Download ROYAL FREE INTER- NATIONAL ROYAL FREE INTERNATIONAL

ROYAL FREE
INTERNATIONAL
ROYAL
FREE INTERPROSPECTUS
NATIONAL
Training
opportunities
Training
opportunities
forfor
internainternational
nurses
and midwives
tional
nurses and
midwives
Welcome...
Royal Free International prospectus - Training opportunities for international nurses and midwives
Contents
About the Royal Free
4
About this prospectus
6
Why choose the Royal Free?
8
Training opportunities by specialty:
Accident and emergency
12
Cancer and haematology
13
Critical care
17
Diabetes
21
Gastroenterology
23
Haemophilia and thrombosis
25
Health services for elderly people
28
Hepatology (liver) nursing
30
Infection prevention and control
32
Infectious diseases
36
Midwifery
38
Ophthalmology
44
Orthopaedic nursing
45
Paediatric nursing
46
Palliative care
48
Patient at risk resuscitation team
49
Productive ward initiative
51
Radiotherapy
53
Renal
54
Surgery
56
Tissue viability
58
Contact information
60
3
4
Royal Free International prospectus - Training opportunities for international nurses and midwives
About the Royal Free
THE ROYAL FREE IS ONE
OF THE UK’S LARGEST
LEADING TEACHING AND
RESEARCH HOSPITALS
AND A MEMBER OF THE
WORLD-RENOWNED
NATIONAL HEALTH
SERVICE (NHS).
Our vision is to deliver world class care and expertise in services, research and teaching.
Our specialties include liver, kidney and bone marrow transplantation, plastic and
reconstructive surgery, amyloidosis, haematology, haemophilia, hepatology,
immunology, infection prevention and control, infectious diseases, neuroendocrine
tumours, renal and vascular services and we attract patients nationally and
internationally to our services.
Royal Free International prospectus - Training opportunities for international nurses and midwives
Our patients have access to leading
specialists and some of the latest
drugs and treatments linked to
world-class medical research and
innovations. As well as our services
at the Royal Free Hospital in north
London, we also run clinics and
services at other local hospitals and
NHS sites. The collective name for
all of our services is the Royal Free
London NHS Foundation Trust.
As a teaching hospital, we are
proud to play a pivotal role in
shaping the future healthcare
workforce. We are a campus of
University College London
(UCL) Medical School
and Middlesex
University and train
doctors, nurses,
midwives and many
other clinical and
non-clinical
professionals. We
conduct research
of international
status and are a
founding
member of
UCLPartners,
one of the
world’s
leading
centres of medical
discovery, healthcare
innovation, improvement
and education.
Through Royal Free
International (RFI), a
department of the Royal
Free, we aim to share and
exchange expertise and
experiences to advance
education, training and
research and improve
healthcare services globally
to benefit patients
worldwide.
The Royal Free was
established in 1828 and
5
has a long history of delivering world class services, teaching and research.
We were the first hospital in the UK to provide free hospital care to those
who could not afford treatment and to accept women as medical students.
On July 2014, we successfully acquired the Barnet and Chase Farm Hospitals
in North London, making us one of the largest hospitals in the country. These
two hospitals have more than 170 years of 130 years history respectively. We
work across more than 30 sites including our work in the community.
Today, our areas of excellence include:
Amyloidosis: the only centre in the
UK specialising in these disorders
which occur when proteins called
amyloid are abnormally deposited in
organs, causing disease.
Breast surgery: the only
hospital in the UK to offer
breast positron emission
tomography (PET) and a
pioneer of other novel
breast cancer
treatments.
Cardiology: one of
London`s designated
heart attack centres
and a major
training centre for
interventional
cardiology and
complex
devices. World
class centre
for pulmonary
hypertension,
amyloid and carcinoid heart
disease with major research
programmes.
Haematology: a major bone
marrow transplantation
centre, world class services
for myeloma and lymphoma,
leading treatment and
research centre for acute
lymphoblastic leukaemia and
one of six nationally
designated units in the UK
for lysosomal storage
disorders.
Haemophilia: hub for north
London and world-renowned
for research and training.
Liver services: a major
transplantation centre and one of
the UK’s leading centres for the
diagnosis and treatment of liver
disease.
Immunology, infection
and transplantation: groundbreaking research institute, one
of only five of its type in the
world and one of only two high
security infectious diseases units
in the UK.
Infection prevention
and control: award-winning team
and one of the best performing
teaching hospitals in the UK for
MRSA bacteraemias.
Oncology: European centre of
excellence for neuroendocrine
tumours.
Plastic and reconstructive
surgery: one of the UK’s leading
and largest plastic surgery units
and a major teaching and research
centre. A national centre of
excellence for facial re-animation
surgery, ear and breast
reconstruction.
Renal services: a major
transplantation centre and
nationally-recognised specialties
including one of just a few units
in the UK to specialise in
recurrent kidney stones.
Recommended by London
Cancer as the preferred provider
for specialist renal cancer surgery.
Vascular services: hub for north
central London providing world
class services including EVAR
(endovascular aneurysm repair).
“
“
6
Royal Free International prospectus - Training opportunities for international nurses and midwives
About this prospectus
FOR US WHO NURSE, OUR
NURSING IS A THING
WHICH, UNLESS WE ARE
MAKING PROGRESS EVERY
YEAR, EVERY MONTH,
EVERY WEEK, TAKE MY
WORD FOR IT, WE ARE
GOING BACK...
Florence Nightingale
Nurses and midwives are now
delivering care in a more
challenging environment, with an
ageing population and an
increasing number of people with
long-term conditions. There is an
increasing need for nurses to
extend their role and scope of
practice and to deliver nurse-led
services. We aim to use our
extensive experience to help nurses
and midwives advance and equip
themselves to meet these needs
and ensure patients are getting the
most effective evidence-based care.
This prospectus outlines the
opportunities we have available for
international nurses and midwives
to enhance their skills, knowledge
and experiences and advance their
career opportunities. It is organised
alphabetically by specialty.
The professional development
programmes take a range of
formats, including:
Observerships: taking on the
role of ‘observer’ and shadowing
nurses/midwives and/or
multidisciplinary teams in their
clinical settings.
Workshops: interactive
teaching sessions with practical
elements.
Lectures: educational talks.
Simulation-based training:
skills training workshops based
on real-life scenarios; can involve
the use of virtual reality
simulators.
Observerships usually last weeks or
months, whereas the other
training sessions are short courses
lasting anything from 30 minutes
to one day. These short courses
can be included within an
observership programme, delivered
as stand-alone training here at the
Royal Free Hospital or, in some
cases, delivered in your own
country (please see below for
further details). All programmes
are tailor-made to suit individual
needs and a mix and match
combination of topics/specialties
may also be possible.
Courses in other specialties not
listed within this prospectus can
also be arranged. Please contact us
to discuss your needs further.
?
Royal Free International prospectus - Training opportunities for international nurses and midwives
Pre-requisites, requirements
and costs
All training programmes are aimed
at qualified nurses and midwives
who are keen to develop the skills
needed to play a leading role in
their chosen specialty. All
participants must:
✓ Have an excellent command of
verbal and written English.
✓ Fully meet all costs of the
training programme, travel,
accommodation and living
expenses (temporary on-site
accommodation can sometimes
be arranged for nominated staff
at an extra cost).
✓ Achieve a 95% minimum
attendance rate on the
programme.
✓ Complete assessments of
Participants will be based at the
Royal Free Hospital where they
may study alongside
professionals from other
countries on the same course.
Travel to off-site units may be
necessary depending on the
specialty chosen. In all cases the
qualification gained is an inhouse certificate of attendance.
Costs of the programmes vary –
please contact us to discuss this
further – and some
programmes have a restricted
intake per year.
We are continually developing
our services and as a result
courses advertised within this
prospectus may also be subject
to change.
Delivering training in
your home country
knowledge and skills where
applicable.
diary.
In order for us to visit you, you must:
✓ Complete pre, mid and post
programme interviews or
evaluations.
✓ On completion of the
programme, deliver a 20-minute
presentation to Royal Free
clinical teams on what they will
take back to their organisation.
✓ Adhere to the Royal Free dress
code for infection control
purposes.
✓ Submit a list of educational
objectives.
Did you
know
Our nursing and midwifery
workforce has a rich skill mix,
ranging from consultant and
senior nurses/midwives, clinical
nurse specialists and lecturer
practitioners to general
nurses, assistant practitioners
and healthcare support
workers. They are educated at
diploma and degree level and
some to doctorate level. Many
have contributed to academic
research and publications and
are experts in their specialty.
In some cases, our staff are able to travel to you to
conduct training in your country or help you develop
your services by offering consultancy support. This first
involves conducting a detailed training/service needs
analysis.
✓ Complete a clinical learning
7
• Meet the costs of travel and accommodation as well
as the cost of the training.
• Mutually agree on training/consultation session(s)
topics prior to the visit.
• Ensure the Royal Free expert works a maximum of
seven hours per working day while working with you.
• Provide access to clinical areas and current policies
when necessary.
Please browse through our specialties and contact us to discuss your
needs further by emailing [email protected] or calling
+44(0) 20 7794 0500 x 36347 or +44 (0) 20 7472 6252.
8
Royal Free International prospectus - Training opportunities for international nurses and midwives
Why choose
the Royal Free?
Ranked among the best hospitals in England for
mortality and infection rates
More than 180 years’ experience in providing patient care
A campus of UCL Medical School
Innovator for hospital planning, service redesign and
driving efficiency and productivity
A founding member of the academic health science partnership
UCLPartners which brings together 100,000 clinicians and academics
who concentrate on finding ways to improve people’s health
through new research and innovation
Highly-skilled and knowledgeable clinical staff, many of
whom are leaders in their field and have contributed to
international research and publications
Royal Free International prospectus - Training opportunities for international nurses and midwives
9
One of the UK’s leading or largest centres for a
range of specialties.
Tertiary care specialist hospital and one of the
UK’s leading or largest centres for a range of specialties
One of the UK’s leading teaching and
research hospitals
A reputation for world class research and home to the Institute of
Immunity, Infection and Transplantation – a ground-breaking research
institute, one of only five of its type in the world
Employ 10,000 staff from more than 100 nationalities
Annual turnover of £924million
Around 1500 beds (one of the largest hospitals in the UK) providing
more than 1.6million episodes of care every year and more
than 30 services in the community
Pioneer of innovative care pathways, eg Sepsis six mobile app
and triage rapid elderly assessment team (TREAT)
10
Royal Free International prospectus - Training opportunities for international nurses and midwives
Royal Free
hospital
Hampstead
Belsize park
More than 800 bookshops
and over 380 public libraries
including the British Library
which holds the Magna Carta.
More than 300 music venues
hosting more than 17,000
music performances every year.
Four United Nations
Educational, Scientific and
Cultural Organization
(UNESCO) world heritage sites.
More live comedy than any
other city in the world.
Royal Free International prospectus - Training opportunities for international nurses and midwives
11
Thousands of restaurants
and supermarkets
offering food choices
from all over the world.
More than 170 museums.
Around 250 festivals each
year.
At least 200 shows to
choose from every day in
the city’s famous West End.
Three of the top ten
museums and galleries in the
world and 857 art galleries.
Our location
As well as our reputation for world class services,
teaching and research, the Royal Free is a great place to
receive training as it is situated in London, the capital of
England and one of the world’s most culturally vibrant
cities. There are more than 300 languages spoken in
London, more than in any other city in the world.
You could use your spare time to visit one of the many
iconic London landmarks or enjoy cultural and leisure
activities such as shows, festivals, films, concerts, comedy
gigs, museums, galleries, top restaurants, shopping and
much more.
12
Royal Free International prospectus - Training opportunities for international nurses and midwives
Accident and
emergency
PROFESSIONAL DEVELOPMENT PROGRAMMES
Our accident and
emergency (A&E)
department provides an
emergency medical service
24 hours a day, 365 days a
year, dealing with problems
varying from the minor to
the life-threatening.
In general the department
cares for patients who require
immediate care, either as a
result of an accident or a
medical or surgical
emergency. The department is
divided into a children’s area,
an adult area, a GP-led urgent
care centre and a clinical
decision unit that organises
short stay admissions for
patients who do not require
formal admission to the main
hospital as an in-patient.
