Download Ninewells-Ward 25 - orientation

Students Orientation Document
Ward 25
Ophthalmology
Ninewells Hospital
Student Nurse: _______________________
Mentor 1: ____________________________
Mentor 2: ___________________________
Half way assessment date ___/___/___
Final assessment date ___/___/___
Photocopy when completed and file in SCN office
2015
Review Jun 2017
Welcome to ward 25.
The following information is a guide and any information or education can be added
during your placement.
You should be allocated a mentor, if not see either the SCN or CN during your first
week. If your mentor is absent see SCN or CN immediately.
You should discuss with your mentor particular skills and learning activities you wish
to achieve. Set dates and times of achievement.
Also, write down comments and any problems, which arise affecting your objective
setting.
If you have any particular problems or concerns with your placement please see me
personally, your personal tutor or our ward PEF (contact details on ward poster or in
CPPSU mentor folder), thank you.
SCN S.McGilvray
Ward Information
 Student information is on student notice board and information folder, along
with general NHS policies, NHS Tayside policies and guidelines. Books and
other learning materials are available but please do not remove from the ward.

Your orientation of the ward and objectives should be discussed by the end of
your first week.

You are responsible for arranging with your mentor a date for your halfway
assessment and final assessment. It is your responsibility to keep your
competency books safe and up to date.
General responsibilities to discuss with mentor (date and sign when achieved)

Dress code

Responsibilities if you are sick or absent from duty




CPR and resuscitation trolley
Manual handling equipment and competencies
Fire safety procedure and equipment
Infection control policies, Standard Infection Control Practices, Food Hygiene
and hand washing practice
Student’s experience and previous learning.
Discussion notes
Statement of Values Relating to the Education of Students
Ward 25
Ninewells Hospital
Dundee
We encourage students to ask questions and will always try to answer them. However,
we will expect students to assist with their own learning by developing a questioning
approach. We look forward to hearing your views and suggestions about how we can
improve the learning experience for our students; this opportunity is available through
the university questionnaire, our PEF (Practice Education facilitator), or ward team
members.
We Will:
Treat students as individuals acknowledging their needs and encouraging their
participation in formulating care management.

Encourage students to feel part of the care team by involving them in assisting
and directing healthcare professionals in providing patient care.

Recognise and value the contribution of all students in the process of planning
and carrying out patient care and assist them to achieve/maintain knowledge
and skills in order to provide safe and effective care.
Mentors are responsible and accountable for:
Organising and co-ordinating student learning activities in practice.

Supervising students in learning situations and providing them with
constructive feedback on their achievements.

Setting and monitoring achievement of realistic objectives.

Assessing total performance – including skills, attitudes and behaviours.

Providing evidence as required by programme providers of student
achievement or lack of achievement.

Liaising with others (e.g. mentors, sign-off mentors, practice facilitators,
practice teachers, personal tutors, programme leaders) to provide feedback,
identify any concerns about the student’s performance and agree action as
appropriate.

Providing evidence for or acting as a sign–off mentor with regard to making
decisions about achievement of proficiency at the end of a programme.
Developed with the support of PEF (Practice education Facilitator) and NMC (Nursing & Midwifery Council) Standards to
support learning and assessment in practice July 2008.
Review Jun 2017
Clinical experience (date and sign when achieved)

Guiding the visually impaired

Safety of the visually impaired in hospital setting

Admission and discharge process for routine in-patient and emergency
admission

Admission and discharge process for day case surgery

Bathing the eye

Instillation of pre-operative dilating drops (in accordance with NHS Tayside
drug administration policy)

Instillation of other topical treatments

Application of eye shield/dressing

Diabetic management and care, diet, drug regimes, protocols
Observation opportunities within ophthalmology (record details of learning for
each opportunity achieved)
To be arranged with your mentor
Eye theatre
Learning outcomes
Area 6A/ orthoptist / IV fluoresceine angiography / treatment room/ nurse led
glaucoma clinic
Learning outcomes
Pre-assessment clinic
Learning outcomes
LASER clinic
Learning outcomes
Macular degeneration- Intravitreal treatment clinic
Learning objectives
Ophthalmic education sessions with mentor (date and sign when achieved)

Basic anatomy and physiology of the eye

Measuring visual acuity

Cataracts

Glaucoma

Retinal disorders

Squint

Red eye
Learning outcomes
 As a student you will be able to achieve competent, safe, planned care for
patients with a visual impairment under the supervision of Registered Nurses
in ward 25.

