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WELCOME TO B1 0161 206 4602 Student Nurse: …...................…..
Year of study: Block: Start/End Date: Named mentor: Mentoring team
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Useful Information Practice Education Facilitator
Model of Nursing Care/Multi-disciplinary Team We implement the Roper, Logan and Tierney model of nursing care and we cater for nursing students and cadets. Where to Find Us: 1st Floor Irving building Parking: Students can park on Altram Metro link stop, they must collect a permit from the car park office as this is council run and staff parking in spaces and not displaying a permit could receive a fine from them. The cost is £13 per month with an initial £10 deposit for the permit, this is refundable once they return it to us on finishing their placement Purpose of this pack is: 1. to give an introduction to the placement area. 2. to give information on "what goes on" at the placement in terms of patient care 3. to give an introduction to what attitudes, skills and knowledge the student can learn. B1 Practice Education Link; Sister Leane Donoghue-Horrocks Staff nurse Pamela Mitchell Practice Education Facilitator Andrea Surtees, 2nd floor – Mayo building University Link Lecturer; Mark Mitchell
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Welcome.
We are a 25 bedded ward consisting of 3 bays and 4 side rooms. We specialise in gastro-surgical conditions yet also receive orthopaedic, urology and gynae patients. Each student will be allocated a named mentor within a team. Each member of staff is allocated to a team and regular feedback is given to the named mentor. This system facilitates continuity and aims to ensure your assessments are fair and valid with all team members being fully aware of the stage you are at within your training as well as knowing your strengths and areas for improvement. Students are expected to act in a professional manner and adhere to NMC code of professional conduct (and Trust policies) with upholding patient confidentiality at all times. Therefore please ensure you dispose of your handover sheet in the confidential bin located next to the crash trolley prior to leaving each shift. You should expect you mentor and team to be supportive and enhance your learning needs. Any problems PLEASE speak with your named mentor and/or the PEL. It is your responsibility to inform your named mentor when your assessments (both midpoint and final point) need to be completed by. This should be set out, and documented on off duty, at the beginning of you placement.
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Off Duty. Sickness: Shift Patterns:
Shifts are allocated according to your mentoring team’s rota, allowing for 40% of your time to be with your named mentor (though this is not always possible due to sickness, holidays, etc, hence team mentoring). You will be encouraged to work some weekends to be with your mentor (at least 2, no more than 4, in an 8 week placement) in order to fully understand and experience the full range of care given. We understand due to family commitments/study you may need to alter your of duty. If his is the case please speak to your mentor / PEL – if not available speak to the nurse in charge of the shift. Student off duty is kept in the student nurse off duty (pink folder) which is kept in the ward office. Sickness: Please contact the ward ( ) as soon as you are aware you are going to be off sick, and when you are going to return. Please also remember to contact university, as a close relationship between the unit and university exists and all episodes of sickness are reported weekly. Shift Patterns: Early (E) Late (L) Long Day (LD) Night Duty Breaks: short shift = 30 mins, long day/night shift = 2 x 30 mins
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Health & Safety Needle stick Injuries Infection
Manual Handling Ensure mandatory training is up to date and you are able to provide evidence to your mentor. Action to be taken on discovery or suspicion of a fire. Raise the alarm! Break glass and ring 2222 giving exact location of fire: B1 1st floor Irving building. . Infection Control It is everyone’s responsibilities to uphold high standards of practice as regards infection control. Please wash your hands on entering and leaving the unit, and stop any person not doing so. Needle stick Injuries During working hours mon-fri 8-4 contact and select option 1 to be assessed. If out of hours but low risk contact this number the next working day. If out of hours and high risk please attend A&E Personal Items Label any food & drink products before putting in the fridge. Lockers are available at cost of £1 (or trolley token) which is refunded when finished with . Code of Conduct Always work within own limitations. Do NOT perform any procedures or use equipment you are not trained to do/use. Wear correct uniform and act responsibly and professionally in line with NMC. Avoid mobile phones on the unit
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Ward B1 Philosophy The ward aims to provide a SAFE, CLEAN AND PERSONAL service to patient care delivered in an individual and appropriate way. We actively believe in patient choice and work in partnership with the patient involving family members and carers to be able to provide and support individual needs. In order for us to provide individual needs we aim to provide a holistic approach to patient care doing this in a dignified and respectable manner. We believe in order to provide a quality service open communication is a necessity between a broad multi-disciplinary team to be able to provide seamless care. The staff caring for patients on B1 foster the SRFT values built up of PATIENT & CUSTOMER FOCUS, CONTINUOUS IMPROVEMENT, ACCOUNTABILITY and RESPECT that helps guide them to provide excellent service in a professional manner whilst working within the environment of the ward and the trust as a whole. We hope you will enjoy your placement with us and gain valuable skills, knowledge and experience.
