During your cancer/palliative care placement, you may have learned, developed and demonstrated many of the clinical skills which meet the NMC standards of competence for pre-registration education (NMC 2010). The following activities highlight some of these core skills and encourage you to reflect upon your current practice abilities. The activities focus on patients with other medical conditions/heath problems to help you transfer your knowledge and skills into other clinical situations and fields of practice.

Each of you will respond to each activity in your own way and at a different level, depending on the stage of your course and your individual abilities, development and progress. You should discuss these activities with your mentor or personal tutor, using your practice document to help you identify your achievements, demonstrate your competency and highlight any learning needs and opportunities. Your mentor may find these exercises helpful to guide you and support your learning.

Activity

Essential skills clusters

What do you consider are the important issues when caring for a patient with a cancer diagnosis. Make a list of the core nursing skills needed to care for a patient with cancer and identify which part of the cancer pathway each skill might relate to.

Now consider which of the skills in your list might be important for care of a patient without a cancer diagnosis. What are the differences in your lists?

Refer to the NMC essential skills clusters (ESCs) (NMC 2010) in Box 25.1. Consider the ESCs you may have achieved while on your cancer/palliative care placement. How might you adapt these skills in other healthcare settings and with patients who do not have a cancer diagnosis? There may not be many differences.

NMC Domain 1: 1.1; 1.8

NMC Domain 4: 4.3; 4.4; 4.5

Box 25.2 Documentation checklist

Review your practice documentation to reflect on all of the clinical skills you have achieved and those that still need to be assessed. Discuss these with your mentor to develop an action plan, ensuring that you are prepared for your next placement. If this is your final placement, your sign off mentor will be reviewing your achievements and assessing your overall performance.

The following activities explore some of the fundamental aspects that you need to consider when caring for patients to ensure you are providing up-to-date, relevant and comprehensive patient-centred care, while safeguarding vulnerable individuals.

Whatever stage you are at in your nursing education and irrespective of the healthcare setting, you are accountable for your actions and omissions and must work within the professional boundaries set out by the NMC (2008). As an accountable practitioner, you are accountable to the professional governing body (the NMC), your employer, the law and yourself. Think about how your responses to the questions above link to the key aspects or pillars of accountability which include:

Accountability

You are preparing to discharge a widowed man you have looked after for 2 weeks on a surgical gastrointestinal ward. He has had a colostomy performed for benign bowel disease. The colostomy may be reversed in the future, but this decision will not be made by the medical team for several months. You might wish to consider reading a surgical book explaining the nature of the surgery he has had and the possible outcomes (such as Chapter 17 in Pudner 2010).

You are having a conversation with him about his discharge and he raises a few issues. Consider how you might respond to each of his questions and how your responses relate to your professional practice:

He asks you to explain his new flange and colostomy bag the stoma nurse has provided. This is a system you are not familiar with.

He asks that you leave out some of the information about his admission on the discharge letter since he does not want his daughter to know about his disease.

He asks that the community nurse who was looking after him before admission is not asked to go back to him since they did not see ‘eye to eye’.

He asks you to reassure him that he will soon be back to ‘normal’.

He is worried about being lonely when he gets home and asks if you will visit him.

NMC Domain 1: 1.1; 1.7; 1.8

NMC Domain 2: 2.5; 2.8

NMC Domain 3: 3.8

NMC Domain 4: 4.4

Refresh your understanding of the underpinning background of accountable practice by reading Chapter 1 in Caulfield (2005). You should refer back to Chapter 5 to revisit the ethical principles. Develop your responses further using this additional reading to help you justify your decisions.

Box 25.3 Professional practice checklist

Identify key healthcare professionals (within the healthcare setting and university) who you can discuss issues of your own accountable practice with.

Ensure that you have read up on and are aware of the current evidence regarding the nature of patient(s) conditions and care needs for those patients you are responsible for (alongside your mentor).

Reread the NMC code of conduct and refresh your understanding of your own personal and professional boundaries

You should discuss duty of care with your mentor and how this can be compromised and maintained.

If you have the opportunity, you may wish to visit a local coroners’s court. Think about the role of the nurse in a particular case.

Ask your mentor how and what they are accountable for, with respect to their accountability to their employer.

Activity

Assessment

You are working on a surgical ward and preparing to assess the care needs of a man being admitted for planned (elective) surgery. While this might be your first experience of a surgical environment, you may have transferrable skills from your cancer placement. You have already picked up knowledge and skills about caring for a person with a cancer diagnosis and you can apply these experiences to the assessment process in this new environment.

Choose one of the nursing assessment tools you have been introduced to in your current placement or from this book (for example, the activities of living section on page 131, family assessment in Appendix two or pain assessment on page 137). Spend some time considering how the tool you have chosen might be used for a patient who has been admitted to an acute surgical environment for routine surgery and make some notes under each part of the assessment. To guide you with this activity, you might choose to look at some of the examples of surgical interventions given in the surgical placement pocket book in this series.

NMC Domain 3: 3.1; 3.3

NMC Domain 4: 4.1

Box 25.4 Principles of assessment checklist

1. Aims to gather information

2. Allows an opportunity to give information to the patient and family

3. Assists the patient to tell their own story

4. Ascertains patient understanding of what is planned for their care

5. Affirms patients’ holistic identity and needs

Now refer back to your completed assessment tool for the surgical patient and check that you have covered these five principles.

For further information on the principles of assessment, refer to Chapter 1 in Holland et al (2008) which consolidates the principles of assessment as it is applies to the activities of living model.

Communication is a core skill that is central to effective high-quality health care. As well as communicating with patients and their carers, it is essential that we communicate with other healthcare professionals to ensure information is shared appropriately and in a timely fashion. It is important that we think about who we are communicating with; what the purpose of the communication is; what the person needs to know; what the best method of communication is; and when the best time to communicate is.

As well as preserving confidentiality in terms of professional accountability, patients have the legal right to confidentiality under the Data Protection Act 1998, the Human Rights Act 1998 and the common law duty of confidence (Freedom of Information Act 2000). They have the right to ask for a copy of their health records and any other personal information that healthcare organisations hold about them. Find out what the process is in your healthcare organisation in order for patients to access their medical records.

Activity

Communication

You are a final year student and preparing to hand over a critically ill woman to the nurses arriving on the next shift. The patient has been diagnosed with sepsis (see page 99) and is deteriorating. You have been caring for this patient for the past 4 days and have got to know her family quite well. Her husband has dementia.

Make notes on the important elements of what you need to communicate at this handover to the next shift under the following headings:

Evaluation of current condition.

Ongoing medical interventions.

Role of multiprofessional team members.

Evaluation of care delivered during the last shift.

Ongoing observations and nursing care requirements (don’t forget to consider her care needs from a holistic perspective. Refresh your memory on page 45).

Relatives’ understanding of the situation (go to page 32 to refresh your memory on supporting patients and relatives who may be given bad news).

You can refer back to page 99 where you were introduced to the principles of caring for a patient with sepsis. Use this as a checklist to review how you have planned your communication.

Read Jootun and McGhee G (2011) (see References) for guidance on communicating with a person who has a diagnosis of dementia. This will help to focus on the needs of the husband.

At every handover, there is the potential that vital information may not be communicated correctly and this can have a detrimental impact on the experiences and outcomes for the patient, relatives and care team. Therefore, you need to structure the way you communicate and be systematic in your approach to providing this information.

NMC Domain 1: 1.4; 1.5; 1.6

NMC Domain 2: 2.1; 2.2; 2.7; 2.8

NMC Domain 4: 4.3; 4.6

Activity