Gastroenterology Directorate€¦ · Web viewThe unit has specific observation charts and utilises “core care planning” which includes safety checklists. Infection Control

An Introduction for Pre-Registration

Nursing Students

Updated November 2017

Name: Mentor: Start Date:

(Tel: 0161 206 5729)

Division of Surgery

Welcome to H6 Monitored Surgical High Care Unit

The staff of H6 will make every effort to make your placement, educational and enjoyable. We aim to help you develop knowledge and skills that you will be able to utilise throughout your nursing career. This pack provides information needed to introduce you into the H6 environment.

The function of the eight bedded area is:

The early detection of organ dysfunction, that leads to early intervention before organ failure supervenes

As advised by the Royal College of Anaesthetists, patients admitted to H6 are nursed on a one nurse to two/three patient ratio. The method of care delivery on H6 is that of patient allocation. Patients are allocated to nurses by the coordinator of each shift, taking into account: continuity of care, skill mix and the experience and learning needs of individual nurses.

Philosophy of Care

H6 monitored believes that each patient is an individual with the right to appropriate skilled nursing care and that each person has the freedom to choose regarding their own care. All staff will strive to provide a service that is personal and respectful to the individuals needs.

All patients have a right to up to date information about their condition, including the risks, benefits and probable outcomes of treatment, to enable them to make an informed choice. These rights extend to all patients regardless of age, sex or ethnicity and are summarised below.

The patient has a right to:

Be treated as an individual and be afforded respect, dignity and equity of access to service and care.


Have choices in his/her care and be given enough knowledge to enable him/her to make an informed decision

Be provided with appropriate written information

Receive skilled care by all members of the hospital team to meet his/her individual needs

Be provided with the knowledge and skills to enable where able self care and independence

Have their care organised in such a way that enables a therapeutic relationship to exist between the patient, family and all staff involved in their care

Be involved in the assessment of their needs and in the planning, implementation and evaluation of their care.

We believe that all staff within the directorate should act as a resource for imparting relevant knowledge and skills to other colleagues. We recognise the need for new staff and students to be provided with an appropriate induction and a mentor who will facilitate learning by recognising and discussing the learners individuals needs, whilst working in partnership, setting realistic goals and formulating personal/professional development plans, with ongoing clinical supervision.

Finally we recognise the need to continually assess ourselves and take every opportunity to update our own knowledge and skills in order to improve and maintain high standards of care and service delivery reviewed at appraisal.Nursing Structure

The nursing establishment for H6 consists of a Unit Manager, band 6 Sister’s, Band 5 nurses (some nurses work part time), Clinical Support Workers and Healthcare Assistant. There is also a house keeper and a regular domestic.

Usual daily activity on H6 as follows

Safety huddle starts at 7am in staff room Allocation of patients and any code reds, brief handover of all patients’. Main handover conducted at bedside Medications checked with staff member. Safety checks and observations carried out, medications reviewed and

given appropriately Patients washed and transferred out of bed. Doctors ward round carried out any time from 8am onwards. All patients on H6 must have a daily review.


Multidisciplinary team attend unit on a daily basis, physios, pain team, pharmacy, dietitian, diabetes nurse, stoma nurses and specialist nurses.

Nursing on H6 is one nurse to two/three patient ratio All nurses attend to their allocated patients’ needs from washing, making

beds to making patients breakfast. It is expected when you’re not busy we help each other out.

Complete the table of other members of the MDT:

ADNS Surgery

Lead Nurse Surgery

Matron H6

Infection Control Nurse

Colorectal Nurse Specialist

Colorectal Nurse Specialist

Colorectal Enhanced Recovery Nurse(ERAS)Urology /Gynae Enhanced Recovery Nurse (ERAS)Upper GI Nurse Specialist

Practice Trainers

Academic in Practice

Stoma Nurses

Pain Nurse Specialists

Head Pharmacist

Head Physiotherapist

Domestic


Dietician

Surgical Structure

The clinical director for SHDU is Consultant Surgeon Mr. J Vickers. Each patient admitted to the unit remains under the care of their admitting Consultant: -

Mr. Anderson Consultant Colo-rectal Surgeon

Prof. Carlson Consultant Colorectal Surgeon

Mr. Lees Consultant Colorectal Surgeon

Mr. D. Slade Consultant Colorectal Surgeon

Mr. Vickers Consultant Upper Gastrointestinal Surgeon

Mr. Chaparla Consultant Upper Gastrointestinal Surgeon

Mr. Ammori Consultant Bariatric Surgeon

Mr. Akhtar Consultant Upper Gastrointestinal Surgeon

Mr. Senapati Consultant Upper Gastrointestinal Surgeon

Prof. Clarke Consultant Urologist

Mr. Betts Consultant Urologist

Mr. O’Flynn Consultant Urologist

Mr. Shackley Consultant Urologist

Mr Lau Consultant Urologist

Mr. R. Slade Consultant Gynaecologist

Miss H Doran Consultant Endocrinologist

Miss Saad Consultant Breast Surgeon

Patients can also be admitted under the care of Orthopaedics and the Medical Team with the authorisation of the surgical consultant on call.

