Hong Kong College of Medical Nursing Advanced Practice Nursing · PDF fileAdvanced Practice Nursing (Medicine) Certification Program Fellow Membership Examination (Sub-Specialty Module

1 Respiratory Nursing Log Book 2017

Hong Kong College of Medical Nursing

Advanced Practice Nursing (Medicine) Certification Program

Fellow Membership Examination (Sub-Specialty Module – Respiratory Nursing

Clinical Log Book

Endorsed on 5 May 2017

Name of Candidate


Advanced Practice Nursing (Medicine) Certification Program

Fellow Membership Examination (Sub-Specialty Module – Respiratory nursing

Clinical Log Book

Table of Contents

1 GENERAL INSTRUCTION FOR THE CANDIDATE ………………………………….3

2 PURPOSE OF THE LOG BOOK …………………………………………………………….3

3 RESPONSIBILITIES OF THE CANDIDATE ………………………………………….3-4

4 RESPONSIBILITIES OF THE MENTOR ……………………………………………………4

5. PERSONAL DATA OF THE CANDIDATE …………………………………………………5

6 RECORD OF EXPERIENCES……………………………………………………………..6-14

7 RECORD OF CASE STUDY AND/OR PRESENTATION ……………………………14

8 DEVELOP NURSE LED CLINIC …………………………………………………………...14

9 DEVELOP SMOKING CESSATION PROGRAM …………………………………….14

10 PATIENT ADVOCACY AND END OF LIFE CARE …………………………………..14

11 FACILITATE CHANGE AND EDVIDENCE-BASED PRACTICE ………………….14

12 INITIATE IMPROVEMENT STRATEGIES ………………………………………………15

13 CLINICAL LOG SHEET ………………………………………………………………………..16

14 EVALUATION FORM ………………………………………………………………………….17

15 REFERENCE – COMPETENCE FRAMEWORK …………………………………18-19


1. General Instructions for the Candidate

The Candidate should regularly read and access information related to

Specialty Training published by the Hong Kong College of Medical Nursing as

updated on website.

2. The Purpose of the Log Book

2.1 To assist the Candidate in reflecting the learning opportunities in clinical

practices

2.2 To facilitate the Mentor to assess the clinical competence of the Candidate

and provide support and guidance to accomplish the Certification Program

3. Responsibilities of the Candidate

3.1 Each Candidate, upon enrollment, will be issued with the Log Book at the

commencement of Advanced Practice Nursing (Respiratory) Certification

Program training. It will be the property of the Candidate

3.2 The Candidate should record the followings:

3.2.1 All supervised assessment on the patients

3.2.2 All supervised interventions on the patients

3.2.3 All special encounters with the patients/families

3.2.4 All nursing activities in Nurse-led Clinic / Patient Support Group

3.2.5 Case conferences

3.2.6 Research activity

3.2.7 Journal reading and reflection

3.2.8 Continuous Professional Activities

i. Attending Mortality and Morbidity Meetings

ii. Attending/ leading Continuous Nursing Education activities

iii. Case presentations

iv. Nurses rounds

v. Attending/presentation in conferences, seminars

vi. Speaker or author in nursing education seminars / conference / journal

paper

3.2.9 Leading Patient Safety activity

3.2.10 Leading Staff Occupational Safety activities

3.2.11 Leading Risk Management and Quality improvement activities

The above list is not exhaustive as the log book serves as a means that demonstrate

reflective learning of the Candidate.

3.3 The Candidate is strongly advised to keep the Log Book with him/her at all

times and to fill in relevant information on a regular basis. Patient(s) MUST

NOT be identified by names or Hong Kong Identity Card numbers. Cases

should be recorded using patients’ initials and /or hospital numbers.


3.4 The Candidate should discuss his/her progress as documented in the Log Book

with his/her mentor at regular intervals. This dialogue serves an opportunity

for the Candidate to reflect on the learning and growth in the nursing

profession. This regular assessment allows deficiencies in experience to be

remedied early in the course of the training. Evaluation Form must be signed

by the mentor and endorsed by the Chairman of Examination Panel before

recommendation to the Hong Kong Academy of Nursing for admission to

Fellow Member.

3.5 The Candidate should seek the mentor’s endorsement of the Training Program

before submission to the Examination Panel.

3.6 The Candidate should complete at least 70% of the Log Book before final

assessment.

4. Responsibilities of the Mentor

4.1 The Mentor facilitates the Candidate to map learning opportunities in the

clinical practices to the competence framework.

4.2 The Mentor has the responsibility to guide the Candidate to reflect on

encounters in the clinical areas by asking what has happened, why and what is

the learning point?

