aims and objectives which reflect the Essential Skills Clusters (NMC, 2010). There will be an opportunity for peer and facilitator feedback as well as personal reflection from the student before, during and after each session. The completed SPLEF sheets are to be utilised, through discussion between mentor and student, to help guide related learning objectives and action plans when in the practice placement as well as supporting any direct care the student is involved in. Nursing and Midwifery Council (2007) Simulation and practice learning project. London: NMC. Nursing and Midwifery Council (2010) Standards for pre-registration nursing education. London: NMC.

Preparation for Practice Experience Forms

Session title Date of SPL session: Attendance verified by facilitator: Aims & Objectives of SPL session: Pre session activities undertaken: Feedback from peers and facilitator/s:

Post session activities undertaken: Reflection of SPL opportunity facilitated through discussion with mentor (to include implications for your developing practice, relevant practice learning objectives and actions plans): Mentor signature: Student signature: Date:

Short Placement forms:

For placements that are 1 to 3 weeks long

Short Placement: Orientation to the practice placement

This form is to be completed on the first day of the student’s placement. Aspects to be discussed

Mentor initials Student Signature

Layout of the practice area.

Procedure in event of a fire.

Procedure for emergencies including resuscitation.

Moving and handling equipment.

Trust and local practice area policies

General information about the practice including shift times; procedure for reporting sickness; uniform policy and professional issues.

Practice learning outcomes and learning opportunities are identified and discussed – to be recorded on the initial interview form.

Personal learning needs are discussed - to be recorded on the initial interview form.

Date:

Short Placement: Evaluation of student professional conduct

For each placement that the student attends the form below MUST be completed The MENTOR should tick whether the student has demonstrated the ability to accept RESPONSIBILITY for their own action in the areas identified, PROVIDE COMMENTS, DATE AND SIGN the form

Demonstrates ability to accept responsibility for their own actions in relation to:

Yes No Comments

• Arriving on duty on time

• Wears uniform in line with Trust and

UCS dress code policy

• Responds appropriately to

constructive feedback

• Reports sickness/absence in line with

University Campus Suffolk/Trust policy

• Adheres to current NMC Guidance on

professional conduct

Number of hours sick/absent during the placement: Mentor Signature: Date:

SHORT PLACEMENT MEETING FORM This form is to be used for placements that last less than four weeks Name of Practice Placement: On the First Day

Learning outcomes to be achieved during this placement

Date:

Mentor/Facilitator Signature:

Student Signature:

At the end of the practice placement

Mentor/Facilitator’s comments on the student’s performance during the placement

Date:


Student Signature:












Date:




Yes No Comments









professional conduct for nursing and midwifery students




Date:


Student Signature:



Date:


Student Signature:












Date:




Yes No Comments













Date:


Student Signature:



Date:


Student Signature:












Date:




Yes No Comments













Date:


Student Signature:



Date:


Student Signature:

Long Placement forms: For placements that are more

than 4 weeks long

Long Placement: Orientation to the practice placement











Date:

Initial Interview form To be completed by the end of the first week of the student’s practice placement

Placement: I have read the Student’s On-going Record of Achievement and discussed any issues with the student Mentor Signature: Date: Learning Opportunities available in the practice placement: Specific Learning Outcomes for the placement: Link these to the objectives the student has identified in their preparation for practice form in their PAD. Discussion on Integrated Practice Assessment: Is this relevant to this placement – Yes No If answer is yes please record details below Student signature: Date: Mentor signature: Date:

Mid-point Interview

At the mid-point the mentor and student must meet to discuss their progress and development. The discussion should focus on the student’s achievement of generic and field specific competencies; progress in achieving competency with the relevant essential skills and feedback on the specific learning outcomes identified at the initial interview. Mentor comments: Mentor signature: Date: Student signature: Date:

Service User Feedback Sheet

The opinions of Service Users are an integral part of the assessment of student’s in practice settings. Registered Nurses working in an appropriate area can select a Service User and request their opinion on the care they have received from the student. These opinions are to be recorded by the Registered Nurse. The student is required to have the opinions of two service users for each of their four week or longer placements, except for the final placement when the opinions of three service users must be sought. There is no expectation of service user feedback for placements shorter than four weeks N.B. The Service User’s anonymity must be maintained Areas for Service User comment

• Maintain privacy and dignity • Polite, courteous and respectful • Provide adequate information • Listen attentively • Made them feel welcome

1. Aspects of the student’s care that is commendable.

2. Aspects of this student’s care that could be further developed. This is an accurate representation of the Service User’s feedback and has been discussed with the student. Signature of Registered Nurse: Date: Print name

Record of visits/Practice learning opportunities away from the allocated practice placement

Date

Hours/days spent

Details of visit/ Practice Learning Opportunity

Student reflection on their learning: Mentor/Supervisor’s comments on the student’s performance: Mentor/Supervisor Name: Signature: Contact telephone number:

Date

Hours/days spent



Record of visits/Practice learning opportunities relevant to the allocated practice placement

Date

Hours/days spent



Date

Hours/days spent



Record of Meetings between student and mentor These schedules are to be used to record a student’s progress/any issues that arise during the placement

Date

Details of meeting Outcome

Student signature: Date:

Mentor signature:

Date:


Mentor signature:

Date:


Mentor signature:

Date:


Mentor signature:

Date:

Record of Meetings between student and mentor

Date



Mentor signature:

Date:


Mentor signature:

Date:


Mentor signature:

Date:


Mentor signature:

Date:

Action Plan To be completed if there is an area that the student needs to develop Area of practice that requires development: Plan: Resources and support required: Date for review of action plan:

Action plan agreed: Yes No


Mentor signature:

Date:

Outcome of action plan: Student signature: Date:

Mentor signature:

Date:

Long Placement: Evaluation of student professional conduct



Yes No Comments











Final Interview

At the end of the practice placement the mentor and student must meet to how the student has progressed and developed during the placement. The discussion should focus on the student’s achievement of generic and field specific competencies; progress in achieving competency with the relevant essential skills and achievement of the specific learning outcomes identified at the initial interview. Mentor comments: Areas to develop in future practice placements: Is the student achieving at the required level of performance YES/NO (please delete as applicable) If answer is no please see the assessment process in practice flowchart Overall this student is safe to progress: YES/NO (please delete as applicable) Please provide below the rationale for these decisions: Mentor signature: Date: Student signature: Date:












Date:

Mid-point Interview


Service User Feedback Sheet The opinions of Service Users are an integral part of the assessment of student’s in practice settings. Registered Nurses working in an appropriate area can select a Service User and request their opinion on the care they have received from the student. These opinions are to be recorded by the Registered Nurse. The student is required to have the opinions of two service users for each of their four week or longer placements, except for the final placement when the opinions of three service users must be sought. There is no expectation of service user feedback for placements shorter than four weeks N.B. The Service User’s anonymity must be maintained Areas for Service User comment





Date

Hours/days spent



Date

Hours/days spent




Date



Mentor signature:

Date:


Mentor signature:

Date:


Mentor signature:

Date:


Mentor signature:

Date:




Mentor signature:

Date:


Mentor signature:

Date:




Yes No Comments











Final Interview


Orientation to the practice placement











Date:

Mid-point Interview



Date

Hours/days spent



Date

Hours/days spent




Date



Mentor signature:

Date:


Mentor signature:

Date:


Mentor signature:

Date:


Mentor signature:

Date:




Mentor signature:

Date:


Mentor signature:

Date:




Yes No Comments











Final Interview













Date:

Mid-point Interview



Date

Hours/days spent



Date

Hours/days spent




Date



Mentor signature:

Date:


Mentor signature:

Date:


Mentor signature:

Date:


Mentor signature:

Date:




Mentor signature:

Date:


Mentor signature:

Date:




Yes No Comments











Final Interview


INTERVIEW SCHEDULE WITH PERSONAL TUTOR (1)

