NSE 111 - Week 12 - Getting Ready for Clinical!! - F232 [Autosaved].pptx

NSE 111 – Week #12 Getting Ready for Clinical! HERE WE GO!! Week #12 Learning Outcomes 1. Introduce the Performance Appraisal for year one clinical practice (NSE 121)  Link to CNO Code of Conduct 2. Discuss the importance of reflective practice in the clinical setting  Link to CNO Quality Ass...

NSE 111 – Week #12 Getting Ready for Clinical! HERE WE GO!! Week #12 Learning Outcomes 1. Introduce the Performance Appraisal for year one clinical practice (NSE 121)  Link to CNO Code of Conduct 2. Discuss the importance of reflective practice in the clinical setting  Link to CNO Quality Assurance  Discuss strategies for reflective practice (eg. journaling) 3. Clarify expectations for NSE121 - Clinical Practice 1  Professional  Scope accountability of practice - Year 1 nursing students  Strategies for success  Introduction  Members  Working to the Long Term Care setting (e.g. resident rights, home environment etc. ) of the health care team with unregulated care providers Week #12 Learning Outcomes 4. In-Person Lab Outcomes and Activities:  Performance  Open Lab Skill Testing ( catch up as needed) Your first clinical experiences will not be forgotten – let’s get prepared… Think back to Week #1 - What is the role of the CNO? College of Nurses of Ontario Recall that the CNO provides practice standards and guidelines to support nurses in providing safe and ethical nursing care to the people of Ontario. Practice standards outline the expectations for nurses that contribute to public protection. They inform nurses of their accountabilities and the public of what to expect of nurses. The standards apply to all nurses regardless of their role, job description or area of practice. Practice guidelines, which often address specific practice-related issues, help nurses understand their responsibilities and how to make safe and ethical decisions in their practice. Most practice standards have Learning Modules and Resources – check them out on the CNO website!! https://www.cno.org/en/ The CNO Code of Conduct…our central practice standard The Code informs nurses of the standard of practice they are professionally accountable to. It also explains the professional behaviour and ethical conduct people can expect from a nurse when receiving care. Principles of the Code The Code consists of six principles: 1. Nurses respect clients’ dignity. 2. Nurses provide inclusive and culturally safe care by practicing cultural humility. 3. Nurses provide safe and competent care. 4. Nurses work respectfully with the health care team. 5. Nurses act with integrity in clients’ best interest. 6. Nurses maintain public confidence in the nursing profession. Each principle is supported by a set of statements of core behaviours all nurses are accountable for. All principles have equal importance and work together to describe the conduct, behaviour, and professionalism necessary for safe and ethical nursing practice in Ontario. What doe the CNO say about Quality Assurance (QA)?  Nurses maintain and enhance their competence through daily practice reflection, lifelong learning and by integrating that learning into their practice.  As practicing nurses, QA is integral in ensuring the public receives safe, quality and ethical care.  The Regulated Health Professions Act, 1991 requires CNO to establish and administer a QA Program that assists nurses in maintaining competence and continually evaluating their practice. CNO’s QA Program consists of three components:  Self-Assessment  QA Assessment  Coaching support  CNO's Quality Assurance (QA) Program assures the public of nurses’ commitment to continuing competence by continually improving their nursing practice.  Being self-reflective and committed to life-long learning is a critical part of providing the safest and highest quality care to patients. This is why all nurses engage in daily practice reflection and participate in quality assurance activities throughout their careers. Quality Assurance Assessment  Quality Assurance Assessment promotes nurses’ continuing competence and quality improvement of their practice.  Each year, CNO randomly selects nurses from the General and Extended classes to participate in a Quality Assurance (QA) Assessment. If you are selected, you will be notified by email with instructions on how to complete the assessment requirements. Nurses selected for QA Assessment are required to:  Identify two learning goals  Complete and submit a Learning Plan  Complete a CNO Code of Conduct practice activity. Bottom line… As professionals, nurses must demonstrate their commitment to lifelong learning. The QA program at the CNO serves to monitor participation and compliance and includes goal setting for continuing competency and a variety of peer, self and proactive assessments. A quick note about reflection….  