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STUDENT WORKBOOK

Clinical Placement

NRS3103
Aged Care Nursing - Clinical

Student Name: Aya agha

Student Number: A00043712

Semester/Year #2020_2021

Date of Submission: 15-11-2020

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FCHS COVID-19 GUIDELINES

Clinical Training (at Campus Laboratories or in Hospitals)

 All students shall complete the Covid-19 test and download ALHOSN Application on their
mobiles
 All students shall complete the online training course on Covid-19 infection provided by the
educational institution.

Personal Protective Equipment (PPE) and Infection Control Protocol

 All students shall complete training in handling PPE.


 All students shall follow public safety protocols, in addition to special procedures to reduce the
transmission of infection in health care facilities.

Clinical Training

 Students shall be exempted from being in direct contact with patients who are diagnosed as or
suspected of having Covid-19. However, students shall attend in hospitals providing treatment
for Covid-19 cases, on a rotational basis.

Undertaking

 Before starting clinical training, students shall sign a waiver of any right to take legal action in the
event of being diagnosed as having Covid-19 due to such training.

Safety Precautions

 Students shall comply with the latest safety measures and any additional measures such as
(wearing face masks, checking the temperature, maintaining physical distancing, and following
hand hygiene practices recommended in areas of patient and non-patient care).
 Students who shall be associated in clinical training must undergo the necessary periodic checks
according to the health educational facility’s guidelines

Exemptions
 If students have valid reasons that clinical training would harm their health, they will need to
communicate directly with the educational institution to give them a leave, so that conditions are
safe for them to return to such clinical training.

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 Basic science students, enrolled from the first to the third (1-3) academic year in faculties of
medicine, and from the first to the second (1- 2) academic year in nursing, shall be exempted
from clinical training this year, and training shall be provided through clinical skills and
simulation laboratories.
Monitoring

 The clinical tutor shall monitor students' compliance with the procedures.

Physical Distancing

 All (employees/visitors/trainees) shall undergo a mandatory temperature check before entering


any educational establishment on a daily basis.

 All employees, visitors, and students shall wear face masks at all times upon entry into the
establishments. Failure to comply with this procedure would deprive them of entry.
 Hand sanitizers shall be installed.

 Signs of physical distancing shall be placed on elevator floors and users shall comply with
standing on such signs. Priority shall be given to people of determination and pregnant women.
 A distance of (1.5 meters) shall be maintained between individuals in (training classrooms and
training institutes and centers) and 2 meters shall be maintained in meetings, common areas,
workplaces, coffee makers, elevators, bathrooms and customer service areas.
 As for classroom training tables, a distance of not less than 2 meters between trainees and
trainers shall be maintained.
 Group activities shall be prohibited.
 Two meters shall be left between dining tables.
 All waiting/sitting areas inside the facility shall be removed.

Reference

Ministry of Education (MOE). (2020). Operation of Educational Establishments during the Pandemic:


Protocols & Procedures. Third Release 3.0. Abu Dhabi: MOE.

3
Nursing Programme
Student Workbook

Course Name: Aged Care Nursing- Clinical

Course Code: NRS 3103

Credit Hours: 2

Pre-requisite NRS2207,NRS2208,NRS2209
NRS3106,NRS31073,NRS2204
, NRS2205,NRS2205,
NRS2206

Co-requisite -

Semester/Academic year Semester 1/2020 - 2021

Clinical instructor
Course Coordinator: Jeffrey Victorino de Jesus

Extension: 06 701 7259

Pager: -

E-mail: Jeffrey.jesus@fchs.ac.ae

4
Revision Table

Release Date Revised by and Approved by Approval date


Reason for Revision
#

1 August Imad Maalouf Dr Ahmad 30 August 2018


28, 2018 Nathira Al Hmaimat Saifan
Reason : periodic

2 August Imad Maalouf


19, 2019 Reason : Periodic
3 August Jeffrey de Jesus
18, 2020 Reason: Periodic
4
5
6

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Contents

Revision Table.......................................................................................................................................................... 3
INTRODUCTION...................................................................................................................................................... 4
CLINICAL OBJECTIVES.......................................................................................................................................... 5
................................................................................................................................................................................. 5
Clinical Competencies............................................................................................................................................ 11
CLINICAL ASSESSMENT TOOL (CAT)................................................................................................................. 41
KEY to FINAL RESULT.......................................................................................................................................... 42
Key…………….................................................................................................................................................... 42
Marginal.............................................................................................................................................................. 42
Assisted.............................................................................................................................................................. 42
GUIDELINES FOR THE CLINICAL ASSESSMENT TOOL (CAT).........................................................................50
Nursing Care Plan.................................................................................................................................................. 52
Nursing Care Plan Grading Criteria:....................................................................................................................... 69
Student Continuous Assessment - Professionalism............................................................................................... 72
Appendices............................................................................................................................................................. 76
1. Mini-Mental State Examination (MMSE)..................................................................................................... 76
2. The Mini CogTM........................................................................................................................................... 80
3. MORSE FALL SCALE................................................................................................................................ 82
4. Braden Scale.............................................................................................................................................. 83

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INTRODUCTION
The students’ Clinical workbook is aimed at enabling the student to implement the skills and
knowledge gained, and keep track of their performance throughout all clinical courses during
the nursing program. By the end of each course, students be able to successfully fulfil all the
clinical objectives included in this clinical workbook.
This clinical workbook contains records and evidences about students’ clinical learning
experiences, skills and competencies. As a self-directed lifelong adult learner, students are
expected to demonstrate high level of responsibility towards utilising every learning opportunity
available at the clinical setting.

CLINICAL OBJECTIVES
The aim of this workbook is to guide you to achieve the Clinical Learning Outcomes visualized
in Table 1. Students should be aware of the daily clinical objectives for each course and
should be involved with the health care team to achieve their goals

Fatima College of Health Sciences


School of Nursing
Clinical Objectives & Requirements
Student Year
4th year, Semester 1
Level

Course Code &


NRS3103 Aged Care Nursing-Clinical
Name
Course
Convenor Abu Dhabi & Al Dhafra:
Dr. Nathira Al Hmaimat 02/ 5078659
nathira.alhmaimat@fchs.ac.ae

Al Ain:
Mr. Imad Maalouf 03/ 7035416 Imad.Maalouf@fchs.ac.ae

Ajman

7
Jeffrey Victorino De Jesus 06/ 7017295 jeffrey.jesus@fchs.ac.ae0

The Course FIRST POINT OF CONTACT FOR ACADEMIC PERFORMANCE ISSUES


Convenor can ON PLACEMENT
be contacted in
relation to:  The academic ability of individual students
 The course content and objectives
 The level of clinical competency each student should demonstrate
during clinical placement
 The development and implementation of a Formative Review for at
risk students
Abu Dhabi :
Dr. Nathira Al Hmaimat
nathira.alhmaimat@fchs.ac.ae
Office: 02-5078659
Mobile: 0551219708

Al Ain :
Dr. Mohamed Mekkawi
Mohamed.Mikkawi@fchs.ac.ae
Office: 03-7035417
Mobile: 050583654
Clinical
Coordinator
Ajman
Contact Details
Mr. Jeffrey Victorino De Jesus
jeffrey.jesus@fchs.ac.ae
Office: 06 7017295
Mobile# 050 603171

AL Gharbia
Mohannad Al Jabery
mohannad.aljabery@fchs.ac.ae
Office:
Mobile:

The Clinical  Any clinical placement related issue


Coordinator
can be  Please contact the clinical coordinator if you have not been able to
contacted in contact the course convenor or facilitator
relation to:

Learning On completion of this course students will be able to:


Outcomes

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1. Identify normal ageing patterns.

2. Demonstrate an awareness of personal attitudes and beliefs and how


they affect nursing care.

3. Identify and implement effective communication and management


strategies for working with older adult clients.

4. Analyse at a basic level haemodynamic parameters in association with


illness in older person.

5. Exhibit beginning clinical skills for working in high acuity areas.

6. Demonstrate clinical competency and theoretical knowledge of


effective work practices when working with older people living with
chronic illness.

7. Demonstrate knowledge, accuracy and accountability in quality use of


medicines.

Relevant
Learning
No Assessment Tasks Value Due Date
Outcome
s

Professionalism 20% 1-6 Weekly


1

Assessment
2 Nursing Care Plan 20% 1-6 TBA
Summary
Clinical Assessment 40% 1-6 Week 14
3
Tool - CAT

TBA by
Drug calculation 20% 7 individual
4
clinical
staff

Placement Each student must attend 3 days for a period of 10 weeks per the
dates semester.

Expected
Full patient load working under the guidance of a registered nurse.
patient load
RESTRICTIONS
If the health agency has specialist skills that an RN must achieve then

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the student is not allowed to perform that task, such as IV cannulation, or
any other procedure specified by the hospital policy.

Medication Administration:

MUST BE SUPERVISED BY A REGISTERED NURSE


AT ALL TIMES

Medication Administration:

 All students have successfully completed the medication


calculation competency, however they are not allowed to
administer any medication (oral, topical, inhalation, eye, and
ear, intramuscular, subcutaneous and intravenous
medications) without the supervision of a Registered Nurse.

 Students are able to manage UNDER SUPERVISION IV lines


and fluids via gravity and pump devices

 Students are not allowed to administer controlled drugs (S8).


Students should be made aware of the Hospital
processes/guidelines and policies of controlled drugs and high
alert medication administration.

