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Student Workbook Clinical Placement NRS3103 Aged Care Nursing - Clinical
Student Workbook Clinical Placement NRS3103 Aged Care Nursing - Clinical
Clinical Placement
NRS3103
Aged Care Nursing - Clinical
Semester/Year #2020_2021
1
FCHS COVID-19 GUIDELINES
All students shall complete the Covid-19 test and download ALHOSN Application on their
mobiles
All students shall complete the online training course on Covid-19 infection provided by the
educational institution.
Clinical Training
Students shall be exempted from being in direct contact with patients who are diagnosed as or
suspected of having Covid-19. However, students shall attend in hospitals providing treatment
for Covid-19 cases, on a rotational basis.
Undertaking
Before starting clinical training, students shall sign a waiver of any right to take legal action in the
event of being diagnosed as having Covid-19 due to such training.
Safety Precautions
Students shall comply with the latest safety measures and any additional measures such as
(wearing face masks, checking the temperature, maintaining physical distancing, and following
hand hygiene practices recommended in areas of patient and non-patient care).
Students who shall be associated in clinical training must undergo the necessary periodic checks
according to the health educational facility’s guidelines
Exemptions
If students have valid reasons that clinical training would harm their health, they will need to
communicate directly with the educational institution to give them a leave, so that conditions are
safe for them to return to such clinical training.
2
Basic science students, enrolled from the first to the third (1-3) academic year in faculties of
medicine, and from the first to the second (1- 2) academic year in nursing, shall be exempted
from clinical training this year, and training shall be provided through clinical skills and
simulation laboratories.
Monitoring
The clinical tutor shall monitor students' compliance with the procedures.
Physical Distancing
All employees, visitors, and students shall wear face masks at all times upon entry into the
establishments. Failure to comply with this procedure would deprive them of entry.
Hand sanitizers shall be installed.
Signs of physical distancing shall be placed on elevator floors and users shall comply with
standing on such signs. Priority shall be given to people of determination and pregnant women.
A distance of (1.5 meters) shall be maintained between individuals in (training classrooms and
training institutes and centers) and 2 meters shall be maintained in meetings, common areas,
workplaces, coffee makers, elevators, bathrooms and customer service areas.
As for classroom training tables, a distance of not less than 2 meters between trainees and
trainers shall be maintained.
Group activities shall be prohibited.
Two meters shall be left between dining tables.
All waiting/sitting areas inside the facility shall be removed.
Reference
3
Nursing Programme
Student Workbook
Credit Hours: 2
Pre-requisite NRS2207,NRS2208,NRS2209
NRS3106,NRS31073,NRS2204
, NRS2205,NRS2205,
NRS2206
Co-requisite -
Clinical instructor
Course Coordinator: Jeffrey Victorino de Jesus
Pager: -
E-mail: Jeffrey.jesus@fchs.ac.ae
4
Revision Table
5
Contents
Revision Table.......................................................................................................................................................... 3
INTRODUCTION...................................................................................................................................................... 4
CLINICAL OBJECTIVES.......................................................................................................................................... 5
................................................................................................................................................................................. 5
Clinical Competencies............................................................................................................................................ 11
CLINICAL ASSESSMENT TOOL (CAT)................................................................................................................. 41
KEY to FINAL RESULT.......................................................................................................................................... 42
Key…………….................................................................................................................................................... 42
Marginal.............................................................................................................................................................. 42
Assisted.............................................................................................................................................................. 42
GUIDELINES FOR THE CLINICAL ASSESSMENT TOOL (CAT).........................................................................50
Nursing Care Plan.................................................................................................................................................. 52
Nursing Care Plan Grading Criteria:....................................................................................................................... 69
Student Continuous Assessment - Professionalism............................................................................................... 72
Appendices............................................................................................................................................................. 76
1. Mini-Mental State Examination (MMSE)..................................................................................................... 76
2. The Mini CogTM........................................................................................................................................... 80
3. MORSE FALL SCALE................................................................................................................................ 82
4. Braden Scale.............................................................................................................................................. 83
6
INTRODUCTION
The students’ Clinical workbook is aimed at enabling the student to implement the skills and
knowledge gained, and keep track of their performance throughout all clinical courses during
the nursing program. By the end of each course, students be able to successfully fulfil all the
clinical objectives included in this clinical workbook.
This clinical workbook contains records and evidences about students’ clinical learning
experiences, skills and competencies. As a self-directed lifelong adult learner, students are
expected to demonstrate high level of responsibility towards utilising every learning opportunity
available at the clinical setting.
CLINICAL OBJECTIVES
The aim of this workbook is to guide you to achieve the Clinical Learning Outcomes visualized
in Table 1. Students should be aware of the daily clinical objectives for each course and
should be involved with the health care team to achieve their goals
Al Ain:
Mr. Imad Maalouf 03/ 7035416 Imad.Maalouf@fchs.ac.ae
Ajman
7
Jeffrey Victorino De Jesus 06/ 7017295 jeffrey.jesus@fchs.ac.ae0
Al Ain :
Dr. Mohamed Mekkawi
Mohamed.Mikkawi@fchs.ac.ae
Office: 03-7035417
Mobile: 050583654
Clinical
Coordinator
Ajman
Contact Details
Mr. Jeffrey Victorino De Jesus
jeffrey.jesus@fchs.ac.ae
Office: 06 7017295
Mobile# 050 603171
AL Gharbia
Mohannad Al Jabery
mohannad.aljabery@fchs.ac.ae
Office:
Mobile:
8
1. Identify normal ageing patterns.
Relevant
Learning
No Assessment Tasks Value Due Date
Outcome
s
Assessment
2 Nursing Care Plan 20% 1-6 TBA
Summary
Clinical Assessment 40% 1-6 Week 14
3
Tool - CAT
TBA by
Drug calculation 20% 7 individual
4
clinical
staff
Placement Each student must attend 3 days for a period of 10 weeks per the
dates semester.