Reflection, as a conscious, dynamic process of thinking about, analyzing, and learning from clinical experience helps a nurse gain insight into self and practice.  It’s long been considered essential for building competence and professional comportment in nursing education. (Asselin, 2011) Reflection  John Dewey (1983): “We do not learn from experience. We learn from reflecting on experience.”  Reflection is a continuous process that generates learning, deepens learning, and documents learning, and takes place before, during, and after an learning experience. It solidifies the connection between what a student experiences and the meaning that they derive from these experiences (Denton, 2011).  It is a continuous, iterative process (Schön, 1983). A word about reflective practice…  What  Why does this mean? is it important??  https://www.youtube.com/watch?v=tPWjahqK 1HA What about reflective writing? Refer to the OER that you used in NSE 101: The Scholarship of Writing in Nursing Education: 1st Canadian Edition https://pressbooks.library.torontomu.ca/scholarlywriting/ Reflective Writing  Have you ever been asked to reflect on a text or an experience?  Reflective writing is used by different healthcare professions in various ways, but all reflective writing requires that you think deeply and critically about an experience or a text. At the centre of reflective writing is the “self” – including a deep analysis of you in relation to the topic. Reflective writing is a process that involves recalling an experience or an event, thinking and deliberating about it, and then writing about it. (Lapum, 2019)  in nursing, reflective writing is part of what is called “reflective practice.” Early in your nursing program, you will become familiar with the College of Nurses of Ontario requirements for nurses to engage in reflective practice: this legislated professional expectation involves an intentional process of reflecting to explore and analyze a clinical experience so that you can “identify your strengths and areas for improvement” with the aim of strengthening your practice (College of Nurses of Ontario, 2019). How to do it?  There are many ways to reflect/many reflective nursing frameworks that you will be exposed to. Often instructor or teachers will give you a series of questions upon which to reflect. Many ways in which to do this…a couple of frameworks to guide your writing:  More recently, reflective writing has been described in the context of narrative writing in which you engage in personal and professional storytelling. A narrative approach to reflective writing asks you to think about storied elements (e.g., characters, events, setting) of an experience: What happened? How did the situation begin? Who was involved? Where did it take place? What emotions were people feeling? How did the situation end? (Lapum, 2019) Reflective Journaling  In NSE 121- Clinical Practice 1,you will be encouraged to keep a journal in which you will reflect and write about an experience(s) that occurred during your weekly clinical day. In an effort to help you further develop as a reflective practitioner, you will be encouraged to share your thoughts and feelings about your experiences with your clinical instructor and peers during postconference time.  Journaling and sharing will account for 5% of your final NSE 121 grade.  A final reflection that looks at your growth over your first clinical placement with we worth an additional 5% of your final NSE 121 grade. This Photo by Unknown Author is licensed under CC BY-SA-NC NSE 121 – Clinical Practice 1 …a sneak peek!! NSE 121 - Clinical Practice 1  Introduces the student to the profession of nursing as a practice discipline. Students develop their understanding of the role of the nurse within the interprofessional team. In the clinical setting, students learn to apply caring, communication, critical thinking and foundational nursing skills to maintain and support clients’ health and well-being. NSE 121 – Course Learning Outcomes By the completion of this course, the student will have had the opportunity to:  1. Identify self as a novice practitioner within the profession of nursing, using the College of Nurses of Ontario professional standards as a guide.  2. Demonstrate critical thinking and reflective practice in the application of theoretical, empirical, and personal knowledge to nursing practice.  3. Perform a range of nursing interventions at a novice level, to promote, maintain and restore health and well-being.  