Queen Elizabeth Hospital Gateshead Health NHS Foundation Trust. Profile of learning opportunities. WARD 22 MEDICAL ELDERLY

Transcription

1 Queen Elizabeth Hospital Gateshead Health NHS Foundation Trust Profile of learning opportunities. WARD 22 MEDICAL ELDERLY

2 CONTENTS Guidance for learners and mentors Page: 1 Introduction Page: 2 Philosophy of care Page: 3 Members of the Multidisciplinary team Page: 4-5 Learning Zones Page: 6 Key Elements Page: 7 Anatomy & Physiology Page: 8 11 Clinical Skills Page: Communication Page: 14 Management Issues Page: 15 Management of Patient Care Page: Staff Development Page: 18 Quality Issues Page: 19

3 GUIDENCE FOR LEARNERS AND MENTORS This document, (POLO) has been produced to detail all the learning opportunities that are available on ward 22. The team has its own unique learning opportunities offering a valuable insight into the nursing management of stroke patients. The team provides care using a multidisciplinary team approach. It is intended that learners and their mentors work with the team, to select the appropriate opportunities to meet specific competencies. Learners should not expect access to all of these opportunities whilst shadowing the team, but should look upon this POLO as a window of learning opportunities available. 1

4 INTRODUCTION Ward 22 is a 24 bedded unit. The unit specializes in the care of patients following a stroke. Patients are admitted direct from A and E and MAU/SSU. The ward is based in the Jubilee Wing of the hospital and patients are nursed in single, double and four bedded rooms. The rooms have their own their own toilet facility. The ward welcomes students at all stages of their training. We also support NVQ Candidates and newly qualified members of staff. All students are encouraged to visit the ward prior to commencing their training. All students are allocated a mentor at this point. There are many opportunities to gain a variety of new experiences, which we hope you will utilise. 2

5 PHILOSOPHY OF CARE We believe that people are individuals and that they have their own identity and unique set of problems. They have experienced a cerebral incident resulting in stroke or neurological problems. We believe that patients should be involved in their planning of care, and encouraged at the earliest opportunity to participate in all aspects of care. We believe that carers are an important part of this care and are encouraged to participate at any time with support and advice on continued care. Care is planned to allow freedom of choice, and joint decision making. We believe in good communication across the multi-disciplinary team, both in hospital and in the community. We respect our patient s wishes, beliefs and always maintain confidentiality. We believe that patients should be treated with respect and their privacy should be maintained at all times. 3

6 USEFUL INFORMATION Ward telephone number / Shift Patterns The shift times may vary, but here are the most common. Early Late Full Day Night Duty The expectation is that the student will work alongside their mentor for at least 50% of the time. It is the student s responsibility to ensure that this is the case. Off Duty Please refer to the ward off duty file that is kept in the filing cabinet behind the Nurse s station. Discuss off duty with your mentor. This should then be documented in the off duty file Uniform Please wear student issue uniform, and adhere to trust policy. It is not advisable for you to bring valuables to work. There are locked male and female changing areas. The codes will be given to you on your first day. Jewellery must not be worn in this department in accordance with hospital uniform policy. Smoking Gateshead NHS Foundation Trust operates a no smoking policy on all its premises. 4

7 Fire At the beginning of your placement on ward 22 please familiarise yourself with the layout of the department and the position of the fire exits and extinguishers, also your local fire policy. Your mentor will facilitate this. You should aim to complete this on your first shift. In the event of a fire, do not hesitate, break call point glass and dial 333. On hearing fire alarms stay with your mentor and await instructions from the Senior Nurse on duty. The Senior Nurse will decide whether to fully evacuate or compartmentalise the department. Admissions and transfers to ward 22 Stroke patients are admitted from a variety of sources. Direct admissions from A/E or transferred from MAU or any ward in the QE. We also take transfers from other hospitals. When patients are transferred to ward 22 a full secondary assessment is carried out, including risk assessments, ADLs and social assessments in anticipation of discharge planning. In addition all acute stroke patients are assessed for their suitability for continuous monitoring. Observations are recorded, including snobs, as well as a swallow assessment. Rehabilitation is commenced as soon as possible on the ward and continues on discharge with input from the community team. A multidisciplinary approach is taken when planning care to ensure effective delivery of care is achieved through MDT meetings, and huddles which are held twice weekly. All patients have multidisciplinary team notes, enabling all professionals involved to communicate effectively. These files are kept at the end of the bed. MDT meetings are held on a Monday at and a Thursday at Huddles are held prior to these meetings where discharge is discussed. 5

