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CHILDREN’S THEATRES NEW VICTORIA WING ROYAL VICTORIA INFIRMARY DEPARTMENT PROFILE Welcome to Children’s Theatres. We are part of the Peri-Operative and Critical Care Directorate within the Newcastle Upon Tyne Hospital Trust, and also have close links with Children’s Services and Plastic Surgery. The suite is made up of 6 theatres with 5 currently in use. Autumn 2010 will see Orthopaedic surgery joining the suite. We are based within the New Victoria wing of the hospital, where all the Children’s wards will eventually be situated The department covers a broad spectrum of specialities, e.g. general surgery, plastics and reconstructive surgery, and so on. We also cover Children’s surgical emergencies on a 24-hour basis. The six Theatres are numbered 20-25. 20 is predominantly used for Plastic and General surgery, 21 and 22 are integrated laparoscopic Theatres, 23 and 24 have laminar flow facility, 25 is the Procedure room, slightly smaller than the other Theatres but useful for Painful procedure lists ,Endoscopy and Bronchoscopy. Theatre 24 will be the Orthopaedic Theatre, with 23 the designated Emergency facility. The suite has a dedicated reception area, where Children and their families are met by the Anaesthetic nurse. Toys are available while they wait. There is a ten bed Recovery room, which is staffed by a minimum of two nurses at any time. Changing facilities are within the Suite, with showers available if required. Rest room facilities include a vending machine ,fridges, freezers and microwaves. The department is the regional centre for Children’s surgery, therefore within it there is great scope for the development of your knowledge and skills. We welcome all levels of student nurse to the department and hope that you find your placement enjoyable and worthwhile. Before commencing your placement you will be allocated a mentor who will work with you throughout your placement. However, during your placement you will also be allocated co-mentors who you will work with so that you have a whole picture of the department. There are many skilled nurses working within the department who can pass on their knowledge and expertise to you. Shift Times/Off Duty The department operates on a number of shift patterns. It is preferable that you work the same shifts as your mentor ( at least 50% of the time), however there is flexibility if required. We tend to work one long day a week (7.30am-8.30pm) and three altering shifts. These are 0900-1700 and 08001730.Shifts may vary to suit the needs of the Department on any given day. Uniform As every person in the theatre needs to conform to infection control regulations, you will also wear the theatre greens with a pair of clogs and a hat, these are all supplied by the department. You will change in the theatre suite, and there is no need to wear your student nurse uniform to placement. Identification At all times you are expected to wear your university identity badge, and the theatre environment is no exception to this rule. February 2010 PROFILE OF LEARNING OPPORTUNITIES FOR PAEDIATRIC THEATRES KEY ELEMENT: INTERPERSONAL SKILLS RESOURCE/ LEARNING OPPORTUNITIES RELEVANT PERSONEL/ DEPARTMENT Use of Telephone: Answering calls Making calls Ring back, etc. Bleep & Telephone systems Use of the Computer: Tray tracking system Patient investigation results Patient information Internet & Trust intranet E-mail Talking to: Patients Relatives Multi-disciplinary team members Colleagues Ancillary staff Multi-disciplinary meetings & Medical ward rounds Facilitating investigations Nursing handovers Nursing staff/Medical staff/Health care assistants/Orderlies Nursing staff/Medical staff/Health care assistants Theatre & Ward sisters/Registered nurse/ Health care assistant/Medical staff/Multidisciplinary team/Specialist nurses/Research sisters/Orderlies Domestics/Porters Medical staff/Registered