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Overview of Competency Hits from 3 Reflective AFEN Case studies

Case Study 1 to 3 study could potentially partially/fully meet the following core competencies and specialist unit competencies (A:adult; P:paed, OP:older person; T: trauma; MI/I: minor injury/illness; Psy:psychological care including mental health; M In: major incident; Pre: prehospital care)

AFEN REFLECTIVE CASE STUDY 1: 29 YEAR OLD WITH DISLOCATED SHOULDER29 year old male, with history of head injury that has left cognitive impairment, presents having dislocated his left shoulder. He lives in a care home and is accompanied by a nurse from the home, whilst having dislocation reduced his wife arrives. Whilst undergoing reduction of the dislocation, he has an anaphylactic reaction to Midazolam and his airway becomes compromised due to swelling. The case study covers the following aspect of care: Initial assessment, prioritisation and care planning. Comprehensive assessment using a structured approach. Communication and psychological assessment. Pain assessment and management adjusted for patients with cognitive impairment Pharmodynamics and pharmokinetics of medicines used to sedate and in response to anaphylaxis Interpretation of vital signs and other observations taking into account his normal and choses monitoring equipment appropriately Medicolegal and professional implications of caring for an adult with congitive impairment: capacity, consent for individual with residual congnitive

capacity. Challenges other health care professionals who are arguing the obtaining consent is unnecessary in this patient Supervision of junior staff nurse and student Team member in managing anaphylactic reaction.

This reflective case study could potentially partially/fully meet the following core competencies and specialist unit competencies (A:adult; P:paed, OP:older person; T: trauma; MI/I: minor injury/illness; Psy:psychological care including mental health; M In: major incident; Pre: prehospital care)

AFEN CASE STUDY 2: RTA OLDER PERSON84 year old male with previous history of ischaemic heart disease on beta blockers, pedestrian, hit by car @ approx 40 mph sustaining: head injury (GCS 13: M6, E3, V4), fractured ribs with haemothorax, fractured mid shaft femur. Included in this reflective case study are: Rationalises requirement for immediate care. Assessment and management of breathing, chest drain.

Judith Morgan. 20/05/2023 Faculty of Emergency Nursing 1

Assessment and management of circulatory deficit due to blood loss chest and femur Assessment and management of reduced conscious level; includes guidance from NICE head injury. Interpretation of vital signs & other observations with ongoing monitoring set including rationalisation of use of equipment. Assessment and management of fractured femur. Assessment and management of pain Psychological management of patient and his elderly wife who was with him. Refers to determining capacity and using best interest with family involvement to deliver care and safely manage patient. The case study demonstrates a systematic approach to trauma care using primary and secondary survey (ATLS, ATNC or TNCC)

The above is underpinned by application of anatomy, physiology, psychology and draws on other work to substantiate practice.

This case study could potentially partially/fully meet the following core competencies and specialist unit competencies (A:adult; P:paed, OP:older person; T: trauma; MI/I: minor injury/illness; Psy:psychological care including mental health; M In: major indicent; Pre: prehospital care)

AFEN CASE STUDY 3: 15 YEAR OLD OVERDOSE15 year old female presents having taken an overdose her grandmother’s tablets of 20 x 25mg Amitriptyline with 18 Paracetmol tables some 16 hours prior to presentation. She was found in the shed at the bottom of the garden. She was very drowsy and had left a suicide note. The suicide note said that felt unloved and couldn’t take the arguments with her mother anymore. Soon after admission she has a seizure, is found to have cardiac arrhythmias, hypotension and metabolic acidosis. The case study covers the following aspect of care: Initial assessment, prioritisation and care planning. Comprehensive assessment using a structured approach. Interpretation of vital signs and other observations taking into account her normal (she is a very fit athlete, running 5 miles per day, with a normal

bradycardia) Psychological assessment as much as was possible whilst she was in a drowsy state. Nursing inverventions with rationalisation of cannulation and blood sample taking. Medicolegal and professional implications of caring for a 15 year old girl, discussing: Fraser Guidelines (Gillick) and child protection issues. Supervision of junior staff nurse and student Lead in managing seizure and administration of medicines under PGD.

