Portfolio Guidelines

Transcription

1 Assistant Practitioner Training Portfolio Guidelines Information for the External Examiner/ Supervising Podiatrist/ Assistant Practitioner The Assistant Practitioner will be eligible to be entered for the final assessment when they have undertaken thorough practical training and a minimum of 500 logged hours of work/ training/ observation and placement. The competencies in the training manual can then be completed. Candidates will not be entered for the final assessments until they have completed the competencies check list. There are four parts to the final assessment, one of which is the Portfolio of evidence. The Portfolio/ reflective log is to be completed throughout the training period. This will be submitted to the College and reviewed by the External Examiner, prior to the examination taking place. It is expected that the Supervisor will have reviewed the Portfolio prior to submission. The Portfolio should be submitted at least 3 weeks prior to the Examination. The Assistant Practitioner in training must keep a copy of the Portfolio and the Reflective Log in case the original is misplaced. The continuous self-assessment tasks and tutorials at the end of each section of the manual, will be completed and recorded by the Supervising Podiatrist and the Assistant Practitioner. 1 P a g e

2 During the period of instruction, these will be evidenced in the Exam Portfolio, the Reflective Learning Log and on the Continuous Assessment/ Competency sheets which should be dated and signed contemporaneously (section 18). The Portfolio will be reviewed by the appointed External Examiner prior to the Examination. Marks will be awarded on a scale of 1-5 as with the practical and viva (oral) assessments. These marks will be recorded on the Exam paperwork. On the Examination date, the Internal and External Examiners will discuss the Portfolio with the candidate (Assistant Practitioner). The Internal Examiner is not necessarily the Supervising Podiatrist (The Supervisor) but it usually is. There are various models of Reflective Practice which can be explored. The one that is commonly used in Healthcare and Education is Gibbs Model of Reflection (1998). Gibbs, G. (1998) Learning by Doing: A Guide to Teaching and Learning Methods. Further Education Unit, Oxford Brookes University, Oxford. 2 P a g e

3 The Professor Pod Guide to Portfolios Assistant Practitioners 1. Take an A4 Lever Arch File- Pimp the cover- make it yours! 2. Insert 20 file dividers- use different colours for different sections 3. Open the training manual at the contents section- label Portfolio sections Introduce yourself- with your CV, and a photo if you like 5. Insert evidence into the Portfolio- for each section of the training manual 6. Make sure the sections are evenly balanced- plenty of evidence in each section 7. Section 19: Competency sheets- filled in, signed off, dated- inserted in the Portfolio 8. Section 20: Appendix- include any relevant Trust policies and procedures! 9. Case Studies- try and put at least 10 case studies in your evidence 10. Reflective Journal-Tell us your stories using Gibbs Model- Keep it real! 3 P a g e

4 Reflection and Reflective Practice Reflection is a state of mind and an ongoing element of practice. As a reflective practitioner, you learn from experience about yourself, your work, significant others and wider society and culture. Gillie Bolton, in her book on reflective practice identifies that practitioners need to take responsibility for all their own actions and values and their share of responsibility for the political, social and cultural situations within which they live and work. She also identifies that reflective practice can fall in to the trap of becoming a confession and this should be discouraged, as it passes the responsibility to others. (Bolton, G Reflective Practice writing & professional development. 3 rd Edition. London: Sage) Joy Amulya, from the Centre for Reflective Community Practice ( defines and explains reflection very well: Reflection is an active process of witnessing one s own experience in order to take a closer look at it, sometimes to direct attention to it briefly, but often to explore it in greater depth. This can be done in the midst of an activity or as an activity in itself. The key to reflection is learning how to take perspective of one s own actions and experience in other words, to examine that experience rather than just living it. By developing the ability to explore and be curious about our own experience and actions, we suddenly open up the possibilities of purposeful learning derived not from books or experts, but from our work and our lives. This is the purpose of reflection: to allow the possibility of learning through experience, whether that is the experience of a meeting, a project, a disaster, a success, a relationship, or any other internal or external event, before, during or after it has occurred. There are various models of reflective practice that can be explored, however one that is used much in health care and education is outlined on the next page and will be used throughout the manual to guide you through the journey. 4 P a g e

5 Gibbs Model of Reflection (1988) Gibbs, G. (1988) Learning by Doing: A guide to teaching and learning methods. Further Education Unit, Oxford Brookes University, Oxford 5 P a g e