What is Professionalism
expected from  100% attendance on clinical placements is MANDATORY
the students
during the  Maintains confidentiality of patient information
clinical
placement  Adheres to uniform dress code

 Respects patient’s right (e.g. Privacy during procedures)

 Accepts constructive feedback positively

Interpersonal skills
 Is honest and trustworthy

 Works well with other healthcare professionals

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 Displays effective verbal and nonverbal communication skills

 Reports back with answers to questions asked by clinical facilitator

Technical competency(General)
 Demonstrates safe practice (e.g. putting up side rails)

 Complies with international infection control practices (e.g. hand


washing, standard precautions)

 Follows hospital policies (e.g. patient identification before any


procedure)

 Students are required to write daily objectives including objectives


from all domains: cognitive, psychomotor, and affective Domains.

 A comprehensive nursing care plan should be submitted at the


end of the second week with a detailed focus on the system most
concerned with the patient’s main complaint.

 The student should be ready for discussing the normal and


abnormal findings appropriate for each case on weekly basis in
the reflective meeting.

During clinical training, students have to:


 Submit daily learning objectives every week
 Present 2 case discussions.
Students’  Submit one comprehensive NCP.
Requirement of  Practice drug calculation
the Clinical  Complete all competency skills of the course
Placement

Clinical Skills: Students are allowed to undertake the following skills under the
supervision of a Registered Nurse

Cardiovascular

 Vital signs and documentation


 Cardiac arrest roles (airway, chest compression, documentation, drugs)
 Observation of defibrillation in a safe environment
 12 lead ECG
 Care of a patient suffering from chest pain

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Intravenous Therapy

 Priming IV lines
 Care of the IV cannula site
 Calculation of IV infusion rates - drops per minute and volumetric pump
infusions
 Fluid balance documentation
 Monitoring of patients receiving blood products

Respiratory

 Care of a patient with a chest drain in situ


 Oxygen therapy, including ambi-bag resuscitation
 Incentive spirometry
 Tracheostomy care, including suctioning and tracheostomy site dressing and
care
 Respiratory observation and documentation, including SpO2
 Peak flow meters
 Basic chest physiotherapy

Neurological Care
 Seizure management
 Neurological assessment and documentation
 Stroke patient positioning, transfer and ambulation

Musculoskeletal

 Plaster/ cast care


 Mobility of a client with an orthopaedic injury
 Neurovascular assessment
 Pain management

Pain assessment
 Monitoring of a patient receiving Patient Controlled Analgesia (PCA)
 Pre/post-operative care
 Students may follow a patient through the peri-operative episode - admission,
pre-op, intraoperative, recovery and return to the ward - primarily as an
observer

Wound management

 Wound assessment
 Simple wound dressings
 Staple/suture removal
 Care and removal of drains
 Pressure area care

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Elimination:

 Insertion, care and removal of an indwelling catheter


 Stoma care
 Bladder scan, incontinence (urinary & bowel) management and care

Enteral Feeding

 Insertion and removal of a nasogastric tube


 Care of a PEG tube
 Feeding regimes

Diabetic Care:

 Care of a diabetic patient


 Blood sugar monitoring

Medication Administration Under the Supervision of a RN

 Oral, topical, inhalation, eye and ear administration


 Intramuscular, intravenous and subcutaneous medications
 Intravenous medication and intravenous additive administration

Others

 Admission and discharge procedures, including documentation and patient


education
 Progress notes and documentation in observation charts
 Adherence to standard precautions and transmission-based precautions
 Management of activities of daily living
 Accompany patients to diagnostic testing or other health care departments eg.
X-ray, rehab etc
 Collection of pathology specimens

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Clinical Competencies
Clinical Skills: Students are allowed to undertake the Date of Student Preceptor
following skills under the supervision of a performi Sign. Sign.
Registered Nurse ng the
skills.
Cardiovascular  Vital signs and documentation 6910
 Cardiac arrest roles (airway, chest
compression, documentation, drugs)
 Observation of defibrillation in a safe
environment
 12 lead ECG
 Care of a patient suffering from chest
pain
Intravenous  Priming IV lines
Therapy
 Care of the IV cannula site
 Calculation of IV infusion rates - drops
per minute and volumetric pump infusions
 Fluid balance documentation
 Monitoring of patients receiving blood
products
Respiratory  Care of a patient with a chest drain in-situ
 Oxygen therapy, including ambo-bag
resuscitation
 Incentive spirometry
 Tracheostomy care, including suctioning
and tracheostomy site dressing and care
 Respiratory observation and
documentation, including SpO2
 Peak flow meters 6910
 Basic chest physiotherapy
Neurological  Seizure management
Care
 Neurological assessment and
documentation
 Stroke patient positioning, transfer and
ambulation
Musculoskeletal  Plaster/ cast care
 Mobility of a client with an orthopedic
injury
 Neurovascular assessment
Pain  Pain assessment
management  Monitoring of a patient receiving Patient
Controlled Analgesia (PCA)
Pre/post-  Students may follow a patient through the pre

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operative care -operative episode - admission, pre-op,
intraoperative, recovery and return to the ward
- primarily as an observer

Wound  Wound assessment


management  Simple wound dressings
 Staple/suture removal
 Care and removal of drains
 Pressure area care
Elimination:  Insertion, care and removal of an
indwelling catheter
 Stoma care
 Bladder scan, incontinence (urinary &
bowel) management and care
Enteral Feeding  Insertion and removal of a nasogastric
tube
 Care of a PEG tube
 Feeding regimes 6910
Diabetic Care:  Care of a diabetic patient
 Blood sugar monitoring
Medication  Oral administration
Administration  topical administration
Under the  inhalation administration
Supervision of a  eye administration 6910
RN  ear administration
 Intramuscular administration
 subcutaneous administration
 Intravenous medication and intravenous
additive administration
Others  Admission and discharge procedures,
including documentation and patient
education
 Progress notes and documentation in
observation charts
 Adherence to standard precautions and
transmission-based precautions
 Management of activities of daily living
 Accompany patients to diagnostic testing
or other health care departments eg. X-
ray, rehab etc
 Collection of pathology specimens

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Clinical Goal Setting Sheet
(To be completed by the student in Day 1)

Student Name: Aya Agha


Course & Code: Aged care Nursing clinical _ 1147
Placement Dates: 19-10 started.
Facility: Amana health care
Clinical Facilitator: Mrs. Hillary twiggs.

What would you like to achieve during this clinical practicum placement, and
Why?

I would like to improve my nursing skills and enhance my


experience in the clinical field. To train myself to handle different
types of situations and to solve the various challenges. I want to
be more flexible and have the ability to stand up for my patients.
To fight for their health with them and to learn from everyone.

What are my weaknesses? What are my strengths?

Medications
I seek knowledge and skill improvement
medical abbreviations

What can I do to overcome my


What can I do to utilize my strengths?
weaknesses?

Take important notes


Keep going and look for new information
Write new knowledge, and memories it

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Student’s Signature: Aya Agha Date: 25/10

18,19,20 October week 1


Student’s Clinical Daily Objectives
(To be completed by student daily)

Student Name: Aya Agha


Course & Code: Aged care Nursing clinical _ 1147
Placement Dates: 19-10 started.
Facility: Amana health care
Clinical Facilitator: Mrs. Hillary twiggs.

1. Daily Objectives

Objective 1: Today I will listen to Amana health care orientation videos and will take some
quizzes through teams by 12 pm.

met  not met  If not met, why? Met.

Objective 2: Today I will have a tour in the hospital and learn more about the place and my
patient by 8.

met  not met  If not met, why? Met.

Objective 3: Today I will take my age care nursing midterm. OFF of clinical.

met  not met  If not met, why? Met

2. Tasks and/or Procedures Accomplished


This week

I listened to all of the videos provided and made a good score on the quizzes.
Met our teacher
I handed my papers (consent, other information papers.)
I was introduced to amana’s staff and it’s sections
I was assigned to my great patient and preceptor also I had the chance to read about
her.
I helped my preceptor in bathing my patient.

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I observed medication administration + tracheostomy care + ECG leads placement
I interpreted some of lab results like ABG.

3. New Knowledge Acquired

Amana operates medical and rehabilitation hospitals in the United Arab Emirates.
It’s for people who’ve been through a life-changing event like an accident or
serious surgery and need specialized rehabilitation, to people who need long-term
care for medically complex issues.

12-lead Precordial lead placement
1. V1: 4th intercostal space (ICS), RIGHT margin of the sternum.
2. V2: 4th ICS along the LEFT margin of the sternum.
3. V4: 5th ICS, mid-clavicular line.
4. V3: midway between V2 and V4.
5. V5: 5th ICS, anterior axillary line (same level as V4)
6. V6: 5th ICS, mid-axillary line (same level as V4)

4. Reflective Comments

Strengths
I’m so excited for this training! I think Amana hospital is going to teach me a lot of
knowledge. It was my first time joining a bathing for a bedridden patient and her
tracheostomy care and it was new work for me but it went very well.

Weaknesses:

Medication + medical abbreviations.

Instructor Feedback:

Student’s Signature: Aya Agha Date: 18,19,20 October

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25,26,27 October week 2
Student’s Clinical Daily Objectives
(To be completed by student daily)

Student Name: Aya Agha


Course & Code: Aged care Nursing clinical _ 1147
Placement Dates: 19-10 started.
Facility: Amana health care
Clinical Facilitator: Mrs. Hillary twiggs.

