Summative Assessment of Nursing Practice Competencies

Student Name: Dinh Hien Vu (Harry Vu)

Clinical Placement/s: 5 South Wellinton hospital Date:

Domain One: Professional Responsibility

Pass/Fai
Competency Student Evidence
l
I acknowledge my responsibility to uphold safety
practice and maintain professional standards as an
Enrolled Nurse (EN). According to the Nursing Council
Competency 1.1
of New Zealand, acknowledgement and understanding
Accepts responsibility for
of the Code of Conduct (2012), the Code of Rights, the
ensuring that his/her nursing
practice and conduct meet the
Medicines Act (1981), and the Privacy Act. I recognize
standards of the professional, that working under supervision and delegation adheres
ethical and relevant legislated to my role as an EN and being able to distinguish
requirements. between the responsibilities of an EN and a Registered
Nurse (RN). Additionally, I am aware that there are
specific skills that I cannot perform without appropriate
training.

For example, during my practice as a student, I was

instructed to do a chest drain procedure under
supervision of a RN. However I told the RN that as an
EN I cannot perform a chest drain because this
procedure is not a part of my scope of practice. But
being there and observing the process is still very
educational and a learning opportunity.

According to the NZNC, Code of Ethics (2019) is the

standard practice exploring ethical beliefs, a guide and
framework to work in partnership with different
individuals for nurses in New Zealand. Nursing in an
ethical manner is being able to distinguish the
differences in the people (cultures, religions,
ethnicities, backgrounds, etc.) The Code of Ethics
(2019) divided into 2 main principles that applies to
Maori worldview and Western worldview.

Maori values include:

- Rangatiratanga: Self-determination.
- Manaakitanga: Hospitality and care for others.
- Tika: Correctness, fairness, and justice.
- Whanaungatanga: Relationships and
connections.
- Wairuatanga: Spirituality beliefs and its values.
- Kotahitanga: Unity between the people.
- Kaitiakitanga: Guardianship and protection of
the environment and natural resources.

Dip EN Assessment of Nursing Practice Competencies

©2024 Te Pūkenga TA Whitireia & WelTec 1
 Western values include:

- Autonomy: The right of individuals to make

their own choices.
- Beneficence: The obligation to act in the best
interest of patients.
- Non-maleficence: The commitment to do no
harm.
- Justice: Fairness and equality in the distribution
of resources.
- Confidentiality: The duty to protect patient
information.
- Veracity: The obligation to be truthful.
- Fidelity: The commitment to keep promises and
be loyal.
- Guardianship of the environment and its
resources: Responsibility for environmental
sustainability.
- Being professional: Adhering to standards of
conduct and competence.

Both values of the Code have different ways of

approaching different individuals, however it would be
fair to say it is to be applied to every health consumer
depending on their background, interest and beliefs.

For example, Mr. T is a Maori patient and I

acknowledge that it is in his best interest as well as the
family to be involved in the day to day care. Mr. T and
his family believe that practicing Rangatiratanga
(self-determination) and Kotahitanga (unity of the
people) is the way to heal and get through a tough
time in life. So allowing his brother, sister and wife to
stay with Mr. T during the day time to support Mr. T
personal care. I worked along Mr. T’s family with daily
updates on his health status for the family and provide
as much information as I can to the family in the care
plan and doctor review. This allows the patient to
decide on the daily care and his treatments and
decisions were made as a family interests more than
just personal view.
As a nursing student, it’s crucial for me to understand
and apply the principles of the Treaty of Waitangi in my
Competency 1.2 practice. The five principles can be utilized in various
Demonstrates the ability to apply ways to ensure safety and quality of healthcare by
the principles of the Treaty of prioritizing Maori and diverse cultures.
Waitangi/te Tiriti o Waitangi to 1. Self-determination: By allowing patients to
nursing practice.
express their beliefs and understanding cultural
perspectives. Recognizing and respecting the
values, traditions, and beliefs of Maori health
consumers is essential for cultural safety in
healthcare.
2. Partnership: Collaborating with Maori and
individuals from different cultural backgrounds

Dip EN Assessment of Nursing Practice Competencies

©2024 Te Pūkenga TA Whitireia & WelTec 1
 is vital to provide healthcare with cultural
preferences. This principle expresses
compassion and empathy for the patient and
their whanau.
3. Equity: Treat all health consumers with dignity
and respect. Equity enables healthcare
providers to offer care that is fair and respectful
to Maori clients and others.
4. Active protection: Taking consideration into the
patient's physical and mental health. The
principles of the Treaty of Waitangi guide
nursing practices to ensure that Maori clients
are respected and protected in all aspects of
their treatment.
5. Options: Offering a range of choices in
treatments by understanding the worldview of
Western culture, Maori culture and other
various cultures (both physical and cultural).

