CLINICAL
PORTFOLIO
WORK BASED LEARNING
RENAL COHORT
NQCG 3032
Name:
Commencement Date:
Student Number:
Submission Date:
Module Lead:
Level of Study and Credit(s):
40 Credits/Level 3
Cohort Facilitator:
INDEX
Page
Introduction
3
Guidance on completion of your portfolio
3
Learning outcomes
6
Insert WBL learning contract
9
Clinical competencies guidance
11
Clinical competencies grid/overview
12
Reflection for clinical competencies
13
Insert case study
17
Insert proposal for change/education resource
18
Insert action plan
19
Insert appendices
20
Learning activities
22
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Introduction – Work Based Learning Renal Cohort
Work based learning (WBL) is about learning in, and through practice. You are
undertaking WBL as a cohort (or group) and are all practicing at similar levels
i.e. Band 5 and more than one years experience in renal nursing. Because of
this, our senior nursing team are keen that we develop you to become a “fully
rounded renal nurse. To do this, we have had to be somewhat prescriptive
with what we would like you to achieve in the way of clinical skills and
knowledge.
The result of this is that you have to demonstrate achievement of some
specific learning outcomes and clinical competencies. You will all submit a
portfolio for the assessment of this module which contains two specific pieces
of work (see below). You will also attend some taught sessions/study days
and other identified learning activity days – which will include clinical workstations and action learning groups.
Guidance for Completion of Portfolio
This clinical portfolio is designed to enable you to present the evidence of what
you have achieved through learning. This will be the achievement of the
learning outcomes and clinical/practice competencies for the work-based
learning (WBL) module, focussing on renal care and nursing.
The evidence for you as a cohort of learners is demonstrated through:
a) A written case study
b) A proposal for either the development of a change in clinical
practice or an educational resource
c) Reflection upon your achievement of 2 clinical competencies
To complete your portfolio, you have to produce work that reflects 6,000
words. Your reflection on the clinical competencies accounts for 1,000 words.
The remaining two pieces of evidence should reflect 5,000 words.
Please use your Wessex Renal and Transplant Service (WRTS)
Development Programme to guide you when you are working in practice,
and record the competencies achieved. Your mentor/assessor will also need to
counter-sign the reflective slip in this portfolio too (before you complete your
reflection if you prefer). This means it will not be necessary to submit both
your portfolio and WRTS Development Programme.
Make good use of appendices and keep descriptive information to a minimum;
this will allow you the maximum capacity for critical discussion and analysis.
If you wish to submit pieces of evidence like visual posters, educational
booklets or audio/visual tapes etc. please discuss with the WBL Unit Leader or
Renal Cohort Facilitator at the time of agreeing your learning contract.
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Format of your portfolio
When compiling and developing your portfolio, it will need to include:

An introductory section in which you outline:
o Your experience and skills you already have
o The learning needs you have identified for your development and
your learning contract
o A summary of the material you are presenting in your portfolio

The evidence demonstrating the achievement of the outcomes
and learning contract. Remember to outline which learning outcomes
are being achieved within each piece of work/evidence.

An action plan in which you outline future learning or action

Avoid including certificates and numerous documents/papers/policies
etc. unless these are central to a specific outcome or piece of work. If
you do include such things, it is important that in your work you provide
a clear critique or analysis of the document.
Learning Activities
At the back of this portfolio (p22) you will find some learning activities and
work-sheets. These are small activities that you can undertake and reflect
upon when working in clinical practice. The aim of these activities is to help
you to focus your learning in practice and begin gathering the evidence and
ideas for your portfolio.
Confidentiality
You are reminded that names of all clients/staff/institutions should not be
identified within the assignment. Use pseudonyms where necessary. If you
wish to include any documents that name a person or institution you must
provide evidence of permission (see Student Handbook) or delete the name
and any logo so that it is not recognisable. Items that are “in the public
domain” are exempt from this, but if you have any queries, please review the
information in the Student Handbook or discuss it with the cohort facilitator.
Academic Level 3
Remember, with all the learning outcomes, you must achieve an academic
standard of level 3. This involves some critical analysis and discussion of the
“issues” rather than description of events or processes. You must always
provide supporting evidence and references.
For further guidance on writing and producing work at level 3, see the level
descriptors in the student handbook. You should have received a copy of the
student handbook from the University when you registered and received the
information pack. If you do not have one, please contact the School of Health
Sciences directly who will send you a copy.
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LEARNING
OUTCOMES
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LEARNING OUTCOMES FOR WBL MODULE – RENAL COHORT
Students undertaking the WBL Renal Cohort Module of study must identify
their learning outcomes from those included in this document. All outcomes
must be achieved.