It is staffed by a team of
consultants specialising in
emergency medicine along
with specialist A&E nurses
including emergency nurse
practitioners and is led by
two matrons. They are
further supported by
emergency department
assistants, radiographers,
housekeepers, porters and
administrative staff.
TYPE OF TRAINING
Observership for maximum 2 people at a time or workshop for >5 people
CONTENT
Individualised programme covering any or all of the following areas:
▶
•
•
•
•
•
Role of the nurse practitioner and nurse-led services:
pre-nurse practitioner and pre-emergency care nurse roles
minor injuries and treatment
plastering
suturing
competency framework for minor procedures
▶ Role of the triage nurse:
• patient assessment (prioritising patients being seen)
• quarterly triage study day
▶ Processes:
• managing waiting times
PRE-REQUISITES
Qualified nurse
DURATION
1- 2 weeks
Royal Free International prospectus - Training opportunities for international nurses and midwives
Cancer
and
haematology
Our nurse-led chemotherapy day
care unit provides chemotherapy
administration to oncology and
haematology patients who do not
need to stay in hospital for
treatment. The unit is staffed by
nurses who are certified in
chemotherapy administration and
who are able to provide other
services including PICC line care,
venesections and the administration
of supportive therapies.
Our haematology services cover
various forms of leukaemia,
lymphoma, myeloma, bone marrow
transplants, lysosomal storage
disorders and a late-effect service.
The department teaches
undergraduate and postgraduate
medical, technical and scientific
students and all clinicians in the
department are actively engaged in
research and have national and
international reputations. As well as
providing well-established
treatments in a comfortable and
highly professional setting, the
department also offers a wide range
of clinical trials for patients who
may benefit from new therapies
which are not routinely available.
13
The Royal Free’s cancer
services specialise in the
treatment of cancer and
tumours with radiotherapy,
chemotherapy and other
medicines, such as hormones,
in conjunction with this.
PROFESSIONAL DEVELOPMENT PROGRAMMES
TYPE OF TRAINING
Lectures/workshops
CONTENT
Oncology
Individualised programme of lectures and workshops covering any or
all of the following:
▶
•
•
•
•
Common cancers:
breast
upper/lower gastrointestinal
prostate
lung
▶
•
•
•
•
•
Knowledge transfer:
developing policies and protocols
role of the oncology clinical nurse specialist
competency framework
nurse-led services model
patient-focussed care
▶ Treatment modalities:
• chemotherapy including pre-chemotherapy assessment, symptom
management, extravasation and spills
• radiotherapy
• surgery
• combined options
• symptoms management
▶
•
•
•
Central line care:
PICC line insertion
porta-cath access
central line dressing
PRE-REQUISITES
Nurse with previous experience of looking after patients with cancer
DURATION
2-3 days
?
14
Royal Free International prospectus - Training opportunities for international nurses and midwives
Did you know
TYPE OF TRAINING
Observership
CONTENT
Bone marrow transplantation (BMT)
Individualised programme covering any or all of the following:
•
•
•
•
•
•
•
•
planning a bone marrow transplant - autologous and allogeneic
patient journey from pre to post transplant
in-patient care (including stem cell administration)
supportive care
the multi-disciplinary team
post-transplant follow up and care
apheresis and donor care
accreditation process and documentation
PRE-REQUISITES
Post registration nurse with haematology and BMT experience
DURATION
The Royal Free has the
largest myeloma clinic in
the UK.
3-5 days
We are one of six nationally
designated units in the UK
for lysosomal storage
disorders.
Observership
TYPE OF TRAINING
CONTENT
Haematology
Our patients benefit from
world-class lymphoma
diagnosis through the
leadership of Dr Peter
Issacson, who has
contributed substantially to
the modern day
classification of lymphoma.
Individualised programme covering knowledge and management of
lymphoma, leukaemia, myeloma and myeloproliferative neoplasms, including:
• the role of the haematology nurse and clinical nurse specialist
• the patient journey from diagnosis through to treatment/in-patient stay and
follow up care
• patient information and education
• out-patient clinic consultations
• the multi-disciplinary team and diagnostic MDT meeting
• chemotherapy and radiotherapy in haematology
• the ambulatory care setting
• patient support groups
PRE-REQUISITES
Post registration nurse with an interest in haematology. Experience desirable.
DURATION
3-5 days
Royal Free International prospectus - Training opportunities for international nurses and midwives
Neuroendocrine
tumours
We were the first centre in the
UK to be awarded European
centre of excellence and we
receive referrals from across
the UK and internationally.
Our aim is to provide optimal
management for patients with
neuroendocrine tumours,
taking into account how the
tumour affects each
individual. We work within a
multidisciplinary team and aim
to enhance the prospects for
treatment by a combination of
clinical and laboratory
research.
The unit conducts a number
of clinical and basic science
research trials relating to the
treatment of, and the
pathogenesis of, NET
development. The NET unit
clinicians and researchers
collaborate with clinicians and
research staff in the UK and
abroad.
Our neuroendocrine
tumour (NET) unit has an
international reputation
for the management of
neuroendocrine tumours,
a rare type of cancer.
PROFESSIONAL DEVELOPMENT PROGRAMMES
TYPE OF TRAINING
Lecture
CONTENT
Diagnosis and types of NETs
PRE-REQUISITES
Nurse with some experience of dealing with oncology, endocrine,
gastroenterology or NET patients.
DURATION
45 minutes
TYPE OF TRAINING
Lecture
CONTENT
Treatments for NETs
PRE-REQUISITES
Nurse with some experience of dealing with oncology, endocrine,
gastroenterology or NET patients.
DURATION
45 minutes
15
16
Royal Free International prospectus - Training opportunities for international nurses and midwives
TYPE OF TRAINING
Observership
CONTENT
Individualised programme covering any or all of the
following areas:
• lectures as outlined above
• types of NETs eg gastro-intestinal NETs, bronchial NETs,
phaoechromocytomas/ paragangliomas, medullary
thyroid cancer (MTC), adrenal cortical cancer (ACC),
high grade NETs, goblet cell carcinomas, MEN-1 and
other genetic disorders
• specialist investigations eg PET, MIBG, secretin test,
72 hour fast
• treatment options eg surgery, somatostatin (SSTs)
analogues, chemotherapy, peptide receptor targeted
therapy (PRRT), Interferon (IFN), Sunitinib, Everolimus
• research programmes
• role of the multidisciplinary team
• symptom management including special considerations
ie carciniod and phaeo crisis and Zollinger-Ellison
syndrome (ZES)
• developing nurse protocols
• role of the clinical nurse specialist within the
multidisciplinary team and in the care of the NET patient
• nurse-led clinics - face to face and telephone
• nurse-led discharges and admissions
• patient support initiatives and links to national
groups - setting up patient support days and patient
satisfaction surveys
PRE-REQUISITES
Nurse with some experience of dealing
with oncology, endocrine,
gastroenterology or NET patients.
DURATION
1-2 weeks
Royal Free International prospectus - Training opportunities for international nurses and midwives
Critical care (ICU)
PROFESSIONAL DEVELOPMENT PROGRAMMES
The Royal Free is home
to a state-of-the-art
£11.8million intensive
care unit (ICU) which
has 34 beds.
TYPE OF TRAINING
Lectures (on any of these topics) or observership
CONTENT
Individualised programme covering any or all of the following areas:
We are a major tertiary
referral centre for medical
and surgical specialties
and the ICU provides
services to support all inpatient specialities
including hepatobiliary
surgery, hepatology,
complex vascular surgery,
infectious diseases, and
haematology. The Royal
Free also has an active
organ transplant
programme and the ICU
cares for more than 70
liver transplant recipients
each year. In total, the
department sees more
than 1,100 patients a year.
The unit has 24-hour
consultant cover by a
specialist in intensive care
medicine and all care is
consultant led. Each
consultant is supported
by a team of junior grade
doctors who are at
different stages of their
training. A senior nurse
leads each shift on each
unit.
▶ Cardiovascular care:
• factors affecting BP, CO, SVR
• normal fluid balance
▶
•
•
•
•
•
•
•
•
•
•
•
Cardiovascular assessment:
clinical assessment
basic cardiovascular monitoring
knowledge of the skills relevant to a cardiovascular assessment
including assessment of determinants of cardiac output eg heart
rate, stroke volume, blood pressure, CVP
assessment of systemic and peripheral perfusion eg urine output
and peripheral temperature
interpreting data obtained and recognising common cardiovascular
pathology
indications for, and types of, haemodynamic monitoring
advantages and disadvantages of haemodynamic monitoring
including invasive arterial pressure
care associated with invasive and non-invasive haemodynamic
monitoring
interpreting results and identifying nursing priorities associated with
abnormal haemodynamic data
cardiac output measurement devices
17
18
Royal Free International prospectus - Training opportunities for international nurses and midwives
▶ Shock and sepsis:
• basic understanding of shock
and sepsis
• pathophysiology related to the
general compensatory shock
response
• differing pathophysiology and
clinical presentation of
hypovolaemic, septic and
cardiogenic shock
• patient fulfilling criteria for SIRS,
sepsis and septic shock
▶
•
•
•
•
•
•
•
•
•
•
•
•
Rhythm recognition:
common arrhythmia
arrest rhythms
components of normal sinus
rhythm
practical technique for
methodically analysing an ECG
rhythm
narrow and broad complex
arrhythmias and their aetiologies
atrial fibrillation, atrial flutter,
SVT, junctional and ventricular
ectopics and the presence of a
heart block and their potential
causes
fluids and inotropes
principles of cardiovascular
interventions
types and components of
common fluids used
principle behind fluid challenges
indications for, and actions of,
adrenaline, noradrenaline and
dobutamine
nursing considerations and
observations associated with the
use of inotropic therapy
(including route of
administration, weaning drugs,
compatibilities)
▶ Clinical respiratory assessment:
• common causes of respiratory
and metabolic acid-base
imbalances
• management strategies for
respiratory and metabolic acidbase imbalances
• SpO2/pO2 and Oxygen
• arterial blood gases sampling
and acid/base analysis
• normal values/ derangement and
compensation
▶ Non-invasive respiratory support:
• ventilation / perfusion mismatch
and ventilatory ‘pump failure’
and their consequences
• appropriate use and expected
benefits of continuous positive
airway pressure (CPAP) or noninvasive support therapies (NIV)
• nursing priorities and
interventions for patients on
non-invasive respiratory support
▶ Intubation and artificial airways:
• role of the nurse during
intubation of a patient
• assisting intubation
• caring for a patient with an
artificial airway
• types of endotracheal and
tracheostomy tubes and the
indications of use
• indications for intubation
• equipment used and sequence of
events for a ‘straightforward’
intubation
• routine safety considerations
associated with managing a
patient with an artificial airway
(eg cuff pressures, noting lip
level)
• methods of ensuring airway
maintenance including
humidification, secretion
clearance and the use of inner
tubes
• suctioning patients (when and
how)
• airway emergencies and possible
interventions related to artificial
airways
• communication issues associated
with artificial airways and how
these might be addressed
• specific tracheostomy care
▶ Basic invasive ventilation:
• basic concepts underlying
invasive ventilation
• nursing observations appropriate
for a ventilated patient
• volume and pressure control
ventilation and the ventilator
settings needed for each
• principles underlying SIMV,
pressure support, bi-level and
triggering
▶ Weaning and rehabilitation:
• ventilator weaning and possible
methods
• factors to be considered prior to
attempting to wean a patient
from ventilation
• clinical signs associated with
failure to cope with a reduction
in respiratory support
• techniques that can help with
patients on a long-term wean
• rehabilitation for ICU patients
• discharge from the unit
▶ Extubation:
• criteria for extubation and
nursing interventions before,
during and after
• safe extubation of a patient
• common post extubation
problems and possible
interventions
▶ Renal:
• assessment for acute kidney
injury (AKI)
• conservative management of AKI
in the critically ill patient
• predisposing factors of AKI in
critical illness
• renal assessment and patient
developing AKI
• conservative management
strategies for AKI, eg for high
potassium and fluid overload
• indications for renal replacement
therapy
▶
•
•
•
Sedation, analgesia and delirium:
indications for sedation
assessing level of sedation
basic knowledge of commonly
used sedative drugs
• difficulties associated with
assessing pain in a sedated
patient
• importance of, and possible
methods for, nonpharmacological pain relief
▶ basic knowledge of commonly
used analgesics
• indications for paralysing agents
• nursing implications of caring
for a patient receiving
analgesics, sedatives and
paralysing agents
• delirium and contributing factors
Royal Free International prospectus - Training opportunities for international nurses and midwives
19
20
Royal Free International prospectus - Training opportunities for international nurses and midwives
Nayab Nadeem
Final year medical student from Pakistan
▶ Neurology:
• Glasgow coma scale (GCS)
the
completed a medical observership in
3.
