Adult Nursing Practice Year 1
UZTS74-40-1
Preparation for Practice Resource Book
September 2008 Cohort
Module Leader
Angharad Hughes
D:\106762100.doc
Welcome to your Practice Resource Book
Contents
1. Space for notes about dealing with end of life issues
2. Worksheet for preventing violence and aggression in the
workplace
3. Work based Learning Days. Including some exercises you
will undertake in WBLD and practice.
4. Preparation for Placement. Ideas to help you prepare.
5. Information about pages available through Blackboard
6. Top Tips
7. Placement exercises to help you focus on working in clinical
placement areas particularly when you first arrive.
Although you will have noticed this booklet is not very thick, it has
many links to information that you will find useful and should
access and read.
This resource booklet is available via Blackboard and you should
access it there to use the automatic links to the articles and
websites
Included in this paper version are some worksheets that you will
use during the preparation for planning weeks and the worksheet
to use when you are first in practice.
It also includes some information and ideas to help you get started
with Work Based Learning Days. Exercises are included that you
work through with your group and in your placement area.
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End of Life Issues week 1
This is space for you to make any notes you think will be helpful. You
could include information about practical things, places to go for support
or information, things that you have learnt today or perhaps things you
will need to go and find out more about. There is also information
available via blackboard. Please spend some time looking at this.
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Preventing Violence and Aggression in healthcare
Avoiding Aggression
1. How can aggression and violence arise within the practice setting?
Preventing Aggression
2. List the Behaviours that would indicate that a person is feeling frustrated
and may start to behave in a violent way
3. When might you find it difficult to maintain a professional and caring image?
Controlling aggression
4. How can you control your feelings of anger and fear when you are
confronted by aggressive or violent behaviour?
De-escalating aggression
5. What is one important technique for defusing aggression?
6. How can you visibly demonstrate that you are listening?
7. What are the basic steps you need to work through in order to defuse
aggression?
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Work Based Learning Days
What are work based learning days?
Work based learning days occur every fortnight during practice. They are an
opportunity for you to share your experiences and support each other. They
also are opportunities for you to consider how you can meet learning
outcomes in practice so you may spend some time talking about assessment.
You can discuss any aspect you’re your practice in the work based learning
day sessions as long as you remember the agreed rules around confidentiality
and reasonable behaviour. These will be agreed within the group.
What needs to be achieved during the work based learning days?
You have several things that need to be achieved. There are learning
outcomes to achieve. You are trying to make links between the theory you
have learnt already and real life practice. You are increasing your knowledge
and your skills and looking at your attitudes to the work you are doing. Some
of your learning takes place in the clinical area and some in the WBLD’s so be
prepared to talk about your practice.
What to do in Work Based Learning Days
Your facilitator will discuss with you how the days are to be organised and you
will have some say in these so if there are activities you wish to do or topics
you want to look at then speak up.
Much of the time you will talk about patients you have nursed, colleagues you
are working with and situations you have seen and experienced. Any relevant
topic is fine as long as you remember issues of confidentiality and the
discussions are nursing related.
This is also an opportunity for you to meet your colleagues regularly and
support each other.
There are some scheduled exercises to do to help you make the links
between theory and practice but otherwise it will be ideas brought in and
shared by yourselves.
Work Based Learning Day exercises for ANP year 1.
These exercises are intended to help you to link the theory they learnt in
Foundations of Health, IP1 Adult nursing in Context (ANIC) and skills for Adult
Nursing (SFAN), through practice to successful practice assessment. There
are two exercises in each placement. You will discuss the exercise one week
and bring their results to the next session for discussion.
Discussion may be in small groups and or the bigger group. You will be
encouraged to use what you have learnt to write reflections to be included in
your portfolio and to report back to your mentors what learning you have
made.