This reflective case study could potentially partially/fully meet the following core competencies and specialist unit competencies (A:adult; P:paed, OP:older person; T: trauma; MI/I: minor injury/illness; Psy:psychological care including mental health; M In: major indicent; Pre: prehospital care)


SECTION 1: KNOWLEDGECode & subject Competency Learning Outcome

A P OP T MI/I PSY Min PreAs an FEN Associate, you will: As an FEN Associate, you will:1.1.1Anatomy & physiology

have a comprehensive knowledge of normal anatomy and physiology for all body systems

demonstrate and apply an understanding of anatomy and physiology of all body systems

1.1.2 apply comprehensive knowledge of anatomy, physiology and psychology to recognised patterns of illness and injury

demonstrate and apply an understanding of anatomy, physiology and psychology

1.2.1Nursing assessment

undertake and document a comprehensive, systematic and accurate nursing assessment of the physical, psychological, social and spiritual needs of a patient in an emergency situation

demonstrate the ability to undertake an accurate, comprehensive assessment for a patient requiring emergency care, using recognised assessment tools

1.2.2 Assessment frameworks

use a structured approach to individual clinical assessment

competently apply recognised assessment frameworks

systematically document assessment findings

demonstrate use of pain assessment tools

1.3Prioritising care

use a structured approach for prioritising patient care

accurately record your decision-making process

1.4Critical illness or injury

recognise patients with life-threatening presentations, and the need for immediate intervention

differentiate life-threatening presentations and respond appropriately

1.5Emotional & psychological reactions

identify a range of immediate emotional and psychological reactions by patients or those with them to sudden & exacerbation of illness or injury

identify the immediate emotional and psychological impact of sudden & exacerbation of illness and injury on the patients and others and suggests possible coping mechanisms


1.6Pharmacology

use comprehensive knowledge of the relevant pharmacology for emergency patients

discuss the application of relevant pharmacology for the emergency patient

1.7Care needs

provide care and anticipate needs, based on patterns of the actual and predicted illness or injury

demonstrates the ability to provide an appropriate level of care and anticipate further care needs

1.8Monitoring equipment

select and deploy appropriate monitoring equipment for individual patients

identify a range of appropriate clinical indicators for deploying clinical monitoring equipment

1.9Personal influences on care

provide a rationale for the nursing care you deliver, taking into account social, spiritual and cultural influences

demonstrate awareness of social, spiritual and cultural influences that impact on holistic care, informed by robust evidence

1.10External influences on care

provide a rationale for nursing care delivery that takes account of legal, professional, political and economical influences

demonstrate awareness of the multiple influences which impact on holistic care

1.11Standards and guidance

apply standards and guidance provided by the relevant professional governing body, e.g. Nursing & Midwifery Council (NMC) or equivalent, National Institute for Clinical Excellence (NICE), etc.

demonstrate informed understanding of the use of policies and guidance on clinical practice

1.12Legal and ethical principles

use a working knowledge of relevant legal and ethical principles in clinical practice

apply legal and ethical principles to emergency practice which are underpinned by quality diversity and human rights principles

1.13Risk assessment

identify health and safety issues in the work environment

demonstrate knowledge of risk assessment and management strategies and competently apply them in practice

1.14Accountability

apply the principles of the NMC Code of Conduct1 to your own professional practice and conduct

demonstrate responsibility and accountability for your professional practice in accordance with the prescribed level of your personal competence

1.15Leadership

identify the principles of leadership and use them to negotiate and plan your own practice

use principles of leadership in negotiating your own practice

1 For those using this framework outside the United Kingdom, your own professional body guidelines applyJudith Morgan. 20/05/2023 Faculty of Emergency Nursing 4

1.16Communication

demonstrate the application of effective interaction and communication with patients and the multi-professional team

demonstrate knowledge and application of effective communication skills for patients and the multi-professional team

SECTION 2: INTERVENTIONCode & subject Competency Learning Outcome

A P OP T MI/I PSY Min PreAs an FEN Associate, you will: As an FEN Associate, you will:2.1Assessment

assess and prioritise patients according to clinical and psycho-social need

perform appropriate and effective assessment and prioritisation

2.2Observation and evaluation

undertake accurate and appropriate observations and nursing interventions and effectively evaluate impact of interventions and observations in order to plan care.

measure, interpret and record vital signs and other appropriate observations

evaluate interventions and observations and respond appropriately to findings through care planning

2.3Critical situations

identify critical and/or life threatening situations

initiate appropriate action in response to critical and/or life threatening situations