201
and
2
201
Royal Free’s ICU in
assessment
• components of the CGS
• assessment of consciousness and
focal neurology
• difficulties assessing critically ill patients
▶ Psychosocial issues:
• psychosocial issues within the critical care setting
• psychosocial issues relevant to patients, staff and
family members
• strategies used to support patients, staff and
family members
• psychological issues pertinent to the admission
•
•
•
•
and discharge of ITU patients
needs of the dying patient and their relatives
role of nurses caring for the dying in critical care
legal and ethical principles concerning death in
critical care settings
psychosocial issues affecting long term patients
in intensive care and possible nursing
interventions
▶ Nutrition:
• provision of nutrition for ICU patients
• predisposing factors associated with
malnutrition in the critically ill
• nutritional assessment tools available and the
limitations associated with their use
• role of the nurse in the management of nutrition
• enteral and parenteral nutrition and their
advantages and limitations
• nasogastric (NG) tube policy
▶ Infection control:
• reasons why critically ill patients are
She said: “Coming to the Royal Free and spending
time on the ITU was an amazing experience. The unit
is run very efficiently by a highly dedicated team of
nurses and doctors. The staff are very welcoming
and there is a lot of opportunity for learning. The
patients are meticulously monitored and managed.
“By being on the unit I got to know a lot about how
it functions. Detailed handover to help with
continuity of care; the electronic reporting system for
easy access; infection control practices; review of
patients by the microbiology team; input of
pharmacists, physiotherapists and nutritionists to
cover all facets of care; and adherence to protocols
for the management of various conditions are some
of the things that I learnt about during my time here.
“I am very glad that I came to an ITU where
the highest standards of patient care are
maintained and the experience has been of
great value to me - it has completely
changed the way I viewed medical
specialties and I feel very motivated to
pursue intensive care as a specialty in the
future.”
immunocompromised
• nursing strategies to minimise the risks of patients
acquiring infections
• potential difficulties in implementing infection prevention
and control and its appropriate nursing interventions
PRE-REQUISITES
Qualified nurse
DURATION
Negotiable
Royal Free International prospectus - Training opportunities for international nurses and midwives
21
Diabetes
PROFESSIONAL DEVELOPMENT PROGRAMMES
Our diabetes team
provides extensive
in-patient and outpatient services
using a
multidisciplinary
approach that
covers all aspects of
diabetes care for
adults.
We aim to improve the
health of people with
diabetes via education,
training, research and
through the service we
provide and work
closely with other
hospital departments,
local healthcare
organisations and
primary care
colleagues.
More than 20 people
work within the
department including
specialist nurses,
dietitians, podiatrists, a
clinical psychologist
and a medical team of
three consultants
supported by
secretarial staff. We
offer consultant-led
clinics, nurse-led clinics
and specialist clinics
including antenatal,
renal and a clinic for
adolescents.
TYPE OF TRAINING
Observership
CONTENT
Individualised programme covering any or all of the following areas:
▶
•
•
•
•
•
•
•
•
•
▶
•
•
•
•
•
•
•
Role of the diabetes nurse specialist:
nurse-led clinics
advanced practice
hypo/hyperglycaemia management
acute care
primary care
complex diabetes management
outreach services (eg joint renal/diabetes services)
health promotion
fully integrated pathway between primary and secondary care
Education and knowledge transfer:
patient/carer education and teaching
patient safety and patient-held records
staff support and education
developing guidelines, policies and protocols
health promotion and targeting education at high risk groups
insulin pump therapy and blood glucose sensors
advice and service development
▶ Stabilisation of newly-diagnosed patients or patients with unstable blood sugar levels:
• treatment regimen
• insulin dose adjustment (training for patients)
▶ Practical assessment:
• urinary analysis
• blood glucose monitoring
▶
•
•
•
•
•
•
•
Nurse-led services and clinics (including type 1 diabetes complex cases)
diabetes transplant clinic
pre-conception clinic
antenatal diabetes clinic
diabetes transition clinic
joint diabetes/ophthalmology clinic
step-down clinics
annual review primary presentation
PRE-REQUISITES
Qualified nurse
DURATION
2-3 weeks
22
Royal Free International prospectus - Training opportunities for international nurses and midwives
Royal Free International prospectus - Training opportunities for international nurses and midwives
23
Gastroenterology
The centre for
gastroenterology is
a multidisciplinary
department
offering a range of
specialist outpatient and inpatient
gastroenterology
services as well as
state-of-the-art
gastrointestinal
imaging services.
PROFESSIONAL DEVELOPMENT PROGRAMMES
TYPE OF TRAINING
Observership
CONTENT
Individualised programme covering any or all of the following areas:
General gastroenterology:
▶ Nurse-run clinics for patients with family colorectal cancer, iron deficiency and
dyspepsia
Services offered
include: general
gastroenterology outpatient clinics and
telephone clinics;
inflammatory bowel
disease (IBD) clinic,
one-stop dyspepsia
clinic, coeliac clinic,
family colorectal cancer
clinic, capsule
endoscopy service,
enteral and parental
nutrition services,
gastroparesis service,
outreach general
gastroenterology clinic,
gastrointestinal
physiology
investigations, doubleballoon enteroscopy,
transnasal endoscopy
and direct
percutaneous
endoscopic
jejunostomy (DPEJ).
▶ Coeliac disease
• providing diagnosis and treatment to patients with celiac disease (gluten allergy)
• providing dietetic and nurse-run clinics to support patients as they adjust to a
gluten-free diet
• providing information and monitoring adherence
▶
•
•
•
▶
•
•
•
•
▶
•
•
•
•
•
•
•
•
•
•
Stoma and colorectal nursing
support and counselling for patients
caring for patients with stomas (newly formed and problematic)
managing patients with high output stomas and fistulae
Inflammatory bowel disease (IBD) including Crohn’s disease and ulcerative colitis:
in-patient services
out-patient clinics
telephone advice helpline
modular study course
IBD nurse specialists:
nurse-led clinics
telephone advice line
Providing information on:
disease and treatment options
drug treatments
surgical options
pregnancy
advice during a flare-up of disease
diet and lifestyle issues
monitoring patients receiving medications such as Azathioprine
Endoscopy:
▶ Capsule endoscopy and dysepepsia service:
• specialist small bowel investigation for unexplained bleeding, Crohn’s and coeliac
disease and one-stop dyspepsia service
24
Royal Free International prospectus - Training opportunities for international nurses and midwives
▶
•
•
•
•
ong the first
The Royal Free was am
hospitals in the country to use a
tiny camera inside a pill to explore
e
the colon, as well as th
gullet, stomach
and small intestine to search for
l bleeding,
problems such as gastrointestina
cancer and polyps.
The ‘PillCam’ is swallowed by a patient and takes photos as it
travels naturally through the body, allowing doctors and
nurses to look for any problems in the digestive tract
Professor Owen Epstein, professor of gastroenterology at the
Royal Free, said: “The PillCam is very clever because it has a
whole television studio within it – a camera, a light source, a
transmitter, a battery – and it’s only the size of an antibiotic
capsule. It sends a wireless signal to a receiver strapped to the
patient’s belt, which we later detach and plug into a
computer to view the images.
“It’s much less invasive than traditional gastroscopy and
colonoscopy procedures, which involve inserting a flexible
camera called a gastroscope into the patient’s throat or rectum.
This can be quite uncomfortable and can require sedation.
Diagnostic endoscopy:
medical and nurse endoscopy
push enteroscopy
colonoscopy, bronchoscopy
endoscopic retrograde
cholangiopancreatography (ERCP) and
endoscopic ultrasound (EUS)
▶ Therapeutic procedures:
• gastric and oesophageal endoscopic
treatment
• enteral dilatation and stent placement
• thermal destruction of vascular lesions
• endoscopic mucosal resection
• polypectomy
• colonic decompression
• placement of naso-gastric and nasojejunal tubes
• percutaneous endoscopic gastrostomy
• ‘virtual’ CT colonoscopy
• ERCP integrated patient pathway
• consent protocol
▶ Nutrition support:
• Care of patients with all types of access
for artificial feeding including:
• nasogastric (NG) tube feeding
• nasojejunal (NJ) tube feeding
• percutaneous endoscopic gastrostomy
(PEG)
• radiologically inserted gastrostomy (RIG)
• IV access for parenteral nutrition (PN/IVN)
▶ Louise Ryan unit: nurse-led continence
and gastrophysiology services:
• high resolution oesophageal manometry
• ambulatory 24 hour pH studies
• ambulatory 24 hour pH/impedance
studies
• high resolution anorectal manometery
• colonic transit marker studies (shapes
test)
• electrogastrogram (EGG)
• hydrogen breath tests
• nurse-led biofeedback clinic (bowel
continence clinic)
PRE-REQUISITES
“The PillCam, on the other hand, is completely
painless. Once it has been swallowed, the patient
can go home and just return to hospital once the
pill has passed through their system – which takes
up to 10 hours.”
Nurse with previous experience and
currently caring for patients in
gastroenterology.
We have nurse endoscopists who are specially trained in
delivering this service.
2-3 weeks
DURATION
Royal Free International prospectus - Training opportunities for international nurses and midwives
Haemophilia
and
thrombosis
Pioneering research in gene
therapy for haemophilia B is
currently being undertaken
at the centre.
The centre, which is the
haemophilia hub for north
London, is also one of only
three international training
centres of the World
Federation of Haemophilia
(WFH) in the UK. We
oversee the training of
clinicians, physiotherapists,
nursing staff and biomedical
scientists from all over the
world who go back to their
home nations with the
necessary skills and
knowledge to develop
services, to provide accurate
diagnosis and wherever
possible, improved
treatment and care.
Nurse-led services include a
specialist nursing team who
run a community and
outreach service to support
young patients, parents and
their families with treatment
at home. Our thrombosis
nurses also lead venous
thrombosis prevention in
hospital and run
anticoagulation and deep
vein thrombosis clinics.
25
Our world-renowned Katharine
Dormandy haemophilia centre
and thrombosis unit provides
comprehensive haemophilia
care and the excellence of our
services and the quality of our
research is widely recognised.
PROFESSIONAL DEVELOPMENT PROGRAMMES
TYPE OF TRAINING
Observership
CONTENT
Individualised programme covering any or all of the following areas:
Role of the haemophilia nurse
▶
•
•
•
•
•
•
Clinic support:
orientating new patients following transfer from other centres
educating patients and family members on a new diagnosis
home treatment skills and knowledge review
nursing observations and clinical assessment
arranging referrals
participating in board and ward rounds and multidisciplinary team meetings
▶ Managing walk-in patients:
• assessment
• triage and making appropriate referrals eg to senior nurse, physiotherapist,
registrar or consultant
▶ Treatment delivery:
• preparing and administering treatment for expected and emergency
out-patients and in-patients including clotting factor concentrate
▶
•
•
•
Other patient management:
arranging emergency admissions to wards
giving telephone advice
dispensing home treatment
26
Royal Free International prospectus - Training opportunities for international nurses and midwives
Role of the haemophilia clinical nurse specialists and nurse
consultant
▶
•
•
•
Service delivery:
coordinating services
patient pathway management
providing advanced assessment
and triage and making treatment
decisions utilising patient group
directions
• developing protocols and
educational materials
▶ Education and support:
• handling complex telephone
enquiries
• providing support and education
to patients, carers and family
members
• training junior staff
• formal and informal teaching:
haematology registrar trainees on
rotation, patients and carers
• conducting family interviews and
drawing pedigrees in association
with genetic testing
▶ Home treatment programme
management:
• setting up home delivery and
managing prescriptions and
monitoring
• teaching and updating skills for
self-infusion including vein
management
• continuous education on dose
decision making and the
management of bleeding episodes
• providing support for optimal selfmanagement to avoid
complications and hospitalisations
▶ Stock management:
• managing and planning clotting
factor concentrate stock levels in
conjunction with the data team,
according to current and
anticipated demands
▶ Individual treatment plan
management:
• coordinating individual surgical
and dental treatment plans within
the Royal Free and with external
teams
▶ Research and development:
• participating in pharmaceutical
industry-sponsored clinical trials of
clotting factor concentrates and
other pharmaceutical agents
• participating in investigator-led
studies into laboratory science,
clinical care and the psychosocial
aspects of managing inherited
bleeding disorders
• presenting work at national and
international meetings
PRE-REQUISITES
Nurse who cares for patients with
haemophilia as part of their current
practice.