Expected
Full patient load working under the guidance of a registered nurse.
patient load
RESTRICTIONS
If the health agency has specialist skills that an RN must achieve then
9
the student is not allowed to perform that task, such as IV cannulation, or
any other procedure specified by the hospital policy.
Medication Administration:
Medication Administration:
What is Professionalism
expected from 100% attendance on clinical placements is MANDATORY
the students
during the Maintains confidentiality of patient information
clinical
placement Adheres to uniform dress code
Interpersonal skills
Is honest and trustworthy
10
Displays effective verbal and nonverbal communication skills
Technical competency(General)
Demonstrates safe practice (e.g. putting up side rails)
Clinical Skills: Students are allowed to undertake the following skills under the
supervision of a Registered Nurse
Cardiovascular
11
Intravenous Therapy
Priming IV lines
Care of the IV cannula site
Calculation of IV infusion rates - drops per minute and volumetric pump
infusions
Fluid balance documentation
Monitoring of patients receiving blood products
Respiratory
Neurological Care
Seizure management
Neurological assessment and documentation
Stroke patient positioning, transfer and ambulation
Musculoskeletal
Pain assessment
Monitoring of a patient receiving Patient Controlled Analgesia (PCA)
Pre/post-operative care
Students may follow a patient through the peri-operative episode - admission,
pre-op, intraoperative, recovery and return to the ward - primarily as an
observer
Wound management
Wound assessment
Simple wound dressings
Staple/suture removal
Care and removal of drains
Pressure area care
12
Elimination:
Enteral Feeding
Diabetic Care:
Others
13
Clinical Competencies
Clinical Skills: Students are allowed to undertake the Date of Student Preceptor
following skills under the supervision of a performi Sign. Sign.
Registered Nurse ng the
skills.
Cardiovascular Vital signs and documentation 6910
Cardiac arrest roles (airway, chest
compression, documentation, drugs)
Observation of defibrillation in a safe
environment
12 lead ECG
Care of a patient suffering from chest
pain
Intravenous Priming IV lines
Therapy
Care of the IV cannula site
Calculation of IV infusion rates - drops
per minute and volumetric pump infusions
Fluid balance documentation
Monitoring of patients receiving blood
products
Respiratory Care of a patient with a chest drain in-situ
Oxygen therapy, including ambo-bag
resuscitation
Incentive spirometry
Tracheostomy care, including suctioning
and tracheostomy site dressing and care
Respiratory observation and
documentation, including SpO2
Peak flow meters 6910
Basic chest physiotherapy
Neurological Seizure management
Care
Neurological assessment and
documentation
Stroke patient positioning, transfer and
ambulation
Musculoskeletal Plaster/ cast care
Mobility of a client with an orthopedic
injury
Neurovascular assessment
Pain Pain assessment
management Monitoring of a patient receiving Patient
Controlled Analgesia (PCA)
Pre/post- Students may follow a patient through the pre
14
operative care -operative episode - admission, pre-op,
intraoperative, recovery and return to the ward
- primarily as an observer
15
Clinical Goal Setting Sheet
(To be completed by the student in Day 1)
What would you like to achieve during this clinical practicum placement, and
Why?
Medications
I seek knowledge and skill improvement
medical abbreviations
16
Student’s Signature: Aya Agha Date: 25/10
1. Daily Objectives
Objective 1: Today I will listen to Amana health care orientation videos and will take some
quizzes through teams by 12 pm.
Objective 2: Today I will have a tour in the hospital and learn more about the place and my
patient by 8.
Objective 3: Today I will take my age care nursing midterm. OFF of clinical.
I listened to all of the videos provided and made a good score on the quizzes.
Met our teacher
I handed my papers (consent, other information papers.)
I was introduced to amana’s staff and it’s sections
I was assigned to my great patient and preceptor also I had the chance to read about
her.
I helped my preceptor in bathing my patient.
17
I observed medication administration + tracheostomy care + ECG leads placement
I interpreted some of lab results like ABG.
Amana operates medical and rehabilitation hospitals in the United Arab Emirates.
It’s for people who’ve been through a life-changing event like an accident or
serious surgery and need specialized rehabilitation, to people who need long-term
care for medically complex issues.
12-lead Precordial lead placement
1. V1: 4th intercostal space (ICS), RIGHT margin of the sternum.
2. V2: 4th ICS along the LEFT margin of the sternum.
3. V4: 5th ICS, mid-clavicular line.
4. V3: midway between V2 and V4.
5. V5: 5th ICS, anterior axillary line (same level as V4)
6. V6: 5th ICS, mid-axillary line (same level as V4)
4. Reflective Comments
Strengths
I’m so excited for this training! I think Amana hospital is going to teach me a lot of
knowledge. It was my first time joining a bathing for a bedridden patient and her
tracheostomy care and it was new work for me but it went very well.
Weaknesses:
Instructor Feedback:
18
25,26,27 October week 2
Student’s Clinical Daily Objectives
(To be completed by student daily)
1. Daily Objectives (select the objectives from the course objectives sheet)
Objective 2: Demonstrate an awareness of personal attitudes and beliefs and how they affect
nursing care by 12 pm.
met not met If not met, why? Met
Objective 3:. Identify and implement effective communication and management strategies for
working with older adult clients.
met not met If not met, why? Met
19
Observed tracheostomy care and suctioning for both mouth & tracheostomy
Changed the patient position and gave her a bed bath.
