CHARLES DARWIN

Charles Darwin University.









PLACEMENT MANUAL

FOR NURSING STUDENTS









UPDATED 2007



Charles Darwin University

www.cdu.edu.au

Phone (08) 8946 6666







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Charles Darwin University.







Bachelor of Nursing Pre Registration

(BNURSE)



Medical and Surgical Nursing Care clinical placement units



► 1st year NUR 109- Introduction to Medical / surgical

nursing.



► 2nd year NUR 224- Medical and Surgical Nursing

practice.



► 3rd year NUR 331- Advance Practice 1,

NUR 332- Advanced Practice 2,

NUR 350- Speciality Practice









Certificate IV Community Services and Health.

Enrolled Nurse

(70008NT)



Clinical placement Units



► UGM 003- Provide care and support for aged clients in a

residential setting



► UGM 011- Develop skills for effective clinical participation in

the acute setting



► UGM 018- Provide Nursing in a variety of clinical settings



► UGM 016- Implement nursing skills for specialised clients

across the life span



► UGM 023- Provide service delivery in community settings









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Charles Darwin University.







INDEX



Introduction 5



Lecturers/ CDU Contacts 6



Definition of roles 7



Placement pre requisites 8

( Bachelor of Nursing)



Placement requirements



NUR109 10



NUR224 11



NUR331/NUR332/NUR350 12



Certificate IV Community Services and Health 14

Placement Pre Requisites & Requirements



Assessment flow chart 17



Placement locations 18



Travel and accommodation 18



Placement attendance 18



Student supervision 19



Student code of conduct 19



Insurance 20



Process for problem solving 21



Assessment procedure 21



Failure to achieve competence 22



Preceptor welcome 23









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Charles Darwin University.









ANMC

Registered Nursing

Enrolled Nursing 24



DEU 26



Appendix (1-6) 27









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Charles Darwin University.



INTRODUCTION



This manual is designed to provide comprehensive information for students

enrolled in Certificate IV and Bachelor degree nursing programs and undertaking

clinical placements.



At CDU the Bachelor of Nursing students from Year 1 to 3 and Certificate IV

Community Services (Enrolled Nursing) students are required to complete annual

clinical placements following a compulsory one week clinical teaching block

where all clinical skills are practiced.



The university placement coordinator allocates students to clinical placements,

records rosters and documents sick leave. Any student who is unable to attend

clinical placement due to sickness or other circumstances is required to notify the

ward area (prior to the shift commencement time) as well as the placement

coordinator. A certificate is required if a student is absent for more than two

shifts.



Any queries about student allocations can be directed to the placement

coordination office



nurplaccoord@cdu.edu.au

Placement Co-ordinator Phone (08) 8946 6243

Monday- Friday, 8.30am - 4pm



Clinical Facilitators are available to assist students and preceptors in the clinical

setting. In Darwin and Alice Springs they are on-site and CDU has three models

of clinical supervision for students undertaking clinical placements in interstate

locations.



We have three different models of clinical supervision for our external students:



1. The preceptor model (suitable for up to 3 students in any one area):



This model incorporates the provision of a preceptor by the clinical institution.

The preceptor is a registered nurse with a Bachelor Degree (or equivalent) and a

minimum of one year postgraduate clinical experience who the student is

assigned to work closely with throughout their placement. The preceptor is

responsible for guiding the student to acquire the skills and professional practice

objectives of the placement. The preceptor is also

responsible for completing the documentation provided by Charles Darwin

University that reports on student achievement of objectives including signing the

student attendance form. The student may be assigned more than one preceptor

over the duration of the placement, providing a handover is given to maintain

consistency of supervision. In this situation, the Nurse Manager (or equivalent) is

required to ensure that the responsibility for completing the documentation is

clearly defined and that the assessment results are an accurate reflection of the





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Charles Darwin University.



student‟s entire placement. The Nurse Manager (or equivalent) is also

responsible for reporting any problems encountered during the clinical placement

to the supervising academic at Charles Darwin University.



This model is extensively used for community, mental health, specialty

placements and small metropolitan or rural hospitals that provide places for a

limited number of students. While many institutions provide this service free of

charge as part of a commitment to developing the profession and graduate

recruitment, payment at a rate that acknowledges a commitment of 5 hours per

week per student is provided by CDU upon request.



2. The Professional Development Model (suitable for 6 or more students

located in a single area)



This model incorporates the provision of a clinical liaison nurse by the clinical

institution. The clinical liaison nurse is a registered nurse Bachelor Degree (or

equivalent) and a minimum of 2 years postgraduate experience, who normally

works in the nominated ward/department and who has undertaken specific

clinical teaching training within the clinical institution or an affiliated academic

institution. Ideally, the nurse who nominates for this position is interested in

exploring nursing education as a career pathway. The student is assigned to a

preceptor who works closely with the student throughout their placement, but the

clinical liaison nurse oversees the clinical learning opportunities provided to the

student. The clinical liaison nurse engages in a reduced patient load, but also

provides support for the preceptor and the student. In consultation with the

preceptor, the clinical liaison nurse is responsible for guiding the student to

acquire the skills and professional practice objectives of the placement and

completing the documentation provided by Charles Darwin University that reports

on student achievement of objectives including signing the student attendance

form. The Nurse Manager (or equivalent) is required to ensure that the

assessment results are an accurate reflection of the student‟s entire placement.

The Nurse Manager (or equivalent) is also responsible for ensuring that the

clinical liaison nurse reports any problems encountered during the clinical

placement to the supervising academic at Charles Darwin University. The

university pays the clinical institution for providing this service by reimbursing the

difference between the clinical liaison nurse‟s substantive salary and that of a

clinical teacher/supervisor in recognition of a time commitment of 4 hrs per day

for a cohort of 8 students or pro-rata for a smaller cohort.



3. The seconded Clinical Supervisor model: (up to 8 students are located

in one area or dispersed in different areas of the clinical institution):



This model incorporates the provision of a clinical supervisor by the clinical

institution. The Clinical Supervisor is a registered nurse with a Bachelor Degree

(or equivalent) and a minimum of 2 years postgraduate experience, who normally

works in the clinical institution, who has undertaken specific clinical teaching

training within the clinical institution or an affiliated academic institution, and has





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previously supervised undergraduate or postgraduate nursing students. The

student is assigned to work alongside a member of nursing staff each day, who is

guided by the Clinical Supervisor to select specific clinical learning experiences

for the student. The Clinical Supervisor is not assigned a patient load and is

responsible for guiding the student to acquire the skills and professional practice

objectives of the placement and completing the documentation provided by

Charles Darwin University that reports on student achievement of objectives

including signing the student attendance form. The Nurse Manager (or

equivalent) is required to ensure that the assessment results are an accurate

reflection of the student‟s entire placement. The Clinical Supervisor is required to

keep the Nurse Manager (or equivalent) and Charles Darwin University informed

of the student‟s progress. In particular, the Clinical Supervisor is responsible any

problems encountered during the clinical placement are reported to the

supervising academic at Charles Darwin University. The university pays the

clinical institution for providing this service at a designated rate in recognition of a

time commitment of 8 hrs per day for a cohort of 8 students or pro-rata for a

smaller cohort.



The standard rates for each of the models are available from the placement

office: nurplaccoord@cdu.edu.au



Quality assurance:

A clinical placement agreement is signed prior to students engaging in clinical

placement. The clinical placement agreement includes provisions for insurance

coverage for students while on placement and acceptance of specific

responsibilities on behalf of Charles Darwin University (CDU) and the affiliated

clinical institution. In order to ensure that the supervision provided on behalf of

CDU is of a standard consistent with the requirements of the University and the

accreditation requirements of the Nursing and Midwifery Board of the Northern

Territory, CDU requires the following assistance from the Nurse Manager (or

equivalent) and/or the institution‟s undergraduate clinical placement officer to

provide:



 The names and qualifications of preceptors to the CDU clinical placement

coordinator;

 A CV for the clinical liaison nurse to the CDU clinical placement coordinator;

 A CV for the clinical liaison nurse to the CDU clinical placement coordinator;

 A review of the performance of the staff providing clinical support to CDU

students.





CDU provides support to the Nurse Manager (or equivalent) and the clinical staff

as follows:

 An initial contact (either telephone or face-to-face depending on location) to

orientate the supervisor to his/her role and the requirements of the placement;

and the performance of the nurse(s) nominated to supervise the students:

 A resource manual for clinical placements;





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 Weekly contact (either telephone or face-to-face depending on location) with

both the student and the supervisor to discuss progress and any problems

encountered;

 Business hours mobile phone contact number for any urgent issues that

require attention of the University;

 Email contact for any issues that require written clarification;

 A clinical supervision review form



CDU also supplies

 all assessment tools relevant to the placement;

 guidelines for completion of the assessment tasks relevant to the placement;

 a procedure to follow for identified clinical performance deficits;

 an evaluation tool for appraisal of the performance of the preceptor/clinical

teacher/supervisor



Communication

All communication relating to clinical placements is via the clinical placement

office. Our principal placement coordinator is Ms. Pam Marlow, assisted by Ms.

Olivia Fernando. The telephone contact for the placement office is: (08) 8946

6243 and the email address is: nurplaccoord@cdu.edu.au.



Any problems encountered involving or affecting students can be directed to

following staff who can be contacted via the switch/pager system or via e-mail or

phone.



One of the following staff members will also contact the student and his/her

nominated preceptor/ supervisor each week of the placement.



Angela Sheedy

Unit Coordinator

Darwin & Interstate Clinical Supervisor Resource Academic (WA & Tas)

phone; (08) 89 466156;

email: angela.sheedy@cdu.edu.au

mobile: 0438 883826





Sarjeet Gill

Darwin & Interstate Clinical Supervisor Resource Academic (QLD & SA)

Phone : (08) 8946 6144;

email: sarjeet.gill@cdu.edu.au

mobile: 0438883675





Karen Wade

Darwin & Interstate Clinical Supervisor Resource Academic (NSW & VIC & ACT)

Ph; (08) 89 46 6508;

e-mail: karen.wade@cdu.edu.au





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Mobile: 0438382468



Certificate IV, Enrolled Nursing Course Coordinator

Beryl McEwan

Ph:08 89 46 6281

e-mail: beryl.mcewan@cdu.edu.au



Bachelor of Nursing (Pre registration) Program Manager

Julie (Gylo) Hercelinskyj

Ph: 08 8946 6438

Email: gylo.hercelinskyj@cdu.edu.au



Head: School of Health Sciences

Professor Sandra Speedy

Ph: 08 8946 6089

Email: Sandra.speedy@cdu.edu.au









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Definitions of roles



There are a range of people involved in the success of clinical placements of

students in health care settings. A brief definition of their roles is provided below

to assist students and clinical staff supervising students understand the various

roles.





CHARLES DARWIN UNIVERSITY Teaching Staff



Course Coordinator/Program Manager

The Charles Darwin University staff member who has overall responsibility for

course coordination and management. This person is required to be a

Registered Nurse licensed to practice in the Northern Territory.



Unit Coordinator

The Charles Darwin University staff member who has responsibility for the

delivery and assessment of specific units in the course. Depending on the

content of the unit, this person may or may not be a registered or enrolled nurse.



Placement Coordinator

The Charles Darwin University staff member who arranges clinical placements

for students in the Bachelor of Nursing and Certificate IV in Community Services

and Health (Enrolled Nurse) courses. The Placement Coordinator works closely

with the Course Coordinator/Program Manager, the various health agencies and

students to negotiate and plan appropriate clinical placements to meet course

requirements.



Clinical Facilitator or Teaching Fellow

Charles Darwin University staff members who facilitate and generally oversee

students on clinical placement. Clinical Facilitators and teaching fellows located

in Darwin are easily accessible to Darwin-based students. During clinical

placement, students out of Darwin will be followed up by telephone, either

directly or through clinical supervisors in partner health services. Charles Darwin

University satellite centres may have Faculty staff available that act as Clinical

Facilitators in their location.



Clinical Facilitators have an important role in teaching clinical skills to students

and assessing clinical practice.



Principal Academic, Dedicated Education Unit

The Charles Darwin University staff member with overall responsibility for the

coordination, facilitation and support of students and health service staff that are

hosting student placements under a dedicated education unit arrangement.









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Charles Darwin University.





PARTNER HEALTH SERVICE STAFF



Executive Director (EDON) or Director of Nursing (DON)

The member of the health service who has overall responsibility for nursing and

nursing staff employed by the health service. In some instances, the EDON or

DON may be the manager of the health service.



Clinical Nurse Consultant (CNC), Clinical Nurse Manager (CNM) or Nursing

Unit Manager (NUM)

A member of the health service who manages a ward or unit in the health

service. The CNC (or however titled):

 Is responsible for the day to day management of the ward or unit that she/he

manages

 Nominates preceptors or supervisors for students whilst on placement

 Ensures that preceptors or supervisors have appropriate training and support

 Ensures that students are adequately supported in their clinical setting and

that appropriate procedures are followed where inappropriate behaviour or

unsatisfactory clinical practice are identified

 Contributes to an evaluation of the clinical placement



Clinical Nurse Educator

A member of the health service employed by the health service to support the

professional development of all nurses in specific clinical settings. Clinical Nurse

Educators may also provide supervision and support to nursing students on

placement and undertake assessment of student performance.



Liaison Nurse

A Registered Nurse appointed by the partner health service to oversee students

on clinical placement where the facility is hosting students under a dedicated

education unit arrangement.



Preceptor/Supervisor/Buddy

Registered or Enrolled nurses employed by the health services where students

are undertaking clinical placement who provide supervision and guidance to

students during clinical placements. Students work alongside the preceptor to

practice and gain competence in required nursing skills. Preceptors and

supervisors may also assess student performance during clinical placements.



Clinical supervisor

A nurse employed by either the health service, Charles Darwin University or

jointly by the two parties that oversees student progress while on placement.



Placement Coordinator

Some health services employ staff to act as student placement coordinator in

their facility. This person works closely with the Charles Darwin University

Placement Coordinator in arranging student placements.





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PLACEMENT UNIT PRE-REQUISITES Bachelor of Nursing





UNIT PREREQUISITES

NUR109 Introduction to Medical/Surgical Nursing SBI171, SBI172, SID175

Theory 26 hours, 5 day Clinical Teaching Block

(laboratory practice), 3 weeks (15 days) practice





NUR224 Medical and Surgical Nursing Practice NUR109, NUR223, NUR214,

NUR213



NUR331 Advanced Practice 1 NUR224

5 day Clinical Teaching Block (laboratory practice),

6 weeks (30 days) medical/surgical practice

NUR332 Advanced Practice 2 NUR224

2 weeks (10 days) mental health

2 weeks (10 days) community health

OR 4 weeks (20 days) community mental health

NUR350 Specialist Elective Placement NUR224 and the relevant

4 weeks (20 days) in a clinical area selected from theoretical unit (see below):

an area of specialisation within the core units

(included, but not limited to: gerontology,

neurosurgery, orthopaedic surgery,

oncology/palliative care, cardiology, community

health, paediatrics, mental health) OR the list below

to correspond with a specialty theoretical unit

successfully completed by the student

NUR350 Perioperative NUR317

NUR350 Remote Health NUR318

NUR350 Emergency Nursing NUR320

NUR350 Renal Health Placement NUR322

NUR350 Alcohol and Other Drugs Placement AOD201



Certificate/Statement of Competency in CPR is to be submitted to the

Placement Coordinator prior to the commencement of clinical practice.

Acceptable documentation includes First Aid Certificate or a certificate from

hospital/health institute where you are employed.

All students are to submit a police check to CDU prior to commencing their

clinical placement.



