ALL5 (Elective)
University of Manchester, School of Nursing, Midwifery and Social Work
and
The Greater Manchester Strategic Health Authority
PRACTICE PLACEMENT ASSESSMENT DOCUMENT
This section to be completed by the student
Unit Title:
ELECTIVE / CONSOLIDATION
Placement Dates: From
To
Student’s Name:
Programme (Course):
University ID No:
Intended Branch:
Intake/Group:
Mentor/Assessor’s Name:
Placement Area (Unit/Ward) Name:
Placement Area (Unit/Ward) Address:
Placement Area (Unit/Ward) Tel No:
Placement Code:
Academic Teacher:
Unit Coordinators:
Julie Apps
Jane Hughes
Steven Prymachuk
(Adult)
(Child)
(Mental Health)
0161 237 2288
0161 275 8708
0161 237 2575
Julie.Apps@manch
ester.ac.uk
j.m.hughes@manch
ester.ac.uk
Steven.Pryjmachuk@manc
hester.ac.uk
E-mail:
Personal Teacher:
E-mail:
Tel No:
This Practice Placement Assessment Document is summative and must be submitted on the advertised
Unit submission date and a receipt gained.
It may not be returned to you
Students are advised to make a copy of the completed document prior to submission for your
portfolio.
It is the responsibility of the student to keep this document safe and to ensure that the document is made
available during the placement so that the mentor/assessor can complete the appropriate parts of the form.
Mentors to complete this section
Evidence supplied is of a satisfactory level:
Yes
No
Unit Team to complete this section
Document complete:
Yes
No
If No – Learning Contract Issued:
Yes
No
Learning Contract submission date:
Unit Teacher Signature:
1
Reason
GUIDELINES FOR STUDENTS AND MENTORS
During this placement the following sections of this document MUST be completed:
 Placement orientation checklist (p.5) – within the first week of starting the placement.
 Preparation for the initial meeting with the mentor (p.6) – within two or three days of starting the
placement.
 Record of initial meeting with mentor and the student action plan (p.7) – the initial meeting to be
held during the first week of starting the placement.
 Interim/mid allocation review of progress (p.8) – must be timed to allow the student the
opportunity to improve if necessary by the end of the placement.
By the end of the placement the following sections of this document MUST be completed:
 Unit practice outcomes (pp.9-11) – the student must also, where appropriate, provide evidence
in the Portfolio to support achievement of the specified outcomes. Identification of
strengths/learning needs whilst achieving these outcomes will help students and mentors
plan for the next placement (see below).
 End of placement review of progress and the learning needs identified by the student and
mentor for the next placement (p.32).
 The Mentor’s statement on achievement during the placement (p.33) – whether the student has
met the criteria for EMERGING PRACTITIONER and whether the student’s attendance and
conduct have been satisfactory.
 Record of attendance and summary of learning at practice-based seminar days (p34).
 Record of attendance and summary of learning at “spoke” placements (p35).
At the end of the placement the following should be completed:
 Placement evaluation (ask your Unit leader for these forms).
Orientation
Students should have access to an introductory pack of information that will help orientate them to new and
unfamiliar surroundings. An orientation programme covering the first few days in the practice area would
normally address issues relating to:




personal safety;
procedures in emergency situations;
introduction to other members of the multi-disciplinary team;
confirmation of arrangements for clinical supervision (which should be weekly wherever possible).
Off Duty
Whilst on placement, students are expected to work a 37.5 hour week within the normal shift times of the
placement areas. Weekends can – and should be – included in the student’s shift pattern. The
supernumerary status of students implies that they should closely shadow the duty rota of their mentor or
another qualified nurse who is willing to actively support the student’s learning.
Should a bank holiday occur during a placement period, it is up to the discretion of the placement area
whether students work the bank holiday or whether the bank holiday is allocated as one of the student’s
days off. During bank holiday weeks, students are still expected to work a 37.5 hour week.
Students are only allowed “time off” from practice hours to attend the practice-based seminar days that fall
during the placement blocks in each of the branch Units. Students and mentors will be informed of the
dates of these seminar days in advance. Students are not allowed time off from practice hours to write
assignments, deliver examinable work to the School or to attend tutorials.
2
Night duty
In order to experience the 24-hour cycle of care, all students must undertake between 2 and 6 weeks
night-duty at some point during the course (normally during branch studies). Some branch units are more
suitable for night duty than others and students should, in the first instance, discuss the undertaking of
night duty with their mentors.
Your personal teacher will periodically check whether you have fulfilled the night duty demands; it is
important, therefore, that you keep records of any night duty undertaken on the form provided.
Sickness and Absence Arrangements
Students are responsible for reporting their own sickness and absence to Emma Sharp, Sickness/Absence
Secretary on 0161 237 2540. Students must also contact their placement area as soon as possible.
Sickness and Absence must be declared in this document (see p.13). See also the Student Handbook for
specific information.
If you are outside the UK and sickness is likely to render your placement unfeasible, you (or
someone acting on your behalf) must contact the School (your personal teacher) with the utmost
urgency.
ROLE OF THE MENTOR
Each student will be allocated a named mentor (by the placement area) for the total duration of the
placement. As some of the pre-registration allocations are lengthy it is possible that a mentor may be
absent due to sickness, etc. It is desirable therefore, that students also be allocated an appropriately
qualified associate mentor where possible.
Off duty rota should be planned so that mentors / associate mentors have an opportunity to work with
students regularly.
Duties of the mentor include:

ensuring that summative assessment of practice competence is appropriately completed and
recorded.

Undertaking ongoing observation and discussion with the student to assess his/her level of
competence.

Identifying the student’s strengths and shortfalls. Setting agreed objectives and proposing
subsequent action. Informing the academic staff when a student fails to achieve an appropriate
level of competence within the target date.

Liaising with other members of the team to gather observations and perceptions of the student’s
progress.

Facilitating ongoing practice teaching and experience for the student.

Acting as a role model for the student

Ensuring that the student has an adequate orientation

Carrying out an initial interview with the student (within 3 days of him/her starting the placement),
an intermediate interview and a final interview. Making appropriate records at each stage.
We believe that summative assessment of student’s practice can be enhanced by using a team approach
where the associate mentor has an opportunity to contribute to the final judgement of student
achievement.
3
Duties of the associate mentor should include:

Supporting the qualified mentor in the assessment process

Undertaking ongoing observation and discussion with the student to assess her/his level of
competence.

Provide feedback to the qualified mentor regarding observations and perceptions of the student’s
progress, strengths and shortfalls.

Acting as a role model for the student

Facilitating practice teaching and experience for the student

Assisting and supporting students in learning new skills and acquiring new attitudes
All students must be assessed and have their documentation signed by a qualified mentor.
Levels of Competence explained
Year 1 (Weeks 1-52) Safe Practitioner
The student will:

Perform safely the practice skills detailed in the Unit outcomes

Act with care, avoiding undue risk

Act honestly and lawfully and recognise their limitations

Be able to draw upon appropriate nursing knowledge, interpret it and apply it to the unit outcomes
being assessed.
Year 2 (Weeks 53-104) – Emerging Practitioner
The student will continue to meet the criteria for SAFE practitioner, and in addition will:

Actively seek to repeatedly practice the practice skills detailed in the Unit outcomes in the correct
manner.

Demonstrate a willingness to check their practice skills development by engaging with their mentor.

Be able to draw upon nursing knowledge to explain their actions.
Year 3 (Weeks 105-156) – Effective Practitioner
The student will continue to meet the criteria for SAFE and EMERGING practice and in addition will:

Effectively perform the practice skills detailed in the Unit outcomes.

