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________________________________________________________ Student Handbook DEU Medical Ward Acknowledgements: Susan Cartmell – Hutt Valley DHB Joy Richards – Whitireria Community Polytechnic Updated 2012 by Rebecca Ferguson and Sally Huntsman HVDHB STUDENT HANDBOOK 2012 Page 2 Contents Welcome to the Acute Medical Ward ................................................................. 4 Structural Chart ............................................................................................. 1 The Acute Medical Ward .................................................................................. 7 Ward Round Communication ........................................................................... 8 Multi-disciplinary Communication ..................................................................... 8 Patient Communication ................................................................................... 8 Communication .............................................................................................. 9 ISBAR ........................................................................................................ 9 Communication Book ...................................................................................... 9 Uniform Guide ............................................................................................. 10 Education .................................................................................................... 10 Shift Times .................................................................................................. 10 Morning shift guide ...................................................................................... 10 Afternoon Shift Guide ................................................................................... 12 Documentation ............................................................................................ 13 Handover .................................................................................................... 14 After Hours Nursing Support .......................................................................... 14 After Hours Managers (AHM) ......................................................................... 15 Policy Guide ................................................................................................ 15 Appendix 1: Acute Medical Ward Checklist .................................................... 16 Appendix 2: HVDHB Student Nurse / Midwife Placement ................................ 18 Appendix 3: Medical Floor Layout ................................................................ 20 Appendix 4: Nursing Practice skills 1 ........................................................... 21 Appendix 5: Nursing Practice Skills 2 ........................................................... 23 Notes Page .................................................................................................. 25 Welcome to the Acute Medical Ward Dear Student This booklet has been assembled to help you with your orientation to the Acute Medical Ward, as well as an ongoing reference during your stay. We understand that you will be getting a lot of information especially in the first few days, so we hope that this booklet will help put some of the information into perspective for you. While on placement within the Dedicated Education Unit if you have any questions just ask. Clinical Nurse Liaison (CNL) – ______________________ Academic Nurse Liaison (ANL) – ______________________ You will work alongside a ’clinical coach’ the registered nurse – they are your support during your shifts within the ward environment, along with the CNL, ANL and your peers. Expectations of Clinical Liaison Nurse (CLN) The CLN role is one of facilitation and co-ordination. The CLN liaises with key personnel regarding the students’ role, learning needs and progress by: Providing a structured orientation to the clinical area for students and arranging students rosters Allocating student to DEU staff, patients / clients and working with students on a one to one basis as required Anticipating and organising student experiences including working with allied health professionals and rotating to specialist or related areas i.e. endoscopy clinic, theatre and community agencies Working in partnership with the ALN and DEU staff to undertake student assessments Providing ongoing feedback to students throughout their clinical placement and working with the ALN to develop ‘action plans’ for students if required HVDHB STUDENT HANDBOOK 2012 Page 4 Expectations of Academic Liaison Nurse (ALN) The ALN is a Registered Nurse who is an academic teaching staff member of a Bachelor of Nursing programme. The ALN works with all nursing students in the DEU as well as with all DEU staff and hence becomes known to those staff members. They help to support and encourage students to: Socialise into the professional nursing role Demonstrate their knowledge and skills Explore theory and practice links, including the clinical application of Evidence Based Practice Develop appropriate communication, clinical decision making and clinical practice skills Identify and apply curriculum threads to clinical practice The ALN also supports DEU staff to: Increase their knowledge and understanding of the BN programme Set realistic expectations Expectations of Registered Nurse (RN) As a registered nurse in the DEU you will be working with student nurses in a variety of ways: You may ‘clinically coach’ a student for a shift (just like the