Clinical placements cannot occur until all required theoretical units and one week

clinical teaching block for each year are successfully completed.









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REQUIREMENTS FOR 1ST YEAR NURSING STUDENTS ON

CLINICAL PLACEMENT

Medical and Surgical Nursing Care Practice NUR 109



First year nursing student requirements prior to commencing clinical placement:

1. Attend the 1 week clinical teaching block

2. Hold a current Senior First Aid Certificate or equivalent approved Basic

Life Support course;

3. Have a current police check including working with children clearance

completed



Students are placed on medical or surgical wards for: 3 weeks equates to 15 

standard ward length shifts. 100% attendance is required



This does not included night duty, however students may be required to work

either morning or afternoon shifts and on weekends.



Documents to be competed by the student during the clinical

placement for NUR 109 are:



 Confidentiality Agreement

o signed prior to first day of placement by the student



 Preparing for clinical placement strengths/weaknesses

o completed prior to clinical placement by the student



 Clinical Practice Objectives

o to be developed throughout the students clinical placement



 Competency Based Evaluation- ANMC Standards

o this involves interim assessment to be completed at commencement of

week two and final assessment completed at end of week three by the

student, the nurse preceptor and the Nurse Unit Manager or CDU clinical

facilitator



 Introduction to Medical/Surgical Clinical Skills List

o Skills to be performed under supervision of the nurse preceptor and/or

CDU clinical facilitator. When competency in the skill is achieved the nurse

preceptor and/or CDU clinical facilitator can assess the student and sign

the skill as competent.



 Student Attendance Record

o to be signed daily by nurse preceptor or CDU clinical facilitator









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Charles Darwin University.



REQUIREMENTS FOR 2ND YEAR NURSING STUDENTS

ON CLINICAL PLACEMENT

Medical and Surgical Nursing Care Practice NUR 224

Second year nursing student requirements prior to commencing clinical

placement are:

1. Attendance at the 1 week clinical teaching block

2. NUR214 and NUR223 must be completed before NUR224 can be

undertaken

3. Hold a current Senior First Aid Certificate or equivalent approved Basic

Life Support course;

4. Have a current police check including working with children clearance

completed



Students are placed on medical or surgical wards for 4 weeks which equates to:

20  normal ward length shifts. 100% attendance is required



This does not included night duty, however students may be required to work

morning or afternoon shifts and on weekends.



Documents required to be completed by the end of clinical placement

NUR 224

Confidentiality agreement

o signed prior to first day of placement by the student



 Clinical Practice Objectives

o to be developed throughout the students clinical placement



 Competency Based Evaluation - ANMC Standards

o This involves an interim assessment to be completed by week 2 and a

final assessment to be completed at week 4 by the student and the

preceptor and the Nurse unit Manager or CDU Clinical facilitator



 Attendance Record

o To be signed daily by preceptor or CDU clinical facilitator



 NUR 224 Medical/ Surgical Clinical Skills List

o skills to be performed under supervision of the nurse preceptor and/or

CDU clinical supervisor and signed as competent when performed as

such



 Oral Presentation “Handover”

° 4th week of placement the student is to undertake a verbal handover

for 3 patients they have been caring for to the Clinical facilitator using

the assessment criteria as a guide.





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Charles Darwin University.



REQUIREMENTS FOR 3RD YEAR NURSING STUDENTS

ON CLINICAL PLACEMENT

NUR 331/ 332



Third year nursing student requirements prior to commencing clinical placement

are:



1. Attendance at 1 week clinical teaching block

2. NUR350 clinical component can only be undertaken after completion

of the theoretical unit in which students are required to have a grade

average of Pass or better prior to undertaking the clinical component;

3. Hold a current Senior First Aid Certificate or equivalent approved Basic

Life Support course;

4. Have a current police check including working with children clearance

completed



Placement requirements are:

NUR331 6 weeks acute health facility

30 x normal ward length shifts

NUR332 2 weeks in a mental health facility (inpatient or outpatient)

= 10 x normal ward length shifts

2 weeks in a community health setting

= 10 x normal ward length shifts

NUR350 4 weeks specialist placement

= 20 x normal ward length shifts



Students may be required to work morning or afternoon shifts as well as night

duty and weekends.



Documents required to be completed by the end of clinical placement for

each of NUR 331/ NUR332



 NUR 331 Practice competency Tool

o Confidentiality agreement



 NUR 350 Specialty Practice Competency Tool



 Competency Based Evaluation- ANMC Standards

o interim assessment to be completed by week 2, final assessment to be

completed by week 4 and to continue to be completed in 2 week blocks by

the student and the preceptor and the Nurse unit Manager or CDU clinical

facilitator

 NUR 332 Mental Health Placement Tool

● NUR332 Community Health Placement Tool

● NUR 331, 332, 350 Clinical Skills Competency list





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Charles Darwin University.







 Reflective Practice Assignment for NUR331/NUR332 /NUR 350

 Attendance sheets for each placement

 Confidentiality agreement for each placement

 Clinical Objectives for each placement

 Case Study/ In-service presentation

SUBMISSION OF ASSESSMENT TASKS:

Assessment:

Students are to be formally assessed by their Preceptor, Nurse Unit Manager

and/or Clinical Educator and/or CDU Student Supervisor at the workplace



It is the student‟s responsibility to submit the assessment outcome along with an

assignment cover sheet signed by the above named clinical staff.



If an assessor has concerns with regard to the lodgement of forms/integrity of

documentation he/she is advised to retain a copy of the assessment report and

to contact the unit coordinator.



STUDENTS ARE REQUIRED TO SUBMIT ALL ORIGINAL

DOCUMENTS

They are advised to make photocopies of forms and are required to

return the original completed and signed forms to the Unit

Coordinator via:



Access Services.

Library & Information Access

Charles Darwin University

PO Box 41246

Casuarina NT 0811

Phone: (08) 89466483

Fax: (08) 89466549

Email: assignments@cdu.edu.au



DOCUMENTS MUST BE SUBMITTED within 14days of completion

of placement.



Assessment forms are available at the following URL

http://www.cdu.edu.au/ehs/health/practicum/forms.html









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Charles Darwin University.



CERTIFICATE IV COMMUNITY SERVICES and HEALTH

ENROLLED NURSE

A critical aspect of nursing education is to provide students with clinical

experience in a variety of practice settings to build on and develop nursing skills

and knowledge that are taught in theoretical course work or clinical teaching units

in the nursing laboratory.



Clinical placements are designed to prepare student nurses for professional

clinical nursing practice by providing the opportunity to experience first hand the

diversity and complexity of clinical nursing practice in a range of health care

settings and to introduce students to aspects of nursing work that cannot be

taught or replicated in the teaching and learning environment such as the

demands of shift work, and working in a multidisciplinary environment.



Students are advised that clinical placements are not paid work.



Clinical placement units

There are five (5) clinical placement units in the Certificate IV in Community

Services and Health (Enrolled Nurse) course.



UGM003 Provide care and support for aged clients in a

residential setting

70 hours/9 shifts clinical placement in an Aged Care residential facility.

Students who have already completed a Certificate III in Aged Care Work

may be eligible for credit transfer for this unit.



UGM011 Develop skills for effective clinical participation in the

acute setting

70 hours/9 shifts clinical placement in an acute hospital setting



UGM018 Provide nursing services within the health care system

140 hours/18 shifts clinical placement in an acute hospital setting



UGM023 Provide service delivery in community settings

140 hours/18 shifts clinical placement in a community nursing setting





UGM016 Implement nursing skills for specialised clients

30 hours/4 shifts of clinical placement in a paediatric or maternal child

health setting. Where students are unable to be placed in one of these

settings, or have completed a paediatric placement in an earlier clinical

placement unit, alternate arrangements will be offered.



Students will be provided information about unit requirements and assessments

in the clinical teaching block preceding the clinical placement unit/s.





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Assessment Overview

Each clinical placement units has specific requirements and assessment items

that are outlined in the relevant unit information booklet provided to students in

clinical teaching blocks conducted prior to clinical placement. A summary of

assessment requirements for clinical placement units can be found on the

following page.



Competency must be achieved in ALL assessment elements and items to meet

course and registration requirements.



A final clinical appraisal against the Australian Nursing and Midwifery Council

Competencies for Enrolled Nurses is a requirement for registration as an

Enrolled Nurse in the Northern Territory.



The final clinical appraisal is completed in consultation with the Preceptor,

Clinical Nurse Consultant or Clinical Supervisor, the Charles Darwin University

Clinical Facilitator or Principal Academic with responsibility for the relevant

clinical practice setting, and the student.



If a student does achieve competence in the final clinical appraisal, the student

will be placed on a learning contract and will be required to undertake further

learning and clinical placement regardless of whether competence is achieved in

other assessment items and/or other units in the course.



Students are responsible to ensure that the required assessment items are

completed by the appropriate clinical staff at the health care facility at which they

are placed and to submit all assessment items to the relevant unit coordinator by

the date specified in the unit information booklet.



Clinical Skills

The Clinical Logbook contains the list of clinical skills to be achieved while on

clinical placement.



Students must have practiced a skill in a clinical teaching block before

attempting the skill while on clinical placement. To do otherwise is to

practice outside the student‟s current scope of practice and is not in accordance

with the CDU Student Code of Conduct and Clinical Placement Agreement in

place with the relevant health care facility.



Where students are unable to achieve the skills on one placement, it is expected

that every attempt will be made to complete the skills on subsequent placements.



Where students are unable to complete the required skills on placements, they

should contact CDU Clinical Facilitators or Course Coordinator to make

arrangements to complete skills in a simulated clinical environment.







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All clinical skills lists must be completed and sighted by the Course

Coordinator before students can be deemed to meet course requirements

for graduation.

A summary of the assessment requirements for clinical placement units is

provided below. Students are referred to the relevant unit information booklet for

specific details of assessment items.



Clinical Placement Unit Assessment

UGM003  Timesheet

Provide Care and support for aged  Clinical appraisal x 1

clients in a residential setting  Reflection on placement and

practice



UGM011  Timesheet

Develop skills for effective clinical  Clinical appraisal x 1

participation in the acute setting  Reflection on placement and

practice



UGM018  Timesheet

Provide nursing services in a variety of  ANMC Competency Assessment x

clinical settings 1

 Clinical appraisal x 1

 Reflection on placement and

practice



UGM023  Timesheet

Provide service delivery in community  Clinical appraisal x 2

settings  Reflection on placement and

practice



UGM016  Timesheet

Implement nursing skills for specialised  Clinical appraisal x1

clients  Reflection on placement and

practice

 Worksheet





Clinical Skills

Students will have specific clinical skills to be achieved on each clinical

placement. Where students are unable to achieve the skills on one placement, it

is expected that every attempt will be made to complete the skills on subsequent

placements.



Where students are unable to complete the required skills on placements, they

should contact CDU Clinical Facilitators or Course Coordinator to make

arrangements to complete skills in a simulated clinical environment.







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Clinical Supervisors, preceptors or Clinical Educators in the Health Services in

which students are placed can also be approached to undertake simulated

assessments.



Students must NOT attempt clinical skills until they have practiced the skill

in a clinical teaching block.



All clinical skills lists must be completed and sighted by the Course

Coordinator before students can be deemed to meet course requirements

for graduation.





ASSESSMENT FLOW CHART









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PLACEMENT LOCATION

Given the limited places available for placements in the Darwin area, some

students may elect to undertake placements outside of Darwin by completing and

returning the placement nomination forms. The decision to place students

outside the Darwin area will be the decision of the Placement Coordinator in

consultation with the Course Coordinator and specific health/community

agencies.

Please Note: your preferences will be taken into consideration, but for a number

of reasons, there is NO GUARANTEE that we will be able to accommodate all

your wishes.

Students must not negotiate on an individual basis with health/community

agencies. This is the role of the Placement Coordinator. Student‟s clinical

rotations may include a placement within one DEU at DPH or RDH.

TRAVEL AND ACCOMMODATION

Travel and accommodation arrangements, and all costs associated with

placements are solely the responsibility of the student. Student Services will

however, assist external students in finding accommodation for the clinical

teaching weeks held at CDU.

ATTENDANCE

 Students must not seek variance of roster/shift start and finish times and

must work all shifts as set down by the organization.



 100% attendance is required for all practice days. This is a registration

requirement of the Nursing and Midwifery Board of the Northern Territory.



 Students must notify the appropriate staff member of the organization

(CDU and health agency) if an absence is unavoidable and must notify the

course coordinator as soon as possible. Days missed due to illness must

be verified by a Doctor‟s certificate or other certified relevant

documentation and must be made up in consultation with the Placement

Coordinator. Any missed clinical practice days/hours must be made up

after negotiation with the clinical supervisor or Course Coordinator.



 The final grade for the unit will be withheld until the total clinical practice

hours required by the unit are completed.



 All practicum / clinical units are graded as „Pass Ungraded‟ or „Fail‟ for

Bachelor of Nursing students and „Competent Ungraded‟ or „Not

Competent‟ for Enrolled Nursing students.



 Ongoing placements at time of grade entry will be allocated an „AC‟ or „IP‟

for that unit until the unit is completed and a change of grade will be

submitted by the Unit Coordinator.







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Charles Darwin University.



SUPERVISION

Students will work under the supervision according to one of the models

described at the beginning of this manual.



The supervision of students while on placement is viewed as a crucial aspect of

the placement experience. Good supervision is empowering for students and

makes a considerable difference to the quality of learning and reflection.

Students frequently comment on the value of good feedback.

While on placement, students will comply at all times with the Student Code of

Conduct. Failure to comply with the code will lead to automatic withdrawal

from placement.



STUDENT CODE OF CONDUCT

It is expected that Charles Darwin University students will:



 Follow all policies and procedures as set down by the organisation

 Practice within own competence and not outside skill parameters required

of this nursing program

 Wear the CDU uniform and name badge while on placement. Any student

out of uniform while on placement shall be immediately withdrawn – cost

of the uniform is the student‟s responsibility

 Abide by all ethical guidelines as determined by the health agency

 Maintain confidentiality of patient/client information at all times. A breach

of confidentiality will result in immediate failure of the unit of study

 If doubt exists, consult with the preceptor and/or clinical supervisor for the

purpose of interpretation of the health agency‟s policies and procedures

 Consult with the preceptor and/or clinical supervisor when nursing

interventions beyond their scope of

competence are required

 Request supervision from the preceptor and/or clinical supervisor when

unsure of their

competence

 Maintain accurate, comprehensive, objective records of nursing care given

as required by the health agency

 Inform the nurse responsible for client care in the area, when leaving the

area

 Use equipment and supplies for client care in accordance with their

defined purpose and the rules and regulations of the health agency

 Be aware of the location of documentation regarding policies and

procedures of the agency and make appropriate reference to such

sources

 Respect the philosophy of the health agency

 Follow directions regarding the use of specialised equipment and seek

appropriate advice if necessary







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Charles Darwin University.



 Report any malfunction and/or breakage of equipment to the Nurse

responsible for client care in the area

 Ensure client safety

 Ensure cultural safety



We consider that students are ambassadors of the Charles Darwin

University and of the profession of Nursing and expect that respect,

courtesy and professional workplace manner is maintained at all times.



DRESS REQUIREMENTS



Students will be expected to present for their clinical placement in the

CHARLES DARWIN UNIVERSITY uniform of:

 Navy slacks or knee length shorts/culottes/ skirt – NO DENIM

 CDU Health Sciences polo T-shirt

 Name badge in holder with clip (student ID card)

 Closed shoes, (NOT white, NOT runners.)