1. Daily Objectives (select the objectives from the course objectives sheet)

Objective 1: Identify normal aging patterns for my patient by 9.

met  not met  If not met, why? Met

Objective 2: Demonstrate an awareness of personal attitudes and beliefs and how they affect
nursing care by 12 pm.
met  not met  If not met, why? Met

Objective 3:. Identify and implement effective communication and management strategies for
working with older adult clients.
met  not met  If not met, why? Met

2. Tasks and/or Procedures Accomplished


First day:
Taking and interpreting Vital signs three times
Observed medication check
Crushed medication + preparation of medication + gave patient her medications
through the PEG tube under supervision.
Observed chest auscultation and compared normal vs. abnormal lung sounds
Changed pt position with my preceptor
Did tracheostomy suctioning under supervision
Took progressive notes on my patient through handover
Sec day:
Took vital signs and interpreted it first thing at the early morning and in the afternoon
Prepared medications by crushing them under supervision
Gave nebulizer under supervision
Did mouth hygiene

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Observed tracheostomy care and suctioning for both mouth & tracheostomy
Changed the patient position and gave her a bed bath.
Third day:
Vital signs interpreting three times within the day
Bathing
Tracheostomy care
1. Ventilator care: Maintain a patent airway. ... 
2. Assess oxygen saturation, bilateral breath sounds for adequate air movement,
and respiratory rate per policy.
3. Check vital signs per policy, particularly blood pressure after a ventilator setting
is changed. ...

3. New Knowledge Acquired


skin thins and becomes less elastic and more fragile, and fatty tissue just below the
skin decreases. Bruises happen to be more. Decreased production of natural oils might
make your skin drier. Wrinkles, age spots and small growths called skin tags are more
common.

Today, nurses are required to have knowledge and awareness


concerning professional values as standards to provide safe and high-quality ethical
care. Nurses' perspective on professional values affects decision-making and
patient care

4. Reflective Comments
Strengths

Maintained privacy and dignity of my patient

Weaknesses:

My patient doesn’t have iv lines so I have not met one of my competency list area.
Instructor Feedback:

Student’s Signature: Aya agha Date: 25,26,27 October

1,,2,3 November Week 3

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Student’s Clinical Daily Objectives
(To be completed by student daily)

Student Name: Aya Agha


Course & Code: Aged care Nursing clinical _ 1147
Placement Dates: 19-10 started.
Facility: Amana health care
Clinical Facilitator: Mrs. Hillary twiggs.

1. Daily Objectives (select the objectives from the course objectives sheet)

Objective 1: Today I will learn about fluid balance documentation on my patient information by 2

met  not met  If not met, why? Met

Objective 2: Today I will apply an integumentary assessment on my patient by 1 pm.

met  not met  If not met, why? Met

Objective 3: Today I will attend a physiotherapy session with my patient at 11

met  not met  If not met, why? Met

2. Tasks and/or Procedures Accomplished


This week I did:
Vital signs interpreting three times each day
Crushed tablets
Tracheostomy care and change
PEG care
Bathing + clothes changed
ECG leads placed
Pulse oximeter changed
Observed tracheostomy suctioning
Did three assessments on the patient which are neurovascular , neurological and pain
assessment.
Attended a TPN session and learnt about the sacral pressure ulcer wound
Attended a ventilator machine teaching session
Attended a teaching session on how to collect blood from a patient and applied what I
learned on a mannequin

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3. New Knowledge Acquired
Some common signs and symptoms of aging include:
 Increased susceptibility to infection.
 Greater risk of heat stroke or hypothermia.
 Slight decrease in height as the bones of our spines get thinner and lose some
height.
 Bones break more easily.
 Joint changes, ranging from minor stiffness to severe arthritis.
Stooped posture.
It’s better to take blood from the cephalic vein first

4. Reflective Comments

Strengths
I had 3 learning sessions this week about TPN, ventilator support and blood
collection.

Weaknesses:
My patient doesn’t have any sutures so I had the chance to check how to remove
sutures nor change it.

Instructor Feedback:

Student’s Signature: Aya agha Date: 1,2,3 November

8,9,10 November week 4

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Student’s Clinical Daily Objectives
(To be completed by student daily)

Student Name: Aya Agha


Course & Code: Aged care Nursing clinical _ 1147
Placement Dates: 19-10 started.
Facility: Amana health care
Clinical Facilitator: Mrs. Hillary twiggs.

1. Daily Objectives (select the objectives from the course objectives sheet)

Objective 1: Today I will apply musculoskeletal assessment for my patient by 12 pm.

met  not met  If not met, why? Met

Objective 2: Today I will do observe my patient’s respiratory status and will document the SPO2
met  not met  If not met, why? Met

Objective 3: Identify and implement effective communication and management strategies for
working with older adult clients.

met  not met  If not met, why? Met

2. Tasks and/or Procedures Accomplished


During last week I did:
Took her blood pressure
Gave medication through PEG tube
Gathered information for my NCP
Discussed my ncp with my preceptor and finalized it
Gave my patient a bed bath
Changed my patient position
Suction under supervision
Crushed medications and supervision
Checked skin for any break downs around PEG stoma
Flushed the PEG with 50 ml of water
Attended a code blue teaching session and played a role to help to making the
information clear

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3. New Knowledge Acquired
Strokes are caused by the following: Large artery thrombosis. Large artery
thromboses are caused by atherosclerotic plaques in the large blood vessels of
the brain. Small penetrating artery thrombosis. Small penetrating artery
thrombosis affects one or more vessels and is the most common type of ischemic
stroke. Cardiogenic emboli are associated with cardiac dysrhythmias, usually atrial
fibrillation.
Code blue is the term used by most medical institutions to indicate that a patient is
having cardiopulmonary arrest and needs immediate resuscitation. The resuscitation is
done by the “code team” of the hospital but initial resuscitation efforts should be done
by the nearest nurses on duty.

4. Reflective Comments

Strengths

Had the chance to join a code blue teaching session and finished my ncp

Weaknesses:

Medical abbreviations

Instructor Feedback:
Student helped for basic care of patient. Needs more practical experience to perform
independently

Student’s Signature: Aya Agha Date: 8,9,10 of October

24
Clinical Half-Way Feedback Form
(To be completed by clinical facilitator for all students)

Student Name: Aya Agha


Course & Code: Aged care Nursing clinical _ 1147
Placement Dates: 19-10 started.
Facility: Amana health care
Clinical Facilitator: Mrs. Hillary twiggs.

1. Management of Nursing Care

2. Professional and Ethical Practice

3. Professional Development

4. Comments

Clinical Facilitator’s Signature: ___________________ Date: __________________

Student’s Signature: ___________________________ Date: __________________

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Bachelor of Science in Nursing
Clinical Formative Review
Student Name: Aya agha
____________________________________________________________________
Student Number: A00043712
__________________________________________________________________
Agency Name: Amana health care
____________________________________________________________________
Clinical Setting and Ward Area/Type: Ward C
_________________________________________________
Placement Dates: 19/10 – 10/11
__________________________________________________________________
Course Name/Code: Aged care Nursing clinical _ 1147
________________________________________________________________
Clinical Facilitator: hilary twiggs
_________________________________________________________________

Prior to the middle of the clinical placement period, and at any other time deemed necessary, if the
Clinical Facilitator considers a student to be performing at an unsatisfactory level in any criteria listed in
the Clinical Assessment Tool, a student should undergo a formative review of professional practice. A
plan (as detailed below) must be constructed to address the problem area(s) identified.

Unsatisfactory standards of practice with supporting reasons (relate to criteria on CAT):


________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

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________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

Anecdotal Notes Attached (please circle): Yes No


Plan to address problem(s):

(Plan should specify objectives, evaluation criteria and time frames for achievement of goals)
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
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__________________________________________________________________________________
__________________________________________________________________________________

Action:
Discussed with Course Coordinator (circle one) YES NO
Discussed with Clinical Coordinator (circle one) YES NO

27
Facilitator’s Signature: _____________________________________ Date:
__________________

Student comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
This Formative Review has been discussed with me.
Student’s Signature: _______________________________________ Date:
__________________
Outcome(s):
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Page 2 – Formative Review

Course Convenor
Sign ___________
Date ___________
Bachelor of Science in Nursing
ANECDOTAL NOTES

28
STUDENT NAME Aya agha
STUDENT NUMBER A00043712
PLACEMENT DATES 19/11- 10/11
COURSE NAME & Aged care Nursing clinical _ 1147

FACILITY/AGENCY Amana health care center


CLINICAL
CLINICAL

Anecdotal Notes provide the clinical facilitator with the opportunity to expand on exceptional or
interesting aspects of a student’s performance. In addition, they are required in situations where less
than desired standards of professional practice have occurred.

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

Assessor Signature:___________________________________ Date: ______________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

29
________________________________________________________________________________________

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________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

Assessor Signature: ________________________________ Date: ______________________________

Final Mark

Course Convenor
Signature:
Bachelor of Science in Nursing
Name:

Date:

30
CLINICAL ASSESSMENT TOOL (CAT)
STUDENT NAME: Aya agha
STUDENT NO: A00043712
CLINICAL SETTING & WARD: Amana healthcare, ward c
PLACEMENT DATES: 19/10 – 10/11
COURSE NAME AND CODE: Aged care nursing clinical
Attended Excuse Make up plan
Absent days
days provided Y/N
Midterm
Online
10 orientation

KEY to FINAL RESULT

Key Description of Performance

Dependent 1 Unable to demonstrate procedure/behavior, Lacks confidence, coordination, efficiency

2 Unskilled; inefficient, Considerable expenditure of excess energy, Prolonged time period


Marginal

Skillful in parts of behavior, inefficiency and incoordination, Expends excess energy, Within a delayed time
Assisted 3 period

Efficient; coordinated: confident Some expenditure of excess energy Within a reasonable time period
Supervised 4
Proficient: coordinated; confident Occasional expenditure of excess energy
Independent 5 Within an expedient time period
Documentation attached: Yes Anecdotal notes attached: Yes
Number of documents attached: 4 papers which are competency list , attendance ,
instructors feed back.

