In the present environment of health care, a student graduating from any entry must be ready to hit the rat racing world. The student must be able to manage the client’s skilfully in an effective manner to achieve effective outcome of the patients, as the ultimate goal of nursing is to provide a quality and comprehensive health care. So to achieve the goal, the nursing students who are the future care givers are to be assessed in such a way that, the care provided by them should be effective and reliable. Mostly the students are assessed against a benchmark of a competent professional. As a part of course, I, Miss Sunkari Bhavani, would like to formulate an assessment tool, to assess the clinical competencies of an individual (a student nurse in the internship).In this piece of work, I would like to assess the core clinical competencies of a nursing student who is doing her internship period, while performing a procedure that is Ryle’s tube insertion. This tool is formulated in such a way that it helps in the self assessment of student and also aids in the performance appraisal of the individual which helps her in personal and professional development. In this work, I would like to give the general meaning of clinical competence and its importance in nursing, state the main aim of the assessment, general objectives, specific objectives of the assessment, what are the strategies of assessment, design a table to assess the student as per the rating scale outlining the criteria against which she should be assessed and finally I will conclude my work.
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MEANING OF COMPETENCE:
Nurse training is a multifaceted blend of Knowledge, performance, skill, values and attitudes. Researches remain in difficulty to define the competency and its measurement. Indeed, nursing competency is seen as an indefinable assemble which cannot be observed directly. Competency is need not be a skill or a task, but it is the one which is often reflected by characteristics that are required to act effectively in the nursing team and these characteristics are termed as competency standards.
IMPORTANCE OF COMPETENCE:
Besides the assessment of theoretical assessment, practical assessment of clinical competence also plays a major role in the overall assessment of the student. In order to register as a nurse, a student nurse has to pass clinical assessment besides theoretical assessment. Clinical competence also plays a major role in post registration process but not uniform. Some qualifications like midwifery etc, include clinical competent as an effective outcome.
AIM:
The aim of the component of the revise reported in this paper is, to assess a student nurse in her clinical competencies and to apprise the learner, which aids in the personal and professional development.
GENERAL OBJECTIVES:
To assess the professional behaviour of the student nurse.
To assess the patient management of the nursing student.
SPECIFIC OBJECTIVES:
To assess the core clinical competency of a student nurse in providing safe and quality nursing care.
To determine the clinical competence of beginner in satisfying ethico-moral responsibility
To measure the clinical competency of learner in managing resources and environment.
To estimate the clinical competence of trainee nurse in satisfying legal responsibility.
To find out the clinical competence of apprentice nurse in personal and professional development.
To calculate the core competence of nursing student in quality improvement.
To evaluate the core competency of student in research
To apprise the knowledge of nursing student in records and reports management
To determine the communication skills of student nurse with patient, significant others and health team members.
To assess the clinical competence of student nurse in collaboration and teamwork.
To assess the maintenance of her conduct and appearance.
To measure the familiarity of student nurse in assessing the client and formulating the nursing diagnosis.
To calculate the knowledge of nursing student in goal setting and planning a care based on the priority of the need.
To assess the awareness of student in implementing the procedures or interventions as per the need.
To assess the students ability in evaluating the patents feedback.
ASSESSMENT SRTATEGY:
Assessing clinical competency of a student nurse is major in nursing education process. Though these assessments appear to be straightforward, the history of assessment of competence appears to be a complex process which has undergone many modifications. As a result of these changes, many assessment tools has been introduced which resulted in constant change of roles of supervisors or tutors and preceptors. In this assessment tool, two main strategies that is Professional behaviour and Patient management in performing Ryles tube insertion has been used to assess the nursing student for both professional and personal development. While evaluating the student on their professional behaviours, the occurrence of the appropriate behaviour is rated against never which means 0% use, rarely or sometimes are regarded as 50% use, most of the time, or always are rated as 100% use and we must aim the students to ALWAYS demonstrate professional behaviour in clinical setting. In the same way while we are evaluating the students on patients management skills, as well below (requires an immense deal of guidance), below (need least amount of direction), at average level (can perform by herself and attains effective out comes), above (handiness is extremely helpful), well above (attained masters in performing skills). In the rating scale, 1&2 stands for well below,3&4 stands for below, 5&6 stands for at that level, 7&8 stands for above, 9&10 stands for well above.
