Topic outline

  • General

  • Introduction

    The clinical Practicum manual is a document designed to provide guidance for
    the associate nurse student running program to determine the level of clinical
    attachment by year throughout the program.

    Clinical placement provides an important opportunity for associate nurse students
    to apply skills and theory in real life situation in a variety of clinical settings.
    Experiencing nursing in different types of health care environments is important for
    professional growth and development. It enables students to gain competence of
    many various skills required across various health care settings.

    The placements will be conducted on a daily basis and they are organized at the
    level of community, health center or hospital depending on the clinical objectives.

    The goal of the clinical placement is to provide each student with the experience,
    clinical skills and attitude in line with theoretical package acquired in class. Clinical
    practice for Nursing profession involves both theory and clinical practice which is an
    important component required to help students translate theory into practices by any
    student undergoing training. It involves the cognitive, affective, and psychomotor
    domains. The students will be supported by a teacher from the teaching institution
    who supervises and assists in meeting the clinical learning and assessment needs.
    The teachers will be supported by the mentors at the health facility settings.

    This manual provides hints on clinical practice for students to further equip them and
    to provide effective quality basic nursing care for clients at all levels of health care
    settings. It will guide teachers and students in a variety of settings to provide quality
    and efficient client care. It will also be a resource in coaching and mentoring student
    to build their competence and confidence in client care. The manual will provide
    clearly defined roles and expectations of each party during clinical experiences.
    Students will be able to cultivate their critical thinking, clinical reasoning, interpersonal
    communication and interprofessional collaborative competencies.

    The incorporation of this manual into the clinical setting will facilitate a successful
    placement by providing students with the resources they need to engage with the
    community members, healthcare team, clients, and their families fully and safely.
    During clinical practice, clinical facilitators and students are all involved in clinical
    placement activities and assignments.
    1.1 Purpose of the clinical placement
    The aim of this clinical module is to provide a clear and comprehensive document
    that outlines the start to end process and guidelines which govern the clinical
    placement for associate nurse students. Clinical teaching is a core component of

    nursing education.

    The clinical teachers’ roles and responsibilities are to supervise and coordinate
    clinical activities in order to empower students to gain clinical competence in terms

    of knowledge, skills and attitude as well as confidence in all acts.

    1.2 Structure of clinical placement

    The clinical placement aims to introduce students to the clinical and practical
    sessions expected of them as professional associate nurses. It introduces students
    to maternal, health, medical and surgical conditions which require optimal theoretical
    package of nursing care in their theoretical courses. The clinical practice goes
    beyond the health care setting and extends to the community setting to familiarize
    themselves with the environment where individuals and families live as well as
    identifying their problems and seeking interventions. The competence students
    will gain in this clinical practice will enable them to carefully and professionally
    implement relevant nursing care and community interventions based on the needs
    of individuals, families and communities.
    The clinical placement starts in senior four (4) where students need to integrate
    theory into practice. The placement is organized in six (6) periods per week and
    each period takes 40 minutes per day totaling to four (4) hours in week while the
    year is composed of three (3) trimesters.
    In senior five (5), the clinical placement is organized in seven (7) periods per week
    while in senior six (6) it is organized in 10 periods. Like in senior four, each period
    takes 40 minutes per day in week. Every year is composed of three (3) trimesters.
    SECTION 2: PRE-CLINICAL PREPARATION
    In preparing for a clinical placement, there are some important requirements to
    organize and information to gather or to communicate. These preparations are
    required for good practice to help students get the most out of the clinical experience.
    The students’ behavior and attitude need to be considered before clinical practice
    as you prepare for general conduct that you will expect them to demonstrate while

    in clinical placement.

    2.1 Strategies to be considered when preparing the clinical

    placement

    The following strategies need to be considered when preparing the clinical
    placement:
    – There is need to read through the materials provided by the training institutions
    such as policies and procedures relating to clinical placement. The old saying
    ‘knowledge is power’ is true.
    – Prepare and compile the clinical materials according to clinical objectives
    – The students’ behaviors need to be considered along the clinical teaching in
    the delivery of nursing care to clients. This will inform the behavior, attitude
    and the general conduct that is expected to be demonstrated during clinical
    placement
    – The student orientation information needs to be prepared for clinical placement
    and knowing what to expect about the types of clients and services provided
    in the facility
    – The students’ clinical objectives should be formulated to meet the students’
    clinical expectations
    – The teacher needs to create linkage through interprofessional communication
    and collaboration with hospital leadership authorities and the in-service
    nurses during clinical practice
    2.2 Responsibilities of the Faculty
    – Ensures that all documents related to the clinical teaching plan are prepared
    – Ensures that the clinical site staff are well informed
    – Schedules communication with clinical staff to gain mentor support on student
    practice and progress, these conversations should occur minimally at the
    beginning of each clinical course, midterm, and in the final week of clinical for
    each course unit
    – Reviews if the clinical hours planned on a weekly basis are met and if not,
    plan ahead accordingly.
    – Ensures all evaluation processes are completed in a timely manner
    – Reviews clinical competencies on a weekly basis and provide feedback to
    students as needed.
    – Reviews individual student clinical experience at the completion of each
    clinical course
    – Collaborates with the hospital staff around student assignments for required
    clinical experiences
    – Coordinates student clinical learning with clinical facilitators
    – Ensures that student clinical experiences commence as soon as feasible at
    the beginning of a courses
    – Ensure that students will be able to complete the required clinical hours within
    the timeframe of the course
    – Evaluates student competencies in the clinical setting using clinical facilitators’
    input to ensure students are providing optimal client care while adhering to
    objectives, guidelines and standards
    – Documents student clinical performance and evaluation
    – Assesses the process of student clinical evaluation within a course and
        recommends improvements when necessary
    – Takes note of student difficulties in meeting clinical objectives
    – Ensures the student have pre-required theory and practical demonstrations
         before clinical placement
    – Clinical experiences and time spent in each experience should be varied
         and distributed in a way that prepares the student to provide care to the
          populations served.
    – Provide students with all clinical documents: clinical objectives, portfolio and

         attendance lists

    2.3 Orientation of the students at school for clinical practice

    The first two (2) clinical periods will be spent in the school most probably in the skills
    laboratory. This aims to brief the students on the tools needed in the clinical practice,
    lay their anxiety and remind them the way of conducting themselves throughout the

    clinical practice. The teacher will:

    Address the students and prepare them for the clinical experience
    – Lay their anxiety especially during the first week of year 4 in facing new
    situations that will be encountered in a clinical placement
    Remind students the ethical code, professional code of conduct as well as guidelines

    that govern the nursing profession

    2.4 Ethical code of conduct

    – value quality nursing care for all people
    – value respect and kindness for self and others
    – value the diversity of people
    – value access to quality nursing care while respecting the equality
    – value informed decision making
    – value a culture of safety in nursing and health care
    – value ethical management of information
    – value a socially, economically, and ecologically sustainable environment
    promoting health and wellbeing
    2.5 Professional code of conduct
    – students practice in a safe and competent manner
    – students practice in accordance with the standards of the profession and
    broader health system
    – students practice and conduct themselves in a professional manner
    – students respect the dignity, culture, ethnicity, values, and beliefs of people
         receiving care and treatment including their families
    – students treat personal information obtained in a professional capacity as
         private and confidential
    – students provide impartial, honest, and accurate information in relation to
         nursing care
    – students support the health, wellbeing and informed decision making of
    people requiring for or receiving care
    – students promote and preserve the trust and privilege essential in the
    relationship between student and clients
    – students maintain and build on the clients’ trust and confidence in the nursing
         profession
    – students practice nursing reflectively and ethically
    – Inform/remind them to observe the clinical policies, rules and regulations
    – Remind the students about the professional dressing code
    – Explain the safety and hygiene regulations
    – Prepare all materials needed in a real work situation: Thermometer, Blood
        pressure apparatus, second hand wrist watch, a note book, logbook and pen
    – The clinical objectives and learning outcome are explained to the students

    – Remind students they are students and not workers

    2.6 The Student Role

    The points below outline the role of the student within clinical placement:
    – The learners must have the content to apply in clinical placement
    – Students will be held accountable for her/his acts
    – Respect punctuality at all times.
    – Demonstrate professional and ethical behaviors to all persons in the
    healthcare environment.
    – Gathers information, completes, and submits the clinical portfolio at the end
    of each trimester.
    – Provide a copy of the clinical objectives to the respective departments during
    the clinical practice.
    – Participates in some morning staff meeting, clinical presentations.
    – Complies with the institution’s rules and regulations.
    – Respect the dress code: Wear professional attire.
    – Wear your identification badge in all clinical experiences.
    – Ensure privacy, personal and confidential information related to clients, family
    members, employees and people affiliated with your practical experiences.
    – Avoid to disclose or access any personal or confidential information
    unnecessarily.
    – Respect Clinical hours for each period

    – Collaborate effectively with other team members.

    2.7 Information on clinical support

    The Teacher will brief students on how they will be supported while in clinical practice.
    This support will be from a clinical mentor who is facility based for continual support
    of students in addition to the school teachers. A mentor is someone who provides
    a relationship that facilitates a student’s personal growth and development. It is a
    dynamic relationship. The mentor guides the student through the organizational
    networks of the clinical environment. Students are informed that:
    – It is important to develop a good relationship with the clinical facilitator
    – Students will spend much of their time with clinical facilitator
    – Students must have the ability to communicate their learning needs which will
    help to attain their goals
    – Students should observe what the clinical mentor does and inquire about the

    performed care/ interventions

    2.8 Orientation of the students in health care clinical setting

    Clinical practice orientation provides students with accurate information to make
    them more comfortable during the clinical practice. It also facilitates students to
    adapt faster and increases confidence throughout their practice. Orientation also
    introduces students to the clinical staff/ community members and integrates them
    into the clinical setting culture.
    When the students arrive at the clinical site for the first time, the teacher will have
    to do the following:
    – Introduce students to the clinical site leadership specifically to the head of
        Nursing services who does it through an institutional tour as an opportunity to
        show them all services within the institution etc….)
    – Introduce the students to team working within the clinical setting
    – The clinical objectives and expected outcomes are communicated to the
        clinical setting
    – The teacher (clinical facilitator) collaborates with the health care authorities in

        preparation for the commencement of clinical practice

    After the institutional tour, the head of Nursing services or delegate will hold a
    session and:
    – Get to know students through self-introduction
    – Explain the organizational structure and hierarchy of the institution
    – Explain to the student the facility overview
    – Explain the work policies, rules and regulations of the health facility (ethics,
    values, institutional culture, code of conduct, working timetables, safety and
    health procedures, insurance policies, the clinical placement agreement as

    well as other relevant documents).

    2.9 On site Clinical support

    The students need some additional support to perform well in their role in order
    to reach their full potential. The teacher will communicate to the clinical staff and
    prepare them for this need.

    S/he/ will:

    – Make sure that the staff supporting students are confident enough before the
        students start clinical practice
    – Speak to clinical staff to check that they are confident enough to work with
        and support students in the clinical setting
        To achieve this, you will need to:
    – Hold a short meeting with the clinical staff
    – Ensure you know if students have any specific support needs (for example, a

       language difficulty, physical disability etc…) and plan for their support

    SECTION 3. FACILITATION OF PROCEDURES IN CLINICAL

    SETTING

    This step is concerned with the “learning by doing” in the clinical setting where the
    student is required to perform different procedures assigned under the supervision

    of the clinical mentor/Clinical class teacher.