In placement 1 the exercises are:Admission assessment
Problem solving scenarios
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Admission Exercise
Preparation Using a mind map to plan the assessment
You are going to do an admission assessment. You have previously
discussed this in Adult Nursing in Context (ANIC) and now you are going to
apply your knowledge to a real patient.
Think of a patient. The patient is central and may be real or imaginary. Think
of all the areas about which you should or could ask questions. What
information do you need to know about their life outside that may affect how
you care for them?
Put all these ideas down as a mind map
Discuss with others in a group what you included and why.
Assessment is the first stage of any care that you give the patient and carries
on throughout their care. It may start with admission. Often ward staff have a
very limited time to spend carrying out admission assessments but students
have more time so this is a great opportunity for you to look at all aspects of
the patients life. You may find out useful information to pass on to the ward
staff. One aim is to get you to spend a longer period of time with one patient
admitting them, and to consider a wide range of issues that affect the patient
that relate to their life before and after their hospital admission.
You will need
An Admission Assessment document from your placement
A willing patient
Negotiated time to carry out the assessment
In the next week pick a patient and carry out an admission assessment with
them. You may not be admitting them (for example in clinic) but you can still
ask to interview and assess them as if you were. You are looking for a patient
who will be happy to let you spend time with them doing an in depth
admission assessment.
What sort of things do you need to consider before you approach anyone to
do this? What other admission assessments may be done? Are their
medical students who are also finding patients to do this with? How will you
negotiate the time and the access to a patient? How do you share your
information with other staff? When you have found someone suitable and
they are happy for you to do this get yourself a fresh admission assessment
document
Look at the questions that the admission assessment asks and work your way
through them. Be as thorough as you can. If something is unclear then ask
for clarification. Don’t forget to ask questions that cover the patient’s
biological, psychological and social situations. Watch your patient for any non
verbal cues such as their ability to communicate, what makes them happy or
sad or scared, when they are getting tired etc. You may find you need to carry
out the assessment a bit at a time. There may be interruptions, the patient
may become tired or you may need a break.
Don’t forget consent, confidentiality and privacy issues
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When you have finished then reflect on this experience.
How was the experience for you?
What did you observe apart from the answers to your questions?
How did you feel about asking very personal questions?
What are the key points you need to pass on to the ward staff?
What do you still need to know?
When you have got enough information from your patient you may find that
you still have some questions that you can answer from other sources. For
example, you can read up about drugs and conditions, you can discuss
treatments with other professionals. Did you read their notes before you
admitted them?
You may feel this is a patient who you could study in more depth
Bring this learning back to the work based learning day. What aspect would
be interesting to share with your colleagues? What would they benefit from
knowing that you have learnt? It needs to be something that you would be
willing to discuss in a small group.
Problem Solving Scenarios
Preparation reflection
Think of a patient you have been nursing. Consider one aspect of their care
with which that they need your help.
e.g.
- cannot feed themselves easily due to hemiplegia
- Are worried about dad coping with looking after children
- Is having a lot of post op pain
- Fearful of having an anaesthetic
In a group discuss and list all aspects of the problem
What effect may this have on the patient?
Think of issues around caring for this patient – who is involved? What
can/needs to be done? How is the patient involved in determining their care?
Are there equipment and resource issues?
What assessment outcomes may be relevant to this situation?
What are you going to do now?
Before the next session
Reflect on how discussing care with others may help you to consider more
possible solutions
Spend time looking at relevant material that discusses this patients issue
Provide a glossary and at least 3 sources of info about the issue to share with
others in your group
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Placement 2
In placement 2 the exercises are:Working with professionals from other groups
Using Carper to reflect on knowledge gained.
Working with professionals from other groups
Reflect on your experiences to date. Have you observed how professional
work together. Think about when you were studying IP1.
What were the benefits and the difficulties for IP working?
What makes a group work well? What can prevent this?
Before the next work based learning day
Find out if the multidisciplinary team meet to discuss patients
 Ask to attend a meeting
 Note what sort of issues were discussed
 Do you see a leader?
