CAPE Tool

NEW GRADUATE NURSE PROGRAM Competency Assessment Planning And Evaluation Tool (CAPE Tool) IEN Medical Surgical
Nursing DRAFT 2007
Date of First Assessment
Mentee
Date of Second Assessment
Mentee
Mentor Facilitator Facilitator
Mentor Facilitator Facilitator
Fraser Health 2005 DRAFT - Adapted: Benner 1984, RNABC Standards of Practice 1998, Adapted with Permission from Childrens and Womens Health Centre of B.C. 2000, C & W CAPE TOOL 2000, FHA CAPE Tool 2002, RHS 2004, Surrey Health Services. N:/SD&PP/PP/IEN /IEN CAPE Tools/Medical Surgical Nursing October 2007 Revised IEN Med/Surg CAPE Tool
NEW GRADUATE NURSE PROGRAM Competency Assessment Planning & Evaluation Tool (CAPE Tool): IEN Medical Surgical Nursing DRAFT OCT 2007
Goal: The purpose of this tool is to assist nurses consolidate their nursing practice and experience as well as supporting nurses to assess, plan and evaluate their current competence in relation to the scope of practice. This tool assists the nurse to develop a learning plan to meet their personal learning needs Instructions and Definitions: 1. Review the competencies from start to finish 2. Review the headers on top of pages 3. Locate the key with the 5 self rating levels 4. Read the definitions of the 5 self rating levels 5. Locate the initial self assessment column on the top of the page 6. Place a number from the key (between 1-5, novice to expert) to reflect your level for that competency. 7. Discus potential learning activities with the RN, RPN or LPN on your unit and your Clinical Educational team (Mentor, CRN, CNE, PCC). 8. Write learning activities in the column titled learning activities/resources. 9. Place a check mark in the column titled Reviewed with Mentor/preceptor/Clinical Educator/manager/peer once you have reviewed with these individuals. 10. Write date and your signature once you have completed the learning activity for each competency.