4. Establish and maintain a therapeutic environment that is supportive of self and will be supportive of a diverse group of clients.  5. Demonstrate behaviours that contribute to effective partnerships with clients, peers, faculty and the interprofessional team.  6. Integrate and apply knowledge attained in all first year courses to nursing practice. The details:  Clinical begins the week of January 15, 2024. Placements are assigned and will be on Tuesdays, Wednesdays or Thursday. The shift you are assigned may be either days (~7am-3pm) or evenings (3pm – 11pm)  You will be in the clinical setting for a total of 48 hours, 6 eight hour shifts every other week over the Winter semester.  Attendance in clinical is mandatory and critical to your learning. Nothing will replace in-person experiences. Please refer to student expectations for clinical attendance in your NSE 121 Course Outline. More details…  Students are expected to be punctual, prepared, and ready to actively engage in all clinical practice in a professional manner.  You will keep to your assigned clinical, days, groups and instructors – no changes will be permitted once assignments are set.  Play close attention to mandatory orientation sessions at your assigned facility. They may take place prior to actual start of clinical. Some are online and others will be in-person.  Students who are unprepared for the clinical experience, as determined by the instructor, may have his/her clinical practice restricted, or at the discretion of the instructor, the student may be asked to leave, and he/she will be recorded as absent for the day. Students who demonstrate a pattern of inadequate preparation will be unable to successfully meet the course objectives and will receive a failing practice grade. Assignments: 1) There are a variety of independent/online learning activities, quizzes, a reflective journal and a clinical care plan assignment in this course. 2) A final self-appraisal is also due at the end of your clinical practicum and is based on the CNO Code of Conduct, Revised 2023. TIP: Keep your performance appraisal (PA) and the CNO Code of Conduct on your device for easy access. Add to your PA daily in an effort to keep close track of your weekly accomplishments!!  You must achieve 63% in graded assignments AND a PASS from your clinical instructor in order to pass NSE 121. HOLD for new PA A quick word about Scope of Practice…  Updated CNO Standard – updated July 1, 2023  Scope of practice refers to a range of activities that nurses’ have the legislated authority to perform.  Employer policies and practice setting requirements, as well as the individual nurse’s competence, also impact nurses’ decisions and accountability related to scope of practice.  To meet the expectations of this standard, a nurse must consider each of the following key concepts: Authority, Context and Competence As Year One Nursing Students, you have a very limited scope of practice in the clinical setting!! Never be afraid to ask for help or tell a buddy nurse that do not have the knowledge, skill or judgement to perform a task or make a decision. Scope of Practice Year One Nursing Student  Communication skills introduced and practiced in NSE 101  Documentation skills introduced in NSE 101 – this will be determined at your clinical setting and supported by your CI – always follow facility policy, but you may always practice with your CI  Psychomotor skills introduced and practiced in NSE 111 (including skills related to transferring, supporting ambulation, positioning in bed, supporting ROM, bed making, bathing, grooming, dressing, toileting and all other forms of supporting elimination, meal assistance and feeding)  As a Year One Nursing Student, you do not yet have the knowledge skill or judgement to administer any form of medication including topical creams, insert a catheter, change a dressing, manage a feeding tube or bladder scanner. If you are given the opportunity to observe these or any other more advanced nursing skills, TAKE IT!! There is much to be learned through observation  You will not be using a Hoyer lift on your own, but with appropriate education in the facility, you may assist your partners. IPAC…critical knowledge!! Welcome to Ontario Long-Term Care… What do you know about Ontario Long-Term Care? This Photo by Unknown Author is licensed under CC BY-SA The Fixing Long-Term Care Act, 2021 (FLTCA)  On April 11, 2022, The Fixing Long-Term Care Act, 2021 (FLTCA) was proclaimed into force to regulate Ontario's long-term care home sector. On the same day, the Long-Term Care Homes Act, 2007 (LTCHA) was revoked, which means it is no longer in force.  The Act generally maintains the status quo set out in the Long-Term Care Homes Act, 2007 while making incremental changes relating to staffing and care, accountability and transparency, enforcement, and licensing.  