6 Reflection writing it down: Description: What Happened? Feelings: What were you thinking and feeling? Evaluation: What was good and bad about the experience? Analysis: What sense can you make of the situation? Conclusion: What else could you have done? Action Plan: If it arose again, what would you do? You may find it useful to copy this sheet and complete reflections at your leisure. Reflection must not focus on having a bad day, or having something happen which made you unhappy. It is a process of looking back on situations to make sure you have understood them 6 P a g e

7 Case Study Example 1 History/ Description 19 year old girl presented with Psoriasis diagnosed by GP, family history of Psoriasis. Patient has had 3 periods of kidney infection in the last 8 months and was admitted to hospital on all 3 occasions with severe pain in the abdomen and lower back with dark urine. Patient underwent test and it was confirmed to be a bacteria kidney infection. Patient developed red spots on back arms, stomach, and groin and feet which become larger, scaly and itchy approximately 1 month after kidney infection, she visited GP and it was confirmed that patient had developed psoriasis. Patient was referred to podiatry for educational information on how psoriasis may affect the feet and nails and possible further treatment if the condition develops. Psoriasis is a common skin condition that produces thick red plaques covered with silvery scales. The most common areas affected are the scalp, knees and lower back although any skin surface may be involved. It can occur in the nails and body folds. Psoriasis is not contagious and cannot be passed from person to person bit it can occur in members of the same family. Psoriasis usually begins in early adulthood which is the case with this patient or in later life. In most people the rash is limited to a few patches of skin in severe case it can cover larger areas of the body. The rash can heal and come back again throughout a person s life. Signs and Symptoms The signs of psoriasis vary depending on the type. Patient has plaque psoriasis according to the GPs diagnosis and this includes- Plaques of red inflamed skin often covered with loose silver coloured scales. These plaques may be itchy and painful and sometimes crack and bleed. Disorders of fingernails and toenails include discolouration and pitting of the nails. The nails may be also being to crumble or detach from the nail bed. Regular podiatry care would be needed to care for the nails, reduce the risk of infection and to monitor treatment methods. Psoriasis can also be associated with psoriatic arthritis which can cause pain and swelling in the joints. The Psoriasis Association estimates that between 5% and 7% of people with psoriasis have psoriatic arthritis although there are now signs of the patient having developed this is could be a possibility in the future. Psoriasis is a condition which runs in families but the exact way in which the disease moves from generation to generation has not yet been established. People who have family members with psoriasis are more at risk especially is they are exposed to stress, alcoholism, infection, medical treatment or stressful events such as divorce. In the patients case the psoriasis may have been triggered by infections due to the genetic predisposition. Treatment No further treatment is required at present. Patient continues with topical corticosteroid cream prescribed by GP. Information given to patient on possible podiatrist issues that may develops but at present no further treatment is necessary. 7 P a g e

8 Case Study Example 2 History/ Description Male 16 year old present at the clinic with ingrown toenail right hallux lateral border. Patient had pulled a piece of this nail off because it had splintered resulting in the nail becoming ingrown and sulci, becoming inflamed and red. Patient is on no medication. An ingrown toenail also called Onychocryptosis in medical terms can affect both men and woman. They are common in teenagers and older people. During teenage years the feet tend to sweat more. This can cause the skin around the toenail to soften and split resulting in an ingrown toenail which is most likely the case in this patient. An ingrown toenail develops when the sides of the toenail grow into the surrounding skin. The nail curls and pierces the skin which becomes red, swollen and tender. The toe can also feel painful when pressure is placed on it. The hallux is most likely to be affected either on one of both sides, in this case it is one side. Other symptoms may include a build-up of fluid in the area surrounding the toe, white or yellow coloured pus coming from affected area, bleeding and infection. Severe symptoms may include an overgrowth of skin around the affected toe (hypertrophy) Signs and Symptoms There are several different things that can cause an ingrown toenail to develop. These include incorrectly cut toenails. Cutting your toenails too short or cutting the edges will encourage the surrounding skin to fold over your nail and the nail to grow into the skin. Tight fitting shoes, socks or tights places pressure on the skin around your toenail if the skin is pressed into the toenail it may be pierced. Tight fitting footwear can also cause your toenail to sure inwards towards your skin resulting in an ingrown toenail. Other causes may include sweating or poor foot hygiene, injury or the natural shape of your toenail. Always insure you change your socks every day and never rip off splinters in your toenails as this can leave sharp edges which can pierce the surrounding area. Treatment Patient has mild symptoms in this case nail surgery may not be required however referral to a Podiatrist is needed to assess. Patient given some information on what to do to prevent it getting any worse and to practice good foot hygiene by taking care of their feet, washing them regularly using soap and after, trimming the nail straight across to help prevent it continuing to dig into the surrounding skin and never rip off the nail. Wear comfortable shoes not too tight and provide space around your toes. Painkillers such as paracetamol may be used if patient is feeling any discomfort. If symptoms worsen or Podiatrist requires patient to have nail surgery then part of the nail will be removed under local anaesthetic which is injected into the base of the toe. The edge of the nail will be cut away to make the toenail narrower and give the nail a straight edge. This makes it less likely to dig into the surrounding skin. After the edges of the toenail are cut a chemical called Phenol will be applied to the affected area. This prevents the nail growing back and stops the ingrown toenail from developing in the future. If the nail is infected then a course of antibiotics may be prescribed. 8 P a g e

