checklist for assessors general nursing … - nurse...checklist for assessors general nursing...

F. Forms for use in the assessment of competencies F-1

msp/psd/hhrdb/12-11

Annex F.

Checklist for Assessors General Nursing Competencies

Levels 1 and 2


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Assessment Checklist for Use by Assessors

Note: What follows is a template of the form that assessors will use in reviewing the competencies of a candidate.

Name of Candidate: ____________________________________________________________ Hospital of current assignment: __________________________________________________ Introduction: This form shall be accomplished by the assessors assigned for RNheals Trainees/ Nurse Candidates. This Checklist for Assessors is both formative and summative. As such it provides information as to the areas and levels of competency of the Candidate with respect to the standard performance criteria. It also informs on competency gaps and therefore provides the Candidate with leads on which learning and development interventions he/she should undertake.

Instructions: The second column in the table lists behavioural indicators that determine successful/outstanding performance in the workplace. In order to provide a calibrated picture of the Candidate’s proficiency at demonstrating these behaviors, the tool uses a two-point rating scale that indicates whether or not the candidate is competent in the specific behaviour in a given situation at the workplace. This summarizes the results of the assessment done by the Assessor, applying the suggested assessment methods and evidence guides. Indicate with a tick mark in the corresponding box areas in the hospital where the candidate was assigned (most of the time) to perform the required competencies:

Ward OPD DR OR Others_____

Place a tick mark in the corresponding column if candidate demonstrates the behaviour indicated in the second column as the situation arises at the workplace C for Competent or NYC for Not Yet Competent. General Nursing Level 1

No. Performance Criteria Assessment

Methods Evidence

Guide C NYC

Assessor’s Remarks

Assessor’s Signature

1

NCWDNL1A01 Obtain complete and accurate patient’s history to include family history of allergy and illnesses

2

NCWDNL1A02 In OPD: Perform basic triaging upon arrival of patient


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3

NCWDNL1A03 Perform accurate head to toe physical assessment utilizing standard protocols

4

NCWDNL1A04 Formulate accurate nursing diagnosis based on the assessment

5 NCWDNL1A05 Prepare documents for networking and referral

6

NCWDNL1A06 Explain to patient diagnostic procedures to be performed and the necessary preparations

7

NCWDNL1A07 Prepare the patient for diagnostic procedures after securing informed consent

8

NCWDNL1A08 Identify abnormal laboratory and other diagnostic findings

9

NCWDNL1A09 Identify expected outcomes of a holistic nursing intervention

10

NCWDNL1A10 Formulate nursing care plan according to patient’s needs as determined by the assessment process

11

NCWDNL1A11 Implement the Nursing Care Plan with the participation of the patient’s significant others

12

NCWDNL1A12 Validate doctor’s orders before carrying them out

13

NCWDNL1A13 Perform appropriate infection control measures

14

NCWDNL1A14 Anticipate patient’s needs and provide for them accordingly


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15

NCWDNL1A15 Monitor patient’s progress and evaluate against

16

NCWDNL1A16 Gather feedback from the patient and his/her significant others on the care received and its outcomes

17

NCWDNL1B01 Disseminate information that will promote healthy lifestyle, wellness, disease management, environmental sanitation and protection, and DOH program thrusts to the patient and his/her support system

18

NCWDNL1C01 Interact with the patient and significant others in a manner that will promote a trusting and helping relationship

19

NCWDNL1C02 Discuss with patient his/her rights, responsibilities and obligations

20

NCWDNL1C03 Secure patient’s informed, written consent for hospital admission and treatment

21

NCWDNL1C04 Utilize proper and effective channels of communication in collaborating with the health care team and providing patient care

22

NCWDNL1D01 Provide regular and accurate updates to the members of the health team on the condition of the patient for the continuity of care


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23

NCWDNL1D02 Participate in meetings and discussions on the patient’s condition and plan of care with other members of the health care team

24

NCWDNL1F01 Organize own workload through prioritization and time management in order to be more efficient in provision of patient care