DURATION
Maximum 6 weeks
Royal Free International prospectus - Training opportunities for international nurses and midwives
TYPE OF TRAINING
Observership
CONTENT
Thrombosis - anticoagulation
specialist nursing
Individualised programme covering
any or all of the following areas:
▶ Routine anticoagulant
monitoring service:
• monitoring patients on oral
anticoagulants and adjusting
their anticoagulant doses
• dealing with patient questions
and problems relating to their
anticoagulant therapy
• counselling patients who are
stopping Warfarin at their final
appointment, enabling them to
promote good health in the
future
▶ Remote monitoring clinics:
• taking appropriate actions for
the results of blood samples sent
from off-site sources: eg dialysis
units, GP surgeries, district
nurses and nursing homes
▶ Warfarin initiation clinics:
• counselling patients regarding
the purpose, potential risks and
procedures relating to oral
anticoagulation
• assessing patients on their
understanding and suitability for
therapy
• arranging prescriptions and
obtaining baseline bloods for
patients who are appropriate to
start anticoagulation
• arranging follow up
appointments with patients
▶ Ambulatory deep vein
thrombosis (DVT) out-patient
service:
• counselling patients about
anticoagulant therapy
• teaching patients the necessary
skills (this usually involves
teaching the patient to self-inject
Heparin)
▶ New referrals from in-patients:
• education and follow up for inpatients
• advising nursing and medical
colleagues
• counselling patients who were
started on anticoagulants during
an in-patient stay before
discharge
• following up patients in routine
clinics post discharge
▶ Peri operative planning –
bridging anticoagulant therapy
and post operation follow up:
• reviewing all patients taking oral
anticoagulants that are seen in
the pre-operative assessment unit
• making adjustments to
anticoagulation accordingly and
informing the patients by phone
to advise when they should stop
their oral anticoagulation and
giving appointments to attend the
clinic and start Heparin injections
• scheduling dose regime before
the patient’s operation and
discussing timeframes regarding
recommencing oral therapy after
their operation
• teaching the patient the
injection technique to avoid
unnecessary repeat attendances
• arranging post-operative
anticoagulation follow up
▶ Antenatal thrombophilia clinics:
• running a joint consultant
haematologist clinic for pregnant
woman with thrombotic
problems
• explaining heparin therapy to
patients
• teaching the patient the selfinjection technique
• arranging follow up by the
specialist nurses for checking of
Anti Xa blood results
▶ Travel clinic:
• seeing patients at risk of
thrombosis who are planning on
travelling and arranging Heparin
prescription
• giving advice and teaching the
injection technique
• compiling letters for Customs
and giving appropriate means of
disposal for needles
27
▶ Telephone and email advice:
• offered to patients, GPs, other
community healthcare
professionals and nursing and
medical staff at the Royal Free
• managing generic
anticoagulation email address for
GPs and others to email non
urgent queries
▶ Self-testing patients:
• seeing all self-testing patients
every six month to carry out
quality assurance checks on their
allocated device and to evaluate
how they are doing with selftesting
▶ Thrombosis prevention:
• promoting good
thromboprohylaxis practice in
line with the National Institute
for health and Care Excellence
(NICE) guidelines and quality
standards
• maintaining the Commissioning
for Quality and Innovation
(CQUIN) targets of 90%
▶ Risk assessment for thrombosis
for admitted patients:
• conducting audits of
thromboprophylaxis
administered to patients
• conducting root cause analysis of
hospital acquired thrombosis
▶ Audit:
• to comply with the National
Patient Safety Agency (NPSA)
alert 18
PRE-REQUISITES
Experienced nurse wanting to
offer anticoagulant/ thrombosis
services or lead nurse planning to
develop new services.
DURATION
Maximum 1 week
28
Royal Free International prospectus - Training opportunities for international nurses and midwives
Health services
for elderly people
The department of
health services for
elderly people is a
hospital-based team
which aims to provide
the best diagnosis,
treatment and care
for older people.
The unit has nine
consultant geriatrician
teams who work within
multidisciplinary teams
and are responsible for
the care of older people
who have acute medical
illness. They also provide
a service to older
patients who are under
the care of non elderly
specialist teams such as
surgery to ensure they
receive optimum care
whilst undergoing
specialist treatment. The
department is
developing pathways in
partnership with primary
care to provide outreach
specialist advice to older
people in the
community.
The department has
developed a new model
of care, the triage rapid
elderly assessment team
(TREAT), which has
received interest from
healthcare professionals
nationally and
internationally.
PROFESSIONAL DEVELOPMENT PROGRAMMES
TYPE OF TRAINING
Observership
CONTENT
TREAT: an innovative model to
enhance the patient experience,
decrease length of stay and reduce
emergency readmissions.
Individualised programme covering any
or all of the following areas:
▶ Approach:
• advice line for GPs and HOT clinics to
ensure rapid assessment of
• patients who are at risk of an imminent,
unplanned visit to A&E
• offering comprehensive geriatric
assessment at the front door
• ensuring that older people receive the
best care and have the best chance to
remain in their homes
• providing robust triaging and signposting of patents in the emergency
department to ensure a right care, right
setting, first time approach
• improving satisfaction and outcomes for
older people
▶ ‘Hot clinics’:
• rapidly assess older people who are at
risk of an imminent, unplanned visit to
A&E within a multidisciplinary structure
• take referrals via the advice line for GPs
• liaise directly with either the patient or
their carer to organise the appointment
once the referral is received
• provide rapid access to diagnostic
imaging, vascular studies, Holter
monitoring as well as PACE service
• integrated falls clinic which includes
vestibular clinics and tilt-table tests
▶ Patient criteria:
• available to those requiring rapid
assessment and intervention to
prevent an A&E attendance and
those with acute or sub-acute
exacerbation of chronic
conditions
• for frequent attenders requiring
comprehensive geriatric input
and multidisciplinary assessment
and patients at high risk of
readmissions
▶ Multidisciplinary team working:
• collaborative working with the
PACE team to ensure seamless
and supported discharge
• TREAT nurse coordinates
patient’s journey from
presentation to post discharge
• hotline access for GPs and
community teams to avert
potential crises
▶ In the community:
• TREAT nurse provides an
outreach service identifying and
case managing complex,
vulnerable older people as well as
providing specialist input and
support to care homes
• liaison work with local GPs such
as attending GP rounds in care
homes
▶ Monthly Wednesday afternoon
teaching for community matrons
▶ Enhanced dementia training day
PRE-REQUISITES
Qualified nurse who deals with
integrated care as part of their
current practice.
DURATION
Maximum 4 weeks
Royal Free International prospectus - Training opportunities for international nurses and midwives
29
TYPE OF TRAINING
The Royal Free’s triage rapid
elderly assessment team
(TREAT) are specialists in
elderly care medicine who
attend to elderly patients
with complex health
problems in the hospital’s
A&E department. To our
knowledge, the Royal Free
is unique in this service
provision in London.
Lecture
CONTENT
Teaching for community
matrons delivered by
multidisciplinary teams
▶ Range of topics covered
(one topic per session)
including:
• dementia
• palliative care and pain
• falls
• incontinence
• speech and language
therapy and prescribing
• tissue viability
• nutrition
PRE-REQUISITES
Qualified nurse
DURATION
3 hours (on one
Wednesday afternoon per
month)
TYPE OF TRAINING
The role of TREAT is to thoroughly assess elderly patients who have come to A&E,
identifying those who are well enough to be discharged, and ensuring that
support is put in place so that they can receive all of the care they require at home.
After assessing the patient, TREAT can organise investigations and support on the
same day, such as X-rays, CT scans, and occupational therapy, and put in place the
relevant community healthcare and social services support if required.
In the past, these patients may have been admitted because they had complex
medical and social problems which could not all be treated straight away in
A&E or the support wasn’t in place at home to safely discharge them. But now
TREAT is on hand to provide that extra support, which is making a real
difference to patients. The service operates seven days a week.
The service also aims is to identify patients who come to A&E on multiple
occasions. The team assess their circumstances to help them keep well at home
and avoid future visits to A&E.
Workshop
In addition to the team at the Royal Free, we also have an outreach team of
both nurses and consultants who provide support to care homes.
CONTENT
This includes:
Enhanced dementia
training day
Provides practical tips for
healthcare professionals in
hospitals and community
settings who care for
people with dementia.
PRE-REQUISITES
Qualified nurse or
healthcare support worker.
DURATION
1 day on set days of the
year
ng.
Nurse support to provide training and support care planni
Consultant geriatrician support including anticipatory
care planning.
TREAT hotline – a direct line for staff in care homes to
contact the team for support.
Access to the post acute care enablement (PACE) service
which allows patients to continue to receive clinical
treatment at home including IV therapy, wound and drain
care, medications management and blood monitoring.
for all
further assessments
‘Hot clinics’ providing
.
ce
e TREAT servi
patients accessing th
30
Royal Free International prospectus - Training opportunities for international nurses and midwives
Hepatology
(liver) nursing
We are one of seven liver transplant
centres in the UK and patients are
referred to us from across the UK and
abroad. Some of these seek a second
or a third opinion, having been deemed
inoperable or untreatable elsewhere.
We are host to one of two liver
transplant and hepatopancreatobiliary
(HPB) units in London and are a
designated cancer centre for the
treatment of tumours of the liver and
pancreas.
Our nurses play an active role in
reducing deaths from liver disease.
They make every contact with patients
count by identifying risk factors for the
three major types of liver disease –
alcohol, hepatitis B and C and obesity
leading to non-alcoholic fatty liver
disease (NAFLD) – and by offering
health promotion and education to
help individuals to make informed
lifestyle choices.
Key to the service is the liver disease
competence framework, which was
designed by one of our clinical nurse
specialists and other members of the
UK government’s liver strategy
specialist nurses expert reference
group (SNERG) and adopted
nationally. Designed in collaboration
with the Royal College of Nursing, it
enables nurses to develop and expand
their knowledge of how to care for
patients with, or who are at risk of,
liver disease and describes the
knowledge, skills and attitudes that
are required to deliver patient-centred
care and reduce deaths from liver
disease. We work as a multidisciplinary
team with our patients at the centre
of the care and services we offer.
Liver disease is currently
the fifth highest killer in
England and an
increasing problem
worldwide. The Royal
Free is at the forefront
of this specialty.
PROFESSIONAL DEVELOPMENT PROGRAMMES
TYPE OF TRAINING
Observership
CONTENT
Individualised programme covering any or all of the following
areas:
▶
•
•
•
•
•
•
•
•
•
•
Knowledge transfer on the range of liver diseases including:
alcoholic-related liver diseases
viral hepatitis
NAFLD
acute liver failure
autoimmune liver diseases
drug-induced hepatitis
haemochromatosis
primary sclerosing cholangitis
Wilson’s disease
hepatocellular carcinoma
▶ The role of the hepatology clinical nurse specialist (CNS):
• General nurse-led services:
◦ alcohol liaison
◦ stable cirrhosis clinic
◦ viral hepatitis clinic and outreach services
◦ managing complications of liver disease
◦ health promotion and education
• Liver transplantation:
◦ alcohol and drug dependence pre and post-transplant
◦ live related donor co-ordinator
follow up and assessment
◦ nurse-led transplant waiting
list clinic and outreach clinic
◦ post-transplant clinic and
outreach clinics
◦ joint oncology and
hepatology hepatocellular
carcinoma clinic
Royal Free International prospectus - Training opportunities for international nurses and midwives
▶ Knowledge and skills:
• managing the complications of chronic liver disease,
ie ascites and paracentesis, transjugular intrahepatic
portosystemic shunt (TIPS), variceal bleeding, options
for hepatic encephalopathy and nutrition
• supporting the patient during an assessment for
transplantation, on the waiting list and following
transplantation
• complex treatment of viral hepatitis in cirrhotic
patients and in post transplantation patients
• NAFLD clinic
• sharing of guidelines and polices
Fazlina Binte Abdul Hathi,
a nurse from Singapore
won a scholarship from her hospital to
spend six weeks shadowing our specialist
hepatology nurses in 2012.