8 MEMBERS OF THE MULTIDICIPLINARY TEAM Ward Manager Ward Sisters Educational Lead Ward Sisters Clinical Lead Stroke Assessment Nurses Staff Nurses Ward based Staff nurses Community based Nursing Axillaries Rehabilitation Assistants Ward Doctor Consultants Pharmacist Pharmacist Technician Occupational Therapist Physiotherapist Speech and Language Therapist Dysphasia Nurse Specialist Dietician Nutritional Nurse Specialist Social Worker Ward Clerk Students 6

9 There is also a wide range of specialists teams we need to refer patients to at various times such as RIK team, Discharge liaison, Diabetic nurse specialist, vascular nurse, tissue viability, infection control Macmillan nurses, respiratory nurses, continence advisor, chaplains, drug and alcohol teams and ECG dept. We aim to create a relaxed and friendly environment to facilitate ongoing stroke rehabilitation. We believe the ward team should act as health educators and promote health education associated to stroke disease. 7

10 WARD 22 LEARNING ZONE. While on ward 22 as a student you will have the opportunity to work with key members of our multidisciplinary stroke service. Following the patients journey from admission into hospital, as an inpatient on the ward and then on discharge into the community. Acute Stroke Patient Care. The first 72 hours following the patient s stroke. Focusing on the assessment of patients and the prevention of further deterioration. Includes Assessment by the Stroke Assessment Nurse, Thrombolysis. Monitoring. SNOBS. Swallow assessment. Incontinence assessment. Occupational therapist assessment. Physiotherapist assessment. Speech and Language therapist assessment. Rehabilitation. Begins as patient s recover from the immediate effects of the stroke. Care focuses on assisting the patient to overcome, or learn to cope with the damage the stroke has caused and achieving their maximum level of independence. Includes Nurses. Doctors. Ward based Physiotherapists Ward based Occupational Therapists Speech and language therapists. Dietitians. Nutritional Nurse Specialist. Rehabilitation Assistant. Discharge. Rehabilitation for many of our patients continues into the community and you will have the opportunity to work with our community teams. 8

11 Including. The community stroke rehab team OT s, physios, SALT, The Stroke Rehab Nurse. This is supported by our early assisted discharge team. The Clasp nurse. Palliative Care. Unfortunately not all of our stroke patients survive and you may have the opportunity to care for the dying patient and their relatives. 9

12 KEY ELEMENTS Anatomy, physiology and pathology. Clinical nursing skills. Communication skills. Management issues. Management of patient care. Staff development. Quality issues. 10

13 ANATOMY, PHYSIOLOGY AND PATHOLOGY Learning Opportunity Normal anatomy, physiology and pathology. Cardiovascular. Angina. Myocardial infarction. Heart failure, LVF. Cardiac arrest. ECG. Medication. Disturbances electrolyte balance. Normal fluid balance. Dehydration. Recording and understanding fluid balance charts. Fluid retention/oedema. Acidosis. Obtaining, reading and recording blood results. Observing obtaining, reading and recording blood gases Endocrine system. Diabetes. Thyroid problems. Pituitary problems. Pancreatitis. Medication. Relevant Resource education and resource files, books, posters, x-rays. Mentor, ward staff, cardiac arrest team, education and resource files, coronary care staff, medical staff, books, on call pharmacist. books, education and resource files books, education and resource files, on call pharmacist. 11

14 Learning Opportunity. Gastrointestinal system. Nausea and vomiting. Diarrhoea. Constipation. Haematemesis/Maleana. Dysphasia. Ulceration and cancers upper and lower GI tract. Management of: Nasogastric feeding. Peg feeding. Preparation for GI investigations. Post procedure care. Bowel preparation. Haematology. Blood formation and bone marrow function. Red cells. White cells. Platelets. Collecting blood specimens. Blood transfusion. Haemorrhage. Thrombosis. Infection causes. Spread. Infection screening. Specimen collection. Prevention. Barrier nursing. Reverse barrier nursing. Relevant Resource. books, education and resource files. books, education and resource files, blood transfusion literature and infection control policies. Laboratory staff. Mentor, ward staff, on call infection control team and policies. 12