nurse/ Physiotherapist/Infection control team/ Pharmacist Registered nurse/Medical staff Registered nurse Managerial structure within the Trust Registered nure/Theatre & Ward sisters/ Clinical nurse manager/Speciality manager/ Modern matron Team working Observation of roles with the team – all team members Patient transfer within the Trust Patient transfer outside the Trust Patient/Relative/Bed co-ordinator/Ward staff Bed co-ordinator/Ward staff/Ambulance crew KEY ELEMENT: CLINICAL SKILLS RESOURCE/ LEARNING OPPORTUNITIES RELEVANT PERSONEL/ DEPARTMENT Patient hygiene: Skin care Pressure care Registered nurse/Health care assistant Recording of physiological observations: Blood pressure, Central venous pressure, Temperature, Pulse, Respirations, Oxygen saturations, Weight, Blood glucose, Fluid balance Maintaining accurate documentation Registered nurse/Anaesthetic & Recovery staff/Ward nurses/Medical staff Administering medication: Oral Intramuscular Intravenously Rectal Subcutaneously Intravenous infusions Care of cannulas & Central lines Venepuncture & Cannulation NG/NJ Phlebotomy Administratin of blood & blood products Registered nurse/Anaesthetic & Recovery staff/Ward nurses/Medical staff/Infection control team/Transfusion nurse/ Nutritional nurse/Dietician/Trust policies/Intranet/ Literature/Internet Aseptic Technique/Universal Precautions Theatre nurses/Anaesthetic & Recovery staff/ Health care assistants Nutritional intake Ward nurse/Nutritional nurse/Dietician Risk assessment: Falls Health & Safety COSHH Moving & Handling – use of patslide Infection Control: Handling blood-borne infection in the perioperative environment Hand hygiene policy Theatre wear policy Infection control policy – trust intranet Registered nurse/Theatre, Anaesthetic, & Recovery staff/Infection control team & Link nurse/Moving & Handling link nurse/Health care assistants/Orderlies Theatre nurse/Medical staff/Infection control team/Trusts policies – Intranet Theatre nurse/Medical staff/Health care assistants/Theatre sisters/Trusts policies Intranet KEY ELEMENT: CLINICAL SKILLS CONTINUED RESOURCE/ LEARNING OPPORTUNITIES RELEVANT PERSONEL/ DEPARTMENT Catheter Insertion & Care: Procedure for inserting catheter Urinalysis CSU MSU collecting Registered nurse/Medical staff Registered nurse Registered nurse/Health care assistant Faecal occult blood testing Registered nurse/Medical staff Arterial pressure monitoring: Patient safety Checking/setting up equipment Insertion & removal Arterial blood removal Scrubbing up Procedure: Handwashing Gowning up Gloving up Disinfection Policy: Registered nurse/Medical staff/Haematologist Theatre sisters/Registered nurse/Medical staff/Intranet/Trust policies/Literature/ Internet – NATN website Cleaning endoscopes Setting up medivator Theatre sisters/Theatre nurses/Health care assistants Risk assessment Theatre sisters/Theatre nurses/Medical staff/ Risk assessment officers Health & Safety Theatre sisters/Theatre nurses/Medical staff/ Health care assistants/ Health & Safety officers Preparation for investigations: Consent Information Invasive radiology Non-Invasive radiology [1] Registered nurse/Medical staff/Trust policies/ Intranet/Literature Radiologist/Radiology nurse/Trust policies/ Intranet/Literature KEY ELEMENT: MANAGEMENT OF CARE RESOURCE/ LEARNING OPPORTUNITIES RELEVANT PERSONEL/ DEPARTMENT Use of Nursing Model Philosophy of Care Documentation used Registered nurse/Theatre sister Registered nurse/Theatre sister Registered nurse/Theatre sister/Health care assistant Nursing Process: Assessment – Who assesses? How is assessment carried out/open or closed questions? What is assessed? Where does assessment take place? Registered nurse Sources of information Patient/Relatives/Notes/District nurse/ Transferring nurse nurse/Pharmacist/Specialist nurse Ward/Theatre communication concerning assessment issues Ward/Theatre personel Planning – Care Plans Risk assessment tools