 Hair contained – off the face and neck

 No jewellery apart from an unadorned wedding ring

 Students may also wear stud ear rings or sleepers only



The cost of uniforms is borne by the student.

CDU T-shirts can be ordered over the phone from the bookshop

Student ID cards are provided by the Info Shop and can be ordered over the

phone



For clinical teaching blocks dress requirements are:

 Appropriate dress for active practice

 Enclosed shoes





INSURANCE



The Charles Darwin University carries personal accident and public liability

coverage which extends to cover the legal liability of students while engaged on

university sponsored authorised activities. This includes work experience

activities provided the student is not engaged as a paid employee or receives

remuneration. In assisting the CDU with provision of this work experience, it is

understood that the student will be under supervision at all times and practice

within own level of competence.



ACCESS AND EQUITY FOR STUDENTS ON CLINICAL PLACEMENT



Where a problem arises (e.g. clarification of clinical experiences relevant to the

student, or Preceptor student conflict) the Principal Academic, Clinical Nurse





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Charles Darwin University.



Consultant, Clinical Supervisor or course coordinator/program manager should

be contacted as soon as possible.

The University has guidelines and policies for conflict resolution. Equity and

Student Access (located in Building 29 Casuarina Campus, CDU) provides

conciliation services as well as career support, cross cultural counseling,

disability support, equity information and support, personal counseling, and other

student support services. The university‟s Student Charter is available from

Student Facilities and Equity.





ASSESSMENT PROCEDURES AND PRACTICES



Assessment is a staged process throughout the specific level of study with each

level of assessment building upon the previous level (as detailed in the Flow

Chart above). All assessment elements must be passed. It is imperative that the

final appraisal form, done in consultation with the Preceptor, Clinical Nurse

Consultant and Principal Academic (Darwin only), is to a satisfactory standard

otherwise an automatic fail will be allocated to the unit regardless of the standard

of other assessment elements. Students who are not completing clinical

placements in Darwin will have their final appraisal in consultation with their

Clinical Nurse Consultant and Clinical Supervisor/Preceptor.

Students are responsible for ensuring all competency assessment forms, skills

checklists and clinical appraisal forms are provided to the appropriate staff during

the placement. Students must ensure their completion and return all forms and

additional assessment tasks, to the course coordinator by the specified date. All

elements of assessment must be completed to a satisfactory standard in order to

be successful in the unit.

Further detail about assessment will be provided in unit outlines for specific

course units.



Assessment forms for each unit can be found under practicum at the following

URL http://www.cdu.edu.au/ehs/health/practicum/placements_bach_nurs.html.









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Charles Darwin University.





FAILURE TO ACHIEVE COMPETENCE



If a student fails to meet the necessary standards within a reasonable time during

the placement and despite advice from the Liaison Nurse and/or the clinical

preceptor/supervisor, in consultation with the course coordinator, continues to be

unable to demonstrate satisfactory achievement of competence the following

procedure will be instigated.

A meeting between the student, student support person, Preceptor, CDU staff

representative (usually the course coordinator or Head of School) and, where

possible, the Clinical Nurse Consultant or clinical preceptor/supervisor, will be

convened to discuss issues of concern

At this meeting a learning contract will be designed to meet the identified needs

of the student. The contract will be signed by the student, clinical

preceptor/supervisor and the CDU staff representative. The student will be

provided with a copy of the learning contract and the original will be placed in the

students file.



When a learning contract is in place, the clinical preceptor/supervisor or CDU

clinical delegate will have consultation with the student on a daily basis to ensure

the student is given every opportunity to achieve the level of practice acceptable

for a passing grade for the unit.



The learning contract may, in some instances, involve undertaking components

of placement or the entire placement, in a setting other than originally assigned.

It may involve extending clinical practice or repeating assessment elements.



If the procedures for failure to achieve competence (as listed above) are not

followed the student may be withdrawn from placement. Failure to achieve the

learning contract shall result in a failing grade for the unit.









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Charles Darwin University.









PRECEPTORS MANUAL



Thank you for taking the role of a CDU Student Preceptor.



A manual has been formulated to assist you in Preceptoring a CDU nursing

student. It outlines….



 The roles and responsibilities of being a CDU preceptor

 Necessary characteristics and skills for being a CDU preceptor

 Barriers to preceptorship

 Preparing for a CDU student

 Dealing with difficult situations

 Identifying problems

 How to contact the CDU Clinical Facilitator or Course Coordinator.

 Registered and Enrolled Nursing ANMC Competency (updated versions

2006)



Clinical practice is a vital part of developing skills and confidence for the student

nurse. It helps to clarify the role of a nurse in different clinical settings and to

prepare students with the relevant knowledge and experience to become fully

registered or enrolled nurses.

The university clinical facilitators are available to support preceptors as well as

the students and value any feedback preceptors contribute.





If you are interested in becoming a CDU preceptor inform your Nurse Unit

Manager or Clinical Educator.





A copy of the Preceptors Manual has been has been sent with the Placement

Information Manual. If more copies are required please contact the CDU

Lecturers at the front of this manual.









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Charles Darwin University.



ANMC

AUSTRALIAN NURSING AND

MIDWIFFRY COUNCIL

“The Australian Nursing Midwifery Council is a peak national nursing body

established by the Australian nurse regulatory authorities to develop national

standards for statutory nurse regulation. Its work contributes to the protection of

the community through developing and promoting these standards for nursing

practise.



The National Competency Standards for Registered and Enrolled Nurses in

Australia are the core competency standards that nurses must be able to

demonstrate to the nurse regulatory authorities in order to be

authorized/registered/enrolled to practice.”



(Referenced- www.anmc.org.au)





The ANMC form is included in the student‟s clinical assessment to ensure they

are practising at a level in accordance with the ANMC Competency Standards.



All students are expected to complete these forms in conjunction with two of the

following

 Clinical Nurse Consultant / Unit Manager

 Clinical Educator

 Preceptor,

 CDU Clinical Facilitator or Course Co-ordinator if they are able to be

present.



CDU School of Health Sciences has based the student’s clinical

assessment on standards or competency ratings in conjunction

with the relevant domain/competency unit.



Each year level has different expectations according to the predetermined

competency lists. Some students may perform at a higher or lower level than

expected.



The ANMC Competency Standards are divided into 4 main Domains with

underlying units. The main domains are…

 Professional Practice

 Critical Thinking and Analysis

 Provision and Coordination of Care

 Collaborative and Therapeutic Practice







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Charles Darwin University.



The ANMC Competency levels are to be assessed throughout the student‟s

clinical placement with the student being formally assessed twice.

This occurs at the “interim" or the half way point of the student‟s clinical

placement and the “final” or completion of the student‟s clinical placement.



The ANMC Competency also requires a written evaluation at the interim and final

level.



Included is an example of the ANC Competency form now being utilised by

Students in RDH. Pleases leave the original copy available for others to look at.



The ANMC for the Enrolled Nursing Student



The ANMC National Competency Standards for the Enrolled Nurse are an

integral component of the regulatory framework of nursing practice in Australia.

Some Australian nursing regulatory bodies use the National Standards as a

benchmark to assess competence for practice for initial and continuing

registration as an Enrolled Nurse.



It is a requirement of the Nursing and Midwifery Board of the Northern Territory

that ALL students in the Charles Darwin University Certificate IV in Community

Services and Health complete a competency assessment against the Australian

and Nursing Midwifery Council (ANMC) National Competency Standards for the

Enrolled Nurse.



As these competency standards are professional competencies, any currently

practicing Registered Nurse may undertake assessment of students

against the ANMC National Competency Standards.



The ANMC recommends that anyone undertaking assessments against the

National Competency Standards should familiarize themselves with the

Principles for the Assessment of National Competency Standards for Nurses and

Midwives available from the ANMC website http://www.anmc.org.au. Briefly, the

principles for assessment are:

 Accountability

 Performance based assessment

 Contextual relevance

 Evidence based assessment

 Validity and reliability in assessment

 Participation and collaboration





Reference

Australian Nursing and Midwifery Council (2002). National Competency Standards for the

Enrolled Nurse. Australian Nursing and Midwifery Council, available from http://www.anmc.org.au











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Charles Darwin University.



DEDICATED EDUCATIONAL UNITS





The running of DEU‟s by Charles Darwin University commenced as a new project

in 2004 at Royal Darwin Hospital and at Darwin Private Hospital. This concept

has been utilised widely throughout Australia. The Flinders University of South

Australia model has been adapted by CDU and is used upon request.



The concept of dedicated educational units is to have student nurses from 3rd

year, 2nd year and Enrolled nursing students work together on one ward/unit.

The more experienced students act as preceptor for the less experienced. This

is referred to as a Peer Support model.



The main aim is to provide a positive clinical learning environment with a closer

collaboration between students, nursing peers and academics.



A group of up to 3 students is formed to work together throughout their clinical

placement. This group buddies‟ with a nurse/preceptor each shift. They can

then plan their workload in accordance with their required skill level giving

support to each other as a team.



Each DEU is also supported by a Principal Academic, Clinical Supervisor from

CDU, preceptor and a liaison nurse based on the ward.









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Charles Darwin University.









APPENDIX



Appendix 1 Clinical Skills List for Bachelor of Nursing

Students



Appendix 2 Clinical Skills List for Certificate IV Enrolled Nursing



Appendix 3 Student Evaluation Form: ANMC Competency

Based Assessment (Bachelor of Nursing

students)



Appendix 4 NUR 109 Practice Competency Tool

NUR 109 Skills List



Appendix 5 NUR 224 Practice Competency Tool

NUR 224 Skills List

Oral Presentation/ Handover



Appendix 6 NUR 331 Practice Competency Tool



NUR 350 Practice Competency Tool



NUR 332 Community Health Placement Tool



NUR 332 Mental Health Placement Tool



NUR 331/332/350 Linked Skills List



NUR 331- Reflective Practice



NUR 331- Oral Presentation/ In-Service



Students are required to download a copy of each of these forms from the

CDU website: http://www.cdu.edu.au/ehs/health/practicum/forms.html





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Charles Darwin University.









Appendix 1









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Charles Darwin University.



CHARLES DARWIN UNIVERSITY



CHARLES DARWIN UNIVERSITY

Clinical skills list for each year level

st

1 year clinical skills 2nd year clinical skills 3rd year clinical skills



Assessment of Medications-care & storage Medication management

appearance & behaviour of, locking drug trolley

Taking & documenting Correct administration of Use of patient controlled

vital signs medications /charts analgesia

Measuring & recording Preparation/administration Syringe drivers

height & weight of intramuscular injections

Ward urinalysis Accurate drug calculations





BSL monitoring & c/o Preparation/administration Care of Underwater seal

equipment of subcutaneous injections drainage/documentation

Hand washing-domestic Blood transfusions-legal Care of Total Parenteral

& clinical requirements/observations/ Nutrition/ documentation

relevant paper work

Assistance with ADLs – Demonstrate accurate Venipuncture-

Bathing/sponging pt IV flow & drip rate Collection of blood

Showering pt specimens

C/o hair & nails

calculations Correct use of pathology

Oral hygiene Setting up IV therapy forms

Priming of IV lines

Assistance with feeding Use of volumetric pumps Insertion of urinary catheter-

pt- Understanding of IV fluid male and female

Orally order charts

Nasogastric Charting IV therapy

Gastrostomy/PEG

Care of IDC – r/o IDC, Care of intravenous cannula Care of :

specimen collection. sites central venous access device

PICC lines

Port-a caths

Incontinence Care of complex dressings Continuous bladder washout

management

Manual Handling R/O sutures & clips Cardiac monitoring- acute

Bed making patient monitoring

Isolation nursing Wound care chart Code Blue Management

-checking the resus trolley

Pressure area care Peri-operative Check lists Code Blue- mock cardiac

arrest.



Passive & active Post operative care of pt ECG placement of leads &

movement Transferring pt recording

Maintaining body Ostomy care Time Management

alignment-in chair/bed

Assisting ambulation Preceptoring /mentoring

Documenting- nursing Glasgow Coma Scale Mental health assessment

care plans, BSL, FBC, Neurological observations Mini mental health exam

progress notes









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Charles Darwin University.



Wound care- basic Care of/administration Assessing a patient with

aseptic dressings of nebulisers. alcohol and other drugs

Peak flow/charts

Bandaging of Management & care of Cardiac and respiratory

limb/joint/stump/dressings tracheostomy tubes. assessment

Collection of specimens- Insertion & care of Abdominal assessment

urine, faeces, sputum. nasogastric tube

Swabs-wound/nasal

Disposal contaminated Management of traction and Reflective practice

wastes splints



Neurovascular Management of oral

observations airways

- oropharyngeal tube

- nasopharyngeal

tubes

- suctioning



Care of/administration of

oxygen therapy







Basic health assessment-

- auscultation

- palpatation

- inspection









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Charles Darwin University.









Appendix 2









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Charles Darwin University.



CERTIFICATE IV COMMUNITY SERVICES and HEALTH,

ENROLLED NURSING

_______________________________________

UGM 003

Provide care and support for aged clients in a residential setting





Clinical Skills associated with this unit

Students completing UGM003 are expected to demonstrate safe and competent

practice at the beginner level in the following skills or activities during clinical

placement.





Ability to plan and organise

 Ability to prioritize workload



Safe practice and competent practice

 Works under direct or indirect supervision of an Enrolled or Registered

Nurse and within current scope of practice

 Demonstrates an awareness of duty of care and professional

responsibility

 Demonstrates awareness of organizational and emergency procedures,

including fire and evacuation, that apply in the health care setting in which

they are placed

 Effective infection control practices

 Hand washing, universal precautions

 Maintaining a clean environment

 Clinical skills

 Bed making – occupied and unoccupied bed

 Sponging, showering, shaving

 Care of nails, hair (not shampoo), skin, ears and eyes

 Oral and nasal hygiene – dental care, mouth care

 Continence management – bedpan/urinal, assisted toileting, care of

IDC/uridom and drainage bag

 Assisting patients/clients meet nutritional needs – assisted feeding,

PEG feeds

 Maintaining skin integrity – pressure area care

 Passive/active movement, assessment of joint mobility

 Manual handling techniques

 Assessing client needs

 Transfer between bed, chair, wheelchair, floor

 Appropriate use of lifting and positioning devices









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Charles Darwin University.



Effective communication and interpersonal skills

 Demonstrates appropriate communication skills with other health care

workers

 Reports and communicates appropriately to supervising Enrolled Nurse or

Registered Nurse

 Demonstrates the ability to work as part of a team

 Demonstrates ability to communicate appropriately with patients/clients

and their significant others

 Maintains patient/client dignity, privacy confidentiality

 Demonstrates an awareness of:

 individual personal care plans

 nursing and medical terminology and common approved abbreviations

 Demonstrates respect for cultural, spiritual and religious needs and

practices



_______________________________________________________

____



UGM 011

Develop skills for effective participation in the acute setting





Clinical Skills associated with this unit

Students completing UGM011 are expected to build on skills learnt in their

previous qualification or clinical placement as well as the skills gained in the

clinical teaching block preceding this clinical placement. During clinical

placement, students are required to, at all times, demonstrate safe and

competent practice at the beginner level in the acute care setting in the following

skills or activities.





Ability to plan and organise Ability to prioritize workload



Safe practice and competent practice

 Works under direct or indirect supervision of an Enrolled or Registered

Nurse and within current scope of practice

 Demonstrates an awareness of duty of care and professional

responsibility

 Demonstrates awareness of organizational and emergency procedures

that apply in the health care setting in which they are placed

 Demonstrates the ability to reflect on their own practice and to identify

issues of concern and areas of learning and development

 Effective infection control practices

 Clinical hand washing

 Barrier or isolation nursing

 Clinical skills







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Charles Darwin University.