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Meet the Team Leane Donoghue-Horrocks Elizabeth Woodhouse
BAND 7 Nichola McKeown LEAD NURSE Joanne Hughes MATRON Rebecca Gleave-Leary BAND 6s Leane Donoghue-Horrocks Elizabeth Woodhouse BAND 5s Katharine Roberts Charlotte Pedder Rachel Jowett Ashleigh McKenzie Lydia Nheta Valentina Tarquinio Tracey Clements Dora Asare Mairead Burke Pamela Mitchell Karen Francis-Walker Joanna Mataya Siby Thomas Preethi George Precious Tshabangu efe Cont…….
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Selina Clarke Joanne Edwards Debra Dunsmore Janine McMahon
……. Cont BAND 2s Selina Clarke Joanne Edwards Debra Dunsmore Janine McMahon Bernadette Loughrey Victoria Newbury Priscilla Cox BAND 4s BAND 3s Heather Tonge Niah Hanknson WARD CLERK Glynnis Cooke DOMESTIC HOUSEKEEPER Wendy Plaister PHARMACIST CONSULTANTS Miss Melhado Mr Goscimski Mr Slade Mr Lees Mr Senapati Mr Chaparala Mr Watson Miss Mason
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Mentoring Arrangements
We aim to ensure you fulfil your learning outcomes and gain much more as well. You will be allocated a named mentor within a mentoring team to assist your learning and development. Your mentors are thereto provide guidance and support. They will help you bridge the gap between the classroom and ward, help you to identify areas that require development and therefore assist you to achieve your goals. Hopefully you will find that your mentor-student relationship is a beneficial and amicable one. If you should encounter any difficulties with your mentor, the ward manager or another senior member of staff are always available for consultation. We look forward to having you on the ward. Learning is a two-way experience. We gain greatly from the input you bring to us, and hope this is reciprocated. We aim for you to work with your mentor or mentoring team on as many occasions as possible; if this is not always achievable another team member will temporarily mentor you. If you have specific off duty requests please contact us as soon as possible so that we can try to accommodate them. Please be aware that your off duty is based around your mentor. Requests that mean you will work less than 12 hours per week with your mentor will not be granted unless there are extenuating circumstances. Your mentor will arrange a time, during your first week to go through the ward paperwork, policies and your learning outcomes. To maximise the student learning environment on B1 we adopt a team mentoring approach. The student will be allocated a mentor who will be responsible for all their paperwork, meetings, learning needs and any problems they may have. At the same time a team of none mentor nurses will be allocated to work with the student when the student’s mentor for whatever reason cannot work with them. The mentoring team will feed back to the named mentor with the student’s progress and any problems encountered. This should provide a good flow of information between all parties
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Mentoring teams Team 1 Team 2 Team 3
Sister Leane Donoghue-Horrocks (Registered mentor & PEL) Staff nurse Karen Francis-Walker (Registered mentor) Staff nurse Katharine Roberts Staff nurse Lydia Nheta Staff Nurse Mairead Burke Health care assistant Heather Tonge Clinical support worker Bernadette Loughrey Clinical support worker Priscilla Cox Team 2 Sister Elizabeth Woodhouse (Registered mentor) Staff nurse Joanna Mataya (Registered mentor) Staff nurse Rachel Jowett Staff nurse Valentina Tarquinio Staff nurse Siby Thomas Clinical support worker Victoria Newbury Clinical support worker Joanne Edwards Clinical support worker Selina Clarke Team 3 Staff nurse Pamela Mitchell (Registered mentor & PEL) Staff nurse Ashleigh McKenzie (Registered mentor) Staff nurse Charlotte Pedder (Registered mentor) Staff nurse Preethi George Staff nurse Precious Tshabangu Clinical support worker Janine McMahon Clinical support worker Debra Dunsmore
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Nurse Link Roles Our nurse link roles are currently under review; please refer to any updates in the ward clerks office
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What’s Expected From You? Punctual Interested Get “stuck in” Hard working Caring Honest Willingness to learn Ask questions Professional Patient Polite Responsible Organised Reliable Adaptable To bring with you, daily, all university documentation in order to be seen as and when required. Complete learning outcomes/expectations for hub and spoke placements. Inform your mentor/ PEL / nurse in charge of any problems or concerns immediately. Complete evaluation forms at the end of your placement to improve the learning environment for future students.
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What Can You Expect From Us?
