Worksheet No.

1 on
Competency Appraisal 1








Submitted by:
Fate Lee E. Oira
C2- Adarna
Submitted to:
Asst. Prof. Jennifer T. Duhaylungsod



June 24, 2014
Scenario:

Imagine that you are working the evening shift in a hospital on the medical unit. As a registered
nurse, you share the assignment of clients with an unlicensed nursing assistant. You have
worked with this assistant previously and know that she does her work in an efficient and
accurate manner. You are able to communicate effectively with her because she asks questions
when she needs clarification and she reports relevant client data as indicated.

Among the clients, you and the assistant are caring for a female adult receiving intravenous
chemotherapy for lung cancer, a female adult with a possible deep venous thrombosis, and a
male adult who has chronic lung disease (COPD). (Adapted from Berman & Snyder, 2012)

Questions:

In the 2012 National Core Competency Standard, the beginning nurses role on client care
responsibilities 1,2,3,4,& 5, the nurse is expected to provide quality nursing care.

When you auscultate the lungs of the client with lung disease, you hear bronchovesicular
sounds in the upper and middle lobes and adventitious sounds in both left and right lower
lobes. The client reports no significant changes in the previous 24 hours & vital signs are
substantially the same as previously. The day shift nurse had reported that the clients lungs
were clear throughout, and the previous night shift nurse did not record the results of
auscultated lung sounds in the client record. (Adapted from Berman & Snyder, 2012)


1. How does this situation relate to the beginning nurses role on client care standards?
(Limit to 2 sentences only).

The first three responsibilities in the client care in the 2012 National Nursing Core
Competency Standard were not followed by the previous night shift nurse; in the
fourth responsibility, there is a collaboration with the other colleagues but only
between the licensed nurse and the unlicensed nursing assistant while none
between the previous night shift nurse which leads to disruption in the continuation
of care for the client. The fifth responsibility was not practiced or shown in the
scenario since the previous night shift nurse didnt do his/her job that is to
document any care given to the client and the nurse had not communicated in the
team about the result of the assessment; there is no proper communication and
collaboration between the colleagues in this case.

2. Do you see opportunities to improve the quality of practice? How? (List down 5 ways
you can improve client care.)

Yes, I see opportunities to improve the quality of practice though the following:
Record the care given to the client since the document is a legal paper wherein
the next shifts will have a comparison for the assessment that they have
collected from the client.
Refer the client to the counselor or psychologist if the client cannot emotionally
handle the situation or if the client needs an emotional or mental help.
Teach the client about their condition and its management especially when the
client is in pain.
Proper communication system should be observed by the team especially in the
endorsement of the assessment or progress condition of the client.
Observe a continuity of care through documentation of care and proper
endorsement to the next nurse and collaboration with other health care
providers.

3. Beyond the care of this client, what might you do that the nurses on this unit will
meet the National Nursing Core Competencies? (List down 5 ways)


i. Attend seminars and trainings to keep updated about the new discoveries or
new development in the care of client.
ii. Distribute tasks and responsibilities to each member of the team to give a
satisfactory quality of care.
iii. Manage the time wisely especially if there are many clients being assigned to the
nurse. This is to produce a good quality of care to the client and to avoid
negligence by having a timeline or plan of activities to be done to the client.
iv. Engage in studies in the development of the quality of nursing care and utilizing
the concepts being gathered to the study.
v. Give importance to the responsibilities and duties that the nurse had pledged in
and remembering his/her duties as a healthcare provider.

Scenario:

Michael was diagnosed with an advances stage of lung cancer 2 months ago following a biopsy
that revealed oat cell carcinoma, one of the fastest growing forms of lung cancer. His oncologist
recommended treatment with chemotherapy and radiation therapy, but informed him that the
prognosis was poor and his condition was most likely terminal. Since that time, Michael has
undergone four chemotherapy and 6 weeks of radiation therapy, but additional chemotherapy
treatments needed to be held until his platelet count improved. Diagnostic tests revealed
metastasis to the brain and the bone. He has decided to discontinue all treatments and was
discharged home care.