 Health Assessment

 Overall appearance and behaviour

 Physical assessment

 Vital signs – TPR, BP

 Neurovascular observations

 Blood glucose monitoring

 Nutrition and hydration

 PEG management and feeds

 NG management and feeds

 Fluid Balance Chart

 Continence management

 Care and removal of IDC, SPC

 Ostomy care – ileostomy, colostomy

 Changing ostomy appliances

 Specimen collection – urine, stool

 Urinalysis

 Respiratory/Oxygen Therapy

 Oxygen delivery devices

 Care of a patient receiving oxygen

 Monitoring oxygen therapy

 Tri-flow

 Deep breathing and coughing, sputum collection

 Wound Care

 Simple dressings

 Removal sutures/staples

 Wound assessment

 Collection of wound swab

 Bandaging – stump, limbs, head

 Pain Assessment

 Introduction to paediatric nursing concepts

 Handover

 Documenting nursing care, use of charts related to skills taught



Effective communication and interpersonal skills

Demonstrates appropriate communication skills with other health care workers

 Reports and communicates appropriately to supervising Enrolled Nurse or

Registered Nurse

 Demonstrates the ability to work as part of a team

 Demonstrates ability to communicate appropriately with patients/clients

and their significant others

 Maintains patient/client dignity, privacy confidentiality

 Demonstrates an understanding of:

 nursing plans

 nursing and medical terminology and common approved abbreviations

 Demonstrates respect for cultural, spiritual and religious needs and

practices







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Charles Darwin University.



UGM018

Provide nursing in a variety of clinical settings



UGM016

Implement nursing skills for specialised clients across the life

span



UGM023

Provide service delivery in community settings

Students completing UGM018, UGM016 and UGM023 are completing final

clinical placements in the Certificate IV in Community Services and Health

(Enrolled Nurse) course.



Students are expected to build on skills and knowledge gained in all theory units

and previous clinical teaching blocks and clinical placements and to prepare for

nursing practice as a registered Enrolled Nurse in the state or territory in which

they are planning to practice.



Where clinical skills have not been achieved in previous clinical placements,

students are expected to achieve the required skills in these final clinical

placements.



During clinical placement, students are required to, at all times, demonstrate a

safe and competent level of practice in the acute care setting and at a novice

level of practice in the community setting in the following skills or activities.





Ability to plan and organise

 Ability to prioritize workload



Safe practice and competent practice

 Works under direct or indirect supervision of an Enrolled or Registered

Nurse and within current scope of practice

 Demonstrates an understanding of duty of care and professional

responsibility

 Demonstrates an understanding of organizational and emergency

procedures that apply in the health care setting in which they are placed

 Demonstrates the ability to reflect on their own practice and to identify

issues of concern and areas of learning and development

 Effective infection control practices

 Gowning and gloving

 Barrier or isolation nursing

 Clinical skills

 Health Assessment

 Physical assessment





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Charles Darwin University.



 Neurological observations

 Respiratory/Oxygen Therapy

 Peak flow

 Airway management, including suctioning

 Tracheostomy management and care

 Nebulized medications

 Chest drains

 Wound Care

 Wound assessment

 Complex dressings

 Drain tube management



 Pre and post operative nursing care

 Preparation of patient and bed unit

 Transferring a patient to and from operating theatre

 Post operative care

 Orthopaedic nursing

 Traction and splints

 Spinal collars

 Log rolls

 Medication administration

 Oral, ear & eye and topical medications

 PV and PR medications

 SC and IM injections

 Checking S8 medications

 Intravenous therapy

 Care, maintenance and monitoring of IV therapy

 Checking and changing a plain flask

 Removing IV cannula

 Care of a patient receiving a blood or blood product transfusion

 Continence management

 Bladder washout

 Introduction to paediatric nursing

 Family centred care

 Normal parameters vital signs

 Personal hygiene needs

 Feeding and hydration

 Introduction to community nursing practice

 Primary health care

 Health promotion

 Role and function of community based nurses

 Handover

 Documenting nursing care, use of charts related to skills taught



Effective communication and interpersonal skills

 Demonstrates effective communication skills with other health care

workers







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Charles Darwin University.



 Reports and communicates effectively to supervising Enrolled Nurse or

Registered Nurse

 Demonstrates the ability to work as part of a team

 Demonstrates ability to communicate effectively with patients/clients and

their significant others

 Maintains patient/client dignity, privacy confidentiality

 Demonstrates the application of:

 nursing plans

 nursing and medical terminology and common approved abbreviations

 Demonstrates respect for cultural, spiritual and religious needs and

practices









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Charles Darwin University.









Appendix 3









41

Charles Darwin University.









Competency Based Evaluation

Form

ANMC National Competency Standards.

NUR





STUDENT NAME: NUMBER:



Contact details:









HEALTH FACILITY:

Contact details:









UNIT MANAGER:

Contact details:









DATE of PLACEMENT: from to:

CDU Clinical Supervisor:









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Charles Darwin University.



Competency Based Evaluation Form.

The Australian Nursing and Midwifery Council Incorporated (ANMC) in conjunction with the

Nursing and Midwifery regulatory authorities (NMRAs) have devised the National Competency

Standards for the Registered Nurse.



Throughout clinical placement, assessment of the student nurse occurs using the Competency

Based Evaluation Form, based on the standards set out by the ANMC. Evaluation of assessment

of the student nurse is against each Domain and Section, as set out, in the ANMC National

Competency Standards for the Registered Nurse (2004/2005)



CLINICAL PERFORMANCE EVALUATION CRITERIA



COMPETENCY STANDARD

RATING PROCEDURE PERFORMANCE ASSISTANCE

QUALITY

Proficient, coordinated,

INDEPENDENT Safe Without Direction,

confident.

I Accurate maintains support

Expedient use of time

Efficient, coordinated, With occasional

SUPERVISED Safe

confident. physical or verbal

S Accurate

Expedient use of time direction

Partial demonstration of

skills. May be uncoordinated, Frequent verbal

ASSISTED Mostly safe and

and inefficient. and/or physical

A accurate

Delayed time expenditure. direction

Requires further practice.

Questionable

Tends to be unskilled and Continuous verbal

MARGINAL safety and

inefficient. Considerable and and/or physical

M questionable

prolonged time expenditure. direction

accuracy

Unable to demonstrate

Continuous verbal

DEPENDENT Unsafe procedures. Lacks

and/or physical

D Inaccurate confidence, coordination and

direction

efficiency.

(Above table adapted from MSU Northern Department of Nursing clinical evaluation criteria,

The following document has used the standards directly from the ANMC document as can be seen on

the website. [Australian Nursing & Midwifery Council / National Competency Standards for the

Registered Nurse. http://www.anmc.org.au/docs/Competency_standards_RN.pdf]



Assessor and Student to read the following before completing the following form.



The student nurse with the support commensurate to the student‟s level (year) will at this time

have demonstrated an acceptable standard of knowledge, skills and attributes in relation to the

competency ratings and the four (4) domains of nursing practice as set in the ANMC competency

standards for the RN. IF NOT, then in conjunction with CDU clinical supervisors and student

nurse, strategies (e.g. a learning contract) are required to be put in place for the support

and aid of the student nurse.









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Charles Darwin University.



During the clinical placement, it is highly recommended:

 Preceptor/educator/clinical supervisor/manager undertake an interim assessment of the

student nurse‟s performance

 Ask the student nurses to complete the Evaluation form and assess themselves.

 Identify and justify areas that the student requires further practice and development. This

allows the student nurse to perceive their strengths and areas for improvement, from your

perspective, and gives them the opportunity to improve their performance.

 Please document comments and examples under each domain and its sections in order

to justify the grade given.

 If required you may add supporting notes, especially if there has been an incident, or lack

of performance in delivering an adequate standard of care, OR exceptional performance.

(Please keep the CDU clinical supervisors appraised at all times of any student

nurse who proves to be of concern, or is exceptional.)

 Documentation is vital for any student nurse of concern, if the evidence is NOT

documented then it is difficult to explain and demonstrate to the student nurse the areas

in which they are not demonstrating an adequate level for the practicum. The result is the

student nurse does not improve and we may have a student nurse going unprepared into

a higher level, before registration.





Student nurses are continually assessed throughout their entire clinical placement. During each

placement it is a requirement for student nurses to be assessed every 2 weeks, using the

following form; this helps to identify any student nurses requiring extra support and

encouragement.



Please indicate a rating for the following domains by circling the appropriate letter/s:

I = Independent S = Supervised A = Assisted M = Marginal D = Dependent









Domain 1: PROFESSIONAL PRACTICE.

Professional Practice, relates to the professional, legal and ethical responsibilities which require

demonstration of a satisfactory knowledge base, accountability for practice, functioning in

accordance with legislation affecting nursing and health care, and the protection of individual and

group rights.



1. Practises in accordance with legislation affecting nursing practice and health care

1.1 Complies with relevant legislation and common law.

1.2 Fulfils the duty of care.









I S A M D









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Charles Darwin University.



2. Practises within a professional and ethical nursing framework.

2.1 Practices in accordance with the nursing profession‟s codes of ethics and conduct.

2.2 Integrates organisational policies and guidelines with professional standards

2.3 Practises in a way that acknowledges the dignity, culture, values, beliefs and rights of

individuals/groups.

2.4 Advocates for individual/groups and their rights for nursing and health care within

organisational and management structures.

2.5 Understands and practises within own scope of practice.

2.6 Integrates nursing and health care knowledge, skills, and attitudes to provide safe and

effective nursing care.

2.7 Recognises the differences in accountability and responsibility between Registered

Nurses, Enrolled Nurses and unlicensed care workers.









I S A M D





Domain 2: CRITICAL THINKING AND ANALYSIS

Critical Thinking and analysis relates to self-appraisal, professional development and the value of

evidence and research for practice. Reflecting on practice, feelings, and beliefs and the

consequences of these for individuals/groups is an important professional benchmark.



3. Practises within an evidence-based framework.

3.1 Identifies the relevance of research to improving individual/group health outcomes.

3.2 Uses best available evidence, nursing expertise and respect for the values and beliefs of

individuals/groups in the provision of nursing care.

3.3 Demonstrates analytical skills in accessing and evaluating health information and

research evidence.

3.4 Supports and contributes to nursing and health care research.

3.5 Participates in quality improvement activities. (PTO)

3. Practises within an evidence – based framework, continued.









I S A M D







4. Participates in ongoing professional development of self and others.

4.1 Uses best available evidence, standards and guidelines to evaluate nursing performance.

4.2 Participates in professional development to enhance nursing practice.

4.3 Contributes to the professional development of others







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Charles Darwin University.



4.4 Uses appropriate strategies to manage own responses to the professional work

environment.









I S A M D



Domain 3: PROVISION AND COORDINATION OF CARE

Provision and coordination of care relates to the coordination, organisation and provision of

nursing care that includes the assessment of individuals/groups, planning, implementation and

evaluation of care.



5 Conducts a comprehensive and systematic nursing assessment

5.1 Uses a relevant evidence-based assessment framework to collect data about the

physical socio-cultural and mental health of the individual/group.

5.2 Uses a range of assessment techniques to collect relevant and accurate data.

5.3 Analyses and interprets assessment data accurately.









I S A M D



6. Plans nursing care in consultation with individuals/groups, significant others and

the interdisciplinary health care team.

6.1 Determines agreed priorities for resolving health needs of individuals/groups.

6.2 Identifies expected and agreed individual/group health outcomes including a timeframe

for achievement.

6.3 Documents a plan of care to achieve expected outcomes.

6.4 Plans for continuity of care to achieve expected outcomes.









I S A M D









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Charles Darwin University.





7. Provides comprehensive, safe and effective evidence-based nursing care to

achieve identified individual/group health outcomes.

7.1 Effectively manages the nursing care of individuals/groups.

7.2 Provides nursing care according to the documented care or treatment plan.

7.3 Prioritises workload based on the individual‟s/group‟s needs, acuity and optimal time for

intervention.

7.4 Responds effectively to unexpected or rapidly changing situations

7.5 Delegates aspects of care to others according to their competence and scope of practice.

7.6 Provides effective and timely direction and supervision to ensure that delegated care is

provided safely and accurately.

7.7 Educates individuals/groups to promote independence and control over their health

7.8 Uses health care resources effectively and efficiently to promote optimal nursing and

health care.









I S A M D



8. Evaluates progress towards expected individual/group health outcomes in

consultation with individuals/groups, significant others and interdisciplinary health

care team.

8.1 Determines progress of individuals/groups toward planned outcomes.

8.2 Revises the plan of care and determines further outcomes in accordance with evaluation

data.









I S A M D









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Charles Darwin University.







Domain 4: COLLABORATIVE AND THERAPEUTIC PRACTICE

Collaborative and Therapeutic Practice relates to establishing, sustaining, and concluding

professional relationships with individuals/groups. This also contains those competencies that

relate to the nurse understanding their contribution to the interdisciplinary health care team.

9. Establishes, maintains, and appropriately concludes therapeutic relationships.

9.1 Establishes therapeutic relationships that are goal directed and recognises professional

boundaries.

9.2 Communicates effectively with individuals/groups to facilitate provision of care.

9.3 Uses appropriate strategies to promote an individual‟s/group‟s self-esteem, dignity,

integrity and comfort.

9.4 Assists and supports individuals/groups to make informed health care decisions.

9.5 Facilitates a physical, psychosocial, cultural and spiritual environment that promotes

individual/group safety and security.









I S A M D

10. Collaborates with the interdisciplinary health care team to provide comprehensive

nursing care.

10.1 Recognises that the membership and roles of health care teams and service providers

will vary depending on an individual‟s/group‟s needs and health care setting.

10.2 Communicates nursing assessments and decisions to the interdisciplinary health care

team and other relevant service providers.

10.3 Facilitates coordination of care to achieve agreed health outcomes.

10.4 Collaborates with the health care team to inform policy and guideline development.









I S A M D









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Charles Darwin University.



Overall Feedback:

Student comments:









Signature: Print Name: Date:





Assessor comments and overall feedback:









Signature: Print name: Date:





Final Grading (Circle appropriate grading and sign.)





Satisfactory Unsatisfactory





Assessor Signature: Print name: Date:

Student Signature: Print name: Date:









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Appendix 4









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Charles Darwin University.









School of Health Science





BACHELOR OF NURSING





PRACTICE COMPETENCY TOOL



NUR109

Introduction to Medical/Surgical

Nursing Practice

Semester 2 2007





STUDENT NAME: _____________________________



STUDENT ID. NO.: _____________________________



AGENCY: ____________________________________



DATE: _______________________________________







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Confidentiality Agreement

I agree to keep confidential all client/patient information that I have

access to during my clinical placement. I also agree to comply with

the policies and procedures of the agencies in which I undertake

clinical placement as part of my clinical education.



Name_________________________ Student ID No

_______________



Signature _____________________ Date

_______________________



Please list your strategies for ensuring confidentiality:



_______________________________________________________



_______________________________________________________



_______________________________________________________



_______________________________________________________



_______________________________________________________



_______________________________________________________



_______________________________________________________



_______________________________________________________





It is a good idea to discuss your strategies with the Clinician you are

being supervised by.









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Charles Darwin University.







Preparing for Clinical Placement

Prior to commencing your clinical placement, please read your Clinical

Placement Manual – this is available from the School of Health Sciences Home

Page. Also check the following:

 Your contact person if you are not doing clinical practice in Darwin

 How many weeks of clinical practice is required for the unit

 Attendance requirements for the unit

 What you are expected to wear

 Who you need to contact if unable to attend a clinical practice day

 What documentation you need if unable to attend clinical practice

 What assessments are required during your clinical practice

 Do you have a copy of the ANC National Competency Standards for the

Registered Nurse?