▶ Introduction to the liver diseases competence
framework including an outline of the competences,
explanation of the skills and knowledge required to
meet them and guidance on producing evidence to
demonstrate them.
She was given the
opportunity to learn
about the setup of
nurse-led clinics, the
competence
framework and
various skills
needed in looking
after liver patients.
PRE-REQUISITES
Nurse with previous experience of hepatology nursing.
DURATION
She said:
2-6 weeks
TYPE OF TRAINING
Observership
CONTENT
Hepato-pancreato-billary (HPB) surgery nursing
Individualised programme covering any or all of the
following areas:
•
•
•
•
•
•
•
•
•
interventional radiology services
liver resection
major biliary surgery
pancreatic cancer surgery
pancreas head resection
policy and protocol sharing
tertiary transfer for investigations
enhanced recovery concept for HPB surgery
management of patients following HPB surgery
PRE-REQUISITES
Nurse with previous experience of hepatology nursing.
DURATION
3-4 weeks
31
?
“I really enjoyed the placement
and it provided me with lots of
knowledge which I am able to
share with my colleagues.”‘
Did you know
The Royal Free performed the
first UK transplant between
an adult live donor and an
adult with acute (fulminant)
liver failure. The Royal Free is
one of the few centres in the
UK to offer liver transplants
from live donors.
32
Royal Free International prospectus - Training opportunities for international nurses and midwives
Infection
prevention and
control
PROFESSIONAL DEVELOPMENT PROGRAMMES
The Royal Free’s work around
infection prevention and control
is seen as exemplar and as result
we have trained and shared best
practice with healthcare staff
across the globe including China,
Hong Kong, Japan and Lebanon.
TYPE OF TRAINING
Observership
CONTENT
Role of the infection prevention and control nurse
Individualised programme covering any or all of the following areas:
We have pioneered initiatives such
as deep cleaning of wards, a ‘bare
below the elbows’ policy for staff
and the introduction of infection
control patient liaison nurse and
practice educator roles. Our team
are also instrumental in developing
new infection control products such
as an equipment disinfection wipe
and a patient skin disinfection wipe
used prior to invasive procedures,
which are now widely used nationally
and internationally.
•
•
•
•
•
•
•
•
•
•
•
As well as lecturing and delivering
training internationally, the team
also have a service level agreement
with Marie Currie, a well-known UK
cancer charity, to help develop their
infection control programme in
hospices. The team’s work has also
been featured in national and
international publications and
journals.
Qualified nurse
infection prevention and control practices
hand hygiene practice and understanding
infection prevention and control arrangements in England
practical infection prevention and control delivery
central line care and CVC site management
cleaning and general decontamination
infection control in the built environment
policies and protocols
outbreak management and pandemic flu planning
surgical site surveillance
individualised face-to-face patient case management for those
with infections
PRE-REQUISITES
DURATION
1 week
Royal Free International prospectus - Training opportunities for international nurses and midwives
33
TYPE OF TRAINING
TYPE OF TRAINING
Workshop
Lecture
CONTENT
CONTENT
Hand hygiene practice and understanding:
Infection prevention and control
arrangements in England and in acute
trusts:
• how hand hygiene helps prevent healthcare associated
infections
• the practice of hand hygiene – six step technique,
World Health Organization five moments
• demonstration with UV light box for good technique
• promoting compliance with good hand hygiene practice
• audit and feedback of hand hygiene practice
• legislation around IPC arrangements
• guidelines, national policies and
recommendations
• implementation strategies in an acute
London trust
PRE-REQUISITES
PRE-REQUISITES
Qualified nurse
Qualified nurse
DURATION
DURATION
1 hour
40 minutes
34
Royal Free International prospectus - Training opportunities for international nurses and midwives
TYPE OF TRAINING
In summer 2013
we trained two
nurses from the
Hong Kong
Health
Authority.
Workshop
CONTENT
Practical infection prevention
and control delivery:
Regina Chan and Wan Mui Lee
spent five days learning about infection
prevention and control practices
team of specialists
from our highly regarded
for
who won the Nursing Times Award in 2009
control.
best practice in infection prevention and
• training and competence
assessment of clinical skills
• use of ‘saving lives high impact
intervention audits’ in improving
practice
• practical hand hygiene training
PRE-REQUISITES
Qualified nurse
DURATION
1 hour
They shadowed the infection prevention and control specialist
nurses, observed a cleaning audit, deep clean and the
decontamination of equipment and joined ward rounds and
infection and control meetings. Royal Free staff also shared the
trust’s protocols and policies relating to infection prevention and
control and Reyon Yan, RFI’s clinical and development programme
manager, organised a programme which allowed the nurses to
spend time with tissue viability nurses, the patient safety facilitator
and staff in the microbiology laboratory, as well as seeing different
departments such as the high security infectious diseases unit, the
intensive care unit and sterile services.
Regina, who works at the United Christian Hospital, said: “I was very
impressed by the team and the leadership of Yvonne. There is very
good support in place to ensure high standards of infection prevention
and control across the hospital. A very thorough programme was
arranged for us so we could see a range a different departments and
share experiences. I have since successfully introduced the detergentdisinfectant wipes to the hospital where I am working.”
TYPE OF TRAINING
Workshop
CONTENT
Central line care and CVC site
management:
• general priorities in CVC care
and management
• site dressing choice and
application
• use of site assessment tools
PRE-REQUISITES
Qualified nurse
Wan Mui, who works at Princess Margaret Hospital, said:
DURATION
“I was impressed by the team’s relationship with other
staff in the hospital. That is very important as an
infection control nurse because if you do not have
cooperation with other members of staff, you cannot
do anything.”
40 minutes
Royal Free International prospectus - Training opportunities for international nurses and midwives
35
TYPE OF TRAINING
TYPE OF TRAINING
TYPE OF TRAINING
Workshop
Lecture
Lecture
CONTENT
CONTENT
CONTENT
Cleaning and decontamination
– product choice and use:
Infection prevention and
control policies and protocols:
Surgical site surveillance (SSI):
• which cleaning products to use
for what purpose
• how cleaning can aid in
improving infection rates
• choosing equipment and fixtures
with cleanliness in mind
• properties of cleaning products
• policy development
• policy evidence base
• major policies including dress
code, isolation, waste
management and standard
precautions policies
PRE-REQUISITES
Qualified nurse
DURATION
40 minutes
TYPE OF TRAINING
Lecture
CONTENT
Infection control in the built
environment – IPC experience
in hospital and clinical service
design:
• compliance with health building
regulations
• when to safely adapt design
recommendations
• shared experience in choosing
fixtures, fittings and furnishings
PRE-REQUISITES
Qualified nurse
DURATION
40 minutes
PRE-REQUISITES
surveillance process
data collection
SSI definitions
data to information
report writing
changing practice from
surveillance findings
• benchmarking with other
healthcare providers
Qualified nurse
PRE-REQUISITES
DURATION
1 hour
TYPE OF TRAINING
Lecture
CONTENT
Outbreak management and
pandemic flu planning:
• outbreak management
procedures and practical
processes
• practical influenza pandemic
planning
• contact screening and tracing
• root cause analysis
PRE-REQUISITES
Qualified nurse
DURATION
1 hour
•
•
•
•
•
•
Qualified nurse
DURATION
1 hour
36
Royal Free International prospectus - Training opportunities for international nurses and midwives
Infectious diseases
Our infectious diseases
unit looks after adult
patients with all types
of infection or
suspected infection.
PROFESSIONAL DEVELOPMENT PROGRAMMES
TYPE OF TRAINING
Workshop
CONTENT
The team consists of five
consultants with
supporting specialist
registrars and senior
house officers, and an inpatient unit with
dedicated nurses trained
in the care of patients
with infectious diseases.
Introduction to the HSIDU and viral haemorrhagic fevers:
The unit has considerable
experience in caring for
patients with: infections
acquired in the UK;
illnesses acquired
overseas and in the
tropics; viral illnesses;
bacterial illnesses;
tuberculosis; viral
hepatitis; and fevers of
unknown origin. The unit
also works closely with
other departments within
the hospital to provide a
comprehensive infection
service to all patients
with infections related to
other medical conditions.
Qualified nurses and doctors.
• how the unit is set up and how patients are admitted
• what viral haemorrhagic fevers are and how patients with them are cared
for – examples drawn from recent admissions
• practical experience of getting into the isolation suits built into the patient
isolator
PRE-REQUISITES
DURATION
2-hour tour of the unit and talk
37
Our high security infectious diseases unit (HSIDU)
is one of just two dedicated units in the UK with
facilities for caring for patients with hazardous
infections including Lassa fever, Ebola, Marburg,
and Crimean-Congo haemorrhagic fever.
The unit is activated only when a patient requiring HSIDU
care is identified. All facilities in the unit are tested
weekly to ensure the service can be fully operational
within hours of notification that an infected patient is on
the way.
The HSIDU is located in a purpose-designed ward that is
sealed and separated from other public and ward areas,
with its own filtered air supply and outlets. It has two
special isolation beds and a special laboratory for testing
patient blood samples. The unit is specifically designed to
provide as much comfort as possible to the patient whilst
also fully protecting staff. It is maintained and run by
infectious disease specialists which include doctors,
nurses and lab staff, who regularly receive specialist
training to deal with every aspect of using the HSIDU.
Dr Michael Jacobs, clinical lead for the HSIDU and
consultant in infectious diseases, said: “The most
important part of the unit is the staff. Everyone involved
with the HSIDU receives very specific training, which
allows us to offer the best possible care to the patient
while protecting our staff.
“We have seven consultants in infectious
diseases, including myself, and all of us are
trained should a patient be transferred to the
unit. We are on call 24/7, along with a senior
nurse, to offer advice to healthcare
professionals across the UK and to transfer a
patient to our HSIDU if needed.”
n.
“As a team, we plan for the unknow
There are new and emerging diseases and we are
ready to take those on at the HSIDU.”
38
Royal Free International prospectus - Training opportunities for international nurses and midwives
Midwifery
Our maternity service aims to
harness innovation to optimise the
health of mothers and babies and
to ensure a contemporary, safe and
family-focused service.
PROFESSIONAL DEVELOPMENT PROGRAMMES
We primarily provide care to
women from the London
boroughs of Islington,
Camden, Barnet and Haringey
and to women from further
afield who choose to come
here to have their baby. Care is
led by a midwife in cases
where there are no
complications or underlying
risks and by an obstetrician for
women with more complex
medical or social needs.
The Royal Free offers a full
range and antenatal and
postnatal care and depending
on individual circumstances,
mothers can choose to have
their baby either at home, in
our birth centre which
includes a birthing pool or
our labour ward. There are
around 3,000 deliveries a
year. We achieved level three
Clinical Negligence Scheme
for Trusts (CNST)
accreditation in February
2013. This is the highest level
that can be achieved for any
maternity unit in the UK.
We became only the 11th
hospital in England to launch
a blood collection
programme in January 2012,
which the hospital is running
in partnership with blood
cancer charity Anthony
Nolan. This programme
allows mothers to donate
their umbilical cord and
placenta after birth, which
can then be used in lifesaving
transplants for people with
blood cancer.