9 Case Study Example 3 History/ Description 34 Year old male born with transposition of the Great Vessels (congenital) a heart defect involving the two major vessels that carry blood away from the heart, the aorta and the pulmonary artery are switched (transposed). Patient developed medical conditions like Pulmonary Hypertension, Secondary Polycythaemia and Congenital Aortic Valve Stenosis and was treated from 1998 and 2010 when he received a heart and lung transplant. The cause of most congenital heart defects is unknown. However factors in the mother that may increase the risk of this condition are being aged 40 or over, diabetes, poor nutrition during pregnancy and Rubella or other illness during pregnancy. Signs and Symptoms A Heart and Lung Transplant is a complex operation and the risks of complications are related to the operation itself. Others are a result of taking immunosuppressive medication to prevent the body rejecting the new heart and lungs. Other risks include failure of the transplanted lungs and heart, infection, narrowing of the arteries connected to the new heart. Rejection is one of the most common complications in that the immune system, the body s defence against infection, mistakes the transplant as a foreign body and begins to attack it. Infection for people who have received a transplant is higher than average for a number of reason including, immunosuppressant s weakening the immune system, minor infection is more likely to progress to a major infection and surgery can damage the lymphatic system. Kidney disease is a common long term complication. Diabetes can develops specifically type 2 which is treated using a combination of lifestyle changes, medication such as metformin or injections of insulin. High blood pressure can develop due to side effects of immunosuppressant s or as a complication of kidney disease. Osteoporosis usually arises as a side effect again because of the immunosuppressant s use. Vitamin D supplements and a type of medication known as a bisphosphonates which help maintain bone density are given. Podiatric Complications Patient present for an annual assessment as a Podiatry Clinic, he had developed type 2 diabetes, high blood pressure and had chronic kidney disease stage 3 due to transplant. Podiatric complications than can occur in diabetes are diabetes neuropathy motor sensory and autonomic. Nerve damage can occur due to high blood glucose. Sensory, motor and autonomic tests are performed to assess the level of risk in developing complications in the feet. People with diabetes can develop ulcers as sensation may be reduced this could present as a problem as the patient may heal slower and is at greater risk of infection. Annual assessments are carried out to reduce this risk. Diabetes can also affect the kidneys and as patient has chronic kidney disease this is also recorded and monitored. Patient has a known heart condition complications where circulation may be a factor. Patient has 3 risk factors associated with the development of atherosclerosis, diabetes, hypertension and a (cont d) 9 P a g e

10 history of heart/ peripheral vascular disease. Patient is assessed for intermittent claudication, rest pain, numbness of the extremities, feeling of coldness in the legs and feet, changes in colour of the lower limb, hair loss, atrophy of the skin, onychauxis of the toenails. Painful ulcers, gangrene and weakness or absent arterial pulses this is an important process to prevent the loss of toes, foot or limbs and is a great indication of problems developing. Treatment Patient had a good sensation, vibration and pulses were present. Patient was considered as low risk and presented no podiatric problems to date. Annual assessment will be carried out to monitor any changes. Patient advised on checking feet regularly and informed of problems that could develop. The patient is to contact if there are any problems before next visit. 10 P a g e