Identify your strengths:

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

_________________________

________________________________________________________________

________________________________________________________________

__________

Identify your weaknesses:

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

______________________________

________________________________________________________________

_____



This will assist you in developing your personal objectives for this clinical practice









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Charles Darwin University.



Individual Clinical Practice Objectives



Student to date each entry and discuss with the Clinical Nurse

Objectives Strategies Evaluation/Outcome









Clinical Nurse’s Signature (Objectives/strategies)

________________



Clinical Nurse’s Signature (Evaluation/outcome)

_________________

Competency Based Evaluation







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Charles Darwin University.



CHARLES DARWIN UNIVERSITY

Student Attendance Record for NUR109



Student name ____________________Student No _____________



Date Agency Hours of Sick Clinical Clinical

and/or attendance Leave Nurse Nurse

Ward Name Signature









Please note, Sick Leave hours are required to be made up. This

time will need to be negotiated with the area the student is

placed in







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NUR109 Introduction to Medical/Surgical Nursing

Clinical Skills List

Student Name_________________________Student No__________________



The following Clinical Skills have been taught in the Clinical Teaching Block for

NUR109. The student has practiced these skills under supervision and is now

required to practice them during their Clinical Placement and to be deemed as

competent by your preceptor at the end of their Clinical Placement.



CLINICAL SKILL PRACTISED DURING DEEMED COMPETENT

CLINICAL PLACEMENT DURING CLINICAL

(Preceptor to sign & PLACEMENT

date) (Preceptor to sign &

date only when deemed

competent)

Assessment:

1. Overall appearance and

behaviour

2. Taking vital signs – T,

P, R & BP

3. Measuring height and

weight

4. Ward urinanalysis



5. Blood Glucose

monitoring & care of

equipment

Hand washing:

1. Domestic



2. Clinical



Hygiene/Activities of

Daily Living:

1. Bathing patient in bed

(sponging)

2. Showering patient



3. Care of hair and nails



4. Oral hygiene









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CLINICAL SKILL PRACTISED DURING DEEMED COMPETENT

CLINICAL PLACEMENT DURING CLINICAL

(Preceptor to sign & PLACEMENT

date) (Preceptor to sign &

date only when deemed

competent)

5. Shaving male patient



6. Assisting patient with

feeding – oral

7. Assisting patient with

feeding – nasogastric

8. Assisting patient with

feeding – gastrostomy

9. Pressure area care

10. Basic catheter care –

hygiene

11. Basic catheter care –

removal of

12. Basic catheter care -

specimen collection

13. Incontinence

management

Client mobility:

1. Manual handling

2. Passive and active

exercises

3. Maintaining body

alignment in bed

4. Maintaining body

alignment in chair

5. Assisting patients to

ambulate

Documentation:

1. Observation Charts –

recording of T, P, R, BP,

weight, height, bowel

actions, urinalysis



2. Nursing care plans



3. Blood glucose chart



4. Fluid balance chart



5. Medical record –

ongoing progress notes

6. Pressure area care









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CLINICAL SKILL PRACTISED DURING DEEMED COMPETENT

CLINICAL PLACEMENT DURING CLINICAL

(Preceptor to sign & PLACEMENT

date) (Preceptor to sign &

date only when deemed

competent)

Wound care:

1. Basic aseptic technique

–simple dressing

2. Removal of sutures and

clips

Collection of specimens:

1. Urine



2. Faeces



3. Sputum



4. Swabs – nasal, wound,

other



Other procedures:

1. Bed making and client

environment – safety

issues

2. Isolation nursing



3. Disposal of

contaminated matter

4. Bandaging of joint, limb,

stump and dressings









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Appendix 5









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Charles Darwin University.









School of Health Science





BACHELOR OF NURSING





PRACTICE COMPETENCY TOOL



NUR224

Clinical placement

Semester 1 2007

STUDENT NAME: ______________________________

STUDENT ID. NO.: _____________________________



Student‟s contact information: _____________________

_____________________________________________



Clinical Area – Name & Address: __________________

_____________________________________________

_____________________________________________



Preceptor‟s name: ______________________________

Preceptors contact information: ____________________



Start Date: ______________ End Date: _____________



Total Number of hours completed: ____________



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Confidentiality Agreement



I agree to keep confidential all client/patient information that I have access to

during my clinical placement. I also agree to comply with the policies and

procedures of the agencies in which I undertake clinical placement as part of my

clinical education.



I realise that breach of this confidentiality agreement may result in suspension of

training and have other legal ramifications. These may include being sued by the

patient and other parties.



Name_________________________ Student ID No _______________



Signature _____________________ Date _______________________



List all actions which you will take to respect patients confidentially.

E.g. I will destroy all private notes at end my shift.

___________________________________________________________

___________________________________________________________

___________________________________________________________

___________________________________________________________

___________________________________________________________

___________________________________________________________

___________________________________________________________

___________________________________________________________

List all activities which you will refrain from in order to respect patient

confidentially.

E.g. I will not take home patient‟s notes.

___________________________________________________________

___________________________________________________________

___________________________________________________________

___________________________________________________________

___________________________________________________________

___________________________________________________________

___________________________________________________________



It is a good idea to discuss your strategies with your preceptor in your clinical

area.









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Preparing for Clinical Placement



Prior to commencing your clinical placement, please read your Clinical

Placement Manual – this is available from the School of Health Sciences Home

Page. Also check the following:

 Your contact person if you are not doing clinical practice in Darwin

 How many weeks of clinical practice is required for the unit

 Attendance requirements for the unit

 What you are expected to wear

 Who you need to contact if unable to attend a clinical practice day

 What documentation you need if unable to attend clinical practice

 What assessments are required during your clinical practice

 Do you have a copy of the ANC National Competency Standards for the

Registered Nurse?



Identify your strengths:

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

______________________________________________________

________________________________________________________________

____________________________________________________________



Identify your weaknesses:

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

__________________________________________________



This will assist you in developing your personal objectives for this clinical practice









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Individual Clinical Practice Objectives



Student to date each entry and discuss with the Clinical Nurse

Objectives Strategies Evaluation/Outcome









Clinical Nurse‟s Signature (Objectives/strategies) ________________



Clinical Nurse‟s Signature (Evaluation/outcome) _________________

Competency Based Evaluation









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The Australian Nursing Council National Competency Standards are the core

competency standards that we as registered nurses must be able to demonstrate

our competence in, no matter which state/territory we practice in.



The regulatory authorities i.e. the Nurse‟s Registration Board, apply these

standards for a number of reasons, including to:

 Determine the eligibility for registration of people who have undertaken

nursing courses in Australia

 Determine that all Nurses are safe practitioners in caring for clients in all

settings.



The School of Health Science therefore bases student‟s clinical assessment on

these standards.



Competency Criteria

Rating

Independent Practices in a safe, accurate, coordinated and effective manner with

little need for guiding cues

Proficient Practices in a safe, accurate, coordinated and effective manner with

some need for guiding cues

Advanced Beginner Practices in a safe, accurate, coordinated and effective manner most

of the time, with frequent cues required

Novice Practices in a safe manner when continuous cues are given

Unsatisfactory Unable to demonstrate safe practice, adequate knowledge base

and/or appropriate professional behaviour

Not Applicable Not observed or not applicable



(This Legend has been adapted from Benner and Bondy, 1983)



Minimum Competency Rating



DOMAIN/COMPETENCY YEAR 1 YEAR 2 YEAR 3 YEAR 3

UNIT Medical/Surgical Linked

Specialty

Professional & Ethical Advanced Proficient Independent Independent

Practice Beginner



Critical Thinking & Novice Advanced Proficient Proficient

Analysis Beginner



Management of Care Novice Advanced Proficient Proficient

Beginner



Enabling Novice Advanced Proficient Proficient

Beginner



This tool is to be used in conjunction with Australian Nursing Council, 2002 ANC

National Competency Standards for Registered Nurses 3rd Ed ANC ACT







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Competency Based Evaluation

Students are to be assessed throughout the NUR224 Clinical Placement. It is

expected that students are assessed fortnightly. This assessment form is to be

submitted once every fortnight with the student attendance record and the week

of clinical placement clearly marked.



DOMAIN: PROFESSIONAL & ETHICAL PRACTICE

COMPETENCY UNIT COMPETENCY

RATING

1. FUNCTIONS IN ACCORDANCE WITH LEGISLATION

AND COMMON LAW EFFECTING NURSING PRACTICE

(Elements 1.1 – 1.5)

COMMENTS:





COMPETENCY UNIT COMPETENCY

RATING

2. CONDUCTS NURSING PRACTICE IN A WAY THAT CAN

BE ETHICALLY JUSTIFIED

(Elements 2.1 – 2.4)

COMMENTS:





COMPETENCY UNIT COMPETENCY

RATING

3. PROTECTS THE RIGHTS OF INDIVIDUALS AND

GROUPS IN RELATION TO HEALTH CARE

(Elements 3.1 – 3.7)

COMMENTS:





COMPETENCY UNIT COMPETENCY

RATING

4. ACCEPT ACCOUNTABILITY AND RESPONSIBILITY

FOR OWN ACTIONS WITHIN NURSING PRACTICE

(Elements 4.1 – 4.3)

COMMENTS:









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DOMAIN: CRITICAL THINKING AND ANALYSIS

COMPETENCY UNIT COMPETENCY

RATING

5. ACTS TO ENHANCE THE PROFESSIONAL

DEVELOPMENT OF SELF AND OTHERS

(Elements 5.1 – 5.4)

COMMENTS:



COMPETENCY UNIT COMPETENCY

RATING

6. VALUES RESEARCH IN CONTRIBUTING TO

DEVELOPMENT IN NURSING AND IMPROVED

STANDARDS OF CARE

(Elements 6.1 – 6.3)

COMMENTS:





DOMAIN: MANAGEMENT OF CARE

COMPETENCY UNIT COMPETENCY

RATING

7. CARRIES OUT COMPREHENSIVE AND ACCURATE

NURSING ASSESSMENT OF INDIVIDUALS AND GROUPS

IN A VARIETY OF SETTINGS (Elements 7.1 – 7.3)

COMMENTS:





COMPETENCY UNIT COMPETENCY

RATING

8. FORMULATES A PLAN OF CARE IN COLLABORATION

WITH INDIVIDUALS AND GROUPS (Elements 8.1 – 8.3)

COMMENTS:





COMPETENCY UNIT COMPETENCY

RATING

9. IMPLEMENTS PLANNED NURSING CARE TO ACHIEVE

IDENTIFIED OUTCOMES WITHIN SCOPE OF

COMPETENCE

(Elements 9.1 – 9.3)

COMMENTS:



COMPETENCY UNIT COMPETENCY

RATING

10. EVALUATES PROGRESS TOWARD EXPECTED

OUTCOMES AND REVIEWS AND REVISES PLANS IN

ACCORDANCE WITH appraisal DATA (Elements 10.1 –

10.2)

COMMENTS:









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DOMAIN: ENABLING

COMPETENCY UNIT COMPETENCY

RATING

11. CONTRIBUTES TO THE MAINTENANCE OF AN

ENVIRONMENT WHICH PROMTES SAFETY, SECURITY

AND PERSONAL INTEGRITY OF INDIVIDUALS AND

GROUPS (Elements 11.1 – 11.5)

COMMENTS:



COMPETENCY UNIT COMPETENCY

RATING

12. COMMUNICATES EFFECTIVELY WITH INDIVIDUALS

AND GROUPS (Elements 12.1 – 12.2)

COMMENTS:





COMPETENCY UNIT COMPETENCY

RATING

13. MANAGES EFFECTIVELY THE NURSING CARE OF

INDIVIDUALS AND GROUPS (Elements 13.1 – 13.4)

COMMENTS:





COMPETENCY UNIT COMPETENCY

RATING

14. COLLABORATES WITH OTHERS in HEALTH CARE

TEAM. (Elements 14.1 – 14.3)

COMMENTS:



EVALUATION

Student Self Evaluation:

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

____________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

_______________



Clinical Nurse‟s Evaluation:

________________________________________________________________

________________________________________________________________

________________________________________________________________

_______________





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________________________________________________________________

________________________________________________________________

________________________________________________________________

_______________



Clinical Liaison/Unit Manager‟s/Clinical Coordinator‟s evaluation:

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

____________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

_______________

Please sign & date EACH entry





ASSESSMENT GRADING – Please tick the appropriate box

Satisfactory  Unsatisfactory 



If a student is deemed unsatisfactory then the preceptor must be able to identify

the specific reasons for assessing at that level. Please see example below:

DOMAIN: PROFESSIONAL & ETHICAL PRACTICE.

1. FUNCTIONS IN ACCORDANCE WITH LEGISLATION AND COMMON LAW EFFECTING

NURSING PRACTICE. (Elements 1.1 – 1.5)

“Jane Doe does not function in accordance with currents legislation. She put the

patient‟s medications down his nasogastric tube when he refused them. Patient

was voluntary”.

Name of Student ____________________________ Signature ________________

Date_________



Name of Clinical Nurse ______________________ Signature ________________ Date

_________



Name of CL/UM ____________________________ Signature ________________ Date

_________









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Student Attendance Record.



Student name _______________________ Student No _____________



Date Agency or Ward Hours of Sick Leave Clinical Nurse Clinical Nurse

attendance Name Signature









Please note, Sick Leave hours are required to be made up. This time will need to

be negotiated with the area the student is placed in. All sickness must be

reported in a timely manner to the clinical area and the placement coordinator at

Charles Darwin University.



I certify that I have completed one hundred and sixty hours of clinical practice.



Name: ____________________Signature: _______________

Date:____________

Revised: Sarjeet S. Gill. Feb. 2007









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NUR224 SEM 1 2007

ORAL PRESENTATION

“HANDOVER”



During Clinical Placement, it is expected that students develop a range of skills

which are not independently assessed. These skills include the following:

 Team work – ability to work with all members of the caring community.

 Interpersonal – ability to relate with the patient and others with accurate

empathy.

 Time management – Reports for duty in a timely manner, finishes tasks in

timely manner without sacrificing quality and safety.

 Patient management – Able evaluate, plan and implement care of patients

assigned.

 Prioritorising – Able to make clear and reasoned distinctions between

more and less important tasks.

 Communication – Able to communicate effectively with all members of the

caring community.



By the end of the fourth week of Clinical Placement, students should be able to

manage the care of three (3) uncomplicated patients with supervision.



The oral “handover” of patients is an important part of nursing to ensure the

continuity of their care from one group of nurses to the next. This time also allows

for problem solving of patient care issues.



During your fourth week, you are expected to “handover” three patients you

have been caring for.



During your clinical placement you have listened to many handovers. Feel free to

use the handover method that is used in your area. The University‟s suggested

method of a handover is outlined below.



HANDOVER GUIDELINES



 Time Allowed: 15 minutes, 5 minutes per patient.

 Biographical data – name, age, gender (This is often referred to as

identifying information, in US literature.)

 Date & Reason for Admission – previous admission, this admission

related to the same disease or complaint

 Current Medical History – history of the current admission, allergies and

medications





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 Investigations – has any specific tests been taken and are there any

results of these? Any changes to the treatment as a result of this?

