ROLE DEVELOPMENT PROGRAMME

Male Catheterisation

Supervised Practices & Competency Document

NAME (capital letters):

WARD/DEPARTMENT:

OKS

110

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November 2022
Version: E1.0.3
 Key For Assessed Levels Attained
Scale Label Level Quality of Performance and Assistance required
Unsafe
Unable to demonstrate behaviour or articulate
Dependent 1 intention
Lacking in confidence, coordination and efficiency
Required continuous directive cues (verbal and
physical cues / interventions to correct the
performance)

Safe only with guidance (close supervision)

Uses excess energy and takes prolonged time period
Marginal 2 Incomplete achievement of intended outcome
(unskilled and inefficient)
Required continuous directive cues

Safe and knowledgeable most of the time

Skilful in parts
Assisted 3 Achieved most objectives for intended outcomes
Proficient throughout most of procedure however is
inefficient with some skill areas
Required frequent directive and supportive cues (to
reinforce or encourage performance)

Safe and knowledgeable

Efficient and coordinated
Achieved intended outcome within a reasonably
timely manner
Supervised 4 Reasonably Competent
Reasonably confident
Reasonably expedient
Required occasional supporting cues
Performance is appropriate to context

Safe and knowledgeable

Proficient and coordinated
Achieved intended outcome in a timely manner
Independent 5 Competent
(PRO – Proficient) Confident
Expedient
No supporting cues required
Performance is appropriate to context

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November 2022
Version: E1.0.3
 Record of Supervised Practices Male Catheterisation
(Minimum of 4 supervised practices)

FORMATIVE ASSESSMENTS (minimum of 3 – last one must be Level 5)

Identify assessed level Any Development areas Assessor’s Full Name & Job
Date Assessor’s signature
attained identified & discussed title (Print in Capital Letters)

SUMMATIVE ASSESSMENT (must be Level 5)

Identify assessed level Any Development areas Assessor’s Full Name & Job
Date Assessor’s signature
attained identified & discussed title (Print in Capital Letters)

The person signing the summative assessment must now sign the certificate as summative assessor on Page 4.

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November 2022
Version: E1.0.3
 Certificate of Completed Supervision
Male Catheterisation

(OKS 110)

Name: …………………………………… Ward/Dept: …………..…………………..

I can confirm that I have read all associated policies.

I have undertaken a minimum of 4 supervised practice assessments of competency

I feel confident to perform Male Catheterisation on patients without supervision.

Signature: ………………………………… Date….…/….…/...…

Summative Assessor’s signature: …………………………… Date….…/……/……

(Must be the same person who signed the summative assessment on page 3)

Summative Assessor’s NMC / GMC / HCPC No: ......................................................

(Please circle your regulatory body and write PIN number)

Please upload evidence of completion of the Record of Supervised Practices and

Certificate of Completed Supervision on Sherwood e-academy. This will be checked
within a week by PETTs.

If there are any inaccuracies the competency will be returned to you for resolution.
Please check your eAcademy for feedback.

If accurately completed and assessed by a member of staff whose competency is

recorded on the Trust system it will be signed by a member of the PET Team,
recorded on your personal training record, and returned to you via the Sherwood
eAcademy. Please do not practice independently until verification is complete.

PET Nurse Signature: …………………………… Stamp:

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November 2022
Version: E1.0.3