An example of being culturally respected during my

placement was a dying patient under the TAW pathway
(Te Ara Whakapiri) which is a set of principles and
guidance for the last days of life. This patient was a
Maori patient, who had last stage R) pleural effusion
and hemothorax. The Medical team has already
reviewed and changed the goal of care to D and in her
last few days, the patient was on a syringe driver with
Fentanyl, aiming for pain free and comfort. The big
extended family was allowed to stay at the bedside,
upto 12 visitors as per request of the daughter which
was an exception since the ward only allows 2 visitors
each patient at a time. I collaborated with the family in
the care of comfort for the patient by positioning,
providing PRN fentanyl medication. I also prioritised
this patient such as providing reassurance to the family
about the patient’s pain by saying the PRN
medications are always ready for her pain and
discomfort. On the last few days, we were allowed the
patient’s family to come in with their extended family to
pray, as well as on the day she passed away, a tangi
was allowed to perform in the single room with family
members surrounding. We also contacted the chaplain
beforehand for consultation and to provide religious
support for the patient and their family.
As a student enrolled nurse, I acknowledge the
significance to my defined responsibilities and
Competency 1.3 understand the role of the registered nurse (RN) in
Demonstrates understanding of providing direction and delegating tasks to ensure
the enrolled nurse scope of effective healthcare delivery.

Dip EN Assessment of Nursing Practice Competencies

©2024 Te Pūkenga TA Whitireia & WelTec 1
 practice and the registered nurse Under the TAW pathway (Te Ara Whakapiri) which is
responsibility and accountability principles and guidance for the last days of life, patient
for direction and delegation of
nursing care. B handovered to the palliative care team. Patient B
was diagnosed with aspiration pneumonia and was in
severe pain, the palliative care team charted syringe
driver fentanyl 200 mcg for 24 hours. I understand that
Fentanyl is a controlled drug, medications which are to
be monitored closely due to risk of abuse, addiction
and harm. Since fentanyl is a control medication,
therefore they are needed to be locked away in a lock
drawer where the Pyxis medication computer system
will count and regulate the dosage. As an EN student, I
understand that I need supervision, direction and
delegation from RN to administer any medications,
especially with controlled drugs, an EN would always
require RN’s directions and delegations to administer
with safety. Taking out fentanyl or any controlled drugs
required a “check” or witness from at least two RN or
one EN and one RN. Under the supervision of the
primary RN, I started to calculate the number of
ampoules to be taken out and volume of the dosage. I
hit the key button which will ring a bell, call an RN to
come and give us a check of the fentanyl doses. Under
the supervision, direction and delegation of the primary
RN, I requested RN T to double check the fentanyl
dose that I was about to take out. I explained that we
were taking out 200 mcg of fentanyl liquid, the
availability were ampoules containing 100 mcg per 2
ml. So to get 200 mcg fentanyl, I explained that I would
need 2 ampoules of 100mcg/2ml and draw out 4 ml of
fentanyl. So before taking out anything, me and RN T
began to count the number of stock 100mcg/2ml
fentanyl ampoules in the Pyxis medication drawer, it
was 9 ampoules, I was meaning to take out 2, so the
remain would be 7 ampoules, doubled check with RN
T and requested the primary RN to supervision and
check the remain doses one more time and took out
the 2 ampoules. I asked RN T to co-signed on the
chart along with the primary RN next to my signature. I
then under the direction of the primary RN and began
to prepare the syringe driver.

Dip EN Assessment of Nursing Practice Competencies

©2024 Te Pūkenga TA Whitireia & WelTec 1
 Creating an environment that ensures consumer safety
and encourages independence is important for
consumers' health and enhancing their quality of life.
Competency 1.4
I always make sure to check the mobility of the patient
Promotes an environment that
(independent, x 1-2 assist, handheld, walking frame,
enables health consumer safety,
independence, quality of life, and
sara steady etc.,) to make sure the patient's handling
health. is always correct before moving the patient to prevent
falls. By doing the smallest things from noticing objects
on the ground such as rubbish or patient’s personal
items, I clean up the rubbish or patient’s personal
items away so the patient won’t slip or walk into them
which will put them at risk of falls.
Mobilise wise, I always encourage patients to get up to
the toilet, assist them to go to the toilet to help them
gain back strength within their muscles with the
intention of increasing independence.
Since most of the patients were bed bound or needing
assistance for mobilising, this means they would spend
a lot of time in bed. I would frequently check their bed
sheet/pillows to see if they need a sheet change due to
soaking wet from sweating or being incontinent to
ensure comfort and clean environment as well as
contribute to infection controls. I also look for creases
on the bed and straighten them up to prevent skin tear
and pressure injuries.
Ongoing education is essential in every aspect of
nursing practice as the type of patients in the
healthcare system are varry. With the world changing
Competency 1.5
and technology, research and studies are getting
Participates in ongoing
advanced every day, new methods and products are
professional and educational
development.
being released with the aim of improving healthcare
services. As nurses, the people who directly work
within the system, knowing new products and
knowledge is significant to deliver appropriate
healthcare.

In one of the teaching sessions, a Convatec

representative explained about their gel wound
dressing product and why it is important to use this gel
technology.

Aquacel Extra is a wound dressing product that uses

hydrofiber technology. The dressing consists of a
bonding network of sodium carboxymethyl cellulose
(CMC) with high level of absorption. The main future of
this CMC fiber network is how it can extract and
absorb fluid like blood and remove exudate, debris,
bacteria from the wound. Once the exudate and debris
is sucked into the dressing, the dressing fibers expand
and form a gel, securing and pulling the infection from
the wound. The dressing also provided micro
contouring technology which allows it to fill and close
any gap between the wound and the dressing,
avoiding dead space or environment for bacteria to
grow. Not only that, the dressing has a 2nd layer
where the exudate is held to prevent fluid spreading,
minimising skin maceration.