These specific outcomes will direct you in developing your case study and
proposal. You also have the capacity to add in a further outcome to your
proposal. This might reflect or relate to the topic you have identified
underpinning your proposal.
Abbreviations:
CKD = Chronic Kidney Disease
AKI = Acute kidney injury
ERF = Established Renal Failure
KSF = Knowledge and Skills Framework
Case Study Outcomes
Comments
1a. Compare and critically analyse the
treatment options for a specific patient,
incorporating aspects of the underlying cause
of CKD/AKI. KSF: HWB 2, 6, 7
1b. Examine and explore the psychological,
social and cultural influences over adaptation
to change for a patient (and their family) with
CKD/ERF or AKI. KSF: HWB 2, 4, C6
1c. Critically discuss the processes and
influence of education for patients requiring
renal replacement therapy. KSF: HWB 2, 4
1d. Appraise multi-professional
communication processes and the application
of effective communication to enhance care
for an individual receiving renal replacement
therapy. KSF: C1
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Proposal Outcomes
Comments
2a. Appraise a recognised clinical
standard/guideline and identify the
implications for care delivery. KSF: C4, C5
2b. Demonstrate an appreciation of wider
management or educational issues and the
need to prioritise and maximise care and
resources. KSF: C4
2c. Propose and give a rationale for either a
change in clinical practice or the development
of an educational resource. KSF: C1, C2, C4,
C5
2d. Insert individualised outcome – this
may relate to the topic you which to address
in your proposal.
Clinical Competency Outcomes
Comments
3a. Demonstrate evidence-based
knowledge and expertise in caring for
patients’ requiring renal replacement
therapies. KSF: HWB 1, 2
3b. Recognise and respond to
complications associated with renal
replacement therapies demonstrating a
clear understanding of related and altered
physiology. KSF: HWB 1, 2
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Students must complete the following clinical competencies of the
Wessex Renal and Transplant Service (WRTS) Development Programme (see
also pages 11 and 12) to demonstrate achievement of outcomes 3a and 3b:



Units 1, 2, 4 - levels 1 and 2
Units 3 and 5 - level 1
Complete a minimum of 2 sub-units to level 3 (these to be
negotiated with manager and module lead)
Working and learning in practice
You will have been provided with a practice placement plan which outlines
your rotation through the key areas of the unit. It is important to point out
at this stage, that you are not working in a supernumerary capacity. You
are also responsible for the reporting of sickness and absence as per PHT
policy.
Your learning contract
Once you have finalised and agreed your outcomes and the work you will
produce, you need to transfer the information and write this up as a
learning contract. An electronic copy of the WBL learning contract is
available on Blackboard. You can also refer to the information in the WBL
module handbook which you will receive from the University.
Presentation of your proposal for change/educational resource
Once you have handed in your portfolio, as a group, you will present your
proposals for change/educational resource to an invited group of staff from
the WRTS. This will be informal, but is an important recognition of the
value of the work you have produced. You will therefore need to keep an
extra copy of your proposal for this purpose. If you need to discuss this
further, please do not hesitate to contact your cohort facilitator.
Comments
Please note here any comments or discussions you have with your manager
regarding the learning outcomes.
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WBL
LEARNING
CONTRACT
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CLINICAL
COMPETENCIES
(Outcomes 3a, 3b)
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CLINICAL COMPETENCIES
To achieve outcomes 3a and 3b, you must demonstrate you have completed
specific clinical competencies from the Wessex Renal and Transplant Service
Development Programme. Some of these, you will have achieved prior to
commencing the module (please note which these are on the grid - p12).
In practice you will be expected to demonstrate to your assessor/mentor
that you have achieved the required level of the competency. When you
have achieved it, your mentor will sign you off. Before you begin each
placement, please ensure you review the competencies you aim to achieve
and plan the focus of your work and patient care accordingly.
It is important that you show evidence for reflection upon learning, as
well as having the clinical competencies signed off in practice. The next
pages provide a reflective sheet for 2 of the competencies. You can
choose which 2 competencies you reflect upon. These two reflections
should total 1,000 words (e.g. 500 words each). An electronic copy of the
reflection sheet is available on Blackboard.
Underpinning evidence is also important and you may note some of the
references/evidence you have identified and used at the bottom of your
reflective piece. . We would also recommend that you complete a reflective
sheet for any other competencies you achieve and keep these in your
development folder (a blank copy is available on Blackboard).
On the next page you will find a table outlining the competencies you have
to achieve and the required minimum level. You will also need to identify
two further sub-units of the development programme (negotiated with your
manager and WBL facilitator) to achieve at level 3. These are likely to be
focussed on the particular clinical area where you work.
