Download Welcome to the Acute Medical Ward - Hutt Valley District Health Board

________________________________________________________
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:
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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
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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:
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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:
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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:
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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:
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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
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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
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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:
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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:
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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
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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
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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.
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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;
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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.
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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
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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
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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.
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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
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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.
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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.
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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:
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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:
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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
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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
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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
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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.
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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
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Appendix 3: Medical Floor Layout
HVDHB STUDENT HANDBOOK 2012
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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
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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
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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
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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
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Notes Page
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