Dip EN Assessment of Nursing Practice Competencies

©2024 Te Pūkenga TA Whitireia & WelTec 2
 Knowing about the dressing, I’m that now aware of the
micro environment that exists between the would and
the dressing where bacteria can grow and cover the
wound which explained by the wound nurse that no
matter how much we clean the wound, they would
always come back and although frequently cleaning
the wound is a good idea, but the fact that there
always an extra layer of bacteria, chances that the
dressing could minimise that and speed up the healing
process.
Culturally safe nursing involves ensuring that nurses
are skilled in providing care to patients from diverse
backgrounds and ethnicities.
Competency 1.6
Practises nursing in a manner During my placement, a patient was admitted to the
that the health consumer
ward after experiencing complications related to her
determines as being culturally
safe. status epileptic (acute uncontrolled seizures). The
patient is a 62 year olds woman from Samoa, she flew
to New Zealand 2 weeks ago to visit her daughter who
is working and living in New Zealand. The patient has
limited English, she speaked Samoan, confused and
seemed to be in distress upon admission. As a student
nurse worked along the primary RN of this patient, we
went into her room and introduced ourselves to our
new patient.

The patient appeared to be anxious, however she was

very nice and pleasant to talk to. The RN and I
discussed about the patient's situation as she
appeared to be anxious. We looked at the patient's
background and came up with a rationale about how
the patient might feel anxious about being admitted to
a hospital in a foreign country. Understand the
underlying background of the patient, as nurses, we
must ensure the patient feels culturally safe,
respectful. So I approached the patient with openness.
After introducing myself and getting to know the
patient, I asked her if there were any customs or
cultural practices that would make her feel more
comfortable during her stay. The patient was trying to
explain in English, although it was an effort to
understand what she was saying, I patiently waited
and let her express herself as much as she wanted to.
In shoft, in her culture, prayer is an important part of
healing, and she would feel more at ease if she could
pray before meals and treatments. She also shared
that her family was central to her well-being, and it was
important for her husband or daughter to be present
during consultations.

After I listened carefully and responded by ensuring

that all family members were welcome during all
important medical discussions. The RN and I were
also provided with chaplain services where she could
pray and get consultations from the church. I also
recognized through her daughter that food was
another key aspect of the patient cultural experience.
Dip EN Assessment of Nursing Practice Competencies
©2024 Te Pūkenga TA Whitireia & WelTec 1
 Since the patient disliked the hospital food, the RN and
I discussed with the house officer and the senior nurse
about the situation and assured the family and the
patient that it is totally appropriate to provide patient
with their home cook food.

Lecturer’s Comments:

..................................................................................................................................................................

..................................................................................................................................................................

..................................................................................................................................................................

..................................................................................................................................................................

..................................................................................................................................................................

Dip EN Assessment of Nursing Practice Competencies

©2024 Te Pūkenga TA Whitireia & WelTec 1
 Domain Two: Provision of Nursing Care
Pass/Fai
Competency Student Evidence
l
Patient health’s outcome is a collaboration of
treatments and care. For this reason, PADP or Patient
Competency 2.1 Admission to discharge Plan. A care plan which
Provides planned nursing care to provides nurses all the information about the patient
achieve identified outcomes. upon admission. This is to determine onboard
assessment such as risks of pressure injuries such as
Braden scale assessments and S.S.K.I.N assessment
(S for Skin check, S for bed Surface, K for Keep
moving, I for Incontinence, N for Nutritions). PADP
contains information such as smoking status, nutrition
intake/ diet, infections/ risks of foreign infectious
diseases, etc. PADP also provides nurses and health
care assistants with day to day care plans provided
daily by nurses which the goal is to achieve identified
outcomes for the health consumers.

A patient I was taking care of had Jock itch (which is a

kind of fungal infection). It spreaded all over his groin
and covered a large area behind his knee. I received
him upon admission to the ward with the already
existing fungal infections, hence the doctor charted
him with miconazole nitrate cream to treat the fungal
infections. According to the plan, the cream is charted
daily and it was noted in the progress note and the
drug chart that the cream is to be applied twice a day
and work well after a wash or a shower as it would
clean off the skin. Since during that week, I had the
same patient load so everyday after doing the patient
care (shower or wash) I always remember to dry his
skin and check for the infections. I also checked the
surrounding area to see if the infections spread. After
every shower or wash or even if the patient does not
want any ADLs, I always make sure to put miconazole
cream on the infected area and document the progress
of the fungal infections. What I have also taken into
consideration was the patient bed, I made sure to
check and change the sheet if needed. I also
frequently checked patient pads since he was
incontinent and documented for the next shift. Nutrition
wise, the patient was doing good as he was eating and
drinking well. For the first few days, it was read and
looked the same. About day 5, the redness started to
fade away showing signs of healing. I documented the
progress into the PADP as the infection area slowly
healed. On day 12, the infection reduced the redness
to very faded red area, the patient reported nil itchy
anymore and the result of consistent care based on
the planned care plan showed a great result in treating
fungal infection for this patient.
Collecting information is crucial in monitoring patients
closely and understanding their conditions in order to
Competency 2.2 report to the RN and provide the planned nursing care.