Third day:
Vital signs interpreting three times within the day
Bathing
Tracheostomy care
1. Ventilator care: Maintain a patent airway. ...
2. Assess oxygen saturation, bilateral breath sounds for adequate air movement,
and respiratory rate per policy.
3. Check vital signs per policy, particularly blood pressure after a ventilator setting
is changed. ...
4. Reflective Comments
Strengths
Weaknesses:
My patient doesn’t have iv lines so I have not met one of my competency list area.
Instructor Feedback:
20
Student’s Clinical Daily Objectives
(To be completed by student daily)
1. Daily Objectives (select the objectives from the course objectives sheet)
Objective 1: Today I will learn about fluid balance documentation on my patient information by 2
21
3. New Knowledge Acquired
Some common signs and symptoms of aging include:
Increased susceptibility to infection.
Greater risk of heat stroke or hypothermia.
Slight decrease in height as the bones of our spines get thinner and lose some
height.
Bones break more easily.
Joint changes, ranging from minor stiffness to severe arthritis.
Stooped posture.
It’s better to take blood from the cephalic vein first
4. Reflective Comments
Strengths
I had 3 learning sessions this week about TPN, ventilator support and blood
collection.
Weaknesses:
My patient doesn’t have any sutures so I had the chance to check how to remove
sutures nor change it.
Instructor Feedback:
22
Student’s Clinical Daily Objectives
(To be completed by student daily)
1. Daily Objectives (select the objectives from the course objectives sheet)
Objective 2: Today I will do observe my patient’s respiratory status and will document the SPO2
met not met If not met, why? Met
Objective 3: Identify and implement effective communication and management strategies for
working with older adult clients.
23
3. New Knowledge Acquired
Strokes are caused by the following: Large artery thrombosis. Large artery
thromboses are caused by atherosclerotic plaques in the large blood vessels of
the brain. Small penetrating artery thrombosis. Small penetrating artery
thrombosis affects one or more vessels and is the most common type of ischemic
stroke. Cardiogenic emboli are associated with cardiac dysrhythmias, usually atrial
fibrillation.
Code blue is the term used by most medical institutions to indicate that a patient is
having cardiopulmonary arrest and needs immediate resuscitation. The resuscitation is
done by the “code team” of the hospital but initial resuscitation efforts should be done
by the nearest nurses on duty.
4. Reflective Comments
Strengths
Had the chance to join a code blue teaching session and finished my ncp
Weaknesses:
Medical abbreviations
Instructor Feedback:
Student helped for basic care of patient. Needs more practical experience to perform
independently
24
Clinical Half-Way Feedback Form
(To be completed by clinical facilitator for all students)
3. Professional Development
4. Comments
25
Bachelor of Science in Nursing
Clinical Formative Review
Student Name: Aya agha
____________________________________________________________________
Student Number: A00043712
__________________________________________________________________
Agency Name: Amana health care
____________________________________________________________________
Clinical Setting and Ward Area/Type: Ward C
_________________________________________________
Placement Dates: 19/10 – 10/11
__________________________________________________________________
Course Name/Code: Aged care Nursing clinical _ 1147
________________________________________________________________
Clinical Facilitator: hilary twiggs
_________________________________________________________________
Prior to the middle of the clinical placement period, and at any other time deemed necessary, if the
Clinical Facilitator considers a student to be performing at an unsatisfactory level in any criteria listed in
the Clinical Assessment Tool, a student should undergo a formative review of professional practice. A
plan (as detailed below) must be constructed to address the problem area(s) identified.
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________________________________________________________________________
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(Plan should specify objectives, evaluation criteria and time frames for achievement of goals)
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Action:
Discussed with Course Coordinator (circle one) YES NO
Discussed with Clinical Coordinator (circle one) YES NO
27
Facilitator’s Signature: _____________________________________ Date:
__________________
Student comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
This Formative Review has been discussed with me.
Student’s Signature: _______________________________________ Date:
__________________
Outcome(s):
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Page 2 – Formative Review
Course Convenor
Sign ___________
Date ___________
Bachelor of Science in Nursing
ANECDOTAL NOTES
28
STUDENT NAME Aya agha
STUDENT NUMBER A00043712
PLACEMENT DATES 19/11- 10/11
COURSE NAME & Aged care Nursing clinical _ 1147
Anecdotal Notes provide the clinical facilitator with the opportunity to expand on exceptional or
interesting aspects of a student’s performance. In addition, they are required in situations where less
than desired standards of professional practice have occurred.
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Final Mark
Course Convenor
Signature:
Bachelor of Science in Nursing
Name:
Date:
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CLINICAL ASSESSMENT TOOL (CAT)
STUDENT NAME: Aya agha
STUDENT NO: A00043712
CLINICAL SETTING & WARD: Amana healthcare, ward c
PLACEMENT DATES: 19/10 – 10/11
COURSE NAME AND CODE: Aged care nursing clinical
Attended Excuse Make up plan
Absent days
days provided Y/N
Midterm
Online
10 orientation
Skillful in parts of behavior, inefficiency and incoordination, Expends excess energy, Within a delayed time
Assisted 3 period
Efficient; coordinated: confident Some expenditure of excess energy Within a reasonable time period
Supervised 4
Proficient: coordinated; confident Occasional expenditure of excess energy
Independent 5 Within an expedient time period
Documentation attached: Yes Anecdotal notes attached: Yes
Number of documents attached: 4 papers which are competency list , attendance ,
instructors feed back.
31
Completion of the CAT: The 5-point Bondy rating scale provides a structure for scaffolding the degree
of competency of relevant skill/ behaviors within the 3 domains of the Health Authority for Abu Dhabi
(HAAD) Competency Standards for the Registered Nurse. However, within the competencies, the
words Registered Nurses have been replaced by the term student nurse to make it consistent
with the students’ status.
