Care provision or a clinical skill may have to be carried out in different ways in order to meet the specific needs of a patient. This may also be influenced by, for example, the age or mental capacity of the patient and the care setting. This should be clearly documented and been informed by a thorough assessment of the individual needs of the patient. A combination of a model of care and appropriate assessment tools will have been utilized in order to make this decision.

Example: Within a community setting the nurse will modify the technique utilized in order to carry out a dressing change. The patient may well have a supply of all the required constituents in order to have a dressing change at home. However, it is unlikely that the nurse will utilize a trolley! The nurse is more likely to utilize a table or other suitable piece of furniture within the home setting after ensuring the patient’s consent. Other modifications may include handwashing in a sink, which does not have elbow taps. You may therefore observe the nurse utilizing disposable hand towels in order to switch the taps off.

You may ask your mentor about the specific policy or guideline relative to the procedure and discuss what you have been taught in relation to this procedure within your clinical skills lab.

A variation in practice will allow you to understand that adaptations are often necessary in order to meet the individual and sometimes varying needs of each patient but should not compromise the care being delivered or be detrimental to the patient.

I would inform my practice educator, tutor or lecturer immediately. I would seek help from an appropriately qualified practitioner immediately if I felt that someone who is being cared for has suffered harm for any reason. I would also seek help from my mentor, tutor or lecturer if people indicate that they are unhappy about their care or treatment.

It is likely that I would be asked for a full verbal account of the circumstances, which may then result in a full written report.

You can also seek advice from your professional body or trade union who will offer confidential advice and support.

A wide variety of responses is anticipated. However, an example has been provided for illustration.

Example: You may have been involved in securing a place at a day care centre for a patient (working in partnership), arranging a home visit at a time most suited to the patient’s daily routine (providing service user-centred care) etc.

Psychomotor Domain is the practical skill.  In order to demonstrate effective care you will be graded on how you carry out the skill.  This will include how you use the thermometer, locate the radial pulse, count the respiratory rate and perform hand hygiene.

Cognitive Domain is your knowledge.  To demonstrate effective care you need to have the knowledge of the skill but also the theory behind this.  You can demonstrate this to the marker by indicating the measurements of temperature, pulse and respiration you have taken are within normal expected limits, which demonstrates your knowledge of normal ranges in relation to vital signs.  This is also demonstrated through correct hand hygiene, correct use of equipment and correct location of pulses.

Affective Domain is your attitude and professional approach.  To demonstrate effective care within the affective domain your marker will be expecting you to communicate with your patient, to introduce yourself, gain consent, reassure the patient and provide an explanation of your findings.