Dip EN Assessment of Nursing Practice Competencies

©2024 Te Pūkenga TA Whitireia & WelTec 3
 Contributes to nursing assessments While on placements, I was assigned a patient load
by collecting and reporting and all patients’ vital signs are to be taken every 4
information to the registered nurse.
hours. I was taking Mrs. R’s vital sign. Mrs. R was
complaining of left knee pain, so I assessed the pain
by asking Mrs. R questions like, where is your pain?
Can you scale it from 0 - 10 as 10 being the worst pain
ever, does it hurt when you stay still or mobilise. I
found that Mrs. R scaled the pain 7/10, the knee pain
hurt only when she moved her leg, however the pain
was sting Mrs. R said the pain was not manageable. I
went to the RN, reported the situation to the RN, after
that I explained to the RN my course of action is to ask
the patient if they want any PRN medications to relieve
the pain. So I asked if Mrs. R wanted any pain relief
like Paracetamol or Celecobxi as these 2 was charted
in the PRN section of the drug chart. Mrs. R said she
would like Paracetamol and I went with the RN to get
Mrs. R PRN Paracetamol. Upon getting the
paracetamol, I also checked the previous dose and
found out it was given by the AM nurse early morning
which is well over 8 hours into the PM shift, which was
safe to administer Paracetamol for Mrs. R. After Mrs. R
took the pills, about 15 minutes later, Mrs. R knee pain
was improved and Mrs. R appeared more settled. The
paracetamol had good effects. I then documented the
situation into the nursing note to make sure the
patient's progress and care plan is done properly.
Being able to recognise changes in health and
functional status of a patient through observing and
Competency 2.3 monitoring patients and acting accordingly is an
Recognises and reports changes in important part of being a nurse and it is a nurse’s
health and functional status to the responsibility to report any abnormalities.
registered nurse or directing health
professional. Mrs. B is a female patient who has pleural effusion
(fluid build up between the lungs and chest wall) as a
result of complicated breast cancer. Because of this
condition, Mrs. B is not getting enough oxygen from
room air (due to the fluid build up between the lungs
and the chest wall), Mrs. B is charted Oxygen
supplement 2 litre through nasal prongs.
It was a PM shift and at the start of the shift, I was
checking Mrs. B vital signs, the result show EWS of 10
due to RR: 24 per minute, O2 sats 86%, HR 112 bpm,
temp 35.9 C. However, Mrs. B was asymptomatic, alert
and orientated, appeared to be in no discomfort and
stated she was not in pain either and we were just
happily chatting to each other before I took her vital
signs. After scoring EWS 10, I immediately reported to
the RN, rang the emergency bell for a MET call. While
waiting for the house officer to arrive, I put the bed up
for Mrs. B which eventually made her feel easier to
breath and keep monitoring her O2 saturations which
after sitting up, her saturation increased to 89% but it
still wasn’t in the safe zone. When the house officer
arrived, I helped the RN explain the situation about the
patient and our concerns.
Evaluation is a necessary skill in nursing as changes
could happen anytime and care plan will have to
Competency 2.4

Dip EN Assessment of Nursing Practice Competencies

©2024 Te Pūkenga TA Whitireia & WelTec 3
 Contributes to the evaluation of change accordingly in order to fit the patients’ care and
health consumer care. quality of life.
Mrs. L has postural hypotension, in which her blood
pressure drops every time she changes her position
from lying (rest) to standing. Due to this condition, Mrs.
L felt dizzy and light headed every time she got up
walking, however, not every dizzy or episole of light
headed were the same, some dropped in a big amount
leading to severe light headed or headache, some
other time it was more manageable. This put Mrs. L in
risk of falls. However, Mrs. L can move within a short
distance. I have noticed Mrs. L likes drinking tea and
usually asks for a hot cup of tea 3 to 4 times per shift
and she would pass urine a lot of time during the shift
as well. Everytime Mrs. L went to the toilet, it usually
took a long time for her to walk to the toilet with the
assistance of the HCA or the nurse, plus Mrs. L
passing urine a lot was also an effect of Furosemide
which is a diuretic medication. Because Mrs. L always
take a long time to assist to the toilet, at the end of the
shift, I requested bedside commode chair as the
patient can mobilise themselves to the bedside
commode chair which was right next to the bed, easier
for the patient to toilet themselves and help the HCA
and the nurses help her toilet easier. The RN approved
the plan so I started to change the daily care plan,
stating that the patient is at risk of fall, x 1 assist the
toilet and put a commode chair at bedside. Throughout
the rest of the shift, the patient said it was easier for
her to use the commode chair. So I updated the daily
care plan, note and handover that we provided Mrs. L
with a commode chair for easy toileting and preventing
risk of falls.
Documentation in nursing is to be precise as the
nature of the duty is to accurately observe, monitor
Competency 2.5 and make the right decision. So any documentation
Ensures documentation is accurate must be accurate as they are going to be used for
and maintains confidentiality of matters of life and death. Documents should be
information. maintained confidentiality as personal information is
not for the public as it could be used for wrong
purposes.
During my time at the ward, I made sure to write
everything on my hand notes throughout the shift to
make sure I didn’t miss anything, from observing and
monitoring the patients to talking to the house officer, I
always write down what they say as when I hand over
to their primary nurse or the nurses of the following
shift, I would know what to say and be able to
handover the information accurately. At these
placements, handwritten notes were used to
document, therefore I always make sure to sign my
name and write student nurse next to it. I also
requested my preceptors to counter signs and
proofread before signing my name under notes to
make sure I wouldn’t miss any important information.
Date and time were also documented as part of
ongoing progress. At the end of the shift, I always
throw away the hand notes or the shift planner into the
shred bins to protect the information during my shift.

