Student Nurse Welcome Pack Ward 408, 4th Floor, QEHB.

Contact Number: 0121 371 4080

Contents
Welcome What you can expect from us What we expect from you Student Contact Information The Ward and Nursing Team Ward Philosophy Emergency Situation Admission Procedure checklist Guide to Assessing Patients Stages in individualised patient care Medication and Drug Calculations Recommended Reading Evaluation of placement

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Welcome to your placement on ward 408. This pack has been put together to provide you with information for your placement with us.

Ward Shift Patterns Early Shift: 07:00-15:00 Late: 13:00- 21:00 Night: 20:30-07:30 Long Day 07:00- 21:00 (One Long Day a Week Only in Agreement with Mentor & Ward Manager) (Break: Each 8 hour shift the break entitlement is 30 minutes break)
The following information will be provided to you on your first day with us.

Mentor Name: _____________________________

Associate Mentor: ______________________________

Tutor: ______________________________

Placement Team: _______________________________

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WHAT YOU CAN EXPECT FROM US

You will receive an induction into your work area to ensure you are familiar with the environment and are able to practice safely You will discuss your learning needs and outcomes at the beginning of the Placement We will provide an environment conducive to meet identified individual student learning needs, which is also safe and healthy. During your placement you will be allocated a mentor and an associate mentor to work alongside. The mentor will be a qualified practitioner who will assist and support you during your clinical work. Your mentor will assess your performance against your course learning outcomes, and provide feedback to help you develop your skills. You will receive supervision during your clinical practice. You will be a valued member of the multidisciplinary team during your placement, and can expect support from all our colleagues We will listen to your feedback about your placement and will respond to any issues raised confidentially and sensitively

WHAT WE EXPECT FROM YOU

We expect you to arrive on time for planned shifts and any other activity identified by the Mentor or delegated supervisor. We expect you to ensure your Mentor is aware of your learning outcomes for the placement and specific learning needs. We expect you to act in a professional manner. We expect you to dress in accordance with your College / University uniform policy, and also in accordance with the Trust dress code. You should inform your mentor or delegated person if you are unwell and not able to attend your placement. The process for how to do this will be covered on your induction to the ward/ initial interview. We expect you to maintain and respect confidentiality at all times. This applies to clients, their records and discussions between the student and the Mentor. We would like you to raise any issues regarding your placement with your Mentor or the Ward Manager if

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this is not possible you should contact your link tutor/placement co-ordinator. Your mentor will be responsible for your assessment, co-ordination of learning and personal support. All students are expected and are responsible to provide their contact numbers to ward on the first day or prior to commencing their placements to Rachel Price, Moira Perry or Kiran Kaur.

Student Contact Details

Please complete the following information and give it to your mentor or student link nurse of your clinical area as soon as your placement commences. Please note: if you do not attend work as rostered and you have not contacted the placement area to alert them that you will not be present for the shift, we will initially contact you on the numbers given. If we are unable to get hold of you, we will then use the other numbers given in addition to contacting your academic tutor.

Student Contact Details Clinical Placement Student Name Placement Number & Start Date Home: Contact Numbers Mobile:

Name and Contact Details of Person to Contact in the event of an Emergency or if we are unable to Contact You

Academic Tutor & E-mail Address Student Signature

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The Ward and Nursing Team

Ward 408 is 36 bedded ward with different specialities. Ward cares for patients undergoing ENT (ear, nose, throat), MaxFac (maxillofacial); Plastics, Hand surgery and Trauma & Orthopaedics (T/O). Competence and clinical skills will be gained when caring for patients allocated to them on a daily basis. The students are encouraged to develop organisational and management skills, guided by their supervisors/mentors. The allocation will be dependent on the patients needs and the available skill mix of nurses on each shift. All staff work within their teams as members of a larger team to facilitate quality nursing care for which the patient is the main focus. Other MDT members