31
Completion of the CAT: The 5-point Bondy rating scale provides a structure for scaffolding the degree
of competency of relevant skill/ behaviors within the 3 domains of the Health Authority for Abu Dhabi
(HAAD) Competency Standards for the Registered Nurse. However, within the competencies, the
words Registered Nurses have been replaced by the term student nurse to make it consistent
with the students’ status.

This tool has been developed by Griffith University Australia who adapted the work of Bondy, K. (1983)
Criterion-referenced definitions for rating scales in clinical evaluation . Journal of Nurse Education. 22
(9), 376-82.

The Bondy scale was graded with a grades ranging from 1 – 5, the total grades is 225 and it will
be converted to 70%.
For any scoring of 1 or 2 a formative review should be completed and discussed with the
student with a clear plan of improvement.
To be able to pass the clinical course the student has to achieve an accumulative course grades of
60%.

Domain 1: MANAGEMENT OF NURSING CARE

This domain relates to aspects of a student nurse’s performance and behavior which is required to provide appropriate and safe
care to patients/clients in a manner which is responsive to individual needs and is supported by evidence based nursing
knowledge and skills.
Total Mark for this Domain is 75
Competency 1: Promotes patient optimum health and De Ma Assi Super Inde Total out of
wellbeing p r. s . p. 30

(1) (2) (3) (4) (5)


1. Identifies, promotes and assists patients to understand Yes
major determinants of health related to the course clinical
objectives.
2. Educates patients on health risk factors specific to the Yes
course clinical objectives.
3. Teaches patients and families’ strategies to develop Yes
healthy living behavior focusing on the specific cases of the
clinical course for example, cases of Postpartum, pediatric,
medical diseases, or healthy life style practices” …etc.
4. Identifies and implements health promotion strategies for Yes

32
early detection and screening for communicable diseases.
5. Reduces the risk of disease transmission through applying Yes
standard infection control principles.
6. Uses the nursing process in the promotion of patient Yes
holistic health and wellbeing.
Competency 2: Promotes an environment that De Ma Assi Super Inde Total out of
maximizes patient safety p r. s . p. 15

(1) (2) (3) (4) (5)


1. Identifies environmental and behavioural factors which may Yes
compromise patient safety.
2. Implements appropriate actions to reduce risk and harm. Yes
3. Intervenes and follows-up on incidents to reduce likelihood
of reoccurrence, for example falling down risk management Yes
Competency 3: Promotes patient physiological and De Ma Assi Super Inde Total out of
psychological integrity p r. s . p. 30

(1) (2) (3) (4) (5)


1. Assesses, plans and manages nursing interventions to Yes
optimize outcomes care for patients throughout the specific
lifespan of the clinical course in various states of health
and illness.
2. Conduct comprehensive and systematic nursing Yes
assessment for a specific cases related to the course
clinical objectives.
3. Implements general nursing care and comfort measures for Yes
the chosen patient (s).
4. Provides care for patients with acute and chronic physical Yes
health conditions specific the clinical course the student’ is
register in.
5. Documents care and patient outcomes. Yes
6. Evaluates and manages nursing care, altering delivery and Yes
priorities according to patient needs and outcomes
ensuring continuity of care.

33
Student nurse self-assessment: Identify your current level of competence using the Bondy Scale and
give examples of demonstrated competence in the box below.
My current competency level is independent.
Examples
1. I helped to Reduce the risk of disease transmission through applying standard infection control principles like ppe and
hand hygiene every time I went in and out the patient’s room
2. I used the nursing process in the promotion of patient holistic health and wellbeing by making sure Quraan was on every day
as her family requested
3. Identifies environmental and behavioral factors which may compromise patient safety like the hight of bed and side rails.

Domain 2: PROFESSIONAL AND ETHICAL PRACTICE

This domain reflects competencies related to the professional code of conduct and the ability of student nurses to work
independently and in collaboration with others while maintaining professional standards.

Total Marks for this domain is: 95


Competency 4: Demonstrates professional behaviour when Dep Ma Assi Super Inde Total out
working with people r. s . p. of 55

(1) (2) (3) (4) (5)


1. Provides nursing care that demonstrates respect for human Yes
rights, and work within professional standards and ethical
codes of practice.
2. Protects the patient from risks, harm, abuse or neglect within Yes
the boundaries of nursing care.
3. Demonstrates knowledge of policies and procedures that Yes
guide practice.
4. Recognizes and acts upon policies, procedures or orders that Yes
might put at risk a patient’s therapeutic outcomes or is not at
best practice standards.
5. Advocates sensitively for patients’ rights based on current Yes
legislation and ethical principles.
6. Ensures confidentiality of patient information. Yes
7. Demonstrates a sensitivity to diversity in cultural and religious Yes
beliefs.
8. Utilizes effective time management strategies to organize Yes
workload.
9. Establishes and maintains professional boundaries with Yes
patients and members of the health care team.

34
10. Recognizes limitations in own professional knowledge and Yes
skills and takes appropriate action.
11. Assumes accountability for delegation of nursing care. Yes
Competency 5: Upholds and contributes to the maintenance Dep Ma Assi Super Inde Total out
of professional nursing standards
r. s . p. of 20

(1) (2) (3) (4) (5)


1. Initiates and/or participates in research that contributes to Yes
continual improvement in standards of care and extending
the nursing professional body of knowledge, for example
case study preparation and discussion with peers.
2. Identifies scientific advances and uses technology as Yes
appropriate to enhance patient care. For example online
courses and competency checkoff within SEHA
3. Demonstrates a standard of personal health which ensures Yes
that patient care is not compromised. For example wearing
PPEs
4. Demonstrates the ability to self-regulate through ongoing Yes
reflection and assessment of competency to practice. For
example accepting constructive criticism, participate in
reflection session
Competency 6: Actively contributes to collaborative Dep Ma Assi Super Inde Total out
working relationships with members of the interdisciplinary
r. s . p. of 20
health care team

(1) (2) (3) (4) (5)


1. Establishes collaborative relationships with other members of Yes
the interdisciplinary team to optimize patient outcomes.
2. Identifies, reports and documents health care practices that Yes
may compromise patient care, privacy or dignity and take
appropriate remedial action.
3. Demonstrates respect for variations in competence and Yes
professional knowledge between members of a
multidisciplinary health care team.
4. Provides and seeks constructive feedback in and between Yes
team members.

Student nurse self-assessment: Identify your current level of competence using the Bondy Scale and
give examples of demonstrated competence in the box below.
Independent

Examples
I was professional in every aspect. I helped my nurse preceptor with her other patient when she
needed help in positioning and bathing. I was silent about my patient’s private information and was
confidential. I respected my patient is dignity and health every time I had to take care of her. I made
sure to be advocating for my patient in everything.

35
Domain 3: PROFESSIONAL DEVELOPMENT

This domain acknowledges that each student nurse is accountable for establishing, maintaining and evaluating their own lifelong
learning needs including a commitment to the development of others and the profession.

Total Marks for this domain is 55


Competency 7: Demonstrates a commitment to Dep Mar. Assi Super. Indep Total out
development of self. s . of 25

(1) (2) (3) (4) (5)


1. Reflects upon and evaluates own nursing practice, for Yes
Example: through your active participation in the
reflective discussion
2. Actively seeks new knowledge and information to Yes
ensure ongoing professional development and
competency to practice.
3. Participates in ongoing professional development Yes
activities.
4. Seeks and acts upon constructive feedback from other Yes
health care professionals.
5. Maintains record of all learning and professional Yes
development activities attended. Example: participate
in any lecture or workshop is hold in the unit, or present
a new topic to your classmate during the reflective
session

Competency 8: Demonstrates a commitment to Dep Mar. Assi Super. Indep Total out
development of other’s performance outcomes s . of 10

(1) (2) (3) (4) (5)


1. Collaborates and shares professional knowledge with Yes
others During the reflective session and daily routine
wok
2. Participates in teaching and education programs when Yes
relevant.
Competency 9: Demonstrates a commitment to Dep Mar. Assi Super. Indep
development of the profession performance outcomes s .

36
(1) (2) (3) (4) (5)
1. Contributes to nursing and health care policy. Yes
(Consider modifying this to: contributes to the reflection
session by providing an evidence based knowledge
about their chosen case)
2. Represents the nursing profession on relevant Yes
committees and taskforces. Consider modifying this to:
represent the nursing program in health education or
awareness campaigns )
3. Identifies opportunities and contribute to nursing Yes
research (Consider modifying this to: Identifies a
research based information about the case study they
presented to their peers)
4. Collaborates and shares new nursing knowledge and Yes
research findings during the clinical day and the
reflection session
Total (out of 20)

Student nurse self-assessment: Identify your current level of competence using the Bondy Scale and
give examples of demonstrated competence in the box below.
Independent
Examples
I focused on my self improvement everyday. I asked my preceptor for a clarification when ever I
had knowledge deficit. I shared my experiences and new knowledge. I attended all the teaching
sessions that was provided by the hospital.

Assessor overall feedback:

Final Grade out of 225 Final grades out of 70% Date:

37
Assessor’s Signature: Print Name: Date:

Student reflection and comments:


Basically being in a placement like this was different to me. I learned so much and felt so much. I had mixed feelings and experienced
The real meaning of nursing. Me being beneficial to someone or a group of people raised my self esteem and changed my look on
Things. This placement was mind blowing. I was able to learn more about the elderly patients. It helped me to do physical assessment
For my patient and to learn the right communication. Gave me the keys for success. It was an honor to be with such a great staff
members and an amazing understanding teacher.