    3.1 Task assignment

    Following the weekly plan at hand, the Clinical facilitator will assign tasks, demonstrate
    (know how transfer) and coach the student thereby providing guidance and clear
    instructions for the adaptation of the demonstrated procedure. Task assignment
    follows the main steps as indicated below:


    3.2 Preparing the student in clinical setting

    – Prepare all tools, materials, and eventually the client (visual aids in a real
    work situation)
    – Welcome the student in a friendly manner and arouse his/her interest
    (motivation)
    – Present him/her with the needed materials, equipment and explain how they
    function
    – Ask questions to check prior knowledge
    – Explain the safety and hygiene regulations
    – Place him/her in a good position to observe well
    – Explain the significance of the task to perform (why it is needed)

    – Explain the learning outcome to the students

    3.3 Clinical preparation checklist

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    3.4 Demonstrating and explaining

    The Clinical facilitator demonstrates how to do the assigned procedure /task (the
    process and where to pay more attention when needed) what to use, how to use
    tools, materials and equipment as well as how the system and equipment work.

    Specifically:

    – The Clinical facilitator explains exactly WHAT is being done, HOW it is being
        done it and WHY the procedure is done in this way and not in any other way
    – Before the student’s exercise, the complete procedure to be learned is
    demonstrated by the clinical facilitator at a normal speed
    – After this, the complete procedure is demonstrated slowly in partial steps/
         actions
    – The student is asked to watch the procedure carefully and to ask questions
        if necessary
    – The student and the clinical teacher /mentor should ensure that each work
         step is explained and supported verbally


    3.5 Adaptation

    3.5.1 Imitation (Return demonstration or try-out-performance by the

    student)

    – Under continuous observation of the Clinical facilitator, the student imitates
        the procedure and takes care of the single work steps
    – The Clinical facilitator corrects the performance if it is not conforming to the
         procedure process
    – The Clinical facilitator ensures demonstration of the procedure, respecting
        health and safety guidelines
    – He/she makes no criticism or negative judgment but gives constructive
        corrections
    – During the course of demonstration and learning, a little praise is helpful to
        motivate learning
    – After repeating all work steps, the student should be asked to explain every
        single step. Verbal support during the exercise renders the learning process
        more effective and improves the retention of information
    – Finally, first the learners and then the Clinical facilitator should repeat the
        complete demonstration once again as comprehensively as possible. In
       this way the requisite standards of quality and quantity are mastered by the

       student once more before they go on to the unsupervised exercises

    3.5.2 Mastering by practicing

    – The student practices to acquire the necessary skills directly during
         implementation of procedures in the real clinical setting
    – The student develops a sense of the pace of work, becomes more confident
        and secure in handling the equipment and materials, then begins to look
       autonomous during practice with less physical effort but more efficient
    – The Clinical facilitator must remain in the vicinity during the phase of practice
    – She/ he must regularly check that the student performs the activities correctly
       to avoid errors. Such errors may be difficult to reverse and even if possible, a
       lot of harm will have been caused
    – To achieve the learning success and mastery there is need to repeat the
        exercises again
    – Stay near to the student to answer any questions and observe how she/he

        performs

    3.5.3 Closing the session

    – Ensure respect of the standards

    – Clean the learning space

    – Clean and replace used resources in the right place or place them where they

    are supposed to be

    – Ensure safety and security measures

    – Ensure lifetime of resources for future re-use

    – Record and report what has been done

    – Close the session and agree on the way forward

    – Provide constructive feedback

    – Provide assignment if necessary

    – Encourage students to have individual development plans

    Considering that the Clinical teaching and learning is an effective way of transferring
    technical skills and preparing for the labor market and further learning. With the
    help of the Clinical facilitator, the effective adaptation requires the student to be
    integrated in the Clinical setting team and to build relationship with the Clinical
    facilitator and coworkers.
    For this reason, not only the student has to adapt him/herself to the procedures
    assigned to be performed as directed and demonstrated by the Clinical facilitator,
    but also to the working conditions including:
    – Observing the conditions of clinical setting learning agreement
    – Behaving in a courteous and professional manner
    – Obeying all rules and regulations
    – Not wasting, damaging or injuring the property, goods or business of the
    institution
    – Working towards achieving the competencies according to the training plan
    – Undertaking training and assessment as required under the training plan

    – Keeping the training records and produce it when required

    NB:

    – Students with disabilities and others with special need education should
    benefit from appropriate facilitation and supervision throughout their learning
    – An overview of the clinical setting/site health and safety protocols, including

    fire and evacuation procedures should be done

    3.6 Application and transposition

    3.6.1 Mentoring

    Mentoring is providing continual guidance and empowering a student to advance
    towards a desired goal. It is a process that leads a student to self-reliance or
    confidence. Therefore, for a student to build autonomous capacity, the clinical
    facilitator creates situations and conditions where a student applies the same skills

    in a different context. In such case, the clinical facilitator will play a role of a mentor.

    The level of supervision and support that is expected from the clinical facilitator
    includes regular checks on how you are progressing throughout the shift, group

    debriefing sessions and one-on-one time for specific skill assessments.

    The clinical facilitator provides clinical teaching with opportunity of acquisition
    and demonstration of skills covered in theory. There are key skills that a clinical
    facilitator is required to have in order to assist the student attain confidence and

    competence in provision of quality mentoring and health care. These skills include:

    – Clinical proficiency and capacity to make decisions
    – Willingness to mentor students on site
    – Capacity and desire to motivate the student to perform well
    – Familiarity with and ability to use clinical standards

    – Ability to facilitate a case discussion

    3.6.2 Roles of the clinical facilitator
    The clinical facilitator is a person who provides clinical teaching with opportunity of

    acquisition and demonstration of skills covered in theory.