To be welcomed onto the ward and accepted as a team member for the duration of your placement. To be allocated a named mentor/assessor prior to commencing on the ward, and also mentoring team to work with when unable to work alongside your mentor. Time allocated for initial meeting/orientation and plans for mid-point and final interviews. For all staff members to assist you in achieving your learning outcomes and develop your knowledge and skills. Opportunities to take part in all aspects of nursing are. Opportunity to be involved in MDT meetings and ward-rounds. A variety of learning environments in the form of spoke placements.
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Learning Opportunities
Basic nursing – hygiene, nutrition, bed making Year 1 Manual observations. MDT working. Hand hygiene Catheter care. Observing medication round. Stoma care There are a variety of learning opportunities, and numerous care pathways to follow. Year 2 As per year one plus; Accurate Fluid management. ANTT. Catheter care. Taking part in medication round. Taking part in ward rounds. .Wound care Year 3 As per 2nd year plus; Preparation IV medications. Medication administration. Admission and safe discharge of patients. Own caseload of patients to care for. Handover of care. Co-ordination of shifts.
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Possible Spoke Placements
Eras nurses Endoscopy Diabetes Nurse Colorectal specialist nurse Theatre Tissue viability Stoma Specialist Nurses IFU (H8) Dietitian Upper GI nurses SHDU Nutrition nurse Pharmacy Team It is the responsibility of the student to organise spoke placements (mentors will assist if needed), however, it MUST be written on the off duty where the student is and the named staff member you are working with along with a piece of reflective writing for the next shift.
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Learning Opportunities for Spoke Placements
Colorectal specialist nurse 61249 Stoma care specialist nurse 60204 ERAS specialist nurse 3443 Upper GI/Bariatric specialist nurse 65062 Tissue viability specialist nurse 62113 Pain team Surgical HDU 67892 / 60186 Nutrition specialist nurse 60281 / 61437 Endoscopy 64720 IV nurse 67018 Theatre recovery 65387 / / 65073 IFU (H8) 64520 Dietitian 64255
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Daily routine “Good morning’s”.
Intentional roundings, fluid charts updated Bed making and house keeping. Clinical Observations. Medication administration, including Intravenous. Assistance with hygiene needs (basic nursing care). Drug calculations. Accurate fluid balance (intake & output). Multi-disciplinary involvement. Communication and documentation. Catheter & drain care. Pre operative care Post operative care Mealtimes and drinks. Admissions and discharges. ANTT and many more.
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WHEN & WHO COMPLETED FOR?
On Admission CHECKLIST WHEN & WHO COMPLETED FOR? Name band All patients as soon as they arrive on the ward (including red, blue, green & orange where applicable)) Clinical observations All patients as soon as they arrive on the unit (including neuro where applicable) Check blood glucose levels All patients, for baseline. Check NOK details, valuables, Allergy status All patients as soon as they arrive on the unit (HRM1 form to be checked and signed) Nursing admission document All patients Risk assessments All patients within 4 hours of arriving (including dementia assessment as per policy) Pressure areas All patients within 4 hours of arriving, if grade 2/+ AIR to be completed, swab wound, refer to TVN and photographs taken. Weight & height All surgical patients within 4 hours of arriving MSSU/CSU All patients at earliest time Routine Bloods All patients on admission, some may be completed in A&E Dietary needs All patients on admission and as this changes (diabetic, Halal, NBM, CFO, low salt, etc.) MRSA screen All patients known to be positive or previous – on admission, all other patients within 12 hours of arriving Intentional rounding charts All patients within 4 hours of arriving Care plans Cannula &/or catheter care pathway All patients with cannula &/or catheter insitu Referral to appropriate specialities & discharge checklist All patients on arriving, ensuring smooth running of the assessment unit and patients seen at earliest time.
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We monitor and record the following:
Observations These are of paramount importance in monitoring our patients. Early recognition of deterioration in condition means better care for patients at reduced risk of further complications. This further enhances the following pathways of care: Sepsis 6 Care Bundle and the Acutely Unwell Adult Collaborative. We monitor and record the following: Manual blood pressure, Pulse rate, Pain levels, Temperature, Oxygen saturation levels, Pressure areas Strike through on dressings, Stool movements, Alcohol withdrawal levels, Venflon sites using cannulae patways, Respiration rate –incl. any odd/abnormal sounds/patterns Neurological observations using GCS and AVPU, Fluid balance; incl. Drains, catheters, stomas, orally…
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Abdominal perineal resection
Common Conditions Right hemicolectomy Left hemicolectomy Ulcerative collitis Chrons Gastric cancer Gallstones Hernias Bowel cancer Abdo pain Anterior resection Abdominal perineal resection Hyperemesis Abcess’ Perianal Abcess Cholecystitis Pancreatitis Although we have a varied caseload, some conditions are seen more often than others. During your placement try to identify patients with various conditions and complete the table on the next page.