2.4Therapeutic interventions

provide safe management of therapeutic interventions

demonstrate safe delivery of therapeutic interventions

demonstrate safe monitoring of therapeutic interventions

initiate effective pain management strategies

demonstrate providing essential care needs


2.5Disseminating information

be effective in applying the principles of essential care and reporting this information effectively to other members of the health care team2

demonstrate the ability to access, use and disseminate information from a wide variety of sources, within the department, on admission, transfer or discharge, to support effective co-ordination of a patient’s journey through the health care process

2.6.1Pain assessment

be able to assess a patient's pain, having selected and applied an appropriate pain assessment tool

demonstrate the ability to carry out pain assessment, using a range of appropriate pain assessment tools

2.6.2Pain relief

identify suitable analgesia either by administering analgesia under protocol (eg Patient Group Direction[(PGD), using non-invasive methods of pain relief or initiating intervention by a medical practitioner

access suitable analgesia using a variety of methods or initiating intervention by a medical practitioner

2.7Psychological impact

recognise the psychological impact of an emergency situation on a patient and family/carers, and instigate appropriate interventions

demonstrate the ability to recognise and respond appropriately to the psychological impact of an emergency on a patient and family/carers and to instigate appropriate interventions

2.8Health promotion

initiate appropriate health promotion strategies when providing emergency health care

demonstrate an understanding of the term ‘health promotion’

apply appropriate health promotion principles to emergency care practice

evaluate health advice given 2.9Managing aggression & violence

be able to recognise trigger points for aggressive and violent behaviour, and effectively manage violent incidents until further support arrives

demonstrate the ability to recognise trigger points for aggressive and violent behaviour and de-escalates such situations, recognising your own limitations and seeking assistance as necessary

2 the health care team may include the patient and their relatives - informed consent principles apply here.


2.10Care pathways

initiate patients’ journeys on appropriate care pathways

demonstrate the ability to anticipate and instigate the preliminary stages of access to the care pathway for a patient

SECTION 3: PATIENT MANAGEMENT Code & subject Competency Learning Outcome

A P OP T MI/I PSY Min PreAs an FEN Associate, you will: As an FEN Associate, you will:3.1Care delivery

identify, assesses, plan and evaluate appropriate care for patients, taking into account their age, gender, ethnicity, culture, values and spiritual beliefs

demonstrate the ability to evaluate and plan appropriate and timely care for patients, taking into account their age, gender, ethnicity, culture, values and spiritual beliefs

3.2care delivery to vulnerable patients

identify, assess and complete comprehensive and appropriate care plans for emergency patients who are vulnerable, including those with learning disabilities

distinguish which individuals are vulnerable or potentially vulnerable

evaluate effectively the care of patients who are vulnerable

demonstrate ability to design comprehensive care plans for vulnerable patients, including protection issues

3.3.1Communication

use communication skills to rapidly form effective therapeutic relationships

discuss principles of effective therapeutic communication

demonstrate the ability to communicate effectively and achieve therapeutic relationships with patients and carers

3.3.2 understands the principles of how to negotiate patient care outcomes with senior staff/mentors

demonstrate an ability to communicate effectively with other health care professionals and managers, to negotiate appropriate patient care outcomes

3.4Equity and dignity3.10.1

assist in delivering and developing an emergency service that shows equity and respect to all patients and staff

demonstrate providing care that treats patients with equity and dignity

responds appropriately when patients or staff are not treated with respect and dignity


3.5Consent and advocacy

uphold ethical and legal principles, particularly showing respect for patients’ views and their right to self-determination when making decisions about their care

discuss the use of ethical and legal principles to underpin decision-making about patients' care

demonstrate an understanding of the principles of advocacy in the emergency care setting

3.6 Coping strategies

encourage patients and families/carers to use helping and coping strategies during critical events

show an ability to help patients and families/carers to use helping and coping strategies during critical events

3.7Patient empowerment

use the principles of empowering patients and families during critical events

demonstrate that you apply the principles of support and empowering patients and families during critical events

3.8 Managing relatives' lloss

use the principles of research-based practice in managing relatives and friends who are experiencing loss and sudden bereavement

demonstrate that you apply best practice guidelines in managing relatives and friends experiencing loss and sudden bereavement

