NVQ evidence
Saturday, January 13, 2007
EVIDENCE LOG
Unit X19 Prepare and undertake agreed clinical activities with clients in acute care settings
Element X19.1 Prepare clients for clinical activities
Stool SpecimensIn my role as a worker in the A&E department, I regularly takes stool specimens for patients.
H0w I undertake this
PC
1
The correct necessary documents and records for the clinical activity are ready for use.
I check to see if the specimen of as being requested in the nursing notes.
2
Before the activity starts, the essential resources for the clinical activity are prepared ready for use.
I checked to see if the following resources are suitable and ready for use: -Commode: I see that this is clean and ready for use.Specimen pot: i ensure that this is the correct pot and catch increase sealed and undamaged.Toilet paper: I ensure that this is close at handSpecimens form: I ensure this is a correct form.
3
Before any actions are taken, the client’s consent to the activity is confirmed.
I approach a client and inform them that a specimen of their faeces is required. I explained that it is necessary to use either a bed pan or a commode to produce a specimen. I explain to them that it is important that the specimen does not become contaminated with urine. To this end, I explained that I will put a sterile pot in the commode to collect the specimen. I ask the client if they have understood this and if they do not mind if I proceed with the specimen collection.
4
Where the client and advocate do not give consent to the activity, advice is sought from an appropriate member of the care team without delay.
If the client says no, I explain to them that the specimen is important and it can help the doctors to know what is going on. However if they continue decline, I approached the qualified nurse and or doctor and explain to them that they have declined to have the test taken and I recall this in the patients care plan.
5
The client is offered appropriate support and information in preparation for the activity in a manner appropriate to them.
If the client is able to, I put the commode in the toilet where possible; otherwise, I ensure that the curtains are drawn around the bed space.
If the client needs assistance with mobilising, I help them with this.
If they require the use of a bed pan to have their bowels open, the I offer and give help where required.
6
Client behaviour and condition is observed and monitored throughout contact and any unexpected change or aspect, which gives cause for concern, is reported to an appropriate member of the care team without delay.
I give all clients the call bell so that they can summon help if they require it. I ensure that they are able to use it and tell them that they need not hesitate to do so should they need assistance.
For some individuals, the action of passing a stool can be quite strenuous, especially if the client is feeling ill and is constipated. This can make the client feel unwell. if this is the case, it a client feels unwell like this I summon assistance of a qualified nurse. If I am unsure about whether a client is safe to get out of bed, then I ask the view of the qualified nurse concerned as to whether it is safe for the individual to get out of bed for the client to get out of bed. If they client is feeling unwell, then I offer to stay with the client for support.
If the client suffers pain whilst having their bowels open, then I immediately tell the qualified nurse.
7
Any questions from the client and advocate are answered correctly and in a manner, and at a level and pace, appropriate to them.
If the client asks a question that it is within my role to answer, then I do at a level that is appropriate using words within their vernacular where appropriate.
8
Where the client and advocate raise questions which are beyond the worker’s responsibility, further appropriate advice or assistance is sought before undertaking the activity.
When this occurs, I seek the aid of a Registered practitioner as I am not a Registered Practitioner and am responsible for my actions and not as accountable for them as a Registered Practitioner is. If a question occurs that is outside my knowledge base or frame of reference, then I seek the assistance of a registered practitioner as I may say the wrong thing. In particular, I would seek trained help when clients/advocates seek advice about medical condition and diagnosis, as it is not my role to discuss this area with them.
9
The reasons for any particular forms of dress and protection are explained in a manner appropriate to the client.
A client may need to wear a gown whilst in the department to facilitate medical examination and/or x-ray. If I am the worker who assists the client with the donning of a gown, then I explain that this is done for the above reasons.
I wear gloves and apron, which I don prior to the commencement of the specimen and post washing and drying my hands. I explain that they are necessary as they help prevent infection spread. I remove them post the collection of the specimen and place them in a yellow bin bag for clinical waste. Then I wash and dry my hands.
How I undertake this
10
Where there are contra-indications before starting the activity, the preparation is halted and advice sought from the appropriate member of the care team with minimum delay.