Within some FH CAPE tools there are sections entitled Practice Limitations or notes of exceptions are written within the framework. These tasks cannot be undertaken by those individual nurses covered by these specific CAPE tools under any circumstances. Although the frequency of reassessment is noted on the tool, it can be complete more often or as required
Competence develops over time. Each nurses development is unique and unfolds according to his/her learning needs, initiative and education/practice experiences. Generally, you will continue to build on foundational knowledge through your nursing education program and this employment experience, gradually your abilities and confidence will increase and you will progress to recognizing the prominent features present in the situation. The ability to appraise your knowledge, performance, and practice is fundamental to any professional.
Self Assessment Levels (Benner, 1986)
i. Novice Use theory Follow rules Focus on tasks Are unaware of resource Lack experience in context
ii. Advanced Beginner Limited theoretical knowledge & experience Enough experience to grasp aspects Can recognize recurrent meaningful components of the situation Marginally acceptable performance Able to make simple decisions re: care Concerns re: looking stupid if reporting inaccurate data iii. Competent Focus still on routines Can differentiate which aspects of the situation are important / can be ignored Demonstrates conscious and deliberate planning Deepening theoretical knowledge with experience Increased level of proficiency, confidence in decision-making iv. Proficient Able to perceive the situation as a whole Performance guided by principles, rules of conduct Recognizes most important conditions Intuitive grasp of situation based on understanding (knowledge / skills) Analytical approach to decision-making, confidence in their assessment findings v. Expert
Rapid analytic assessment Judgment based on understanding of paradigms Integration of theoretical and experiential knowledge of similar care situations Confident decision-making / intuition
Reassessment (3 6 mo) Reassessment (1 year) Learning Activities/Resources Reviewed with Mentor/ Preceptor Clinical Educator Manager Peer Planned Learning Activities Achievement & Validation of Competency (include examples from clinical practice and learning plan) Date and Signature
Needs Learning and Practice Knowledgeable but needs Practice Competent: Independent Practice Proficient Practice Expert Practice
Initial Self Assessment
KEY 1. 2. 3. 4. 5. CRNBC STD. I. 1,6 1,6 1.
Second self assessment
COMPETENCY STATEMENTS RESPONSIBILITY/ACCOUNTABILITY/SELF-REGULATION Health Care In Canada: Has studied the health care system in Canada Has studied social determinants of health in Canada Has examined social epidemiology, health seeking behaviors Understands public and professional values & expectations related to health care Has studies and uses teaching and learning theory Understands and uses health promotion concepts and practices Uses the nursing process Understands the concept of patient focused care Has examined legal, ethical, professional and leadership issues in Canada Has examined and understands Standards of Nursing Practice and Code of Ethics for nurses
2. II. 3,4 1. 2. 3.
At all times practices in a safe manner, is accountable, and takes responsibility for own practice ESTABLISHING EFFECTIVE RELATIONSHIPS WITH CLIENTS, FAMILIES, AND HEALTH CARE TEAM Demonstrates honesty, integrity, support, and respect in interpersonal relationships Adapts care to respect clients cultures and backgrounds and advocates for client/family Understands the roles of health care team members and collaborates with team to provide care:
Reassessment (3 6 mo) Reassessment (1 year) Learning Activities/Resources Initial Self Assessment KEY 1. 2. 3. 4. 5. CRNBC STD. Reviewed with Mentor/ Preceptor Clinical Educator Manager Peer Planned Learning Activities Second self assessment Achievement & Validation of Competency (include examples from clinical practice and learning plan) Date and Signature
Needs Learning and Practice Knowledgeable but needs Practice Competent: Independent Practice Proficient Practice Expert Practice COMPETENCY STATEMENTS Collaborates with health care team members to provide care Understands the concept of the role of a team member and a team player Understands the concept of delegation Delegates tasks appropriately to other categories of staff, e.g. LPN (Licensed Practical Nurse), RPN (Register Psychiatric Nurse), Care Aide Understands and identifies the role and contributions of members of the interdisciplinary team Demonstrates ability to give and receive help from others Enters discussion with other unit staff Gives assessment data and receives assessment data from all team members including physicians, interdisciplinary team members, patient and family Anticipates the need to ask for assistance from other team members
Anticipates giving assistance to other team members III. COMMUNICATION AND DOCUMENTATION OF CARE 3,4,5 1. Demonstrates English Language Skills that enable effective communication in clinical areas: Communicates fluently in written English Communicates fluently by listening to and speaking in English Gives evidence of comprehension of the English language as used in nursing practice areas Communicates with other unit staff and team members in a questioning manner improves overall care planning Understands and uses Canadian medical terminology and abbreviations
Needs Learning and Practice Knowledgeable but needs Practice Competent: Independent Practice Proficient Practice Expert Practice COMPETENCY STATEMENTS Can pronounce and enunciate key English words used in the practice environment Demonstrates ability to read and comprehend key parts of a patients chart. E.g., nurses notes, interdisciplinary progress notes and physicians orders
2. 3. 4.
Can communicate confidently in English by telephone Communicates relevant information about clients to the health care team in a timely manner Documents relevant assessments, interventions, and patient responses in a timely manner according to protocol Correctly uses the following documentation tools: Assessment Flow Sheet ADL Flow Sheet Progress Notes Fluid Balance Record Neurological Record Graphics Record Medication Administration Record Other Manuals Call Bells Phones Meditech Internet

