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Profile

Of

Learning

Opportunities

Chesterholme

A learning zone for Student

Nurse training

May 2012

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Contents

Guidance for students and mentors

Area profile

Confidentiality

Learning opportunities

Interpersonal skills

Organisation of care

Clinical skills

Biological processes

Health development opportunities

Management skills

Reading list

Learning Zones

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Guidance for students and mentors

This Learning Profile is a comprehensive document detailing all the learning

opportunities available to any students whilst in Chesterholme.

It is intended that students, supported by their mentor, can use this information in

order to select appropriate opportunities to help meet the specified competencies

outlined in the Practice Portfolio and any other agreed competencies for their

placements at Chesterholme.

At Chesterholme the student will be able to access a wide and varied range of learning

opportunities; however we cannot guarantee that every learning opportunity included

in this document will be available to every student on a given placement.

The team at Chesterholme ensure that this document is current and relevant through

the process of annual review. Learning opportunities are in the process of continual

development and Chesterholme welcome any positive suggestions in order to develop its

standard of educational provision.

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Profile

Chesterholme is part of Castlebeck Ltd group and has more than 20 years experience

supporting people with learning disabilities and additional complex need, providing

specialist healthcare and rehabilitation services.

Chesterholme is an assessment and intervention unit, consisting of the Annexe, the main

unit and the flat.

Within the flat the patients complete all daily living tasks including shopping, cooking,

domestic skills and voluntary work in the community.

Chesterholme provides individualised places for adults with learning disabilities and

behaviours that challenge, including those with complex needs and dual diagnosis. Here

they are encouraged to live their own life to their optimum potential, accessing the

community with support and enjoying a range of educational and recreational activities

as well as receiving 24 hour nursing support.

Chesterholme ‘step down’ Graded rehabilitation Annexe has 4 places and is a service

where people can learn life skills, access the community more independently and do

more for themselves from planning a meal to general household tasks to organising

finances.

Student allocation

Chesterholme provides a valuable learning opportunity for a maximum of two

nursing students at any point in their training.

Chesterholme is also able to provide a learning arena to other students in the

health and social environment.

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Allocation of nursing care

At Chesterholme this is organised via a named nurse system, each nurse is responsible

for a maximum of two patients, it is the nurses responsibility to ensure that each

patient’s care plans are up to date, current treatment programmes are consistently

implemented and to write their case conference reports. Each of those patients is

further supported by their own associate key worker, a support worker, whose

responsibly include maintaining family contact, organising gifts at birthdays and

Christmas amongst other duties.

Practical issues

Shift patterns will be wherever possible reflect that of the mentor, this may vary

to accommodate specific learning opportunities or to meet a specific request

from the student, however such requests should not occur on a regular basis and

should be submitted to the mentor/co mentor as soon as the student identifies

the need for the change.

After the first fortnight of the induction period of working 9am-5pm a student at

Chesterholme would be expected to work shifts of 8am-8pm. Nightshifts would

be generally not expected of a student unless specifically requested.

Chesterholme has a dress code as specified by the Castlebeck policy, students

must be well presented at all times. As part of the policy no denim, trainers or

expensive jewellery should be worn.

If at any time a student is unable to attend a shift due to sickness they must

inform the unit as soon as possible. The student must follow the University

sickness protocol.

The information within this document is to be read in conjunction with the student

handbook.

Address is:

Chesterholme

Anick Road

Hexham

Northumberland

NE46 4JR

01434600980

Website http://www.castlebeck.com/

Confidentiality

Any information regarding the patients, staff or company should not be

discussed outside of Chesterholme. Consent should be sought from the

patient to access any information regarding their care and treatment.

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No information should be passed on to any other person without consent

from the patient and in the case of written reports the authors consent.

No information should be passed on via the telephone unless you have

verified who they are and are authorised to have the information please

follow procedure on OPSM.

You must always follow NMC guidelines on confidentiality of information

and Data protection act 1998.

Expectations of students whilst on duty

It is important that we continue to maintain a high standard of care for our service

users and the expectations of our staff we feel should be also met by students that utilise

this service as a learning opportunity.

Maintain the company dress code of smart dress no denim covering of tattoos

and removal of excess jewellery i.e. eyebrow bars etc.

Team work and a positive attitude

Maintaining confidentiality

Passing on all relevant information to the Nurse in Charge of the shift or

management

Adherence to university sickness policy

Always punctual for work this is 15 minutes before shift starts to have a

handover.

Be involved in daily activities gaining as much experience from each opportunity

Depending on which year you are in you will be asked to undertake different

responsibilities under supervision.

This will include

Assisting in completing care plans

Assist qualified staff to dispense medication

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Attend weekly MDT/CPA/MHRT meetings

Assist with any admissions/ discharges and the process this entails

Carry out handovers

Assist in planning the daily activities with support from Nurse in Charge

Observation policy

Our company has a patient support system which is broken down into 4 different

categories these are

Level 1 – General observation

This is the minimum acceptable level of observation for all in-patients. It should be

compatible with providing the individual with a sense of responsibility for the use of

their free time in a carefully planned and monitored way. The staff on duty should

know the general whereabouts of the person at all times, whether in or out of the unit.

