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Hey guys this is Tammy and today we are
talking about nursing competencies. What are they? How do I write to them? and how
do I pass these darn things in so I get successful every time I talk to my
instructor or my regulatory body? We'll talk about that right after this. Welcome
back my name is Tammy and this is NurseMinder and on this channel we do
everything nursing so if you're new here consider subscribing below so that you
get the next video when it's released. Alright ladies and gentleman, we are talking
about CARNA competencies today, I'm from Alberta so we call them CARNA you might
be BC, Saskatchewan, maybe or from the states. You do likely have a document
that outlines those entry to practice expectations of where your knowledge and
skills that would be depending upon the patient population in which you're
working with and we call those competencies. Now sometimes you're
introduced to, you are introduced to them first when you're in school and every
time you go to clinical, and sometimes in labs, you're having to write how what
you're learning and doing actually applies to a particular competency and
so there these are just kind of like overarching principles that there's an
expectation that we have an awareness of and if we don't know the skill or the
competency itself that we know how to access the content right. So it looks at
lifespan, it looks like all different populations, it is evidence based, we are
also looking at not just the patient but families and groups of people and
society as a whole. So these competencies are really
foundational to the practice of Nursing and so for us in Alberta they've just
actually got a massive undertaking and they've restructured it so we now have
nine core columns or core areas of competencies that we would address on a
regular basis. So for us it's every year but I have a teacher and so my students
also have to do this. I want to share with you an example of how to address
them and how not to address them and I'm going to give you some tips on what, how
you can do them faster without having to spend a lot of time racking your brain
like oh my god what does she you want like I just don't get it, tell
me what they want. I'm gonna tell you what they want. So first I'm going to
share my screen here with you, let me just get that up here. All right
so what we can see here now is a, this is one one category as a clinician what
would an entry and a practicing nurse be expected to know and be able to do for
their patient population? And let's just say we are going to select that we
provide safe ethical confident compassionate client centered and
evidence-informed nursing across the lifespan in response to client needs.
WHOA, that is a mouthful. I'm going to copy this. Copy that because we're going to
now go to a whiteboard. Competent compassionate client centered and
evidence informed nursing across the lifespan and for their needs. Now here's
the evidence I will get, that I do not want you to pu.t I provided safe care for
my patient I was compassionate and focused on the
patient. Yes I felt confident with my care. So in writing this which
by the way is not how to address and I make this in red and do not do this one.
This tells me nothing as a reader all you've done is restate the competency.
What we're looking for is evidence. Let me say that again what we're looking for
is evidence. Okay. So let me start by saying what is the action word here? Can
I do a highlight? I don't think I can but I can do a spotlight so here's the key
word, provides. Provides is an action word so you need to be showing me what you
did. Answer the question: what did I do that was safe? that was ethical? that was
competent compassionate client centered and considered the lifespan of the
patient population? So I'm going to focus, let's just say
working in a geriatric, that's pretty commonplace for a lot of new nurses to
work and a lot of students in, a lot of students to go into clinical. Provided
action so I cared for a geriatric patient who was diagnosed with
dehydration. Let's just do that one. I'll fix that spelling in one second here.
Change the color here, oh it's no not blue we already got blue boring. Dehydration. Okay so this is telling me I
have a life span, I have a geriatric population, I have a diagnosis
which situates my mind set as the reader as to what potentially I might
be dealing with okay. I now know a few things but what do I do
about that patient? The patient's, okay no wait let's do it this way, while
assessing their IV I noted it was not infusing. ahhhh There's a problem After troubleshooting, I determined from
my evidence base the IV was interstitial and it was removed. So that's some
evidence base to have some critical thinking happen here and this is
compassionate. You do not want to leave in that IV if it's interstitial and it is
not infusing. Okay. So what else did I do? Okay let's move on. With this I used - what
else would you use to help with an IV that's interstitial? A warm compress to
help reduce the swelling. Evidence-based informed action okay, it is compassionate
at the same time because you do not want them to suffer in pain. Now
client-centered absolutely we're focused on the patient. Ethical
and safe. Yes and yes. There's no ethical dilemma here I suppose if you had left
it in I would have an ethical dilemma about your practice. Okay so we're
looking focusing on this part. Let's just up the ante a little bit more and say
that the patient was confused and unable to state where they were. This is
different than the morning's assessment. I spoke with the daughter who said this
is the first time patient has been confuse. Ok so I have another problem
here that's potentially related to dehydration. Okay. It may not be. It could be
something else. It may be an infection happening or something. We are talking
about dehydration and we're going to connect this to dehydration now. I talked to the doctor and
received an order for an HDC. For those who don't know HDC hypodermoclysis, I
have a video on that as well and so this is addressing the patient's
need to still be treated for dehydration so this is competency, collaboration so
it's compassionate we're not just ignoring them, we're going to return and
come back with an HDC instead of an IV because the HDC can stay in longer and
deliver the amount of fluids and we want to make sure that they're not continuing
down this negative spiral. This is how you answer a competency. Did I demonstrate that I provided care? Absolutely. Was it safe care? Yes. Was it
ethical? Yes I didn't ignore the problem. Competent? Absolutely .Compassionate? Yes.