5.
Currently uses supports/resources:
2,3,5
COMPETENCY STATEMENTS IV. ORGANIZES, COORDINATES, AND PLANS CARE EFFECTIVELY 1. Collects data for planning care from a variety of sources/assessments: Chart Kardex Assessment: physical, psychological, social, emotional Lab Values Diagnostic test results
2. 3.
Patient response to treatment Completes assignment within required time period with consideration for unit needs
Communicates in a timely manner with Preceptor, Team Leader, Program Educator or Preceptorship Coordinator about factors hindering ability to provide safe care: Unit Workload Patient Acuity Emergencies Equipment Issues Team Issues
V. PATIENT CARE MANAGEMENT 2,3 A. CLINICAL DECISION MAKING A.1. Individualizes patient assessment based on:
Age adult or geriatric patient Diagnosis
Needs Learning and Practice Knowledgeable but needs Practice Competent: Independent Practice Proficient Practice Expert Practice COMPETENCY STATEMENTS
Underlying health problems A.2. Prioritizing individualized patient assessment based on:
Age adult or geriatric patient Diagnosis Underlying health problems
A.3. Recognizes and reports clinically significant changes in the patients status A.4. Individualizes, evaluates, and re-prioritizes nursing care for patients with medical illnesses:
Heart Failure Asthma/COPD Pneumonia Substance Abuse/Alcoholism Diabetes Renal Failure Hepatic Failure CVA Cancers GI Bleeds ACS, Chest Pain, Post MI Angina Inflammatory Bowel Disease HIV/AIDS Other 8
Reassessment (3 6 mo) Reassessment (1 year) Learning Activities/Resources Initial Self Assessment KEY 1. 2. 3. 4. 5. CRNBC STD. 2,3 Reviewed with Mentor/ Preceptor Clinical Educator Manager Peer Planned Learning Activities Second self assessment Achievement & Validation of Competency (include examples from clinical practice and learning plan) Date and Signature
COMPETENCY STATEMENTS B. PROTOCOLS/GUIDELINES B.1. Implements and individualizes unit specific protocols for:
C.
Admission Transfer Discharge Death/Organ Donation Bowel Protocol Nadroparin, heparin, LMMH Prep for Diagnostic Procedures Least Restraints Pain Assessment & Management Seizures CIWA Allergy
Other POTENTIAL COMPLICATIONS
C.1. Analyzes the patients history, clinical course, and current status to predict potential complications C.2. Recognizes signs of complications and intervenes with help of team members for:
Hypo/hyperglycemia Hypo/hypertension Electrolyte imbalances
Fever Arrhythmias Hypo/hypervolemia Bladder distention Paralytic Ileus
Sepsis C.3. Recognizes, intervenes, reports and seeks help for urgent patient situations: Respiratory Depression/Failure