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Common Conditions Symptoms Condition Overview Treatment .
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Abbreviations (Ab) Ab. Meaning Flexisig Flexible sigmoidoscopy OGD
Oesophago-gastroduodenoscopy NIDDM Non-insulin Dependent Diabetes Mellitus ERCP Endoscopic retrograde cholangio-pancreatography EWS Early Warning Score NPU (PU) Not Passed Urine (Passed Urine) HAP Hospital acquired pneumonia CAP Community acquired pneumonia N&V Nausea & Vomiting CSU Catheter specimen urine Hb Haemoglobin OD Once Daily UTI Urinary tract infection H/O History Of… BM Capillary blood glucose A/W Aw Admitted with Awaiting HR Heart Rate ABX Antibiotics TPN Totap parental nutrition HYPER High PMH Past Medical History BD Twice a day HYPO Low PR Per Rectum BMI Body Mass Index IDDM Insulin Dependent Diabetes Mellitus PCA Patient controlled analgesia BNF British National Formulary IF Illiac Fossa QDS Four Times A Day BO BNO Bowels Opened Bowels Not Opened NG NJ Nasal gastric Nasal Jejenostomy D/N District nurse BP Blood Pressure IVDU Intravenous Drug User R/V Review Ca Carcinoma (Cancer) IV(I) Intravenous Infusion SPC Supra Pubic Catheter DVT Deep vein thrombosis HAT Hospital acquired thromnosis IMC Intermediate care CD Controlled Drug TPR Temperature, Pulse, Respirations CDT Clostridium Difficile Toxin MANE Morning TTO To Take Out TVN Tissue Viability Nurse MSSU Mid Stream Sample Urine TWOC Trial With Out Catheter
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Overview of Investigations
X-rays - a form of electromagnetic radiation, just like visible light. In a health care setting, a machines sends are individual x-ray particles, called photons. These particles pass through the body. A computer or special film is used to record the images that are created. Structures that are dense (such as bone) will block most of the x-ray particles, and will appear white. Metal and contrast media (special dye used to highlight areas of the body) will also appear white. Structures containing air will be black, and muscle, fat, and fluid will appear as shades of gray. CT Scan (Computerised tomography) - is a special kind of x-ray machine. Instead of sending out a single X-ray through your body as with ordinary X-rays, several beams are sent simultaneously from different angles. US Scan (Ultra-sound) - a painless test that uses sound waves to create images of organs and structures inside your body. It is a very commonly used test. As it uses sound waves and not radiation, it is thought to be harmless. M.R.I Scan (Magnetic resonance imagery) - An MRI scan uses a strong magnetic field and radio waves to create pictures, on a computer, of tissues, organs and other structures inside your body. Using a magnetic field means that there is no exposure to x-ray or any other damaging forms of radiation. It is a fairly new technique that has been used since the beginning of the 1980s. Blood tests - have a wide range of uses and are one of the most common types of medical test. For example, a blood test can be used to: assess your general state of health confirm the presence of a bacterial or viral infection see how well certain organs, such as the liver and kidneys, are functioning. Tests done on the ward in FBC, U&Es, TPN, CRP, Clotting (APTT/PT) & Group and Save. E lectrocardiogram (ECG) -is a test that measures the electrical activity of the heart. The heart is a muscular organ that beats in rhythm to pump the blood through the body. In an ECG test, the electrical impulses made while the heart is beating are recorded and usually shown on a piece of paper. This is known as an electrocardiogram, and records any problems with the heart's rhythm, and the conduction of the heart beat through the heart which may be affected by underlying heart disease.
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Chest Drain A chest drain is a narrow hollow tube that is inserted and sits in the space between the lung and the chest wall. This space is lined on both sides by a membrane called the pleura and is known as the pleural cavity or pleural space. A chest drain is inserted when air, fluid or pus has collected in the pleural space. The external end of the chest drain tube is attached to a bottle containing water which acts as a seal to prevent air from leaking back into the pleural space. Gastroscopy (OGD) This test inspects your oesophagus and stomach using an endoscope (a thin, flexible, telescope with a light and tiny video camera at the tip). An upper endoscopy allows the doctor to explore the cause of such symptoms as difficulty swallowing, abdominal pain, vomiting up blood, or passing blood in the stool. It can also diagnose irritation, ulcers, and cancers of the lining of the oesophagus and stomach. During this type of endoscopy, the doctor can also take biopsy samples of tissue.