You will achieve any planned outcomes relevant to the stage of your training
and education.

The student will gain awareness of special needs of the visually impaired
person.

Communicate effectively with colleagues, patients and relatives

Demonstrate safe effective practice using initiative, judgement and showing
awareness of areas of learning development asking advice when necessary to
maintain patient safety

Demonstrate understanding of common ophthalmic conditions, nursing
interventions and treatments
Student’s learning objectives should be documented in their personal books
Mentor’s comments
Glossary of terms commonly used
Amblyopia
Angiography
Anisometropia
Anterior chamber
Aphakia
Aqueous
Astigmatism
Axis
Band keratopathy
EDTA
Blepharitis
Cataract
Canal of Schlemm
Canthus
Cataract extraction
Chalazion
Conjunctiva
Reduced visual acuity, vision in one eye does not
develop fully during early childhood. In most cases,
however, glasses do not help
Diagnostic test in which vascular system is examined
Fluoresceine angiography is an eye test that uses a
special dye and camera to look at blood flow in the
retina and choroid, the two layers in the back of the eye.
two eyes have unequal refractive power
The anterior chamber is filled with a watery fluid known
as the aqueous humour, or aqueous. Produced by a
structure alongside the lens called the ciliary body, the
aqueous passes first into the posterior chamber (between
the lens and iris) and then flows forward through the
pupil into the anterior chamber of the eye
Absence of crystalline lens
Clear, watery fluid that fills anterior and posterior
chambers
Astigmatism is usually the result of an irregular-shaped
cornea or lens. The cornea is the transparent layer of
tissue at the front of the eye.
The cornea should be regularly curved like the surface
of a football, but in cases of astigmatism it has an
irregular curve, more like the shape of a rugby ball. This
means that light rays entering the eye aren't focused
properly, creating a blurred image
Line through the centre
Calcium deposits on cornea – debridement used to
remove calcium deposits
Apply 0.05 mol, 1.5% neutral disodium
ethylenediaminetetra-acetic acid (EDTA) to the corneal
surface, then scrape off calcium deposits
Inflammation of the eyelids
Opacity of crystalline lens
Drains aqueous humour
Angle formed by junction of upper and lower eyelids
Removal of cataract either by intracapsular - the entire
natural lens of the eye, including the capsule that holds
it in place, is removed. or by extracapsular- involves
removing the eye's natural lens while leaving in place
the back of the capsule that holds the lens in place
Small swollen sebaceous gland in eyelid
Mucous membrane covering front of eyeball and lining
of eyelids
Convergence
Cornea
Cyclodiode laser
Cycloplegic
Dacryocystorhinostomy
DASEK – decemet’s automated
stripping endothelial keratoplasty
Process of directing visual axis of eyes to a near point
Transparent portion of anterior surface of eyeball
For painful blind glaucoma – use a G-probe contact
surface to indent the conjunctiva and sclera, thus
improving energy delivery to the ciliary body
Drug to paralyze ciliary muscle
Procedure to create opening between lacrimal sac and
nasal cavity
Only the back layer of the cornea is removed, consisting
of the endothelial cells and the Descemet's membrane
that holds the cells. A partial thickness of the donor
cornea, containing new endothelial cells, then is
implanted to replace the dysfunctional cells.
Unit used in measuring lenses for spectacles
Seeing one object as two
A way of testing visual acuity for someone who cannot
understand the alphabet
Turning out of eyelid
Ectropion
Turning inward of eyelid
Entropion
Overflow of tears
Epiphora
Entire area which can be seen without shifting gaze
Fields of vision
Opacities in vitreous humour that move about and
Floaters
appear as spots before eyes
Raised intra-ocular pressure
Glaucoma
Long-sightedness
Hypermetropia
Blood in anterior chamber
Hyphaema
Cone shaped deformity of cornea
Keratoconus
Instrument for measuring curvature of cornea
Keratometer
Dilated area at junction of nasolacrimal duct and
Lacrimal sac
cannaliculi