 Treatment – non-pharmacological that is ordered (e.g. physiotherapy,

exercise, diet), pharmacological what drugs have been prescribed and

their grouping (e.g. antibiotic, hypnotic)

 Nursing Management – needs/problems identified; planned strategies

implemented

 Discharge Planning – any patient education required, services following

discharge







ORAL PRESENTATION “HANDOVER”ASSESSMENT CRITERIA





Criteria Met/Not Met

Ability to integrate knowledge into practice

Biographical data

Date & Reason for Admission

Current Medical History

Treatment

Nursing Management

Discharge Planning







Name of Student: __________________Student Number ________



This student has satisfactorily handed over the care and nursing management of

three patients.



Clinical Supervisor‟s name:

____________________________________



Clinical Supervisor‟s Signature: ___________Date: _____________



Student Comments:

____________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

_______________Supervisor‟s

Comments:_________________________________________________

_______________________________________________________

Revised: Feb 2007 Sarjeet S. Gill







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Charles Darwin University.









NUR224 Medical/Surgical Nursing Clinical Skills List



Student Name_________________________Student No__________________

Name of Institution:

__________________________________________________

Name of Principal Preceptor.

___________________________________________



The following Clinical Skills have been taught in the Clinical Teaching Block for

NUR224. The student has practiced these skills under supervision and is now

required to practice them during their Clinical Placement and to be deemed as

competent in the clinical setting.



Student education is one of the many roles of health care institutions. Your help

in assisting the student achieve his/her clinical competence is sincerely

appreciated. When you feel that a student is competent in a particular skill please

acknowledge it by signing and dating in the appropriate section, next to the skill.



CLINICAL SKILL Deemed Competent.

(please sign and date)

Medications:

1. Care and correct storage of medications – locking

of drug trolley.

2. Correct administration of medications &

documentation.

3. Preparation, administration and documentation

Intramuscular injections.

4. Able to perform accurate calculations for drugs

used in this clinical area.

5. Preparation and administration of SC injections.

6. Blood Transfusions: legal requirements,

observations, & relevant paperwork.

7. Demonstrate accurate IV flow & Drip rate

calculations.

Setting up IV therapy

Priming IV lines.

IV injections into burette.

8. Able to use volumetric pumps. Able to display

understanding of IV fluid orders.

Charts IV fluids correctly.

9. Able to care intravenous cannula sites.

10. Care / administration of nebulisers.









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Deemed

Clinical Skills: Competent.

11. Able to perform a complex wound dressing

aseptically.

12. Able to remove sutures and clips.

13. Able to document and understand wound care

charts.

14. Pre-operative checklist – understands its

importance and is able to complete a pre-operative

check list.

15. Able to care for the post-operative patient. Able

to state common post-op complications.

16. Able to provide ostomy care.

17.Demonstrates understanding of Glasgow Coma

Scale and document Neuro observations.

18. Care of / administration of nebulisers.

19. Management and care of tracheostomy tubes.

20. Insertion & care of nasogastric tubes.

21. Management of Traction and splints.

22. Management of oral airways:

a. oropharyngeal tubes

b.nasopharyngeal tubes

c.suctioning.



If you learn other skills during this clinical placement please write them in and

request your preceptor to sign them. You can also use this section to document

competence in skills which were not completed in your first year.



CLINICAL SKILL Deemed

Competent.









I certify that I have learned these skills and am competent in performing them.

Further, I certify that all signatures are those of my preceptor or designate.



Student‟s name: ________________Signature: ___________ Date: __________









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Appendix 6









74

Charles Darwin University.









School of Health Science



BACHELOR OF NURSING





PRACTICE COMPETENCY TOOL

NUR331

Advanced Practice 1

6 Week Acute Placement

2007



Student Name: ______________________________



Student Number: _____________________________



Health Facility: _______________________________



Contact Details of

Facility:_____________________________________



____________________________________________





Unit Manager:________________________________





Date of Placement:

____________________________________________



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Charles Darwin University.



Preparing for Your 6 week Acute Clinical Placement

Prior to commencing your clinical placement please read your NUR 331 Unit

Guide and Clinical Placement Manual; this is available from the Nursing

Practicum page on the CDU Web site. Also check the following:



 Your contact person if you are not doing clinical practice in Darwin(CDU

staff are available for any clinical issues no matter where you are).

 Attendance requirements for the unit- Shift starting and finishing times.

 Have your CDU shirt and Identification; present your self neatly and

professionally.

 Know who you need to contact if unable to attend a clinical practice day



Assessment required on this placement:



 Your confidentiality agreement and objectives are to be completed prior to

the commencement of your placement and are to be discussed with your

preceptor.

 Attendance record

 ANMC National Competency Assessment form a total of 3 to be

completed during your placement- 1 form every 2 weeks.

 Your Oral case study/ in-service

 You may also like to work on your reflective practice and complete this

during this time.









Confidentiality Agreement

I agree to keep confidential all client/patient information that I have access to

during my clinical placement. I also agree to comply with the policies and

procedures of the agencies in which I undertake clinical placement as part of my

clinical education.



Name_______________________Student ID No _______________



Signature ___________________Date _______________________









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Charles Darwin University.



NUR 331 Clinical Practice Objectives



Student to date each entry and discuss with the Clinical Nurse

on the commencement of their clinical placement.



Objectives Strategies Evaluation/Outcome









Clinical Nurse’s Signature (Objectives/strategies)

________________



Clinical Nurse’s Signature (Evaluation/outcome)

_________________









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Charles Darwin University.



CHARLES DARWIN UNIVERSITY

Student Attendance Record for NUR331

Student name ____________________Student No _____________



Date Agency Hours of Sick Clinical Clinical

and/or attendance Leave Nurse Nurse

Ward Name Signature









Sick Leave hours are required to be made up. This time will need

to be negotiated with the area the student is place





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CHARLES DARWIN UNIVERSITY

Student Attendance Record for NUR331

Student name ____________________Student No _____________



Date Agency Hours of Sick Clinical Clinical

and/or attendance Leave Nurse Nurse

Ward Name Signature









Sick Leave hours are required to be made up. This time will need

to be negotiated with the area the student is placed.





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Charles Darwin University.



Competency Based Evaluation Form.

The Australian Nursing and Midwifery Council Incorporated (ANMC) in conjunction with the

Nursing and Midwifery regulatory authorities (NMRAs) have devised the National Competency

Standards for the Registered Nurse.



Throughout clinical placement, assessment of the student nurse occurs using the Competency

Based Evaluation Form, based on the standards set out by the ANMC. Evaluation of assessment

of the student nurse is against each Domain and Section, as set out, in the ANMC National

Competency Standards for the Registered Nurse (2004/2005)



CLINICAL PERFORMANCE EVALUATION CRITERIA



COMPETENCY STANDARD

RATING PROCEDURE PERFORMANCE ASSISTANCE

QUALITY

Proficient, coordinated,

INDEPENDENT Safe Without Direction,

confident.

I Accurate maintains support

Expedient use of time

Efficient, coordinated, With occasional

SUPERVISED Safe

confident. physical or verbal

S Accurate

Expedient use of time direction

Partial demonstration of

skills. May be uncoordinated, Frequent verbal

ASSISTED Mostly safe and

and inefficient. and/or physical

A accurate

Delayed time expenditure. direction

Requires further practice.

Questionable

Tends to be unskilled and Continuous verbal

MARGINAL safety and

inefficient. Considerable and and/or physical

M questionable

prolonged time expenditure. direction

accuracy

Unable to demonstrate

Continuous verbal

DEPENDENT Unsafe procedures. Lacks

and/or physical

D Inaccurate confidence, coordination and

direction

efficiency.

(Above table adapted from MSU Northern Department of Nursing clinical evaluation criteria,

The following document has used the standards directly from the ANMC document as can be seen on

the website. [Australian Nursing & Midwifery Council / National Competency Standards for the

Registered Nurse. http://www.anmc.org.au/docs/Competency_standards_RN.pdf]



Assessor and Student to read the following before completing the following form.



The student nurse with the support commensurate to the student‟s level (year) will at this time

have demonstrated an acceptable standard of knowledge, skills and attributes in relation to the

competency ratings and the four (4) domains of nursing practice as set in the ANMC competency

standards for the RN. IF NOT, then in conjunction with CDU clinical supervisors and student

nurse, strategies (e.g. a learning contract) are required to be put in place for the support

and aid of the student nurse.



During the clinical placement, it is highly recommended:

 Preceptor/educator/clinical supervisor/manager undertake an interim assessment of the

student nurse‟s performance

 Ask the student nurses to complete the Evaluation form and assess themselves.









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 Identify and justify areas that the student requires further practice and development. This

allows the student nurse to perceive their strengths and areas for improvement, from your

perspective, and gives them the opportunity to improve their performance.

 Please document comments and examples under each domain and its sections in order

to justify the grade given.

 If required you may add supporting notes, especially if there has been an incident, or lack

of performance in delivering an adequate standard of care, OR exceptional performance.

(Please keep the CDU clinical supervisors appraised at all times of any student

nurse who proves to be of concern, or is exceptional.)

 Documentation is vital for any student nurse of concern, if the evidence is NOT

documented then it is difficult to explain and demonstrate to the student nurse the areas

in which they are not demonstrating an adequate level for the practicum. The result is the

student nurse does not improve and we may have a student nurse going unprepared into

a higher level, before registration.



Student nurses are continually assessed throughout their entire clinical placement. During each

placement it is a requirement for student nurses to be assessed every 2 weeks, using the

following form; this helps to identify any student nurses requiring extra support and

encouragement.



Please indicate a rating for the following domains by circling the appropriate letter/s:

I = Independent S = Supervised A = Assisted M = Marginal D = Dependent



Domain 1: PROFESSIONAL PRACTICE.

Professional Practice, relates to the professional, legal and ethical responsibilities which require

demonstration of a satisfactory knowledge base, accountability for practice, functioning in

accordance with legislation affecting nursing and health care, and the protection of individual and

group rights.



1. Practises in accordance with legislation affecting nursing practice and health care

1.3 Complies with relevant legislation and common law.

1.4 Fulfils the duty of care.









I S A M D



2. Practises within a professional and ethical nursing framework.

2.8 Practices in accordance with the nursing profession‟s codes of ethics and conduct.

2.9 Integrates organisational policies and guidelines with professional standards

2.10 Practises in a way that acknowledges the dignity, culture, values, beliefs and rights of

individuals/groups.

2.11 Advocates for individual/groups and their rights for nursing and health care within

organisational and management structures.

2.12 Understands and practises within own scope of practice.

2.13 Integrates nursing and health care knowledge, skills, and attitudes to provide safe and

effective nursing care.

2.14 Recognises the differences in accountability and responsibility between Registered

Nurses, Enrolled Nurses and unlicensed care workers.







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I S A M D





Domain 2: CRITICAL THINKING AND ANALYSIS

Critical Thinking and analysis relates to self-appraisal, professional development and the value of

evidence and research for practice. Reflecting on practice, feelings, and beliefs and the

consequences of these for individuals/groups is an important professional benchmark.



3. Practises within an evidence-based framework.

3.6 Identifies the relevance of research to improving individual/group health outcomes.

3.7 Uses best available evidence, nursing expertise and respect for the values and beliefs of

individuals/groups in the provision of nursing care.

3.8 Demonstrates analytical skills in accessing and evaluating health information and

research evidence.

3.9 Supports and contributes to nursing and health care research.

3.10 Participates in quality improvement activities. (PTO)

3. Practises within an evidence – based framework, continued.









I S A M D



4. Participates in ongoing professional development of self and others.

5.4 Uses best available evidence, standards and guidelines to evaluate nursing performance.

5.5 Participates in professional development to enhance nursing practice.

5.6 Contributes to the professional development of others

5.7 Uses appropriate strategies to manage own responses to the professional work

environment.









I S A M D









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Domain 3: PROVISION AND COORDINATION OF CARE

Provision and coordination of care relates to the coordination, organisation and provision of

nursing care that includes the assessment of individuals/groups, planning, implementation and

evaluation of care.



6 Conducts a comprehensive and systematic nursing assessment

6.1 Uses a relevant evidence-based assessment framework to collect data about the

physical socio-cultural and mental health of the individual/group.

6.2 Uses a range of assessment techniques to collect relevant and accurate data.

6.3 Analyses and interprets assessment data accurately.









I S A M D







6. Plans nursing care in consultation with individuals/groups, significant others and

the interdisciplinary health care team.

6.1 Determines agreed priorities for resolving health needs of individuals/groups.

6.2 Identifies expected and agreed individual/group health outcomes including a timeframe

for achievement.

6.3 Documents a plan of care to achieve expected outcomes.

6.4 Plans for continuity of care to achieve expected outcomes.









I S A M D



7. Provides comprehensive, safe and effective evidence-based nursing care to

achieve identified individual/group health outcomes.

7.1 Effectively manages the nursing care of individuals/groups.

7.2 Provides nursing care according to the documented care or treatment plan.

7.3 Prioritises workload based on the individual‟s/group‟s needs, acuity and optimal time for

intervention.

7.4 Responds effectively to unexpected or rapidly changing situations

7.5 Delegates aspects of care to others according to their competence and scope of practice.

7.6 Provides effective and timely direction and supervision to ensure that delegated care is

provided safely and accurately.

7.7 Educates individuals/groups to promote independence and control over their health

7.8 Uses health care resources effectively and efficiently to promote optimal nursing and

health care.









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I S A M D







8. Evaluates progress towards expected individual/group health outcomes in

consultation with individuals/groups, significant others and interdisciplinary health

care team.

8.1 Determines progress of individuals/groups toward planned outcomes.

8.2 Revises the plan of care and determines further outcomes in accordance with evaluation

data.









I S A M D



Domain 4: COLLABORATIVE AND THERAPEUTIC PRACTICE

Collaborative and Therapeutic Practice relates to establishing, sustaining, and concluding

professional relationships with individuals/groups. This also contains those competencies that

relate to the nurse understanding their contribution to the interdisciplinary health care team.

9. Establishes, maintains, and appropriately concludes therapeutic relationships.

9.1 Establishes therapeutic relationships that are goal directed and recognises professional

boundaries.

9.2 Communicates effectively with individuals/groups to facilitate provision of care.

9.3 Uses appropriate strategies to promote an individual‟s/group‟s self-esteem, dignity,

integrity and comfort.

9.4 Assists and supports individuals/groups to make informed health care decisions.

9.5 Facilitates a physical, psychosocial, cultural and spiritual environment that promotes

individual/group safety and security.









I S A M D









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10. Collaborates with the interdisciplinary health care team to provide comprehensive

nursing care.

10.1 Recognises that the membership and roles of health care teams and service providers

will vary depending on an individual‟s/group‟s needs and health care setting.

10.2 Communicates nursing assessments and decisions to the interdisciplinary health care

team and other relevant service providers.

10.3 Facilitates coordination of care to achieve agreed health outcomes.

10.4 Collaborates with the health care team to inform policy and guideline development.









I S A M D









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Overall Feedback:

Student comments:









Signature: Print Name: Date:





Assessor comments and overall feedback:









Signature: Print name: Date:





Final Grading (Circle appropriate grading and sign.)





Satisfactory Unsatisfactory





Assessor Signature: Print name:

Date:

Student Signature: Print name:

Date:









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NUR 350 Specialty Practice

Student Assessment





STUDENT NAME: NUMBER:







Contact details:









HEALTH FACILITY:

Contact details:









UNIT MANAGER:

Contact details:









DATE of PLACEMENT: from to:





CDU Clinical Supervisor:







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Charles Darwin University.



NUR 350 Specialty Placement

NUR 350 is a 4 week/ 20 shift placement at a designated facility to correspond

with the student nurse‟s special elective area.

It is expected the student will display an advanced knowledge in this area and

participate as a member of the allocated health care team.

It is requested the student has an orientation to their workplace area; a form has

been provided by CDU, however this can be replaced by an orientation form

used by the clinical area for new staff. This form can be included in the forms

submitted to CDU by the student as part of their assessment.