H6 Monitored is part of the Surgical Directorate and is closely linked with the surgical wards, medical gastroenterology wards, ICU, A&E, and theatre either as an emergency or electively.


Unit Profile

Patients admitted to H6 Monitored High Care area are admitted for varying reasons, examples would include: -

Close observation and monitoring following major complex surgery either with invasive or non-invasive methods

Patients needing monitoring prior to going to theatre, or patients developing post-operative complications

Patients can also be admitted to the unit directly from A&E with conditions such as pancreatitis, upper or lower gastrointestinal bleeding, perforated ulcers or bowel.

Trauma

Step down surgical patients from intensive care, which still require monitoring and close observation.

Patients who require high flow Oxygen or need frequent suctioning from tracheostomies.

Complex post operative pain management

The unit has specific observation charts and utilises “core care planning” which includes safety checklists.

Infection Control

Gloves and apron to be worn in patient area when providing cares.

Gloves and aprons are to be removed when leaving the patient area and hands washed using soap and water.

All patients are swabbed for MRSA on admission to the unit – check coordinator for up to date protocol.

All patients are prescribed Prontoderm foam & Prontoderm gel whilst in the High Dependency Unit.

Aseptic None Touch Technique (ANTT) to be followed.

Personal hand gel to be attached to uniform.

Shift Patterns


Early half 07.00 – 13:30Late half 13.00 – 19:30Long Day 07.00 – 19:30Nights 19.30 – 07.30

You will be expected to work your mentors shift pattern.

You will be allocated two half hour break. Tea and coffee is available at a cost of one pound per month, please bring your own packed lunch. You must wear your uniform to placement, for study days and spoke placement’s elsewhere in the trust. Footwear is black shoes. Please try not to bring valuables onto the placement.

Car parking: Students are allowed to park on the staff multi-storey car park from 16:30pm onwards, nights and weekends included.

At present student’s park on one of the satellite carparks, they can obtain a parking application form from the PEF Team if they have not obtained one when they commenced the course. Parking then needs to be arranged and paid for in advance of placement, at the Car Parking Office.

Unit telephone numbers:

0161 206 11940161 206 5729

Emergency Number:

2222 Emergency/crash call

5555 Security emergency

Your First Day

You will need to attend the critical care induction day before commencing your placement. You will be notified of these days when you ring the unit for your off duty or request via email. If you are not rostered to work on the day of the induction then 6 hours will be given back.

You will be introduced to your mentor, orientated to the unit and introduced to the staff on duty. There will be time for you to read this pack and familiarise yourself with some of the common conditions within the speciality as well as reasons for admission to H6. Learning opportunities and learning contracts will also be discussed.

Activity Levels


The unit is generally very busy and you will be expected to work closely with your mentor, observing, but also assisting where appropriate in direct nursing care.

The unit has specific observation charts and utilises “core care planning”. There is a file kept in the resource filling cabinet that contains evidence based and research articles, which underpin the care we have “prescribed” on our core care plans. A modified Roper Logan & Tierney model of nursing has been adopted for the assessment of patients.

Many of the other staff employed within H6M have specific skills, link roles, knowledge and interests and these staff can be a resource to you.

Learning Opportunities

Holistic care of the critically ill patient and his/her family: -

Preparation of the bed area to receive an admission

Receiving the patient onto the unit from their source of admission, including the wards, A&E, theatres and ICU

An understanding of the psychological support and help our patients and their families need regarding the environment they have been admitted to, remembering that often these patients have been diagnosed as having cancer, or have been suffering from very debilitating gastrointestinal disease.

An understanding of the type of surgery the patients undergo

Become familiar with the documentation used on h6 and be aware of the need to practice defensible documentation

Gain a basic understanding of the monitoring system, including connecting the patient to the monitor, invasive monitoring, pulse oximetry and ECG

Obtain basic understanding of oxygen therapy, including high flow, warmed, humidified and nebulised, tracheostomy care

Become familiar normal blood values e.g. FBC, U & E’s, and of normal haemodynamic measurements such as urine output, blood pressure, central venous pressure, oxygenation, and normal sinus rhythm.

Develop clinical skills of manual pulse recording & respiration (Rate, rhythm, depth etc) along side invasive monitoring skills.

Basic understanding of fluid balance, intravenous fluid replacement and total parental nutrition.