    The level of supervision and support that is expected from the clinical facilitator
    includes regular checks on how students are progressing throughout the shift,
    group debriefing sessions and one-on-one time for specific skill assessments for

    progression. This includes to:

    – Participate in identification of learning needs of the nursing students
    – Set goals with the students in collaboration with the institution and in line with
        the curriculum.
    – Provide patient care in accordance with established evidence- based nursing
        practice standards
    – Fulfill nursing duties according to hospital and training institution’s policies
        and procedures
    – Facilitate the student’s professional socialization into the new role by building
        their practice.
    – Provide the student with feedback on his / her progress, based on clinical
        facilitator’s observation of clinical performance, achievement of clinical
        competencies and patient care documentation.
    – Participate in educational activities of the institution to promote continuous
        learning and professional growth of nursing students.
    – Promote safe, effective and qualitative client care
    – Know the strengths and weaknesses of the student, find experiences to
        address the weaknesses and capitalize on the strengths
    – Create a non-threatening environment to make integration and transition less,
        stressful for the students.
    – Outline the requirements and expectations of both the clinical facilitator and
        students
    – The mentor is expected to notify the Course Faculty immediately when the
        performance of the student is in question
    3.6.3 Mentoring Tips
    Students should be assigned a clinical facilitator who also acts as a mentor. The
    clinical facilitator may assign other employees the role of a mentor because the
    student is going to be spending time in different departments of the institutions. A
    mentor is an experienced person who trains, guides and advises someone to help
    them learn something new.
    The type of clinical supervision and support that you will experience may differ
    depending o health care environment where students are placed. Here are some
    examples and explanations of the types of clinical support, and where you may

    experience that model of supervision.

    3.6.4 Procedure to reduce risk of training dropout

    According to Clinical placement syllabus/and education system each end of term,
    there is a midterm clinical setting assessment which will be graded to show the
    student’s performance progress. The marks will not be considered at the end of
    the term but it will be recorded. At the end of every term there will be clinical setting
    comprehensive assessment for all students organized in which the general situation
    of progress of the student is assessed. If the conclusion is that the student shows
    difficulties and risks to repeat the class/program; the herewith described procedure

    must be applied.

    The procedure aims to fast intervene and define effective measures. This should
    happen as early as possible in the first term of the year. A discussion based on

    careful professional assessment is the right way to do this.

    3.6.5 Coaching

    Coaching is an ongoing professional learning relationship in which a clinical
    facilitator with appropriate competences inspire students (by challenging them) to
    maximize their professional potentials through initial and follow up conversation
    aiming to support them to learn from within rather than teaching them. It builds on a

    shared understanding on effective teaching, learning and leadership.

    As students get in deep of application or develop autonomous capacity, the clinical
    facilitator shifts from the mentoring to the coaching role. Through the conversation,
    the clinical facilitator helps students to be able to find solutions to the problems and

    challenges they encounter in the clinical setting.

    The student should be able to use the professional language and quality standards,
    as well as methods, procedures, equipment, and materials in a professional manner

    (professional competence).

    – Throughout clinical setting learning process, the clinical facilitator must
        highlight that:
    • The quality work should be organized carefully and consciously
    • Attention is paid to the economic and ecological aspects
    • The professional work techniques, learning, information, and communication
    strategies are applied in an objective-oriented way
    • Thinking and acting in processes and networks is needed
    – The coach facilitates the student to consciously shape his/her relationships
        with her/ himself, in the team and with customers and deal constructively with

        challenges in communication and conflict situations

    – Let it be known that students reflect on their thinking and acting on their
       own. They are flexible about changes, learn from the limits of resilience and
       develop their personality. They are willing to perform, maintain good working
       posture and continue to train for lifelong learning
    – Guide the student in time management and setting procedures priorities
       (e.g. to stay focused when assigned a procedure, to take the initiative to find
       additional work, to record procedures, to know how to say NO, etc.).
    – Involves the student in the activities of the institution (formal and informal) so

       that they develop a sense of belonging

    3.7 Supervision and interaction with the student

    From the first day a student gets in the clinical setting, the clinical facilitator will
    play the supervision role of all the activities that a student will be involved in. That
    is why the clinical facilitator as In-house supervisor will play a central role in the
    success of the student minimizing dropout and irregularities risks by meeting his/
    her expectations and achieving outcomes, providing quality training with good
    general clinical setting conditions; gender responsive environment and effective
    clinical setting relationships, as well as increasing the student feelings about how

    supported he/she is in the clinical setting.

    As the clinical setting supervisor, the clinical facilitator is responsible for:
    – On-site training for the student
    – Answering any questions that the student may have regarding hers/ his
    training, assigned procedure or other aspects of his/her work
    – Informing the student of clinical setting expectations, safety procedures,
    codes of conduct, working hour’s information, etc.
    – Ensuring that the student is not harassed or bullied at the clinical setting
    To be an effective clinical setting supervisor the clinical facilitator will:
    – Provide a safe and supportive clinical setting environment
    – Integrate learning procedures into work activities based on the training plan
    – Manage safety and production risks during facilitation
    – Act as a role model
    – Collaborate with the school clinical placement teacher regularly to ensure
        effective training delivery and assessment, practices and to review progress
        according to the training plan
    – Promote independence and self-direction in learning
    – Motivate the student and manage the learning needs
    – Provide regular feedback, encouragement, monitor progress and maintain
       records

    – Help the student to develop problem solving and general employability skills

    Reminder:

    – Giving regular feedback on performance is a big role of a clinical facilitator,
       feedback should be balanced, emphasizing the positive but also giving
       suggestions for improvement. The positive feedback can build the students’

       confidence and make them feel good about themselves.