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Flexible Sigmoidoscopy
A thin, lighted tube is inserted through the anus and rectum and into the sigmoid area (lower part) of the colon to look for abnormal areas. The procedure can detect inflamed tissue, abnormal growths, ulcers and early signs of cancer. It help doctors diagnose unexplained changes in bowel habits, abdominal pain, bleeding from the anus, and weight loss. Colonoscopy An endoscope is passed through the anus and all the way up through the entire colon (also called the large intestine) as far as the caecum (area where the large and small intestines meet), so that the doctor can see any abnormalities. This screening test is used to find early cancers and potentially cancerous polyps (growths on the colon lining). With colonoscopy, the doctor can immediately remove polyps and take biopsies of suspicious tissue.
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Medicine Administration.
The following abbreviations may be seen during medication administration. Please also complete the blanks on the safe administration check list “The 6 Rs”. MANE - …………………………………… NOCTE - ………………………………… OD - ………………………………………… BD - …………………………………………… TDS - ……………………………………… QDS - …………………………………………. PRN - ………………………………………… STAT - …………………………………… Transdermal - ………………………………… mcg - …………………………………………… mg - ……………………………………… Topical -………………………………………… NKDA / NK(D)A - …………………………………………… Multi – route - ……………………………………. “The 6 Rs”. The right ----c----; comparison of the ----c-----– to the ----c-----– prescription is imperative. The administrator must only give ----c-----– they have prepared and be present when it is taken. The right d---; to ensure that the right d--- is given, the administrator must triple check any calculations and have another team member check the calculation. The right t; the administrator must identify the t by checking the medication order and the t ’s identification bracelet to ensure that the right t is receiving the right medication. The right –o---; the administrator must give the medication via the right –o--- . In preparing the medication, the triple check will identify the –o--- to be given on the medication order. The right t---; the administrator will check the medication order to ensure that the medication is given at the right t--- . The prescriber will identify the t--- s that the medication is to be given. Proper --c---n----o-; the administrator will record the patient’s status prior to the medication administration as well as the medication given, the time it was given, the dose given, and the route it was given in. Then the administrator will follow up and record the patient’s response to the medication given.
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PipercillanTazobactom
Medications Take a look at some of the medications used on the ward regularly. Can you state what doses they may come in, by what route they can be given, type/group of medication it belongs and any side effects? Medication Usual Dose Routes Given Frequency Type / Group Side Effects Paracetamol Cyclizine Loperamide Buscopan Metformin Furosemide 40mg Po/ IV OD / BD Loop Diuretic Dizziness, Nausea, Lethargy Omeprazole Morphine PipercillanTazobactom Vancomycin Ibuprofen Ondansetron Tinzaparin Metronidazole Movicol Fentanyl Warfarin Bisoprolol Pabrinex Chlordiazepoxide Amoxicillin Codiene
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Group & Save / Cross match bottle:
Normal Blood Values. Biochemistry: Albumin g/L Amylase g/L Bicarbonate mmol/L Bilirubin umol/L Calcium mmol/L Cholesterol mmol/L Creatinine umol/L Glucose mmol/L Potassium mmol/L Sodium mmol/L Urea mmol/L Haematology: Haemoglobin (Hb) Male g/dL Female g/dL Platelet count x109/L White blood count (WBC) x109/L Coagulation: APTT seconds Prothrombin time seconds INR seconds Group & Save / Cross match bottle: Blood Gas Values: Analysis: pH STEP 1; Is pH normal? PaO Kpa <7.35 Acid >7.45 Alkali PaCO Kpa HcO STEP 2; Find the Cause? BE TO PaCo2 – Low alkalosis: High acidosis SaO >95% HcO3/BE – Low acidosis: High alkalosis Blood Culture: Need to be on the BC register to taken samples.
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Use separate sheet of paper for your answers.
Routine Blood Tests. Can you describe what would we be looking for and why when obtaining blood samples for analysis? Use separate sheet of paper for your answers. FBC - Full Blood Count Hb - Haemoglobin CRP – C-reactive Protein WCC – White Cell Count Ues – Urea and Electrolytes LFT – Liver Function Tests TFT – Thyroid Function Test Aptt – Activated Partial Thromboplastin Time INR – International Normalised Ratio ESR – Erythrocyte Sedimentation Rate HbAc1 - Glycated Haemoglobin Trop T – Troponian T PCO2 – Partial Pressure of Carbon Monoxide in Arterial Blood pH – Acidity or Alkalinity of a substance. PO2 – Partial Pressure of Oxygen in Arterial Blood
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