3.9Prioritisation

be self-reliant within the scope of your responsibility, identify the unit's and patients' priorities for care and organise your workload appropriately

demonstrate professionalism and awareness of the scope of your own role within the emergency team

demonstrate an ability to manage yourself and your personal workload in this rapidly changing environment

3.10 Documentation

ensure all aspects of care are fully documented

produce complete and appropriate documentation

3.11 Role modelling

act as a role model in the emergency care setting

show how you work as a role model

3.12.1Multi-professional team working

contribute to effective multi-disciplinary team working and care delivery

demonstrate your ability to share workload

involve other team members in providing care

refers to team members for help and advice

apply the principles of effective communication and team working in delivering care


3.12.2 Be an effective team member in an emergency situation

Demonstrate the ability to function effectively as a member of a team in an emergency situation

3.13Inter-agency working

work effectively with primary care and social service teams to ensure safe discharge of patients

instigate safe discharge for patients who require community support

demonstrate effective communication with community support teams to facilitate continuity of care

3.14 audit & monitoring care delivery

participate in audit and developing practice in emergency care

demonstrate that you participate in audit processes to develop practice in emergency care

3.15 Risk management policy

use information provided in your unit’s risk management policy to inform practice

demonstrate effective use of the risk management policy in practice

SECTION 4: MANAGING YOURSELF AND OTHERSCode & subject Competency Learning Outcome

A P OP T MI/I PSY Min PreAs an FEN Associate, you will: As an FEN Associate, you will:4.1 Reflective practice

apply a reflective approach to delivering care and analyse your own practice

apply a reflective framework to your own practice, identifying strengths and weakness in care delivery

4.2 Portfolio reflect on your care delivery, developing a progressive portfolio of evidence of your professional practice

record your progressive practice in a professional portfolio of evidence

4.3 Personal development

negotiate and work with a mentor to develop a personal development plan, determining an action plan for achievement

record a personal development plan and action plan to meet set targets, showing progressive achievement

4.4 Education & preceptorship

undertake a preceptorship programme/period in the emergency care environment

use appropriate teaching and learning principles to develop your own knowledge and skill in the emergency environment, and support other junior staff

4.5 Mentorship provide support to junior members of the team and actively encourage their development

apply the principles of mentorship in your own professional practice


4.6 Coping identify the potential impact of working in emergency care settings on your own values and emotions, and uses recognised coping strategies to respond appropriately

be self aware about the potential impact of the range of emotions that can be provoked in the emergency environment

demonstrate best practice & professionalism in response to the wide range of emotions provoked in the emergency environment

4.7stress

work actively towards providing finding ways to reduce the effects of stress on yourself and others in the team

develop coping strategies to manage stress in yourself and others

apply best practice in preventing yourself from developing stress

show an ability to provide supporting mechanisms to prevent and alleviate stress in others

4.8 Organisation| use appropriate organisational techniques to plan and organise your own workload

demonstrate the ability to plan and organise your own workload effectively

4.9 Leadership and development

use the principles of leadership to negotiate and plan your own practice

demonstrate an ability to use the principles of leadership in negotiating your own practice


AFEN REFLECTIVE CASE STUDY 1: 29 YEAR OLD WITH DISLOCATED SHOULDER29 year old male, with history of head injury that has left cognitive impairment, presents having dislocated his left shoulder. He lives in a care home and is accompanied by a nurse from the home, whilst having dislocation reduced his wife arrives. Whilst undergoing reduction of the dislocation, he has an anaphylactic reaction to Midazolam and his airway becomes compromised due to swelling. The case study covers the following aspect of care: Initial assessment, prioritisation and care planning. Comprehensive assessment using a structured approach. Communication and psychological assessment. Pain assessment and management adjusted for patients with cognitive impairment Pharmodynamics and pharmokinetics of medicines used to sedate and in response to anaphylaxis Interpretation of vital signs and other observations taking into account his normal and choses monitoring equipment appropriately Medicolegal and professional implications of caring for an adult with congitive impairment: capacity, consent for individual with residual congnitive

capacity. Challenges other health care professionals who are arguing the obtaining consent is unnecessary in this patient Supervision of junior staff nurse and student Team member in managing anaphylactic reaction.