preceptorship model) You might work with a small group of students developing specific skills (e.g. doing a dressing, carrying out assessments, screening) You will be expected to get to know all the students, nurture them and make them feel part of the team You will be expected to provide feedback to the CLN and ALN for student assessment Expectations of Student The student is someone who is participating in a Bachelor of Nursing programme and who will be working alongside the ALN, CLN and RN. The student will: Be punctual to the start of each shift Be prepared to participate in normal duties expected of an RN at an emerging level Have an understanding of the role of the nurse in a multi-disciplinary team Understand infection prevention standards HVDHB STUDENT HANDBOOK 2012 Page 5 Structural Chart Clinical Nurse Manager/s ACNM/s Nurses Shift Coordinator Educator/s Complex discharge nurse Case Management Stroke CNS Health Care Assistants Complete the table below when you meet the staff: POSITION NAME HVDHB STUDENT HANDBOOK 2012 Page number Page 6 The Acute Medical Ward The Acute Medical Ward at Hutt Valley DHB is split into two wards. During your placement, you will be allocated to either Medical 1 – 12 or Medical 13 – 24, which includes the acute stroke unit. Each ward has a 23 bed capacity, with a mixture of isolation rooms and four bedded cubicles. Patients can be admitted from a number of different locations from around the hospital; emergency department, other wards or hospitals and occasionally directly from a consultant review. We work closely together to ensure optimal patient outcomes. We work as part of a multi-disciplinary team that includes medical staff, physiotherapy, occupational therapists, speech language therapy, pharmacists, social workers, dieticians, specialty nurses and community teams. While on your placement you will be allocated to work with a member of our health care assistant (HCA) team during your placement. Our patients can present with a number of conditions that affect a variety of body systems including: Respiratory Cardiology Gastrointestinal Neurology Renal Endocrine We also care for patients with mental health conditions who require medical treatment (toxicology / self harm), surgical patients with complex medical conditions. You will have the chance to become familiar with a variety of medical conditions. You will learn to perform critical nursing tasks/procedures, including: Patient assessment Time management Documentation The admission / discharge /transfer of patient Basic wound care Nasogastric (NG) placement and care Indwelling catheter (IDC) placement and care Telemetry monitoring ECG recording Assistance with Daily Living (ADL) cares Pressure Area (PA) cares and prevention Communication Malnutrition Screening Tool (MUST) Early Warning Score (EWS) Ward Round Communication Nurses are expected to be part of the medical ward round for their allocated patients. Please accompany your RN ‘clinical coach’ for this time. This allows for participation in the joint care planning and assessment of the patient. Attending ward rounds allows nurses to advocate where appropriate and to be aware of any changes to treatment plans. Any ‘stat’ doses of medication will be handed over to the nurses caring for the patient or a ‘New Order’ tab will be placed outside the patients room in the appropriate space by the medical team. Please ensure you check the progress notes before the end of your shift for further instructions from the team. Multi-disciplinary Communication The multi-disciplinary team (MDT) comprises of; speech and language therapists, physiotherapists, occupational therapists and social workers. Referrals to any member of the multi-disciplinary team are made via computer or folders located in the slots in the main office, opposite the photocopier. Members of these teams check the folders daily. To refer; place a patient sticker into the appropriate book, the reason for the referral, date and name of the person referring. Every consultant team has a member of each of the MDT attached to their patient group. The MDT meet on a weekly basis to discuss and plan patient care, nurses attend these meetings and present their patients to the group. The therapists have an office at the 13 – 24 end, from the patient lounge. Patient Communication In the Acute Medical Ward we aim to achieve effective communication with all our patients and family. It is important that at the start of each shift you introduce yourself by name and your role. To reduce the number of interruptions you can HVDHB STUDENT HANDBOOK 2012 Page 8 receive from families, the ward has two phone message boards. These are located between the office and the ward corridor. If a family member phones and requires a nurse to phone back, this message is placed on the board. It is important to check this at regular intervals. Communication Achieving effective communication across the shifts and between inter-disciplinary teams is always a challenge. Please ensure that all communication is clear and concise. We advocate the use of the ISBAR communication tool. ISBAR I Indentify – yourself, your location, the patient, consultant, their location S Situation – state the purpose of call. If urgent say so and why B Background – current problem, relevant history, examination, test results, treatment to date A Assessment – state what you think is going on. Give results of physical examination including vital signs and EWS Request – if requires urgently say so and reason why. State what you R would like done, ask questions. If the patient doesn’t