Ontario is investing $20 million this year to hire 193 new inspections staff and is launching a new annual proactive inspections program in long-term care homes. The new program focuses on residents’ rights, infection prevention and control, plans of care, abuse and neglect, nutrition and hydration, medication management, policies and directives, and dining observations.  Currently, close to 70,000 Ontarians live in 626 long-term care homes and more than 60,000 Ontarians live in over 770 licensed retirement homes across the province.  As of June 2021, more than 38,000 people were on the waitlist to access a long-term care bed in Ontario. The median wait time is 163 days for applicants to be placed in long-term care. https://www.blg.com/en/insights/2022/02/what-you-need-to-know-about-ontarios-fixing-long-term-care-act https://news.ontario.ca/en/release/1001060/ontario-introducing-new-legislation-to-fix-long-term-care https://www.ontariocanada.com/registry/view.do?postingId=40508&language=en The Fixing Long-Term Care Act, 2021(FLTCA)  Key features of the new Act lay the groundwork for systemic and long-term reforms that will enhance resident quality of care and quality of life, including:  expanding the rights of residents to have support from their caregivers, to assistance in contacting those caregivers and to receive care and services based on a palliative philosophy;  establishing a target for an average of four hours of direct care to be provided per resident per day by March 2025;  requiring public reporting on progress towards the hours of care target and develops a plan to achieve the target where a target has not been met;  placing greater emphasis on quality of care, quality of life and continuous quality improvement, including provisions to enable the Minister to establish a Long-Term Care Quality Centre;  implementing new enforcement and compliance tools (e.g., providing inspectors with the flexibility to allow licensees to immediately address low-risk non-compliance during an inspection, incorporating a system of Administrative Monetary Penalties, etc.) to hold poor performing homes to account; and  streamlining the development and redevelopment process and providing the Ministry with more flexibility to manage license expiries. https://www.ontariocanada.com/registry/view.do?postingId=39507 Bottom Line: Measures under this part of the Bill would fall under the three pillars of the government’s plan to ensure Ontario’s seniors get the quality of care they need and deserve both now and in the future:  improving staffing and care,  protecting residents through better accountability; enforcement and transparency,  building modern, safe, comfortable homes for our seniors. https://www.ontariocanada.com/registry/view.do?postingId=39507 Who works in an Ontario long –term care home (LTCH)?  Personal Care Aids/Personal Support Workers (PCA/PSW), Registered Practical Nurses (RPNs), Registered Nurses (RNs), Nurse Practitioners (NPs) – providing direct resident care – all have a clearly defined scope of practice! 1. PSW – hands on/routine care, 2. RPN – nursing assessments/nursing care/medication administration, 3. RN – advanced nursing care, administrative responsibilities, 4. NP – primary care, medication management, specialist referrals  Nursing Management (Director of Care)  Physicians (Attending Physician(s) and a Medical Director)  Senior Leadership (Administrator(s), Mangers (of many disciplines/departments), Resident Care Coordinators)  Housekeeping, Environmental/Maintenance, Dietary/Kitchen, Recreation/Activities  Interdisciplinary Health Care Team – physiotherapy, social work  Clergy/Chaplain/Spiritual Care Provider  Other visiting health care providers – foot care specialists, denturists, dentists, opticians, wound care specialists, etc…  Family members And this is not an exhaustive list – every home is a little different, uses different titles for their health care professionals, but all need to meet Ontario standards of care. We know that this has been particularly challenging and many struggles have been noted during the Pandemic. Care Providers in LTC:  Regulated (RPN, RN, NP) and Unregulated Care Providers (PSW) work in LTCHs.  Increasingly, unregulated care providers (UCPs) assist with, or perform, certain aspects of care traditionally provided by regulated health care professionals. UCPs perform a variety of tasks based on their employment setting and on the role or employment description the employer provides.  Nurses are often expected to teach, delegate, assign tasks to and supervise UCPs. The nurse must determine appropriateness of providing care in each client situation, and then ensure that measures are in place to promote the UCP’s continuing competence.  