Not all person need to be kept within sight. Positive engagement with the person

should take place at least once per shift in order to assess their mental

state/functioning. This interview should always include an evaluation of the person’s

mood and behaviours associated with risk and should be recorded in their notes. Such

observation should include the practice of “regularly walking the floor” and include also

observation and monitoring of the resident environment (Bowers, Gournay & Duffy,

2000).

Level 2 – Intermittent observation

This level of observation should be considered when a person poses a potential, but not immediate high risk to self or others including those who have previously been at risk but are in the process of recovery. The person’s location should be checked every 15 – 30 minutes although a decision may be taken to check the resident more or less frequently as required. The exact times are to be specified in their care plan. Respect for privacy is an important consideration and positive engagement with the person should still take place. A balance should be struck on the side of safety in all matters such as escorting to the toilet, etc.

In light of the person’s progress, increasing repertoire of skills, awareness and responsibility under certain conditions/situations (e.g. particular activity,

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environment, trigger/stimulus control) the M.D.T. may reduce the level of observation to an intermittent level with further regular checks to determine how they are coping with increased responsibility towards their well being. The person’s care plan must be amended to include these details and additions show those therapy activities that will take place reduce the associated risks involved. Level 3 – Within eyesight

This level of observation is required when the resident could, at any time, make an attempt to harm themselves and/or others. The person should be kept within sight at all times. Any possible tools or instruments to cause harm should be removed. Searching of the person and their property may be necessary which should be done with regard to their rights and appropriate guidance.

Level 4 – Within arms length

Should a person pose a substantial risk and in particular an immediate danger to themselves or others, they may need to be observed in close proximity. They may also need intensive and skilled intervention as a consequence of their serious behaviour. The person will be within arms length of a member of staff at all times. There may be exceptions to this proximity i.e. 2 arms length between the person and those observing in order to minimise risk to the observer (safe space / inter-positioning). Safety overrides the person’s needs for privacy. In some situations more than one member of staff will be necessary to observe the person at this level.

Each patient has been assessed looking at their individual needs and associated risks

this may pose within different environments such as the community, within the unit and

when in their bedrooms. It has also take into account whether the person is detained

under the mental health act. These are reviewed monthly if nothing significant has

arisen. These may need to be changed if there is a risk posed such as self harm or

absconding.

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Learning

Opportunities

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Key element

Interpersonal skills

Learning opportunities Resource/ Relevant Personnel

Interact appropriately with

patients and their

relatives/carers/significant others

Communicate effectively with the

nursing team using verbal and

written communication

Conducting handovers

Daily care notes

Duty planner

Communication book

Interact/communicate with the

multi-disciplinary team.

Maintain accurate written

documentation

Daily care notes

External healthcare notes

Supporting/organising

appointments with other

health/social care professionals

Support residents with tasks of

daily living

Utilise NMC policies to inform

practice

Patients

care staff

Valuing people (DOH,2001)

care staff

Mentor

MDT

care staff

Mentor

NMC publications

MDT

care staff

Mentor

NMC publications

Patient

care staff

Mentor

Patient

care staff

Mentor

NMC publications

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Key element

Organisation of care

Learning opportunities Resource/Relevant Personnel

To understand the role of the

named nurse and key worker

system

To implement the nursing process

for patient care and treatment

Patient reviews –CPA

Section renewals

MH tribunals

Discharge meeting

Emergency reviews

Risk assessments

Care plans

Assessments

Behavioural interventions

Utilise NMC policies to inform

practice

Care plans

Care staff

Care plans

Mentor

Care staff

MDT

Named nurse

Nursing reports

Other professional reports

Family

Patient input

Codes of practice

Manager

care staff

Care plans

Care plans

CAT programmes

NMC publications

(codes and guidelines)