Personal and Social History:
Michael lives with his wife of 40 years. They have two sons who are grown and live out of state
with their wives and families. Michaels wife accompaniers him to all his doctors appointments
and therapies and they are frequently seen in the waiting room or examination room holding
hands and laughing together. Michael works as an architect and his wife owns a business selling
childrens clothing. They have a comfortable life together and were looking forward to spending
their retirement years together traveling. Michael says he cant stop apologizing to his wife
because I would never develop lung cancer if I had quit smoking, and now she has to live alone
because of my stupid habit. His wife tells him it is not his fault whenever he apologizes, and
that she loves him, but tells the nurse privately that she feels angry that he is dying so young.
(Adapted from Berman & Snyder, 2012)

Questions:

In the 2012 National Nursing Core Competency Standard, the beginning nurses role on client
care responsibilities 1,2,3,4 & 5, the nurse is expected to demonstrate caring behaviors that
promote quality care.

1. Using Watsons 6 Cs of caring, how would you demonstrate caring Michael and his
wife?

(6 Cs: Compassion, Commitment, Comportment, Conscience, Competence,
Confidence)
Using the 6 Cs of care to the family, I can demonstrate the care to the client and to
the family by having a sense empathy and sensitivity to whatever the client or SO
would say about the situation. I should competently assess their current situation,
physically and mentally at the same time guide them to view the condition in what
they are now and not about what they have to lose in the future or on the later part.
I should show confidence whenever I face them and be presentable and ready to
render them care and would never leave or neglect them in the middle of the
situation and be able to fulfill my duties to them. I should be punctual and be honest
in everything Im going to do whenever there are procedures to be done and should
not show disinterest in my work to show how committed I am to my profession. I
should also have a sense of moral in everything that I am going to do to prevent
misinterpretations or misunderstanding in the care of the client and also towards
the significant others.

2. Using the nonverbal communication methods, how can nurse communicate caring to
this family?

Body language, eye contact, gestures, and tone of voice are all examples of nonverbal
communication.

As a nurse in this situation, begin to assess Michael's understanding about hospice
and palliative care and seek to determine what his goals of care were, ask open-
ended questions, lean forward, do not interrupt, nod your head, and encourage
communication by making comments like "I see," or "tell me more." The following
also show an effective nonverbal communication between the client/ significant
others and the nurse:

A. The nurse should show a genuine or sincere smile to the client and his family to
show my appreciation and interest to work with them in the care of the client.
B. Maintaining eye to eye contact during conversations to show that the nurse is
focused on what the client is saying. Same goes with the significant others.
C. Use therapeutic touch as a means of communication and to show the client and
his family the empathy that the nurse felt towards the situation.
D. Avoid gestures that might offend the client or SO like sighing or looking over the
watch seemingly uninterested to the communication.
E. The nurse must be presentable or show neatness in him/her to know how ready
she is to render care to the client.
F. Maintaining a calm voice tone and a pleasant aura or atmosphere throughout the
care.
G. The rate of speech should be in slow pace and the intonations or release of words
should not be offending for the part of the client or SO.

3. The barangay health sees that Michaels death is imminent within the next few hours
or days and wants to teach his wife about what to expect. Based on what you learned,
what factors would the nurse interpret as indicating his wifes readiness to learn?

A. There is forgiveness in their family especially to the client. Forgiveness relieves
tension between the family members.
B. The wife has opened up about what she felt about the situation.
C. The wife is passed the denial stage about her husband. Wife has accepted the fact
that his husband is dying.
D. His wife verbalized about her realization that Michael may want to spend his last
days being peaceful with his wife without worries and to grant this, the wife would
do everything to make Michael glad.
E. Wife is able to assist the client in his daily activities without hesitations.


In the 2012 National Nursing Core Competency Standard, the beginning nurses role on
management and leadership responsibilities 1,2,3,4,5 & 6, the nurse is expected to
demonstrate leadership and management skills in the professional practice setting.