This tool has been developed by Griffith University Australia who adapted the work of Bondy, K. (1983)
Criterion-referenced definitions for rating scales in clinical evaluation . Journal of Nurse Education. 22
(9), 376-82.
The Bondy scale was graded with a grades ranging from 1 – 5, the total grades is 225 and it will
be converted to 70%.
For any scoring of 1 or 2 a formative review should be completed and discussed with the
student with a clear plan of improvement.
To be able to pass the clinical course the student has to achieve an accumulative course grades of
60%.
This domain relates to aspects of a student nurse’s performance and behavior which is required to provide appropriate and safe
care to patients/clients in a manner which is responsive to individual needs and is supported by evidence based nursing
knowledge and skills.
Total Mark for this Domain is 75
Competency 1: Promotes patient optimum health and De Ma Assi Super Inde Total out of
wellbeing p r. s . p. 30
32
early detection and screening for communicable diseases.
5. Reduces the risk of disease transmission through applying Yes
standard infection control principles.
6. Uses the nursing process in the promotion of patient Yes
holistic health and wellbeing.
Competency 2: Promotes an environment that De Ma Assi Super Inde Total out of
maximizes patient safety p r. s . p. 15
33
Student nurse self-assessment: Identify your current level of competence using the Bondy Scale and
give examples of demonstrated competence in the box below.
My current competency level is independent.
Examples
1. I helped to Reduce the risk of disease transmission through applying standard infection control principles like ppe and
hand hygiene every time I went in and out the patient’s room
2. I used the nursing process in the promotion of patient holistic health and wellbeing by making sure Quraan was on every day
as her family requested
3. Identifies environmental and behavioral factors which may compromise patient safety like the hight of bed and side rails.
This domain reflects competencies related to the professional code of conduct and the ability of student nurses to work
independently and in collaboration with others while maintaining professional standards.
34
10. Recognizes limitations in own professional knowledge and Yes
skills and takes appropriate action.
11. Assumes accountability for delegation of nursing care. Yes
Competency 5: Upholds and contributes to the maintenance Dep Ma Assi Super Inde Total out
of professional nursing standards
r. s . p. of 20
Student nurse self-assessment: Identify your current level of competence using the Bondy Scale and
give examples of demonstrated competence in the box below.
Independent
Examples
I was professional in every aspect. I helped my nurse preceptor with her other patient when she
needed help in positioning and bathing. I was silent about my patient’s private information and was
confidential. I respected my patient is dignity and health every time I had to take care of her. I made
sure to be advocating for my patient in everything.
35
Domain 3: PROFESSIONAL DEVELOPMENT
This domain acknowledges that each student nurse is accountable for establishing, maintaining and evaluating their own lifelong
learning needs including a commitment to the development of others and the profession.
Competency 8: Demonstrates a commitment to Dep Mar. Assi Super. Indep Total out
development of other’s performance outcomes s . of 10
36
(1) (2) (3) (4) (5)
1. Contributes to nursing and health care policy. Yes
(Consider modifying this to: contributes to the reflection
session by providing an evidence based knowledge
about their chosen case)
2. Represents the nursing profession on relevant Yes
committees and taskforces. Consider modifying this to:
represent the nursing program in health education or
awareness campaigns )
3. Identifies opportunities and contribute to nursing Yes
research (Consider modifying this to: Identifies a
research based information about the case study they
presented to their peers)
4. Collaborates and shares new nursing knowledge and Yes
research findings during the clinical day and the
reflection session
Total (out of 20)
Student nurse self-assessment: Identify your current level of competence using the Bondy Scale and
give examples of demonstrated competence in the box below.
Independent
Examples
I focused on my self improvement everyday. I asked my preceptor for a clarification when ever I
had knowledge deficit. I shared my experiences and new knowledge. I attended all the teaching
sessions that was provided by the hospital.
37
Assessor’s Signature: Print Name: Date:
38
GUIDELINES FOR THE CLINICAL ASSESSMENT TOOL (CAT)
The Clinical Assessment Tool (CAT) is designed to provide Clinical Facilitators with a systematic
process to assess clinical performance, in consultation with students. Over time this assists students to
develop knowledge, skills and attributes beneficial to their role as Registered Nurses.
Marking sheets containing the 3 domains of nursing competency as per HAAD standards for
Registered Nurses. Within these domains are the main sub-domains which provide more detail;
For each domain there are two Bondy Scale Chart. One should be completed by the student
and assessor for each domain;
Example and comments boxes for completion by the student and assessor should be completed
to evidence each scale;
A comments/reflection section for the student and assessor for each domain.
The front page must be completed for the student to have their clinical performance recorded. Please
take particular note of the number of days attended or missed because students must undertake 100%
of their clinical experience in order for FCHS to consider them eligible to pass courses and ultimately to
apply for registration. Please attach any additional document or evidence.
When you meet individual students, it is a highly recommended to read the CAT together so that you
each share a common understanding. This also gives you both an opportunity to clarify your
expectations of each other. Students have the responsibility to be aware of the particular learning
outcomes and scope of practice for the relevant academic courses for this current clinical experience,
to attend regularly and on time, and to be respectful, appropriate role models for nursing and the
university. You have the responsibility to facilitate quality clinical learning opportunities for students, to
guide their skill development, to assist them to practice competently and finally to assess their skills.
Goal-setting sheets give the student the opportunity to identify skills and experiences that they deem
important to them. With reflection and support from the Clinical Facilitator/Preceptor the student may
39
identify areas and skills which need further development. This provides the student with a perspective
of their strengths and gives them the opportunity to improve their performance where required.