15 Learning Opportunity. Clotting disorder. INR Warfarin Therapy Sub lux shoulder. Shoulder protocol. Muscle tone tightening / loss. Bot tox. Drop foot. Posture. Contractures of limbs and fingers. Brain tumours. C.V.A. T.I.A. Epilepsy. Parkinsons. M.S. Headaches. Infections. C.T. Scan. M.R.I. Scan. Learning Opportunity. Renal and Urinary System. Acute/chronic renal failure. Urinary tract infections. Urine testing. Specimen collection. Catheter insertion/removal. Fluid balance. Respiratory System. Chest infections. Aspiration. C.O.P.D. Asthma. Drugs, inhalers, nebulisers. Oxygen therapy. Tumours/lung cancer. Skeletal System. Rheumatoid/osteoarthritis. Infections. Osteoporosis. Assessment of falls. Relevant Resource. pharmacist, books, education and resource files. on call physios, Books, education files and resource files. stroke team, books, education and resource files. Relevant Resource. on call infection control team, books, education and resource files. books, education and resource files, on call pharmacy team, on call physios. on call physios, books, education and resource files, policies. 13

16 Management of falls. CLINICAL NURSING SKILLS Learning Opportunities. Administration of Medication. Using drug/iv/s/c charts. Oral medication. Nasal gastric / peg medication. Intravenous medication. Subcutaneous medication. S/C and I/V infusions. Controlled drugs. Controlled drugs audit. Aseptic technique. Dressings. Wound management. Catheterisation. Cannulation. Site IV/S/C venflon. Care of IV/S/C venflon. Obtaining blood specimens. Observation of obtaining blood gases. Clinical Devices. Using and checking: Infusion pumps. Syringe drivers. Space lab monitors. E.C.G. machine. Crash trolley/ defibrillator. B.M. machine. Urine testing machine. Relevant Resource. Mentor, ward staff, on call pharmacist, books, education and resource files, leaflets, medical staff. Mentor, and nursing staff, medical staff, on call infection control team. Mentor, ward staff, medical staff. cascade trainer, policies. 14

17 Learning Opportunity. Moving and Handling. Risk assessing patient. Use of equipment: Hoist. Slings. Glide sheets. Sam hall turner. Banana slide. Pat slide. Physiological Observations. Blood pressure. Temperature, pulse, respiration. Oxygen saturation s. Blood glucose. Urinalysis. Urine volumes. Weight. Maintaining accurate charts. Snobs. EWS score. ALERT. Preparation for Investigations. Obtaining consent information for each investigation. Administering the preparation. C.T. scans of head. C.T. scans chest/abdomen. Ultrasound scans. M.R.I. scans. Endoscopy. Sigmoidoscopy. Colonoscopy. Relevant resource. Mentor, ward staff, on call physios, risk assessment and policy file, education resource file. respiratory team, stroke team, education and resource files. endoscopy, sonar and ultrasound departments, books, literature, leaflets and policies. 15

18 Learning Opportunity. Risk assessment of the patient and the appropriate action. Falls. Mouth care. Nutrition. Risk of pressure damage. Documentation. Setting up equipment. Catheter insertion. Lumbar puncture. C.V.P. line insertion/removal. Wound dressing. Fine bore feeding tube insertion. Using specialist beds and chairs. Assessing patient for bed. Ordering beds. Types of beds and how to use them. Assessing patient for type of chair. Chairs available such as: Upright Parker knoll SUFFICK. Relevant resource. policies education resource files, policies. Mentor, ward staff, policies, on call physios. 16

19 COMMUNICATION SKILLS Learning opportunity Verbal communication. Using the telephone. Receiving / giving information. Bleep system. Fast bleep system. Multi-disciplinary handovers. Patient/relative enquiries. Non verbal communication. White boards. Boarders list. Staffing availability/bed forms. Computers. Potential complaints form. Computer skills. Understanding confidentiality. Access nursing documentation. Access A&E information. Use of trust e mail/intranet. Relevant resource Mentors ward staff, telephonists, doctors, porters. Mentors ward staff Mentor nursing staff, IT department Policy/procedure file. MANAGEMENT ISSUES 17