Final Grade out of 225 Final grades out of 70% Date:

Student’s Signature: Print Name: Date:

38
GUIDELINES FOR THE CLINICAL ASSESSMENT TOOL (CAT)

The Clinical Assessment Tool (CAT) is designed to provide Clinical Facilitators with a systematic
process to assess clinical performance, in consultation with students. Over time this assists students to
develop knowledge, skills and attributes beneficial to their role as Registered Nurses.

How to use the CAT


The clinical assessment tool contains:

 A front page of demographic and administration details;

 A Bondy Scale key to explain the description of the performance level;

 Marking sheets containing the 3 domains of nursing competency as per HAAD standards for
Registered Nurses. Within these domains are the main sub-domains which provide more detail;

 For each domain there are two Bondy Scale Chart. One should be completed by the student
and assessor for each domain;

 Example and comments boxes for completion by the student and assessor should be completed
to evidence each scale;

 A comments/reflection section for the student and assessor for each domain.

The front page must be completed for the student to have their clinical performance recorded. Please
take particular note of the number of days attended or missed because students must undertake 100%
of their clinical experience in order for FCHS to consider them eligible to pass courses and ultimately to
apply for registration. Please attach any additional document or evidence.

At the beginning of the clinical experience

When you meet individual students, it is a highly recommended to read the CAT together so that you
each share a common understanding. This also gives you both an opportunity to clarify your
expectations of each other. Students have the responsibility to be aware of the particular learning
outcomes and scope of practice for the relevant academic courses for this current clinical experience,
to attend regularly and on time, and to be respectful, appropriate role models for nursing and the
university. You have the responsibility to facilitate quality clinical learning opportunities for students, to
guide their skill development, to assist them to practice competently and finally to assess their skills.

During the clinical experience

Goal-setting sheets give the student the opportunity to identify skills and experiences that they deem
important to them. With reflection and support from the Clinical Facilitator/Preceptor the student may

39
identify areas and skills which need further development. This provides the student with a perspective
of their strengths and gives them the opportunity to improve their performance where required.

Halfway Feedback

Undertake an informal half-way assessment of student performance based on the 3 domains in the
CAT. Identify and justify areas in which you feel the student needs further practice and development.
This enables the student have some idea of your perspective of their strengths and areas for
improvement and may give them a chance to improve their performance. Ideally you should provide
comments and examples for each domain.

Formative Review

If a student seems unlikely to successfully achieve one or more of the domains, you are advised to
raise and outline concerns with the student as soon as possible. If concerns are not resolved it will be
necessary to place the student on a Formative Review. Seek support and assistance from the appropriate
Course Co-ordinator and/or the Clinical Coordinator during this process. As near as possible to the
completion of the clinical experience, it is essential that you provide a final assessment of the student.
Every domain must be assessed and documented. If a student receives a failing mark for any domain,
following effective performance management (via the Formative Review), in consultation with the
Course Co-ordinator and/or the Clinical Co-ordinator, they will fail the clinical experience. Should you
wish for this not to be the case, it is essential that you complete supporting notes and file them. The
final mark will be recorded in the student’s file where it is added to other assessment items before an
overall course grade is awarded.

Anecdotal Notes

If a student is failing, an incident has occurred, or the student has performed exceptionally in specific
areas this should be recorded in the form of Anecdotal Notes.

At the completion of the clinical experience

A final assessment is discussed and given to the student close to the completion of the clinical
experience. Every domain must be assessed as ‘Assisted’ or higher to obtain a final grade of ‘Non-
Graded Pass’. If a student falls within the ‘Dependent or Marginal’ range for any domain, following
effective performance management via the Formative Review AND in consultation with the Course
Convenor, they will receive a ‘Fail’ grade for the clinical placement. If you are unsure of the appropriate
grade, please record ‘Result Withheld’ and discuss this with the Course Convenor. Students who are
absent from placement for any reason also require ‘Result Withheld’. Students must obtain a Medical
Certificate or a correctly completed FCHS Statutory Declaration. A copy of either document must be
attached to the CAT. The student’s final grade will be determined when the CAT is reviewed by the
Course Convenor. This is then combined with other assessment items before an overall course grade
is awarded.

40
Nursing Care Plan

Student Name: Aya Agha

Student Number: A00043712

Date:27-10-2020

Client’s Name: ________________

DOB: 1/12/1926 Age: 94 Marital Status: Married

Religion: Muslim Occupation: None

Admitted from: Al Rahba Hospital

Mode of Arrival : ambulance

Reason For admission: ventilator dependent long term care patient

Past medical & surgical history:

Tracheostomy tube. Parkinson disease. DM 2


PEG tube. Seizure. CVA.
Foley catheter. Aspiration Pneumonia. Hypothyroidism.

History of medication use at home :

None

Family History :

None

Current Medical Diagnosis:


Chronic respiratory failure
Parkinson
Seizure

41
Subjective Data:
Not applicable, patient is assessable due to unconsciousness.

Objective Data:
Vital signs: BP:135/55 Heart rate : 39 RR:14 Temperature:36.3 SPO2:98%
Body measurements: weight 64kg height 143cm BMI is between 30-34.99 (Obese Class 1)
Physical assessment (focused head to toe)
General: Bed ridden. Semi conscious. On ventilator.
Integumentary assessment: Pale warm skin. Senile lentigines (brown/age spots). Dry wrinkled
skin. Thin grey short hair. Has skin tear in left inguinal area. Left knee abrasion. Stage 4 sacral
pressure ulcer. Capillary refill within 3 seconds. Decreased skin turgor Nails are thick rigid and
has splits. Skin peel under both breasts.
Hair, neck     ,eye,
ears, nose, mouth  
head and neck: Her hair is grey. Has tracheostomy on the middle of her neck size 6.
symmetric pupils. , pupils in center, rounded ,pupils are equal, pupils is react to the light. Her
ear lobes are sagging and elongated. Bilateral size, shape and no discoloration or lesions. Ear
wax is thick and dry. Her nose is long and bigger and the tip is dropped. Her mouth looks
normal without ulcers no dentures. Symmetrical head/face shape is square. No depression in
the skull or lesions.
Respiratory assessment patient is on a ventilator machine. Symmetric chest movement.
Minimal crackles relieved by suctioning. FIO2 :2L PEEP:6 sputum color : white and it’s
consistency is sticky.
Cardiovascular system: heart rate 45 bradycardia within normal limits. normal ECG findings,
present peripheral pulse. Capillary refill within 3 sec. Normal heart sounds (S1 and S2 sounds
are heard), no murmur. No edema. No chest pain no palpitations.
Musculoskeletal assessment: Bilateral contracture deformities of upper and lower limbs.
Resting tremor, general weakness, hypokinesia, stiffness of the body , jerking movements ,
limited range of motion
Gastrointestinal system Soft, no tenderness, smooth skin, symmetric umbilicus in midline,
gargling sound, no diarrhea , no heartburn , she is on the percutaneous endoscopic
gastrostomy on her left side for feeding and administering medication as well , no tenderness
around PEG stoma.
Urinary system No inguinal tenderness. Groin and inguinal region are bilateral, and within
normal limits. No dysuria, left inguinal lesion. No discharge, no hematuria. Menopausal.
Neurological assessment:
GCS: Eye Opening (E) spontaneous =4 Verbal Response (V) none =1 Motor Response
(M) localizing =5 / gcs tot = 10 moderate.
Pain : 3 using (BPS) tool.

42
LABORATORY TESTS:
Test Category Test Name Normal Range Patient Specific Result Interpretation
Lab Values

Complete WBC 3.4-10.8 5.9 x10E3/uL Normal


blood count
RBC 3.8-5.3 3.1 x10E6/uL Low

Hemoglobin 11.1-15.9 9.4 g/dL Low

Hematocrit 34.0-46.6 30.8% Low

MCHC 32-36 30g/dL Low

Eosinophils 0.0-0.4 0.6x10E3/uL Low

Renal function
panel, serum Glucose 65-99 156 mg/dL HI

BUN 10-36 38 mg/dL HI

BUN/Creat 11-26 51 HI
ratio

Calcium 8.7-10.3 8.6 mg/dL Low

Hepatic A/G Ratio 1.1-2.5 1.0 Low


function panel,
serum

43
DIAGNOSTIC TESTS: My patient did not have any extra diagnostic tests.

Test Name Specific findings for Significance of results in relation to the


patient disease process for this patient including
nursing implications for care.

COVID-19 SP Not detected

MRSA No MRSA Isolated


screening
culture

44
MEDICATIONS:

Drugs Order/ Mode of drug actions Indications Adverse effects Nursing


Classification consideratio
s n
Abixaban [2.5 selectively inhibits the AF, To bleeding gums. Hold if bleed
mg – 2 times activated factor Xa in a prevent nosebleeds. or procedure /
daily] reversible manner. It stroke and through PEG
systemic heavy
inhibits both free factor Xa
embolism in vaginal bleeding.
and also clot bound factor
Xa. Inhibition of factor Xa nonvalvular red, pink, or brown
atrial urine.
also leads to reduced fibrillation
formation of factor II red or black, tarry
(thrombin) stools.

Calcium + constipation through PEG


Vitamin Calcium plays a very Supplement
[ 1tab -once a important role in the body.
day] It is necessary for normal
functioning of nerves, cells,
muscle, and bone. If there
is not enough calcium in
the blood, then the body
will take calcium from
bones, thereby weakening
bones.