Halfway Feedback
Undertake an informal half-way assessment of student performance based on the 3 domains in the
CAT. Identify and justify areas in which you feel the student needs further practice and development.
This enables the student have some idea of your perspective of their strengths and areas for
improvement and may give them a chance to improve their performance. Ideally you should provide
comments and examples for each domain.
Formative Review
If a student seems unlikely to successfully achieve one or more of the domains, you are advised to
raise and outline concerns with the student as soon as possible. If concerns are not resolved it will be
necessary to place the student on a Formative Review. Seek support and assistance from the appropriate
Course Co-ordinator and/or the Clinical Coordinator during this process. As near as possible to the
completion of the clinical experience, it is essential that you provide a final assessment of the student.
Every domain must be assessed and documented. If a student receives a failing mark for any domain,
following effective performance management (via the Formative Review), in consultation with the
Course Co-ordinator and/or the Clinical Co-ordinator, they will fail the clinical experience. Should you
wish for this not to be the case, it is essential that you complete supporting notes and file them. The
final mark will be recorded in the student’s file where it is added to other assessment items before an
overall course grade is awarded.
Anecdotal Notes
If a student is failing, an incident has occurred, or the student has performed exceptionally in specific
areas this should be recorded in the form of Anecdotal Notes.
A final assessment is discussed and given to the student close to the completion of the clinical
experience. Every domain must be assessed as ‘Assisted’ or higher to obtain a final grade of ‘Non-
Graded Pass’. If a student falls within the ‘Dependent or Marginal’ range for any domain, following
effective performance management via the Formative Review AND in consultation with the Course
Convenor, they will receive a ‘Fail’ grade for the clinical placement. If you are unsure of the appropriate
grade, please record ‘Result Withheld’ and discuss this with the Course Convenor. Students who are
absent from placement for any reason also require ‘Result Withheld’. Students must obtain a Medical
Certificate or a correctly completed FCHS Statutory Declaration. A copy of either document must be
attached to the CAT. The student’s final grade will be determined when the CAT is reviewed by the
Course Convenor. This is then combined with other assessment items before an overall course grade
is awarded.
40
Nursing Care Plan
Date:27-10-2020
None
Family History :
None
41
Subjective Data:
Not applicable, patient is assessable due to unconsciousness.
Objective Data:
Vital signs: BP:135/55 Heart rate : 39 RR:14 Temperature:36.3 SPO2:98%
Body measurements: weight 64kg height 143cm BMI is between 30-34.99 (Obese Class 1)
Physical assessment (focused head to toe)
General: Bed ridden. Semi conscious. On ventilator.
Integumentary assessment: Pale warm skin. Senile lentigines (brown/age spots). Dry wrinkled
skin. Thin grey short hair. Has skin tear in left inguinal area. Left knee abrasion. Stage 4 sacral
pressure ulcer. Capillary refill within 3 seconds. Decreased skin turgor Nails are thick rigid and
has splits. Skin peel under both breasts.
Hair, neck ,eye,
ears, nose, mouth
head and neck: Her hair is grey. Has tracheostomy on the middle of her neck size 6.
symmetric pupils. , pupils in center, rounded ,pupils are equal, pupils is react to the light. Her
ear lobes are sagging and elongated. Bilateral size, shape and no discoloration or lesions. Ear
wax is thick and dry. Her nose is long and bigger and the tip is dropped. Her mouth looks
normal without ulcers no dentures. Symmetrical head/face shape is square. No depression in
the skull or lesions.
Respiratory assessment patient is on a ventilator machine. Symmetric chest movement.
Minimal crackles relieved by suctioning. FIO2 :2L PEEP:6 sputum color : white and it’s
consistency is sticky.
Cardiovascular system: heart rate 45 bradycardia within normal limits. normal ECG findings,
present peripheral pulse. Capillary refill within 3 sec. Normal heart sounds (S1 and S2 sounds
are heard), no murmur. No edema. No chest pain no palpitations.
Musculoskeletal assessment: Bilateral contracture deformities of upper and lower limbs.
Resting tremor, general weakness, hypokinesia, stiffness of the body , jerking movements ,
limited range of motion
Gastrointestinal system Soft, no tenderness, smooth skin, symmetric umbilicus in midline,
gargling sound, no diarrhea , no heartburn , she is on the percutaneous endoscopic
gastrostomy on her left side for feeding and administering medication as well , no tenderness
around PEG stoma.
Urinary system No inguinal tenderness. Groin and inguinal region are bilateral, and within
normal limits. No dysuria, left inguinal lesion. No discharge, no hematuria. Menopausal.
Neurological assessment:
GCS: Eye Opening (E) spontaneous =4 Verbal Response (V) none =1 Motor Response
(M) localizing =5 / gcs tot = 10 moderate.
Pain : 3 using (BPS) tool.
42
LABORATORY TESTS:
Test Category Test Name Normal Range Patient Specific Result Interpretation
Lab Values
Renal function
panel, serum Glucose 65-99 156 mg/dL HI
BUN/Creat 11-26 51 HI
ratio
43
DIAGNOSTIC TESTS: My patient did not have any extra diagnostic tests.