1. The barangay health nurse arranges care during Michaels final days. Using the
decision tree found on pages 526-527 of Berman & Snyder (2012), what types of care
will the nurse delegate to the unlicensed assistant or the barangay health worker?

A. An unlicensed nurse or barangay health worker can give over-the-counter drugs and
topical medications and also herbal medications. Giving of suppositories, over-the-
counter eye and ear drops and foot-soak treatments.
A. Monitoring of the patients condition (by observation and getting the vital signs of the
client).
B. Providing safety to the client by environmental manipulation and teaching the family
about providing safety like giving support during repositioning or feeding the client.
C. Teaching the SOs about assisting the client in his daily activities and to never leave the
client as much as possible since the client needs more support not just physically but
also emotionally and spiritually.
D. Doing some referrals to other health care providers or to a chaplain for clients spiritual
care.
E. Telling the unlicensed nurse or BHW that just by being present and have a listening ear
for the client can help them ease their sufferings.
F. It is also important for the unlicensed nurse or BHW to communicate to other health
care providers for the care of the client.

2. What care will only the registered nurse will perform?

In consultation with the physician, a registered nurse will set up a plan of care.
Nursing care may involve administering medication, monitoring the condition of
patient, controlling pain, and providing other health support. These are also being
considered for caring the client:
A. Physical Care
One of the biggest concerns of a dying person is the control of acute and chronic
pain. Those with high values on their self-image maybe concerned about their
hair loss, dark circles around the eyes, and the changes in their skin color. It is
important for the nurse to perform pain management to the client and provide
them some physical care to make them more comfortable. Examples of these
procedures are: foot-soak treatments and suppositories, giving bed baths,
assisting in activities in daily living pain medications (administered rectally or
sublingually), turning, mouth care, eye care, positioning to facilitate draining of
secretions, and measures to protect the skin from urine or feces (if the patient is
incontinent).
B. Psychological Care
It is important to take seriously what the dying persons are feeling. They are
more likely to express negative feelings. A gentle touch is often psychologically
healing. It is important for the nurse to be a counselor in this situation and
encourage other family members to support the client in everything that the
client is going to do. It is also important to refer the client to a chaplain or
psychologist for the client to show what he feels about the situation.
C. Social Care
Dying persons want to maintain relationships with the special people in their
lives. Communicating to other members of the family can help the client enjoy
the last days of his life with the people he love. It is also important for the nurse
to communicate to other health care providers in giving a quality care to the
client even in his final days.
D. Spiritual Care
Dying persons look for a connection or continuity with some aspect of existence
beyond the death of the body (Staten, et al, 2001, p.239). Dying persons often
bring up the issues that are spiritual in nature. It is important for the nurse to be
a counselor or adviser in this situation. The nurse can also refer him to a
chaplain.

3. What instructions will the nurse provide the barangay health worker related to things
to report immediately as they occur?

A. Focus on emotional support and client education along the required physical care (teach
about deep breathing and coughing exercises).
B. Help clients maintain a sense of control by keeping them informed about all scheduled
tests and prescribed medications.
C. Care must incorporate measures designed to help the client cope the anxiety and fear,
family responses, financial considerations, absence from work and social activities and
possible recurrent infections.
D. Refer immediately to nearest hospital for worsening of the manifestations of lung
cancer such as cough (productive or nonproductive), fatigue, dyspnea, pain, weight loss
and recurrent infections.
E. Report whatever the client felt especially pain, its level, the duration and frequency.
F. Report immediately to the nurse the lack of proper ventilation to the client such as
shortness of breath, pale appearance and abnormal vital signs.

4. On the next visit to the family, the nurse reviews the barangay health workers care of
the client and notes that the client is not being repositioned and is developing signs of
pressure ulcer. What should the nurse do?

Approach the barangay health worker that is assigned to the client and present the
things observed in the care of the client. Suggest things to the BHW to improve the
care like repositioning the client every two hours and changing of linens. Upon the
next visit to the client and the nurse still noticed that there is no change in the care
given, the nurse have the right to do the intervention by herself or teach the
significant others the ways to prevent the developing signs of pressure ulcer.