4.3 The Mentor is to facilitate the Candidate to identify opportunities to develop

the leadership abilities to lead the team.

4.4 The Mentor is to polish the Candidate’s presentation and writing skills and

encourage him/her to present cases and papers.

4.5 The Mentor is to encourage the Candidate to be active team players in clinical

rounds.

4.6 The Mentor should not take more than two Candidates at the same work

place.

4.7 The Mentor should not hold Trainer status in more than 2 specialties.

4.8 The Mentor has the responsibility to guide the Candidate to prepare for the

Training Program.


5. Personal Data of the Candidate

Name of the Candidate Sex

Chinese Name

Registration Number of the Candidate

Date of entry into the training program

Address

Email Telephone

Mentor’s Name Title/Rank

Institution/Department/Unit

Supervision Period


6. Record of Experience

(* = Mandatory)

6.1 * Applied anatomy and patho-physiology, etiology in respiratory patient care

(5 scenarios)

Date Patient

initials

Major Experience

Mentor

Signature

6.2 * Screening, diagnosis and related investigation / assessment for respiratory

diseases (5 scenarios)

Date Patient

initials

Major Experience Mentor

Signature

6.3 * Screening of the infectious disease and safe environment control in

preventing nosocomial infections (3 scenarios)

Date Patient

initials


Signature

6.4 Screening of patients according to updated Government supported programs

such as Nurse & Allied Health Clinic (2 scenarios)

Date Patient

initials

Major Experience

Mentor

Signature


6.5 *Establishment of Patient Centered Care Therapeutic relationship (3 scenarios)

Date Patient

initials


Signature

6.6 Multi-disciplinary Collaboration such as case conference and pre-discharge

plan (2 scenarios )

Date Patient

initials


Signature

6.7 *Management of patients Receiving Interventional Pulmonology:

bronchoscopy ( 3 scenarios)

Date Patient

initials


Signature

6.8 Management of patients Receiving Interventional Pulmonology: pleuroscopy

( 1 scenario)

Date Patient

initials


Signature

6.9 Management of patients Receiving Interventional Pulmonology:

endobronchial ultrasound (EBUS) ( 1 scenario)

Date Patient

initials


Signature


6.10 *Management of patients with Pneumonia (3 scenarios)

Date Patient

initials

Major Experience

Mentor

Signature

6.11 *Management of patients with Asthma (3 scenarios)

Date Patient

initials


Signature

6.12 *Management of patients with Chronic Obstructive Pulmonary Disease (5

scenarios)

Date Patient

initials


Signature

6.13 *Management of patients with Respiratory Failure (5 scenarios)

Date Major Experience Mentor

Signature


6.14 Management of patients with Acute Respiratory Distress Syndrome (2

scenarios)

Date Major Experience Mentor

Signature

6.15 *Management of patients with Bronchiectasis (3 scenarios)

Date Patient

initials


Signature

6.16 Management of patients with Pulmonary Fibrosis (2 scenarios)

Date Patient

initials


Signature

6.17 Management of patients with Interstitial Lung Diseases (1 scenario)

Date Patient

initials


Signature

6.18 Management of patients with Neuromuscular Diseases (2 scenarios)

Date Patient

initials


Signature

6.19 Management of patients with Pleural Diseases: Tumour (1 scenario)

Date Patient

initials


Signature


6.20 *Management of patients with Pleural Diseases: Spontaneous Pneumothorax

or Pleural Effusion (3 scenarios)

Date Patient

initials


Signature

6.21 *Management of patients with Pleural Diseases: pleural empyema (3

scenarios)

Date Patient

initials


Signature

6.22 *Management of patients with Lung Cancer (2 scenarios)

Date Patient

initials


Signature

6.23 *Management of patients with Pulmonary Tuberculosis (3 scenarios)

Date Patient

initials


Signature

6.24 Management of patients with Extra-pulmonary Tuberculosis (2 scenarios)

Date Patient

initials


Signature


6.25 Management of patients with Multidrug Resistant / Extensive Drug Resistant

Tuberculosis (2 scenarios)

Date Patient

initials


Signature

6.26 Management of patients with Novel Viral Infection (1 scenarios)

Date Patient

initials


Signature

6.27 *Management of patients with Critical Respiratory conditions Receiving

Oxygen Therapy (5 scenarios)

Date Patient

initials

Experience Mentor

Signature

6.28 Management of patients with Critical Respiratory conditions with Invasive

Mechanical Ventilation (IMV) (3 scenarios)

Date Patient

initials

Experience Mentor

Signature

6.29 *Management of patients with Critical Respiratory conditions with

Non-invasive Ventilation (NIV) (3 scenarios)