Client centered we could actually add here for compassionate that the patient was
reassured that they did not do anything wrong after she stated "I am so sorry
dear for causing you this work" Okay. All right.
So that's how you answer a competency. Let's do another one. I'm going to get
rid of this okay coming back over to my second screen I'm just gonna grab one.
I'm gonna pick a different column, I could share that screen with you let's
do a new share I'm gonna go down into let's see professional, all right a lot
of people pick these they're pretty easy to do they think. Demonstrates
accountability, accepts responsibility, seeks assistance necessary for decisions.
well let's let's do one of these because they look easy but often people don't
give data and that's what I want you to really focus on is data. So let's just
pick two point two what does this one say? I know I got a little bit extra there
let me just fix that and it's always good to put the number in here I
don't think I did that with the last one but just to make sure we do that. 2.2 demonstrates a professional presence and confidence honesty
integrity and respect and all interactions. Perfect. Good. Now let's talk
about what most people put down. Okay so when caring for my patient I was
respectful and professional with my peers. I am going to make that in red cuz I don't like
it. No, I'm going to be blunt, this sucks.
When you restate the competency you haven't met the competency and that's an
important thing to recognize. So let's write this one out. What would this look
like? Okay the thing, the verb is demonstrate so again this is another
action word so I need to give evidence that I have done something. Not that I've
thought about it, not that I can reword it but it actually physically done
something. And what is it I'm looking to do? Have a professional presence,
confidence, honesty, integrity, and respect at all interactions. Now here's the
kicker. You do not have to meet these you can say
I didn't meet this in this situation here's what I'm going to do next time. So
let's do one of those. Okay let's pick a new patient and a new color. This time we
will do blue. Alright so here's the scenario, let's paint the scene so that
the reader has an idea what's going on. Carrying for an 11-year old post
fractured arm. Sure, okay so I have this patient who's in the hospital after
breaking their arm and one day after surgery. There we go a little bit more
information. Okay we're gonna do one where I didn't meet the competency but I
have an action plan. So let's see: professional appearance, confidence,
honesty, integrity and respect. Let's pretend that this is the first time I've
had to care for an eleven-year-old who's broken their leg and I was like freaking
out myself because I don't know what to do with an eleven-year-old. It's my first
day on the job. I made some comments that were not, um, that
were not received as favorable. I stated "guess you won't be riding your bike like
a maniac again will you" The patient's ah I can't spell, patient's family was
upset with me because he child had only just learned how to ride and was
proud of his accomplishment. I realized after that this statement held a lot of
judgment and provided
an opinion on how he should live his life. I was not feeling very confident
about how to care for this child and was, and covered it up with a judgement. I recognize now that
statements of opinion should be kept to myself and I need to stick to the facts. What I could have
said differently: since this happened while riding your bike what will you do
differently to prevent this from happening again? This statement would
allow the patient to identify reasonable options going forward without feeling
pressure to do what the nurse said. I recognize as a nurse I hold nurse I hold a lot of power in a relationship and I need to be mindful. I am honest with myself in this reflection
I'm reflecting back on what happened I wasn't quite, I didn't have good
integrity in it, I'm recognizing that I need to be better at that and my respect
was certainly not there because I was judging so this example gives me
evidence of doing, gives me evidence of what you said, what the impact was and
what you're going to do better next time. BONUS This is how you deal with
competencies guys let's just do one more. I recognize that the typing, hmm, we will just go with that. let's go back we'll just go with that
okay let's go back to sharing my other screen cuz I want you to see what I'm
picking it's like playing bingo. Let's see where we're going next shall
we? Okay communicator let's just randomly pick
number I don't know what ICT is so not gonna use that one. Okay conflict resolution speaks to my heart so we're gonna go past cuz I could just talk about that one all day.
