Portfolio of Learning Opportunities

Ward 24

Queen Elizabeth Hospital.

Introduction: Welcome to Ward 24 which is a 24 bedded acute medical ward specialising in the care of the older person. Our patients have complex needs and often present with multiple problems; offering the learners a diverse and rich learning experience. The ward welcomes students from many disciplines and from all stages of training in addition to newly qualified Staff Nurses. The ward is divided into two teams – Blue and Red – and consists of 13 male beds and 11 female beds. We also have direct admissions from home of patients requiring medical intervention/rehab

following assessment by Dr. Crabtree, who works closely with the Community Resource Team

for the Older Person (CROP).

All ward based staff are expected to act as role models and specifically, we expect the students to display:

Professionalism

Punctuality

Correct Apparel

Positive Attitudes

Shift patterns:

Early shift 07:30 – 14:30 (20 min. break)

Late shift 13:30 – 20:30 (20 min. break)

Full Day 07:30 – 20:30 (One hour lunch break)

Night 20:00 – 08:00 (One and a half hour break)

Full-time staff work 37.5 hours using this shift pattern over 4/5 days. Off-duty is prepared at

least 6 weeks in advance; staff self-roster but alterations may be made due to skill mix needs.

The Ward Team: Ward Manager – Debbie Whittaker Education Lead – Christine Mulhern Clinical Lead – Sandra Small

Band 5 Mentors x 6 Band 5 Staff Nurses x 6 Band 2 Staff x 12 Housekeeper x 2 Ward Clerk x 1 Physiotherapist Occupational Therapist Consultants x 2 Medical Registrar x 1 Staff Grade Doctor x 1 F2 Doctor x 1 F1 Doctor x 1 Social Worker x 1 Discharge Liaison Nurse x 1

Philosophy of Care: We aim to deliver care which reflects respect for the privacy dignity religious and cultural

beliefs and practices of the individual. We aim to maintain high standards of care whilst

working in collaboration with carers and relatives.

To achieve this we recognize that:

each patient has a unique identity and with that they have their individual care needs.

carers are an integral part of the care pathway and are encourage to participate.

communication across the multi-disciplinary team is essential

communication between patients and carers is important and is encouraged

throughout their stay.

privacy and dignity of the patient should be respected at all times.

patients’ confidentiality should be maintained at all times.

the nurse should act as a health-educator.

the care delivered is based on the Roper, Logan and Tierney Activities of Daily Living

Model (1990) in collaboration with Orem’s Model of Self Care (1980)

Care Standards have been developed and are used within the Trust.

ANATOMY, PHYSIOLOGY AND PATHOLOGY

Learning Opportunity Relevant Resource

Normal anatomy, physiology and Mentor, co-mentor, nursing staff,

pathology. physiotherapist, other relevant

members of the multi-disciplinary

team, education resource files, books

, articles, trust intranet, internet.

Blood Disorders Relevant Resource

Blood formation/destruction

Red/White blood cells Mentor, co-mentor, nursing staff,

Anaemia/Treatment medical staff, Pathology Department,

Collection of blood specimens Haematology Department,

Phlebotomy Phlebotomist, Nurse Specialist,

Blood Transfusion Pharmacist, McMillan Nurse, Policies

Haemorrhage/Treatment and Procedures Files, Blood

Thrombosis/Treatment Transfusion File, Trust Intranet,

Malignant Disorders Internet, Books, Articles.

Medication

Investigations

Cardiovascular System Relevant Resource

Angina Mentor, Co mentor, Nursing Staff,

Myocardial Infarction Medical Staff, Nurse Specialist, ECG

Failure – Cardiac arrest Technicians, Pharmacist, Trust

Cardiac Arrhythmias

Intranet, Internet, Books, Articles, and

Hypertension/Hypotension

Resource Files.

Investigations

Echocardiogram, Pacing

24 Hour Tracing

Angiogram, Angioplasty

Treatments and Medication

Cerebrovascular/Brain Relevant Resource

Disorders

Cerebrovascular accidents (stroke) Mentor, Co- Mentor, ward staff,

Brain Tumours medical staff, Stroke Team, Specialist

Transient Ischaemic Attacks Nurses, Physiotherapist, Mental

Epilepsy Health Liaison Nurse, Parkinson’s

Parkinson Disease Disease Nurse Specialist, MacMillan

Alzheimer’s Disease/ Lewy Body Nurse, Resource Files, Books,

Dementia Articles, Trust Intranet, Internet

Infections

C.T. Scans

MRI Scans

Connective Tissue, Skeletal Relevant Resource

and Joint Disorders

Anatomy and Physiology Mentor, Co- Mentor, ward staff,

Rheumatoid Arthritis medical staff, Physiotherapist, Falls

Osteoarthritis, Osteoporosis Team, Osteoporosis Nurse Specialist,

Investigations and causes of falls MacMillan Nurse, Rheumatology

Fractures/Treatment – Lupos Department, Orthopaedic

Contractures – Tumours Rehabilitation Team, Resource Files,

Infection - Rehabilitation Books, Articles, Trust Intranet,

Internet.