TYPE OF TRAINING
Observership
CONTENT
Individualised programme covering any or all of the following areas:
▶
•
•
•
•
•
•
•
•
•
•
•
Maternity unit:
care of women in labour
birthing pool (low risk cases only)
choice of pain relief
intrapartum care: conducting normal vaginal delivery
caesarean section
perineal repair
care of the newborn
support with breastfeeding
complicated/normal delivery
discharge
antenatal clinic (midwifery & obstetric high & low risks)
▶ Foetal medicine unit:
• ultrasound scanning
▶ Day assessment unit:
• general observation
• caring for pregnant women who need further monitoring (ie cardiovascular
issues, blood pressure monitoring/analysis, concerns with foetal growth).
▶ Community care:
• antenatal and post-natal home visits
PRE-REQUISITES
Practicing midwife
DURATION
1 week – 1 month
Royal Free International prospectus - Training opportunities for international nurses and midwives
39
40
Royal Free International prospectus - Training opportunities for international nurses and midwives
TYPE OF TRAINING
Workshop
CONTENT
Breastfeeding training
Training on the UNICEF baby
friendly initiative, benefits of
breast feeding for mother and
baby and promoting responsive
parenting practices.
PRE-REQUISITES
Practicing midwife
DURATION
2 days
Our maternity team
have completed two
visits to Iraq to help
improve patient care
and midwifery
education and
training.
The first visit in 2012
saw a team visit
Hawler Medical University in Erbil to help set up
the country’s first midwifery school. During the three-day visit, the
Royal Free team helped the university to begin to think about
what they might want to include as part of their syllabus by
showing them what is done in UK universities. They gave lectures
on various topics, including the role of a midwife and the role of
an obstetrician and how they can work together to provide care
for pregnant women. They also gave lectures on the provision of
pregnancy care for low risk and high risk women, as well as
foetal monitoring, emergency procedures and life support.
TYPE OF TRAINING
Series of lectures, workshops and
simulation-based training
CONTENT
Practical obstetric multiprofessional training (PROMPT)
Multi-professional training
package for obstetric emergencies
including lectures from a range of
professionals and scenario-based
workshops.
PRE-REQUISITES
Practicing midwife
Obstetric and midwifery training workshops were also held for the
management of obstetric emergencies such as eclampsia, maternal
collapse, postpartum haemorrhage, difficult deliveries and neonatal
resuscitation. Dr Fareed H. Abdulahad, vice president for scientific
affairs and postgraduate studies at Hawler Medical University said
he was very grateful to the Royal Free staff for providing their
services. In a letter, he said:
“We really appreciate the time and efforts taken to
come and teach us, and we are really very grateful to
all members of the team for their generosity in
delivering the training and teaching us their
excellent skills.
“The workshop was very well received and much
appreciated by all attendees. We believe the
workshop set a very good step to encourage the
establishment of a midwifery training programme
and multidisciplinary team working for providing
maternity services in the region of Kurdistan, Iraq.”
DURATION
1 day
The team’s second visit to Iraq a few months later concentrated
on teaching healthcare professionals about cervical screening as it
is currently not standard practice in the country. The four-day trip
involved lectures, workshops and teaching healthcare
professionals about performing a colposcopy.
Royal Free International prospectus - Training opportunities for international nurses and midwives
41
At the Royal Free,
our elite nursing
staff are trained
to take on many
roles and
responsibilities,
some of which
would have
historically been
conducted by
doctors.
is
Nurse Sheila Johnston
just one example
nical lead and lead
of this. She is the cli
nurse for chronic kidney disease (CKD).
“As clinical lead, my role is to ensure
the CKD service is safe, efficient,
cost-effective and of the highest
quality. I help to continually develop
the service and set up new services
to meet patients’ needs,” Sheila said.
“As lead nurse, I run nurse-led clinics
for patients with symptoms of CKD.
Previously, many patients with these
symptoms would have had to wait
months for an initial appointment
with a consultant nephrologist. Now,
around 90% of patients can instead
be seen much more quickly by me or
one of my clinical nurse specialists.
“As experts in the field of CKD, we
are able to provide a one-stop-shop
where we take a medical history,
perform a physical assessment, make
a diagnosis, prescribe where
appropriate, make a referral for
further investigations and review
results. We are then able to design
an individualised care plan based on
the patient’s needs and provide
continuing support such as
symptoms management and
education.
“Feedback about the service has
been incredibly positive – patients
enjoy the shorter waiting times and
having a single point of contact from
initial investigation through to
treatment. From the hospital’s point
of view, we have been able to reduce
the number of referrals from GPs to
secondary care, allowing our doctors
to concentrate on more complex
cases.”
Sheila has a masters-level degree in
advanced practice and has been
heavily involved in developing
services based on best practice. She
has presented work at national
conferences and has had articles
published in various publications. She
manages a team of clinical nurse
specialists and the lead research
nurse for the department and also
teaches fourth year medical students
about CKD.
42
Royal Free International prospectus - Training opportunities for international nurses and midwives
fection
service lead for in
e
th
is
r
rte
Ca
ne
Yvon
lves ensuring
rol. Her role invo
nt
co
d
an
on
ti
preven
ntrol
tional infection co
we comply with na
Yvonne is responsible for ensuring a
clean and safe environment for
patients and staff, ensuring patients
receive the appropriate information
on infections and that staff,
contractors and volunteers are
trained in infection control practices
and procedures. She is also involved
in the identification of infections
and implementing processes to
reduce cross infection, ensuring
there are adequate isolation facilities
and that laboratory services are upto-date with the appropriate
accreditations, as well as the
development of policies for patient
care and service design.
“I work closely with the estates
team, for example, on the design of
new buildings and refurbishments to
ensure they comply with infection
control standards and they have the
appropriate ventilation and filtration
systems,” Yvonne said. “I also
conduct extensive research-related
subjects to ensure our clinical
protocols such as antibiotic
and
ally improve systems
standards and continu
tice.
the latest best prac
processes to meet
administration policies and
cleaning methods are up-to-date
and evidence-based.”
Yvonne manages a team which
consists of clinical nurse
specialists, a specialist sister, an
audit and surveillance nurse, a
patient liaison service nurse and
practice educators. She has two
degrees and teaches all groups
of staff including medical
students.
The Royal Free has some of the
lowest infection rates in the
country and Yvonne has
lectured and delivered training
in countries abroad, as well as
having articles published in
various international
publications.
As well as
delivering
excellent clinical
care, our nurses
play a
fundamental role
in designing,
improving and
ensuring the
smooth running
of our services.
Royal Free International prospectus - Training opportunities for international nurses and midwives
Nurses and
doctors work
closely together
at the Royal Free
as part of a
multi-disciplinary
team.
nsultant
Isobel Mason, nurse co
in gastroenterology
“Our nursing service complements
the medical service – it’s very much
about teamwork,” Isobel Mason,
nurse consultant in gastroenterology
said. “Everyone is respected in their
own area of work and we’re very
flexible in terms of adapting services
and roles to meet the needs of
patients. We have lots of support
from our medical colleagues in
developing skills and responsibilities.”
Isobel leads a team of clinical nurse
specialists who are qualified in
advanced nursing practice and able
to examine patients and prescribe
medication independently. They run
nurse-led clinics for endoscopy,
nutrition, physiology testing,
continence and inflammatory
bowel disease.
“My role is to support our clinical
nurse specialists to carry out research
and audits to ensure services run
smoothly and are meeting patients’
needs,” Isobel said. “I am the lead
for the service, conduct academic
research, teach in universities and
develop education and guidance on
gastroenterology nursing.
“I’m also chair of the Royal College
of Nursing’s gastroenterology forum
and help to raise the profile of
gastroenterology nationally.”
As well as taking a leadership role,
Isobel also has clinical commitments
and runs her own nurse-led clinic.
43
44
Royal Free International prospectus - Training opportunities for international nurses and midwives
Ophthalmology
PROFESSIONAL DEVELOPMENT PROGRAMMES
Our ophthalmology
service is based on a
hub and spoke
model based around
the Royal Free
Hospital. There are
out-patient clinics at
the Royal Free,
Edgware and Barnet
hospitals with day
case surgery on each
of the sites.
The in-patient beds are
sited at the Royal Free
and this is also the site
for emergencies out of
hours.
We have specialists in
the following areas:
cataract surgery; age
related macular
degeneration;
oculoplastic, orbital and
lacrimal surgery;
diabetic eye disease;
external eye disease;
paediatrics; HIV and eye
disease;
neuroophthalmology;
glaucoma; medical eye
diseases; and
vitreoretinal surgery.
There are nurse-led
clinics in glaucoma,
YAG laser, intravitreal
injection of Lucentis for
wet age-related macular
degeneration (AMD)
and diabetic retinal
screening.
TYPE OF TRAINING
Observership
CONTENT
The role of the ophthalmology clinical nurse specialist (CNS)/nurse practitioner
Individualised programme covering any or all of the following areas:
▶
•
•
•
Nurse-led clinics:
glaucoma
diabetic retinal screening
intravitreal injection of Lucentis
▶ Patient education:
• eye cleaning
• drops instillation
▶ Advanced practice:
• laser treatment (eg post cataract and glaucoma treatment)
▶ Clinical competencies framework development:
• competency based learning
▶ Emergency eye care:
• management
• triage guidelines/protocols
▶
•
•
•
•
•
•
•
•
•
•
▶
•
•
•
Care of patients:
cataract surgery and pre-assessment (CNS)
age-related macular degeneration (CNS)
oculoplastic, orbital and lacrimal surgery (CNS)
diabetic eye disease (lead nurse)
corneal and external eye disease (nurse practitioner)
paediatrics (orthoptist)
HIV and eye disease (general)
glaucoma (nurse practitioner and orthoptist)
medical eye diseases (general)
vitreoretinal surgery (lead nurse)
Service development:
advice on setting up an ophthalmology unit
service design
day case surgery management
PRE-REQUISITES
Qualified nurse, preferably working in this specialty.
DURATION
4-6 weeks
Royal Free International prospectus - Training opportunities for international nurses and midwives
Orthopaedic
nursing
Our consultants have interests in the
sub-specialist areas of upper limb
surgery, complex shoulder surgery,
hand surgery, hip replacement
(conventional and resurfacing),
revision hip replacement, knee
replacement, revision knee
replacement, complex knee
ligament reconstruction, surgery for
degenerative conditions of the
knee, foot and ankle surgery and
paediatric orthopaedics. We have
close links with the rheumatology
and haemophilia departments and
have extensive experience of
scleroderma and haemophiliac joint
disease. Orthopaedic trauma is
managed by assessing patients in
out-patient fracture clinics and
following urgent admission via
accident and emergency.
Diagnosis and treatment are
supported by the expertise of the
hospital’s musculoskeletal
radiologists. Imaging facilities
include a state-of-the-art filmless
digital image transfer and viewing
system (PACS).
The department is fully recognised
for the training of specialists in
orthopaedic and trauma surgery.
Consultants also participate as
examiners for the Royal College of
Surgeons and UCL Medical School.
There are also formal teaching
associations with the Institute of
Orthopaedics and Musculoskeletal
Science, UCL.
45
Our orthopaedic department
has a multidisciplinary team
who provide consultation and
treatment for all general
orthopaedic ailments.
PROFESSIONAL DEVELOPMENT PROGRAMMES
TYPE OF TRAINING
Observership
CONTENT
Individualised programme covering any or all of the following areas:
▶ Orthopedic surgery:
• Elective, trauma and day surgery covering:
◦ upper limb surgery
◦ complex shoulder surgery
◦ hand surgery
◦ hip replacement (conventional and resurfacing)
◦ revision hip replacement
◦ knee replacement, revision knee replacement
◦ complex knee ligament reconstruction
◦ surgery for degenerative conditions of the knee
◦ foot and ankle surgery
◦ paediatric orthopaedics
▶ Orthopaedic trauma:
• assessing patients in the out-patient
▶
•
•
•
fracture
clinics and following urgent admission
via the A&E department
Out-patient department:
daily fracture clinic
pre-operative assessment
general orthopaedic service with
physiotherapy input
• outreach clinic
PRE-REQUISITES
Qualified nurse, preferably working in
this specialty.
DURATION
2-4 weeks
46
Royal Free International prospectus - Training opportunities for international nurses and midwives
Paediatric
nursing
Our services have some of the shortest waiting
times locally and nationally so children don’t have
to wait long to be seen. All our nurses have
specialist paediatric training and we offer excellent
career and development opportunities to ensure we
retain skilled and experienced staff.