Become familiar with certain methods of intravenous fluid administration using IVAC pumps and syringe drivers, as well as enteral feeding pumps.

Basic understanding of commonly used drugs within gastrointestinal surgery

When agreed with your assessor/mentor it may be possible for you to care for your own patient (under supervision)

Patient journey

76 year old lady admitted into A+E with a 7 day history of vomiting and abdominal pain. Abdomen grossly distended, bowels not opened for 4 days.

PMH:Hypertension usually controlledType two diabetic well controlledLeft knee replacement 6 weeks ago

Medications:Amlodipine 10mh ODMetformin 500mg TDSParacetamol and codeine for pain PRN

Observations on admission:Blood pressure 75/40mmhg, map of 40mmhgIrregular heart rate at 85-135bpmRespiratory rate 28bpm, with audible wheezeNil urine output last 4 hrsTemperature 38.7oc

Plan:

Chest x-ray, CT with IV contrast

Bloods including blood cultures

Plasma-lyte fluids given stat followed by IV fluids with potassium running 6hrly

IV antibiotics tazocin

Regular nebulisers

Catheterised with residue of 200mls

Nasogastric tube passed into right nostril, with 1500mls of bile and liquid faeces smelling fluid drained.

Transferred to Surgical High Dependency for closer monitoring


Blood result findings, potassium 3, magnesium 50, HB 75.

X-ray finding bilateral consolidation, distended abdomen reducing lung capacity.

CT findings, descending colon grossly distended full of gas, query ischemic bowel/ CA colon?

Reviewed by surgeons and consultant radiologist, decision emergency Laparotomy Hartman’s procedure.

This is an operation to remove part of the sigmoid colon and/ or the rectum. It is most usually performed for patients with a bowel cancer or diverticular disease.

It is often performed in an emergency situation where there is a blockage of the bowel, a perforation of the bowel or of if there is a lot of infection (abscess) around the bowel.

Returned after theatre to H6, with colostomy, Right CVC Left arterial line, 2 x cannula, catheter, and left abdominal drain, PCA for pain and NG on free drainage. Patient is to be kept NBM.

Learning Resources

There are many learning resources throughout the unit. These include:

Patients – Patient history and presenting conditions including investigations etc; talking to patients can provide information about the symptoms of illness; their journey from home to hospital


http://www.birminghambowelclinic.co.uk/diverticular-disease/

http://www.birminghambowelclinic.co.uk/diverticular-disease/

http://www.birminghambowelclinic.co.uk/bowel-cancer/

Mentors - Many of the trained nurses on the unit are trained mentors. You will be allocated a mentor and you will also be given a second named person to identify with. Alongside this the whole staff team has a huge resource of knowledge & skills to be utilised.

Equipment - What equipment is used on the Unit & why?

Placement Educational Lead - This role is carried out by Polly Hamilton & Rachael Connolly who are responsible for the overall quality of the learning environment and are available if there are any major problems with your placement.

Pre-registration Practice Education Facilitator –Andrea Surtees will provide support for students & mentors & also provide us with feedback from your evaluation forms. Contact details:[email protected] Tel: 01612068991

University Link Lecturers – Sue Walker: 0161 295 7276. E-mail: [email protected] Melanie Stephens: 0161 295 2877. E-mail: [email protected].

General Notice Boards

Trust Library

Student Information folder ( H6 Back of nursing station office) -

Teaching and Learning Aids - There are a number of information packages available through out the unit. Your mentor will be able to direct you to these & encourage you to search for information via Athens, Google etc. Study sessions are delivered on a variety of subjects relevant to the unit. We also have Link Nurses on the unit who can offer you more information in these areas. They include:

Infection Control / ANTT Pain control Wound Care Food Hygiene Nutrition Health & Safety Resuscitation Palliative care Alcohol Risk assessment Dementia care Productive ward

Associate Departments:


mailto:[email protected]



Surgical Wards – The wards provide a quality service for patients requiring investigations, diagnosis and surgery. There is a multi-disciplinary approach to care, coordinated by six teams of nurses covering two wards.

Surgical Triage Unit – Acute admissions either directly from here or via theatre.

Endoscopy Unit – This offers a comprehensive range of investigations and therapeutic facilities.

Intestinal Failure Unit (Nutrition Unit) – A unit with an international reputation in dealing with individuals with varying degrees of intestinal failure, the staff on the unit support patients from around the country who have Parenteral Nutrition at home.

Level 1 & 3 Theatres – This provides a 24-hour service delivered by a dedicated multi-disciplinary team. You are encouraged to arrange a spoke placement.

Post Anaesthetic Care Unit (PACU) Level 1 & 3- Initial post operative care & assessment prior to transfer to the relevant ward area.

Surgical Out-Patients Department – The department provides a quality service to patients and their families, led by our Specialist Nurses, providing support during procedures, explanations, counselling and some nurse led clinics.

