Hong Kong College of Medical Nursing

Advanced Practice Nursing (Medicine) Certification Program

Membership Examination (Core Module)

Clinical Log Book

Endorsed on 8 May 2016

Amended on 4 July 2016

Name of Associate Member

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Advanced Practice Nursing (Medicine) Certification Program

Membership Examination (Core Module)

Clinical Log Book

Table of Contents :

1. GENERAL INSTRUCTION FOR ASSOCIATE MEMBER ................................................................... 2

2. THE PURPOSE OF THE LOG BOOK .............................................................................................. 2

3. RESPONSIBILITY OF THE ASSOCIATE MEMBER ....................................................................... 2-3

4. RESPONSIBILITIES OF THE MENTOR .......................................................................................... 3

5. PERSONAL DATA OF THE ASSOCIATE MEMBER ......................................................................... 3

6. RECORD OF EXPERIENCE. ..................................................................................................... 4-10

7. CLINICAL LOG SHEET ............................................................................................................... 11

8. EVALUATION FORM ............................................................................................................... 12

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1. General Instructions for Associate Member

The Associate Member 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 Associate Member in reflecting the learning opportunities in clinical practices

required by the Certification Program

2.2 To facilitate the Mentor to assess the clinical competence of the Associate Member and

provide support and guidance to accomplish the Certification Program

3. Responsibilities of the Associate Member

3.1 Each Associate Member, upon enrollment, will be issued with the Clinical Log Book at the

commencement of Advanced Practice Nursing (Medicine) Certification Program training.

The Clinical Log Book is the property of the Associate Member.

3.2 The Associate Member should record the followings:

All supervised assessment on the patients

All supervised interventions on the patients

All special encounters with the patients/families

Case conferences/Nurses rounds/Research activity that facilitate change and adopt

evidence-based practice in nursing care

Participation in activities that lead to maintain safe patient environment and initiate

improvement strategies in quality and risk management

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

Associate Member.

3.3 The Associate Member 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 Associate Member should discuss his/her progress as documented in the Log Book with

his/her mentor at regular intervals. The signature of the Mentor is the evidence that the

Mentor is satisfied with the mentee performance.

3.5 The Associate Member should complete one Clinical Log Sheet every 3 months. This

dialogue serves as an opportunity for the Associate Member to reflect on the learning and

growth in the nursing profession. This regular assessment allows the Associate Member’s

deficiencies in experience to be remedied early in the course of the training.

3.6 The Associate Member should seek the Mentor’s endorsement of the Training Program

before s/he is qualified to sit for the Membership Examination of Advanced Practice

Nursing (Medicine) Certification Program.

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3.7 The Associate Member should complete at least 70% of the Log Book (fulfill the mandatory

items) before final assessment.

4. Responsibilities of the Mentor

4.1 The Mentor facilitates the Associate Member to map learning opportunities in the clinical

practices to the competence framework.

4.2 The Mentor has the responsibility to guide the Associate Member 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 Associate Member to identify opportunities to develop the

leadership abilities to lead the team.

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

encourage him/her to present cases and papers.

4.5 The Mentor is to encourage the Associate Member to be active team player in clinical

rounds.

4.6 The Mentor should not take more than three Associate Members 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 Associate Member to prepare for the

Training Program.

5. Personal Data of the Associate Member

Associate Member Name Sex

Chinese Name

Associate Member Registration Number

Date of Entry into the Training Program

Address

Email Telephone

Mentor Name Title

Institution/Department/Unit

Supervising Period

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6. Record of Experience

Mandatory

Item Module Date Patient initials &

brief particulars

Mentor’s

sign

Remarks

6.1 Essential Module

6.1.1

Interpretation of

laboratory data

(5 scenarios)

6.1.2

Interpretation of

radiological findings

(5 scenarios)

6.1.3

Electro-diagnostic

examinations

(5 scenarios)

6.1.4

Management of

patients with common

acute medical

conditions (5 scenarios)

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Item Module Date Patient initials &

brief particulars

Mentor’s

sign

Remarks

6.1.5 Ambulatory medical

care and community

service: (not less than 1

scenario each)

6.2 Health Assessment

Module

6.2.1

Patient assessment

skills ( 10 scenarios )

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Item Module Date Patient initials &

brief particulars

Mentor’s

sign

Remarks

6.2.2

Symptomatic based

assessment and

assessment tools ( not

less than 3 scenarios)