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Key element

Clinical Skills

Learning opportunities Resource/Relevant Personnel

Delivering care via the Positive

Behavioural support model

Delivering medication looking at

Medication usage

Classification

Side effects

Ordering monthly medication via

SPEEDS

Registering medication changes

Delivering CAT Menu to patient

Completing nursing notes

Assessment visit

Mentor

Management

care staff

OPSM file

Mentor

OPSM file-medication policy

BNF

Patient

Mentor

OPSM file –ordering medication

Ordering sheets

Monthly medication repeats prescription

Diary

Message book

Mentor

Kardex

Changes to medication form

Message book

pateint permission

CAT menu/ rationale

Mentor

Training course

Mentor

patients file

OPSM nursing notes policy

RC

Charge nurse/ SSN

Information from other unit re patient

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Key Element

Clinical skills Learning opportunities Resource/Relevant Personnel

Attendance of academic programme

Positive Behavioural support

Assessments

Care plans

This would also include risk

assessment and behaviour

motivation

TPR ability to monitor

BP

Weight

Body mass index

Role of registered nurse in relation

to mental health act

Patient confidentiality policies and

procedures

Access to codes of practice

Understanding the role of the

named nurse and key worker

Mentor/registered staff

patients permission

care staff

Individual programmes

Incentive file

Mentor/named nurse

HoNOS-LD

Social functioning

OPSM file

Mentor/named nurse

paitents permission

patients file

OPSM

Mentor

care staff

Mentor

care staff

Mentor

Registered staff

Responsible Clinician

Mentor

Care staff

OPSM

Mentor

care staff

OPSM

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Key element

Biological processes

Learning opportunities Resource/relevant personnel

Supporting appointments with

other health professionals

Understanding the impact physical

health can have on behaviour

Aware of health needs of people

with learning disabilities

Understanding impact of epilepsy

on an individual

To have the opportunity to attend

relevant physical investigations

with patients including

ECG

EEG

Chiropody

Dentistry

To be aware of the need to take blood and

reasons for this especially for patients on

clozaril

To gain understanding of the use of

medication in the stabilisation and

treatment of Mental Health/ behaviour

symptoms and their potential impact on

physical health

Patients permission

care staff

Responsible Clinician

patients permission

Mentor

Responsible Clinician

Epilepsy protocol

OPSM

BNF

patients permission

care staff

care staff

Mentor

care staff

Mentor

BNF

Responsible Clinician

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Key element

Health development opportunities

Learning opportunities Resources/ Relevant Personnel

Health promotion/heath education

for individuals

i.e. healthy eating promotion towards no

smoking

monitoring of food intakes

physical health checks

observation of patients physical and

mental wellbeing

carry out nursing assessments of

mood, behaviour and mental state

understand the importance of a

structured day via activities

programme

awareness of other disciplines in

healthcare

Care staff

Relevant information

GP

care staff

care staff

Support staff

care staff

Support staff

Activity Coordinator

Mentor

Mentor

care staff

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Key element

Management skills

Learning opportunities Resource/ Relevant Personnel

Nurse in charge role

Delegation

Skill mix

Financial systems

Weekly MDT reviews

CPA reviews

Record keeping

Report writing

Accident/ incident reporting

Staff allocation

Staff training

Sickness and absence

Policies and procedures

Staff meeting

Recruit and selection

Facilitate and promote good practice

Mentor

Nurse in charge

OPSM

Mentor

Nurse in charge

Mentor

care staff

Responsible Clinician

care staff

Responsible Clinician

NMC guidelines

Mentor

NMC guidelines

Mentor

OPSM

Mentor

Mentor

OPSM

OPSM

Mentor

OPSM

Mentor

OPSM

NMC guidelines

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Reading list

Learning disabilities Bob Gates 2002

Mental Health Care for people with learning disabilities Helena Priest PhD MSC BA

RN DIPN DIPN ed and Michael Gibbs MA RN PG CERT CERT ED

Risk assessment in people with learning disabilities Carol Sellars, 2002

The handbook of Forensic Learning Disabilities Colin Dale, Tim Riding, Carol Swann

and Bob Swann, 2005

Learning Disability: a life cycle approach to Valuing People Peter Goward, Gordon

Grant, Paul Ramcharan and Malcolm Richardson

Person centred planning and care management with people with learning disabilities

Paul Cambridge and Steven Carnaby

Mental Health Nursing Skills Patrick Callaghan, John Playle and Linda Cooper

Blackstones guide to the Mental Health Act 2007 Paul Bower

Mental Health Act 1983 code of practice 2008 edition (revised edition)

Mental Capacity Act 2005 code of practice 2007 final edition department of

constitutional affairs

Deprivation of liberty safeguards, code of practice to supplement the main Mental

Capacity Act 2005 code of practice (final edition) by Great Britain ministry of justice

2008.

This is not an exhaustive list please feel free to explore other literature.

Company policies and procedures will be provided if appropriate.

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Within chesterholme patients are included in a number of different meetings

information regarding these can be found below

Service user involvement meeting

Held each week on a 1:1 basis to

discuss the weeks planned sessions

and what they have enjoyed or

would like to change or try

Spiral skills user forum

This is held on a monthly basis and

any patient can attend. It is there

so that people can learn about

new topics find out and share

information and meet new people

Voicability this is an advocacy

service which is independent

and confidential. It occurs at

chesterholme on a weekly

basis.

Castlebeck user forum

This is open to all patients/residents/

service users within Castlebeck. It is held

every couple of months and is designed

to share information, discuss relevant

and important topics and meet new

people

Weekly forum meeting

This is an open forum for patients to

discuss information, share ideas and

views/thoughts. It gives them a chance

to decide on different things such as

changes to menus etc.

CPA /MDT meetings

These are an opportunity for the

patient to share their thoughts,

views and opinions. It is also an

opportunity to be fully involved in

decisions that are being made about

them.

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Learning Zones

Student

To develop an understanding of ways of

dealing with excessive/ deficit behaviours

with a behavioural approach via the

positive behavioural support Working with the multi disciplinary

team, with opportunities to

participate in case conferences,

MHRT, managers meetings.

To develop a clear

understanding of the Mental

Health Act and the Metal

capacity Act including

deprivation of Liberty

Safeguards.

Effective

management skills

Effective communication skills

Care planning

Care planning

Practical skills

Pharmacology

Participation in

activities

programmes