DSN (direct client care) Peer review
PEER REVIEW
DESIGNATED SENIOR NURSE
Direct Client Care
Name:
SHADED AREA TO BE COMPLETED BY THE NURSE RECEIVING FEEDBACK
Date review requested:
Date feedback due:
Designation:
Department & Service:
The purpose of the review:
PDRP level:
Annual Appraisal
PDRP
N/A
Reviewer Name:
Position:
 Designated Senior Nurse
 Expert
NAME AND POSITION OF NURSE COMPLETING PEER REVIEW
Designation:
Signature:
Department & Service:
Contact Number:
Assessing another nurse:
If you have been asked to complete an assessment for another nurse first of all clarify what the assessment is
for and whether it is appropriate for you to complete the assessment. It is not appropriate to complete
assessments for close friends and family members. We recommend that you do the following to prepare for
the assessment:
 Identify that you have the appropriate tool (e.g. peer review form and at the you write to the
appropriate PDRP level)
 Make sure you understand the competencies and indicators
 Prepare an assessment plan (consider time for document review, observation of practice, discussion
and giving feedback –what order and when-timing, resources and any special needs of the nurse being
assessed or the environment)
 Have a pre-assessment discussion with the nurse to clarify expectations
 Gather evidence – you will need enough evidence to be sure the competencies are met
 You can also discuss the assessment with the nurse’s manager
If you are uncertain as to the requirements the Nursing Council suggests seeking advice from others with
knowledge and experience e.g. PDRP coordinator, PDRP assessors, Nurse managers or educators.
The type of evidence you will need may include the following:
 Direct observation of practice
 An interview with him/her to ascertain nursing care in different scenarios
 Evidence provided by him/her including self-assessments, exemplars or examples of practice
 Reports from other nurses and other health professionals
Assessors should reflect on what is a ‘competent nurse’ and how he/she practices in the particular setting. Each
comment made by an assessor against a competency needs to provide a specific example as to how the nurse
meets each competency. Rephrasing of the competency or the indicators is not acceptable.
NORTHLAND DISTRICT HEALTH BOARD
TITLE: DSN (direct client care) Peer review
Page 1 of 6
Date of first Issue: 2013
Current Issue: May 2013
Revision Date: March 2016
Authored by: Nurse coordinator PDRP
Reviewed by: PDRP assessors / PDRP council
AUTHORISED BY: Director of Nursing and Midwifery
Signature of nurse completing form:
.
DSN (direct client care) Peer review
DOMAIN ONE: PROFESSIONAL RESPONSIBILITY
This domain contains competencies that relate to professional, legal and ethical responsibilities and cultural safety.
These include being able to demonstrate knowledge and judgement and being accountable for own actions and
decisions, while promoting an environment that maximises patients’ safety, independence, quality of life and
health.
Competency
1.1 Accepts responsibility for ensuring that his/her nursing practice and conduct meet the standards of the
professional ethical and relevant legislated requirements.
1.2 Demonstrates the ability to apply the principles of the Treaty of Waitangi/Te Tiriti o Waitangi to nursing practice
1.3 Demonstrates accountability for directing, monitoring and evaluating nursing care that is provided by
assistants, enrolled nurses and others.
nurse
1.4 Promotes an environment that enables client safety, independence, quality of life, and health.
1.5 Practices nursing in a manner that the client determines as being culturally safe
DOMAIN 2: MANAGEMENT OF NURSING CARE
This domain contains competencies related to client assessment and managing client care, which is responsive to
clients’ needs, and which is supported by nursing knowledge and evidence based research.
THIS IS FOR SENIOR NURSES WHO ARE ALSO IN CLINICAL PRACTICE
2.1 Provides planned nursing care to achieve identified outcome.
2.2 Undertakes a comprehensive and accurate nursing assessment of clients in a variety of settings.
NORTHLAND DISTRICT HEALTH BOARD
TITLE: DSN (direct client care) Peer review
Page 2 of 6
Date of first Issue: 2013
Current Issue: May 2013
Revision Date: March 2016
Authored by: Nurse coordinator PDRP
Reviewed by: PDRP assessors / PDRP council
AUTHORISED BY: Director of Nursing and Midwifery
Signature of nurse completing form:
.
DSN (direct client care) Peer review
2.3 Ensures documentation is accurate and maintains confidentiality
2.4 Ensures the client has adequate explanation of the effects, consequences and alternatives of proposed treatment
options
2.5 Acts appropriately to protect oneself and others when faced with unexpected client responses, confrontation,
personal threat or crisis situations.
2.6 Evaluates client’s progress toward expected outcomes in partnership with clients.
2.7 Provides health education appropriate to the needs of the client within a nursing framework.
2.8 Reflects upon, and evaluates with peers and experienced nurses the effectiveness of nursing care.
2.9 Maintains professional development
DOMAIN THREE: INTERPERSONAL RELATIONSHIPS
This domain contains competencies related to interpersonal and therapeutic communication with clients, other
nursing staff and inter-professional communication and documentation.