improve when should they be called again Please return all patient folders to the main office and put them back in the appropriate patient slot. They are not to be left on the benches in the ‘write up’ area. Communication Book Each staff room has a communication book that can be used by anyone wanting to share information between shifts, upcoming education or changes in practice. It is not intended to be used for criticism and if there are concerns about practice please go directly to the CNM/ ACNM/ Educator for the area. There is information and education boards located in each of the staff rooms. HVDHB STUDENT HANDBOOK 2012 Page 9 Uniform Guide There is a mixture non and uniformed staff. Here is a guide to the ‘stripe’ colour on the sleeves of the uniforms Clinical nurse manager Associate clinical nurse manager Clinical nurse educator Specialist nurse Registered nurse Enrolled nurse After hours managers Double dark blue Single dark blue Single light blue Single burgundy Single dark green Single gold Single red Education While you are on the DEU Acute Medical Ward, there will be a variety of options available to you for education. This includes the following; Viewing investigations either at the bedside or away from the ward Assisting with procedures with either the ALN or RN In-service education from both internal and external presenters Hospital library Shift Times A taped/verbal handover takes place at the beginning of every shift – it is important that you arrive on time for each duty. Morning shift (AM) 0700 – 1530 Afternoon shift (PM) 1445 – 2315 Morning shift guide Handover is held in the tea rooms of each ward. There is an ACNM / co-ordinator for each ward. Their role is to help staff and facilitate the running of the ward. If there are any concerns or issues please discuss these with your RN ‘clinical coach’ and the ACNM / co-ordinator HVDHB STUDENT HANDBOOK 2012 Page 10 Patient allocation is written on the large white board at the end of each office area. Your ‘clinical coach’ will be allocated a team to go to for help and handover for breaks etc Fluid balance charts are completed and totaled at 0800 with the 24 hours fluid summary completed. A sub-total is done at the end of each shift Health Care Assistants are allocated to teams. Their role is to assist patient cares, give out meals and menus and general re-stocking of supplies Guide to the morning routine This is a rough guide as patient care needs change. Time Nursing tasks 0700 Handover from the previous shift 0715 Bedside handover of IV fluids, subcutaneous pumps, unwell patients, EWS >3 0730 1.Check patients, 2.read notes, prioritise work load, check emergency equipment (oxygen, suction). Discuss care with your team 0800 Fluid balance charts totaled for the 24 hours. Observations before medications, pre-meal BSL, daily weighs 0830 Patient breakfast – Ensure patient environment is suitably set up 0830 1130 Medications, medical ward rounds – please be present at bedside for this, as able – follow up on any tests, medications, discharge planning Personal cares, dressings OT, PT, tests, procedures 0945 / 1000 Fit your morning tea around your workload It is important to take a break 1130 First lunch 1215 Second lunch 1230 Patient lunch – ensure that the patient environment is set up 1300 1400 Rest period for patients, ward lights are dimmed (visitors are discouraged but arrangements can be made due to circumstances) Observations, Medications, Finish any patient cares, Update the handover sheet on the computer 1400 1445 Write up patient notes – follow the nursing documentation framework found in the patient folder HVDHB STUDENT HANDBOOK 2012 Page 11 Time Nursing tasks Dictate your nursing notes 1430 Ward tidy, check your patient space: clean away uneaten food, clean tray, clear space around the bed Check linen skips Check rubbish bags Tidy away extra chairs 1515 1530 Handover fluids and complex patients at patient bedside 1530 – Finish duty Afternoon Shift Guide Handover is held in the tea rooms of each ward. There is a Co-ordinator for each ward. Their role is to help staff and facilitate the running of the ward. If there are any concerns or issues please discuss these with your RN ‘clinical coach’ and the co-ordinator Patient allocations are written on the large white board at the end of each office area. Your ‘clinical coach’ will be allocated a team to go to for help and handover for breaks etc. Fluid balance charts are sub-totaled at the end of the shift Health Care Assistants are allocated to teams. Their role is to assist patient cares, give out meals and menus and general re-stocking of supplies For medical assistance during the afternoon there is the computer system – SPADE. Urgent medical assistance, first discuss with the co-ordinator and the ‘2nd on’ paged via the operator. Further senior nursing support is available by Critical Care Outreach Nurse (CCON) and After Hours Manager (AHM) Guide to the afternoon routine This is a rough guide as patient care needs change. Time 1445 1515 1530 1600 1730 Nursing tasks Handover Bedside handover of IV fluids, subcutaneous pumps, complex patients, EWS >3 1.Check patients, 2.read notes, prioritise workload, check emergency equipment (oxygen, suction). Discuss care with your team Observations, medications Pre-meal BSL HVDHB STUDENT HANDBOOK 2012 Page 12 Time 1730 1800 1930 1730 2030 2030 2200 2200 2245 2245 2300 2315 Nursing tasks Patient’s dinner – Ensure patient environment is set up First dinner break – fit with your team Second dinner break – fit with your team Medications Observations Personal cares / dressings Settle patients – commodes at bedside etc Medications Replace telemetry batteries Ward tidy - check your patient space: clean away uneaten food, clean tray, clear space around the bed Check linen skips Check rubbish bags Tidy away extra chairs Write patient notes, follow the nursing documentation framework found in the patient folder Update the handover sheet on the computer Dictate your nursing handover Night shift handover begins Handover IV fluids, subcutaneous syringes, complex patients Finish duty Documentation On the Acute Medical ward we use a documentation framework, (found on a red sheet in the front of each patient folder). This framework provides the format for which patient notes are to be written. The framework makes notes easier to read and information quicker to find. All patient documentation is written on ’progress’ pages. At the top it has an area for the patient sticker and page number. All documentation must contain: your name (legible), signature, designation, date and time. As a student writing in patient notes, you must have it counter signed by the RN who is working with you for the shift. Ensure that you and your RN update the patients’ condition on the computer system and the nursing care plan each duty. HVDHB STUDENT HANDBOOK 2012 Page 13 Handover On 1 – 12 side the hand over is verbal. The staff completes a handover sheet and the shift coordinator hands over all patients to the oncoming staff. 13 – 24 side handover is taped using a Dictaphone. The dictaphone is found in the staff room; please get your RN to show you how this works. Speak slowly and clearly. Start with the patients’ name, room and bed space. Then current EWS score. Give information that is relevant to the oncoming shift, other information should be clearly documented in the patients’ notes. All handovers should be concise. All patients with IV or subcutaneous fluids, neuro observations, EWS >3, chest drains, tracheotomy or acutely unwell must be handed over at the bedside. After Hours Nursing Support Critical Care Outreach Nurse & EWS The critical Care Outreach Nurse (CCON) service operates on the PM shift only. The team consists of senior experienced ICU and ED nurses; there is one CCON per PM shift. They are available on page number 495, SPADE or in person. They have both a patient and nursing focus that supports the nurse and or other health professionals. The CCON service facilitates the Early Warning Score (EWS), it is a tool that has arisen in response to the increased acuity and dependency of ward-based patients, this type of tool is being used in many clinical areas world-wide. The EWS tool is aimed at reducing adverse clinical events to identify deterioration and EWS compliance from ward staff is of paramount importance to its success. Each time you record a patients observations you should be calculating the EWS. The tool does not replace your own clinical knowledge and instinct regarding a patient condition. HVDHB STUDENT HANDBOOK 2012 Page 14 After Hours Managers (AHM) Hutt Valley DHB has two nurse managers on duty each PM, night and weekend / public holiday shifts The hospital is divided into two ‘zones’ Medical and Surgical. After hours managers are contactable on pagers via the operators. The shift co-ordinator is always your first contact and they will help liaise with the AHM as appropriate. All After Hours Managers are senior nurses with clinical backgrounds and are resources for staff in area such as: Attend all arrest calls Attend all emergencies Attend all security situations Fire wardens Obtaining medications that the ward does not hold Assist with transport of patients within the hospital and within the community Manage bed allocation for acute admission / boarders within other specialty areas Policy Guide Hutt Valley DHB has produced policies and procedure documents that are available to direct and guide your practice. These are available on the hospital intra-net in the ‘Policies’ link. There are also hard copies available in the main office. Policies that are frequently referred to on the Acute Medical Ward include: Patient supervision: Minders Policy Chest pain/discomfort – nursing management of patients with known ischemic heart disease Medicines Policy Restraint minimisation and safe practice Patient falls prevention and management Abbreviations in patient records HVDHB STUDENT HANDBOOK 2012 Page 15 Appendix 1: Acute Medical Ward Checklist Please locate and familiarise yourself with the following items /processes during your first two days. Item Located / code if required Completed date Staff toilet Call bell & Emergency bell system Oxygen outlets & how they work Suction outlets & how they work Sharps container in cubicle Defibrillator trolley ECG machine Fire extinguishers & hose reels Manual call points Emergency exits Manual handling equipment Treatment room Public toilet Public telephone MDT slots MDT office Paper work slots Patient board ‘white board’ Staff room Medication / prep room Blood glucose machine Discharge lounge Discharge board Phone message board HVDHB STUDENT HANDBOOK 2012 Page 16 Item Located / code if required Completed date Disposal room Linen trolley Observation machines Lamsen tube machine Photocopy machine Service lifts Library Cafe Radiography Orderlies office How a 777 call is activated HVDHB STUDENT HANDBOOK 2012 Page 17 Appendix 2: HVDHB Student Nurse / Midwife Placement Hutt Valley District Health Board Student Nurse/Midwife Placement Manual: Doc No: Issue Date: Review Date: Written By: Approved: Pages CLINICAL HS2 January 2001 January 2003 P. Doole EMT 