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WELCOME TO E4 INFORMATION FOR STUDENT NURSES 1 Expectations of Mentors As a student you can expect ……. An appropriately qualified nurse to act as your mentor/ associate mentor A minimum of 3 formal meetings per placement to complete your assessment documentation Time and patience to facilitate your learning at a comfortable pace appropriate to your particular stage of experience Respect for your individual learning needs and capabilities Learning opportunities to achieve the objectives assigned by the University Help liaising with the different MDT to achieve appropriate learning experiences Assistance arranging spoke placements appropriate to the placement Openness and honesty regarding your progress both clinically and professionally Reporting to and liaison with the university regarding any untoward incidents Expectations of student nurses As a practice placement, we would expect you ………. To treat patients with dignity and respect To work as a team member, demonstrating respect for your colleagues through respect, honesty and a willingness to learn To be punctual To work a 37.5 hr week (excluding breaks) or appropriate part time hours To experience 24 hour cycle of care via a variety of shifts e.g. early, late, weekends and nights appropriate to your stage in the course To complete assignments in your own time. To arrange any part-time work around your placement shift patterns, not visa- versa To adhere to Trust and University dress codes To take responsibility for reporting sensitive information disclosed by patients To work within your own capabilities and if in doubt ask 2 Acknowledge the work load of staff and appreciate your needs cannot always be met immediately Acknowledge that you have supernumery status but you are expected to work as part of our team and be involved in patient care An Introduction to Ward E4 for Student Nurses. Welcome to ward E4, the ward specialises in vascular surgery, as well as dealing with general surgical patients. We do take other specialities but this is dependent on the bed situation within the hospital. It is an extremely busy ward as we have theatre lists nearly every day and can receive patients from list admissions, clinics and emergency admissions at any time of the day. The ward has a multi-disciplinary approach and utilises many specialities to give the best patient care we can. We are committed to an education programme and to a high standard of nursing care and we hope that you find this allocation an enjoyable and rewarding experience. We are a 25 bedded mixed sex ward comprising of 3, 7 bedded bays and 4 side wards. The ward is divided into 3 areas SW 1 &SW 2 and Bay 1 = Red Team SW 3 and Bay 2 = Blue Team SW 4 and Bay 3 = Green Team The ward staff have excellent knowledge base to teach during your surgical experience on E4, they have a variety of clinical experiences and all doing or completed further courses of studies in their areas of interest. There are also packs available to explain each speciality specific to the ward. Current staff members are: Consultants: Vascular: Mr G Ferguson and Mr M Onwudike. Colorectal: Mr D Smith, Mr P Harris and Mr H Michie. Miss G Faulkner. Upper GI: Mr J Varghese, Mr B. Smajer and Mr U Uzair Urology: Miss Lee, Mr Pantelides, Miss Gall Senior Sister/Ward Manager: Julie Power 3 Junior Sister: Louise Gill and Helen Millward Staff Nurses:, Terri Wareing, Beverley Talbot, Emma Skett, , Hannah Leather, Jyothi Gomes, Andrea Breithaupt, , Kelly Binks, Louise Day, Ruben Escobar, Janet Hodson and Kerry Sturrock. HCA: Chris Smith, Sheila Potter, Chelsea Foley , Stephanie Tootill, Amy Thornhill, Gill Urmson, , Prav Vara, Katie Gibney , Caroline Pendlebury, Robert Aspinall, Alison Butler, Kellie Pollard , Michela Eweka and Alex Shone. Ward Clerk: Carole Bolton Current Shifts: Early: Late: Night: Long Day: 07.30 – 15.30. 12.00 - 20.00. 19.30 – 20.00 07.30 – 20:00 There is a request book and all requests will be taken into consideration when the off-duty is done. You will be able to negotiate your off duty, as long as it meets your statutory requirement to complete your training. There is a variety of literature and information available on the ward for you to access if you choose. You will have an assessor/mentor assigned to you during your allocation. It will not always possible to work with your assessor, therefore you will work with another member of staff, who act as associate assessor. You will also have the opportunity to complete a theatre induction (if not already done so) and follow a patient to theatre during your allocation on E4. If there is anything else you want to see or do whilst on E4 then please let your mentor or assessor know and we will do our best to arrange this. BASIC HOUSEKEEPING The uniform policy must be adhered to at all times. A locker room is located off the ward for your personal belongings. Please ask a member of staff for the security code for the door. 4 Staff breaks are allocated between 10:00 and 11:00 on an early shift and 15:00 and 16:00 on a late shift. Emergency and Fire procedures will be explained to you at the start of your allocation as well as the emergency equipment and fire exits. Spoke placements ENT clinic Bereavement and organ donation team Theatre E4 F6 admission ward Night duty Acute pain team Infection control (Year 3 only) (Year 3 only) Students are encouraged to participate in spoke placements – above is a selection of what is available. Please discuss with your mentor which would be beneficial for your learning. Spoke placements should link in with the placement – please discuss with your mentor if you wish to spend time with a speciality not listed above. 