D.
Shock Hypoxia Decreased LOC Delirium
Cardiac/Respiratory Arrest Hemorrhage Compartment Syndrome Pulmonary Edema DVT Pulmonary Embolus AIRWAY MANAGEMENT
D.1. Initiates, monitors and maintains low flow oxygen delivery systems with correct use of pulse oximetry D.2. Notifies RT as needed for set up and assistance in maintaining of high flow systems and patient oxygenation problems D.3. Maintains, monitors, identifies complications and troubleshoots tracheostomy
10
Reassessment (3 6 mo) Reassessment (1 year) Learning Activities/Resources Initial Self Assessment KEY 1. 2. 3. 4. 5. CRNBC STD. E. 2,3 Reviewed with Mentor/ Preceptor Clinical Educator Manager Peer Planned Learning Activities Second self assessment Achievement & Validation of Competency (include examples from clinical practice and learning plan) Date and Signature
COMPETENCY STATEMENTS DRUG THERAPY
E.1. Understands the clinical indications, usual doses, routes, and adverse effects of drugs commonly administered in the Medical/Surgical Units: Analgesics Antiemetics Sedatives Bronchodilators Antibiotics Antihypertensives Antiarrythmics Anticoagulants Antianginals Diuretics Cardiac Drugs: Beta Blockers, Ace Inhibitors, Calcium Channel Blockers Epidurals (N52, Surgery) Chemotherapy (N51)
2,3
E.2. Evaluates the patients response to drug therapy E.3. Administer medications safely using the following: Oral Subcutaneous butterfly Transdermal
11
Reassessment (3 6 mo) Reassessment (1 year) Learning Activities/Resources Initial Self Assessment KEY 1. 2. 3. 4. 5. CRNBC STD. F. 2,3 Eye, ear, nose IM, IV Reviewed with Mentor/ Preceptor Clinical Educator Manager Peer Planned Learning Activities Second self assessment Achievement & Validation of Competency (include examples from clinical practice and learning plan) Date and Signature
Rectal IV THERAPY
F.1. Familiar with all aspects of needleless systems F.2. Maintains, troubleshoots, and discontinues IV infusions per hospital protocols F.3. Able to use automatic infusion devices F.4. Takes appropriate actions to prevent or minimize the effects of adverse IV therapy outcomes F.5. Administers blood and blood product transfusions in accordance with hospital protocols F.6. Ensures informed consent or refusal to consent to blood/blood products using hospital forms F.7. Calculates doses, admixes and administers IV medications at appropriate rates F.8. Maintains troubleshoots and discontinues central lines as per hospital protocol F.9. PCA (Surgery) G. NUTRITIONAL THERAPIES
2,3,5
G.1. Collaborates with nutritionist/SLP as needed G.2. Maintains accurate intake and output G.3. Recognizes S&S of dysphagia G.4. Follows the Enteral Feeding Protocol monitoring:
Weights
12
Checking residuals Flush maintenance Phosphate
G.5. Inserts enteral feeding tube as necessary G.6. Monitors and maintains G-tube, J-tube feeds H. DRAINAGE SYSTEMS H.1. Maintains, monitors, identifies complications and troubleshoots drainage system:
Gastric I. SKIN AND WOUND CARE I.1. Identifies patients at risk for skin breakdown, and implements preventative interventions I.2. Implements hospital protocols for wound care:
Chest tubes Urinary Incisional
Braden Scale
J. 2,3
Ostomy management DIAGNOSTIC TESTS
Appropriate use of products Dressing change Wound assessment Documentation on Flow Sheet
J.1. Recognizes and reports abnormal results of common diagnostic tests:
13
Cardiac markers K. STERILE PROCEDURES K.1. Demonstrates the difference between sterile and clean procedures and maintains appropriate technique: Wound care Catheterization Bladder irrigation Suctioning L. INFECTION CONTROL L.1. Understands the different isolation techniques, sets up patient area accordingly, and informs visitors:
CBC Electrolytes Glucose Urea, creatinine Coagulation profile (PTT, INR)
Droplet M. EQUIPMENT CHECKS 2,3,5 M.1. Checks each patient area for functional equipment and required supplies M.2. Performs routine checks for BCLS cart
Contact Respiratory/Airborne
14
COMPETENCY STATEMENTS N. PATIENT/FAMILY EDUCATION N.1. In collaboration with the interdisciplinary team, implements and evaluates education to assist the patient/family achieve learning needs N.2 Uses available teaching/learning resources to supplement education O. SPECIAL NURSING SKILLS
2,3,5
O.1. Successfully demonstrates the following specialized nursing skills::
Capillary blood glucose monitoring Central Venous Catheter Management Peritoneal Dialysis Epidural management IV initiation (N51) Other
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NEW GRADUATE NURSE PROGRAM Competency Assessment Planning And Evaluation Tool (CAPE Tool) IEN Medical Surgical

Nursing DRAFT 2007

Date of First Assessment

Date of Second Assessment

Mentor Facilitator Facilitator

Mentor Facilitator Facilitator

Initial Self Assessment

KEY 1. 2. 3. 4. 5. CRNBC STD. I. 1,6 1,6 1.

Second self assessment

Currently uses supports/resources:

Age adult or geriatric patient Diagnosis

Other POTENTIAL COMPLICATIONS

Hypo/hyperglycemia Hypo/hypertension Electrolyte imbalances

Fever Arrhythmias Hypo/hypervolemia Bladder distention Paralytic Ileus

Shock Hypoxia Decreased LOC Delirium

COMPETENCY STATEMENTS DRUG THERAPY

Checking residuals Flush maintenance Phosphate

Chest tubes Urinary Incisional

Ostomy management DIAGNOSTIC TESTS

J.1. Recognizes and reports abnormal results of common diagnostic tests:

CBC Electrolytes Glucose Urea, creatinine Coagulation profile (PTT, INR)

O.1. Successfully demonstrates the following specialized nursing skills::

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