When this occurs I do this because continuing with the procedure could cause damage, not only to the client, but also to member of staff and others as well. Contra-indications could be, in this instance:-
Client is unable to weight bare and requres the use of a bedpan
Client may had physical problems such as arthritic or a fracture that mean that two workers assist the client to use a bedpan.
I get someone as quickly as possible as to limit or prevent any harm occurring.
11
The client is offered the opportunity to use toilet facilities prior to the activity when this is appropriate.
Faeces specimens, in theory, should not be contaminated with urine. This can alter the results giving false reasons. If it is possible and there is the likelihood of a client contaminating a faeces specimen with urine, then I offer the client a bottle , for male clients, or an other bedpan/commode so they can maturated separately should they need to. I also put a sterile foil bowl in bedpans/commodes to facilitate collection of faeces without contamination via urine.
12
The client is assisted to reach as comfortable a position as possible given the constraints of the activity.
I do this as to reduce discomfort to a minimum but ensuring that health and safety is maximilsed. If a client needs help to gain a comfortable possition, then i do this. for example, if a client is on a bed pan and they are uncomfortable, I try to make them as comfortable as I can, with the use of pillows, for example.
Range
1
2
Clinical activities:
a) care of lesions and applications of dressings
b) elimination
c) extended personal care
d) tube feeding
e) obtaining specimens
f) undertaking physical measurements and monitoring
Essential resources:
a) for the activity to be undertaken
b) necessary protective clothing
Candidate Signature: …………………………………………………………
Observer Signature: …………………………………………………………
30/9/06
Date: ………………………………
Alan P Jack
Candidate Name: …………………………… Registration No: …………………………
EVIDENCE LOG
Unit X19 Prepare and undertake agreed clinical activities with clients in acute care settings
Element X19.3 Obtain and test specimens from clients
Stool Specimen
How I undertake this
PC
1
Hands are cleansed effectively before and after the activity.
Before I take a stool specimen, I wash and dry my hands and don plastic apron and latex gloves as a measure to reduce infection spread
2
The client is informed of the activities related to obtaining specimens in a manner which is sensitive to their needs and concerns and is at an appropriate level and pace.
I inform the client that I am required to take a stool specimen, which requires a collection of faeces. I explain that I will provide a receptacle, be that merely a sterile container or a bedpan/commode. If required, I adopt the vernacular of the client, to facilitate comprehension if the client does not understand. I only do this if the client does not understand. I ask if the client has understood at regular intervals
3
Any questions from the client are answered correctly or referred to the appropriate member of the care team.
If a question is within my frame of reference, I answer it. If it is not, I ask a registered practioner to come and talk to the client. I would call a registered practitioner to come and speak to a client if the client/advocate asked anything about the client/s medical condition/diagnosis/prognosis. This is not within my frame of reference to answer. If the client asked why I was taking the specimen, I would ask would they like to speak to one of the doctors/nurses as, on some occasions, the answer could have pertinence to the client's diagnosis. This would then fall outside my frame of reference and would then mitigate the summoning of a registered practitioner.
4
The specimen is collected using the correct technique and at an appropriate time according to the plan of care.
Once the stool is produced, I collect a sample of it using the paddle that is within the specially designed faeces collection pot. I place a small portion of the stool in the pot and close the lid. I ensure that the specimen has the client’s name, date of birth and hospital number on it as well as the Unit name and date and time. I place the specimen pot in a form that contains the same information as on the pot plus:-
Important client history, possible diagnosis
If the client is on any antibiotics - so that these can be eliminated from the list of antibiotics that are tested.
Doctor and consultant
Required test
I then place the specie men form in the specimen collection tray so it can be collected. I record that the specimen is taken and sent to the lab.
5
The client is given appropriate support throughout.
If the client has reduced mobility, I assist them as required. If the client is worried, or looks so, then I offer reassurance. If the client shows signs of not coping with the procedure, then I step in and offer appropriate assistance as required.