Care pathways Multi-disciplinary planning Discharge planning Registered nurse Link nurse Registered nurse/Specialist nurse/Medical staff Multi-disciplinary team Registered nurse/Medical staff/Patient/ Relatives Referrals to other agencies – Specialist nurses (child protection, laser nurse specialist, etc) Implementation/Evaluation – Multi-disciplinary team Documentation Standards Protocols Policies Communication with patients & relatives Registered nurse/Medical staff Registered nurse/Medical staff/Health care assistant/Orderlies/Physiotherapist/Infection control team/Dietician/Radiologists Registered nurse/Medical staff Registered nurse Registered nurse/Theatre sister/Trust Intranet/Medical staff Registered nurse/Medical staff/Trust Intranet – Royal Marsden handbook KEY ELEMENT: MANAGEMENT OF CARE CONTINUED RESOURCE/ LEARNING OPPORTUNITIES RELEVANT PERSONEL/ DEPARTMENT Time Management Registered nurse Planning priorities Registered nurse/Medical staff Dealing with difficult situations Registered nurse/Theatre sister Deceased patients Patient property/valuables Refusal of operation Religious needs – Arranging priest, communication, etc Registered nurse/Theatre sister/Bereavement officer/Chaplain/Priest Registered nurse/Health care assistant Registered nurse/Medical staff/Ward manager/Theatre sister/Specialisty manager Registered nurse/Medical staff/Hospital chaplian/Priest/Interperator KEY ELEMENT: ORGANISATIONAL AND MANAGERIAL ISSUES RESOURCE/ LEARNING OPPORTUNITIES RELEVANT PERSONEL DEPARTMENT Managing a Team: Organisational skills Delegation skills Prioritising skills Time Management Leadership Off-Duty Managing patient work load Quality Standards of care Registered nurse/Theatre sister Registered nurse/Theatre sister Registered nurse/Theatre sister/Medical staff All Theatre staff Senior nurses/Theatre sister Senior nurses/Theatre sister Registered nurse Registered nurse/Theatre sister/Audit tool Registered nurse/Theatre sister Implementing change Registered nurse/Theatre sister/Medical staff Giving information to – Staff Theatre sister/Speciality manager/Modern matron/Registered nurse Medical staff Theatre sister/Speciality manager/Registered nurse/Multi-disciplinary team/Theatre staff/ Ward staff Patients & Relatives Registered nurse/Theatre sister/Medical staff/ Anaesthetics & Recovery staff/Health care assistant Multi-disciplinary team members Registered nurse/Medical staff/Theatre sister Other departments Radiologist/Histopathology/etc Resources: Stock control Drugs Materials management Non-stock Stationary Establishment/Skill-mix Budget control Managing risk: Policies & Procedures – Safeguards for Invasive procedures Senior nurses/Theatre sisters Registered nurse/Pharmacist Senior nurses/Theatre sisters Registered nurse/Health care assistant Registered nurse/Theatre sisters Senior nurses/Theatre sisters Theatre sisters/Speciality manager/Senior nurses Theatre sisters/Senior nurses/Medical staff/Trust Intranet KEY ELEMENT: ORGANISATIONAL & MANAGERIAL ISSUES CONTINUED RESOURCE/ LAERNING OPPORTUNITIES RELEVANT PERSONEL/ DEPARTMENT Managing risk continued: Equipment safety checks – Bi-polar & diathermy machines, etc Health & Safety officer/Electronics/Registered nurse/Health care assistant Quality control Theatre sister/Registered nurse Infection control Theatre sister/Registered nurse/Infection control team & link nurse/Health care assistant Moving & Handling Moving & Handling link nurse/Health & Safety advisor/Registered nurse Emergency situations: Cardiac arrest Cardiac arrest team/Registered nurse/Medical staff/Anaesthetist & anaesthetic nurse Fast bleep system Registered nurse/Switchboard Violen incidents Registered nurse/Medical staff/Theatre sister/ Security officer Fire Theatre sister/Registered nurse/Fire officer Patient falls Registered nurse/Health & Safety officer Staff Development: Clinical supervision Registered nurse/Theatre sister Reflective practise