visual acuity is scored with reference to the Logarithm
Log MAR chart
of the Minimum Angle of Resolution, as the chart's
name suggests
designed to enable a more accurate estimate of acuity
A drug to constrict pupil
Miotic
MOH’s (developed by Dr Frederick Technique for removing Basal Cell Carcinoma and
Squamous Cell Carcinoma (BCCs and SCCs), the two
Mohs
most common skin cancers
The procedure entails removing one thin layer of tissue
at a time; as each layer is removed, its margins are
studied under a microscope for the presence of cancer
cells. If the margins are cancer-free, the surgery is
ended. If not, more tissue is removed from the margin
where the cancer cells were found, and the procedure is
repeated until all the margins of the final tissue sample
examined are clear of cancer
A drug to dilate pupil
Mydriatic
shortsightedness
Myopia
Dioptre
Diplopia
“E” test
OCT
Optical coherence tomography - non-invasive imaging
test that uses light waves to take cross-section pictures
of your retina, the light-sensitive tissue lining the back
of the eye.
Ophthalmoscope
Orthoptist
Phacoemulsification of lens
Instrument for viewing inner eye particularly retina and
associated structures
Diagnose and manage disorders of binocular vision and
mainly work in the NHS.
The phaco probe is an ultrasonic handpiece with a
titanium or steel needle. The tip of the needle vibrates at
ultrasonic frequency to sculpt and emulsify the cataract
while the pump aspirates particles through the tip. In
some techniques, a second fine steel instrument called a
"chopper" is used from a side port to help with chopping
the nucleus into smaller pieces. The cataract is usually
broken into two or four pieces and each piece is
emulsified and aspirated out with suction. The nucleus
emulsification makes it easier to aspirate the particles.
After removing all hard central lens nucleus with
phacoemulsification, the softer outer lens cortex is
removed with suction only. An irrigation-aspiration
probe or a bimanual system is used to aspirate out the
remaining peripheral cortical matter, while leaving the
posterior capsule intact. The foldable IOL, made of
silicone or acrylic of appropriate power is folded either
using a holder/folder, or a proprietary insertion device
provided along with the IOL. It is then inserted and
placed in the posterior chamber in the capsular bag.
Photophobia
Pinguecula
Sensitive to light
Posterior chamber
Part of aqueous chamber that lies behind the iris, but in
front of lens
Impairment of vision occurring in old age
Presence of artificial intraocular lens implant
A growth that develops across the clear cornea of the
eye that can affect people who spend a lot of time
outside in the sun.
Presbyopia
Pseudphakia
Pterygium
Yellowish patch or bump on the conjunctiva near the
cornea. The conjunctiva is the thin, moist membrane on
the surface of the eye.
Ptosis
Punctum
Pupil
Refraction
Refractive error
Retina
Retinal detachment
Retinopexy
Pneumatic Retinopexy
Sclera
Sheridan Gardner test
Slit lamp
Snellen chart
Strabismus
Tarsorraphy
Tonometer
Trabeculectomy
Uveitis
Visual acuity
Vitreous
Drooping of eyelid
Opening of lacrimal ducts at inner canthus of eye
Small hole in centre of iris through which light passes
into eye
Bending or deviation of rays of light, the test to
ascertain amount of refractive error
Optical defect which prevent light rays from focusing
on retina
Light-sensitive layer at the back of the eye that covers
about 65 percent of its interior surface. Photosensitive
cells called rods and cones in the retina convert incident
light energy into signals that are carried to the brain by
the optic nerve. In the middle of the retina is a small
dimple called the fovea or fovea centralis. It is the
centre of the eye's sharpest vision and the location of
most colour perception.
occurs when the thin lining at the back of your eye
called the retina begins to pull away from the blood
vessels that supply it with oxygen and nutrients
Laser retinopexy uses a powerful light beam around the
hole to seal or “spot weld” the retina to the underlying
tissues, stopping the retina from detaching
Pneumatic retinopexy, inject a gas bubble into the