End of Semester 1 Assessment Comments Practice Assessment Document discussed

Yes/No

Ongoing Record of Achievement discussed

Yes/No

EU Directives Achieved: general and specialist medicine

general and specialist surgery

child care and paediatrics

maternity care

mental health and psychiatry

care of the old and geriatrics

home nursing

Yes/No

Overall comments by Personal Tutor Signature of Personal Tutor: _________________________________ PRINT NAME: _____________________________________________ Signature of Student: _________________________________ Date: _______________


End of Semester 2: end of year 1 Assessment Comments Practice Assessment Document for year 1 complete

Yes/No


Yes/No




maternity care



home nursing

Yes/No

Overall comments by Personal Tutor Result Pass Refer

Signature of Personal Tutor: _________________________________ PRINT NAME: _____________________________________________ Signature of Student: _________________________________ Date: _______________



(printed)


area


area


placement

Name of Manager




Session title Date of SPL session: Number of equivalent practice hours: Attendance verified by facilitator: Aims & Objectives of SPL session: Pre session activities undertaken: Feedback from peers and facilitator/s:












Date:




Yes No Comments













Date:


Student Signature:



Date:


Student Signature:












Date:




Yes No Comments













Date:


Student Signature:



Date:


Student Signature:












Date:




Yes No Comments













Date:


Student Signature:



Date:


Student Signature:












Date:




Yes No Comments













Date:


Student Signature:



Date:


Student Signature:


than 4 weeks long












Date:

Mid-point Interview



Date

Hours/days spent



Date

Hours/days spent




Date



Mentor signature:

Date:


Mentor signature:

Date:


Mentor signature:

Date:


Mentor signature:

Date:




Mentor signature:

Date:


Mentor signature:

Date:




Yes No Comments











Final Interview













Date:

Mid-point Interview



Date

Hours/days spent



Date

Hours/days spent




Date



Mentor signature:

Date:


Mentor signature:

Date:


Mentor signature:

Date:


Mentor signature:

Date:




Mentor signature:

Date:


Mentor signature:

Date:




Yes No Comments











Final Interview













Date:

Mid-point Interview



Date

Hours/days spent



Date

Hours/days spent




Date



Mentor signature:

Date:


Mentor signature:

Date:


Mentor signature:

Date:


Mentor signature:

Date:




Mentor signature:

Date:


Mentor signature:

Date:




Yes No Comments











Final Interview













Date:

Mid-point Interview



Date

Hours/days spent



Date

Hours/days spent




Date



Mentor signature:

Date:


Mentor signature:

Date:


Mentor signature:

Date:


Mentor signature:

Date:




Mentor signature:

Date:


Mentor signature:

Date:




Yes No Comments











Final Interview



End of Semester 3 Assessment Comments Practice Assessment Document for year 1 complete

Yes/No


Yes/No




maternity care



home nursing

Yes/No




End of Semester 4: End of year 2 Assessment Comments Practice Assessment Document for year 1 complete

Yes/No


Yes/No




maternity care



home nursing

Yes/No





(printed)


area


area


placement

Name of Manager














Date:




Yes No Comments













Date:


Student Signature:



Date:


Student Signature:












Date:




Yes No Comments













Date:


Student Signature:



Date:


Student Signature:












Date:




Yes No Comments













Date:


Student Signature:



Date:


Student Signature:


than 4 weeks long












Date:

Mid-point Interview



Date

Hours/days spent



Date

Hours/days spent




Date



Mentor signature:

Date:


Mentor signature:

Date:


Mentor signature:

Date:


Mentor signature:

Date:




Mentor signature:

Date:


Mentor signature:

Date:




Yes No Comments











Final Interview













Date:

Mid-point Interview



Date

Hours/days spent



Date

Hours/days spent




Date



Mentor signature:

Date:


Mentor signature:

Date:


Mentor signature:

Date:


Mentor signature:

Date:




Mentor signature:

Date:


Mentor signature:

Date:




Yes No Comments











Final Interview


YEAR 3 Final Placement documentation

Sign-off Mentor Signature Sheet

The Sign-off Mentor MUST complete the sheet below. This is a requirement of UCS as it allows for signatures to be checked and confirmed. Please read the following statement before signing this sheet. By signing this sheet Signoff mentors are signing to say they have attended a mentor update in the last 12 months and that their triennial review is up-to date as required by NMC (2008).