 Is it working well for the patients benefit?
 How do different professionals interact in the clinical setting
If your area does not have MDT meetings
 Arrange to meet up and work with some other professionals who also
work with your patients
 Find out how their job relates to the nursing role
 Discuss with them how they organise their role and how they fit in with
other professionals
 What are the difficulties and the benefits for the patients?
In the following session discuss how professional work together differently in
different situations and reflect on your observations and consider how you will
ensure that this is done well for the patients benefit.
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.
Domain knowledge Exercise
What do you know about…? Using Carper to reflect on knowledge
gained
Pick any of the domains in the assessment document and choose one
outcome criteria. Think of one particular patient where you might have carried
out some care that relates to this domain/criteria. Consider one aspect of
nursing that you carried out with them. E.g. You could have given them some
drugs, talked about their family, organised something for them, accompanied
them when they went for a test, anything that relates to your care for them.
Using Carper’s ways of knowing to reflect on your knowledge.
The Empirical knowledge is found in text books, literature and research, or
evidence obtained by direct or indirect observation and measurement. It is
knowledge that is publicly verifiable, objective and factual and research
based. .
Personal Knowledge arises from experiences, both as sympathy and
empathy and understanding. It is subjective. It requires self awareness and
incorporates and promotes respect and holism in the nurse patient
relationship.
Ethical knowledge is about belief systems, expressed through moral codes
and ethical decision making. Nurses often have to make choices between
competing interventions and make considered judgements about based on
quality information and debate.
Aesthetic knowledge is the ‘art’ of nursing, as much about how you do
something as why. It incorporates and links the other three ways of knowing.
It is subjective, individual and unique involving intuition, interpretation,
creativity, empathy, understanding and valuing.
You are going to make a list of the knowledge you needed in each area under
the headings Empirical, Personal, Ethical and Aesthetic
Here’s a simple example to help you
Your patent says they are very scared because they are having an operation
Empirical, what the operation is, what care is given pre and post op. How
scared people have physiological changes as well as psychological effects
Personal, empathise about being frightened. Discuss coping strategies such
as deep breathing.
Ethical. Must do something to help patient cope with situation personal and
professional requirements for action
Aesthetic, can get the anaesthetist to visit Reassurance is more than words
need to show concerns and caring Maybe conversation and touch could be
used
This list is not at all exhaustive but may give you an idea of what to put where.
Your list will probably be much longer and you may take several days to
complete it as you realise what a lot of different knowledge you do have.
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When you have a list reflect by asking yourself:Where did you get the knowledge?
Is it accurate?
Do you need to increase your knowledge in any area?
Do you need more experience or practice in any area?
How could you improve your knowledge?
Can you attach a timescale to these to help you be motivated to do
something?
How will you know when you have enough knowledge for now?
Bring your ideas and reflections to the next WBLD
Additional Exercises that you can do if you wish to as a group
Media exercise
Collect together a range of media that are related to health issues. These
could be from magazines, news papers, online, from TV and radio. They can
be articles or adverts.
What are the issues being highlighted?
What is the evidence behind this report?
If it quotes research what could we do to check its value?
How do patients clients and carers feel when they read/see these stories?
What can you do to reassure patients and clients?
Are there social care issues as well as health issues?
What are the financial implications?
How might this affect the staff working in these areas?
If you were in control of the situation what variety of actions might you take?
What are the future implications for practice?
What message should we be promoting?
Are there any ethical issues here?
Have a discussion about how the media affects patients perception of the
care they will receive and influences how they feel about accessing that care.
Discuss what the nurses responsibility is in relation to educating patients and
reassuring them with realistic and accurate information.
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Essence of Care
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPo
licyAndGuidance/DH_4005475


In groups pick a relevant Essence of Care Guideline. Consider the main
points and try apply it to patient care of patients you are currently looking
after
Bring to next session to discuss. Bring any materials and references you
have found OR post information and links online.