Demonstrate your understanding and application of practice skills in the clinical area.
Examine critically his/her nursing knowledge in given situations and explore the alternatives
4
Placement Orientation Checklist
Mentor/Assessor must complete this section within 2 – 3 days of starting the placement.
Aspect
Yes
(Initial/Date)
1.
Fire regulations, emergency procedure.
2.
CPR: location of equipment, emergency telephone number,
student’s role in CPR.
3.
Issues surrounding confidentiality discussed.
4.
Health and Safety policies.
5.
Informed of Mentor/Assessor’s name.
6.
Uniform policy/standards of dress discussed
7.
Details of orientation programme/booklet.
8.
Placement philosophy discussed.
9.
Introduced to staff and environment.
10. Student to inform mentor/assessor of Academic/Personal
Teacher’s name and contact details.
11. Informed of Clinical Facilitator’s name and contact details.
12. Informed of Directorate Liaison Teacher’s name and
contact details (if available)
13. Sickness and absence procedures discussed.
14. Have you found your placement code?
Evidence of student attending Moving and Handling
training/update.
(If there is no evidence available, the student MUST NOT be
involved in Moving and Handling until documentary
evidence is received).
When all these
have been
achieved
Mentor/Assessor signature:
Date:
Student signature:
Date:
5
No
Preparation for the initial meeting with Mentor/Assessor
The student should:
Complete this section within 2- 3- days of starting the placement
Fill in this section before you have your initial interview with your mentor assessor
If this is not your first placement, you should also use the identified strengths/ learning
needs from your previous placement to help you plan.
Please use the space below to identify and write down your interests or the issues you
want to explore during this practice placement. You might want to wait a day or so before
you meet with your mentor/assessor so you have a chance to think about the issues and
your interests. You can always firm up your ideas at the initial meeting with your
mentor/assessor and, indeed, at later meetings.
The following questions may help you get started:






What do I want to see/do?
Can I build upon previously identified strengths or work on previously identified
weaknesses?
Where do my priorities lie (bearing in mind what stage you are in your course)?
What help do I need to pursue my interests/the issues I’ve identified?
What part should I play in following up my interests/the issues I’ve identified?
Who should take the lead?
My interests/learning needs/priorities for this placement are:
6
Development of initial Student Action Plan to identify learning needs and
opportunities
Mentor/Assessor should complete the student action plan:
During the first 2-3 days of the placement.
Action plan to be based on the Unit Learning Outcomes and Student’s identified learning
needs.
Student Action Plan
Mentor/Assessor’s signature: …………………………………… Date: ……………..
Student’s signature: ……………………………………………... Date: …..…………
7
Interim/Mid-Placement Review of Progress
Mentor/Assessor should:
Complete this section with the student:
Provide the student with an opportunity to discuss their progress to date and
areas for improvement.
Please note that this review point must be timed so that, if necessary, the student has
time to improve by the end of placement.
Mentor/Assessor’s signature: …………………………………… Date: ……………..
Student’s signature: ……………………………………………... Date: …..…………
8
CORE OUTCOMES TO BE ACHIEVED
Outcome
Related Domain
C01 Identify learning needs
related to this placement,
acknowledging the
importance of seeking
supervision to develop
safe nursing practice.
C02 Demonstrate fairness and
sensitivity when
responding to
patients/clients and
others; challenge
negative and
discriminatory attitudes
towards users of child
and family services.
C03 Demonstrate and apply
an understanding of
professional regulation,
displaying an awareness
of boundaries and
appropriate behaviour in
practice.
C04 Apply an understanding
of legal and ethical
frameworks in practice.
C05 Collaborate effectively
with members of the
multidisciplinary team,
demonstrating
understanding of the
roles and contributions of
others.
C06 Contribute positively to
the assessment,
planning, implementation
and evaluation of nursing
care, demonstrating
clarity and accuracy in
documentation,
C07 Demonstrate an
awareness of the role of
advocacy, user and carer
groups.
Personal/Professional
Development
Professional/Ethical
Practice
Professional/Ethical
Practice
Care Delivery
Professional/Ethical
Practice
Professional/Ethical
Practice
Care Management
Care Delivery
Care Delivery
9
Achieved
Assessor
Signature
Date
SPECIFIC OUTCOMES TO BE ACHIEVED
Outcome
Related
Domain
EL1
Identify how your
chosen specialist
area fits into the
overall delivery of
health services
Care
Management
EL2
Recognise and
analyse the extent to
which specialist
services meet the
needs of users and
make suggestions
about improvements
wherever possible
Analyse legislation,
policy and reports
relevant to your
chosen specialist
area
Care
Management
Compare and
contrast the specific
contribution of the
various health
professionals
involved in the
provision of services
in your specialist
area..
Care
Management
EL3
EL4
Achieved
Professional /
Ethical Practice
Care
Management
Professional /
Ethical Practice
10
Assessor
Signature
Date
SPECIFIC OUTCOMES TO BE ACHIEVED
Outcome
EL5
EL6
EL7
EL8
Related
Domain
Convey skill in
selecting
administering and
interpreting a range
of appropriate
interventions for
care provision
Demonstrate skill in
involving
patients/users and
where appropriate,
carers in the
assessment,
planning, delivery
and evaluation of
interventions.
Care Delivery
Identify and
analyse a range of
evidence based
interventions and
their application to
users of specialist
services;
demonstrate
knowledge of the
relationship
between evidencebased interventions
and your own
practices
With your clinical
colleagues and
mentor,
demonstrate an
ability to tactfully
discuss – and
where necessary –
challenge specific
interventions
employed in your
chosen specialist
area.
Care Delivery
Achieved
Care
Management
Care Delivery
Care
Management
Professional/
Ethical Practice
Care
Management
Professional/
Ethical Practice
11
Assessor
Signature
Date
Evidence of Achievements in Practice Na m e :
Unit of Learning:
Date:
Elective / Consolidation
C01
Core Unit Outcome:
Identify learning needs related to this placement, acknowledging the importance of seeking supervision to
develop safe nursing practice.
Domain:
Type of Activity:
Personal/Professional development
Professional/Ethical Practice
How have I achieved this Outcome?
Discussion with Mentor / Assessor
Mentor / Assessor signature:
Student Signature:
Date:
Date:
12
Evidence of Achievements in Practice Na m e :
Unit of Learning:
Date:
Elective / Consolidative
C02
Core Unit Outcome:
Demonstrate fairness and sensitivity when responding to patients/clients and others; challenge negative
and discriminatory attitudes towards users of child and family services.
Domain:
Type of Activity:
Personal/Ethical Practice
Care Delivery
How have I achieved this Outcome?
Discussion with Mentor / Assessor
Mentor / Assessor signature:
Student Signature:
Date:
Date:
13
Evidence of Achievements in Practice Na m e :
Unit of Learning:
Date:
Elective / Consolidative
C03
Core Unit Outcome:
Demonstrate and apply an understanding of professional regulation, displaying an awareness of boundaries
and appropriate behaviour in practice.
Domain:
Type of Activity:
Professional/Ethical Practice
How have I achieved this Outcome?
Discussion with Mentor / Assessor
Mentor / Assessor signature:
Student Signature:
Date:
Date:
14
Evidence of Achievements in Practice Na m e :
Unit of Learning:
Date:
Elective / Consolidative
C04
Core Unit Outcome:
Apply an understanding of legal and ethical frameworks in practice.
Domain:
Type of Activity:
Professional /Ethical Practice
How have I achieved this Outcome?
Discussion with Mentor / Assessor
Mentor / Assessor signature:
Student Signature:
Date:
Date:
15
Evidence of Achievements in Practice Na m e :
Unit of Learning:
Date:
Elective / Consolidative
C05
Core Unit Outcome:
Collaborate effectively with members of the multidisciplinary team, demonstrating understanding
of the roles and contributions of others.
Domain:
Type of Activity:
Care Management
How have I achieved this Outcome?
Discussion with Mentor / Assessor
Mentor / Assessor signature:
Student Signature:
Date:
Date :
16
Evidence of Achievements in Practice Na m e :
Unit of Learning:
Date:
Elective / Consolidative
C06
Core Unit Outcome:
Contribute positively to the assessment, planning, implementation and evaluation of
nursing care, demonstrating clarity and accuracy in documentation
Domain:
Type of Activity:
Care Delivery
How have I achieved this Outcome?
Discussion with Mentor / Assessor
Mentor / Assessor signature:
Student Signature:
Date:
Date:
17
Evidence of Achievements in Practice Na m e :
Unit of Learning:
Date:
Elective / Consolidative
C07
Core Unit Outcome:
Demonstrate an awareness of the role of advocacy, user and carer groups
Domain:
Care Delivery
Type of Activity:
How have I achieved this Outcome?
Discussion with Mentor / Assessor
Mentor / Assessor signature:
Student Signature:
Date:
Date:
18
Evidence of Achievements in Practice Na m e :
Unit of Learning:
Date:
Elective / Consolidative
EL1
Specific Unit Outcome:
Identify how your chosen specialist area fits into the overall delivery of health services
Domain:
Care Management
Type of Activity:
How have I achieved this Outcome?
Discussion with Mentor / Assessor
Mentor / Assessor signature:
Student Signature:
Date:
Date:
19
Evidence of Achievements in Practice Na m e :
Unit of Learning:
Date:
Elective / Consolidative
EL2
Specific Unit Outcome:
Recognise and analyse the extent to which specialist services meet the needs of users
and make suggestions about improvements wherever possible.
Domain:
Type of Activity:
Care Management
Professional / Ethical Practice
How have I achieved this Outcome?
Discussion with Mentor / Assessor
Mentor / Assessor signature:
Student Signature:
Date:
Date:
20
Evidence of Achievements in Practice Na m e :
Unit of Learning:
Date:
Elective / Consolidative
EL3
Specific Unit Outcome:
Analyse legislation, policy and reports relevant to your chosen specialist area
Domain:
Type of Activity:
Care Management
Professional / Ethical Practice
How have I achieved this Outcome?
Discussion with Mentor / Assessor
Mentor / Assessor signature:
Student Signature:
Date:
Date:
21
Evidence of Achievements in Practice Na m e :
Unit of Learning:
Date:
Elective / Consolidative
EL4
Specific Unit Outcome:
Compare and contrast the specific contribution of the various health professionals
involved in the provision of services in your specialist area
Domain:
Type of Activity:
Care Management
How have I achieved this Outcome?
Discussion with Mentor / Assessor
Mentor / Assessor signature:
Student Signature:
Date:
Date:
22
Evidence of Achievements in Practice Name:
Unit of Learning:
Date:
Elective / Consolidation
EL5
Unit Outcome: Convey skill in selecting, administating and interpreting a range of
appropriate interventions for care provision
Domain:
Care Delivery
Care Management
Type of Activity:
How have I achieved this Outcome?
Discussion with Mentor / Assessor
Mentor / Assessor signature:
Student Signature:
Date:
Date:
23
Evidence of Achievements in Practice Na m e :
Unit of Learning:
Date:
Elective / Consolidative
EL6
Specific Unit Outcome:
Demonstrate skill in involving patients / users and where appropriate, carers in the
assessment, planning, delivery and evaluation of interventions.
Domain:
Type of Activity:
Care Delivery
How have I achieved this Outcome?
Discussion with Mentor / Assessor
Mentor / Assessor signature:
Student Signature:
Date:
Date:
24
Evidence of Achievements in Practice Na m e :
Unit of Learning:
Date:
Elective / Consolidative
EL7
Specific Unit Outcome:
Identify and analyse a range of evidence based interventions and their application to
users of specialist services; demonstrate knowledge of the relationship between
evidence-based interventions and your own practices.
Domain:
Type of Activity:
Care Delivery
Care Management
Professional / Ethical Practice
How have I achieved this Outcome?
Discussion with Mentor / Assessor
Mentor / Assessor signature:
Student Signature:
Date:
Date:
25
Evidence of Achievements in Practice Na m e :
Unit of Learning:
Date:
Elective / Consolidative
EL8
Specific Unit Outcome:
With your clinical colleagues and mentor, demonstrate an ability to tactfully discuss and
where necessary – challenge specific interventions employed in your chosen specialist
area.
Domain:
Type of Activity:
Care Management
Professional/Ethical Practice
How have I achieved this Outcome?
Discussion with Mentor / Assessor
Mentor / Assessor signature:
Student Signature:
Date:
Date:
26
UNIT: Elective / Consolidative
Identified Strengths/Learning Needs
The Mentor/Assessor should:
Provide a summary of the student’s strengths and learning needs
Strengths:
Learning Needs:
The Student should:
Use the strengths/learning needs identified here to help you and your mentor/assessor
plan the learning needs for your next placement (see overleaf).
27
END OF PLACEMENT REVIEW OF PROGRESS
The mentor/assessor should:
Provide a general review of the student’s progress during placement.
Complete the Statement of Achievement overleaf.
Review learning needs for student’s next placement.
General Review of Progress on Placement
Learning needs identified by the student and mentor/assessor for the next placement
The student should:
Use these learning needs to help you prepare for the initial meeting with mentor/assessor
in your next placement (ensure you have a photocopy of this completed page to take with
you on your next placement)
Mentor/Assessor’s signature: …………………………………… Date: ……………..
Student’s signature: ……………………………………………... Date: …..…………
28
MENTOR / ASSESSOR’S STATEMENT OF ACHIEVEMENT
Elective / Consolidative – Year 2 (Year 3) : EFFECTIVE PRACTITIONER
The student has achieved the Unit practice outcomes: the student can perform any practice
skills specified in the Unit outcomes effectively and in the correct manner; the student
demonstrates a willingness to examine critically her/his practice skills in consultation with
his/her mentor and explore alternatives. The student acts honestly and lawfully and
recognises his/her limitations.
These Statements are complementary to the Unit Outcomes. If the student is successful in
all Unit outcomes then this Statement MUST reflect that.
A student can only be recorded as unsuccessful in this Statement if elements of the Unit
Outcomes have NOT been achieved and evidence is insufficient.
Mentor/Assessor’s
Signature
1. Effective
Practitioner
SUCCESSFUL (S)
The student has met the safe
practitioner criteria detailed
above.
UNSUCCESFUL
(U)
The student has NOT met the
safe practitioner criteria
detailed above*.
Date
2. Attendance
Sickness:
Total number of days …….. on number of occasions
…….
Absence:
Total number of days …….. on number of occasions
…….
3. Conduct
SUCCESSFUL (S)
The student’s personal
conduct and interpersonal
contact with patients/clients,
carers, nursing colleagues and
other allied disciplines has
been appropriate.
UNSUCCESFUL
(U)
The student’s personal
conduct and interpersonal
contact with patients/clients,
carers, nursing colleagues and
other allied disciplines has
NOT been appropriate*.
*Where this is the case, the mentor/assessor should, after consultation with the
student’s Academic teacher, include on a separate sheet of paper, a signed and
dated short report justifying this decision.
29
RECORD OF PRACTICE HOURS
Name of Student:………………………………………………………………………………………..
Cohort:……………………………………………………………………………………………………
Programme (DPSM / DPSN / BNurs):………………………………………………………………...
Please complete the hours worked. Otherwise, please select the correct key to indicate the reason for
absence
CS
S
PBS
SP
N
Sickness (Certified – Both the School and the Practice Placement have been notified)
Uncertified Sickness / Unauthorised Leave
Practice Based Seminar
Spoke Placement/Seminar
Night Duty
N.B Please note that DPSN students should work 37.5 hours per week. (This should not
include more than 2 weekends per month and no more than one long shift per week)
B/Nurse students work 35 hours per week.
DATE (w/c)
HOURS
SIGNED BY STUDENT
SIGNED BY MENTOR
DATE (w/c)
HOURS
SIGNED BY STUDENT
SIGNED BY MENTOR
DATE (w/c)
HOURS
SIGNED BY STUDENT
SIGNED BY MENTOR
DATE (w/c)
HOURS
SIGNED BY STUDENT
SIGNED BY MENTOR
30
DATE (w/c)
HOURS
SIGNED BY STUDENT
SIGNED BY MENTOR
DATE (w/c)
HOURS
SIGNED BY STUDENT
SIGNED BY MENTOR
DATE (w/c)
HOURS
SIGNED BY STUDENT
SIGNED BY MENTOR
DATE (w/c)
HOURS
SIGNED BY STUDENT
SIGNED BY MENTOR
DATE (w/c)
HOURS
SIGNED BY STUDENT
SIGNED BY MENTOR
I certify that the total hours worked within this placement is:
31
Hours