6
Client behaviour and condition is observed and monitored throughout contact and any unexpected change or aspect, which gives cause for concern, is reported to an appropriate member of the care team without delay.
Sometimes, clients experience pain of defecation. If I observe this, i call upon a qualified Nurse immediately.
Sometimes, the effort of having bowel open can cause the client to feel faint. If I observe this, i inform the Registered Nurse and carry out Observations as requested by her/him
7
Particular observation and monitoring of the client is carried out at the time intervals specified in the plan of care.
see no 6
8
Any condition or behaviour, which may signify adverse reactions to the procedure, is reported without delay and action appropriate to the client’s condition is taken.
see 6 and 7
9
Where the worker is unable to obtain the specimen, this is correctly recorded and the appropriate member of the care team informed without delay.
When this occurs, I inform the relevant Registered Nurse and record that the specimen still requires collecting in the clients care plan
10
Specimens are labelled correctly for the individual, the relevant documentation attached and they are put in the correct place for storage, collection or transportation.
see no 4
11
Specimens are tested correctly, the results accurately recorded in the required format and reported to the appropriate member of the care team.
At ward level, there are no clinical tests that are preformed. These are all done in the laboratory. They include a test for fat content in the faeces and also a micro screen and sensitivity test where any pathogens are cultured their sensitivity to any antibiotics is tested.
12
Following the activity, the client is assisted to reach as comfortable a position as possible given their current state of health.
Were appropriate, I assist clients to comfortable positions where they need assistance. This includes helping to make sure that clients are comfortable in bed after producing a specimen
13
After use, equipment and materials are cleaned and returned to the correct location for storage, sterilisation and transportation, and waste is disposed of in an appropriate safe manner and place.
I put any unused faeces collected in a yellow clinical waste bag
I wash commodes down with detergent and water then dry it and wipe down with antiseptic wipes.
I put used bedpans in the bet pan washer.
Range
2
Specimens:
b) faeces
Candidate Signature: …………………………………………………………
Observer Signature: …………………………………………………………
30/9/06
Date: ………………………………
Alan P Jack
Candidate Name: …………………………… Registration No: …………………………
Unit X19 Prepare and undertake agreed clinical activities with clients in acute care settings
Element X19.1 Prepare clients for clinical activities
Stool SpecimensIn my role as a worker in the A&E department, I regularly takes stool specimens for patients.
H0w I undertake this
PC
1
The correct necessary documents and records for the clinical activity are ready for use.
I check to see if the specimen of as being requested in the nursing notes.
2
Before the activity starts, the essential resources for the clinical activity are prepared ready for use.
I checked to see if the following resources are suitable and ready for use: -Commode: I see that this is clean and ready for use.Specimen pot: i ensure that this is the correct pot and catch increase sealed and undamaged.Toilet paper: I ensure that this is close at handSpecimens form: I ensure this is a correct form.
3
Before any actions are taken, the client’s consent to the activity is confirmed.
I approach a client and inform them that a specimen of their faeces is required. I explained that it is necessary to use either a bed pan or a commode to produce a specimen. I explain to them that it is important that the specimen does not become contaminated with urine. To this end, I explained that I will put a sterile pot in the commode to collect the specimen. I ask the client if they have understood this and if they do not mind if I proceed with the specimen collection.
4
Where the client and advocate do not give consent to the activity, advice is sought from an appropriate member of the care team without delay.
If the client says no, I explain to them that the specimen is important and it can help the doctors to know what is going on. However if they continue decline, I approached the qualified nurse and or doctor and explain to them that they have declined to have the test taken and I recall this in the patients care plan.
5
The client is offered appropriate support and information in preparation for the activity in a manner appropriate to them.
If the client is able to, I put the commode in the toilet where possible; otherwise, I ensure that the curtains are drawn around the bed space.
If the client needs assistance with mobilising, I help them with this.
If they require the use of a bed pan to have their bowels open, the I offer and give help where required.
6
Client behaviour and condition is observed and monitored throughout contact and any unexpected change or aspect, which gives cause for concern, is reported to an appropriate member of the care team without delay.
