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This article explores the value of teaching clinical skills in pre-registration nurse education. It touches on stages of competence and the knowledge necessary to enable the learner to meet the standards of proficiency expected of registered nurses. Some contemporary issues around clinical skills teaching are discussed. How clinical skills can be taught and learnt as well as common problems encountered by learners and by educators are highlighted. This article also aims to stimulate discussion around the Nursing and Midwifery Council's new standards of proficiency for registered nurses. It discusses how learners will be prepared to undertake all nursing procedures outlined in these standards within a changing healthcare education landscape and an increasingly complex health and social care environment.

'MUST' is a five-step screening tool to identify adults, who are malnourished, at risk of malnutrition (undernutrition), or obese. It also includes management guidelines which can be used to develop a care plan. It is for use in hospitals, community and other care settings and can be used by all care workers. This guide contains: A flow chart showing the 5 steps to use for screening and management BMI chart Weight loss tables Alternative measurements when BMI cannot be obtained by measuring weight and height. Please refer to The 'MUST' Explanatory Booklet for more information when weight and height cannot be measured, and when screening patient groups in which extra care in interpretation is needed (e.g. those with fluid disturbances, plaster casts, amputations, critical illness and pregnant or lactating women). The booklet can also be used for training. See The 'MUST' Report for supporting evidence. Please note that 'MUST' has not been designed to detect deficiencies or excessive intakes of vitamins and minerals and is of use only in adults. The 5 'MUST' Steps Step 1 Measure height and weight to get a BMI score using chart provided. If unable to obtain height and weight, use the alternative procedures shown in this guide. Step 2 Note percentage unplanned weight loss and score using tables provided. Step 3 Establish acute disease effect and score. Step 4 Add scores from steps 1, 2 and 3 together to obtain overall risk of malnutrition. Step 5 Use management guidelines and/or local policy to develop care plan. Malnutrition Advisory Group A Standing Committee of BAPEN MAG MUST 'Malnutrition Universal Screening Tool' 'MUST' BAPEN is registered charity number 1023927 www.bapen.org.uk © BAPEN Step-BMI score (& BMI) Height (feet and inches) Weight (stones and pounds) Weight (kg) Height (m) Note : The black lines denote the exact cut off points (30,20 and 18.5 kg/m 2), figures on the chart have been rounded to the nearest whole number.

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