2 formal student clinical assessments are requested during this 4 week

placement. The feed back from these assessments allows the student to

develop their clinical competence and learn from their nursing peers.



It is expected that the student will complete on this placement:

 Confidentiality agreement

 Clinical Objectives

 Orientation to work area

 Clinical skills appropriate to their specialty area

 Time sheet (160 hours)

 2 formal assessments (CDU /ANMC National Competency Form); 1 for

each 2 weeks of clinical placement.







Confidentiality Agreement

NUR 350

I agree to keep confidential all client/patient information that I have

access to during my clinical placement. I also agree to comply with

the policies and procedures of the agencies in which I undertake

clinical placement as part of my clinical education.



Clinical

Facility:_____________________________________________



Name_______________________Student ID No _______________



Signature ___________________Date _______________________









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Specialty Unit NUR 350 Clinical Practice Objectives

The student is expected to complete the clinical objectives to reflect their

clinical expectations for this placement.

The clinical objectives are to be discussed with their allocated preceptor/

clinical educator on commencement of their placement.



Objectives Strategies Evaluation/Outcome









Clinical Objectives discussed with preceptor/ clinical educator:



Signature of preceptor: _____________________________



Signature of student: _______________________________









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Charles Darwin University.







NUR 350 – Specialty Placement

Orientation to work area: the following is a guide for students; where

possible students are encouraged to follow the orientation supplied for

new staff in their clinical specialty area.





Orientation Check List Date/ Preceptor to

Sign



Staff Room



Nursing Team



Medical Team



Shift times/ Ward Routine/ Rosters



Allied Health Workers



Ward/ Facility Lay out



Medication Imprest Cupboard

Patient / Nursing Documentation



Policy & procedure manual



OH&S Manual & Resource Manuals



Fire Extinguishers/ Alarms / Exits



In- Service/ Educator Planner



Phones/ Paging System



Store Room

Emergency Protocols

Information Management









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Charles Darwin University.



CHARLES DARWIN UNIVERSITY

Student Attendance Record for NUR 350



Student name ____________________Student No _____________



Date Agency Hours of Sick Clinical Clinical

and/or attendance Leave Nurse Nurse

Ward Name Signature









Sick Leave hours are required to be made up. This time will need

to be negotiated with the clinical area the student is placed.









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Charles Darwin University.







Competency Based Evaluation Form.

The Australian Nursing and Midwifery Council Incorporated (ANMC) in conjunction with the

Nursing and Midwifery regulatory authorities (NMRAs) have devised the National Competency

Standards for the Registered Nurse.



Throughout clinical placement, assessment of the student nurse occurs using the Competency

Based Evaluation Form, based on the standards set out by the ANMC. Evaluation of assessment

of the student nurse is against each Domain and Section, as set out, in the ANMC National

Competency Standards for the Registered Nurse (2004/2005)



CLINICAL PERFORMANCE EVALUATION CRITERIA



COMPETENCY STANDARD

RATING PROCEDURE PERFORMANCE ASSISTANCE

QUALITY

Proficient, coordinated,

INDEPENDENT Safe Without Direction,

confident.

I Accurate maintains support

Expedient use of time

Efficient, coordinated, With occasional

SUPERVISED Safe

confident. physical or verbal

S Accurate

Expedient use of time direction

Partial demonstration of

skills. May be uncoordinated, Frequent verbal

ASSISTED Mostly safe and

and inefficient. and/or physical

A accurate

Delayed time expenditure. direction

Requires further practice.

Questionable

Tends to be unskilled and Continuous verbal

MARGINAL safety and

inefficient. Considerable and and/or physical

M questionable

prolonged time expenditure. direction

accuracy

Unable to demonstrate

Continuous verbal

DEPENDENT Unsafe procedures. Lacks

and/or physical

D Inaccurate confidence, coordination and

direction

efficiency.

(Above table adapted from MSU Northern Department of Nursing clinical evaluation criteria,

The following document has used the standards directly from the ANMC document as can be seen on

the website. [Australian Nursing & Midwifery Council / National Competency Standards for the

Registered Nurse. http://www.anmc.org.au/docs/Competency_standards_RN.pdf]



Assessor and Student to read the following before completing the following form.



The student nurse with the support commensurate to the student‟s level (year) will at this time

have demonstrated an acceptable standard of knowledge, skills and attributes in relation to the

competency ratings and the four (4) domains of nursing practice as set in the ANMC competency

standards for the RN. IF NOT, then in conjunction with CDU clinical supervisors and student

nurse, strategies (e.g. a learning contract) are required to be put in place for the support

and aid of the student nurse.



During the clinical placement, it is highly recommended:

 Preceptor/educator/clinical supervisor/manager undertake an interim assessment of the

student nurse‟s performance

 Ask the student nurses to complete the Evaluation form and assess themselves.







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Charles Darwin University.



 Identify and justify areas that the student requires further practice and development. This

allows the student nurse to perceive their strengths and areas for improvement, from your

perspective, and gives them the opportunity to improve their performance.

 Please document comments and examples under each domain and its sections in order

to justify the grade given.

 If required you may add supporting notes, especially if there has been an incident, or lack

of performance in delivering an adequate standard of care, OR exceptional performance.

(Please keep the CDU clinical supervisors appraised at all times of any student

nurse who proves to be of concern, or is exceptional.)

 Documentation is vital for any student nurse of concern, if the evidence is NOT

documented then it is difficult to explain and demonstrate to the student nurse the areas

in which they are not demonstrating an adequate level for the practicum. The result is the

student nurse does not improve and we may have a student nurse going unprepared into

a higher level, before registration.



Student nurses are continually assessed throughout their entire clinical placement. During each

placement it is a requirement for student nurses to be assessed every 2 weeks, using the

following form; this helps to identify any student nurses requiring extra support and

encouragement.





Please indicate a rating for the following domains by circling the appropriate letter/s:

I = Independent S = Supervised A = Assisted M = Marginal D = Dependent









Domain 1: PROFESSIONAL PRACTICE.

Professional Practice, relates to the professional, legal and ethical responsibilities which require

demonstration of a satisfactory knowledge base, accountability for practice, functioning in

accordance with legislation affecting nursing and health care, and the protection of individual and

group rights.



1. Practises in accordance with legislation affecting nursing practice and health care

1.5 Complies with relevant legislation and common law.

1.6 Fulfils the duty of care.









I S A M D









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Charles Darwin University.





2. Practises within a professional and ethical nursing framework.

2.15 Practices in accordance with the nursing profession‟s codes of ethics and conduct.

2.16 Integrates organisational policies and guidelines with professional standards

2.17 Practises in a way that acknowledges the dignity, culture, values, beliefs and rights of

individuals/groups.

2.18 Advocates for individual/groups and their rights for nursing and health care within

organisational and management structures.

2.19 Understands and practises within own scope of practice.

2.20 Integrates nursing and health care knowledge, skills, and attitudes to provide safe and

effective nursing care.

2.21 Recognises the differences in accountability and responsibility between Registered

Nurses, Enrolled Nurses and unlicensed care workers.









I S A M D





Domain 2: CRITICAL THINKING AND ANALYSIS

Critical Thinking and analysis relates to self-appraisal, professional development and the value of

evidence and research for practice. Reflecting on practice, feelings, and beliefs and the

consequences of these for individuals/groups is an important professional benchmark.



3. Practises within an evidence-based framework.

3.11 Identifies the relevance of research to improving individual/group health outcomes.

3.12 Uses best available evidence, nursing expertise and respect for the values and beliefs of

individuals/groups in the provision of nursing care.

3.13 Demonstrates analytical skills in accessing and evaluating health information and

research evidence.

3.14 Supports and contributes to nursing and health care research.

3.15 Participates in quality improvement activities. (PTO)

3. Practises within an evidence – based framework, continued.









I S A M D









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4. Participates in ongoing professional development of self and others.

6.4 Uses best available evidence, standards and guidelines to evaluate nursing performance.

6.5 Participates in professional development to enhance nursing practice.

6.6 Contributes to the professional development of others

6.7 Uses appropriate strategies to manage own responses to the professional work

environment.









I S A M D



Domain 3: PROVISION AND COORDINATION OF CARE

Provision and coordination of care relates to the coordination, organisation and provision of

nursing care that includes the assessment of individuals/groups, planning, implementation and

evaluation of care.



7 Conducts a comprehensive and systematic nursing assessment

7.1 Uses a relevant evidence-based assessment framework to collect data about the

physical socio-cultural and mental health of the individual/group.

7.2 Uses a range of assessment techniques to collect relevant and accurate data.

7.3 Analyses and interprets assessment data accurately.









I S A M D



6. Plans nursing care in consultation with individuals/groups, significant others and

the interdisciplinary health care team.

6.1 Determines agreed priorities for resolving health needs of individuals/groups.

6.2 Identifies expected and agreed individual/group health outcomes including a timeframe

for achievement.

6.3 Documents a plan of care to achieve expected outcomes.

6.4 Plans for continuity of care to achieve expected outcomes.









I S A M D









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7. Provides comprehensive, safe and effective evidence-based nursing care to

achieve identified individual/group health outcomes.

7.1 Effectively manages the nursing care of individuals/groups.

7.2 Provides nursing care according to the documented care or treatment plan.

7.3 Prioritises workload based on the individual‟s/group‟s needs, acuity and optimal time for

intervention.

7.4 Responds effectively to unexpected or rapidly changing situations

7.5 Delegates aspects of care to others according to their competence and scope of practice.

7.6 Provides effective and timely direction and supervision to ensure that delegated care is

provided safely and accurately.

7.7 Educates individuals/groups to promote independence and control over their health

7.8 Uses health care resources effectively and efficiently to promote optimal nursing and

health care.









I S A M D



8. Evaluates progress towards expected individual/group health outcomes in

consultation with individuals/groups, significant others and interdisciplinary health

care team.

8.1 Determines progress of individuals/groups toward planned outcomes.

8.2 Revises the plan of care and determines further outcomes in accordance with evaluation

data.









I S A M D



Domain 4: COLLABORATIVE AND THERAPEUTIC PRACTICE

Collaborative and Therapeutic Practice relates to establishing, sustaining, and concluding

professional relationships with individuals/groups. This also contains those competencies that

relate to the nurse understanding their contribution to the interdisciplinary health care team.

9. Establishes, maintains, and appropriately concludes therapeutic relationships.

9.1 Establishes therapeutic relationships that are goal directed and recognises professional

boundaries.

9.2 Communicates effectively with individuals/groups to facilitate provision of care.

9.3 Uses appropriate strategies to promote an individual‟s/group‟s self-esteem, dignity,

integrity and comfort.

9.4 Assists and supports individuals/groups to make informed health care decisions.









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9.5 Facilitates a physical, psychosocial, cultural and spiritual environment that promotes

individual/group safety and security.









I S A M D



10. Collaborates with the interdisciplinary health care team to provide comprehensive

nursing care.

10.1 Recognises that the membership and roles of health care teams and service providers

will vary depending on an individual‟s/group‟s needs and health care setting.

10.2 Communicates nursing assessments and decisions to the interdisciplinary health care

team and other relevant service providers.

10.3 Facilitates coordination of care to achieve agreed health outcomes.

10.4 Collaborates with the health care team to inform policy and guideline development.









I S A M D









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Charles Darwin University.



Overall Feedback:

Student comments:









Signature: Print Name:

Date:





Assessor comments and overall feedback:









Signature: Print name:

Date:





Final Grading (Circle appropriate grading and sign.)





Satisfactory Unsatisfactory





Assessor Signature: Print name:

Date:

Student Signature: Print name:









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Charles Darwin University.









NUR 332



Community Health Clinical Placement



Placement Time: 2 weeks (10 shifts)







Student Name: _____________________________________





Student Number: ___________________________________





Placement Facility: __________________________________





Unit Manager: ______________________________________





Contact Details: _____________________________________





Date of placement: __________________________________









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Charles Darwin University.



NUR 332: Community Health Clinical Placement



The role of a Community Health Nurse can be described as one who works

outside of the traditional hospital setting to provide Primary Health care and early

interventions to residents of all ages. Today there are many private community

health services also available.

This placement allows you to experience the health care strategies at work in the

community setting.



Learning Objectives



On completion of this unit, students should be able to:



 begin to identify health agencies in the community and their integration

with health practice

 apply the principles of primary health care in community nursing practice

 identify ways by which clients can gain access to health and community

agencies

 apply concepts of education for health education in community nursing

practice

 identify health education programs conducted in community settlings

 outline components of holistic health practiced and the effect on

achievement of health goals

 apply the nursing process in the provision of care for clients in the

community

 evaluate the outcomes of community health practice; apply the principles

of primary health care in community nursing practice



The assessment for this unit includes a clinical skills “potential experience” list

related to clinical experience you may have in the community health sector. This

is intended as a means for you to record your clinical experience and can be a

valuable document to demonstrate what areas in Community health you have

gained experience.



You are required to have your preceptor complete the clinical skills list and the

Unit Manager in co junction with your preceptor to complete the final

assessment for this Clinical Placement Unit where possible.



CDU wishes to draw your attention to the following recommendations in the

interests of personal comfort, professional presentation and occupational health

and safety.

 In respect for professional colleagues and clients, student‟s clothing should be

non-revealing, garments should be clean and tidy, long hair should be tied back

and closed shoes should be worn.

 Jewellery should be kept to a minimum

 Students should wear the CDU student shirt and have identification visible at all

times unless otherwise advised.





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 Be aware of the emergency procedures- fires/ duress alarms etc for your work

area.

 Know location of staff toilets, lockers, staff room, and hand over room.

 Abide by hours of work- arriving, leaving and meal break times.

 Introduction of yourself to fellow team members.

 Locate the policy and procedure manuals and be aware of local protocols



Prior to commencing your Community Health Placement, students are advised to

find information on the Community Health Facility they are to attend including

services provided and geographical areas covered by the facility. Become

familiar with community health programs and partnerships and know what

contemporary health issues affect your regional area.

Students may also like to revisit Unit NUR 111 Health and Health Professions

and NUR210 Health Sociology.

Please bring your clinical objective list at commencement of your placement so

your preceptor can work with you at achieving your objectives for this placement.









Confidentiality Agreement



I agree to keep confidential all client/patient information that I have access to

during my clinical placement. I also agree to comply with the policies and

procedures of the agencies in which I undertake clinical placement as part of my

clinical education.



Name: _________________________ Student ID No: ___________________



Signature: _____________________ Date: ___________________________



Community Health Facility: _______________________________________________









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Charles Darwin University.



Document 6 Clinical objectives for your Community Health Placement, these

objectives can be used as a guide by your preceptor for your clinical expectations.



Objectives Strategies Evaluation/Outcome









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Student Name: _________________________ Student Number:____________________

Community Health Facility:_____________________________________________________



Clinical Skills: Potential Experience Observed/ Practiced/

Articulated Participated

(Preceptor initial) (preceptor initial)

Nurse/ Client Interaction

1. The Nurse as a case manger 1._______________

______________

2. Negotiating a care plan 2._____________

3. Implementation of client care plan

______________

3._____________ ______________

Communication Skills

1. Understanding of Specialist terminology 1.______________ ______________

2. Verbal interaction with Community health clients 2.______________ ______________

(where appropriate)

3.______________

3. Document observations and interactions in case notes and/or ______________

electronic records.