The Royal Free has a separate children’s emergency
department and we are the only hospital in
England to have round-the-clock consultantdelivered care, meaning children have access to a
specialist paediatric consultant 24 hours a day,
seven days a week.
We have a level one neonatal unit for babies born
at 34 weeks gestation or over run by an expert
team of nurses and consultants who provide highly
specialised care such as tube feeding and nasal
oxygen for larger, pre-term babies and for the small
proportion of full-term babies who need extra
support during the first few days of life. This team
includes an advanced neonatal nurse practitioner
who has a higher level of skills and can stabilise
very sick babies and carry out clinical procedures
which elsewhere would be performed by a doctor.
Our paediatric department has an
expert team of nurses, doctors and
therapists providing a range of
services to children including
emergency, urgent, surgical and inpatient care in hospital and outpatient services in hospital and in
the community. We take a holistic
approach, ensuring physical,
emotional, psychological, social and
educational needs are met.
PROFESSIONAL DEVELOPMENT PROGRAMMES
TYPE OF TRAINING
Observership
CONTENT
Individualised programme covering any or all of the
following areas:
▶
•
•
•
•
•
•
•
Paediatric care:
day ward
in-patient ward (medical and surgical patients)
paediatric A&E
children’s community nursing
24/7 consultant on call system
life support
situation background assessment
recommendation (SBAR) as a communication tool
▶ Neonatal care:
• managing a nurse-led unit
• the role of the neonatal nurse with enhanced
skills (eg IV cannulation and venepuncture)
• the role of the neonatal nurse practitioner
(participate in consultant on-call rota)
• life support
▶
•
•
•
▶
•
•
•
•
•
•
•
Paediatric gastroenterology:
Crohn’s disease
failure to thrive investigations
enteral feeding
The role of the paediatric nurse specialist:
allergy
diabetes
epilepsy
inflammatory bowel disease
eating disorders
dressing clinics
child psychiatry
Royal Free International prospectus - Training opportunities for international nurses and midwives
A Royal Free consultant was involved in designing a
paediatric early warning score (PEWS) which is used in
hospitals across the UK, having been adopted as
model of national best practice.
The PEWS helps healthcare professionals to recognise
deterioration in children early and avoid admissions to
higher levels of care. It is calculated using observations such
as pulse, respiratory rate, respiratory distress and conscious
level. If a child’s clinical condition is deteriorating the ‘score’
for the observations will (usually) increase and so a higher or
increasing score gives an early indication that intervention
may be required. Staff can then ensure they respond
appropriately and escalate concerns. Communicating PEWS
during handover raises staff awareness of the sickest
children in their care and can be used to inform decisions
about allocating resources.
are
The PEWS helps healthc
professionals to
recognise deterioration in children early and
her
avoid admissions to hig
levels of care.
▶
•
•
•
•
•
•
•
•
47
Paediatric day case surgery
environment
clinical pathways
guidelines
protocols
pre-assessment clinics
post-surgery care
discharge checklist
referrals to community services
▶ Paediatric early warning score
(PEWS):
▶ Nutrition:
• malnutrition, nutrition protocols,
feeding programme
▶ Child mental health:
• psychology, family therapy and
psychotherapy support
• general child psychiatry
• specialist eating disorders service
▶
•
•
•
Therapy services:
paediatric occupational therapy
paediatric physiotherapy
speech and language therapy for
babies and those with feeding
difficulties (not speech difficulties)
• paediatric dietitian
• play therapy in hospital
▶ Out-patient services
▶ Child protection
PRE-REQUISITES
Practising paediatric nurse.
Disclosure and Barring Service (DBS)
clearance.
Practising neonatal nurse/paediatrician
or paediatric medical trainee/paediatric
therapist.
DURATION
4 weeks, maximum two nursing staff
at a time or one of the other
disciplines.
48
Royal Free International prospectus - Training opportunities for international nurses and midwives
Palliative care
The Royal Free Hospital
was one of the first
hospitals in the UK to
have a hospital based
palliative care team.
PROFESSIONAL DEVELOPMENT PROGRAMMES
TYPE OF TRAINING
Observership
CONTENT
Individualised programme covering any or all of the following areas:
The multidisciplinary nurseled team provide specialist
care to ensure quality of
life for people with
advanced illness and
support for patients and
their families. The team
has specialist skills in pain
and symptom
management and provide
supportive care on
complex social, emotional
and spiritual matters at the
end of life.
The team run a number of
out-patient services
including a consultant
out-patient clinic for
patients with specialist
palliative care needs or
symptom control
problems, particularly pain
requiring management
with strong painkillers; a
joint palliative/renal clinic
for patients with advanced
renal disease; and a
palliative care clinic for
patients with HIV.
▶
•
•
•
Patient care:
assessing patients’ needs
treating symptoms
supporting and advising patients and relatives on psychological, social and
financial issues
• supporting future care planning to plan future care
▶
•
•
•
•
•
•
•
•
▶
•
•
•
•
•
•
The multidisciplinary team:
senior specialist nurses
medical consultants and doctors in training
team administrator
occupational therapist
physiotherapist
specialist social worker
specialist psychologist
assistant practitioner
Settings:
hospital in-patient
out-patient department
community
liaising with local hospice providers
GP surgery
day centre
PRE-REQUISITES
Nurse with previous experience of looking after patients with terminal illness.
DURATION
Negotiable
Royal Free International prospectus - Training opportunities for international nurses and midwives
Patient at risk and
resuscitation team
PROFESSIONAL DEVELOPMENT PROGRAMMES
The patient at risk and
resuscitation team (PARRT)
is a nursing service which
provides 24/7 care to
patients at risk of
deterioration, including
attending medical
emergency calls and
reviewing all patients after
they are discharged from
intensive care.
They aim to promote accurate
recognition and early
management of deterioration,
which has been proven to
reduce the likelihood of cardiac
arrest occurring.
TYPE OF TRAINING
TYPE OF TRAINING
Simulation-based training
Simulation-based training
CONTENT
CONTENT
Advanced trauma life support:
a systematic, concise approach to
the early care of trauma patients.
PRE-REQUISITES
Paediatric life support: providing
the essential knowledge and skills
to treat paediatric patients in
cardiac arrest before the
resuscitation team arrive.
Experienced doctor/surgeon
PRE-REQUISITES
DURATION
Experienced nurse or qualified
doctor
3 days (set days twice a year)
DURATION
TYPE OF TRAINING
An important part of this work
involves discussions around
resuscitation decisions and
multidisciplinary approaches to
these complex scenarios. The
team also co-ordinate care after
a critical care stay, facilitating
rehabilitation pathways and
tracheostomy weaning.
Simulation-based training
The team members provide
education, training and support
to manage life-threatening
situations, including in-hospital
resuscitation, care of patients
with a tracheostomy tube and
continuous positive airway
pressure (CPAP).
PRE-REQUISITES
1 day (set day three times a year)
TYPE OF TRAINING
CONTENT
Advanced life support: delivering
patient-centred, timely and
efficient care to deteriorating
patients and patients in cardiac
arrest.
Simulation-based training
CONTENT
Advanced paediatric life support
(APLS): delivering patient-centred,
timely and efficient care to
deteriorating patients and those in
cardiac arrest.
Experienced doctor/surgeon
PRE-REQUISITES
DURATION
1 day (set day six times a year)
plus 8 hours e-learning
Experienced nurse or qualified
doctor
DURATION
2 days (set days twice a year) plus
15-hours e-learning
49
50
Royal Free International prospectus - Training opportunities for international nurses and midwives
TYPE OF TRAINING
Simulation-based training
CONTENT
Immediate life support:
providing essential
knowledge and skills to treat
patients in cardiac arrest
before the resuscitation team
arrive.
PRE-REQUISITES
Nurses and doctors
DURATION
1 day (set day six times a year)
Our PARRT developed a free
iPhone app to help our staff
and doctors and nurses
around the globe to treat
patients with severe sepsis,
an illness which kills more
people than bowel, lung
and breast cancer
combined.
Sepsis is a life-threatening condition caused by the human body having an
overwhelming response to an infection. The incidence of sepsis is increasing
and is the single most common cause of admission to intensive care units
globally. Symptoms of sepsis usually develop quickly and the body’s immune
system sets off a series of symptoms which can lead to death. However if
sepsis is recognised at an early stage, medical staff can take action and
significantly improve chances of survival.
The ‘sepsis six’ app was designed with this in mind. The app provides advice to
healthcare professionals on how to diagnose sepsis and uses a one-hour timer
and on-screen prompts to guide them through six interventions which can help
reduce the risk of patients dying as a result of sepsis. It is available to download
for free from the Apple store. The six interventions which must be completed
within one hour are: oxygen, blood cultures, intravenous antibiotics, fluid
resuscitation, fluid balance measurement and blood lactate measuring.
Margaret Devaney, lead nurse of the patient at risk and resuscitation team, said:
“The sepsis six app is producing real results for patients at the trust.
Since the launch of the app, there has been an increase in early
recognition of the triggers of potential severe sepsis.
“The number one aim of our staff is to provide world class care, each
and every day. However we recognised that sepsis is sometimes very
hard to diagnose and the six medical interventions need to be delivered
quickly, in a high pressure environment that is why a tool such as the
app is a valuable aid.
critical
emergency and
e
th
on
w
am
In 2013, the te
es Awards for
care category at the Nursing Tim
r, which
nt safety nurse facilitato
the work of the patie
is an essential
re sepsis
part of the seve
ckage.
resuscitation pa
Royal Free International prospectus - Training opportunities for international nurses and midwives
51
Productive ward
initiative – releasing
time to care
PROFESSIONAL DEVELOPMENT PROGRAMMES
The productive ward
initiative is designed to
improve the quality and
safety of patient care by
identifying waste and helping
staff to organise their work
and environment to facilitate
the smooth delivery of care.
It was introduced by the NHS
Institute for Innovation and
Improvement in 2008 and has
been adopted by the Royal Free
in some clinical areas. The
foundation modules concentrate
on finding ways to improve
patient care including:
monitoring performance and
planning improvements;
exploring how the ward is
organised to ensure it works for
the team; and developing visual
patient information that
improves communication, patient
experience and patient flow.
The rest of the modules look at
ward processes including:
meals, medicines, admissions
and planned discharges, shift
handovers, patient observations,
patient hygiene, nursing
procedures and ward rounds.
We can share with you our
experience of applying the
productive ward methodology,
what we have learnt so far and
show you the tools applied as
outlined in the table below.
TYPE OF TRAINING
Workshop
CONTENT
Productive ward initiative:
•
•
•
•
•
•
•
•
•
general introduction, overview and aims
improvement methodology
foundation modules (described above)
process modules (described above)
ward organisation
support and diagnostics
organisation, context and leadership
the productive ward initiative at the Royal Free
guided visits to various clinical areas to see some of the actions and
learn from our experience
PRE-REQUISITES
Previous ward-based experience.
DURATION
1 day overview programme
(introductory teaching session and ward visits for a group of 4-10)
OR
1 week taught programme and ward visits for a group of 4-10
52
Royal Free International prospectus - Training opportunities for international nurses and midwives
Royal Free International prospectus - Training opportunities for international nurses and midwives
Radiotherapy
The department provides
radiotherapy services primarily to
the patients of north London,
Hertfordshire, Bedfordshire and
the surrounding counties and is
also a tertiary referral centre for
specialist cancer services.
53
Our radiotherapy department
hosts a multi-professional
team that encompasses the
work of clinicians,
radiographers, radiotherapy
review specialists,
radiotherapy physicists and
technologists.
PROFESSIONAL DEVELOPMENT PROGRAMMES
TYPE OF TRAINING
The department provides both
palliative and radical cancer
treatments and specialises in
intensity modulated radiotherapy
treatment (IMRT), image guided
radiotherapy (IGRT), total body
irradiation, Iodine 125 prostate
seed implants and participates in
intraoperative radiotherapy to
the breast.
Facilities used to provide safe
and accurate planning and
treatment to patients include:
two linear accelerators, an
orthovoltage unit, intra-operative
radiotherapy, a dedicated
Toshiba CT-scanner, Pinnacle
treatment planning system (TPS),
IMRT, IGRT, respiratory gated
radiotherapy and prostate
brachytherapy.