5 From Sept 2011 cohort – spokes will be formalised and will take place during the middle four weeks of placement. IMPORTANT NUMBERS CARDIAC ARREST FIRE FAST BLEEP WARD 2222 2222 2222 01204 390623 TO BLEEP A DOCTOR – Dial 8 then the bleep number then the extension number from which you are calling. Your Practice Education Lead for the ward is Terri Warring. Please feel free to speak to us or your allocated mentor anytime if you have any questions or concerns. Alternatively you can contact the Practice education Facilitator on 5984. We want you to feel relaxed and enjoy your placement on E4 and will ensure that your supernumerary status is maintained whilst on placement. We hope that you have an enjoyable allocation on E4 ward and utilise the ward as an excellent acute surgical experience. If you should have difficulties please lets us know. Emergencies It is important that you are aware of the following in the event of an emergency:Emergency phone numbers Location of crash trolley Location of defib machine How to fast bleep a doctor What to do in the event of a fire Location of fire exits If you haven’t had your local induction checklist completed within 24 hours of starting your placement, please inform the PEF team. ABOUT THE WARD 6 E4 is a busy acute surgical ward, comprising of 25 beds. The staff on E4 are committed to giving a high standard of patient care and provide students with a learning environment to fit their needs. This profile will describe E4 and the learning experiences available to you. NURSING PHILOSOPHY Caring is a major focus of nursing within the directorate of General Surgery. By using a recognised Model of Nursing and the Nursing Process, the appropriately trained qualified and unqualified staff aim to fill the self deficits within patients’ activities of daily living, brought on by ill health. All relevant aspects of hospital care will be explained to ensure informed consent is obtained and a duty of care is achieved. Whenever possible promotion of health will be emphasised. Where death is the expected outcome, we will endeavour to ensure that it is dignified, peaceful and pain free. All care will be delivered with respect regardless of age, race, culture, gender, sexuality and social status. Staff of all grades will be encouraged to develop their professional skills and are accountable for nursing care that they give in accordance with the Nursing and Midwifery Council. ORGANISATION OF CARE The organisation of Ward E4 reflects the beliefs and values, which we on E4 hold. It puts patients and their families at the centre of care helping to promote individualised holistic care. This takes into account the person as a whole and places a greater value on the psychological components of care, rather than just the physical needs. Nurses are assigned to a group of patients and are completely responsible for their care. A philosophy of care and our organisation designs a patient centred approach to the delivery of care and gives the individual nurses responsibility for the care that they give. All nurses exercise freedom to practice and are autonomous and accountable. 7 The philosophy of care promotes enhanced interaction between patients and nurses. All nurses set their own priority of care and are accountable for patients as well as being answerable for their own decisions. Nurses are allowed to professionally develop and enhance their communication skills and their interpersonal skill. There is an antihierarchical structure, and responsibilities are often shared with all the multidisciplinary team. Communication Communication with patients and relatives form a large part of a nurses’ role, how we communicate with people reflects upon the whole profession. Good communication helps to promote patient confidence at what can be a very difficult time for them; poor communication can lead to impressions of incompetence and loss of confidence in nursing staff. While it is important to keep relatives informed of a patients progress, it must be remembered that confidentiality is an important issue, always confer with a qualified member of staff before disclosing any information. Never give any information out over a telephone. Remember that it is very easy to give misleading information which can lead to disastrous results. If in doubt ask – but make sure the time is appropriate to do so. Students who speak more than one language must be mindful that they must not utilise these skills to act as a translator – official Trust sources should be utilised. No Smoking Policy Students are advised that of 1st July 2009 Royal Bolton NHS Foundation Trust