3.1 Establishes, maintains and concludes effective interpersonal relationships with others, including utilizing effective
interviewing and counselling skills and establishing rapport and trust.
3.2 Practices nursing in a negotiated partnership with client where and when possible
NORTHLAND DISTRICT HEALTH BOARD
TITLE: DSN (direct client care) Peer review
Page 3 of 6
Date of first Issue: 2013
Current Issue: May 2013
Revision Date: March 2016
Authored by: Nurse coordinator PDRP
Reviewed by: PDRP assessors / PDRP council
AUTHORISED BY: Director of Nursing and Midwifery
Signature of nurse completing form:
.
DSN (direct client care) Peer review
3.3 Communicates effectively with clients and members of health team
DOMAIN FOUR: INTERPROFESSIONAL HEALTH CARE & QUALITY IMPROVEMENT
This domain contains competencies to demonstrate that, as a member of the health care team, the nurse evaluates the
effectiveness of care and promotes a nursing perspective within the inter-professional activities of the team.
4.1 Collaborates and participates with colleagues and members of the health care team to facilitate and coordinate
care.
4.2 Recognises and values the roles and skills of all member of the health care team in the delivery of care.
4.3 Participates in quality improvement activities to monitor and improves standards of nursing.
NORTHLAND DISTRICT HEALTH BOARD
TITLE: DSN (direct client care) Peer review
Page 4 of 6
Date of first Issue: 2013
Current Issue: May 2013
Revision Date: March 2016
Authored by: Nurse coordinator PDRP
Reviewed by: PDRP assessors / PDRP council
AUTHORISED BY: Director of Nursing and Midwifery
Signature of nurse completing form:
.
DSN (direct client care) Peer review
NDHB Values: The nurse consistently displays the values and behaviours of NDHB
(please read through descriptors’ attached to reflect on the behaviours and values of the nurse being reviewed)
People first – Taangata i te tuatahi
Respect – Whakaute (tuku mana)
Caring - Manaaki
Communication – Whakawhitiwhiti korero
Excellence – Taumata teitei (hiranga)
Comments:
CHALLENGES:
AREAS OF STRENGTH:
Signature:
Name:
Date:
NORTHLAND DISTRICT HEALTH BOARD
TITLE: DSN (direct client care) Peer review
Page 5 of 6
Date of first Issue: 2013
Current Issue: May 2013
Revision Date: March 2016
Authored by: Nurse coordinator PDRP
Reviewed by: PDRP assessors / PDRP council
AUTHORISED BY: Director of Nursing and Midwifery
Signature of nurse completing form:
.
DSN (direct client care) Peer review
VALUES AND BEHAVIOURS
Our VALUES
Statements
and
Supporting
People First
Taangata i te tuatahi
OUR BEHAVIOURS
He whakapapa, he mokopuna, he tamariki, he maatua, he tupuna
He aha te mea nui. He tangata, he tangata, he tangata.
We are inclusive
People are central to all that we
do
Respect
Whakaute (tuku mana)
We acknowledge individuality, teamwork and partnership
We bring humour in to our work
Kia ngohengohe, whakaaro nui ki etahi atu
We show courtesy, care and respect for people’s needs, values and beliefs
We treat others as we would like
to be treated
We enquire
We take personal responsibility for our actions
We honour commitments
Caring
Manaaki
We nurture those around us, and
treat all with dignity and
compassion
Ko te manaaki – he whangai – he kakahu he ropiropi. Akona e te whanau whaanui
We understand the impact of our actions on others
We are sensitive and empathetic
We are available and accessible
We are kind to each other
We display integrity
Communication
Whakawhitiwhiti korero
We communicate safely, openly
and with respect to promote
clear understanding
Tika, pono, aroha
We listen
We use language the recipient understands
We openly share information and knowledge
We are timely in our responses
We smile
Excellence
Taumata teitei (hiranga)
Our attitude of excellence
inspires success, competence,
confidence and innovation
Kia mataara te wairua – kia ngakau whakaiti
We display leadership, efficiency and commitment in all our activities
We are open to new ideas and doing it differently
We are accountable
We value personal and professional development
We make decisions based on fact and best evidence
NORTHLAND DISTRICT HEALTH BOARD
TITLE: DSN (direct client care) Peer review
Page 6 of 6
Date of first Issue: 2013
Current Issue: May 2013
Revision Date: March 2016
Authored by: Nurse coordinator PDRP
Reviewed by: PDRP assessors / PDRP council
AUTHORISED BY: Director of Nursing and Midwifery
Signature of nurse completing form:
.