    – “Negative” feedback should state what was not done correctly but should
        suggest ways to improve as well. This is also known as constructive
        feedback and can help students further develop their skills and knowledge

        for student to do better.

    3.7.1 The Clinical setting comprehensive assessments

    To evaluate the student performance and make improvement/corrective measures,
    the student will be assessed on the four dimensions of competence (professional,
    methodological, social and self) throughout the clinical setting and as the work

    progresses:

    – Formative assessment: The institutional day-to-day activities, as the clinical
        facilitator is more of a technician than a trainer; the formative assessments
        will mostly be through observation and oral questioning.
    – In addition to the day-to-day formative assessments, the clinical facilitator
        will conduct comprehensive formative assessments. She/he must sit at
        least once in a term with the student and share observations with the student
        regarding the strength, weakness and the way forward. Comprehensive
        formative assessments are non-scored checks on performance criteria at
        the end of each learning procedure. The purpose of this type of assessment
        is to prepare a student for the summative assessment and is done once a
        term in the Clinical setting.
    The clinical setting comprehensive summative assessments are scored
    checks on up-to-date acquisition of all competencies at each end of term under
    the responsibility of the Clinical facilitator and school clinical teacher. A 40 minutes’
    practical schedule for each student at the designated site.
    – If scores are too low, the risk mitigation procedure may be initiated regarding
       career guidance for orientation into a suitable combination.

    SECTION 4. THE ASSOCIATE STUDENT NURSE AND

    COMMUNITY CLINICAL PRACTICE

    Community clinical practice is a grass root approach of practice that is applied
    in communities to promote and protect the health of the population. The clinical
    practice focuses on the health needs and directed towards all groups of community
    members

    Community clinical practice nursing takes place in a wide variety of settings which
    includes promoting health, preventing illness, maintaining health, restoration,
    coordination, management, and evaluation of care of individuals, families, and
    communities. In the community settings, care focuses on maximizing individual
    potential for self-care regardless of any injury or illness. The client assumes
    responsibility for health care provision.

    The purpose of this clinical practice is to introduce the associate student nurse
    to community setting. A major focus of this course is to introduce the student to
    think critically and discuss the role of community health care associate nurse within
    a national environment. Associate student nurses will be exposed to the cultural
    diverse population. Students will enhance critical thinking skills by planning and
    implementing services in the vulnerable population community.

    In this practicum, the student will identify a community health project focusing on
    a plan to improve or maintain the health of a targeted population. The project will
    involve identifying the problem, population, analyzing data, formulation a community
    health diagnosis, plans for implementation, by taking into consideration barriers,
    social, and cultural consideration) and evaluation of the project.

    4.1 Orientation of the students in Community clinical practice
        Before the associate student nurse goes for the practice, it is helpful to understand
        how to approach different types of people of different ages, behavior, lifestyle and
        contextual background. Therefore, the teacher will hold a briefing session to the
        students on:
    – Playing a participatory process among stakeholders to encourage information
        sharing and increase awareness on health needs in the community
    – Community health-care team building comprising representatives from the
        community or members of stakeholder organizations
    – Conducting the assessment process concurrently with other functions
        throughout the course of the community health-care interventions and
        programs
    – Identifying community people’s health-care needs (individuals, families,

        groups in the community), which lays a strong foundation for other functions

    – Collecting up-to-date information, representing both the people’s perspectives/
        experiences
    – Attendance in community setting is encouraged and compulsory
    – The students need to understand the community contexts
    – There are readings that have to completed so as to adequately participate in
        assignments
    – In order to complete this course successfully, the students have to participate
       in all course activities like homework, course project, self–reflections, etc.
    – Students are expected to engage in course activities and submit work by due
       dates and times.
    The associate student nurse needs to follow the steps below for community

    placement to improve the health promotion.

    4.2 Steps for Community Nursing Diagnosis

    Step 1: Assessment

    Assess a targeted population in the community to see what needs exist. This
    is done by searching health data for the specific population. Interviews may be
    conducted among the community members from the population, select and define
    the community by noting its history. What makes the community thrive today,
    describe the physical environment of the community, capture a picture of your
    selected community. What are the vital health needs of the community? Think about
    socioeconomic status. What illness or diseases are present in that community? Do
    members in that community have easy access to primary care? What are the most
    prevalent health problems in that community?
    Characteristics of the assessment process:
    – A participatory process among stakeholders to encourage information sharing
       and increase awareness on health risks and problems in the community
    – Community health-care team building comprising representatives from the
        community or members of stakeholder organizations
    – Conducting the assessment process concurrently with other functions
        throughout the course of the community health-care interventions and
        programs
    – Identifying community people’s health-care demands (individuals, families and
        groups in the community) which lays a strong foundation for other functions
    – Collecting up-to-date information, representing both the people’s perspective/

        experiences and academic perspective.

    Step 2: Community Diagnosis
    Formulate a community health nursing diagnosis related to this health need, based
    on this data, survey results and community input. After conducting the survey and
    community assessment, what are the strengths and needs of that community?
    Step 3: Plan the community intervention
    This includes analyzing data collected and reviewing evidence-based interventions.
    The intervention must be based on data showing the intervention that has been
    done in the past somewhere and was effective. Planning will also include reflecting
    on barriers, social and cultural considerations. The student should ask him/herself
    if this will have a positive health impact in the designated population, whether the
    goals are realistic and whether there will be any need for spending money.
    Step 4: Implementation
    The student creates an educational presentation describing how the program
    would be implemented, present the plan to the teacher to see if the plan will be
    implemented.
    Step 5: Evaluation
    States how to evaluate the intervention and how the evaluation will impact the

    population

    4.3 Student Responsibility

    – Attendance in community setting is encouraged and compulsory
    – The students need to understand the community contexts
    – There are readings that have to completed so as to adequately participate in
        assignments
    – In order to complete this course successfully, the students have to participate
        in all course activities like homework, course project, self–reflections, etc.
    – Students are expected to engage in course activities and submit work by due

        dates and times

    4.4 Reporting the community placement
    At the end of the community placement, students will be required to submit certain
    assignments from each course to demonstrate that they have met the objectives of
    the program. All assignments should be submitted in time and feedback also given

    in time for proper progression of students.