So… in a nutshell





When you begin each placement, review the competencies that you
wish/need to achieve there.
Have an initial meeting with your mentor/assessor and plan how you
are going to achieve them – use the action plan in the Development
Programme (and on the placement plan) as necessary.
Focus your work and identified patient case-load to help you achieve
these competencies – try and do some each day.
Your assessor/mentor will sign them off in practice when you have
achieved them. They will also need to “sign off” on the table overpage.
Complete a reflection sheet for your chosen 2 competences (total
1000 words). Submit these reflections as part of your portfolio and
provide supporting references/evidence.
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Clinical Competencies Overview – WRTS Development Programme
Sub-Units
to
achieve
Minimum
level
to
achieve
1a
1&2
Care for the individual with chronic kidney disease (CKD)
1b
1&2
Care for the individual undergoing investigation of renal function
2a
1&2
Care for the individual undergoing haemodialysis
2b
1&2
Care for the individual with arterio-venous fistula
2c
1&2
Care for the individual with percutaneous access
2d
1&2
Care for the individual undergoing haemodiafiltration
3a
1
Care for the acutely-ill patient with renal impairment
3b
1
Care for the acutely-ill patient requiring haemodialysis
3c
1
Care for the acutely-ill patient requiring haemofiltration
3d
1
Care for the acutely-ill patient requiring plasma exchange
4a
1&2
Preparation for individuals commencing peritoneal dialysis (PD)
4b
1&2
Management of the individual on CAPD
4c
1&2
Management of the individual on APD
4d
1&2
Supporting individuals in the self management of PD
5a
1
Care for the individual with CKD undergoing surgery
5b
1
Care for the individual undergoing transplant work-up/preparation
5c
1
Care for the individual undergoing renal transplantation
5d
1
Long term management/care for the individual with a renal transplant
5e
1
Care for the individual undergoing donor nephrectomy
Choice 1:
3
Choice 2:
3
Competency Statement
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Signature of mentor/assessor when
complete unit achieved
(also insert date completed)
To be achieved prior to commencing module
12
Reflection for Clinical Competencies
Clinical Competency (Level
):
1. What have you learned about the patients’ perspective whilst achieving this
competency?
2. Can you identify changes in your practice or understanding as a result of this
learning (state what has changed)?
3. What further learning needs have you identified?
Supporting Evidence:
Date Achieved:
Signed:
Signed (mentor/assessor):
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Reflection for Clinical Competencies
Clinical Competency (Level
):
1. What have you learned about the patients’ perspective whilst achieving this
competency?
2. Can you identify changes in your practice or understanding as a result of this
learning (state what has changed)?
3. What further learning needs have you identified?
Supporting Evidence:
Date Achieved:
Signed:
Signed (mentor/assessor):
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CASE STUDY
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PROPOSAL FOR
CHANGE/
EDUCATION
RESOURCE
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ACTION
PLAN
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APPENDICES
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LEARNING
ACTIVITIES
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LEARNING ACTIVITIES AND WORKSHEETS
What are Learning Activities?
Learning activities are activities that you can participate in to help guide you
in achieving some of the learning outcomes and putting your portfolio
together. You will find these learning activities on the Blackboard website,
as well as here in this portfolio.
Follow the instructions and undertake the activities as directed. You can
reflect upon them and they can help you gather information and ideas for
the basis of your portfolio and also help demonstrate your achievement of
some of the clinical competencies.
By undertaking any of these chosen learning activities as you
progress, it will help you to build your portfolio steadily rather than
trying to complete the whole thing in the last two months!
Whenever possible, we have suggested where you might undertake these
activities.
Index (pages 21-30)
1. Pre-dialysis support and medicines management
2. Changing renal replacement therapies
3. Managing the patient with acute kidney injury
4. Decision making and education in chronic kidney disease
5. Adaptation for renal replacement therapy
6. Multi-professional communication
7. Managing renal services
8. Audit and renal services
9. Learning and teaching in renal care
10. Ethical issues and renal care
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1. Pre-dialysis Support and Medicines Management
Suggested placement for activity: Renal OPD, Wards G8/G9
Activity:
Spend some time shadowing and working with the pre-dialysis
nurse specialist.
Review a specific patient and make the opportunity to follow them
up at their next clinic visit.
a) Identify what changes have been made to their medication and the
rationale behind these changes.
b) What response was seen as a result of the changes?
c) What were the educational needs of the patient (or others) regarding
their medicines management?
