1. Importance of maintaining fitness to practice.
When someone is ‘fit to practise’, it means that they have the skills, knowledge, character and health to practice their profession safely and effectively. Within the Health and Care Professions Council standards of proficiency, 2014, section 3 states ‘be able to maintain fitness to practice’ and gives guidance to registrants and to students who wish to become registrants to attain this. This guidance is broken down into 5 main components, which if adhered to will help maintain fitness to practice through a professional approach to gaining knowledge and skills development. Each registrant should understand that high standards of personal and professional conduct must be maintained. A good character will lead to being more self-aware and Paramedics must be honest and trustworthy, this is based on an individual’s conduct, behavior and attitude. We should understand the importance of maintaining our own health, this would mean that a person must be capable of safe and effective practice without supervision. We need to understand that both keeping skills and knowledge up to date is an important part of career-long learning, also being able to maintain a high standard of professional effectiveness at all times by using different strategies for self care including psychological and physical self care, by engaging with regular occupational health appointments, to be critically self-aware, by talking about difficult situations rather than bottling feelings and emotions to the point of where it may effect our practice, this may also effect our ability to maintain a safe working environment. The HCPC (2014), Standards of proficiency for Paramedics states that we must accept our own failings and that we must recognise the need to engage in critical incident debriefing, reflection and review to ensure that lessons are addressed for future patient safety and management by having a duty of candor.
When a concern is raised by a member of the public, colleague or patient then the Health and Care Professions Council will gather information about a registrant and they will take into account of whether the standards have been met, when they decide whether they would need to take any action to protect the public, HCPC, (2016). The rest of this document it is laid out as per and reflects the template issued by the Health and Care Professions Council, (2012b), which is encouraged to be used when a registrant is audited for their Continued Professional Development.
2. Summary of recent work / practice.
I am currently employed as a full-time Student paramedic by a large ambulance service and work in large towns, major cities as well as remote rural areas within the United Kingdom. I have been a Student paramedic for 19 months and have daily contact with the public, carer’s, other health care professionals in community and major hospitals as well as other emergency services. Majority of my time is spent working with other paramedics and my allocated mentor. In line with my trusts policies and procedures set out below are some elements of my job description, NEAS NHS trust, (2012), this summarise my professional responsibility, HCPC (2017):
• To treat and transport emergency and urgent cases in accordance with paramedic manual, JRCALC guidelines and Trust protocols.
• To comply with all road safety regulations exercising the safe use of road traffic exemptions in emergency driving.
• Undertake emergency-driving duties on all types of vehicles operated by the Trust, if appropriately qualified and licensed.
• Maintain a high professional image at all times.
• To provide assessment of patients, planning and implementing their care and treatment.
• To continually evaluate and give advice to patients and others. This will include the Handling Prescribing and administering, non–prescription, prescription and controlled drugs.
• Invasive procedures where appropriately trained and competent
• Surgical procedures where appropriately trained and competent
• Cardiac interventions such as advanced electrocardiogram recognition
• Stroke diagnosis and the use of FAST test pathways for treatment and referral.
• Determining which appropriate receiving hospital will be best for the patient and the initiation of treatment in association with other health, mental and social care professionals in cases where transport to hospital is not required.
• To observe safe practices as written within the Trust’s policies, procedures and Trust instructions. NEAS NHS trust, (2012).
• Co-operate with other emergency services as required.
• To comply with the standards of conduct, performance and ethics as stipulated by the Health and Care Professions Council.
• Supply statements and attend legal proceedings as required.
• To attend major incident exercises as directed by the Managers of the Trust.
• Administer appropriate drugs as designated by the trust’s Clinical Advisory Group for use by Registered & Student Paramedics.
• Keep clear, accurate and legible records, reporting the relevant clinical findings, the decisions made, the information given and any drugs or treatment.
• Record where there are exceptions to, or deviations from, standard practice and the reasons for doing so.
• All records must be made at the same time as the events being recorded, or as soon as possible afterwards, using appropriate documentation.
