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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