25

NCWDNL1F02 Conduct regularly an inventory of available medical supplies and medications using standard checklists

26

NCWDNL1F03 Monitor functionality of medical and non-medical equipment

27

NCWDNL1F04 Use supplies for patients appropriately and prudently

28

NCWDNL1F05 Implement measures that will address potential risks to patient safety following risk management guidelines and Patient Safety Principles and Policies

29

NCWDNL1G01 Document patient care/all nursing interventions clearly, concisely, accurately, completely and in a timely manner using standard protocols

30

NCWDNL1G02 Utilize appropriate tools, methods, and systems to maintain integrity, confidentiality, accessibility, and security of patient information and records


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31

NCWDNL1H01 Identify deviations from the standards (as specified in the hospital quality management system) on patient care and ward management

32

NCWDNL1I01 Provide patient care consistent with national laws on health, the Philippine Nursing Act, and with hospital policies, rules and regulations

33 NCWDNL1J01 Identify topics appropriate for research

34

NCWDNL1J02 Participate in preparing a research proposal complying with the ethical principles in nursing research

35

NCWDNL1I01 Provide patient care consistent with national laws on health, the Philippine Nursing Act, and with hospital policies, rules and regulations

36 NCWDNL1J03 Gather data using different methodologies

37

NCWDNL1K01 Perform nursing functions and responsibilities consistent with the vision, mission, core values, and policies of the institution

38

NCWDNL1K01 Perform nursing functions and responsibilities consistent with the vision, mission, core values, and policies of the institution


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39

NCWDNL1L02 Actively secure development opportunities within and outside the hospital

40

NCWDNL1L02 Actively secure development opportunities within and outside the hospital

41

NCWDNL1M01 Provide nursing care that reflects value and respect for people regardless of their place of origin, race, politics, status, role, gender, culture, belief system and/or behaviour

42


43

NCWDNL1M03 Accept accountability for own decisions and actions

_________________ Signature of Assessor

_________ Date


_________ Date


msp/psd/hhrdb/12-11

Assessment Template for Use by Assessors

Note: What follows is a template of the form that assessors will use in reviewing the competencies of a candidate.

Name of Candidate: ____________________________________________________________ Hospital of current assignment: __________________________________________________ Introduction: This form shall be accomplished by the assessors assigned by the facility. This Checklist for Assessors is both formative and summative. As such it provides information as to the areas and levels of competency of the Candidate with respect to the standard performance criteria. It also informs on competency gaps and therefore provides the Candidate with leads on which learning and development interventions he/she should undertake.

Instructions: The second column in the table lists behavioural indicators that determine successful/outstanding performance in the workplace. In order to provide a calibrated picture of the Candidate’s proficiency at demonstrating these behaviors, the tool uses a two-point rating scale that indicates whether or not the candidate is competent in the specific behaviour in a given situation at the workplace. This summarizes the results of the assessment done by the Assessor, applying the suggested assessment methods and evidence guides. Indicate with a tick mark in the corresponding box areas in the hospital where the candidate is currently assigned (most of the time) to provide nursing services:

Ward OPD DR OR Others_____

General Nursing Level 2

No. Performance Criteria Assessment

Methods Evidence

Guide C NYC

Assessor’s Remarks

Assessor’s Signature

1

NCWDNL2A01 Conduct a comprehensive assessment using the body system approach

2

NCWDNL2A02 Inspect body contraptions and their functionality

3

NCWDNL2A03 Refer to the physician critical information obtained based on the assessment findings

4 NCWDNL2A04 Refer to appropriate sub-specialty (area) service


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5

NCWDNL2A05 Follow through full implementation of relevant diagnostic procedures to facilitate prompt interpretation by the physician

6 NCWDNL2A06 Correlate findings with patient’s condition

7

NCWDNL2A07 Identify potential risks or barriers in the implementation of care that will affect the desired outcome