middle of the eyeball then use a freezing probe
(cryopexy) or laser beam (photocoagulation) to seal the
tear in the retina.
It forms the supporting wall of the eyeball, and is
continuous with the clear cornea, the episclera, loose
connective tissue, immediately beneath the conjunctiva;
sclera proper, the dense white tissue that give the area
its color; and the lumina fusca, the innermost zone made
up of elastic fibers
Consists of set of cards, each marked with a single letter
of specific size, cards shown one at a time, at 6 meters
(usually for children)
Combination of light and microscope for examining eye
For testing visual acuity, lines of letters in graded sizes
Squint, It is a condition where the eyes do not look in
the same direction
Surgical joining of upper and lower eyelids
Instrument for measuring intra-ocular pressure
Surgical procedure to create a drainage channel in
treatment of glaucoma
Inflammation of one or part of uveal tract (iris, ciliary
body, choroid)
Measurement of acuteness of vision
Transparent, jelly-like substance filing posterior space
of the eye
COMMONLY USED EYE
TREATMENT
ACETAZOLAMIDE CAPSULES
BENOXINATE
Reduce intra-ocular pressure
Corneal anaesthesia, to allow tonometry, fitting contact
lens, removal of corneal foreign body
Broad spectrum antibiotic
CHLORAMPHENICOL
Dilate pupil and paralyses ciliary muscle lasts 24 hours
CYCLOPENTOLATE 1%
Non steroidal anti-inflammatory and inhibits intraFLUBRIPROFEN SODIUM
operative miosis (does not have mydriatic properties)
(OCUFEN)
Tear deficiency
HYPROMELLOSE
Ocular lubricant
LACRI-LUBE
LIGNOCAINE&FLUORESCEINE Corneal anesthesia and stain
NEPAFEN
Dilate pupil lasts 5-7 hours
PHENYLEPHRINE 10%
Miotic, constricts pupil, treat POAG and angle closure
PILOCARPINE
glaucoma
PREDNISOLONE ACETATE
Beta blocker, reduces intraocular pressure by reducing
TIMOPTOL
production of aqueous humour
Short acting midriatic lasts 4-6 hours
TROPICAMIDE
Ocular lubricant
VISCOTEARS
Instillation of Eye Drops
Learning Resource Pack
Author – Doreen Laing Registered Nurse, Area 6A Ophthalmology OPD
Ninewells Hospital
Reviewed Feb 2016
Introduction
Welcome, this Learning Resource Pack (LRP) has been complied for the use of
students whilst on placement within Ninewells Hospital Ophthalmology Department;
it can also be a resource for Newly Qualified Practitioners or new Registered Nurses
to ophthalmology.
The department incorporates outpatient services in Area6A; ward 25 provides inpatient services, day case surgery and additional specialist clinics. For ophthalmic
examination, surgery or specialist treatment clinics the administration of eye drops is
required, to examine/treat the structures within the eye; administer short-term
treatments; support and educate patient with long-term or lifelong eye medication
administration.
Supplementary material and answers to the activities can be found at the end of the
resource pack. The practical element of the pack involves a skills analysis checklist to
complete with your mentor while observing you carrying out the procedure.
An evaluation questionnaire is also provided. Your feedback and comments are
welcomed.
Aim
The aim of this LRP is to assists your learning and understanding of safe and correct
administration of eye drops, enabling you to apply this knowledge and skills within
ophthalmology department and other clinical areas.
Learning Outcomes
1. Demonstrate patient identification procedure in out-patient setting, in-patient ward,
day case area
2. Demonstrate/describe required hand decontamination prior to procedure
3. Demonstrate safe and correct instillation of eye drops or ointment/gel
4. Discuss with patient / family / carer eye drop instillation procedure
5. Discuss the importance of eye treatment compliance to patient/family/carer
6. Discuss common side effects and action if they occur with patient /family /carer
7. Discuss commonly used eye treatments
Topic Analysis
The learner should be able to answer questions on the following:
1. How patient identification is conducted in the out-patient setting, in-patient setting,
day case area and the rationale
2. The learner must demonstrate good hand washing technique and explain rationale