6.2.3

Focus assessment for

patients with common

acute medical

conditions (not less

than 3 scenarios but

not the same)

Date Patient initials &

brief particulars

Mentor’s

sign

Remarks

6.2.4 Screening of patients

according to update

government supported

programs like dementia

screening; colorectal

screening (not less than

3 scenarios but not the

same)

6.3 Nursing Care Module

6.3.1

Establishment of patient

centered care therapeutic

relationship

(5 scenarios)

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Item Module Date Patient initials &

brief particulars

Mentor’s

sign

Remarks

6.3.2 Management of patients

with complex medical

conditions

6.3.2.1

Management of patients

with cardio pathological

conditions (5 scenarios)

6.3.2.2

Management of patients

with respiratory

pathological conditions (5

scenarios)

6.3.2.3

Management of patients

with critical respiratory

conditions required

non-invasive ventilations

(NIV) or invasive

mechanical ventilations

(not less than 2 scenarios)

6.3.2.4

Management of patients

with respiratory

complications with chest

drain or pigtail drain ( not

less than 2 scenarios )

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Item Module Date Patient initials &

brief particulars

Mentor’s

sign

Remarks

6.3.2.5

Management of patients

with acute kidney

shutdown requires renal

replacement therapy (not

less than 2 scenarios)

6.3.2.6

Management of patients

with emergency condition

with hypoglycemia or

diabetic ketoacidosis ( not

less than 2 scenarios)

6.3.2.7

Management of patients

with epilepsy (not less

than 2 scenarios)

6.3.2.8

Management of patients

with central venous

catheter (not less than 2

scenarios)

6.3.2.9

Screening and

management of patients

with infectious disease

such as MDRA, CRE, VRE,

MERS, TB, HIV, H1N1...

(not less than 5

scenarios)

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Item Module Date Patient initials &

brief particulars

Mentor’s

sign

Remarks

6.3.2.10

Management of patients

receiving blood products

transfusion (not less

than 2 scenarios)

6.3.2.11 Management of patients

with common liver

diseases – hepatitis and

complications of liver

cirrhosis; gastrointestinal

bleed, functional

gastroesophageal disease;

crohn’s disease (not less

than 4 scenarios and not

of the same

disease/condition )

6.3.2.12

Management of patients

with nutritional problems

( not less than 2

scenarios)

6.3.2.13

Management of patients

with Grade 4 pressure

ulcer ( not less than 2

scenarios )

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Item Module Date Patient initials &

brief particulars

Mentor’s

sign

Remarks

6.3.2.14

Management of patients

with dementia (not less

than 2 scenarios)

6.3.2.15 Management of patients

receiving biological

therapy; chemotherapy;

radiotherapy and

management of

complications. ( not less

than 2 scenarios)

6.3.2.16 Management of patient’s

pre and post organ or

marrow transplant care.

(not less than 1 scenario)

6.4 Facilitate change and adopt evidence-based practice in nursing care (not less

than 1 activity to be recorded )

Date Description of the Activity Mentor’s Sign

6.5 Maintain patient safe environment and initiate improvement strategies in

quality and risk Management (not less than 2 activities to be recorded )

Date Description of the Activity Mentor’s Sign

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7. 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 that associate member has provided :

Observation only Primarily mentor managed Independent care

Client information

Name : Sex/age :

Economic background

Family relationship and support

Diagnosis and medication

Nursing intervention and/ or education provided

Reflection / Learning

Mentee signature : Date :

Mentor comment

Mentor signature/Date : Mentee signature/Date :

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8. Evaluation Form

Evaluation form to be completed by the Mentor for recommending to sit for Exit

Examination leading to award of HKCMN Ordinary Member (Medicine)

Name of mentee

Supervising period

EVALUATIOM

Subject areas Grading

Pass Needs

Improvement

Borderline

Fail

Fail

Basic clinical knowledge

Professional judgment

Meeting the domain of competence

Patient management

Nurse – patient relationship

Reliability /sense of responsibility

Leading CQI activities

Ability to work with other hospital staff

Demonstrate leadership abilities

Overall rating :

Recommendation

recommended as qualified and competent

not recommended

Additional comments (use additional sheet if necessary)

Name of mentor :

Signature /Date :

Fellow number :

endorsed

not endorsed

Chairman of Examination & Accreditation committee Signature /Date :