Doctors Physiotherapists Occupational Therapists Dietician Pharmacists Speech and Language Therapists (SALT) Clinical Nurse Specialists: ENT, Max Fac. (Head & Neck) Plastics Breast Reconstruction Hospital @ Home Team Infection control Nurses Falls Prevention Nurse Head and Neck McMillan Nurse & Counsellor Housekeeper, Ward Clerks, Ward Administrator, Voluntary help Social Workers and Community Discharge Liaison Nurse

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Ward Philosophy of Care

It is our belief that nursing staff will act as the patients advocate working towards providing best practice according to the individuals needs. We believe that care is best provided in a warm friendly atmosphere, where each person keeps their identity and independence and where confidentiality is respected. We aim to provide high quality holistic care on an individual basis. The emphasis the uniqueness of the individual and takes in to account the physical, psychological, spiritual, social and cultural needs of the person. Staff members are encouraged to develop and expand their own specialised practice and to take a holistic, empathic approach to the patients and carers needs to achieve optimum potential and personal goals. It is our belief that care should be provided in a safe, clean environment and in a climate, which aims to promote health, prevent further illness and / or helps individuals to cope with their limitations. The aim of the nursing team is to ensure that patients receive care/ assistance whilst they are in hospital and gain the maximum benefit from their stay prior to transfer to home or an appropriate safe place. We will treat our patients in a dignified and courteous manner at all times, respecting their individual needs. We recognise that the care you receive cannot be provided by any one person or profession, and so we value the contribution of the multi-disciplinary team in planning your care both in hospital and in the community. We endeavour to provide an atmosphere that is sensitive to patients cultural, biological, social and emotional needs. The ward provides a valuable placement for student nurses at various stages of their training, offering the opportunity to develop a wide range of essential care skills in a supportive and learning environment. We are constantly striving to improve the quality of the inpatient experience and our communication with relatives and carers, and welcome feedback to ensure our standards continue to be met. Staff development is fundamental to our achievements and future progress, and is likewise an ongoing process.

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Emergency Situation
Emergency Buzzer / Cardiac Arrest There is a red emergency buzzer located by each patient's bed and in bathrooms and toilets. This should be pulled if there is a problem with a patient that requires immediate assistance, such as Cardiac Arrest, an unresponsive patient, a fall or simply where you feel that it is not safe to be alone with or to leave the patient to find assistance.

If you are asked to put a Cardiac Arrest call out - you need to dial 2222 and the operator will ask you where you are and where the patient is; I.e. Ward 408, Room B, Bed 9 If you are asked to fast-bleep a member of the medical team you need to dial 2222 and ask to fast-bleep the member of staff you require assistance from. Have a good look at the Crash Trolley, which is situated in your clinical area by Room no 22 and identify where certain items are located - you never know when you may need to assist the team in a Cardiac Arrest. Next to the trolley is Emergency Suction and Oxygen. Fire Please familiarise yourself with the location of; Fire extinguishers and exits Fire alarm break points

If an intermittent fire alarm rings ensure that all windows are closed and all doors are shut. If a continuous fire alarm rings ensure that all doors and windows are shut. The nurse in charge will explain what to do next.

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Admission Procedure Brief Guidance

Record and report observations of vital signs and assess mood/level of consciousness - inform nurse on duty of any abnormalities using the SEWS scoring system on PICS. Explain call system and orientate to ward environment Complete initial nursing assessment and record (access Trust Documentation guidance on internet for more information) Apply white wristband for pt identification and red band denotes patient is allergic to something. Commence patient care round hourly checklist and explain Ensure patients do not have any broken skin, pressure sore and conduct an skin inspection and maintain clear records as appropriate. Waterlow above 10 then each patient should have a skin tool and completed regularly as appropriate. Ascertain if patient has valuables that require depositing in safe and record in patient property book document. Sign disclaimer and ensure safe record is maintained in patient notes. Ensure all patients should have their risks assessments completed on PICS on within 4 hours of arrival to the ward (MUST, Waterlow, fall, MRSA Screening etc). Briefly explain to patient and relatives the ward routine/visiting, nursing organisation. Check whether patient has brought his own medication and document on nursing records and store in patients bedside locker and inform the nursing staff. Collate doctor and nursing assessments and plan care with your patient and liaise with appropriate medical staff/ teams. Any patient who has past medical history of any falls should have a paper completed falls care and management plan in their bedside folder. (all care plans can be accessed on trust internet system )