1 of 2 Purpose To state the responsibilities of Hutt Valley Health staff in relation to the supervision of nursing and midwifery students. To identify clinical situations which are beyond the scope of student nurse/midwife practice (including transition). Scope This policy includes all areas of Hutt Valley Health where student nurses and midwives participate in clinical education. Policy While on clinical placement at Hutt Valley Health student nurses and midwives are responsible to the Polytechnic for their conduct with clients and staff, and for fulfilling their learning requirements. Students and clinical lecturers are expected to adhere to the policies and guidelines of Hutt Valley Health. Student nurses and midwives come to Hutt Valley Health for clinical education as part of their preparation for Registration. While they participate in client care, they may be assigned responsibility for delivering care to a client or clients according to the student’s ability, learning outcomes and the client’s acuity. All students must be competent in spoken and written English. Informed consent must be gained from clients’ before they are cared for by students (see Informed Consent Policy). All student placements are to be booked through the Director of Nursing. Procedure 1. Student nurses and midwives will work under the supervision of Hutt Valley Health nursing and midwifery staff. Where possible, the student should be assigned to a student preceptor. Students should be assigned to work with experienced unit staff rather than casual, relieving or orientating staff. Hutt Valley Health staff are responsible for the care that clients’ receive except when a student is working directly with a clinical lecturer. 2. Students are supernumerary and must not be substituted for adequate qualified staff cover. HVDHB STUDENT HANDBOOK 2012 Page 18 3. Students do not have sufficient clinical experience and must not independently look after any client who requires a nurse special for medical or psychiatric reasons (unless this is approved by the lecturer). 4. Students must be fully supervised by a Registered Nurse or Midwife when caring for a client receiving intravenous or related therapy (see HVH Intravenous and Related Therapies Policy) or medications (see HVH Medicines Policy) and must follow the procedures outlined in these policies. 5. Students may accompany clients on intrahospital transports when the client is well and does not require a nurse escort. Students may accompany a Registered Nurse providing a nurse escort to a client. 6. Students will not be assigned to clinical situations beyond their expertise. Staff must be aware that students are not always capable of judging clinical situations and it is the staff members’ responsibility to ensure the student is not assigned to these situations without direct supervision. 7. If a staff member is concerned about the conduct of a student, they must contact the Clinical Nurse/Midwife Manager and the student’s clinical lecturer. 8. Students working in the community may not drive HVH vehicles. 9. Students must wear HVH Identification at all times. References HVH HVH HVH HVH Intravenous and Related Therapies Policy CI1 Clinical Policy Manual: Medicines Policy CM1 Clinical Policy Manual: Escort Protocol AE1 Company Policy Manual: Informed Consent Policy GI2 HVDHB STUDENT HANDBOOK 2012 Page 19 Appendix 3: Medical Floor Layout HVDHB STUDENT HANDBOOK 2012 Page 20 Appendix 4: Nursing Practice skills 1 SKILLS – Personal Cares Assisted Date Supervised Date Independent Date RN Sign Assisted Date Supervised Date Independent Date RN Sign Bed bathing Bed making Assisting with patient showering Feeding a dependant patient Hair Care Moving & Handling Hand washing Patient transfers/position Mouth cares Dental/Denture Cares Eye cares Perineal care Toileting Urinalysis Application of a uridome Catheter cares Sluice room layout Bed pan use/cleaning Commodes use/cleaning Stoma/Ileostomy SKILLS – Patient Assessment Neurological assessment Respiratory rate monitoring Blood pressure monitoring Pulse rate monitoring SPO2 monitoring Early Warning Score Height & weight HVDHB STUDENT HANDBOOK 2012 Page 21 SKILLS – Patient Assessment Assisted Date Supervised Date Independent Date RN Sign Malnutrition screening (MUST) Head to toe assessment Blood glucose monitoring CIWA Pressure area risk Falls risk HVDHB STUDENT HANDBOOK 2012 Page 22 Appendix 5: Nursing Practice Skills 2 SKILLS – Medication administration Assisted Date Supervised Date Independent Date RN Sign Assisted Supervised Independent RN Sign Assisted Supervised Independent RN Sign Assisted Supervised Independent RN Sign Oral Topical Subcutaneous Intramuscular Nebulisation Trans – dermal Oxygen therapy Suppositories/Enema SKILLS – Documentation Admission Fluid balance Nursing observations Patient transfer Braden scale Falls risk Discharge planning Shift report-taped MDT referrals SKILLS – Intravenous Therapy Care of peripheral IV line Removal of peripheral IV line Preparation/care of equipment Phlebitis score SKILLS – Environment & Safety Isolation procedure Forming therapeutic relationship Confidentiality HVDHB STUDENT HANDBOOK 2012 Page 23 Working within a team SKILLS – Environment & Safety Assisted Supervised Independent RN Sign Assisted Supervised Independent RN Sign Suction set up Call bells Patient education Aseptic dressing technique Resuscitation trolley checks SKILLS – Nutrition Feeding a dependant patient NGT insertion NGT removal Enteral feeding Altered swallowing HVDHB STUDENT HANDBOOK 2012 Page 24 Notes Page HVDHB STUDENT HANDBOOK 2012 Page 25