became a no smoking site. This covers the entire hospital site, including cards parked in the grounds. Uniforms must be fully covered when off hospital grounds Visiting times Visiting times are 2-3:30pm and 6:30-8pm each day. Visiting out of these times is at the discretion of the nurse in charge of the shift and should be done by prior arrangement. Visiting during meal times is not permitted. Guidelines regarding uniform 8 Students are reminded that they must follow the university’s guidelines regarding uniform. Uniform must be complete and presentable as supplied Cardigans must be removed when in clinical areas Black low heeled quiet soled plain shoes should be worn. Trainers and boots are not permitted Trust identity badges must be worn when on duty, no other badges Hair should be tidy. Long hair should be tied back and off the face and collar. Head scarf worn for cultural purposes must be black of white, no large adornments or tassels It is not permitted to wear a long sleeved garment under uniforms Finger nails should be clean, short. No nail polish or false nails Make-up should be discrete. Aftershave or perfume should be used sparingly No jewellery other than wedding ring and one plain small stud per ear Dark coloured overcoat which covers length of tunic must be worn when off hospital grounds. Students who do not comply to uniform policy will be sent home and marked as absent WHAT CAN YOU LEARN On a surgical ward we nurse patients before and after surgery. Not all patient need surgical intervention, but most are admitted with problems that may require surgery. The consultants on E4 specialise in vascular surgery and urology surgery, however we also have patients who require surgery that is not necessarily related to these specialities. If during your allocation there is anything you wish to see or do, please feel free to ask and we will endeavour to ensure your request is met. As you go through your allocation you will see patients with a variety of surgical conditions, below is a list of surgical conditions, investigations or surgery performed that you may witness whilst you are on the ward. The list is provided so if you wish you can do some background reading. 9 Abdominal Aortic Aneurysm Angiograms /Angioplasty Arteriograms Bowel Resection Carotid endarterectomy Cholecystectomy Cystoscopy Femoral Bypass Graft Gastrectomy Incision & Drainage of abscesses Pancreatitis Thyriodectomy TURP Vascular conditions. Amputation Appendectomy Bowel Obstruction Cholecystitis Colonoscopy EVAR Gastrointestinal Bleeding Gastroscopy Leg Ulcer Repair of Hernia TURBT Urinary Infections These are only a few you will come across more. If you come across anything you do not understand please ask. INTERPERSONAL SKILLS On E4 you will be able to develop your own role as a student in a comfortable and secure supportive environment. You will observe staff using their decision making skills in a number of situations and you will be able to develop your problem solving skills whilst on the ward. Surgical patients have a number of communication problems. Some of these are listed below and you will be able to develop your skills in this area. Hearing problems Speech problems Sight problems People who do not speak the same language People with learning disability People with mental health illness All patients with communication problems need more help and may cope well in their own environment, but hospitals are unfamiliar to them. On E4 you will observe and be able to use verbal and non-verbal communication and will be able to develop your own skills. 10 Admission to hospital can increase anxiety in people, (Franklin 1974) Patients and relatives need support. As a student on E4 you will witness staff use communication skills to ease anxiety and support patients through what can be a very stressful experience. As a student you be encouraged to be involved in this process. Example of when anxiety is heightened: On admission Immediately before going to theatre When a malignancy is suspected or diagnosed Relatives get anxious when a loved one is very ill On discharge, patients wonder if they can cope at home Alter body image i.e. stoma, amputation etc RESEARCH AND ITS APPLICATION Research based practice is an important aspect of health care and research into the needs of the surgical patient is ever changing. We try to provide up to date evidence based care on E4 and to do this we use a number of resources. SPECIALIST NURSES The Trust employs a wide range of Specialist Nurses of which all wards and departments have access to. Their roles vary, but it includes education of staff and patients and implementation of the research. We have link nurses from the ward who attend meetings with the specialist nurses/teams and disseminate new knowledge and information, which in turn cascade to ward level. The aim of this is to continually improve and develop the service we offer. Here a list of some of the Specialist nurses/teams Vascular Nurse: Paula Thompson Acute Pain Team: Janet Roberts & Trudy Hadcroft Bereavement Team: Julie Bramwell and Dave Walker Stoma Nurses:Janette Saunders & Sharon Corbett Tissue Viability: Kate Lewis