• Records must be clear, coherent, comprehensive, factually correct and must maintain confidentiality.
• To recognise and report any concerns regarding Child Protection issues.
• To recognise and report any concerns regarding Vulnerable Adult issues to include social care and mental health. NEAS NHS trust, (2012)
3. Personal statement
Below I have outlined below how my portfolio and activities have ensured that I have consistently met each of the Health and Care Professions Council standards for CPD. HCPC, (2017, 2012b).
Standard 1:
‘A registrant must maintain a continuous, up-to-date and accurate record of their continuing professional development activity’, HCPC, (2017, p.7).
My continuing professional development activities over the previous 19 months have been collated and recorded in the form of a continuing professional development activities portfolio as required to meet standard one. There is a matrix that shows how each activity from the five types set by the Health and Care Professions Council (work based learning, professional activity, formal/educational, self-directed learning and others) contributes to the HCPC standards of proficiency (Evidence 1 – Matrix). HCPC (2017, p.5). Within this portfolio I have also demonstrated how each continuing professional development activities contribute to the quality of care that I provide and the benefits each patient gains through written pieces of work including reviews and reflections.
Standard 2:
‘A registrant must identify that their continuing professional development activities are a mixture of learning activities relevant to current and future practice’, HCPC, (2017, p.7).
The Matrix (Evidence 1) shows how my CPD activities are a mixture of learning from each of the five types set by the Health and Care Professions Council, work based learning, professional activity, formal/educational, self-directed learning and other, HCPC (2017, p.20) Each year I undertake a personal development appraisal with my employer and I have also engaged in monthly and quarterly progress reports with my mentor (Evidence 2,3). I have carried out reflection on non-clinical and clinical events. I have found this has encouraged me to identify a variety of personal points I can work on in the short and long term (Evidence 4). One example of a self-reflection was focused on the mental health act and capacity. My contribution to this type of discussion in the past would have been to agree with the majority amongst my peer group, but as an emergency service we are ill equip to deal with some of the complex situations we are provided with. However on reflection and following the attendance of the social module (Evidence 5) and the subsequent discussion, I have learnt that there are more services and available to staff that are not widely known and these vary from area to area within the country. Subsequently I now have a greater willingness to seek out other forms of mental health help from other non emergency services providers and be aware of what is available to me in the areas I operate in.
Standard 3:
‘A registrant must seek to ensure that there continuing professional development has contributed to the quality of their practice and service delivery’, HCPC, (2017, p.8).
I believe that my continuing professional development activities have contributed to improving the quality of the service I deliver. There are four examples that demonstrate how my continuing professional development has enhanced the quality of my service delivery. Firstly a road traffic collision reflection (Evidence 6). Secondly, I feel the time spent attending the trauma module (Evidence 7), third is my accident and emergency practice placements (Evidence 8) and lastly the written assignment I subsequently produced has helped towards the quality of my practice in the following areas:
• The ability to command and control a scene.
• Implementing clinical guidelines as used by the trust.
• Employing normal and alternative extraction techniques acquired.
• Making the patient as comfortable as I possibly can.
• Employing current and up to date information gained.
• I should always act in the patient’s best interest and to ensure improvement in their condition or to prevent deterioration at all times.
Standard 4:
‘ A registrant must seek to ensure that their continuing professional development benefits the service user’, HCPC, (2017, p.8).
All of my continuing professional development directly or indirectly benefits the service user i.e. the patient, HCPC, (2017, p.8). There is learning achieved from all aspects of my continuing professional development activities, this will have an impact on my ability as I move through my career, hopefully resulting in a more effective and efficient clinical practice. The patient is the one that receives the adjustment of this practice they will benefit from my continuing professional development. The following are examples of how my continuing professional development activities benefit the patient.