44
MEDICATIONS:
45
Blistering, peeling, or
Esomeprazole loosening of the
[20mg-once a Parkinsonis skin.bloating. Monitor for S&S
day] By acting specifically on m of adverse CNS
darkened urine.
the proton effects (vertigo,
drowsiness. agitation,
pump, esomeprazole bloc depression)
ks the final step in acid mood or mental
changes.muscle through PEG
production, thus reducing
gastric acidity. This effect is spasms (tetany) or
dose-related up to a daily twitching.
dose of 20 to 40 mg and
leads to inhibition of gastric
acid secretion.
dry mouth. blurred
Trihexyphenid Older adults
vision.dizziness.
yl appear more
[0.5mg-2 blocks efferent impulses in Parkinson. nausea.nervousnes sensitive to
times] parasympathetically s. usual adult
innervated structures like constipation. doses. Monitor
smooth muscles vital signs.
drowsiness. Pulse is a
(spasmolytic activity), particularly
salivary glands, and eyes sensitive
(mydriasis). indicator of
response to
dizziness. drug.PEG
46
PEG
Dizziness.
Headache.
Levetiracetam modulation of synaptic Seizure Irritability.
[1000mg – 3 neurotransmitter release Observe for
times a day] through binding to the Loss of strength and signs of
synaptic vesicle protein energy.Mood and adverse
SV2A in the brain. behavior changes. effects.
Monitor fluid
balance
closely.
Do not
administer
the injection
undiluted via
the
intravenous
route.
Assess and
document
any signs of
Valproic acid drowsiness. seizure
[2 times – Valproic acid exhibits its Thick activity.PEG
dizziness.
250mg] pharmacologic effects in a secretions headache.
couple of ways, such as by
diarrhea.
acting on GABA
(γ aminobutyric acid) constipation.
levels in the CNS, blocking changes in appetite. NEB
voltage-gated weight changes.
ion channels, and also by back pain.
inhibiting histone
deacetylase.
47
48
1. Nursing Diagnosis *:
Ineffective airway clearance related to Presence of artificial airway: tracheostomy as evidenced by Abnormal breath sounds
(crackles) and difficulty in expectorating sputum
Goals and Expected Nursing Interventions* Rationale for Nursing Evaluations
Outcomes Interventions
Patient will maintains 1-Assess changes In vital 1-Tachycardia
effective airway and signs. and hypertension may be related Goal met. After 8 hrs Patient
experiences normal was able to maintain effective
2- As the patient can’t cough to an increased work of
or baseline breath airway and had normal breath
sounds after 8 hrs. out secretions.i will be breathing. As the hypoxia and/or sounds” low pitched vesicular”.
Instituting her by suctioning hypercapnia become severe, BP The patient was able to cough due
of the airway as needed. and HR drop. Fever may develop to nebulizer that’s given for 30
3-Promote nebulizer for 30 in response to retained minutes which loosened the
minutes and systemic fluid secretions. secretions.
hydration, as appropriate 2-Suctioning removes secretions
4-Note changes in SpO2, tidal if the patient is unable to
volume, and changes in effectively clear the airway.
arterial blood gas values, as Frequent suctioning should be
appropriate. based, not on a present routine,
5-position the patient in a such as every hour. Over
simi- fowler suctioning can cause hypoxia
and injury to bronchial and lung
tissue.
3-Adequate fluid intake enhances
liquefaction of pulmonary secre-
tions and facilitates
expectoration of mucus.
4-Evaluates the status of
oxygenation, ventilation, and
49
acid–base balance
5- In the semi-Fowler's position,
the diaphragm moves downward,
the work of breathing relatively
decreases, lung volume and
ventilation increases, and lung
dilatation is promoted; these
changes can improve oxygenation
and increase oxygen saturation
You must write the patient’s highest priority nursing diagnosis and follow it completely through the process.
* Nursing Interventions must include nursing assessment and a minimum of THREE nursing applications.
50
3. Nursing Diagnosis *:
Impaired skin integrity related to immobility as evidenced by sacral pressure ulcer stage 4.
Goals and Expected Nursing Interventions* Rationale for Nursing Evaluations
Outcomes Interventions
Elderly patient have elastic skin
Patient will Determine the patient age and p, and have thinning of the Goal met. Pressure on bony
experience healing of general condition of the skin. epidermis making it more prone prominence areas was
to skin impairment redistributed which helped in
pressure ulcers
preventing other pressure
and experiences ulcers. performing
pressure reduction. interventions helped in
Patient with pressure ulcer lose promoting patienstage
big amounts of protein in appropriate wound care.
Assess the client’s nutritional wound exudates and may
status, including weight, require 4000 kcal/day or more
weight loss, and serum to remain anabolic.
albumin levels, if indicated.
51
3. Nursing Diagnosis *:
Risk of fall related to presence of illness (Parkinson disease)
Goals and Nursing Interventions* Rationale for Nursing Evaluations
Expected Interventions
Outcomes
Rise side rails Raising the side rails reduces Gaol met patient is free from falls
the risk of patients falling out of
bed during transport.
Patient will be
free from falls Will help in informing all health
Put risk of fall signs
care providers that the patient
is risk of fall
52
53
Nursing Care Plan
Date: _____________________
Family History
_________________________________________________________________________
______________
_________________________________________________________________________
_________________________________________________________________________
_____________________________
54
Nursing Care Plan
Subjective Data:
…………………..
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……………..
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……………………………………………………………………………………………..…………
Objective Data:
…………..
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………..
……………………………………………………………………………………………………………
55
Nursing Care Plan
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…………..
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56
Nursing Care Plan
………………………………………………………………………………………………………
LABORATORY TESTS:
57
Nursing Care Plan
DIAGNOSTIC TESTS:
58
Nursing Care Plan
MEDICATIONS:
59
Nursing Care Plan
60
1. Nursing Diagnosis *:
………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………
……………………………………………………
You must write the patient’s highest priority nursing diagnosis and follow it completely through the process. * Nursing
Interventions must include nursing assessment and a minimum of THREE nursing applications.