Critical care outreach: Kay Lythgoe & Sarah Carden 11 Please feel free to ask who the link nurses are for each topic/speciality on the ward and ask for any up to date information they may have. We also have a selection of files and teaching resources such as books, policies, articles and research papers available in the Day Room specific to each topic/speciality which are available for you to use, these are located in the dayroom. There is other material available you may find of use is Health and Safety policies (YELLOW BINDER) Infection Control polices (RED BINDER) Quality Standards (PINK BINDER) Intranet on computer system which includes the Royal Marsden There is more available, please have a look and see what is useful to you. HEALTH PROMOTION “Health Education and promotion should be a recognised part of health care. All Practitioners should develop skills and use every opportunity for health promotion”. (DOH 1989). It is also part of rule 18 on the Nursing and Midwifery Council Code of Conduct for 1st level nurses. Information on Health promotion can be found on the ward and intranet. MANAGEMENT Management on a busy ward like E4 is very important. You will be able to observe different management styles on the ward and from these you will formulate your own style. You will be able to manage the care of a patient or a whole team depending on your stage of training and experience. You will be under supervision and receive feedback from your assessor. Any staff will be happy to discuss management issues with you. 12 CARING AND CLINICAL SKILLS There is a vast amount of skills you can develop during your allocation. Please use this opportunity to gain them or work towards gaining them. Utilise all the resources available including members of the multidisciplinary such as physiotherapist, Specialist nurses, they are only happy to impart their wealth of knowledge. The team on E4 want to make your learning experience as good as we can, however, we encourage each student, along with their assessor to organise and plan what you want from this allocation, only you know what you want to learn and if you communicate your learning needs, we will do our best to meet them. If however you feel unhappy about anything or you think we can make improvement in our approach in learning, than tell us, please, we can’t change if we are not told. Please enjoy your placement, feel free to ask questions and try to enjoy your time with us! COMMON ABREVIATIONS AAA – Abdominal Aortic Aneurysm AXR – Abdo x-ray COPD - Chronic obstructive airways disease CSU- Catheter specimen of urine CXR – Chest x-ray ERCP – endoscopic retrograde cholangiopancreatography HR – Heart Rate INR – International ratio IVAB – Intravenous antibiotics IVI – Intravenous fluids MI - Myocardial Infarction MRCP – magnetic resonance cholangiopancreatography MRI – magnetic resonance imaging MSU- Mid stream urine NAD – Nothing abnormal detected NBM – Nil by mouth NWB – Non-weight bearing O2 – oxygen 13 OGD- Gastroscopy ORAL ABX – Oral antibiotics PCA – Patient controlled analgesia PR – Per rectum PV- Per vagina RESPS – Respirations RWT – routine ward test SOB – Shortness of breath TPN – Total parental Nutrition TTO- Discharge medications TWOC- Trial without catheter USS- Ultrasound scan UTI – Urinary tract infection 14 E4 ward learning experience feedback sheet Did you feel the placement/ mentors lived up to their roles? Please could you complete this feedback sheet and return it to TERRI WAREING, it may be anonymous if you wish. Competencies Mentor achieved Mentor not achieved Ward achieved Ward not achieved Contribute to a supportive learning environment and quality outcomes for students Be approachable, supportive and aware of how students learn best Have knowledge of the students programme of study and assessment tool Be willing to share knowledge of patient care Identify specific learning opportunities available in the placement area Ensure that the learning experience is a planned process Ensure that time is identified for interviews to assess and identify learning needs Identify with students their core competencies and outcomes to be achieved Make time to observe students undertaking new skills Encourage enquiry based learning and problem solving Build into learning opportunities the chance to experience the skills and knowledge of specialist practitioners Ensure students have adequate break times Offer encouragement to students Provide effective orientation Work with the student at least 2 out of 5 shifts per week Recognise the students supernumery status Provide time for reflection, feedback and monitoring progress Work in a multidisciplinary team to provide holistic care Seek evaluation feedback from the student at the end of the placement Be willing to take pride in sharing the students journey on the path to becoming a registered nurse Feedback sheet developed using RCN Role of a mentor (2002) Thank you for taking the time to complete this questionnaire. Completed by – leave blank if wish 15 Cohort – leave blank if wish Mentor – leave blank if wish Associate – leave blank if wish Any other comments Date received back to ward ……………………………… 16 17