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2. Changing Renal Replacement Therapies
Suggested placement for activity: any of the clinical placements
Activity:
Identify a patient who is changing renal replacement therapies
(including renal transplantation).
a) Analyse why this change is taking place and how the staff have prepared
the patient for this change.
b) What communication has taken place between the multi-professional
team?
b) Does the patient feel like they have made an informed decision and how
does this process fit with the National Service Framework?
c) What changes to their life have they made to accommodate this
change?
d) How have they responded to the change?
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3. Managing the patient with Acute Kidney Injury
Suggested placement for activity: Wards G6, G8/G9, Critical Care
Activity:
Identify a patient with acute kidney injury (AKI). Examine how
they are cared for and managed as they pass through one of the
stages of AKI.
a) What is the focus of their management and what is the rationale for this
and any changes in care or management?
b)
How does the patient respond? Can you discuss what is happening
physiologically?
c) How does their management reflect the “text book” management and
research articles you have read regarding AKI?
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4. Decision making and education in chronic kidney disease (CKD)
Suggested placement for activity: any clinical placement
Activity:
Identify a patient who is either about to begin renal replacement
therapy (including transplantation), or has opted for conservative
management. Spend time talking with them about how they have
found the learning and education process. Discuss some of the factors
which influenced their decision making.
a) What did they think about the methods used for information giving and
learning about CKD and renal replacement therapy (RRT)?
b)
What made learning about CKD and RRT difficult, or easier, for them?
c) What role has their family, lifestyle and “health beliefs” played?
d) How are the issues they have identified, replicated or supported by the
literature regarding patient education and preparation for RRT or
conservative management?
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5. Adaptation for Renal Replacement Therapy
Suggested placement for activity: HD, PD, G5
Activity:
Talk with a patient (and their family) who has recently commenced renal
replacement therapy – or changed treatment.
a) How did they find the transition or change in treatment? How did they
respond and how does this match any psychological response identified
in the literature?
b) What mechanisms have they used to help them adjust to the change?
c) What influence has their culture, spirituality or beliefs had over how
they manage and respond to the change?
d) What role does the family play in supporting them with the change?
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6. Multi-professional communication
Suggested placement for activity: Any clinical placement
Activity:
Attend one of the multi-professional clinical meetings (Monday
meetings). Observe the communication and discussions that go on
during the meeting and between the different professionals.
a) How are problems identified? Who leads the meeting?
b) Does the meeting have a clear structure and what is the purpose of the
meeting?
c) What contribution does each of the professions make?
d) How are decisions made about specific patients? What is the depth of
discussion and are decisions clear?
e) Can you identify ways this meeting could be improved to enhance
communication and patient care. What do you feel your contribution
would be/could be?
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7. Managing renal services
Suggested placement for activity: Any clinical placement
Activity:
Spend some time shadowing and working alongside one of the
senior nurses (e.g. matron’s, lead nurse, bed-manager, staff
development team, ward/unit managers).
a) What problems do they have to deal with on a day-to-day basis?
b) Why are some of the issues they tackle so challenging?
c) Who benefits from the decisions being made?
d) What policies or research are behind their decision making?
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8. Audit and renal services
Suggested placement for activity: any clinical placement
Activity:
Attend an audit meeting. Identify the purpose of at least one audit
presented at this meeting?
a) Is the audit linked to a particular policy or clinical standards such as the
NSF?
b) Did the audit presentation lead to further changes or developments in
practice?
c) What did you learn from this presentation?
d) To take this activity further, you may wish to participate in an audit and
audit presentation. Rather than “going it alone”, you might want to join
up with someone from the clinical team who is doing/interested in audit
and work together?
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9. Learning and teaching in renal care
Suggested placement for activity: any clinical placement
Activity:
Organise a case presentation for a student or group of students.
a) Present the patient (with their consent) and discuss in detail why they
developed chronic kidney disease/acute kidney injury (and any
epidemiological trends or patterns associated with them.
b) Is there anything that could have been done to prevent the deterioration
of renal function, or slow it down?
c) If they have an underlying systemic disease, how is this affecting other
systems in the body, as well as how the patients presents and is feeling?
d) Ask your group to give you feedback on your presentation.
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10. Ethical issues and renal care
Suggested placement for activity: any clinical placement
Activity:
Identify a patient (and/or family) for whom there are some difficult
decisions being made e.g. end-of-life decisions, living related donation.
With their consent, and sensitively, talk to them about some of the
issues surrounding their current situation.
a) Who is involved in the discussions and decisions?
b) Are there any national guidelines or policy which relates to their
situation? How do these help?
c) What particular issues or aspects are making the decisions difficult?
d) What is your role in these discussions and decisions?
e) Why do others involved have differing opinions or thoughts about the
situation (if any are identified)?
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