Useful Contact Numbers

For Switchboard Dial 0 from any trust phones External: 0121 627 2000 Ward 408 Reception no: 0121 371 4056 or 57 Ext no: 14056 or 57 Staff Base 1: 0121 371 4058 or 59 Ext no: 14058 or 59 Staff Base 2: 0121 371 4060 or 61 Ext no: 14060 or 61 To bleep teams: 88 then bleep number and extension from the phone that you are calling and press #. Wait and follow the instructions.

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Guide to Assessing Patients

SOCIAL PROFILE Does the patient live alone, with, or near family or friends? Is the patient receiving support? Carers, package of care, Present or past occupation? Type of accommodation, rent, own Pets, Lifeline BREATHING Breathless on exertion or at rest. Cough? Sputum? (Colour and amount). Smoker - how many? health promotion- advise to quit , any help Is the patient a good colour - blueness of fingers and lips? MOBILITY Waterlow score/ Sterling scale. Does patient have any problems? If aids are used, which? How does he/she manage at home? How many nurses needed to transfer? Hoists? Pressure areas, Cuts/bruising. At risk of falls , care plans, pressure relieving equipments Turning chart, Skin tool, Care Round NUTRITION Is patient well-nourished, hydrated/any nausea, vomiting? Difficulties in swallowing, eating? A special diet, likes, dislikes. Nutritional score, dietician referral, supplements , Recent weight loss/gain ELIMINATION How often bowels open & last opened Normal pattern (constipation, diarrhoea, colour, blood present)? Incontinent , double incontinent Stool chart (PICS), any urinary problems COMMUNICATION/MOOD Is patient conscious, relaxed, anxious? Talkative, withdrawn or confused? Short/Long-term memory Is hearing, speech or sight impaired? Any aids? Is patient aware of time and place? Is language appropriate? PROMOTING COMFORT & SAFETY Vital signs. Own clothes and toiletries with patient & document patient property, disclaimer form. Medication.- list PAIN where? Chronic/acute pain. Pain Score using assessment tools (PICS).

LEARNING AND UNDERSTANDING Patients awareness and knowledge of illness, medication, prognosis and diagnosis

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FEARS FOR THE FUTURE Home situation whilst patient in hospital. Any worries over treatment, admission? Concerns about discharge? Patients expectation. Next of kins expectations. Dependencies Other Issues

SLEEP How many hours? Sedation? How many hours of sleep per day? PERSONAL CARE CAPABILITY Does the patient need assistance? Poor circulation, skin rashes, inflammation? Dental cares, mouth care?

Stages in Individualised Patient Care

ASSESSMENT Collect information via a nursing history. Interpret the information. (Actual and potential) Document on assessment form PLANNING Set patient-centred goals and write specific nursing instructions. Document on Care plan. IMPLEMENTATION Put into practice nursing instructions as specified on care plan. Record and monitor progress EVALUATION Compare patients present stage with goal Observation Team observation Practice skills Expertise Team work Experience Expertise Team planning .SKILLS REQUIRED International communication (Verbal and non-verbal) Observation, Knowledge, Team work

(Modified& adapted: Roper Logan Tierney Nursing Model)

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MEDICATION
AIM To increase knowledge of prescribed medication.

OBJECTIVE The student will be able to list the drugs prescribed for patients in his/her care. To demonstrate an ability to explain to his/her patients the actions, effects and dosage to enable them to comply with their medication after discharge.

AIM To become competent in the administration of medication.

OBJECTIVE To carry out regular drug rounds with a trained nurse, observing correct procedures. To have a sound knowledge of the commonly used drugs, their side effects and action. To safely administer IM, S/C injections and nebulisers.