I give all clients the call bell so that they can summon help if they require it. I ensure that they are able to use it and tell them that they need not hesitate to do so should they need assistance.
For some individuals, the action of passing a stool can be quite strenuous, especially if the client is feeling ill and is constipated. This can make the client feel unwell. if this is the case, it a client feels unwell like this I summon assistance of a qualified nurse. If I am unsure about whether a client is safe to get out of bed, then I ask the view of the qualified nurse concerned as to whether it is safe for the individual to get out of bed for the client to get out of bed. If they client is feeling unwell, then I offer to stay with the client for support.
If the client suffers pain whilst having their bowels open, then I immediately tell the qualified nurse.
7
Any questions from the client and advocate are answered correctly and in a manner, and at a level and pace, appropriate to them.
If the client asks a question that it is within my role to answer, then I do at a level that is appropriate using words within their vernacular where appropriate.
8
Where the client and advocate raise questions which are beyond the worker’s responsibility, further appropriate advice or assistance is sought before undertaking the activity.
When this occurs, I seek the aid of a Registered practitioner as I am not a Registered Practitioner and am responsible for my actions and not as accountable for them as a Registered Practitioner is. If a question occurs that is outside my knowledge base or frame of reference, then I seek the assistance of a registered practitioner as I may say the wrong thing. In particular, I would seek trained help when clients/advocates seek advice about medical condition and diagnosis, as it is not my role to discuss this area with them.
9
The reasons for any particular forms of dress and protection are explained in a manner appropriate to the client.
A client may need to wear a gown whilst in the department to facilitate medical examination and/or x-ray. If I am the worker who assists the client with the donning of a gown, then I explain that this is done for the above reasons.
I wear gloves and apron, which I don prior to the commencement of the specimen and post washing and drying my hands. I explain that they are necessary as they help prevent infection spread. I remove them post the collection of the specimen and place them in a yellow bin bag for clinical waste. Then I wash and dry my hands.
How I undertake this
10
Where there are contra-indications before starting the activity, the preparation is halted and advice sought from the appropriate member of the care team with minimum delay.
When this occurs I do this because continuing with the procedure could cause damage, not only to the client, but also to member of staff and others as well. Contra-indications could be, in this instance:-
Client is unable to weight bare and requres the use of a bedpan
Client may had physical problems such as arthritic or a fracture that mean that two workers assist the client to use a bedpan.
I get someone as quickly as possible as to limit or prevent any harm occurring.
11
The client is offered the opportunity to use toilet facilities prior to the activity when this is appropriate.
Faeces specimens, in theory, should not be contaminated with urine. This can alter the results giving false reasons. If it is possible and there is the likelihood of a client contaminating a faeces specimen with urine, then I offer the client a bottle , for male clients, or an other bedpan/commode so they can maturated separately should they need to. I also put a sterile foil bowl in bedpans/commodes to facilitate collection of faeces without contamination via urine.
12
The client is assisted to reach as comfortable a position as possible given the constraints of the activity.
I do this as to reduce discomfort to a minimum but ensuring that health and safety is maximilsed. If a client needs help to gain a comfortable possition, then i do this. for example, if a client is on a bed pan and they are uncomfortable, I try to make them as comfortable as I can, with the use of pillows, for example.
Range
1
2
Clinical activities:
a) care of lesions and applications of dressings
b) elimination
c) extended personal care
d) tube feeding
e) obtaining specimens
f) undertaking physical measurements and monitoring
Essential resources:
a) for the activity to be undertaken
b) necessary protective clothing
Candidate Signature: …………………………………………………………
Observer Signature: …………………………………………………………
30/9/06
Date: ………………………………
Alan P Jack
Candidate Name: …………………………… Registration No: …………………………
EVIDENCE LOG
Unit X19 Prepare and undertake agreed clinical activities with clients in acute care settings
Element X19.3 Obtain and test specimens from clients
Stool Specimen
How I undertake this
PC
1
Hands are cleansed effectively before and after the activity.