Levothyroxine muscle weakness; through PEG


[50mg – once Hypothyroid Do not add IV
headache, leg
a day] 50% of thyroxine (T4) then doses to
cramps;
gets converted to its active other IV
metabolite L- nervousness, fluids. Use
triiodothyronine (T3). The trouble sleeping; caution in
thyroid hormones then diarrhea; or. patients with
work by binding to thyroid skin rash, partial hair CV disease.
receptor proteins contained loss.
within the cell nucleus.

45
Blistering, peeling, or
Esomeprazole loosening of the
[20mg-once a Parkinsonis skin.bloating. Monitor for S&S
day] By acting specifically on m of adverse CNS
darkened urine.
the proton effects (vertigo,
drowsiness. agitation,
pump, esomeprazole bloc depression) 
ks the final step in acid mood or mental
changes.muscle through PEG
production, thus reducing
gastric acidity. This effect is spasms (tetany) or
dose-related up to a daily twitching.
dose of 20 to 40 mg and
leads to inhibition of gastric
acid secretion.
dry mouth. blurred
Trihexyphenid Older adults
vision.dizziness.
yl appear more
[0.5mg-2 blocks efferent impulses in Parkinson. nausea.nervousnes sensitive to
times] parasympathetically s. usual adult
innervated structures like constipation. doses. Monitor
smooth muscles vital signs.
drowsiness. Pulse is a
(spasmolytic activity), particularly
salivary glands, and eyes sensitive
(mydriasis). indicator of
response to
dizziness. drug.PEG

Carbidopa / works by being converted Seizure loss of appetite. Assess


levodopa to dopamine in the diarrhea. therapeutic
[25\250mg – brain. Carbidopa is in a dry mouth. response. -
Monitoring for
one tab] class of medications called mouth and throat side-effects,
decarboxylase inhibitors. It pain. including
works by mental state
constipation.
preventing levodopa from assessment
being broken down before and blood
it reaches the brain. This pressure
allows for a lower dose measurement. -
Care should be
of levodopa, which causes
taken to avoid
less nausea and vomiting. confusion with
the
antihypertensiv
e medication
methyldopa.
- Levodopa ca
n cause false
results in urine
tests for sugar
and ketones.

46
PEG
Dizziness.
Headache.
Levetiracetam modulation of synaptic Seizure Irritability.
[1000mg – 3 neurotransmitter release Observe for
times a day] through binding to the Loss of strength and signs of
synaptic vesicle protein energy.Mood and adverse
SV2A in the brain. behavior changes. effects.
Monitor fluid
balance
closely.
Do not
administer
the injection
undiluted via
the
intravenous
route.
Assess and
document
any signs of
Valproic acid drowsiness. seizure
[2 times – Valproic acid exhibits its Thick activity.PEG
dizziness.
250mg] pharmacologic effects in a secretions headache.
couple of ways, such as by
diarrhea.
acting on GABA
(γ aminobutyric acid) constipation.
levels in the CNS, blocking changes in appetite. NEB
voltage-gated weight changes.
ion channels, and also by back pain.
inhibiting histone
deacetylase.

47
48
1. Nursing Diagnosis *:

Ineffective airway clearance related to Presence of artificial airway: tracheostomy as evidenced by Abnormal breath sounds
(crackles) and difficulty in expectorating sputum
Goals and Expected Nursing Interventions* Rationale for Nursing Evaluations
Outcomes Interventions
Patient will maintains 1-Assess changes In vital 1-Tachycardia
effective airway and signs. and hypertension may be related Goal met. After 8 hrs Patient
experiences normal was able to maintain effective
2- As the patient can’t cough to an increased work of
or baseline breath airway and had normal breath
sounds after 8 hrs. out secretions.i will be breathing. As the hypoxia and/or sounds” low pitched vesicular”.
Instituting her by suctioning hypercapnia become severe, BP The patient was able to cough due
of the airway as needed. and HR drop. Fever may develop to nebulizer that’s given for 30
3-Promote nebulizer for 30 in response to retained minutes which loosened the
minutes and systemic fluid secretions. secretions.
hydration, as appropriate 2-Suctioning removes secretions
4-Note changes in SpO2, tidal if the patient is unable to
volume, and changes in effectively clear the airway.
arterial blood gas values, as Frequent suctioning should be
appropriate. based, not on a present routine,
5-position the patient in a such as every hour. Over
simi- fowler suctioning can cause hypoxia
and injury to bronchial and lung
tissue.
3-Adequate fluid intake enhances
liquefaction of pulmonary secre-
tions and facilitates
expectoration of mucus.
4-Evaluates the status of
oxygenation, ventilation, and
49
acid–base balance
5- In the semi-Fowler's position,
the diaphragm moves downward,
the work of breathing relatively
decreases, lung volume and
ventilation increases, and lung
dilatation is promoted; these
changes can improve oxygenation
and increase oxygen saturation

You must write the patient’s highest priority nursing diagnosis and follow it completely through the process.
* Nursing Interventions must include nursing assessment and a minimum of THREE nursing applications.

50
3. Nursing Diagnosis *:
Impaired skin integrity related to immobility as evidenced by sacral pressure ulcer stage 4.
Goals and Expected Nursing Interventions* Rationale for Nursing Evaluations
Outcomes Interventions
Elderly patient have elastic skin
Patient will Determine the patient age and p, and have thinning of the Goal met. Pressure on bony
experience healing of general condition of the skin. epidermis making it more prone prominence areas was
to skin impairment redistributed which helped in
pressure ulcers
preventing other pressure
and experiences ulcers. performing
pressure reduction. interventions helped in
Patient with pressure ulcer lose promoting patienstage
big amounts of protein in appropriate wound care.
Assess the client’s nutritional wound exudates and may
status, including weight, require 4000 kcal/day or more
weight loss, and serum to remain anabolic.
albumin levels, if indicated.

Patient with chronic disease typically


exhibit multiple risk factors that
predispose them to pressure ulcers.
These include poor nutrition, poor
Assess history of chronic hydration, inconvenience, and
immobility.
diseases.

Turn / change patient’s Repositioning involves moving the


position every three hours person into a different position to
remove or redistribute pressure
from a particular part of the body

51
3. Nursing Diagnosis *:
Risk of fall related to presence of illness (Parkinson disease)
Goals and Nursing Interventions* Rationale for Nursing Evaluations
Expected Interventions
Outcomes
Rise side rails Raising the side rails reduces Gaol met patient is free from falls
the risk of patients falling out of
bed during transport.
Patient will be
free from falls Will help in informing all health
Put risk of fall signs
care providers that the patient
is risk of fall

Lower bed hight


Keeping the bed closer to the
floor prevents injury and risk of
falls.

A patient who is not familiar


Assess the patient’s with the placement of furniture
environment for factors in an area or who has
associated with an increased inadequate lighting in the
risk for fall. house increases the risk for
falls.

52
53
Nursing Care Plan

Student Name: _______________________________

Student Number: _____________________

Date: _____________________

Client’s Name: __________________________________

DOB: ______________ Age: _________ Marital Status: S M D W

Religion: ______________ Occupation: __________________

Admitted from: _________________________________________

Mode of Arrival : ________________________________________

Reason For admission


_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_____________________________________________

Past medical & surgical history


_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_____________________________________________

History of medication use at home


_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
____________________________________________

Family History
_________________________________________________________________________
______________
_________________________________________________________________________
_________________________________________________________________________
_____________________________

54
Nursing Care Plan

Current Medical Diagnosis


_________________________________________________________________________
_________________________________________________________________________
______________________________

Subjective Data:
…………………..
……………………………………………………………………………………………………………
……………………………………………………………………………………………..
…………………..
……………………………………………………………………………………………………………
…………………………………………………………………………………………………………..
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………..
……………………………………………………………………………………………………………
……………………………………………………………………………………………..…………

Objective Data:
…………..
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………..
……………………………………………………………………………………………………………

55
Nursing Care Plan

……………………………………………………………………………………………………………
………………………………………………………….…………………..
……………………………………………………………………………………………………………
…………………………………..
……………………………………………………………………………………………………………
…………………………………..
……………………………………………………………………………………………………………
…………………………………..
……………………………………………………………………………………………………………
…………………………………..
…………………………………………………………………………
…………..
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………..
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
…………………………………………………
…………………..
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
………………………………………………………………………………………………………
…………………..
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
………………………………………………………………………………………………………
…………………..
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………

56
Nursing Care Plan

………………………………………………………………………………………………………

LABORATORY TESTS:

Test Test Name Normal Patient Result Interpretation


Category Range Specific Lab
Values

57
Nursing Care Plan

DIAGNOSTIC TESTS:

Test Name Specific findings for Significance of results in relation to the


patient disease process for this patient including
nursing implications for care.

58
Nursing Care Plan

MEDICATIONS:

Drugs Order/ Mode of drug Indications Adverse Nursing


Classification actions effects consideration
s

59
Nursing Care Plan

60
1. Nursing Diagnosis *:
………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………
……………………………………………………

Goals and Expected Nursing Interventions* Rationale for Nursing Evaluations


Outcomes Interventions

You must write the patient’s highest priority nursing diagnosis and follow it completely through the process. * Nursing
Interventions must include nursing assessment and a minimum of THREE nursing applications.

61
2. Nursing Diagnosis *:
………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………
……………………………………………………

Goals and Expected Nursing Interventions* Rationale for Nursing Evaluations


Outcomes Interventions

62
You must write the patient’s highest priority nursing diagnosis and follow it completely through the process. * Nursing
Interventions must include nursing assessment and a minimum of THREE nursing applications.