Let's do collaborator or scholar. Scholar is a bit challenging for some to- why
don't we go down to scholar. Even leader is hard for people. Advocate, holy geez,
educator there we go scholar; uses evidence to make informed decisions.
Let's grab it. Coming back to the whiteboard. Okay we're gonna put the
number in there and this is 9.1 Okay, I am going to tell you what to do first. Okay. I used my patients assessment data to
tell me, or to advise, to guide my care for the day. it helped me plan my care. Using
evidence is important as a nurse because without it we would be lost.
Alright you read that right? This is pretty similar to stuff that I get as a
teacher like this is no joke people restate it and then they give me some
other sentence that makes it sound like they've done something, it says nothing.
Okay so let's look at how we can address this one. Uses - action word, best evidence -
I need to talk about evidence - to make informed decisions-
to show that it helped me make a decision or I missed making a decision
and what's my action plan. So I think sometimes the confusion is with the
competence that you have to pick one that you've met, that you've done really good
and that's not the case, you can even do it partially good so let's do a
partially good one here with an action plan. Okay because we always want to be
looking at how I can get better. All right uses best evidence to make
informed decisions. Last night when working with one staff member
absent, so we're short-staffed, I could have said that differently, I recognize
that, you get the gist, let's just change the color here. Okay last night we're
working with one staff member absent we had only three nurses to care for 32
patients. Ridiculous! I know there's other places to work in worst conditions. With
no support available, we needed to devise a plan to ensure patient safety. We
decided that only one nurse would take a break at a time and we did not
communicate. Well we ended up with two nurses on a break at the same time. One
was off the unit and the other has to be called back. So we talked about it but we didn't follow through. and I could do,
actually let me get a little bit more information. And they were to happen at
let's say we're doing the late shift 2:00 a.m. 3:00 a.m. and 4:00 a.m. and we
did that communicate well the first break happened because we
ended up with two nurses on break at the same time. That's a lot more information
gives me a whole different picture right. So what's the results of this? We ended
up, okay the the nurse who was supposed to go on break was the one that was
called back because she was on the unit. As a result she did not get time to
finish her break and needed to apply for overtime. All right so we're showing that
best evidence, um, okay we need to talk about best evidence still. We know that nurses who
are tired and fatigued and maybe a little upset are more likely to make
errors. This did not happen on our shift but we were at higher risk. There's an
impact. We made a decision we did not communicate very well and here's why we
made that decision and here's what could have happened. This gives me data okay.
Now you can't do these point form, you don't have to make a paragraph, you can
certainly do this point form. Let's try that here. Let's see,
working short-staffed only three nurses instead of four, let's change this color
just so you can see how this can be done. purple no I don't want something darker
darker blue breaks determined for two am 3:00 and
4:00 a.m. but two nurses left at 2 a.m. leaving the unit vulnerable. Nurse calls back
at 2:15 a.m. did not get her break for the rest of night, was tired and
cranky, risk factors for errors. We reviewed our communication plan and
found our errors, and found the error, and will write out on the white board next shift.
Something to that effect. So you can't do it point form it feels a little bit less of a
story a little bit less connection but the information is there. So we were
working short-staffed three nurse instead of four, so we came up with a
plan, best evidence suggested that we should only have one nurse off at a
time, two three and four but when two left at two o'clock were like whoa we're
vulnerable best evidence says we need two have to hear who called one back and
then she didn't get her break first the night and on top of that we know that
these are risk factors for errors and patient harm. So we reviewed our plan and
we're gonna fix that for tomorrow night. Let me stop my screen share. So that is how you
address competencies. Look at what the action is telling you to do, look at what
action you are going to be doing, and then give the evidence, tell me the story
right a little scenario so that people can get situated and then connect the
dots all the way through. I hope this helps and until next time don't forget
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you have that power. See you next time