This reflective case study could potentially partially/fully meet the following core competencies and specialist unit competencies (A:adult; P:paed, OP:older person; T: trauma; MI/I: minor injury/illness; Psy:psychological care including mental health; M In: major incident; Pre: prehospital care)

























1.6Pharmacology



1.7Care needs



















1.13Risk assessment



1.14Accountability



1.15Leadership



1.16Communication



























2.6.2Pain relief








2.8Health promotion







2.10Care pathways




A P OP TMI/I

PSY

Min PreAs an FEN Associate, you will: As an FEN Associate, you will:

3.1Care delivery









3.3.1Communication
























3.9Prioritisation




3.10 Documentation



3.11 Role modelling




































4.6 Coping identify the potential impact of

working in emergency care settings on your own values and emotions, and uses recognised coping strategies to respond appropriately




4.7stress










AFEN CASE STUDY 2: RTA OLDER PERSON84 year old male with previous history of ischaemic heart disease on beta blockers, pedestrian, hit by car @ approx 40 mph sustaining: head injury (GCS 13: M6, E3, V4), fractured ribs with haemothorax, fractured mid shaft femur. Included in this reflective case study are: Rationalises requirement for immediate care. Assessment and management of breathing, chest drain. Assessment and management of circulatory deficit due to blood loss chest and femur Assessment and management of reduced conscious level; includes guidance from NICE head injury. Interpretation of vital signs & other observations with ongoing monitoring set including rationalisation of use of equipment. Assessment and management of fractured femur. Assessment and management of pain Psychological management of patient and his elderly wife who was with him. Refers to determining capacity and using best interest with family involvement to deliver care and safely manage patient. The case study demonstrates a systematic approach to trauma care using primary and secondary survey (ATLS, ATNC or TNCC)

The above is underpinned by application of anatomy, physiology, psychology and draws on other work to substantiate practice.

This case study could potentially partially/fully meet the following core competencies and specialist unit competencies (A:adult; P:paed, OP:older person; T: trauma; MI/I: minor injury/illness; Psy:psychological care including mental health; M In: major indicent; Pre: prehospital care)


A P OP T MI/I PSY Min PreAs an FEN Associate, you will: As an FEN Associate, you will:


1.1.1Anatomy & physiology






















1.6Pharmacology



1.7Care needs



















1.13Risk assessment



1.14Accountability



1.15Leadership



1.16Communication




A P OP T MI/I PSY Min PreAs an FEN Associate, you will: As an FEN Associate, you will:


2.1Assessment






















2.6.2Pain relief








2.8Health promotion







2.10Care pathways













3.3.1Communication
























3.9Prioritisation




3.10 Documentation



3.11 Role modelling






















4.7stress











AFEN CASE STUDY 3: 15 YEAR OLD OVERDOSE15 year old female presents having taken an overdose her grandmother’s tablets of 20 x 25mg Amitriptyline with 18 Paracetmol tables some 16 hours prior to presentation. She was found in the shed at the bottom of the garden. She was very drowsy and had left a suicide note. The suicide note said that felt unloved and couldn’t take the arguments with her mother anymore. Soon after admission she has a seizure, is found to have cardiac arrhythmias, hypotension and metabolic acidosis. The case study covers the following aspect of care: Initial assessment, prioritisation and care planning. Comprehensive assessment using a structured approach. Interpretation of vital signs and other observations taking into account her normal (she is a very fit athlete, running 5 miles per day, with a normal

bradycardia) Psychological assessment as much as was possible whilst she was in a drowsy state. Nursing inverventions with rationalisation of cannulation and blood sample taking. Medicolegal and professional implications of caring for a 15 year old girl, discussing: Fraser Guidelines (Gillick) and child protection issues. Supervision of junior staff nurse and student Lead in managing seizure and administration of medicines under PGD.

This reflective case study could potentially partially/fully meet the following core competencies and specialist unit competencies (A:adult; P:paed, OP:older person; T: trauma; MI/I: minor injury/illness; Psy:psychological care including mental health; M In: major indicent; Pre: prehospital care)

























1.6Pharmacology



1.7Care needs



















1.13Risk assessment



1.14Accountability



1.15Leadership



1.16Communication



























2.6.2Pain relief








2.8Health promotion







2.10Care pathways













3.3.1Communication





















3.8 Managing relatives' loss



3.9Prioritisation




3.10 Documentation



3.11 Role modelling






















4.7stress











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