61
2. Nursing Diagnosis *:
………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………
……………………………………………………
62
You must write the patient’s highest priority nursing diagnosis and follow it completely through the process. * Nursing
Interventions must include nursing assessment and a minimum of THREE nursing applications.
3. Nursing Diagnosis *:
………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………
……………………………………………………
63
You must write the patient’s highest priority nursing diagnosis and follow it completely through the process. * Nursing
Interventions must include nursing assessment and a minimum of THREE nursing applications
64
Nursing Care Plan Grading Criteria:
Total Mark: /5
2 /
100
65
Nursing Care Plan Rubric:
Category 4 3 2 1
Assessment Complete and Adequate Adequate Incomplete and
part Accurate interpretation interpretation inaccurate
interpretation of the of the
of the subjective and subjective and interpret
subjective and objective data objective data information of
objective data of the five to but incomplete the
of the 5 areas include in more than subjective and
to include psychosocial one area. No objective data.
psychosocial but incomplete psychosocial
in one area.
Formulate Formulate and Formulate and Formulate and Unable to
and prioritize the prioritize the prioritize the Formulate and
prioritize highest (3) highest (3) highest (3)
Nursing nursing nursing nursing prioritize the
Diagnoses. diagnoses diagnoses but diagnoses but highest (3)
accurately per one is two are nursing
Most NANDA inaccurate inaccurate per
appropriate diagnoses
pertain to NANDA pertain accurately
three (3) patient per NANDA to patient care
diagnoses pertain to per NANDA
patient care pertain to
patient care
67
Correct Constructed Constructed Constructed &
spelling, with no errors with few errors with several
structure, in grammar, in grammar, errors in Incomplete,
and mechanics, mechanics, grammar, difficult to
punctuation mechanics, understand,
And/or and/or spelling and/or spelling
spelling. numerous
errors in
grammar,
mechanics,
and/or spelling
that interfere
with
understanding.
Complies with FCHS and SEHA policies and regulations during clinical placements
69
Day 4: # # # #
Day 5: # # # #
Day 6: # # # #
Day 7: # # # #
Day 8: # # # #
Day 9: # # # #
Day 10: # # # #
Day 11:
Day 12:
Total
Student Comments:
__________________________________________________________________________
_____________________________________________________________________________
______________
_____________________________________________________________________________
______________
Student Name Print: ________________________________ Signature _________________
Date __________
2 = Comply 1 = Comply to some degree 0= Do not comply Total:
70
NRS 3103 - Aged Care Nursing
Attendance Sheet
1.
2.
3.
4. 6910
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
71
Appendices
Mini-Mental State Examination (MMSE)
ATTENTION AND CALCULATION: Ask the patient to spell the word “world”
backwards. Score 1 point per letter in correct order (e.g., DLROW=5; DLRW=4;
DLW=3; OW=2; LDRWO=1).
Alternately, ask the patient to subtract 7 from 100, then subtract a further 7 from that
result, and so on for 5 subtractions (93, 86, 79, 72, 65). Score 1 point per correct
subtraction.
RECALL: Ask the patient to recall the 3 objects learned in the “registration” section of
the test. Score 1 point for each object remembered.
LANGUAGE Naming: Show the patient a wristwatch and ask him/her what it is. Repeat
for a pencil. Score 1 point for each object named.
Repetition: Ask the patient to repeat the following sentence after you: “No ifs, ands or
buts”. Score 1
Point for correct performance.
3 stage command: Give the patient a piece of plain blank paper. Tell the patient to take
the paper in his/her right hand, fold it in half, and put it on the floor. Score 1 point for
each section of the command performed.
72
Reading: On the back of the MMSE page, print the sentence “Close your eyes” in
letters large enough for the patient to see clearly. Ask him/her to read it and do what
it says. Score 1 point only if the patient actually closes his/her eyes.
Writing: On the back of the MMSE page, ask the patient to write a sentence for you.
Do not dictate a sentence; it is to be written spontaneously by the patient. It must
contain a subject and verb and be sensible. Correct grammar and punctuation are not
necessary. Score 1 point only for a correct sentence.
Copying: On the back of the MMSE page, draw intersecting pentagons, each side
about 1 inch long. Ask the patient to copy the diagram exactly as it is. All 10 angles
must be present and 2 angles must intersect for the patient to score 1 point. Tremor
and rotation are ignored.
73
1. Mini Mental State Examination (MMSE)
Patient name:
Date: Visit 1: Visit 2: Visit 3: Visit 4:
Maximu Visit Visit Visit Visit
m 1 2 3 4
score
ORIENTATION
5 () () () () What (year) (season) (date) (day) (month) is it? (1 point for each correct answer.)
5 () () () () Where are we: (province) (country) (town or city) (hospital or clinic) (floor)? (1 point for each
correct answer.)
REGISTRATION
3# ()() ()() ()() ()() Listen to the following: “apple,” “table,” “penny.” Repeat all 3. (1 point for each correct
Trials: answer.) (Repeat the objects until the patient learns all 3. Make a maximum of 6 trials. Record
the number of trials.)
ATTENTION AND CALCULATION
5 () () () () Spell “world” backwards. (1 point for each letter in correct order.) Alternate: Subtract 7
from 100. Take the result and subtract 7 from that. Continue until I ask you to stop.
(Continue for 5 subtractions. 1 point for each correct subtraction.) RECALL
3 () () () () What were the 3 objects we repeated earlier? (1 point for each correct answer.) (Note: Recall
cannot be tested if all 3 objects were not remembered during registration.) LANGUAGE
2 () () () () What are these? (pencil) (Watch).
1 () () () () Repeat the following: “No ifs, ands, or buts.”