Disturbances in Water and Relevant Resource

Electrolyte Balance

Normal Electrolye Balance

Reading and understanding blood Mentor, co-mentor, nursing staff,

results medical staff, Pathology Department,

Dehydration Pharmacist, Resource Files, Trust

Recording and understanding fluid Intranet, Internet, Books, Articles.

balance charts

Fluid retention/ oedema

Acidosis

Hypocalcaemia

Endocrine and Metabolic Relevant Resource

Disorders

Diabetes Mellitus/ maturity onset- Mentor, co-mentor, nursing staff,

symptoms and treatments medical staff, Diabetes Specialist

Thyroid Problems Nurse, Pharmacist, Endocrine

Pituitary Problems Specialist Nurse, Resource Files,

Medication Trust Intranet, Internet, Books,

Long Term use of Steroids Articles.

Gastrointestinal Disorders. Relevant Resource.

Nausea and vomiting/Treatment Mentor, Co-mentor ward staff,

Diarrhoea/Treatment medical staff, Dietician, Nutritional

Constipation/Treatment Nurse Specialist, Dysphagia Nurse

Haematemesis/Maleana. Specialist, Stoma Nurse Specialist,

Dysphasia. MacMillan Nurse, books, Articles,

Malignancies Trust Intranet, Internet, Resource

Management of Files.

Colostomies/Ileostomies

Feeding of Patients

Nasogastric feeding and

management of the patient

Preparation and Investigations

Infection Inflammatory Relevant Resource

Process /Source.

Spread. Mentor, Co-mentor, ward staff, Treatment and Management Medical Staff, Infection Control Team, Infection screening. Pathology Department, Infection Specimen collection. Control Link Nurse, Mental Health Prevention. Liaison Team, Infection Control Barrier/Reverse barrier nursing. Policies, Resource Files, Books, Deliriums (Chronic/Acute) Articles, Trust Intranet, Internet.

Kidney and Genitourinary Relevant Resource

Disorders

Anatomy and Physiology Mentor, Co-mentor, ward staff, Acute/chronic renal failure. medical staff, continence advisor, Urinary/Kidney infections. pharmacist, pathology department, Urine testing. Resource Files, Books, Articles, Trust Prostatic Disease/ Treatment and Intranet, Internet. Management

Specimen collection.

Male and Female Catheterisation

Insertion and removal.

Management of incontinence and

promotion of continence

Investigations

Bladder Scanning

Fluid balance.

Liver and Biliary Disorders. Relevant Resource

Anatomy and Physiology

Jaundice Mentor, Co-mentor, ward staff, Tumours and Malignancy medical staff, Haematologist, Nutrition Dietician, Nutritional Nurse Specialist, Treatments and Management MacMillan Nurse, Pharmacist Clotting Disorders Resource Files, Books, Articles, Trust Ascites Intranet, Internet. Acute/Chronic Liver Failure

Investigations

Alcohol Abuse

Mental Health/Neurological Relevant Resource

Disorders Mentor, Co-mentor, ward staff, Delirium acute/chronic medical staff, Mental Health Trained Dementias Nurses, Psychiatrist, Psychologist, Crusjvelt Jacob Disease Mental Health Nurse Specialist, Depressions Mental Health Liaison Team, Self-Harm Vulnerable adults team, advocacy Suicidal Idealation team, Mental Health Commission, Eating Disorders challenging behaviour team, Management and Treatments memory clinic, early dementia team, Investigations Resource Files, Books, Articles, Challenging Behaviour Trust Intranet, Internet. Violence and Aggression Training

Mental Health Act Training

Assessment and Rehabilitation of

Older People with functional and

organic illnesses

Dementia Screening

Respiratory Disorders Relevant Resource

Anatomy and Physiology Mentor, Co-mentor, ward staff, Chest infections. medical staff, Respiratory Nurse Aspiration. Specialist, Physiotherapist, Critical Chronic Obstructive Pulmonary Care Outreach Team, Pulmonary Disease. Function Department, MacMillan Asthma. Nurse, X-ray Department, books, Malignancies education and resource files, Emphysema articles, trust intranet, internet. Fibrosis

Investigations

Drugs, inhalers, nebulisers.

Oxygen therapy.

Aspiration/Treatment and Management

Management of the patient with a

tracheotomy

CLINICAL NURSING SKILLS

Learning Opportunities. Relevant Resource.

Administration of Medication.