Visits to all of these areas are recommended in order to make you placement educational and interesting. It will also provide you with the opportunity to follow an individual patient around these areas.

Expectations of Students

What students can expect from staff:

To be welcomed as “part of the team”

An appropriately timed orientation to the placement including, layout, routines, staff policies and procedures.

A named mentor

To receive off-duty at least one week in advance


To have provisional dates for mid point & final assessments identified on initial meeting

Continuous feedback on progress and any problems/issues as perceived by staff will be raised as soon as possible ( documented on communication sheet)

Students will not be regarded as “extra pair of hands” and their role as learner will be respected.

Students will have the opportunity to learn and participate in new skills whilst acknowledging any limitations in their knowledge or competence.

Students will be made aware of appropriate learning opportunity before/as they arise.

Students will be aware of their role during emergency procedures (fire, crash call)

Expectations of Staff

What staff expect from students:

Students will arrive punctually on shift, and inform the nurse in charge as soon as possible if they are ill or delayed. Students are requested to provide a contact number on commencement of their placement.

Students are expected to show initiative to learn and participate in care, whilst acknowledging any limitations in their knowledge and competence.

Clinical skills should be ideally learned within the context of holistic patient care.

Should any personal or professional problems arise during placement, these must be raised as soon as possible with an appropriate member of staff, to prevent the problem escalating.

Students must adhere to the uniform policy a set by the School of Nursing.

Students will work at least two shift with their mentor with the exception of night duty in the students first year of training. This includes weekends. A minimum of 1 weekend in 4 and a maximum of 2 in 4 are recommended.


Students should bring relevant documentation (assessment of practice documentation, action plans, profile) on a daily basis for use at appropriate times.

Feedback is provided at the end of the placement in the form of a copy of the learning summary.

Delegation of duties & level of supervision of students – directly or indirectly will be at the level according to the student’s competency.

Year 2 students: Demonstrate becoming an ‘Advanced Beginner’o Be able to explain your actionso Repeatedly practice skillso Demonstrate acceptable performanceo Plan care under supervision

Year 3 students: Becoming a ‘competent & effective’ practitionero Demonstrate understanding & application of

skills to practiceo Prioritise & plan care with relevant support &

supervisiono Evaluate interventions

(Reference: Pan Manchester assessment documentation)


Multidisciplinary Team Working

Record below all the members of the MDT you have observed in patient care.Reflect on their input to team working &how do they impact on patient care?


Patient

Reflection on experience:

Use this to reflect on the whole placement or particular events.

Reflective Record Using Johns (1995) Model

Description of experience

Reflection

Influencing factors

Could I have dealt with the situation better?

Learning


Word search common abbreviations and nursing terminology

R R L A R T N E C L I H N B E

M E X S U O N E V T Y U O D R

O S T N N I O U T P U T I E U

U P I S L O E R E P P U T P S

T T Q U A N T R A N T N C E S

H D S L O L T R X B E I R N E

P N I N A E P R E M G L A D R

I U L A N I T S E T N I F A P

O F L S B R D G B I E A N N A

P E I M I E A R L O I H I T R

E O T G O N T U A L W F T C I

N O H A A N S I U C M E W A S

E T Y M R I A R C D O O L B C

D H E A R T E R I A L Y O S D

M S I L O B M E Y N A E M R Y

Work out the abbreviation then find the word in search puzzle.

Example RA = Room Air


BNO

IDDM

RUQ

IFU

NBM

CVC

CVP

MAP

PE

MI

AF

HR

RR

UO

HTN

POP

NIDD

Placement Evaluation

Your feedback on your learning experience is essential to let us know what we are doing well and how we can improve. Please would you take a moment to complete out short questionnaire? Follow the link here:

https://onlinepare.net/

The survey is common to all learners on nursing and allied health professional programmes.


https://onlinepare.net/



Raising Concerns

If you have concerns regarding your mentoring please speak with the PEL or Shift Leader. If you feel unable to speak to them please contact the PEF.

If you have concerns regarding patient care please speak with your mentor, shift leader or Ward Matron. Our Lead Nurse and ADNS run divisional surgeries where you can speak to them in confidence.

If you are unsure who to speak to at Salford Royal or wish to remain anonymous Trust Executive have an anonymous 'Ask a question'. Here they will be able to direct you to who you would need to speak to.

University of Salford has signed up the 'Speak Out Safely' campaign. More details can be found here

http://www.salford.ac.uk/nmsw/about/nurses-speak-out-campaign

http://www.nursingtimes.net/news/speak-out-safely/



Documents

Gastroenterology Directorate€¦ · Web viewThe unit has specific observation charts and utilises “core care planning” which includes safety checklists. Infection Control