Personal/Professional development
Look at assessment documentation and choose one personal/professional
outcome that you would like to develop. This might be something you think
you are not very good at yet or something you would like to improve.
Find information about this.
Observe others performance.
Talk to staff about your abilities and ask for feedback.
Find helpful info about how to do this well but apply it – don’t just go for
theory.
See if there are any relevant helpful websites with advice
e.g. Time management, diary, talk to people who seem very organised,
Video/DVD on prioritising tasks, get alarm clock.
Timetable - Planning assignment and practice
e.g. Communicate with older people
Discuss in the group how you might put this into practice and several weeks
later feedback on your progress. Think about getting together with others in
the group and helping each other.
Some other popular activities include:Quizzes and Games
Discussion of the assessment
Post it note discussion.
5 Minute talk.
Debates
Media exercise
I’m sure you can think of lots of others
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Preparation for Practice
Things you could do before you start your Placement
In three weeks you have 2 preparation for practice days. You are not
“in class” or “in practice” for those two days but are expected to be
working on preparing to work well during your placement.
So what are you going to do in preparation for practice days to make
them useful?
If you have not done so already you could visit your placement and
check out what the shift times are, where it is, who’s who etc.
If you need particular shifts make sure you talk to the right person
Try and meet your mentor
Find out who is in charge
Ask about transport. Maybe have a practice getting the bus so you
know how long it will take.
Find out basic information about your clinical placement
Speciality of the department
The most common reasons why patients are in there
What are particular issues for these patients?
Do some reading about these topics.
You already know what the placement is, so you should be planning:What learning outcomes you intend to achieve when?
What do you need to include on your learning contract?
Read the articles on Blackboard about working with a mentor, The
student mentor relationship, surviving the student years and giving
students confidence.
Make a start with your EU requirements
Remember how many of your everyday patients are have families, are
pregnant and have mental health issues. Look at staff and relatives and
look outside your work. Get going on this if you have not done so
there’s a lot to do.
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Pages available on Blackboard.
You can go to a variety of links directly and this is a list of pages
available via Blackboard. Please remember that these will change
and be added to, so look at the regularly.
In Module documents you will find a copy of your handbook and
the resource book. This has links to lots of useful articles,
worksheets and presentations.
Module Information has the latest timetables room allocations
and contact details.
The web sites page has links to official sites such as the Rcn
NMC and Department of Health.
It also has advice on clinical skills, dealing with bullying and
harassment, essence of care, referencing etc. Have a look and
see what is on there.
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Module Resources includes
Powerpoints and other information linked to sessions
Information linked to the End of Life session
Preventing Violence and Aggression notes
Resources for achieving your learning Outcomes when in practice
A decision making framework toward skill development
Book recommendations
It also has links to articles of interest that you should read
The following articles are in pdf format and can be reached
automatically
Enhancing Support for Nursing Students.pdf (150.056 Kb)
Giving Students Confidence.pdf (99.16 Kb)
student nursing in nursing homes.pdf (114.886 Kb)
surviving the student years.pdf (190.836 Kb)
The next articles are all available electronically.
You will need your UWE network username and password to access them.
When you click on the links below you should get taken to a page that asks you to
confirm that you are from the University of the West of England. Click on “Take me
to the UWE log in page” and then enter your UWE network username and password.