Paramedic core clinical skills, (Evidence 9). This module covered intraosseous cannulation, a technique I have carried out on a regular basis whilst deployed within the military and also one that I have not practiced for a while. The practical sessions reminded and revised my current knowledge, which gave me more confidence with this procedure, which will benefit the patient. Coronary care unit placement, (Evidence 10). Will influence my practice greatly now that I have an understanding of emergency cardiac events such as Non ST & ST elevated myocardial infarctions, various bundle branch blocks. There are specific criteria for the coronary care unit or the primary percutaneous coronary intervention unit to accept patients and carry out highly specialized procedures and during my placement this was clarified. This will allow me to utilize the information learnt whilst on placement and to provide care in the emergency setting. Whilst on scene this should shorten the on scene time and allow for the patient to reach definitive specialist care sooner.
Advanced Life Support module, (evidence 11) and Resuscitation Council Guidelines (2015) review, (Evidence 12). I now feel that I can take on the new guidelines with confidence, with particular attention to an early shock and quality, uninterrupted chest compressions. Also, I am aware of the importance of the detrimental effects of hyperventilation in cardiac arrest. My actions will provide the patient with interventions based on current best evidence based practice, (Soar, et al., 2015)
Trust yearly Statutory Mandatory Education and training 2018, (Evidence 13). During the Statutory Mandatory Education and training 2018 I had the opportunity to remind, revise and refresh on a variation of skills and knowledge on both clinical subjects and non-clinical subjects. It is therefore very important that as a HCPC Clinician we must try and assimilate a wide and varied knowledge base. The following is a broad stroke of what I have covered during this period:
• IOR & MTFA: How to deal with these situations to remain safe and keep crews safe.
• PREVENT: How to identify and how to raise concerns
• Limb Assessments: How to correctly assess suspected breaks and how to identify correct pathways.
• Pelvic splint: Remind and revise in the application and use.
• Pediatric illness: Introduction and use of the pediatric big 6-screening tool.
• During the workshop I have learnt a variation of skills that can enhance the patients experience through out my delivery of care to them.
• During this workshop the patient centred care element was especially useful which enforced the principles and methodology of the patient centred care ensuring that the understanding and use of active participation can reduce boundaries and how our own authority can be beneficial. The discussions around patient centred care was informative by seeing others points of view of this subject.
• The duty of care element reinforced previous learning and served as a good remind and refresh that as well as patient wellbeing that we have our own wellbeing to consider as well as our colleagues.
Incident Reflections, (Evidence 14). Reflective practice as Boud, et al. (1985) said, “Reflection is an important human activity in which people recapture their experience, think about it, mull it over and evaluate it. It is this working with experience that is important in learning.” This is a process that we use in everyday life most of the time without realizing it we stop and think about what we are doing, consciously analyze our decision making and draw on theory and relate it to what we do or will do in the future. There are numerous models of reflection which include, Schön (1991), Johns (2000) model for structured reflection, The most popular form of reflective writing Gibbs (1998) reflective cycle, this is what I have used in most of my reflections. Once I have reflected I try and obtain evidence too see how effective my actions were and if I would act in the same manner next time. By the use of reflective practice over a period of time as a paramedic I believe I can write reflectively and value reflection on my practice. Veterans care bundles (Evidence 15). After attending this short course which focused not just on Veterans but also their families, an area which I have had very little formal training in but have been around it for a number of years. I looked at what was and is available to veterans and there families and how it can differ from area to area. This course has given me tools to deal with a variety of different people and to understand them it is not just the veterans that are affected but also the whole family life. This has also helped me towards my own practice and will also benefit the people experiencing mental health problems due to there military / uniformed service and whilst they transition into civilian life that I come across personally and professionally.
Paramedic PRM, (Evidence 16). This course has reminded, revised and honed some of the complex situations that I may come across as a paramedic, and has reiterated the need for personalised care pathways.
Standard 5:
‘A registrant must, upon request, present a written profile (which must be their own work and supported by evidence) explaining how they have met the Standards for CPD’. HCPC (2017)
To attain the last standard for continuing professional development and audit I have written the above profile. This profile is only done when asked for by the Health and care professions council as part of there own random audit. We as a profession need to take part in the audit to ensure that our profession is open, honest and also to ensure that we are keeping up to date to achieve the best we can for the service users
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