Date Patient

initials

Experience Mentor

Signature


6.30 *Management of patients with Tracheostomy (3 scenarios)

Date Patient

initials

Experience Mentor

Signature

6.31 *Management of patients with Chest Drain/ Pigtail Drain (3 scenarios)

Date Patient

initials

Experience Mentor

Signature

6.32 Management of patients with Indwelling Pleural Catheter (IPC) (1 scenario)

Date Patient

initials

Experience Mentor

Signature

6.33 *Management of patients with Sleep Breathing Problem (3 scenarios)

Date Patient

initials

Experience Mentor

Signature

6.34 Management of patients Receiving Pulmonary Rehabilitation Program (3

scenarios)

Date Patient

initials

Experience Mentor

Signature


6.35 * Health education to patients Receiving Inhaled Medications (5 scenarios)

Date Patient

initials

Experience Mentor

Signature

6.36 * Health education to patients Receiving Home Oxygen Therapy (3 scenarios)

Date Patient

initials

Experience Mentor

Signature

6.37 Health education to patients Receiving Home Non-invasive Ventilation

including BiPAP & CPAP (3 scenarios)

Date Patient

initials

Experience Mentor

Signature

6.38 Health education to patients Receiving Home Invasive Ventilation (1

scenarios)

Date Patient

initials

Experience Mentor

Signature

6.39 Management of patients Receiving Outpatient Parental Antibiotic (2

scenarios)

Date Patient

initials

Experience Mentor

Signature


6.40 *Home Care Management of patients for Self-Management, Exacerbation

Management and Patient Empowerment (3 scenarios)

Date Patient

initials

Experience Mentor

Signature

7. *Case Study and / or Presentation (at least 2 cases, please refer to Clinical Log

Sheet as a reference format)

8. Develop Nurse Led Clinic – planning, development and operation (at less 1

activity)

Date Activity Mentor

Signature

9. Develop Smoking Cessation Program (at least 2 activities)


Signature

10. *Patient advocacy and End-of-Life Care (at least 2 activities)


Signature

11. Facilitate change and adopt evidenced based practice in nursing care (at least

2 activities)


Signature


12. *Initiate improvement strategies in quality and risk management (at least 2

activities)


Signature


13. Clinical Log Sheet

This is for logging clinical case management experience and provides a framework to

facilitate mentor/mentee discussion. The mentee should complete one Clinical Log

Sheet once every 3 months.

Session date:

Level of care the candidate provided:

Observation only Primarily mentor managed

Independent care with presentation to mentor agreement

Client information:

Initial Sex/Age Occupation

Social background

Resource / support network

Diagnosis / medications

Relevant medical, mental conditions and other parameters

Physical psycho-social problems identified

Intervention and education

Management and educations provided

Reflection / learning

Mentee signature Date

Mentor comment

Mentee signature Mentor signature

Date Date


14. Evaluation form to be completed by the Mentor for recommending to attend

assessment leading to award of HKAN Fellow Member

Name of Mentee

Supervising Period

EVALUATION

Subject areas Grading

Pass Needs

Improvement

Borderline

Fail

Fail

Clinical knowledge & professional

judgment

Meeting the domain of competence

Managed patient with complex clinical

profile

Established therapeutic relationship

with patient/family

Reliability/ sense of responsibility

Led CQI activities

Led nursing team and demonstrated

leadership abilities

Overall rating

Recommendation recommended as qualified and competent

not recommended

Additional comments (use additional sheet if necessary)

Name of Mentor Signature

Fellow Number Date

endorsed

not endorsed

Chairman of Examination & Accreditation Committee Signature

Date


15 Reference – Competence Framework

Subject areas Domains

1 2 3 4 5 6 7

15.1 Health Assessment

15.1.1 Applied Anatomy &

patho-physiology, etiology for

Respiratory diseases

1,2,3,4,5,8

15.1.2 Screening, diagnosis and related

investigation / assessment for

Respiratory Diseases

3,5,6,7 1,3,4,8 1,2 1 5

15.1.3 Screening of the infectious

disease and safe environment

control in preventing nosocomial

infections

All 1,2,3,4,8 1,2 1,2,3 1,2,3,5 1

15.1.4 Screening of patients according

to updated Government

supported programs such as

Nurse & Allied Health Clinic

All 1,2,3,4,8 1 1,2,3 1,2,3,5 1

15.2 Establishment of Patient Centered

Care Therapeutic relationship

All All

1,3,4,5 2 1

15.3 Multi-disciplinary Collaboration

such as case conference and

pre-discharge plan

All All

1,3,4,5 2 1

15.4 Management of patients

15.4.1 Receiving Interventional

Pulmonology such as

bronchoscopy, pleuroscopy &

endobronchial ultrasound

(EBUS)