3. The learner will demonstrate the correct technique of instillation of eye
drops/ointment /gel
4. The learner will demonstrate sound knowledge of the importance of patient
compliance and the Registered Nurses role supporting patients to achieve this
5. The learner will gain knowledge and understanding of the most commonly used eye
treatments
Skills Analysis
1. Introduce yourself and your role
2. Explain to patient/family/carer the procedure you are about to undertake and
obtain verbal consent (NHST consent policy, NMC )
3. Patient seated comfortably in appropriate chair/room/area to have treatment
4. Check patients identity (NHST Correct Patient Identity Policy)
In outpatient setting, orally with patient, full name, DOB CHI address with
patient case notes
In-patient ward / day case patient – orally as above and check ID band
5. Check if patient has any allergies
6. Demonstrate hand washing decontamination (NHST Infection Control Policy)
7. Check doctor/Nonmedical Prescriber has prescribed eye medication in case
notes/as per clinic protocol printed label/ ward patients have medication prescribed
on TPAR chart/day case prescription/laser consent form/clinic printed label NHST
Medicines Management Policy)
8. Check medication is correct dose, expiry date
9. Assist patient into correct position to ensure safe and correct instillation of eye
treatment
10. Instil mediation safely and correctly
11. Deliver a clear explanation of the importance of eye drop compliance
12. Supply patients with relevant written information to supplement oral instructions (
medicines for continued use over a specified period should be labelled (NHST
Medicines Management Policy, NHST TTO policy)
13. Demonstrate correct disposal of containers
14. Demonstrate hand washing decontamination post treatment (NHST Infect ion
Control Policy)
The activities contained within this LRP are in place to facilitate your learning. The
time is purely a guide.
Activity 1
45 mins
Please read:
Shaw M (2014) How to administer eye drops and ointments. Nursing Times;
110: 40, 16-18
Activity 2
1 hour
Please read:
NMC Code of Professional standards of practice and behaviour for nurses and midwives
2015
NMC Standards for medicine management 2008, 2009
Staffnet : our websites : pharmacy: - you will find access to NHST Safe and Secure
Handling of Medicines – see section 18 prescribing system, section 20 administration of
medicines and use of recording sheet, section 27 non medical prescribing, appendices 1
using patient own medicines
Activity 3
1 hour
Your mentor will demonstrate during the course of your placement the safe and correct
instillation of eye medication. Please observe closely and feel free to ask questions
regarding the actions of the eye treatments, side effects and reasons for administration.
BNF online is a good resource and is up to date.
You will be given the opportunity to instil eye treatments to patients when you have
demonstrated your knowledge and understanding of the process and completed the
activities.
Activity 4
30 mins
Please complete the following:
1. What is the most common treatment used for ophthalmic conditions?
a. Oral medication
b. Topical medication
c. IV medication
2. Is eye mediation (eye drops/ointment) governed by the same guidelines as
administration of medicines?
a. No
b. Yes
c. IV medications
3. Practitioners should possess sound knowledge of the therapeutic use of
medications (normal does, side effects, precautions and contraindications) they
administer?
a. No
b. Yes
c. Don’t’ know
4. Which of the following resources could you access to gain know ledge regarding
the contraindications and use of medicines?
a.
b.
c.
d.
e.
BNF (British national Formulary)
Drug information leaflet
Pharmacist
All of the above
None of the above
5. A registered nurse should always be present and supervise student nurses
undertaking administration if medicines?
a. Yes
b. No
c. Don’t know
6. You are asked to undertake the instillation of eye drops without first observing
the procedure with any previous oral or written instructions given. What would
you do?
a. Attempt the procedure regardless
b. Ask for a demonstration first with clear oral and written instructions for future