Community Health Areas

1. Family Planning 1._______________ ______________

2. Health Education 2._______________ ______________

3. Cancer Screening 3._______________ ______________

4. Immunizations 4._______________ ______________

5. School Health Promotion and Education 5._______________ ______________

6. Aged Care Assessment Team 6._______________ ______________

7. Home Visits/ Home Health 7._______________ ______________

8. Palliative Care Team 8. ______________ ______________

9. Hospital In the Home 9. ______________ ______________

10. Child and Maternal Health 10.______________ ______________

11. Discharge Planning 11.______________ ______________

12. Community Mental Health 12. _____________ ______________

13.______________

13. Sexually Transmitted Diseases Screening, Education & Counseling ______________



Team Membership

1. Nursing Handover 1.______________ ______________

2. Team Meetings 2.______________ ______________

3. Case Meetings 3.______________ ______________

Bio-Ethico- legal Issues affecting Clients

1. Clients rights 1.______________ ______________

2. Client Consent 2.______________ ______________

3. Adult Guardianship 3.______________ ______________

Bio-Ethico- legal Issues affecting Nurses

1. Mental Health Act 1.______________ ______________

2. Nurses Act: Duty of Care 2.______________ ______________

3. Personal and professional Liability 3.______________ ______________

4. Workers Compensation 4.______________ ______________

5. MHRT- attend hearing as observer (with client consent) 5.______________ ______________

6. Community Visitor- function 6.______________ ______________

7. Designated Mental Health Professional- function 7.______________ ______________









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Community Health Issues:

1. Communicable Diseases 1.________________ _____________

2. Preventable Chronic disease 2.________________ _____________

3. High risk groups 3.________________ _____________

4. Socio- Economic Factors 4.________________ _____________

5. Early Interventions and Health Screening 5.________________ _____________



Wound Care:

1. Chronic wound management 1.________________ _____________

2. Assessing and planning wound care 2.________________ _____________

3. Client wound care education 3.________________ _____________

4. Knowledge and use of appropriate dressings 4.________________ _____________

5.________________

5. implementation of appropriate wound care/ dressing techniques. _____________



Additional Experience:









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Student Name: __________________________ Student Number: _________________



Date: ___________________________________



Student Assessment- to be completed by the student’s preceptor.

1. Student was able to relate principles of effective communication when collaborating with health

care providers and clients.

S

Comment:









2. Student was able to recognise nursing interventions in the care of clients in the community

health care setting.



Comment:







3. Student was able to identify societal, legal, ethical factors that influence Community Health

issues.



Comment:







4. Student was knowledgeable of the varied areas and disciplines within their Community Health

care facility.



Comment:







5. Student attended and participated in the work environment as part of the Community health

team.



Comment:









Name and designation of Assessor/Preceptor:

_____________________________________________________________________________



Students NUR 332 Community Health Placement assessed as:







Student Comment:

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________









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NUR 332



Mental Health Clinical Placement



Placement Time: 2 weeks (10 shifts)





Student Name: _____________________________________





Student Number: ___________________________________





Placement Facility: __________________________________





Unit Manager: ______________________________________





Contact details Manager/ Facility



: _____________________________________





Date of placement: __________________________________









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NUR 332: Mental Health Clinical Placement



As 3rd Year Registered Nursing Students you have been given the opportunity to

experience nursing in the Specialised Field of Mental Health.



The key to Mental Health Nursing includes nursing objectives such as:

 Provide people with mental ill health or psychological problems with

timely, coordinated and effective mental health assessment, case

management and treatment services, and develop prevention, promotion

and early intervention strategies in collaboration with other agencies.



Prior to commencing your clinical placement in mental health it is recommended

that students take the time to familiarize themselves with:

 The Mental Health and Related Services Act: Guardianship Act,

Information Act, Nurses Act, Pharmacy / Poison Act, Codes of

Ethics< National Mental Health Strategy, Public Service Code of

Conduct and Privacy.

 Details of the facility you are attending for placement.

 Review the core unit NUR 219 Introduction to Mental Health.

 Psychotropic medications.

 Mental health disorders: their signs, symptoms, clinical

manifestations and treatments such as ECT.



The assessment for this unit includes a clinical skills list related to clinical

experience in the mental health sector. This is intended as a means for you to

record your clinical experience and can be a valuable document to demonstrate

what areas in mental health you have gained experience.



You are required to have your preceptor complete the clinical skills list and the

Unit Manager in co junction with your preceptor to complete the final

assessment for this Clinical Placement Unit.

CDU wishes to draw your attention to the following recommendations in the

interests of personal comfort, professional presentation and occupational health

and safety.

 In respect for professional colleagues and clients clothing should be non-

revealing, garments should be clean and tidy, long hair should be tied back and

closed shoes should be worn.

 Jewellery should be kept to a minimum

 Students should wear the CDU student shirt and have identification visible at all

times unless otherwise advised.

 Be aware of the process to call an emergency/ duress alarms

 Know location of staff toilets, lockers, staff room, hand over room.

 Abide by hours of work- arriving, leaving and meal break times

 Introduction of yourself to fellow team members.

 Locate the policy and procedure manuals and be aware of local protocols.









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Confidentiality Agreement



I agree to keep confidential all client/patient information that I have access to

during my clinical placement. I also agree to comply with the policies and

procedures of the agencies in which I undertake clinical placement as part of my

clinical education.



Name: _________________________ Student ID No: ___________________



Signature: _____________________ Date: ___________________________



Mental Health Facility: ___________________________________________________



Document 5 Clinical objectives for your mental health placement, these objectives can

be used as a guide by your preceptor for your clinical expectations.





Objectives Strategies Evaluation/Outcome









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Student Name: _________________________ Student Number:____________________



Mental Health Facility:_____________________________________________________

Clinical Skills: Potential Experience Observed/ Practiced/

Articulated Participated

(Preceptor initial) (preceptor initial)

Therapeutic Interaction

1. The Nurse as a case manger 1._______________ ____________

2. Negotiating a care plan 2._____________

3. Nurse a s mentor

____________

3. ____________

____________

Communication Skills

1. Understanding of Specialist terminology 1.______________ ______________

2. Verbal interaction with mental health clients 2.______________ ______________

(where appropriate) 3.______________ ______________

3. Document observations and interactions in case notes



Clinical Assessment

1. Mental state exam 1.______________ ______________

2. Risk assessment 2.______________ ______________

3. Psychiatric Nursing Admission 3. ______________ ______________

4. Home Visits 4._______________

Team Membership

1. Nursing Handover 1.______________ ______________

2. Team Meetings 2.______________ ______________

3. Case Meetings 3.______________ ______________

Critical Incidents

1. Management of emotional crisis 1.______________ ______________

2. Self reflection 2.______________ ______________

3. Stress Debrief 3.______________ ______________

Mental Health & Related Services Act

1. Voluntary status- decision making 1.______________ ______________

2. Involuntary status- decision making/ implications 2.______________ ______________

3. Community Management Order 3.______________ ______________

4. Mental Health Review Tribunal- 4.______________ ______________

function

5. MHRT- attend hearing as observer (with client consent) 5.______________ ______________

6. Community Visitor- function 6.______________ ______________

7. Designated Mental Health Professional- function 7.______________ ______________



Inpatient Units

1.Category Observations: frequency identified 1.______________ ______________

2.Special environments: 2

 High Dependency Unit ______________ ______________

 Secure Unit ______________ ______________

 Forensic Unit ______________ ______________

3. ECT: 3.

 Principles and process ______________ ______________

 Nursing responsibilities ______________ ______________

4. MHARS Act: 4.

 Seclusion protocol ______________ ______________

 Section 30 ______________ ______________









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Complete the table below: provide the details of 4 common psychotropic medications you have seen utilize in the mental

health sector.



Medication Name Indications for use Dosage Side effects Contraindications









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Student Name: __________________________ Student Number: _________________



Date:____________________



Student Assessment

1. Student was able to relate principles of therapeutic communication when collaborating with

health care providers and patients



Comment:









2. Student was able to recognise nursing interventions in the care of patients with mental health

needs.



Comment:







3. Student was able to identify societal, legal, ethical factors that influence Mental Health issues.



Comment:









4. Student was knowledgeable of the Mental Health Act.



Comment:







5. Student attended and participated in the work environment as part of the health team.



Comment:









Name and designation of Assessor/Preceptor:



__________________________________________________________________________



Students NUR 332 Mental Health Placement assessed as:







Student Comment:

______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________









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Charles Darwin University.









NUR332 Advanced Practice 1, NUR331 Advanced

Practice 2 & Linked Elective Clinical Skills List

Student Name______________________Student No__________________



The following Clinical Skills have been taught in the Clinical Teaching Block

for NUR331. The student has practiced these skills under supervision and is

now required to practice them during their Clinical Placement. Students are to

demonstrate competency of these skills under the Supervision of their

preceptor, students may be deemed competent on their initial

assessment if assessed as such by their preceptor.



CLINICAL NURSING PRACTISED DURING DEEMED COMPETENT

SKILL CLINICAL PLACEMENT DURING CLINICAL

(Preceptor to sign & PLACEMENT

date) (Preceptor to sign &

date when deemed

competent)

Medication Management



Able to perform a

medication round for

allocated patients

demonstrating safe

administration of

medications



Able to prime Intravenous

line and maintain Intra

Venous Infusion



S8 Drug Count at

commencement or

completion of shift.



Checking S8 drugs for

administration



Preparation,

administration and

maintenance of Narcotic

Infusion.:

Epidural

PCA- Patient Controlled

Analgesia

Syringe Infuser









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Charles Darwin University.





CLINICAL NURSING PRACTISED DURING DEEMED COMPETENT

SKILL CLINICAL PLACEMENT DURING CLINICAL

(Preceptor to sign & PLACEMENT

date) (Preceptor to sign &

date when deemed

competent)





Insertion of urinary

catheter- male or female



Care of and

documentation for

Continuous Bladder

Washout/ Bladder

Irrigation.

Care of and

documentation for

Underwater seal drainage/

Chest Tubes



Care of and

documentation Total

parenteral nutrition



Dressing and Care of

Central Venous Access

Devices



Emergency Management





Checking and

maintenance of the Resus

Trolley

ECG placement of leads

and recording

Acute / Cardiac Patient

monitoring



Knowledge of Code blue

management (medical

emergency) of health care

facility



Collection of specimens:



Venipuncture:

collection of blood

specimens



Correct pathway followed

for sending of specimens

to pathology







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Charles Darwin University.





CLINICAL NURSING PRACTISED DURING DEEMED COMPETENT

SKILL CLINICAL PLACEMENT DURING CLINICAL

(Preceptor to sign & PLACEMENT

date) (Preceptor to sign &

date when deemed

competent)

Patient Health

Assessment



Abdominal Assessment



Cardiac Assessment



Respiratory Assessment







Time management



Management of patient

load ( 4- 6 patients)



Preceptoring /mentoring









ADDITIONAL CLINICAL PRACTISED DURING DEEMED COMPETENT

SKILLS CLINICAL PLACEMENT DURING CLINICAL

(Preceptor to sign & PLACEMENT

date) (Preceptor to sign &

date when deemed

competent)









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Charles Darwin University.









Critical Reflective Practice for NUR331, NUR332 & NUR350



Assignment: Critical Reflective Paper 1000 words



Due: Week 10 of your 14 weeks of Clinical Practice



Students are required to complete a reflective paper that explores their own

professional development during placement. You will need to refer to the

ANMC National Competencies, the texts you have used in your course to

date and appropriate journal entries. Formal referencing, using the Harvard

system, will be expected.



This process requires you to reflect and analyse the personal experiences

that you have had during your Clinical Placement. The following guidelines

will assist you with this process:



It is suggested you make a brief journal entry daily describing the situation,

events, experiences, impressions, thoughts and feelings about this. Do not

use the name of persons or places in these entries.

The journal does not need to be handed in – only the reflective practice piece.



 Analyse these situations, events, experiences, impressions, thoughts

and feelings by using all or some of the following questions –

o What happened next?

o What was my role in the event?

o What feelings and senses surround the event for me?

o What did I learn & what do I still have to learn?

o How did I respond?

o How did I feel?

o Why did I feel like this?

o What was the context in which this occurred?

o What were the important elements of the event/situation?

o What resulted from it?

o What do I need to consider if this situation reoccurs?



 Towards the end of your Clinical Placement, read your journal entries

and the answers to the above questions and reflect on them. To assist

this process, you will find that referring to lecture notes, journal articles

and text books allows you to consider how your experiences, feelings

and your interpretation of them compares with what others have said

about similar events/situations /feelings/impressions.





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Charles Darwin University.







 Relate these experiences to the ANMC National Competencies- in

which Domain does the experience fall, is it a good or bad example of

clinical practice when related to the ANMC National Competencies.

 You may also like to consider the political and legal frameworks which

impinge on your role.

 Discuss the ways your experiences have enriched your understanding

and your personal and professional growth.

 Consider how your analysis of these experiences has assisted your

personal understanding of nursing , how theory and practice interact

and the relevance of the ANM Competencies to nursing practice.



You must not use the name of patient/client, staff, families or heath

facilities/services when completing this reflective paper. It is a breach of

ethical principles.



You may choose to write in the first person when completing this paper.









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Charles Darwin University.









NUR332 Oral Presentation: Case Study/In Service

During Clinical Placement, it is expected that students at a third year level are

able to bring together their theory and practice. The maintaining of current

knowledge and keeping up to date with health care trends is commonly

achieved by staff attending in-services. This may be presented by guest

speakers or allocated to individual staff members.



Students are to choose one patient that they are caring for and develop a

case study for a 30 minute presentation. They should focus on the individual

patient presentation and admitting condition. This may be presented as an In-

service for ward staff or be presented to other students who are also on

Clinical Placement in the same area e.g. in a DEU.

It will be assessed by the Preceptor/ Unit Manager/ Clinical Educator or CDU

Supervisor.



The presentation should include:

 Date & Reason for Admission – the presenting problem and

diagnosis (define the diagnosis)

 Current Medical History – history of the current admission, allergies

and medications etc

 Past Medical History – particularly noting relevance to present

situation

 Medical Management – including procedures and investigations, their

relevance to the condition, results and their significance

 Nursing Management – needs/problems identified, planned strategies

implemented with rationales, outcomes

 Treatment – non-pharmaceutical that is ordered (e.g. physiotherapy,

exercise, diet), pharmaceutical what drugs have been prescribed and

rationale for the choice

 Allied Health Workers – Who also assisted in the overall

management of the patient

 Discharge Planning – follow up appointments, services required and

rationale



It is expected that a holistic approach be demonstrated and that students

utilise the resources they have e.g. textbooks, research articles etc. It is also

expected that students will answer any questions that their audience raises

regarding the chosen patient.



Students can use any of the following formats to assist their presentation:

 Overheads

 Handouts

 Power-point Presentation

 Posters





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Charles Darwin University.





Assessment:

A PU (Pass Ungraded) or F (Fail) only will be given. To get a PU, 75% of the

criteria must be met exclusive of a Not Applicable for any section e.g. no

Allied Health involvement required.



ORAL PRESENTATION “CASESTUDY”/ IN- SERVICE

ASSESSMENT CRITERIA



Date of presentation:



Criteria Met/Not Met

Ability to integrate knowledge into practice

Current Medical History

Past Medical History

Medical Management

Nursing Management

Treatment

Allied Health

Discharge Planning

Answers questions knowledgably & appropriately



Student

Name:_____________________________________________



Student Number:___________________________________________



Clinical Venue of presentation:________________________________



Presentation Topic:__________________________________________



Mode of Delivery (power-point/ handouts

etc):_________________________________________________



Clinical Supervisor completing assessment:



_____________________________________________________

Contact details for assessor (phone number/

pager):_______________________________________________





Additional Comments

_____________________________________________________



_____________________________________________________



_____________________________________________________







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