All 1,2,3,4,5,8

1, 2, 4, 5 1,2,4 1 5 1

15.4.2 Pneumonia All 1,2,3,4,5,8 1, 2, 4 1 5 1

15.4.3 Asthma All 1,2,3,4,5,8 1, 2, 4 1 5 1

15.4.4 Chronic Obstructive Pulmonary

Disease

All 1,2,3,4,5,8

1, 2, 4 1 5 1

15.4.5 Respiratory failure / Acute

Respiratory Distress Syndrome

All 1,2,3,4,5,8

1, 2, 4 1 5 1

15.4.6 Bronchiectasis All 1,2,3,4,5,8 1, 2, 4 1 5 1

15.4.7 Pulmonary Fibrosis / Interstitial

Lung Disease

All 1,2,3,4,5,8

1, 2, 4 1 5 1

15.4.8 Neuromuscular Diseases All 1,2,3,4,5,8 1, 2, 4 1 5 1

15.4.9 Pleural Diseases including All 1,2,3,4,5,8 1, 2, 4 1 5 1


Tumour, Spontaneous

Pneumothorax, Pleural Effusion

and Pleural emphysema

15.4.10 Lung Cancer All 1,2,3,4,5,8 1, 2, 4 1 5 1

15.4.11 Pulmonary Tuberculosis,

Multidrug Resistant

Tuberculosis, Extensive Drug

Resistant Tuberculosis, Latent

Tuberculosis & Extra-pulmonary

Tuberculosis

All 1,2,3,4,5,8

1, 2, 4 1 5 1

15.4.12 Novel Viral Infection e.g.

Avian Influenza, Mers CoV

All 1,2,3,4,5,8

1, 2, 4 1 5 1

15.4.13 Critical Respiratory Conditions

Receiving Oxygen Therapy

All 1,2,3,4,5,8

1, 2, 4 1 5 1

15.4.14 Critical Respiratory Conditions

with Non-Invasive ventilation

(NIV) or invasive mechanical

ventilation (IMV)

All 1,2,3,4,5,8

1, 2, 4 1 5 1

15.4.15 Tracheostomy All 1,2,3,4,5,8 1, 2, 4 1 5 1

15.4.16 Chest Drain, Pigtail Drain &

Indwelling Pleural Catheter (IPC)

All 1,2,3,4,5,8

1, 2, 4 1 5 1

15.4.17 Sleep Breathing Problem All 1,2,3,4,5,8 1, 2, 4 1 5 1

15.5 Pulmonary Rehabilitation Program All All 1,2,3,4,5 1, 2, 4 2 1

15.6 Health Education to patient Receiving:

1. Inhaled Medications All 1,2,3,4,5,8 1,2,3,4,5 1, 2, 4 1 5 1

2. Home Oxygen Therapy All 1,2,3,4,5,8 1,2,3,4,5 1, 2, 4 1 5 1

3. Home Non-invasive Ventilation

including BiPAP & CPAP

All 1,2,3,4,5,8 1,2,3,4,5 1, 2, 4 1 5 1

4. Home Invasive Ventilation All 1,2,3,4,5,8 1,2,3,4,5 1, 2, 4 1 5 1

5. Outpatient Parental Antibiotic All 1,2,3,4,5,8 1,2,3,4,5 1, 2, 4

6. Chronic Disease

Self-Management, Exacerbation

Management and Patient

empowerment

All 1,2,3,4,5,8

All 1, 2, 4 1 5 1

15.7 Nurse Led Clinic All All 5,6 1,2,3,4,5,6 2,5 2,3 1

15.8 Develop Smoke Cessation Program All 1,2,3,4,5,8

All 1, 2, 4 1 5 1

15.9 Patient Advocacy and End of Life

care

All 1,2,3,4,5,8 1 3 1,4 2,5,9 1

15.10 Facilitate change and adopt 1,2,3,5 2,3,7 3,4,5,9,10


evidence based practice in nursing

care

15.11 Develop and foster patient safe

environment and initiate

improvement strategies in quality

and risk management

3 2,3,4,8 3,4 1,2,3,

4,5,6

1,2,3,7

4,5,6,7,9

10,11

12,13

1,2

Documents

Hong Kong College of Medical Nursing Advanced Practice Nursing · PDF fileAdvanced Practice Nursing (Medicine) Certification Program Fellow Membership Examination (Sub-Specialty Module