S5: Clinical Placement Manual

Topic outline

• 

  General

  • Announcements Forum
  • S5: Clinical Placement Manual File
• SECTION I: 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

  
  

  
  

  
  

  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

  
  

  
  

  
  

  
  

  SENIOR 5
  

  
  

  
  

  
  

  SENIOR 6
  

  
  

  
  

  
  

• PROPOSED TIMETABLE

  5.1 TENTATIVE TIME TABLE FOR SENIOR FOUR CLINICAL
  

  PLACEMENTS DURING ORIENTATION PERIOD

  
  

  5.2 A TENTATIVE TIME TABLE OF CLINICAL PLACEMENT FOR
  

  SENIOR FIVE-WEEK ONE

  
  

  5.3 A TENTATIVE TIME TABLE OF CLINICAL PLACEMENT FOR
  

  WEEK ONE IN SENIOR SIX

  
  

  5.4 A TENTATIVE TIME TABLE OF CLINICAL PRACTICE AT
  

  DIFFERENT POSSIBLE TIMES OF THE YEAR

  
  

  
  

  
  

  
  

  
  

• 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

  
  

  
  

  
  

  
  

  
  

  
  

  
  

  CLINICAL SITE EVALUATION FORM

  
  

  
  

  
  

  ATTENNDANCE FOR
  

  CLINICAL PLACEMENT