    CONCLUSION

    The program for the associate nurse requires intensive theoretical and practical
    package simultaneously. To learn the basic theory, there is need to understand
    the concept of professional behavior and develop the dexterity to perform practical
    skills to prepare for clinical placement is a large undertaking.

    The complexity of learning in the clinical environment is challenging, the student
    needs to learn to think critically in applying theory to a variety of individuals in
    unique contexts as well as developing the ability to care for individuals. They also
    learn to work with other members of the health care team, again in a variety of
    settings.

    The students in this program are expected to undergo clinical experience assigned
    to them enthusiastically using the nursing process approach as well as current
    trends and issues in nursing profession.

    It is hoped that this clinical manual will provide the information and tools to prepare

    well and participate in a productive, enjoyable clinical learning experience.

    APPENDIX


  • STUDENT CLINICAL LOG BOOK

    SENIOR 4

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    SENIOR 5

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    SENIOR 6

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  • PROPOSED TIMETABLE

    5.1 TENTATIVE TIME TABLE FOR SENIOR FOUR CLINICAL

    PLACEMENTS DURING ORIENTATION PERIOD

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    5.2 A TENTATIVE TIME TABLE OF CLINICAL PLACEMENT FOR

    SENIOR FIVE-WEEK ONE

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    5.3 A TENTATIVE TIME TABLE OF CLINICAL PLACEMENT FOR

    WEEK ONE IN SENIOR SIX

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    5.4 A TENTATIVE TIME TABLE OF CLINICAL PRACTICE AT

    DIFFERENT POSSIBLE TIMES OF THE YEAR

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  • CLINICAL PLACEMMENT OBJECTIVES OF FUNDAMENTALS OF NURSING AND MATERNAL AND CHILD HEALTH S4

    COMPETENCIES:

    At the end of senior four, the student will be able to demonstrate:

    – Professional behavior attitude and observe nursing code of ethics.

    – Team work, by collaborating with other healthcare team members.

    – Empathy and patience during care provision.

    Competence in self-directed learning, by seeking more information on the internet

    and other sources.

    CLINICAL OBJECTIVES:

    At the end of studying fundamentals of nursing in S4, Student will be able to:

    Perform aseptic and non-aseptic techniques (hand washing, applying sterile gloves

    and dressings)

    1. Wash hand with respect of all steps of hand washing
    2. Wear appropriately sterile and non-sterile gloves during provision of nursing
    care
    3. Use appropriately the safety box during provision of nursing care
    4. Clean and disinfect the clinical materials and equipment including tray and
    trolley
    5. Clean and disinfect the used materials according to the healthcare setting
    policy
    6. Dispose the medical wastes according to the healthcare setting policy
    7. Use appropriately personnel protective equipment in clinical settings (Gloves,
    gown, mask, goggles)
    8. Make an unoccupied bed for medical and surgical patients
    9. Make occupied bed for patient who can sit and who cannot sit
    10. Perform bed bath for critically ill patients taking into consideration his/her
          medical conditions
    11. Assist client with and oral hygiene
    12. Ensure cleanliness, proper lighting and ventilation of the ward environment.
    13. Ensure client / patient privacy, hygiene and comfort
    14. Assist client/patient to assume correct positioning
    15. Change position of clients according to the medication condition of the patients
    16. Transfer the client /patient using appropriate techniques
    17. Care for bed-ridden patients appropriately while assisting coughing exercises,
          preventing bedsores and contractures,
    18. Take and interpret vital signs and parameters (temperature, respirations,
    blood pressure and pulse, oxygen saturation, pain, height and weight).
    19. Provide basic nursing interventions during abnormal vital signs
    20. Take patient full history from different sources
    21. Perform physical assessment using inspection
    22. Document health assessment findings
    23. Interpret information collected
    24. Provide for proper elimination (urinal, bedpan and changing of diapers)
    25. Perform a rectal evacuation (enema, high bowel washes out)
    26. Perform manual removal of fecaloma
    27. Perform hygiene care of ileostomy or colostomy
    28. Perform drug administration (IM, SC, ID, PO, sublingual, suppositories,
    vaginal, ear, eye, nose, topical application)
    29. Calculate drug dosages as prescribed.
    30. Monitor drug reactions in patients.
    31. Assess client / patient comprehensively utilizing the nursing process.
    32. Document nursing care effectively and appropriately.
    33. Participate in promotion, preventive, curative and rehabilitative activities to
    the Community
    34. Prepare and conduct health education, counseling for patients or various
    groups
    35. Provide oral and written report
    36. Analyze factors model of personality in dealing with people
    37. Apply the stages of behavior change in influencing behavior of people
    38. Participate in behavior change campaigns to promote health and wellbeing
    39. Adapt patient care based on relevant factors relating to culture, gender and
            religion
    40. Participate in prevention of health risk behavior and promotion of enhancing