Nam

e of Sign-O

ff M

entor (printed)

Signature

Nam

e of placem

ent area

Contact

telephone num

ber for placem

ent area

Dates

student attended clinical

placement

Nam

e of M

anager verifying

the M

entor’s signature

Manager’s

signature

Final Placement: Orientation to the practice placement











Date:


Placement: I have read the Student’s On-going Record of Achievement and discussed any issues with the student Sign-Off Mentor Signature: Date: Learning Opportunities available in the practice placement: Specific Learning Outcomes for the placement: Link these to the objectives the student has identified in their preparation for practice form in their PAD. Discussion on Integrated Practice Assessment: Is this relevant to this placement – Yes No If answer is yes please record details below Student signature: Date: Sign-Off Mentor signature: Date:

Mid-point Interview

At the mid-point the Sign-Off Mentor and student must meet to discuss their progress and development. The discussion should focus on the student’s achievement of generic and field specific competencies; progress in achieving competency with the relevant essential skills and feedback on the specific learning outcomes identified at the initial interview. Sign-Off Mentor comments: Sign-Off Mentor signature: Date: Student signature: Date:


Date

Hours/days spent



Date

Hours/days spent



Record of Meetings between student and Sign-off Mentor These schedules are to be used to record a student’s progress/any issues that arise during the placement

Date



Sign-off Mentor signature:

Date:



Date:



Date:



Date:

Record of Meetings between student and Sign-off Mentor

Date




Date:



Date:



Date:


Sign-off Mentor Sign-Off signature:

Date:




Mentor signature:

Date:



Date:

Final Placement: Evaluation of student professional conduct

For each placement that the student attends the form below MUST be completed The Sign-Off Mentor should tick whether the student has demonstrated the ability to accept RESPONSIBILITY for their own action in the areas identified, PROVIDE COMMENTS, DATE AND SIGN the form


Yes No Comments










Number of hours sick/absent during the placement: Sign-off Mentor Signature: Date:

Final Interview

At the end of the practice placement the sign-off mentor and student must meet to how the student has progressed and developed during the placement. The discussion should focus on the student’s achievement of generic and field specific competencies; progress in achieving competency with the relevant essential skills and achievement of the specific learning outcomes identified at the initial interview. Mentor comments: Has the student achieved the required level of performance? YES/NO (please delete as applicable) If answer is no please see the assessment process in practice flowchart Overall this student is safe?: YES/NO (please delete as applicable) Please provide below the rationale for these decisions: Sign-off Mentor signature: Date: Student signature: Date:

RECORD OF TRIPARTITE MEETING TO BE COMPLETED BY THE OBSERVER Name of Personal Tutor: Name of Observer (if different to Personal Tutor): Name of Student: Name of Sign-off Mentor: Date of Tripartite Meeting: Placement/site: Cohort: SIGN OFF MENTOR to complete:

1. Date of Sign-off Mentor training ………………..

2. Date of Triennial review ………………………………..

3. Is there a record of meeting 1 hour per week / equivalent in the PAD? YES / NO

If the answer is No – Has it been reported to CPF / Link Lecturer/Convenyor YES / NO Has it been reported to the Pre Assessment Board? YES / NO

4. Has the student been involved in the process of achieving the PAD during practice?

5. Is there evidence of discussion leading to the final grades being awarded? Give example

6. Has the student been involved in the decision making of the final grades awarded? Give examples

Tripartite meeting summary (to be completed by UCS Observer): Following tripartite meetings with a sample of students (maximum 10% or minimum of 2 per base site) a summary form should be completed and presented to the Pre-Assessment Board for completing students. Cohort of students sample taken from: Number of tripartite meetings: Number of meetings per base site: Ipswich= West Suffolk= Great Yarmouth= Any issues raised form tripartite meetings (include details of actions and action plans): Signature of Student: Date Signature of Sign off Mentor: Date Signature of Observer: Date Date

Signature of Student: Date: Signature of Sign-off Mentor: Date: Signature of Observer: Date:

Have Sign-off Mentor verified signature and has this been cross matched by the Observer? Yes No Summary of meeting: In the context of the previous question, how was validity, reliability and objectivity of assessments ensured (i.e. use of assessment tools, feedback with peers)?