The department has two
dedicated ‘on treatment review’
specialists who review patients
undergoing radiotherapy
treatment on a weekly basis. The
review specialist meets new
patients in the out-patient clinic
and is there to provide support
during their course of treatment.
This nurse-led service, supported
by clinicians, offers patients
advice on skin and other
reactions and post treatment
reviews. The specialists also
make multidisciplinary team
referrals as required.
Observership
CONTENT
Radiotherapy
▶ Shadowing the nurse providing care to the following cancer patients
undergoing radiotherapy treatment:
• chemo radiation patients
• all breast cancer patients including those having radiotherapy for leftsided breast cancer. Also includes those patients recruited to the import
high trial or intra operative breast trial (TARGIT)
• prostate cancer patients having IMRT treatment and their patient-specific
preparation
• prostate brachy therapy patients
• lung cancer radiotherapy
• bladder cancer radiotherapy
• upper and lower gastrointestinal patients
• haematology patients including those undergoing total body irradiation
• myeloma/lymphoma patients
• skin cancer radiotherapy
• symptom control for palliative patients
▶ Knowledge transfer on nurse-led services including:
• one-stop patient review clinic post treatment (including dressing,
counselling and multidisciplinary teams referrals services)
• coordinating patients with multidisciplinary teams
• developing guidelines(eg radiotherapy skin care)
PRE-REQUISITES
Qualified nurse
DURATION
Negotiable
54
Royal Free International prospectus - Training opportunities for international nurses and midwives
Renal
PROFESSIONAL DEVELOPMENT PROGRAMMES
TYPE OF TRAINING
Our nephrology and renal
transplantation department
serves a local population of
1.4million people, providing
a comprehensive in-patient
and out-patient service for
the investigation and
treatment of kidney
problems. It is also nationally
recognised in a number of
sub-specialty areas.
The Royal Free is a major
transplantation centre and
carries out 110 kidney
transplants every year of which
around 40% are from living
donors. Offering keyhole
surgery (laparoscopic) as
routine, its results compare
favourably with the best
transplant units both nationally
and internationally. The
department has special
expertise in arranging live
donor transplantation from
donors who live abroad. It also
manages dialysis services for
the north central London area,
with all modalities supported
and an active dialysis research
programme.
The department is a regional
centre of excellence for
vascular access surgery for
haemodialysis and has a
specialist service for acute
kidney injury. Our metabolic
kidney stone service is also one
of just a few units in the UK to
specialise in the medical
management of recurrent
kidney stones.
Observership
CONTENT
Renal transplantation
Bespoke programme covering any or all of the following areas:
▶ Protocols, policies and knowledge sharing:
• national standard operating procedure from the Human Tissue Authority
▶
•
•
•
•
•
•
•
The role of the renal transplantation nurse and nurse-led clinics:
renal recipients coordinator
living donation
post-operation transplantation clinic (acute, chronic and failing graft
clinics)
ABO and HLA incompatible transplants: desensitisation and antibodies
removal using drugs/plasma exchange technique
pre-assessment clinic (assesses physical fitness of patients on the
transplant waiting list)
transplant waiting list maintenance - tissue typing, antibodies
monitoring etc
annual review clinic for living donor
▶ Psychological aspects:
• role of the clinical psychologist
• role of the independent assessor
for living donors (as per UK
legislation)
▶ Day case procedures:
• renal vascular access
• renal biopsy
▶ Chronic kidney disease (CKD)
management:
• role of the CKD clinical nurse specialist (CNS)
• health education, treatment options and shared
decision making
• preparation for renal replacement therapy
• general nephrology
• pre-transplant assessment
• CKD patient pathway
• CKD protocols (imaging and cardiac
investigations ordering)
• multidisciplinary working
(psychologist/dietician)
Royal Free International prospectus - Training opportunities for international nurses and midwives
55
ned
llion into a purpose-desig
The trust invested £3mi
munity
kidney care centre at Edgware Com
m.
planned for Tottenha
Hospital and another is
▶ Maximum conservative
management (MCM):
• joint MCM/palliative care clinic
▶ New developments:
• CKD community integrated care pilot
• kidney care centres service redesign
▶ Advanced nursing practice:
• development of advanced nursing
practice guidelines
• advanced practice protocols
• shared care protocols (with community
general practitioners)
• step-down clinic (nurse-led service for
stable patients)
• non-medical prescribing
▶ Developing guidelines
▶ Special formulary development
▶ Renal research nursing:
• coordinating and conducting clinical
trials
• developing trial protocols
• single and multi-centre approach and
placebo controlled
• data collection, monitoring and quality
analysis
PRE-REQUISITES
Qualified nurses
DURATION
2-4 weeks
The Royal Free is bringing care closer to home for
patients with kidney conditions.
The trust invested £3million into a purpose-designed kidney
care centre at Edgware Community Hospital and another is
planned for Tottenham. The Edgware unit has 29 dialysis
stations and five clinic rooms offering a full range of renal
services. This includes haemodialysis and peritoneal dialysis,
preparing patients for dialysis and the treatment of chronic
kidney disease. It has a self care area, which allows patients to
dialyse themselves with minimal staff supervision or prepare for
dialysis in their own homes.
Previously many patients from the Edgware area had to travel to
other dialysis centres across north central London. Care is now
delivered by the same high quality team of Royal Free staff,
saving patients time and making treatment more convenient.
Dr Jenny Cross, dialysis lead clinician at the kidney care centre,
said: “We know that if you are travelling several times a week
for dialysis, having a shorter journey time is really important.
We have listened to the needs of our patients, and we wanted
to provide them with a modern, purpose-built facility closer to
their homes.
“The opening of Edgware is part of a wider strategy
transforming the way we deliver renal services. We want
to give our patients more choice about where they have
treatment, to offer a range of treatment options in
comfortable surroundings and to be able to treat
patients in one place without them having to travel to
different locations.”
56
Royal Free International prospectus - Training opportunities for international nurses and midwives
Surgery
In recent years we have
significantly reduced our
lengths of stay for surgical
admissions as well as
increasing the number of
procedures performed as day
cases, partly through our
development of laparoscopic,
or keyhole surgery techniques.
The main surgeries offered are:
general, trauma and
orthopaedics, vascular (hub for
north central London), breast,
urology, plastic surgery, kidney
and liver transplantation,
ophthalmologic,
gynaecological,
gastrointestinal, colorectal,
hepatobiliary and renal cancer.
We provide a broad range of
general and complex surgery
for our local community as
well as the cancer network
within the north central
London sector.
PROFESSIONAL DEVELOPMENT PROGRAMMES
TYPE OF TRAINING
Observership
CONTENT
Day surgery
Individualised programme including the following areas:
▶ Knowledge transfer:
• admission criteria, guidelines, policies and protocols for a range of
surgical day procedures
• development of clinical pathways, guidelines and protocols
▶
•
•
•
•
Pre-assessment nurse-led clinics:
pre-admission checklist
pre-operative patient assessment
pre-operative investigations
patient criteria for day case surgery
▶
•
•
•
•
Day surgery competencies:
Individual patient care pathways in the following specialties:
ophthalmology
urology
fistula or pilonidal sinus repair
▶ Follow-up nurse-led clinic:
• criteria for referral
• nurse-led discharge
▶ Nurse-facilitated discharge:
• discharge criteria/checklist
• community team referral
PRE-REQUISITES
Qualified nurse interested in surgical nursing.
DURATION
1 day
Royal Free International prospectus - Training opportunities for international nurses and midwives
57
TYPE OF TRAINING
TYPE OF TRAINING
TYPE OF TRAINING
Observership
Observership
Observership
CONTENT
CONTENT
CONTENT
General surgery, vascular and
colorectal surgery
Operating theatre
Enhanced recovery: improving
patient outcomes and speeding
up recovery after surgery
▶ Knowledge transfer:
• admission criteria, guidelines,
policies and protocols for a
range of surgical day
procedures
• developing clinical pathways,
guidelines and protocols
• multidisciplinary working
• nursing competency
assessment
PRE-REQUISITES
Qualified nurse with an interest in
surgical nursing.
Individualised programme
including the following areas:
▶ General operating theatre
•
•
•
•
nursing:
elective and emergency surgery
the role of the scrub nurse
anaesthetics
post-operative recovery ward
▶ Introduction to the high-tech
endovascular operating room
▶ The decontamination unit
▶ SurgiNet (SN) IT system
DURATION
PRE-REQUISITES
Maximum 4 weeks
Nurse with previous theatre
experience.
DURATION
Maximum 2 weeks
Covering the following topics:
• enhanced recovery concepts
and models of care
• enhanced recovery pathways
and approach
• achievement measurement
PRE-REQUISITES
Nurse with some surgical
experience
DURATION
Maximum 2 weeks
58
Royal Free International prospectus - Training opportunities for international nurses and midwives
Tissue viability
PROFESSIONAL DEVELOPMENT PROGRAMMES
Our tissue viability service provides
expert wound assessment, advice,
management and support for both
staff and patients in managing
complex wounds which include
chronic wounds such as leg
ulceration and pressure ulcers and
traumatic and surgical wounds,
along with palliative and other
wounds of atypical nature.
TYPE OF TRAINING
Observership
CONTENT
Individualised programme covering any or all of the following areas:
▶ Role of the tissue viability nurse specialist:
• nurse-led services
• specialist assessment and intervention
▶ Advanced wound care covering various specialties including
This innovative specialist service works
closely with other medical and surgical
specialties within the hospital, including
the surgical appliance department,
dermatology, diabetes, plastic nurse
specialists and the vascular team, as
well as with community, district and
general practitioner and other tissue
viability services.
We also run a nurse-led leg ulcer outpatient service in collaboration with our
vascular surgeons which provides
comprehensive assessment and
management of vascular-related
conditions such as leg ulceration and
chronic oedema or lymphoedema.
Assessment includes: doppler
assessment; compression bandaging
therapy; lymphoedema advice; and
specialist dressing advice and
management.
All of the tissue viability team assist in
the production of evidence-based
pressure ulcer prevention and wound
management policies and have had
work published in nursing and wound
specialist journals and presented their
work at local, national and
international conferences.
•
•
•
•
•
•
•
•
•
•
patients with lymphoedema:
acute non-infective wound management
acute infective wound management
chronic non-infective wound management
chronic infective wound management
wound cleaning
wound debriment
dressing selection
topical negative pressure therapy
advanced wound care in the open abdomen
advanced wound care in the transplant patient
▶ Pressure ulcer prevention and treatment:
• research and audits
• education and training
▶ Service development - advice on setting up a complex wound
•
•
•
•
healing unit:
service design
complex wound management
elective admission for wound care in dedicated in-patient beds
telemedicine consultations
PRE-REQUISITES
Qualified nurse
DURATION
1-8 weeks
Royal Free International prospectus - Training opportunities for international nurses and midwives
59
Jemell Geraghty
clinical nurse specialists in tissue viability
htingale travel
awarded the Florence Nig
scholarship in 2012
Jemell Geraghty, one of our clinical nurse specialists in
tissue viability and a part-time lecturer practitioner in
tissue viability at Kings College London University, was
awarded the Florence Nightingale travel scholarship in
2012.
With this scholarship she was able to explore services in the
north of England and London for intravenous drug users with
leg ulceration. Jemell currently runs a monthly outreach
vascular leg ulcer clinic for intravenous drug users locally in
Camden.
She also won the Journal of Wound Care scholarship in 2006
for novice practitioner in tissue viability. Jemell is on the
editorial board for the tissue viability panel at the British Journal
of Nursing.
As part of her professional doctorate in health research
(DHRes), she is exploring the experiences of intravenous drug
users with leg ulceration using a qualitative design.
60
Royal Free International prospectus - Training opportunities for international nurses and midwives
Contact details
Thank you for your interest in Royal Free International. If you are interested in taking
part in any of our courses, have any questions, or would like to discuss your needs
further, please contact:
Reyon Yan
Clinical and development programme manager
Royal Free International
Telephone: +44 (0)20 7794 0500 x 36347
Email: [email protected] or [email protected]
You can also contact the RFI team on
+44 (0)20 7472 6252 or +44 (0)20 7794 0500 x 35363
Website: www.royalfreeinternational.com