reference
c. Don’t know
7. A patient informs you that they have discontinued their medication because they
have developed an allergy. What t would you?
a. Ignore it
b. Inform medical staff
c. Don’t know
(Your mentor will have correct answers to check with you)
When you have completed activity 1- 4 and 100% with test questions then go to activity
5.
Activity 5
Instillation of eye medications;
1. Check and understand prescribes medication with Registered Nurse
2. Introduce yourself
3. Check the patient name, DOB CHI, address with case notes/referral notes (outpatient), check ID band with patient and case notes (IP and DC)
4. Check if patients has any known allergies
5. Collect and check prescribed medication with registered nurse following NHST
Safe and Secure Handling of Medicines
6. Explain procedure to patient, gain consent, explain any effects they may feel such
as stinging/blurring of vision etc.
7. Use correct disinfection of hands
8. Ensure patient is seated comfortably
9. Ask patience to tilt their head back and look up to the ceiling
10. Gently pull down lower eye lid to form a small pocket
11. Hold the eye dropper/bottle in the other hand just above the lower eye lid and
allow one drop to fall inside the lower fornix, thus avoiding touching the patients
eye lid with the tip of the bottle /dropper
12. Gently ask the patients to close their eye gently and blot gently with a tissue
13. Dispose of dropper /tissue in an appropriate receptacle
14. Ensure patient understands rationale/compliance of the eye drops and leave
patient comfortable
15. Adhere to hand decontamination post procedure
Mentor Checklist for assessing student competency.
Does student:1. Show knowledge that the prescribed eye medication must be checked by a
Registered Nurse? YES/NO
2. Introduces themselves to patient and explain what they are about to do and why,
gain patient consent?
YES/NO
3. Check and clarify patient name, DOB CHI, address (which is applicable to clinical
area) check allergy status?
YES/NO
4. Collect and check the medication with the registered Nurse in accordance with
NHST medicines policy?
YES/NO
5. Use good hand washing/cleansing technique?
YES/NO
6. Ensure the patients seated comfortably?
YES/NO
7. Ask the patient to achieve optimum position by tilting head back?
YES/NO
8. Gently pull down eye lid?
YES/NO
9. Instil eye drop allowing drop to fall inside fornix without touching the eye lid?
YES/NO
10. Continue by gently closing and blotting the patient’s eye with a tissue?
YES/NO
11. Dispose of used items appropriately?
YES/NO
12. Ensure adequate information was given
leaving the patient comfortable?
YES/NO
reading eye medication before
13. Wash their hands effectively afar completion and record medication on relevant
document (appropriate to clinical area)?
YES/NO
Students name ____________________________________
Mentor signature _________________________________
Date competency achieved ___/___/___
If not achieved, then repeat competency and record outcome.
Student evaluation
1. The LRP was simple to follow?
YES/NO if no please comment
2. Were learning outcomes achievable?
YES/NO if no please comment
3. Was the time taken to complete the LRP appropriate to your learning needs?
YES/NO if no please comment
4. Were the references contained informative and relevant?
YES/NO if no please comment
5. The skills assessment questions, were hey helpful focussing learning?
YES/NO if no please comment
6. Did you find this resource a good method of learning?
YES/NO if no please comment
7. What did you enjoy the most in the LRP?
8. What was not useful in the LRP?
9. Any further comments or reflection please record below.
PLEASE HAND YOUR EVALUATION TO YOUR MENTOR, (Mentors please return to SCN
McGilvray ward 25 to review evaluations)
References
NMC Code of Professional standards of practice and behaviour for nurses and midwives
(2015)
NMC Standards for medicine management (2008, 2009)
Shaw M (2014) How to administer eye drops and ointments. Nursing Times; 110: 40,
16-18
www.bnf.org
Locate these policies on NHS Tayside (NHST) Staff Net:
 NHST Medicines Management Policy

NHST TTO (To Take Out) labelled medicines policy

NHST Infection Control Policy