SIGN-OFF MENTOR

END OF PROGRAMME DECLARATION This is to certify that _________________________________ (print name of student nurse) Has successfully achieved the required level and number of skills; generic and field specific competencies required by the Nursing and Midwifery Council. The conclusion of this summative assessment has been made in consideration of service user evaluations of the student and the professional opinions of appropriate members of the multi professional team. They are fit to practice and are deemed competent to be entered onto the professional register as a registered nurse. I also confirm that I am registered on the same field of nursing that the student aims to enter. Signature of Sign-off Mentor ………………………………………………… Print Name …………………………………………………………………….. Date of Signature……………………………………………………………… Clinical Area……………………………………………………………………


End of Semester 5 Assessment Comments Practice Assessment Document discussed

Yes/No


Yes/No




maternity care



home nursing

Yes/No

Overall comments by Personal Tutor Signature of Personal Tutor: _________________________________ PRINT NAME: _____________________________________________ Signature of Student: _________________________________ Date: _______________


End of Semester 6: end of year 3 Assessment Comments Practice Assessment Document for year 1 complete

Yes/No


Yes/No




maternity care



home nursing

Yes/No



Absence Record

This is provided as an aid memoire to assist students in planning any clinical recovery.

DATES

Placement area

No. of hours missed

Type of absence; i.e. sickness or personal To From

Please note: all absence time must be made up

Absence Record This is provided as an aid memoire to assist students in planning any clinical recovery.

DATES

Placement area

No. of hours missed

Type of absence; i.e. sickness or personal To From

Please note: all absence time must be made up

Meeting EU requirements Article 31 of the EU directive 2005/36/EC specifies that students undertaking adult nursing programmes demonstrate that they have had clinical instruction related to the following specific aspects of care:-

• general and specialist medicine • general and specialist surgery • child care and paediatrics • maternity care • mental health and psychiatry • care of the old and geriatrics • home nursing

The students on the BSc. (Hons) Adult Nursing must complete the following forms. It has been agreed that it is good practice for students on the BSc. (Hons) Mental Health Nursing and BSc. (Hons) Child Health Nursing to also undertake this work. Evidence to support the achievement of these aspects of care can be collected throughout the entire programme both through direct care of a patient; completion of the insight work and indirectly (i.e. through simulation in the clinical skills laboratory).

General and specialist medicine Evidence of experiences in which you have had clinical instruction with regard to service users who have required general and specialist medical support. Evidence of instruction/experience Placement details if relevant Mentor/Facilitator/Personal

Tutor Signature Date

General and specialist surgery Evidence of experiences in which you have had clinical instruction with regard to service users who have required general and specialist surgery. Evidence of instruction/experience Placement details if relevant Mentor/Facilitator/Personal


Child care and paediatrics Evidence of experiences in which you have had clinical instruction with regard to paediatric service users.

Evidence of instruction/experience Placement details if relevant Mentor/Facilitator/Personal Tutor Signature

Date

Maternity care Evidence of experiences in which you have had clinical instruction with regard to maternity care.


Date

Mental health and psychiatry Evidence of experiences in which you have had clinical instruction with regard to service users with mental health care needs Evidence of instruction/experience Placement details if relevant Mentor/Facilitator/Personal


Care of the old and geriatrics Evidence of experiences in which you have had clinical instruction with regard to care of the old and geriatric service users. Evidence of instruction/experience Placement details if relevant Mentor/Facilitator/Personal


Home nursing Evidence of experiences in which you have had clinical instruction with regard to service users requiring home nursing.


Date