3. Nursing Diagnosis *:
………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………
……………………………………………………

Goals and Nursing Interventions* Rationale for Nursing Evaluations


Expected Interventions
Outcomes

63
You must write the patient’s highest priority nursing diagnosis and follow it completely through the process. * Nursing
Interventions must include nursing assessment and a minimum of THREE nursing applications

64
Nursing Care Plan Grading Criteria:

Criteria Possibl Assigne Comments


e d Points
Points
1. Client Assessment, Chief Complains 1— 4
and Previous History
2. Subjective & objective data and 1— 4
health alterations including
psychosocial & physiological
alterations with signs & symptoms

3. Medications: including drug 1— 4


classification, dose, frequency, route,
action, rational.
4. Lab data including appropriate 1— 4
interventions.
5. Procedures, interventions, and 1— 4
radiology.
6. Formulates and prioritize the patient’s 1— 4
2 highest priority diagnoses

7. Utilizes a diagnostic statement that is 1— 4


supported by the database and
formatted correctly
8. Short-term goals with outcomes 1— 4
criteria: related to the goal, realistic,
specific, and appropriate
9. Nursing interventions for each 1— 4
nursing diagnosis, including
assessment, treatment, and teaching
strategies.
10. Nursing interventions for each 1— 4
nursing diagnosis are individualized
and realistic based on client
needs/capabilities
11. Scientific rationales. Use a minimum 1–4
of two references
12. Evaluation refers to goal using the 1–4
expected outcomes with supporting
evidence
13. Clear and legible and Correct 1–4
spelling, structure, and punctuation

Total Mark: /5
2 /
100

65
Nursing Care Plan Rubric:
Category 4 3 2 1
Assessment Complete and Adequate Adequate Incomplete and
part Accurate interpretation interpretation inaccurate
interpretation of the of the
of the subjective and subjective and interpret
subjective and objective data objective data information of
objective data of the five to but incomplete the
of the 5 areas include in more than subjective and
to include psychosocial one area. No objective data.
psychosocial but incomplete psychosocial
in one area.
Formulate Formulate and Formulate and Formulate and Unable to
and prioritize the prioritize the prioritize the Formulate and
prioritize highest (3) highest (3) highest (3)
Nursing nursing nursing nursing prioritize the
Diagnoses. diagnoses diagnoses but diagnoses but highest (3)
accurately per one is two are nursing
Most NANDA inaccurate inaccurate per
appropriate diagnoses
pertain to NANDA pertain accurately
three (3) patient per NANDA to patient care
diagnoses pertain to per NANDA
patient care pertain to
patient care

Utilization of Diagnosis is Diagnosis is Diagnosis is Diagnosis


diagnostic appropriate for appropriate for not appropriate portion is
statement patient and per patient per for patient (one incomplete.
NANDA NANDA, but or two),
1. Problem. includes the does not Diagnostic
three parts of include all May not statement is
2. R/T include the inaccurate
diagnostic parts of
3 As AEB statement. diagnostic three parts of
the diagnostic NANDA is
for Actual subjective and statement inaccurate
diagnosis. objective data subjective and statement
listed is objective data NANDA is subjective and
correct listed in the inaccurate objective
wrong part of data is
diagnosis. subjective and
objective data inaccurate
is inappropriate
Goal and Goal and Goal and Goal and Goal and
outcomes outcomes are outcomes are outcomes are outcomes are
appropriate to appropriate to inappropriate incomplete
the patient the patient to the patient
needs and needs and needs and or inaccurate
contribute to contribute to does not for the patient
the nursing the nursing contribute to needs
diagnosis. diagnosis. the nursing and does not
66
Contains two Contains less diagnosis. Has contribute to
measurable than two no measurable the
criteria and a measurable criteria, target
target date & criteria and date or time. nursing
time. missing the diagnosis.
target date or
time.
Nursing Interventions Interventions Interventions Interventions
intervention are appropriate are appropriate are appropriate are
s to the patient's to the patient's to the patient's inappropriate
status and status and status and
goal. goal. goal. Does not to the patient's
Contribute to Contribute to contribute to status, goal,
the nursing the nursing the nursing and nursing
diagnosis with diagnosis with diagnosis with diagnosis, with
adequate adequate inadequate
number of number of number of inadequate
(assessment & (assessment & assessment & number of
application) application) application) (assessment
that are that are not that are not & application)
specific in specific in specific in that are not
action and action and action and
frequency. frequency. frequency. specific in
action and
frequency.
Nursing Each Each In appropriate Rationale s for
Rational intervention intervention use of rational each
has has an to the intervention
comprehensive explanation of intervention
scientific the with is not included
reasoning that intervention inadequately or when
identifies why with justifiable included
the adequately and reasons doesn’t
intervention justifies attempt to
was selected inclusion. Some rational
are missing. explain
the
intervention
Evaluation Evaluation Evaluation Evaluation Evaluations is
does support does support does not incomplete and
Data listed the goal the goal support the
is related to statement. statement. goal statement. doesn’t support
the goal Does describe Does not Does not the goal
statement. goal as met, describe goal describe goal statement
partially met, as met, as met,
or not met. partially met, partially met, or
or not met. not met.
Clear and Sentences are Sentences are Sentences are Sentences
legible and well well well sound awkward

67
Correct Constructed Constructed Constructed &
spelling, with no errors with few errors with several
structure, in grammar, in grammar, errors in Incomplete,
and mechanics, mechanics, grammar, difficult to
punctuation mechanics, understand,
And/or and/or spelling and/or spelling
spelling. numerous
errors in
grammar,
mechanics,
and/or spelling
that interfere
with
understanding.

Student Continuous Assessment - Professionalism


Guidelines for Evaluating Professionalism:
1. Students’ conduct of professionalism will be assessed during the clinical placements.
2. Four (4) main criteria for professionalism will be assessed on a daily basis by FCHS
Faculty, namely punctuality, dress code, communication and attitude, and responsibility.
2.1 Punctuality guidelines:
2.1.1 Arrives on time
2.1.2 Honour break times
2.2 Dress code guidelines:
2.2.1 Wear FCHS ID badge (face out)
2.2.2 Wear prescribed FCHS attire during all theoretical, simulation laboratory and
clinical sessions – follow dress code policy (ensure clean, pressed and not tight
fitting clothes)
2.2.3 No excessive make-up
2.2.4 No long nails or nail polish
68
2.2.5 No jewellery except for engagement ring
2.2.6 No mobile phones used in all clinical placements
2.2.7 Comes prepared with all required resources/necessary equipment relevant to
the session i.e.
 Simulation laboratory and clinical session: stethoscope, second-hand watch,
pen light, etc.)
2.3 Communication and attitude guidelines:
2.3.1 Shares the session/clinical objectives with allocated FCHS Faculty / CRN /
Preceptor
2.3.2 Communicates with faculty, staff, multidisciplinary team and patients / family in a
professional manner, including but not limited to:-
a. Following the line of command during communication
b. Using appropriate respectable words and tone during verbal communication
c. Demonstrating appropriate non-verbal communication (no folded arms, arms
in pockets etc.)
1.3.3 Open to constructive feedback and comments
1.3.4 Maintains patients’ privacy and confidentiality (NO taking pictures, swapping
patient stories during the break)
2.4 Responsibility guidelines:
2.4.1 Accepts responsibility for behaviour
2.4.2 Carries out responsibility as assigned by FCHS Faculty / CRN / Preceptor at any
given time

Complies with FCHS and SEHA policies and regulations during clinical placements

Criteria for Assessment of Professionalism:

Criteria for Assessment


Punctuality Dress Code Communication Responsibility
and Attitude
Day Marks
0 1 2 0 1 2 0 1 2 0 1 2
Day 1: # # # #
Day 2: # # # #
Day 3: # # # #

69
Day 4: # # # #
Day 5: # # # #
Day 6: # # # #
Day 7: # # # #
Day 8: # # # #
Day 9: # # # #
Day 10: # # # #
Day 11:
Day 12:
Total

Course Instructor Comments:


__________________________________________________________________
_____________________________________________________________________________
_______________
_____________________________________________________________________________
_______________
Course Instructor Name Print _________________________Signature
___________________ Date ________

Student Comments:
__________________________________________________________________________
_____________________________________________________________________________
______________
_____________________________________________________________________________
______________
Student Name Print: ________________________________ Signature _________________
Date __________
2 = Comply 1 = Comply to some degree 0= Do not comply Total:

70
NRS 3103 - Aged Care Nursing
Attendance Sheet

Student’s Name: ID #:----------------------------------

Date Arrival Time Leaving Time Student’s Preceptor’s


Signature Signature

1.

2.
3.

4. 6910
5.

6.

7.

8.
9.

10.

11.

12.

13.

14.
15.

16.

17.

18.

19.

20.

71
Appendices
 Mini-Mental State Examination (MMSE)

Instructions for administering the Mini-Mental State


Examination (MMSE)
ORIENTATION: 1. Ask the patient for the current year, season, date, day and time. If
the patient has omitted part of the answer, ask for this part specifically, e.g., “Can you
also tell me what season it is?” Score 1 point for each correct answer. 2. Ask the patient
what country, province, city/town, and hospital/clinic you are in, and which floor you are
on. Again, if the patient has omitted part of the answer, ask for this part specifically, e.g.,
“Can you also tell me what province we are in?” Score 1 point for each correct answer.
REGISTRATION: Ask the patient if you may test his/her memory. Say the name of the 3
unrelated objects, clearly and smoothly, taking about 1 second to pronounce each word.
After you have said all 3, ask the patient to repeat them all. This first repetition
determines the patient’s score. Score 1 point for each object remembered.
Once the score has been recorded, repeat the process (to a maximum of 6 times) until
the patient can repeat all 3 objects. Record how many trials it took for the patient to
remember all 3 objects. If all 3 objects are not eventually learned, recall cannot be
meaningfully tested.