            health behavior

    At the end of studying maternal and child health in S4, Student will be able to:
    1. Assess the expectant mother using the nursing process.
    2. Incorporate the family in the plan of care of the expectant mother.
    3. Admit pregnant woman in antenatal care services
    4. Provide health education focusing on antenatal care
    5. Perform focused antenatal care
    6. Collect laboratory samples for pregnant woman
    7. Interpret laboratory investigation findings for a pregnant woman
    8. Screen for the risks in pregnant woman
    9. Provide appropriate interventions to pregnant woman
    10. Teach mother on self-breast examination.
    11. Measures fundal height for pregnant woman
    12. Uses Leopold’s maneuver in the assessment of the expectant mothers’
    abdomen.
    13. Estimate the strength and duration of uterine contraction
    14. Auscultate and count fetal heart rate.
    15. Give health education to the mother and family according to stage of
           pregnancy.
    16. Perform vulvar disinfection
    17. Perform digital vaginal examination
    18. Estimate descent, dilation, cervical position, and presentation
    19. Interpret the findings of vaginal examination and fetal heart rate
    20. Manage and monitor a mother in labor using a partograph.
    21. Manage and assist the first, second and third stages of labor.
    22. Assist mother in delivery
    23. Preform Active Management of Third Stage of Labor
    24. Appropriately deliver the placenta
    25. Examine the completeness of the placenta
    26. Initiate the management of postpartum hemorrhage while calling for help or
    before transfer the mother to higher level of healthcare setting
    27. Perform the procedure of Help babies breathe
    28. Put the newborn in skin to skin with her/his mother
    29. Initiate breastfeeding with one hour of delivery
    30. Separate newborn from the mother
    31. Perform the procedure of Help babies breathe
    32. Perform immediate newborn assessment
    33. Administer ophthalmic tetracycline
    34. Administer Vitamin K
    35. Administer anti-retroviral medication if indicated
    36. Put on clothes for newborn
    37. Administer vaccines and supplements as prescribed.
    38. Ensure the mother undergoes the recommended laboratory tests
    39. Make use of appropriate positions during different procedures (ultrasound,
            speculum assessment).
    40. Assess the mother and newborn before transferring to the postnatal ward.
    41. Assess and care for the newborn using the nursing process.
    42. Provide postpartum care
    43. Give education concerning the importance of breast-feeding

    44. Give health education using a teaching plan (one on one or group session)

    COMMUNITY CLINICAL

    PLACEMMENT OBJECTIVES S4

    COMPETENCIES:

    At the end of senior four, the student will be able to:
    – Educate on health promotion and illness prevention,
    – Provide health education to community,
    – Educate on promotion of behavioral changes so as to enable persons to take

        control of their health

    OBJECTIVES:

    At the end of senior four, the student will be able to:
    1. Participate in health promotion, preventive, curative and rehabilitative
    activities to the Community
    2. Perform community assessment
    3. Perform community diagnosis
    4. Plan community
    5. Plan interventions
    6. Prepare and conduct counseling for patients or various groups
    7. Provide health education to individual, family, groups and community
    according to their needs
    8. Apply psychosocial concepts in interpersonal collaboration and community
    intervention.
    9. Collaborate with stakeholders for intervening in the community
    10. Initiate the behavior change interventions for individuals, families, groups and
    communities
    11. Advocate for patient
    12. Communicate effectively with client and team
    13. Collaborate effectively with clients and team
    14. Provide oral and written report
    15. Analyze factors model of personality in dealing with people
    16. Apply the stages of behavior change in influencing behavior of people
    17. Participate in behavior change campaigns to promote health and wellbeing
    18. Adapt patient care based on relevant factors relating to culture, gender and
             religion
    19. Participate in prevention of health risk behavior and promotion of enhancing

            health behavior

    CLINICAL PLACEMMENT
    OBJECTIVES OF FUNDAMENTALS
    AND MATERNAL AND CHILD

    HEALTH OF NURSING S5

    COMPETENCIES:
    At the end of senior five, the student will be able to demonstrate:
    – Professional behavior attitude and observe nursing code of ethics.
    – Team work, by collaborating with other healthcare team members.
    – Empathy and patience during care provision.
    Competence in self-directed learning, by seeking more information on the internet
    and other sources.
    CLINICAL OBJECTIVES:
    At the end of studying fundamentals of nursing in S5, Student will be able
    to:
    1. Apply the techniques of simple wound dressing
    2. Perform different techniques of bandaging
    3. Carryout simple laboratory investigations (RTDL, Glycemia, Glucose and
          albumin)
    4. Collect and label different specimens
    5. Interpret complete blood count laboratory results
    6. Apply critical thinking skills in assessing and managing a client with medical
          and surgical health problems
    7. Perform first aid care during asthma attack, hypertensive crisis, heart attack,
          stroke and epileptic seizures.
    8. Apply theories of family in provision of healthcare to the family
    9. Provide healthcare to the family and special population
    10. Interact effectively with special groups in the community
    11. Compare and contrast techniques that enhance communication to techniques
            that hinder communication
    12. Communicate effectively with clients
    13. Apply guidance and counselling techniques to assist individuals group, family
           and
    14. Community
    15. Participate in gender based violence prevention interventions in community
    16. Provide the gender based violence prevention health education to community
    17. Utilize the national gender based violence prevention guidelines in managing
            the cases of gender based violence
    18. Provide first aid care for patients with burn
    19. Perform wound cleaning
    20. Perform wound dressing
    21. Perform health assessment of respiratory system
    22. Perform health assessment of cardiovascular
    23. Perform health assessment of digestive system
    24. Perform health assessment of urogenital system
    25. Administer local anesthesia before wound suture
    26. Perform simple wound suture
    27. Provide bedsore care
    28. Administer enema to a client
    29. Administer bed pan or urinal to client in need
    30. Provide grastrostomy care
    31. Provide ileostomy care
    32. Provide colostomy care
    33. Apply guidance and counselling techniques to assist individuals, group, family
            and community
    34. Apply correctly and appropriately ABCDE approach in emergency situations
    35. Perform victim’s evacation techniques
    36. Carryout rapid laboratory investigations.
    37. Apply first aid techniques in, burns, drowning, Chocking, Cardio respiratory
           distress, Fractures, Hemorrhages, Loss of consciousness, Snake bites and