Dip EN Assessment of Nursing Practice Competencies

©2024 Te Pūkenga TA Whitireia & WelTec 3
 Educating patients about their health status,
medications has significant impact on the patient’s
Competency 2.6
health as it helps the patient become aware of their
own conditions.
Contributes to the health education of
health consumers to maintain and
promote health. Patient R was charted with salbutamol inhaler as PRN
medications for short of breath and it was charted for
the first time so it was my understanding that I should
always inform and educate the patient about the
inhaler as it was a new medication plus the patient had
to learn how to use a spacer for it. I began to explain
that the salbutamol inhaler is a corticosteroid
medication, a bronchodilator which relaxes the airway
muscles, allows more air flow when he feels breathless
and he can use it whenever he experiences shortness
of breath. The inhaler also came with a spacer that
was pre-primed with the medication, and I explained
that all he needs to do is use the inhaler with the
spacer device to make sure he gets all the
medications. I then show the patient the inhaler, I said
that before using the inhaler, shake it well to mix the
medications, remove the cap, hold the inhaler upright,
thumb on the bottom and index and middle fingers on
the top, put his mouth on the entrance of the spacer,
about 2-3 cm, take a deep breath, press the top and
do 5-6 nice deep breath between each time he spray
the inhaler and spray 2 times should be enough.

The patient appeared to understand how to use an

inhaler with a spacer, so I told him I will come back
later and if he found any difficulty using it, don't
hesitate to ring the bell and ask. Later on, when I was
talking to the patient, I noticed that he was mildly
wheezing, so I asked if he felt shortness of breath, the
patient said just a little bit but he did not really notice.
So suggested that he should try to use the inhaler. As I
watched the patient, I slowly walked him step by step
again to make sure he understood and was clear on
the instruction. I was pleased that the patient was able
to use the inhaler with the spacer independently as he
stop me in the middle and said he can do it himself
and I just need to watch and correct him if something
was not right.

Dip EN Assessment of Nursing Practice Competencies

©2024 Te Pūkenga TA Whitireia & WelTec 3
Lecturer’s Comments:

..................................................................................................................................................................

..................................................................................................................................................................

..................................................................................................................................................................

Domain Three: Interpersonal Relationships

Pass/Fai
Competency Student Evidence
l
Maintaining a therapeutic interpersonal relationship is
to establish trust between healthcare worker and
Competency 3.1 patient in order to provide the best healthcare
Establishes, maintains and concludes services, improving patient health.
therapeutic interpersonal relationships.
Mrs. V is a Greek patient with limited English, she is
alert, responsive but very confused and anxious. Mrs.
V is on palliative care review, she has subdural
haemorrhage and R) pleural effusions. So in order to
take care of Mrs. V, altho Mrs. V appeared to be pain
free, the one thing that made it difficult was her being
anxious about being in the hospital as well as jumping
between 2 languages, which made it even more
difficult to communicate for her needs.

Mrs. V always gets agitated with people around,

especially HCA and nurses. I took care of Mrs. V for
about a week and I have managed to gain her trust
throughout this time. I was being patient and observe
Mrs. V, and talk to her with respectful manner and I
found that Mrs. V needed a lot of reassurance and
encouragement. So being extra patient with Mrs. V
needs to be a very good strategy. For example, when
Mrs. V went to the toilet hoping she would open her
bowel, sometimes she would stay there for a long
time and everytime someone rushed her she would
get agitated and start yelling out. I always try to
negotiate with Mrs. V by telling her things like “we will
just 5 more minutes” and reassuring her by saying “if
you need to go later we can take you okay? no need
to rush you can take your time”. Another one is Mrs.
V mobility is x2 assist with sara stedy, however Mrs. V
was also very anxious about mobilizing as she kept
saying “I cant i cant stand”, so besides talking to her
and reassuring her we will handle her safety, I also
held her hand to establish a safe feeling that
someone is with her and taking care of her with good
intentions at that moment. With Mrs. V, I also gave
her extra time and attention to check up on her, talk to
her even though it was hard because she speaks
Greek sometimes, all this was to make sure that she
felt attended and cared for. Even though these were
just small things but throughout the week, Mrs. V

Dip EN Assessment of Nursing Practice Competencies

©2024 Te Pūkenga TA Whitireia & WelTec 4
 appeared to be less anxious and much settled with
me and other nurses around. So by being patient,
putting extra time and attention to Mrs. V, I have
created an interpersonal relationship, reassure the
patient about the care they are receiving and make
sure that they are always attended at all times.