Hand, Helen (2006) Promoting effective teaching and learning in the clinical setting
Nursing Standard. 20(39):55-63, June 7, 2006
http://gateway.ovid.com/athens/ovidweb.cgi?T=JS&NEWS=N&PAGE=fulltext&AN=0
0002311-200606070-00054&LSLINK=80&D=ovft
Wilkes, Zoe (2006) The student-mentor relationship: a review of the literature
Nursing Standard. 20(37):42-47, May 24, 2006
http://gateway.ovid.com/athens/ovidweb.cgi?T=JS&NEWS=N&PAGE=fulltext&AN=0
0002311-200605240-00053&LSLINK=80&D=ovft
McDonald, Helen (2005) TIPS FOR SUCCESS Nursing Standard. 20(6):72, October
19, 2005
http://gateway.ovid.com/athens/ovidweb.cgi?T=JS&NEWS=N&PAGE=fulltext&AN=0
0002311-200510190-00063&LSLINK=80&D=ovft
Effective Learning Number 8: Processing Information Working sensitively in a group
Nursing Standard. 17(30):0, April 9, 2003
http://gateway.ovid.com/athens/ovidweb.cgi?T=JS&NEWS=N&PAGE=fulltext&AN=0
0002311-200304090-00061&LSLINK=80&D=ovft
Wallace, Bruce (2003) Practical issues of student assessment Nursing Standard.
17(31):33-36, April 16, 2003
http://gateway.ovid.com/athens/ovidweb.cgi?T=JS&NEWS=N&PAGE=fulltext&AN=0
0002311-200304160-00057&LSLINK=80&D=ovft
Price, Bob (2003) Working with a mentor or clinical supervisor Nursing Standard.
17(26):0, March 12, 2003
http://gateway.ovid.com/athens/ovidweb.cgi?T=JS&NEWS=N&PAGE=fulltext&AN=0
0002311-200303120-00056&LSLINK=80&D=ovft
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Here are some top tips from previous students.
Top Tips for your first few days in practice
 Keep a small notebook in your pocket
 At report just write down – name age and most relevant info
e.g. nil by mouth 2 nurses to assist.
 Tights bargains available
 Be punctual
 Be enthusiastic
 Be willing
 Smile!
 Wear correct uniform
 Have an early night before an early shift
 Prepare uniform the night before
 Keep a spare pair of gloves in your uniform pocket
 Take your own mug
 Arrive in plenty of time
 Do not undertake any manual handling procedure that you
have not been shown or undertaken at UWE
 Be assertive
 Be open minded
 Relax and Enjoy
 Ask questions
 Always look around to do something – talk to patients
 Keep positive.
In addition in this resource book you have some activities you can
undertake. Take this with you and if you find yourself wondering
what to do, find an activity and try to do it.
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Placement Exercises
What to do when you are new to a
placement
Sometimes it’s difficult to know what to do when you
are in a new place and you don’t know who anyone is or
where anything is, but don’t worry. Everyone feels a bit
adrift, so here are a few exercises to help you get
involved with the people, the place and the work. Take
this workbook with you on your first few days in your
placement and try to work through as many of the
activities as you can. You may find the placement
already has an orientation pack, so use what is most
suitable for you. Please do look at the exercises that
help you relate what you have been learning to real
practice.
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Who’s who and what’s where?
Introduce yourself. You cannot do this enough. If
people know who you are, why you are here and that
you are interested, they will include you in what they
are doing.
Meet some key people
Who’s in charge?
Overall
Today
Who has worked here the longest?
Who cleans the unit?
Who is your mentor?
Who does the clerical work?
Where is:The staff changing room/toilet? Do you need a code or
a key?
How long are:Shifts
Breaks
Do you need to bring coffee/tea/milk with you or is it
provided?
Is there a fridge where you can put your lunch?
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Write down the names of five people who have
different roles in the unit
Other useful Information
Try to meet your mentor in the first few days. Make a
time to meet and discuss your learning needs and the
opportunities available in this unit.
Before you meet your mentor…….. Look at the learning
outcomes, and competencies. What do you think you
will need to do to achieve these? What help will you be
asking for?
Start writing your Learning Contract by thinking about
which of the Learning Outcomes you would like to
achieve first and what sort of experiences might help
you to do this.
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Things everyone should know
If someone needs commode, vomit bowl or resus trolley
FAST where are they?
What are the emergency phone numbers?
What information would you need to give?
“
“
”
”
What does the emergency bell sound like?