8

NCWDNL2A08 Incorporate nursing strategies in the nursing care plan to address potential risks and barriers

9

NCWDNL2A09 Modify nursing care plan according to changes in client’s needs

10

NCWDNL2A10 Modify nursing interventions based on the outcome of care

11

NCWDNL2A11 Report or refer immediately to the physician any adverse reactions to treatment and complications

12

NCWDNL2A12 Perform necessary emergency measures or independent nursing care to alleviate adverse reactions and complications

13

NCWDNL2A13 Identify potential risks for infection and refer to the Infection Control Committee or other responsible persons for action


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14

NCWDNL2A14 Evaluate the effectiveness of nursing and medical management carried out on the patient

15

NCWDNL2A15 Prepare plan for discharge according to patient’s condition

16

NCWDNL2B01 Assess learning needs of patient/ significant others related to health maintenance and continuity of care

17

NCWDNL2B02 Customize a health teaching plan based on needs of patient and significant others

18

NCWDNL2B03 Participate (e.g., teach, facilitate, moderate) in health education activities of the hospital

19

NCWDNL2C01 Validate patient’s verbal and non-verbal responses with other manifestations

20

NCWDNL2D01 Participate in multi-disciplinary patient-care management

21

NCWDNL2E01 Integrate ethical or moral considerations that may affect patient care, treatment or prognosis

22 NCWDNL2F01 Organize own workload / patient assignment

23

NCWDNL2F02 Identify required medical supplies and equipment to carry out medical and nursing management for patient

24

NCWDNL2F03 Monitor stocking level of materials for patient’s use and request for replenishment promptly


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25

NCWDNL2F04 Identify additional or alternative medical supplies and medications

26

NCWDNL2F05 Establish a mechanism to ensure proper functioning of equipment to include preventive maintenance and referrals to repair services

27

NCWDNL2G01 Document patient’s condition and care according to accepted accreditation standards using standard protocols

28

NCWDNL2H01 Identify root causes of deviations from standards in quality patient care and ward management and propose measures to address them

29

NCWDNL2H02 Participate actively in the continuous quality Improvement activities/endeavours of the institution

30

NCWDNL2I01 Integrate in the nursing care plan and services provided legal considerations that may affect patient care, treatment or prognosis

31

NCWDNL2J01 Provide technical support (data gathering, analysis and interpretation of data) to a research team tasked with a particular problem regarding patient care or service delivery systems

32

NCWDNL2J02 Apply relevant evidence-based research findings in nursing practice


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33

NCWDNL2K01 Lead in the performance of nursing care and other assignments in a manner that reflects the mission, vision, and core values of the institution

34

NCWDNL2K02 Act in such a manner that inspires the patient, his/her support system, and other members of the health care team to work in a concerted manner toward positive outcomes for the patient

35 NCWDNL2L01 Prepare a career plan

36

NCWDNL2L02 Assume delegated responsibilities with respect to nursing care

37

NCWDNL2L03 Regularly attend seminars, trainings, and other continuing education activities that will lead to the enhancement of nursing competencies

38


39

NCWDNL2MO2 Exhibit a greater degree of compassion, emotional stability and maturity in handling patients and significant others

40

NCWDNL2MO3 Demonstrate a positive attitude that will contribute to good working relationships with colleagues at all times


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41

NCWDNL2M04 Accept accountability for own decisions and actions

42

NCORNL2A01 Conduct a comprehensive assessment using the body system approach

43

NCORNL2A02 Inspect body contraptions and their functionality

44

NCORNL2A03 Coordinate with Surgeon And Anaesthesiologist regarding requirements for intended procedures

45

NCORNL2A04 Follow through full implementation of relevant diagnostic procedures to facilitate prompt interpretation by the physician

46 NCORNL2A05 Correlate findings with patient’s condition

47

NCORNL2A06 Identify potential risks or barriers in the implementation of procedures that will affect the desired outcome

48

NCORNL2A07 Incorporate nursing strategies in the nursing care plan to address potential risks and barriers