ATTENTION AND CALCULATION: Ask the patient to spell the word “world”
backwards. Score 1 point per letter in correct order (e.g., DLROW=5; DLRW=4;
DLW=3; OW=2; LDRWO=1).

Alternately, ask the patient to subtract 7 from 100, then subtract a further 7 from that
result, and so on for 5 subtractions (93, 86, 79, 72, 65). Score 1 point per correct
subtraction.

RECALL: Ask the patient to recall the 3 objects learned in the “registration” section of
the test. Score 1 point for each object remembered.
LANGUAGE Naming: Show the patient a wristwatch and ask him/her what it is. Repeat
for a pencil. Score 1 point for each object named.

Repetition: Ask the patient to repeat the following sentence after you: “No ifs, ands or
buts”. Score 1
Point for correct performance.
3 stage command: Give the patient a piece of plain blank paper. Tell the patient to take
the paper in his/her right hand, fold it in half, and put it on the floor. Score 1 point for
each section of the command performed.

72
Reading: On the back of the MMSE page, print the sentence “Close your eyes” in
letters large enough for the patient to see clearly. Ask him/her to read it and do what
it says. Score 1 point only if the patient actually closes his/her eyes.
Writing: On the back of the MMSE page, ask the patient to write a sentence for you.
Do not dictate a sentence; it is to be written spontaneously by the patient. It must
contain a subject and verb and be sensible. Correct grammar and punctuation are not
necessary. Score 1 point only for a correct sentence.
Copying: On the back of the MMSE page, draw intersecting pentagons, each side
about 1 inch long. Ask the patient to copy the diagram exactly as it is. All 10 angles
must be present and 2 angles must intersect for the patient to score 1 point. Tremor
and rotation are ignored.

73
1. Mini Mental State Examination (MMSE)
Patient name:
Date: Visit 1: Visit 2: Visit 3: Visit 4:
Maximu Visit Visit Visit Visit
m 1 2 3 4
score
ORIENTATION
5 () () () () What (year) (season) (date) (day) (month) is it? (1 point for each correct answer.)

5 () () () () Where are we: (province) (country) (town or city) (hospital or clinic) (floor)? (1 point for each
correct answer.)
REGISTRATION
3# ()() ()() ()() ()() Listen to the following: “apple,” “table,” “penny.” Repeat all 3. (1 point for each correct
Trials: answer.) (Repeat the objects until the patient learns all 3. Make a maximum of 6 trials. Record
the number of trials.)
ATTENTION AND CALCULATION
5 () () () () Spell “world” backwards. (1 point for each letter in correct order.) Alternate: Subtract 7
from 100. Take the result and subtract 7 from that. Continue until I ask you to stop.
(Continue for 5 subtractions. 1 point for each correct subtraction.) RECALL
3 () () () () What were the 3 objects we repeated earlier? (1 point for each correct answer.) (Note: Recall
cannot be tested if all 3 objects were not remembered during registration.) LANGUAGE
2 () () () () What are these? (pencil) (Watch).
1 () () () () Repeat the following: “No ifs, ands, or buts.”
3 () () () () Take a piece of paper in your right hand, fold it in half and put it on the floor. (1 point for each
section of the command performed.) READ AND OBEY
1 () () () () Read the following (“Close your eyes.”) and do as it says.
1 () () () () Write a sentence.
1 () () () () Copy the following design on the back of this page: No construction problem

Total
score
(max. score
30)

Adapted from Folstein MF et al. “MiniMental State”: A practical method for grading the cognitive state of patients for the clinician. J
Psychiatr Res
1975;12:189198, and Cockrell JR, Folstein MF. MiniMental State Examination (MMSE). Psychopharm Bull 1988;24(4):689692. ©
2007 Pfizer Canada
Inc., Kirkland, Quebec H9J 2M5

74
Mini-Mental State Examination (MMSE) READING:
Reading:

Close your eyes.


WRITING:

COPYING:

75
2. The Mini CogTM
Administration:
1. Instruct the patient to listen carefully to and remember 3 unrelated words and then to
repeat the words. The same 3 words may be repeated to the patient up to 3 tries to
register all 3 words.

2. _Instruct the patient to draw the face of a clock, either on a blank sheet of paper or on
a sheet with the clock circle already drawn on the page. After the patient puts the
numbers on the clock face, ask him or her to draw the hands of the clock to read a
specific time. The time 11:10 has demonstrated increased sensitivity.

3. Ask the patient to repeat the 3 previously stated words.

Scoring: (Out of total of 5 points)


Give 1 point for each recalled word after the CDT distractor. Recall is scored 0-3.
The CDT distractor is scored 2 if normal and 0 if abnormal.
(Note: The CDT is considered normal if all numbers are present in the correct sequence
and position, and the hands readably display the requested time. Length of hands
is not considered in the score.)

Interpretation of Results:
0-2: Positive screen for dementia
3-5: Negative screen for dementia

76
The Mini Cog
Patient name:
Date: Visit 1: Visit 2: Visit 3: Visit 4:

Instruction score Patient score

1. Listen and remember 3 unrelated words

1. Draw the face of the clock


2. Draw the hands of the clock to read 0-2
11:10

1. Ask the patient to repeat the 3 0-3


previously stated words

Total

77
3. MORSE FALL SCALE

78
4. Braden Scale

79
COVID-19 GUIDELINE

The current Covid-19 Pandemic Emergency has created restriction of movement in MOHAP
hospitals and clinics, for both patients, their families, and staff. MOHAP are offering strategies
for the universities to consider to ensure optimum safety for MOHAP patients, MOHAP staff and
any third party stakeholders who wish to enter MOHAP facilities. It is MOHAP’s priority to
ensure the safety of the community and restrictions have been put in place to ensure safety for
all is maintained. This has required that movement between clinical areas is minimized.

Guidelines

1. Clinical capacity for student clinical placement in MOHAP hospitals and clinics will be modified
for student’s safety based on the Covid-19 Pandemic Emergency status. MOHAP will continue to
provide regular updates on the clinical status of hospitals and clinics.
2. MOHAP will accommodate 3rd and 4th year student nurses, following an agreement form the
universities to place them in hospitals caring for both Covid-19 and non-Covid patients.
3. The clinical tutors from each university will be responsible for overseeing all students being
placed in clinical areas. Where clinically possible and if safe to do so, MOHAP nursing staff will
support the nursing students and clinical tutors during the placement.
4. Student nurses in the 1st and 2nd year should be trained in clinical skills and procedures in the
university’s skills laboratory (simulation labs) until further notice from MOHAP and for the duration
of the Pandemic Emergency continues.
5. Clinical Placements will be temporarily postponed for the nurses doing the BSN Bridging program
until further notice. These nurses are already assigned to clinical areas and MOHAP is restricting
movement of staff to different areas and MOHAP wants to reduce the number of times staff are
brought back to the clinical areas to minimize risk. Thus, it is suggested that
curricula developers start to review the length and clinical rotations of the Bridging Program in line
with the accreditation guidelines, to facilitate more flexibility to these programs.
6. Clinical Placements for Master’s Program students will be temporarily postponed until further
notice and regular updates will be provided by MOHAP.
7. Clinical tutors and nursing students must wear the MOHAP recommended PPE at all times in the
clinical areas.
8. Clinical tutors and nursing students must adhere to MOHAP infection prevention policies and
guidelines at all times.
9. In clinical areas such as PHC, all patients entering will be managed as suspected Covid-19 cases
and be managed using the recommended PPE at all times.
10. Covid-19 test will be carried out on clinical tutors and nurse students which must be negative
before the clinical tutor or nursing student is permitted to join the clinical area.
11. Nurse students will work between 4-6 hours with no break to avoid crowding in hospitals and
clinical areas. There are 2 shifts in MOHAP hospital and some clinics.
80
 There will be an option for each student to work shorter hours, e.g. 4 hours, this will
enable 2 students to share an 8-hour shift, this will be up to the individual universities to
decide. Otherwise they can work an 8-hour shift with 1 break.
 Each university can choose to rotate students every 2 -4 weeks throughout the semester to
ensure that all students in the 3 rd and 4th year have the opportunity to collect clinical hours.
 Universities can offer students to work shifts over the weekend to increase capacity and
number of students on placement over seven days.
 The above three suggestions are proposals to guide the universities to assist with
increasing the number of students that can be accommodated.
12. Nursing students’ rotation between departments should be well controlled and organized prior to
shifting (no movements from Covid-19 area to non-COVID area).
13. Gathering in groups is not permitted either in the clinical area reception areas or in the corridors
or cafeteria/break rooms and social distancing must be maintained at all times. It is the responsibility
of the clinical tutor to ensure all the nursing students do not gather in groups or crowds and ensure
social distancing in any area of the hospital or clinic. The clinical tutors are responsible to ensure any
contact with the students during the clinical placement is conducted virtually where possible to avoid
gathering groups of students in one place.
14. It is the responsibility of the university to provide training and education for both nursing
students and clinical tutors before they commence the clinical placement, on;
 Covid-19
 Caring for patients in isolation
 PPE Doffing and Donning
 Infection Prevention guidelines and practices
 Overview of disaster and pandemic emergency preparedness and expectations of clinical
staff during clinical emergencies.
15. Once the students are in the clinical areas the MOHAP staff along with the clinical tutors will
check that practice is in line with MOHAP standards and policies

81