Communication is significant for healthcare workers

as information must be cleared and throughout for
Competency 3.2 any assessments to be accurate.
Communicates effectively as part of
the health care team.
On each patient I was assigned to work with, I always
made sure to report everything to the RN as part of
myself effectively communicating with the RN. I would
ask any questions related to my practice for example
if anything I was assigned to do was out of
knowledge/scope (eg: IV medications), I would tell the
RN that there are certain practices that as a EN I
cannot perform which ensure the safety of the health
consumers.

I ensure that my notes are reviewed and approved by

the RN. I read notes from the doctor, physiotherapist,
and social team to understand the patient situation
and confirm that the care plans are accurately
updated. I also utilise the ISBAR framework to
communicate my concerns about a patient to the
house officer by smart paging them about the
concerns I have with a patient:
- I: introduced myself as a student nurse and
called the house officer on behalf of the RN.
Patient is 72 years old female with L) side
breast cancer
- S: Situation of a patient, L) side breast pain,
burning sensation go up to under armpit, pain
level 7/10. Regular Paracetamol 1000 mg was
given an hour ago with nil effects. Nil PRN
pain relief was charted in the drugs chart.
- B: background was provided such as L) side
breast cancer.
- A: Assessed the patient by checking the
previous notes to see if anything similar
happened the previous shift, but information
was shortened as the patient was a new
admission. I assessed the patient's medical
history, with L) side breast. The patient also
had a recent mastectomy, dressing dry and
intact. So I think breast cancer or the
mastectomy might have something to do with
the patient's pain. I also said that the patient is
allergic to paracetamol and found out through

Dip EN Assessment of Nursing Practice Competencies

©2024 Te Pūkenga TA Whitireia & WelTec 4
 the notes that the patient was charted oral
morphine in the outpatient community.
- R: recommendation, I asked the house officer
to come review the patient and chart pain
relief medications (PRN or Once only).
After that, the house officer came down to review the
patient and charted once only celecoxib stat, as for
oral morphine, the house officer would like the day
team to review. After that, the RN and I gave the
patient the celecoxib stat dose with good effects.
After that, I documented the situation in nursing
notes, wrote down PRN analgesia to be reviewed in
the plans section and handed over what happened to
the next shift nurse.

Dip EN Assessment of Nursing Practice Competencies

©2024 Te Pūkenga TA Whitireia & WelTec 4
 Work in partnership with patients plays a significant
role in ensuring comfort, progress and setting a goal
Competency 3.3 for an achievable outcome.
Uses a partnership approach to
enhance health outcomes for health During an AM shift, a patient who has a rib fracture
consumers. was complaining of back pain, I assessed the pain
the patient stated that the pain was 8/10 and he could
not manage it any longer, I did a set of obs which was
appeared to be normal (EWS of 3 for HR 108 bpm,
RR 24), I reported back to RN and paged the doctor
about the situation using ISBAR framework. Since the
patient has been on a syringe driver fentanyl 150 mcg
since yesterday and the patient was still in pain, the
doctor reviewed and charted a new syringe driver 200
mcg of fentanyl. The primary RN and I proceeded to
prepare the new syringe driver and administered it as
well as a dose of PRN 25 mcg fentanyl. On the next
AM shift, I reassessed and checked the notes from
the previous shift. The patient appeared to be more
settled and stated that he felt so much better since
yesterday and he felt like he was ready to go home.
The primary RN and I went in and had a talk to the
patient about what could be done since at this time,
he would need a constant pump of the syringe driver,
a device which he does not have access to at home.
So the RN and I suggested that the patient could trial
fentanyl patches and one patch would last about 2-3
days to see if the fentanyl patch would be able to
control his pain. The patient liked the idea and he
would like to have a chat with the doctor about that so
we paged the doctor, explained that pt is independent
with minimal assistance. So upon discharge,
managing pain seemed like a priority. The doctor
came and had a chat with the patient and agreed that
the suggestion of trial on the fentanyl patches is
possible but the patient would have to stay for
another 6 days to be monitored as each fentanyl
patch lasts 3 days.

During the trial, I monitored the patient's pain level

closely, actively asked the patient about how he feels
about the treatment and if he experienced any side
effects or anything different. His feedback was that
the fentanyl patches were doing just fine and he was
able to manage his pain well, side effects wise. The
patient said his mouth was a bit dry so I explained
that dry mouth is one of the common side effects, he
just needs to make sure he gets enough fluid.
Reflected on the trial of the fentanyl patches, me and
the RN found that it has been working better than the
syringe driver. We reported to the doctor and with his
permission, we informed the patient about using the
fentanyl patches to manage his pain at home and
begin to plan a discharge plan.

Dip EN Assessment of Nursing Practice Competencies

©2024 Te Pūkenga TA Whitireia & WelTec 4
Lecturer’s Comments:

..................................................................................................................................................................

..................................................................................................................................................................

..................................................................................................................................................................