Clinical Internship Evaluation Tool
: ASSESSMENT TOOL:
STANDARDS AND BENCHMARKS
RATING
PROFESSIONAL BEHAVIORS
Never
Rarely
Sometimes
Most of the
time
Always
SAFETY
1.Follows healthy and safety practice(eg, worldwide/standard safety measures)
2.Takes appropriate measures to minimize the risk of injury to self
3.Follows appropriate measures to minimize risk of injury to patient
INITIATIVE
1.Recognizes and maximizes opportunity for learning
2.Implements constructive criticism
3.Utilizes available resources in problem solving
4.Is a positive contributor to the efficient running of the organization
PROFESSIONAL ETHICS
1.Follows all the rules and regulations regarding patient confidentiality
2.Demonstrates positive interaction with patients and peers
3.Expresess cultural competence :shows broad-mindedness and responsive to individual differentiations
4.Shows adherence to ethical and legal standards of practice
5. Upholds appropriate appearance, attire, conduct and demeanour
6.Exhibits awareness of patients rights
COMMUNICATION SKILLS
Communicates verbally in a précised way with appropriate use of terminology accordingly
1.With patient and significant others
2.With health team members
Communicates nonverbally in a précised way with appropriate use of terminology accordingly.
3.Follows documentation standards(concise, legible, accurate
4.With professionals(recording and reporting the care plan of the client)
5.With patients and his family members(discharge summary and follow up care in home)
STANDARDS AND BENCHMARKS
RATING
PATIENT MANAGEMENT
Well Below
Below
At that Level
Above
Well Above
EXAMINATION AND GOAL SETTING
1.Obtains history from the client
2.Assessing of the clients from head to toe
3.Documents the present chief complaints of the client
4.Formulates the nursing diagnosis as: imbalanced nutrition less than body requirements related to organic poisoning as evidenced by reports
5.Formulates goal so as to meet the nutritional requirements
6. Plans for the insertion of Ryle’s tube or nasogastric tube to meet the goal.
PROCEDURE
1. Explains the procedure, benefits, and risks to the client and significant others to gain the confidence of the client as well co operation.
2.Provides privacy to the client
3.performs hand washing technique and glove technique to prevent risk of infection
4. Selects and gathers equipment according to patient for the effective time management as well to minimise the risk of injury.
5. Examines the nostrils for septal deviation and for the patent nostril.
6.Anesthatize the naso-oropharyngeal mucosa with local anaesthesia
7. Estimates the length of insertion by taking the measurement from the tip of the nose, around the ear, and down to just below the xiphoid process.
8. Positions the client in an upright sitting position with neck partially flexed. And then lubricate the distal tip of the tube.
9. Gently inserts the Naso gastric tube along the floor of the nose and advances the tube parallel to the nasal floor until the distance of the estimated length has reached.
10. Stops advancing of the tube when client experiences respiratory distress, and experiences the resistance.
11. Verifies the proper position of the tube by auscultation while 60ml of air is pushed in to the stomach.
12. Positions the tube in place by securing it with tape.
13.Places the client in a comfort position
14.Reuses and replaces the equipment as per the policies of the organization
15. Evaluates and documents the client’s condition and the procedure.
RATING SCALE:
Put tick in the box which best describes the student’s clinical competence
1
2
3
4
5
6
7
8
9
10
Is the student performing at a level that is satisfactory for her level of education?
Yes ________________
No _________________
Signature of Student: ____________________ Date: _______________
Signature of Clinical Instructor: _____________ Date: ______________
CONCLUSION:
To sum up, every student nurse have to be learned and be assessed in clinical setting on specific skills or clinical competencies. To enable that the student achieves these skills, they are provided with a mentor who is also a nurse educator and ensures that the nursing student learns and achieves the skills required to provide a comprehensive and quality care to the patients. In this tool, student nurse in her clinical internship is assessed in the clinical competencies like the professional behaviour of the student as well the patient management while doing the procedure that is Ryle’s tube insertion. The Naso gastric route is a comparatively common method of providing short term enteral feeding to the clients where oral intake is contraindicated. Though it is a common procedure, skilled and appropriate insertion of the tube is necessary for the nurse to reduce the anxiety and discomfort of the client, as well to ensure that the client receives adequate nutrition. Clinical incompetence sometimes leads healthcare professionals to answer to their regulatory body.
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