The CNO provides clear guidelines to nurses who work alongside UCPs. Please refer to Practice Guideline, Working With Unregulated Care Providers, Updated 2013 https://www.cno.org/globalassets/docs/prac/41014_workingucp.pdf Consider…. Has anyone been inside of an Ontario Long Term Care Home?? What do you remember? What did you notice? Ontario Long-Term Care Homes…  Provide help with most or all daily activities  Provide access to 24-hour nursing and personal care  The Ontario government will pay for personal and nursing care in a long-term care home. Individuals must pay for accommodation charges, such as room and board.  Optional services, where they are offered, such as hairdressing, cable TV, telephone, Internet and transportation, are available for a fee. Ontario Long-Term Care Homes… Types of homes  Long-term care homes in Ontario are regulated and funded by the government and must have a license or minister’s approval to operate. Long-term care licenses are issued to:  not-for-profit  homes homes, such as homes run by a charity run by for-profit companies Minister’s Approvals are issued to:  municipally-run and First Nations homes (as defined in the Fixing Long-Term Care Act, 2021) Accommodation charges are the same at all homes, regardless of the type, but fees for optional services will vary. https://www.ontario.ca/page/explore-your-care-options One can expect to receive the following in a long-term care home:  an individual care plan (reviewed at least every six months)  shared dining room, TV rooms and other living areas  access to 24-hour nursing and personal care  furniture in your room  help with activities of daily living  housekeeping  meals (including special diets)  bed linens and laundry  medical services  personal hygiene supplies  access to health professionals   social and recreational programs medical or clinical supplies (such as walkers and wheelchairs for occasional use)  individualized religious and spiritual services https://www.ontario.ca/page/explore-your-care-options Eligibility Criteria To live in a long-term care home, one must:  be age 18 or older  have a valid Ontario Health Insurance Program (OHIP) card  have care needs that: 1. require 24-hour nursing care and personal care 2. require assistance with the activities of daily living 3. require on-site supervision or monitoring to ensure safety or well-being 4. cannot be met through publicly-funded community-based services and other care-giving support in the community  For more information or to apply for long-term care, one needs to contact their local Home and Community Care Support Services organization. https://www.ontario.ca/page/explore-your-care-options Nursing Station Hospital Room Typical room in LTCH Common Areas in LTCH Clean Utility Soiled Utility A few final things to think about… This Photo by Unknown Author is licensed under CC BY Now is the time to create good habits! Offer help, be kind, be present – be your own advocate! Think about your learning goals… Don’t sit! Do something!! Help out! Answer a call light! Tag along… Kill grumpy nurses with kindness!!! Do you want to do this??? Always say “Yes”!!!!! (scary experiences are good!) Be a sponge…but be clear in your scope of practice and communicate with the team. Be early, look decent, and don’t wear any scents!! Portray confidence…but not over-confident!! - eye contact and posture is important!! Look up!!! Smile! Ask questions! Ditch the clipboard! Put your phone away!! Eat breakfast!!! – Get your sleep!! Be prepared! It’s OK to think that you know absolutely nothing!! Most don’t feel prepared for clinical – always more ready that you think!!! To do:  Scrubs  Shoes  Equipment – stethoscope, blood pressure cuff, penlight  Practice Requirements – should be completed and uploaded  Signature Block – should be completed – keep correspondence professional  Check CC and TMU email accounts daily (or twice a day)  HSPnet – make sure you have logged on and check regularly for updates  When you do hear from your Clinical Instructor (CI) – email them back and introduce yourself – always respond to their emails even if only a short sentence or acknowledgement  Download all materials from this course shell that you think you will need – it will be closing in January! Nursing School Clinical – Tips for Success! (20 minutes) https://www.youtube.com/watch?v=Gst-Mo6Te7s I am your nurse! https://www.youtube.com/watch?v=jy2VfUiv5dc Thanks for your participation…. Please email me with any questions, concerns or comments. Phone calls or virtual meetings with students can be arranged as requested/needed.