49

MCORNL2A08 Modify nursing care plan according to changes in client’s needs

50

Pre-operative NCORNL2A09 Confirm and identify the procedure, discuss with patient, and secure written consent


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51

NCORNL2A10 Establish necessary markings and functionalities of instruments, equipment and relevant facilities

52

Intra-operative NCORNL2A11 Implement strictly the infection control practices and principles of OR nursing

53

Post-operative NCORNL2A12 Identify risk factors affecting immediate post-operative surgery and recommend ways to address them

54

NCORNL2A13 Implement operating room safety measures with utmost care and according to prescribed standards

55

NCORNL2A14

Determine foreseeable crisis or complicating conditions after the operation and during patient’s stay at the PACU and recommend ways to address them

56

NCORNL2B01 Prepare a health teaching plan for use upon discharge from OR-PACU that will contribute to fast recovery

57

NCORNL2B02 Customize a health teaching plan based on needs of patient and significant others

58

NCORNL2B03 Participate (e.g., teach, facilitate, moderate) in health education activities of the hospital

59

NCORNL2C01 Validate patient’s verbal and non-verbal responses with other manifestations


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60

NCORNL2D01 Participate in multidisciplinary patient care management: pre-op, intra-op, and post-op

61

NCORNL2E01 Integrate ethical or moral considerations that may affect the procedure and may have possible adverse effects on the patient during and after the OR procedure

62

NCORNL2F01 Obtain availability of functional equipment, facility, manpower, medicines, anaesthetic and other supplies before the procedure with the OR Head Nurse and Supervisor

63

NCORNL2F02 Establish a mechanism to ensure proper functioning of equipment to include preventive maintenance and referrals to repair services

64

NCORNL2G01 Document the exact procedure done, completeness of sharp instruments and sponges after the procedure

65

NCORNL2G02 Encode and report the specimen extracted from the patient after the surgical interventions

66

NCORNL2H01 Review effectiveness of surgical procedure using the observation and inspection of incision site and length of stay of operative patients

67

NCORNL2H02 Implement strictly the principles of aseptic procedures and the Infection Control Program


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68

NCORNL2I01 Participate in filling up and implementation of WHO Safety Checklist

69

NCORNL2J01 Provide technical support (data gathering, analysis and interpretation of data)to research activities related to operating room procedures

70

NCORNL2K01 Perform nursing care and other assignments in a manner that reflects the mission, vision, and core values of the institution in the context of the OR function

71

NCORNL2K02 Act within the capacity of the scrub and circulating charge nurse

72

NCORNL2L01 Identify learning needs and training needs of an operating room nurse

73

NCORNL2L02 Plan, organize and update skills on operating room nursing and its complexities

74

NCORNL2L03 Regularly attend seminars, trainings, and other continuing education activities that will lead to the enhancement of nursing competencies

75 NCORNL2M01 Perform peri-operative nursing with integrity

76

NCORNL2M02 Exhibit a greater degree of maturity in carrying out critically diverse cases and approaches in OR nursing


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77

NCORNL2M03 Act in a manner consistent with the values and ethical principles of nurses within the context of OR standards and the Nurses ‘ Code of Ethics

78

NCORNL2M04 Accept accountability for own decisions and actions


_________ Date


_________ Date


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RECOMMENDATION FORM FOR THE USE OF ASSESSORS

Name of Candidate: _________________________Address/Contact No._________________ Date of Assessment : ___________________________________________ Area : General Nursing Level : I II (Please encircle) Assessors: 1) _____________________________________________ 2) _____________________________________________ Assessment Findings: Candidate has consistently demonstrated all competency requirements. Candidate was not able to demonstrate all the required competencies. Recommendations: Candidate is recommended to undertake learning interventions on the following competency area/s (Pls. indicate competency code, i.e. NCPPHNL1A01):

______________________________ _____________________________ Name and Signature of Assessor 1 Name and Signature of Assessor 2 _______________ _______________ Date Date

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