20 Learning opportunities Patient falls. Cardiac arrest. Fire. Violent issues. Missing patients. Security issues. Majax Audits Managing a team Staffing levels. Sickness issues. Staff movement. Supervision. Time management. Clinical governance issues. Delegation. Prioritising. Off duty Transfers to other hospitals/between departments Risk management Policies and procedures. Moving and handling Staff development. Site security. Infection control. Health and safety. Relevant resource Medical staff, ward staff, policies Nursing staff, medical staff, policies Nursing staff, 1104 beep holder, telephonist and fire officer, shift fitter. Nursing staff, 1200 bleep holder, security, hospital policeman. fire department, ward staff Ward staff, security staff, hospital policeman Nursing staff, 1200 and 1104 bleep holder senior nurse on call, A&E staff, director on call, ward staff, policies All nursing staff, Medical staff. Relevant resource Ward manager, Nursing staff Mentor policies/procedure files. Nursing staff, moving and handling facilitators. Ward manager, Nursing staff 1200 and 1104 bleep holders, security officer, on site policeman Ward staff, infection control on call team Ward staff, protocols health and safety officer 18

21 MANAGEMENT OF PATIENT CARE. Learning Opportunities. Use of:- Nursing model. Essence of care. Documentation used. Standards / protocols/ policies. Named nurse. Assessment. What is assessed? Who is assessed? How is assessment carried out? When is assessment carried out? Planning. Risk assessment tools. Care plans. Care pathways, i.e. stroke, or the dying patient MDT involvement, i.e. physio, OT Specialist nurses community based services. Discharge planning. Implementing / evaluation and documentation. Ward rounds. MDT meetings. Hospital at night team meetings. Care plans / documentation evaluation Documentation interventions. Relevant Resource. Mentor, ward staff, essence of care files, policy/procedure files, intranet, care plans/ pathways. Mentor, ward staff, policy/procedure files, patients/carers, medical notes, education resource files. Mentor, ward staff, specialist nurses, education/resource files, research literature. Mentor, ward staff, MDT team. MDT team members, patients / carers / relatives. 19

22 Learning Opportunities. Patient s hygiene. Mouth care. Skin care. Pressure area care. Continence. Washing/ dressing. Bathing. Nutrition. Nutritional assessment. Food charts. Supplements. Swallow assessment. Altered texture/thickened fluids. Feeding problems, i.e. positional Use of lap trays, straws, beakers. Nasal gastric feeding tubes and Peg tubes / insertion / care. Feeding regimes pumps. Communication. With patients, verbally and flash cards. Relatives, verbally, leaflets and pamphlets. Medical staff. MDT handovers, meetings, white boards. Referrals to other agencies. Relevant Resource. Mentor, ward staff, assessment tolls, education/resource files, research files, on call physio. Mentor, ward staff, education / resource files, research files, dysphasia trained staff on ward, policies / procedures. Mentor, ward staff, medical staff. MDT pathway. 20

23 Learning Opportunities. Difficult situations. Self discharge. Missing patient. Patient / staff / visitor incident / accident. Missing property. Deceased patients / verification of expected deaths/dnr orders. Religious needs. Special diets. Access to patients own particular religious representative. Time and place to prayer. Communication. Drug administration policy. Controlled drugs. Oral drugs. Intravenous drugs. Subcutaneous drugs. Anti embolic stockings. When / why to use. How to measure correctly. How to apply. Relevant Resource. policies /procedures, security staff, hospital policeman. chaplains. Mentor, ward staff, hospital chaplains, religious and cultural file, switch board. on call pharmacist, policies /procedures. policies / procedures, research files. STAFF DEVELOPMENT Learning opportunities Staff development Teaching sessions Relevant resource Nursing staff, ward manager education lead sister. 21

24 QUALITY ISSUES Learning opportunities Quality issues. Policies, Procedures. Standards of practice. Research. Clinical audits. Changing practice. Handling complaints. Clinical incident reporting. Relevant resource Mentor, nursing staff, doctors. Policy/procedure files Research articles, library, internet. Specialist nurses. 22