When is it tested?
What will you do if it goes off?
Where are the fire alarms, emergency exits, fire
blankets and extinguishers located?
What will you do if the fire alarm goes off?
Where and how are patient records kept? Think about
things like security and confidentiality and who has and
should have access to them.
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Observing Clinical skills
You have had some sessions on skills. You’ve learnt
some theory and you’ve had some practice. Now it’s
time to observe and carry out these skills in real life.
In one of the clinical skills sessions you learnt about
taking a blood pressure. You may have done this
before or it may be a new skill for you, but you do need
to know the theory behind what you are doing so this
may be a good time to check that.
Systolic pressure is?.................................................................
Diastolic pressure is? ………………………………………………………….
What is a normal range for a diastolic blood pressure?
…………………………………………..
Why don’t you watch a member of staff taking a blood
pressure and see if you can observe and makes some
notes on the following.
How did they approach the patient?
Did they get consent?
Was this formally asked for
or gained in a less formal way.
How did they communicate with the patient?
What else could they have been observing whilst taking
the blood pressure?
What was the BP?
for this patient?
Is this in a normal range
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What advantages and disadvantages are there for
using the type of sphygmomanometer that was used?
Can you remember what the patient should be doing
before their blood pressure is taken?
How is the blood pressure recorded?
If there is a potential problem who would be informed?
Could you now take the blood pressure of this or
another patient?
How did you find it?
Think about other skills you have learnt. What will you
observe about them?
You have a section in your skills book to reflect on
taking blood pressures and many other skills. As you go
through the placement remember to record more of
your experiences there.
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A few clinical issues
Imagine you are a patient having their temperature
taken. You are feeling rather hot and sweaty.
What might you be feeling like?
What might you be anxious about?
What would you like a nurse to do for you?
Imagine you have just been admitted to the ward. You
have never been in hospital before.
What might be worrying you?
Who needs to know you are in hospital?
What sort of things need to be sorted out in your life
outside the hospital?
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Imagine
You are going to have some surgery
What sort of things might be frightening you?
What could a nurse do that would help you deal with
your fears?
Observe some clinical situations and try to put yourself
in the patients place. How are you feeling?
It might be appropriate to discuss some of these
issues with a patient. You might want to discuss that
with your mentor first.
How are standard precautions maintained in the
clinical area? Think about how they relate to staff
patients and visitors.
Are there any other clinical issues you have noticed or
would like to find out some more about? You could
discuss some of these in Work Based Learning Days
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Working with other professions
You have been doing the IP1 module, which is about how
professionals work and learn together.
Can you remember three benefits that patients get
when professionals work well together?
Can you remember some reasons why professionals can
find this difficult?
While you are on placement, observe some instances
where professionals are working together.
Things to consider:Are they carrying out care together?
Are they sharing information and expertise?
Is someone in charge and or leading the others?
Do they have similarities and differences in their
technical language?
Do they always agree?
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Talk to some staff from other professions and make
some notes about your discussions. E.g. you might ask
them about their role, or about how they see priorities
for a particular patient, how their role fits with other
professions.
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At the end of the day
Try to have a few minutes after each day to think
about what you have been learning, how you feel about
your experiences and plan for the next day.
Think of three adjectives that describe your day
e.g. busy, exciting, upsetting.
Write a sentence to describe how you feel
Physically
And emotionally
What will you remember about today?
Say 1 thing you will try to do or see tomorrow
Think of three adjectives that describe your day
e.g. busy, exciting, upsetting.
Write a sentence to describe how you feel
Physically
And emotionally
What will you remember about today?
Say 1 thing you will try to do or see tomorrow
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Think of three adjectives that describe your day
e.g. busy, exciting, upsetting.
Write a sentence to describe how you feel
Physically
And emotionally
What will you remember about today?
Say 1 thing you will try to do or see tomorrow
You can keep repeating these steps as often as you
like
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