Oral medication. Mentor, ward staff, on call

Nasal gastric / peg medication. pharmacist, books, education and

Intravenous medication. resource files, leaflets, medical staff.

Subcutaneous medication.

Rectal Medication

S/C and I/V infusions.

Controlled drugs.

Self Administration of Drugs (Levels

1-4)

Aseptic technique. Relevant Resource

Dressings.

Catheterisation. Mentor

Phlebotomy Nursing staff

Cannulation Medical staff

Infection control team.

Clinical Devices. Relevant Resource

Using and checking pumps Mentor

Infusion pumps. Resuscitation Officer

Syringe drivers. Ward staff

Oxygen Saturation Monitors ECG Department

E.C.G. machine. Medical Devices File

Resuscitation trolley OD and Training

Defibrillator.

B.M. machine.

Urine testing machine.

Dinamap

Overhead Electrical Hoist

Moving and Handling. Relevant Resource

Risk assessing patient. Mentor

Hoist. Ward staff

Slings. Moving and Handling Facilitator

Glide sheets. Physiotherapist

Sam hall turner. Ergonomics Department

Banana slide. Risk Assessment and Policy File

PAT slide. Education Resource File

Physiological Observations. Relevant Resource

Blood pressure. Mentor Temperature, pulse, respiration. Nursing Staff Oxygen saturation’s. Education Staff Blood glucose. Education Resource File Urinalysis. Books and Leaflets Weight.

Maintaining accurate charts.

Neurological Observations

Preparation for Relevant Resource

Investigations.

Consent Mentor Information for consent. Nursing Staff

Administering the preparation. Endoscopy, Ultrasound, Sonar and X- C.T. scans of head chest and ray Department abdomen. Policy Files and Procedures Ultrasound scans. Literature and Leaflets M.R.I. scans.

Endoscopy.

Sigmoidoscopy.

Colonoscopy.

Barium Studies

Risk assessment Relevant resource. Falls. Mentor Mouth care. Nursing Staff Nutrition. Policy Files and Procedures Pressure damage. Specialist Nurses: Documentation. 1. Diabetic

2. Tissue Viability

3. Nutritional Nurse 4. Vascular Nurse 5. Falls Specialist

6. Discharge Liaison

7. Stoma Nurse

Specialist Equipment Relevant resource. Assessment of Patient Mentor Ordering types of mattresses and Nursing Staff how to use them Policy Files and procedures Types of chairs Tissue Viability Nurse

Physiotherapist Occupational Therapist

Assessment, planning, Relevant resource. implementation and

evaluation of care

Physical Mentor Psychological Nursing Staff Social Specialist Nurses Spiritual Social Worker Emotional Voluntary and Support Groups Activities of Daily Living Chaplain/Priest

Physiotherapist Occupational Therapist

1

COMMUNICATION SKILLS

Learning opportunity Relevant resource Verbal communication. Mentors Using the telephone. ward staff Receiving / giving information. Medical Staff Bleep system. Ward Clerk Fast bleep system.

Nurse Handovers

Multi-disciplinary handovers.

Doctors Ward Rounds

Patient/relative enquiries.

Patient Transfers

Non-Verbal Communication Relevant resource Single Assessment Process Mentors. Co-Mentor White boards. ward staff Referral Forms Ward Clerk Multi-disciplinary Team Notes Multidisciplinary Members Doctors Diary SAP Team Patient Handover/Transfer notes Discharge Liaison Nurse Discharge, Nursing Home Letter Pharmacist Pharmacy Scripts

Computer Skills Relevant resource Understanding confidentiality. Mentor Access nursing documentation. nursing staff, Access Patient Information IT department Access A&E information. Policy/procedure file. Use of trust e mail/intranet. SAP Team Ordering of equipment e.g.

mattresses

Ambulance Booking

Porter booking

Health Education and Promotion

Learning Opportunity Relevant Resource

Healthy Lifestyle strategies: Mentor Co-Mentor

Nursing staff 1. Smoking Cessation Smoking Cessation Advisor 2. Stroke Rehabilitation Stroke Team 3. Obesity Falls Clinic 4. Falls Avoidance Dietician 5. Diabetes Diabetic Nurse 6. Alcohol Abuse Drug and Alcohol Team 7. Promotion of Exercise Ellison Unit 8. Eating for a Healthy Heart Mental Health Liaison Nurse 9. Coping with Dementia MacMillan Nurses 10. Counselling Psychologist 11. Interface between Hospital and Health Promotion Service