Before I take a stool specimen, I wash and dry my hands and don plastic apron and latex gloves as a measure to reduce infection spread
2
The client is informed of the activities related to obtaining specimens in a manner which is sensitive to their needs and concerns and is at an appropriate level and pace.
I inform the client that I am required to take a stool specimen, which requires a collection of faeces. I explain that I will provide a receptacle, be that merely a sterile container or a bedpan/commode. If required, I adopt the vernacular of the client, to facilitate comprehension if the client does not understand. I only do this if the client does not understand. I ask if the client has understood at regular intervals
3
Any questions from the client are answered correctly or referred to the appropriate member of the care team.
If a question is within my frame of reference, I answer it. If it is not, I ask a registered practioner to come and talk to the client. I would call a registered practitioner to come and speak to a client if the client/advocate asked anything about the client/s medical condition/diagnosis/prognosis. This is not within my frame of reference to answer. If the client asked why I was taking the specimen, I would ask would they like to speak to one of the doctors/nurses as, on some occasions, the answer could have pertinence to the client's diagnosis. This would then fall outside my frame of reference and would then mitigate the summoning of a registered practitioner.
4
The specimen is collected using the correct technique and at an appropriate time according to the plan of care.
Once the stool is produced, I collect a sample of it using the paddle that is within the specially designed faeces collection pot. I place a small portion of the stool in the pot and close the lid. I ensure that the specimen has the client’s name, date of birth and hospital number on it as well as the Unit name and date and time. I place the specimen pot in a form that contains the same information as on the pot plus:-
Important client history, possible diagnosis
If the client is on any antibiotics - so that these can be eliminated from the list of antibiotics that are tested.
Doctor and consultant
Required test
I then place the specie men form in the specimen collection tray so it can be collected. I record that the specimen is taken and sent to the lab.
5
The client is given appropriate support throughout.
If the client has reduced mobility, I assist them as required. If the client is worried, or looks so, then I offer reassurance. If the client shows signs of not coping with the procedure, then I step in and offer appropriate assistance as required.
6
Client behaviour and condition is observed and monitored throughout contact and any unexpected change or aspect, which gives cause for concern, is reported to an appropriate member of the care team without delay.
Sometimes, clients experience pain of defecation. If I observe this, i call upon a qualified Nurse immediately.
Sometimes, the effort of having bowel open can cause the client to feel faint. If I observe this, i inform the Registered Nurse and carry out Observations as requested by her/him
7
Particular observation and monitoring of the client is carried out at the time intervals specified in the plan of care.
see no 6
8
Any condition or behaviour, which may signify adverse reactions to the procedure, is reported without delay and action appropriate to the client’s condition is taken.
see 6 and 7
9
Where the worker is unable to obtain the specimen, this is correctly recorded and the appropriate member of the care team informed without delay.
When this occurs, I inform the relevant Registered Nurse and record that the specimen still requires collecting in the clients care plan
10
Specimens are labelled correctly for the individual, the relevant documentation attached and they are put in the correct place for storage, collection or transportation.
see no 4
11
Specimens are tested correctly, the results accurately recorded in the required format and reported to the appropriate member of the care team.
At ward level, there are no clinical tests that are preformed. These are all done in the laboratory. They include a test for fat content in the faeces and also a micro screen and sensitivity test where any pathogens are cultured their sensitivity to any antibiotics is tested.
12
Following the activity, the client is assisted to reach as comfortable a position as possible given their current state of health.
Were appropriate, I assist clients to comfortable positions where they need assistance. This includes helping to make sure that clients are comfortable in bed after producing a specimen
13
After use, equipment and materials are cleaned and returned to the correct location for storage, sterilisation and transportation, and waste is disposed of in an appropriate safe manner and place.
I put any unused faeces collected in a yellow clinical waste bag
I wash commodes down with detergent and water then dry it and wipe down with antiseptic wipes.
I put used bedpans in the bet pan washer.
Range
2
Specimens:
b) faeces
Candidate Signature: …………………………………………………………
Observer Signature: …………………………………………………………
30/9/06
Date: ………………………………
Alan P Jack
Candidate Name: …………………………… Registration No: …………………………
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