Dip EN Assessment of Nursing Practice Competencies

©2024 Te Pūkenga TA Whitireia & WelTec 4
 Domain Four: Interprofessional Health Care & Quality Improvement
Competency Pass/Fail Student Evidence

Dip EN Assessment of Nursing Practice Competencies

©2024 Te Pūkenga TA Whitireia & WelTec 6
 Nursing involves comprehending a broad view of
healthcare, which encompasses physical and mental
Competency 4.1 health, as well as an awareness of social and family
Collaborates and participates with circumstances.
colleagues and members of the
health care team to deliver care. Mrs. G, who has just undergone a hip replacement
surgery. After surgery, Mrs. G is in a critical recovery
phase, requiring close monitoring and a collaborative
approach to her care. I attended the MDT meeting
with the RN and the medical team along with the
surgeon to review Mrs. G’s surgical details and
anticipate post-operative care plan and pain
management. I listened closely to the plan and since it
was the first time we received Mrs. G as a patient, I
was concerned about her mobility and with the RN
permission, reported that she has not passed urine
ever since she arrived at the ward early this morning.
The RN and I suggested doing a bladder scan and if
the patient doesn’t pass urine needed, we can page
the team to review and consider inserting a catheter.

After that we started to discuss the discharge plan

and education upon home discharge. The social
worker explained that Mrs. G lives with daughter 's
family so she would get support from her daughter's
family. Since mobility was a big one in this case,
therefore, it is necessary for nurses (me and the RN)
to discuss and educate Mrs. G about her mobility
which will be assessed by the physiotherapist. The
physiotherapist said it would be good to discuss an
achievable goal for Mrs. G and requested if I can do a
brief talk to the patient and let them know the
physiotherapist will be in the next morning to assess
her. So after the MDT meeting, I went to see Mrs. G
and let her and her son at the bedside know that the
physiotherapist will be here in the morning to review
her. As per request of the family about the achievable
goal, I asked the physiotherapist about it and she said
because Mrs. G has only been out of surgery for one
day, a realistic plan would be to get her up and
moving, mobility wise, a walking stick or a walking
frame in short distance would be ideal. I explained
that to the RN and the family and they were happy
with the answer. For now, the physiotherapy
requested nurses and HCA to monitor Mrs. G mobility
and her ability to move in bed as well as encouraging
her to sit up in a chair using sara stedy transfer. Later
during that shift, I encouraged Mrs. G sat up in her
chair, using sara stedy as transfer and carefully
helped her to the chair, provided some pillows on the
chair for comfort.

The next morning, the physiotherapist came to

assessed Mrs. G and she was happy about how Mrs.
G can sit up in a chair with minimal discomfort/ pain
which provided the physiotherapist about Mrs. G
strength and level of toleration.

Dip EN Assessment of Nursing Practice Competencies

©2024 Te Pūkenga TA Whitireia & WelTec 6
 I have identified the roles within the unit by observing
how the staff manage shifts and by referring to the
Competency 4.2 student handbook. All staff must work together in a
collaboration in order to deliver quality healthcare and
Recognises the differences in treatments.
accountability and
responsibilities of registered As an enrolled nursing student, I have recognized the
nurses, enrolled nurses and roles and responsibilities of each team member. I
healthcare assistants. understand my scope of practice, guided by the EN
code of practice and the RN scope of practice. I
realize the importance of the delegations and
directions of the registered nurse and their
supervision, as this is crucial to me to become an
enrolled nurse.

Registered Nurse (RN) scope of practice covers a

broad knowledge and training of clinical skills,
judgements and managements. RN overall has more
responsibilities in clinical decisions and assessments,
the RN is also available for EN and HCA for
consultations and advices. While EN contributes to
daily nursing care, assessments and care plans with
evaluations which contribute to the primary care plan/
assessments. These works are overseen by the RN to
ensure the accuracy and appropriate for the patient.
This practice, along with the direction, supervision and
delegation from the RN to the EN, must lie within their
respective scope of practice and competencies, this
includes Code of practice and nursing in a manner
that is appropriate to all human and culturally safe.

Under the NCNZ guidelines, the enrolled nurse (EN)

and registered nurse (RN) collaborate to provide and
achieve quality healthcare. However, their scope of
practice is different as RN covers more clinical
training than EN. For example, certain tasks that the
EN is not authorized to perform, such as
administering IV lines, IV medications, chest drains,
etc,.

Working alongside the RN and the EN are the Health

Care assistants (HCA) who would provide daily care
without in depth clinical judgement. Healthcare
Assistants (HCAs) work under the guidance of nurses
and other healthcare professionals, ensuring patients
receive appropriate daily care. This includes helping
with activities of daily living (ADLs), such as dressing,
laundry, and maintaining a clean living environment.
HCAs also serve as “a watch”, reporting any
significant changes in a patient's mood, behavior, or
physical condition to the nursing staff.