Community Care OD and Training Department

Leaflets

Library

CROP Discharge Liaison Team

Community Stroke Team Primary Care Team

Organisational and Management Issues

Emergency Situations Relevant Resource

Cardiac Arrest Mentor, Co-Mentor

Falls Nursing Staff

Fire OD and Training Department

Violence Cascade Trainers

Security and Alarm Systems Switchboard

Fire Officer

Security Team

Police Officer

Video Entry System

Management of a Team Relevant Resource

Mentorship/Preceptorship Mentor, Co-mentor

Supervision of New Staff Nursing Staff

Prioritising Education Lead Nurse

Organisational Skills Ward Manager

Delegation Skills Audit Tools

Time Management Books and Research Articles

Off Duty/Bank Staff Policy Files and Procedures

Standards of Care

Implementing Change

Resource Management Relevant Resource

Budget Control Ward Manager

Stock Control Budget Sheets

Pharmacy Control Stores

Stationary Pharmacy

Risk Management Relevant Resource

Policies and Procedures Mentor, Co-Mentor

Moving and Handling Ward Manager

Staff Training Policy Files and Procedures

Medical Devices OD and Training Department

Equipment Safety Checks and Audits Moving and Handling

Facilitator

Ergonomic Department

Health and Safety Team

Health and Safety File

Electronics Department

Environmental Assessment Relevant Resource

Quality Control Domestic Team

Infection Control Estates Department

Health and Safety Portering Staff

Waste Disposal Ward Manager

Health and Safety Team Waste Management Team

MANAGEMENT OF PATIENT CARE.

Learning Opportunities. Relevant Resource.

Use of:-

Nursing model. Mentor, ward staff, essence of care

Essence of care. files, policy/procedure files, intranet,

Documentation used. care plans/ pathways.

Standards / protocols/ policies.

Named nurse.

Assessment. Relevant Resource

What is assessed?

Who is assessed? Mentor, ward staff, policy/procedure

How is assessment carried out? files, patients/carers, medical notes,

When is assessment carried out? education resource files.

Planning. Relevant Resource

Risk assessment tools. Mentor, ward staff, specialist nurses,

Care plans. education/resource files, research

Care pathways literature.

MDT involvement, i.e. physio, OT Discharge Liaison Team

Specialist nurses MDT team.

Community based services.

Discharge planning.

Implementing Relevant Resource

Documentation

Ward Rounds

MDT meetings. Mentor, ward staff, medical staff,

Care plans / documentation MDT team members, patients / carers

/evaluation / relatives.

Documentation Planning.

Hygiene Relevant Resource

Mouth care. Mentor

Skin care. Ward staff

Pressure area care. Assessment Tools

Continence. education/resource files

Washing/ dressing. Tissue Viability Nurse

Bathing. Continence Advisor

Occupational Therapist

Physiotherapist

Nutrition Relevant Resource

Nutritional assessment. Mentor, Co-Mentor Food charts. Ward staff Supplements. Dietician Special Diets Catering Staff Cultural and Religious Dietary Research Articles Requirements SALT Team Swallow assessment. OT Staff Altered texture/thickened fluids. Dysphagia Nurse Specialist Feeding Difficulties. Policies / procedures. Nasal gastric feeding tubes and Peg

tubes / insertion / care.

Feeding regimes pumps.

Communication Relevant Resource

With patients, verbally and non- Mentor verbally ward staff Relatives, verbally, and non-verbally Health Education Staff Medical staff. MDT Members. MDT handovers Ward Clerk Referrals to other agencies. Policy Files and Procedures

Difficult Situations Relevant Resource. Self discharge. Mentor Missing patient. Ward staff Patient / staff / visitor incident / Policy File accident. Modern Matron Missing property. Security/Hospital Police Officer Deceased patients Chaplain

Religious Needs Relevant Resource. Special diets. Mentor Access to patients own particular Ward staff religious representative. Dietician and Catering Staff Time and place to pray. Switchboard Communication. Religious and cultural file

Hospital Chaplain Service

Drug administration policy. Relevant Resource.

Controlled drugs. Mentor Oral drugs. Ward staff Intravenous drugs. Policies /procedures Subcutaneous drugs. Pharmacist

Research Articles

Anti embolic stockings. Relevant Resource.

When / why to use. Mentor How to measure correctly. Ward staff How to apply. medical staff

Research Articles.

December 2012

STAFF DEVELOPMENT

Learning opportunities Relevant resource Clinical Supervision Mentor, Co-Mentor Reflective Practice Nursing staff Contacts Modern Matron Personal Development Plans OD and Training Department Knowledge and Skills Framework Development Programmes, ward Staff Development Prospectus manager education lead sister. University of Northumbria

QUALITY ISSUES

Learning opportunities Relevant resource Policies, Mentor Procedures. nursing staff Standards of practice. Modern Matron Research. Research Articles Clinical audits. Library Changing practice. Internet Handling complaints. Safecare Department Clinical incident reporting. Practice Development Team

December 2012