           Epilepsy

    At the end of studying maternal and child health in S5, Student will be able

    to:

    – Perform the rapid initial assessment of a mother during postnatal period
    – Provide care to a mother in postnatal the mother during postnatal period.
    – Recognize the main danger signs for the mother during the post-natal period.
    – Conduct a counselling related to prevention of mother to child transmission
    – Conduct counselling to individuals/couples
    – Identify the main danger signs for the mother during the post-natal period.
    – Advocate against gender based violence.
    – Perform postpartum breast assessment
    – Perform postpartum uterus assessment
    – Perform postpartum bladder and bowel assessment
    – Assess the characteristics of lochia
    – Assess the mother for episiotomy
    – Assess the mother for emotional status
    – Assess for signs and symptoms of postpartum haemorrhage
    – Assess for any signs and symptoms of postpartum obstetrical emergency
    – Ass for signs of postpartum Deep Vein Thrombosis (DVT)
    – Provide care to the mother during postnatal period

    – Perform newborn assessment

    COMMUNITY CLINICAL

    PLACEMMENT OBJECTIVES S5

    COMPETENCIES:

    At the end of senior four, the student will be able to:

    – Educate on health promotion and illness prevention,
    – Provide health education to community,
    – Educate on promotion of behavioral changes so as to enable persons to take
        control of their health
    OBJECTIVES:
    At the end of senior four, the student will be able to:
    1. Apply theories of family in provision of healthcare to the family
    2. Provide healthcare to the family and special population
    3. Interact effectively with special groups in the community
    4. Compare and contrast techniques that enhance communication to techniques
    that hinder communication
    5. Communicate effectively with clients
    6. Apply guidance and counselling techniques to assist individuals group, family
    and
    7. Community
    8. Participate in gender based violence prevention interventions in community
    9. Provide the gender based violence prevention health education to community
    10. Utilize the national gender based violence prevention guidelines in managing
    the cases of gender based violence

    11. Provide counseling related to reproductive health issues

    CLINICAL PLACEMMENT
    OBJECTIVES OF FUNDAMENTALS
    AND MATERNAL AND CHILD

    HEALTH OF NURSING S6

    COMPETENCIES:
    At the end of senior five, the student will be able to demonstrate:
    – Professional behavior attitude and observe nursing code of ethics.
    – Team work, by collaborating with other healthcare team members.
    – Empathy and patience during care provision.
    – Competence in self-directed learning, by seeking more information on the
    internet and other sources.
    CLINICAL OBJECTIVES:
    At the end of studying fundamentals of nursing in S6, Student will be able
    to:
    – Collect relevant information of client from different sources
    – Interpret information collected
    – Use different techniques to conduct client physical exam
    – Determine correctly an individual’s daily dietary requirements
    – Develop individualized nutrition plans for clients of all ages and those with
         special needs, such as children, adolescents, the elderly and pregnant women
    – Practice oral feeding for patients
    – Practice feeding for patients with nasogastric tubes
    – Provide appropriate anti-infective drug for an infectious disease treatment
    – Utilize National treatment guidelines to manage infectious diseases
    – Provide basic palliative care in a healthcare setting and in community.
    – Apply acquired knowledge in promotion of proper nutritional practices in all
         age groups
    – Conducts comprehensive assessment of the nutritional status of a client in a
         culturally sensitive manner
    – Determine correctly an individual’s daily dietary requirements
    – Develop individualized nutrition plans for clients of all ages and those with
         special needs, such as children, adolescents, the elderly and pregnant women
    – Practice oral feeding for patients
    – Practice feeding for patients with nasogastric tubes
    – Offer psycho- spiritual support to the individuals in pain, families and
         community

    – Use non pharmacological pain management to alleviate pain

    At the end of studying maternal and child health in S6, Student will be able

    to:

    – Provide effectively natural family planning methods
    – Explain indications and contraindications of natural family planning methods
        to individuals
    – Provide effectively modern family planning methods
    – Provide effectively barrier family planning methods
    – Provide effectively permanent family planning methods
    – Use appropriate language while providing family planning methods
    – Screen the child growth and development
    – Discuss the growth development of a child
    – Administer vaccines according to Expanded Program of Immunization
    – Identify danger signs of pediatric illnesses
    – Explain common symptoms of pediatric illnesses
    – Detect possible danger signs from sick children
    – Detect possible common symptoms from sick children
    – Provide an appropriate classification of conditions found on sick children

    – Provide care to children with common childhood illnesses using.

    COMMUNITY
    CLINICAL PLACEMMENT 

    OBJECTIVES S6

    COMPETENCIES:
    At the end of senior four, the student will be able to:
    – Educate on health promotion and illness prevention,
    – Provide health education to community,
    – Educate on promotion of behavioral changes so as to enable persons to take
         control of their health
    OBJECTIVES:
    At the end of senior four, the student will be able to:
    – Apply acquired knowledge in promotion of proper nutritional practices in all
         age groups
    – Conducts comprehensive assessment of the nutritional status of a client in a
        culturally sensitive manner
    – Determine correctly an individual’s daily dietary requirements
    – Develop individualized nutrition plans for clients of all ages and those with
        special needs, such as children, adolescents, the elderly and pregnant women
    – Educate individuals, families and communities about how to improve house
        hygiene and environmental hygiene
    – Educate the individuals, families and community members about nutritional
        needs

        Offer psycho- spiritual support to the individuals in pain, families and comm

    CLINICAL EVALUATION TOOL

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    CLINICAL SITE EVALUATION FORM


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    ATTENNDANCE FOR

    CLINICAL PLACEMENT

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