Registered nurse/Theatre sister Preceptorship/mentorship Registered nurse/Theatre sister KEY ELEMENT: PATHOPHYSIOLOGICAL PROCESSES RESOURCE/ LEARNING OPPORTUNITIES RELEVANT PERSONEL/ DEPARTMENT INFECTION: Inflammatory process: Source Cross infection Treatment IMMUNOLOGICAL FACTORS: Antigens Suppression of immune system Drugs Rejections SCIDS Medical staff/Registered nurse/Literature/ Internet/Trust Intranet/Infection control team/Pharmacist Medical staff/Registered nurse/Pharmacist/ Literature/Internet/Transplant team/ Immunologists DISTURBANCES IN ELECTRLYTE BALANCE: Normal electrolyte balance Analysing blood results Dehydration Acidosis Medical staff/Registered nurse/Laboratory staff ONCOLOGY: Aetiology Pathology Treatments, Chemotherapy, Intratechal medications, Bone marrow aspirates & harvests, Bone marrow transplants, Insertion of CVC Lines & Portacaths CARDIOVASCULAR SYSTEM: Anatomy & physiology Investigations Treatment regimes Cardiac arrest Defibrillation Cardiac arrhythmia’s ECG’s Medical staff/Registered nurse/Palliative care team (Ward 16 multi-disciplinary team)/ Radiologists/Haematologists/Pharmacist Medical staff/Registered nurse/Anaesthetic staff/Cardiac arrest team/Cardiology team/ Pharmacist KEY ELEMENT: PATHOPHYSIOLOGICAL PROCESSES CONTINUED RESOURCE/ LEARNING OPPORTUNITIES RELEVANT PERSONEL/ DEPARTMENT RESPIRATORY SYSTEM: Anatomy & physiology Investigations Infections Oxygen therapy Continuous Positive Airway Pressure (CPAP) Treatments Drugs, Nebuliser therapy Analysis of blood gas monitoring Collection of B.A.L specimens Tracheostomy – permanent & temporary Tracheoscopy, Laryngoscopy, & Brochoscopy Laser treatment Medical staff/Anaesthetist/Anaesthetic nurse/ Registered nurse/Medical physics officer/ Physiotherapist/Respiratory consultant/ Pharmacist LIVER & BILIARY SYSTEM: Anatomy & physiology Hepatitis B Paracetamol overdose Liver tumours & biosies of these tumours Symptoms of liver disease – jaundice, ascites, encephlopathy Medical staff/Registered nurse/Hepat-biliary nurse specialist/Literature/Palliative care team Nutrition Treatments Dietician/Registered nurse/Medical staff Medical staff/Registered nurse/Pharmacist BLOOD DISORDERS: Blood formation & destruction process Red blood cells White blood cells Platelets Clotting factors Lymphoma Oesophageal Variceal haemorrhage & banding Endoscopy procedures Blood transfusion DVT Medical staff/Registered nurse/Haematologist/Heamatology nurse/Literature/Gastroenterologists/ Endoscopy unit/Transfusion nurse/ Trust intranet – policies & procedures KEY ELEMENT: PATHOPHYSIOLOGICAL PROCESSES CONTINUED RESOURCE/ LEARNING OPPORTUNITIES RELEVANT PERSONEL/ DEPARTMENT ENDOCRINE & METABOLIC DISEASE: Diabetes mellitus Long term use of steroids & administration of high dose steroids NERVOUS SYSTEM: Encephlopathy Infections Drugs Medical staff/Registered nurse/Diabetic nurse specialist/Diabetologist/Pharmacist/Literature Trust Intranet – policies Medical staff/Registered nurse/Microbiologist/Pharmacist/Literature/ Trust Intranet – policies SKELETAL SYSTEM: Craniofacial Procedures – Cleft palates Treatments Drugs Plating/Wiring/Fixations Removal of accessory digits Medical staff/Registered nurse/Cleft palate team/Radiology/Pharmacist/Ward staff/ Anaesthetist BURNS: Classification of Burns Causes of burns Treatment & Dressings Drugs & Therapies Skin grafts Fluid resucitation Medical staff/Registered nurse/Ward staff/ Pharmacist Specialist Nurse Matro n Orderlies Consultants and Medical Staff Ward 1 Ward 6 BMT 23 Social Services PICU NGH 24 + 26 Radiographers Oncology Gastroenterology UNN ENT Airways Ward 8 Orthopaedics FINANCE Community CHILDREN’S THEATRES RVI Burns and Plastics Out Patients Intensive Care Neo Natology General Surgery Ward 9 Ward11 STERILE SERVICES Cardio FRH Technical Services ie. Medical Physics, Electronics, Anaesthetic Technician Ward 14&16 Ward 35 SENIOR THEATRE NURSE Ward 9 DIRECTORATE MANAGER