Dip EN Assessment of Nursing Practice Competencies

©2024 Te Pūkenga TA Whitireia & WelTec 6
 During one of the shifts on placement, I was
delegated by an RN to remove a subcutaneous line.
However, due to being a student and I have only ever
removed the subcutaneous line a total of 1 times
during my practice, I was unsure about the procedure
and what I need to be aware of. Therefore, I
requested the RN to help me run through and
instructed me while I removed the subcutaneous line.
After performing hand hygiene and putting on gloves,
the RN instructed me to clean the insert site and the
line with alcohol wipe to prevent risk of infections,
then assess the condition of the skin area around the
site. After that applied light pressure above the area
where the line was inserted, slowly and gently pull the
line out with medium force to prevent skin trauma.
After pulling the line out, the RN instructed me to use
a small gauze and apply light pressure on the inserted
area to prevent any bleeding, then applied a dressing
on the insertion site. According to the patient, the
procedure was painless and with the supervision,
direction and delegation of the RN, I have
successfully taken out a subcutaneous line and
gained knowledge about the process.

Enrolled nurses (ENs), registered nurses (RNs), and

healthcare assistants work together to improve the
quality of life for patients in the ward, providing care
that is both attentive and culturally sensitive.

Dip EN Assessment of Nursing Practice Competencies

©2024 Te Pūkenga TA Whitireia & WelTec 6
 With different roles and responsibilities, nurses and
doctors work together to provide the best healthcare.
Competency 4.3 Nurses monitor and report while providing care and
Demonstrates accountability and needs, while doctors focus on conditions, diagnosis
responsibility within the health care and making a plan to help the patients recover.
team when assisting or working
under the direction of a registered Mrs. R is a stroke patient, she had a haemorrhagic
health professional who is not a
nurse. stroke, L) sided weakness and hypoactive delirium
which make her drowsy. One evening I was taking
care of Mrs. R, I found that Mrs. R was responsive but
very little. She wouldn’t eat her meal when I tried to
feed her nor take any medications. I tried to give her
some water but Mrs. R was refusing to open her
mouth. I have noticed that Mrs. R did not respond to
any verbal communication. Since Mrs. R refused
medications (some of them were very important such
as blood thinner and blood pressure medications) and
she was responsive but very little. I checked her obs
and she scored a 3 for HR 99 and RR 24, blood
pressure was very high with systolic was 195 and
diastolic was 97.

RN and I read the notes from the AM shiftI reported

my concerns to the RN and we decided to paged the
house officer S to review the patient medications or if
there is any alternative way to give the patients her
medications (Eg: through IVC line). House officer S
came to the ward and we went into Mrs. R room to
assess her motor responses. Firstly, house officer S
taught me the sternal rub, a technique to test an
unresponsive person's responsiveness by doing a
firm rub on the sternum in a circulating motion and
applying force. I performed the technique several
times but there was no response. I then suggested
that we should look at her pupils' reactions and shine
a torch over her eyes. Her pupils reacted immediately
and her eyelids were shutting very quickly so that
means she was responsive to light hence the
neurological function was still working well. Next, the
house officer instructed me to do an arm dropping test
by lifting the patient arm up and dropping it. The
house officer explained that two possible situations
could occur, the person should either resist the lifting
of the arm or automatically slow down the arm's fall.
Mrs R. was resisting and refused to move her hand.
This indicates that muscle tone and motor control are
still intact. To assess further on the baseline of Mrs. R
motor responses, house officer S taught me a trick
where she took a pen and drew it along the feet sole
and the arch, which triggered her to feel tickled as the
end of the feet is a high density of nerve ending area.
This action triggered the involuntary responses, Mrs.
R quickly pulled her leg up.

All these assessments sum up a conclusion that Mrs.

R motor responses were working and responding, the
house officer predicted that the reason why she was
refusing any oral intake and not responding to the
Dip EN Assessment of Nursing Practice Competencies
©2024 Te Pūkenga TA Whitireia & WelTec 6
 nurses was due to her hypoactive delirium which
symptoms consist of lethargy, drowsiness, slow
speech/ movements, decreased alertness/ interaction
and confusion.
Lecturer’s Comments:

..................................................................................................................................................................

..................................................................................................................................................................

..................................................................................................................................................................

..................................................................................................................................................................

..................................................................................................................................................................

Dip EN Assessment of Nursing Practice Competencies

©2024 Te Pūkenga TA Whitireia & WelTec 6
Marking Criteria

Student nurses must demonstrate consistently safe practice. Previously passed competencies may be
rescinded if safe practice is not demonstrated and maintained.

Pass: All competencies must be passed.

Fail: This grade is given to any student who fails to meet any of the competencies. The student
may be offered an opportunity to repeat the clinical placement; if so, an achievement contract
will be developed to address each of the competencies that have not been passed.

Overall grade:

Overall Student Comments:

..................................................................................................................................................................

..................................................................................................................................................................

..................................................................................................................................................................

..................................................................................................................................................................

..................................................................................................................................................................

..................................................................................................................................................................

..................................................................................................................................................................

Student Signature: ................................................................... Date: .............................................

Overall Lecturer Comments:

..................................................................................................................................................................

..................................................................................................................................................................

..................................................................................................................................................................

..................................................................................................................................................................

..................................................................................................................................................................

..................................................................................................................................................................

Lecturer Signature: ................................................................... Date: .............................................

Dip EN Assessment of Nursing Practice Competencies
©2024 Te Pūkenga TA Whitireia & WelTec 6