3 () () () () Take a piece of paper in your right hand, fold it in half and put it on the floor. (1 point for each
section of the command performed.) READ AND OBEY
1 () () () () Read the following (“Close your eyes.”) and do as it says.
1 () () () () Write a sentence.
1 () () () () Copy the following design on the back of this page: No construction problem
Total
score
(max. score
30)
Adapted from Folstein MF et al. “MiniMental State”: A practical method for grading the cognitive state of patients for the clinician. J
Psychiatr Res
1975;12:189198, and Cockrell JR, Folstein MF. MiniMental State Examination (MMSE). Psychopharm Bull 1988;24(4):689692. ©
2007 Pfizer Canada
Inc., Kirkland, Quebec H9J 2M5
74
Mini-Mental State Examination (MMSE) READING:
Reading:
COPYING:
75
2. The Mini CogTM
Administration:
1. Instruct the patient to listen carefully to and remember 3 unrelated words and then to
repeat the words. The same 3 words may be repeated to the patient up to 3 tries to
register all 3 words.
2. _Instruct the patient to draw the face of a clock, either on a blank sheet of paper or on
a sheet with the clock circle already drawn on the page. After the patient puts the
numbers on the clock face, ask him or her to draw the hands of the clock to read a
specific time. The time 11:10 has demonstrated increased sensitivity.
Interpretation of Results:
0-2: Positive screen for dementia
3-5: Negative screen for dementia
76
The Mini Cog
Patient name:
Date: Visit 1: Visit 2: Visit 3: Visit 4:
Total
77
3. MORSE FALL SCALE
78
4. Braden Scale
79
COVID-19 GUIDELINE
The current Covid-19 Pandemic Emergency has created restriction of movement in MOHAP
hospitals and clinics, for both patients, their families, and staff. MOHAP are offering strategies
for the universities to consider to ensure optimum safety for MOHAP patients, MOHAP staff and
any third party stakeholders who wish to enter MOHAP facilities. It is MOHAP’s priority to
ensure the safety of the community and restrictions have been put in place to ensure safety for
all is maintained. This has required that movement between clinical areas is minimized.
Guidelines
1. Clinical capacity for student clinical placement in MOHAP hospitals and clinics will be modified
for student’s safety based on the Covid-19 Pandemic Emergency status. MOHAP will continue to
provide regular updates on the clinical status of hospitals and clinics.
2. MOHAP will accommodate 3rd and 4th year student nurses, following an agreement form the
universities to place them in hospitals caring for both Covid-19 and non-Covid patients.
3. The clinical tutors from each university will be responsible for overseeing all students being
placed in clinical areas. Where clinically possible and if safe to do so, MOHAP nursing staff will
support the nursing students and clinical tutors during the placement.
4. Student nurses in the 1st and 2nd year should be trained in clinical skills and procedures in the
university’s skills laboratory (simulation labs) until further notice from MOHAP and for the duration
of the Pandemic Emergency continues.
5. Clinical Placements will be temporarily postponed for the nurses doing the BSN Bridging program
until further notice. These nurses are already assigned to clinical areas and MOHAP is restricting
movement of staff to different areas and MOHAP wants to reduce the number of times staff are
brought back to the clinical areas to minimize risk. Thus, it is suggested that
curricula developers start to review the length and clinical rotations of the Bridging Program in line
with the accreditation guidelines, to facilitate more flexibility to these programs.
6. Clinical Placements for Master’s Program students will be temporarily postponed until further
notice and regular updates will be provided by MOHAP.
7. Clinical tutors and nursing students must wear the MOHAP recommended PPE at all times in the
clinical areas.
8. Clinical tutors and nursing students must adhere to MOHAP infection prevention policies and
guidelines at all times.
9. In clinical areas such as PHC, all patients entering will be managed as suspected Covid-19 cases
and be managed using the recommended PPE at all times.
10. Covid-19 test will be carried out on clinical tutors and nurse students which must be negative
before the clinical tutor or nursing student is permitted to join the clinical area.
11. Nurse students will work between 4-6 hours with no break to avoid crowding in hospitals and
clinical areas. There are 2 shifts in MOHAP hospital and some clinics.
80
There will be an option for each student to work shorter hours, e.g. 4 hours, this will
enable 2 students to share an 8-hour shift, this will be up to the individual universities to
decide. Otherwise they can work an 8-hour shift with 1 break.
Each university can choose to rotate students every 2 -4 weeks throughout the semester to
ensure that all students in the 3 rd and 4th year have the opportunity to collect clinical hours.
Universities can offer students to work shifts over the weekend to increase capacity and
number of students on placement over seven days.
The above three suggestions are proposals to guide the universities to assist with
increasing the number of students that can be accommodated.
12. Nursing students’ rotation between departments should be well controlled and organized prior to
shifting (no movements from Covid-19 area to non-COVID area).
13. Gathering in groups is not permitted either in the clinical area reception areas or in the corridors
or cafeteria/break rooms and social distancing must be maintained at all times. It is the responsibility
of the clinical tutor to ensure all the nursing students do not gather in groups or crowds and ensure
social distancing in any area of the hospital or clinic. The clinical tutors are responsible to ensure any
contact with the students during the clinical placement is conducted virtually where possible to avoid
gathering groups of students in one place.
14. It is the responsibility of the university to provide training and education for both nursing
students and clinical tutors before they commence the clinical placement, on;
Covid-19
Caring for patients in isolation
PPE Doffing and Donning
Infection Prevention guidelines and practices
Overview of disaster and pandemic emergency preparedness and expectations of clinical
staff during clinical emergencies.
15. Once the students are in the clinical areas the MOHAP staff along with the clinical tutors will
check that practice is in line with MOHAP standards and policies
81