EvidenceProduce the drug History by Listing the Common Used Medication on the Ward, with the action, side effects and contra indications etc.

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Drug Calculations 1. A client is ordered 50 milligrams of Amitriptyline. 25 milligram tablets are available. How many tablets will you give? Answer: 2. A Client is ordered of 60 milligram/ml Codeine phosphate. 25mg/5ml elixier is available. How many mls will you give? Answer: 3. A Client is ordered 0.5 milligrams of Digoxin. 250 microgram tablets are available. How many tablets will you give and what you need to be aware of before administering this drug? Answer: 4. A client is ordered 300 milligrams of Carbamazepine. 200 milligram tablets are available. How many tablets will you give? Answer: 5. A client is ordered 7.5 milligrams of Bendrofluthiamzide. 2.5 milligram tablets are available. How many tablets will you give? Answer: 6. A client is ordered 50 milligrams of Amoxicillin trihydrate orally. 125 milligrams in 5 millilitres of Syrup is available. How many millilitres will you administer? Answer 7. A client is ordered 5 milligrams of Haloperidol orally. 2 milligrams in 1 millilitre of Syrup is available. How many millilitres will you administer? Answer: 8. A client is ordered 50 milligrams of Sodium Valproate orally. 200 milligrams in 5 millilitres of Syrup is available. How many millilitres will you administer? Answer: 9. One litre of Normal Saline is charted over 9 hours. The drop factor is 15. Calculate the number of drops per minute. Answer: 10. 12. One litre of Dextrose 5% in water is charted over 8 hours. The drop factor is 10. Calculate the number of drops per minute. Answer:

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Drug Calculation Formulas This formula is used to calculate the number of tablets to be administered when given the required dose. Required Dose ------------------ = Number of tablets to be given Stock Dose

This formula is used to calculate the amount of medication in solution for oral, intramuscular, intravenous or subcutaneous injection to be administered when given a dosage, stock dose and volume: Stock Volume Required Dose ---------------------- X ---------------------- = Volume to be given Stock Dose 1 N.B. Units for required dose and stock dose must be the same. Intravenous fluid must be given at a specific rate, neither too fast nor too slow. The specific rate may be measured as ml/hour, L/hour or drops/min. To control or adjust the flow rate only drops per minute are used. Common drop factors are: 10 drops/ml (blood set), 15 drops / ml (regular set), 60 drops / ml (microdrop). To measure the rate we must know: (a) the number of drops (b) time in minutes. The formula for working out flow rates is: volume (ml) X drop factor (drops/ml) ---------------------------------------------- = drops / minute time (min)

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Breast, Human Upper Part and Larynx Anatomy

Breast profile
A B C D E F G Ducts Lobules Dilated section of duct to hold milk Nipple Fat Pectoralis major muscle Chest wall/ rib cage Enlargement A B C Normal duct cells Basement membrane Lumen (centre of duct)

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Laryngectomy

Temporary Tracheostomy

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Lefort I Osteotomy

Sagittal Split Osteotomies

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Recommended Reading & Useful Websites

Basford, L & Thorpe, K. (2004) Caring for the Older Adult. United Kingdom: Nelson Thornes Ltd. Breast Cancer Care (2011) Breast Cancer and reconstruction [online]. Available at:[Link] Buglass, E. (1999)Tracheostomy care: tracheal suctioning and humidification. British Journal of Nursing. 8, (8) 500-504. Craig, j. and Smyth, L. R. (2007) The Evidence- Based Practice Manual for Nurses. (2nd edn). London: Churchill livingstone, Elsevier. Day, T. (2000) Tracheal suctioning: when, why and how. Nursing Times. 96, (20) 13-15. Dimond, B. (2008) Legal Aspects of Nursing. (5th edn). Essex, Harlow: Pearson Education Limited. Docherty, B. (2002) Tracheostomy management for patients in general ward settings. Nursing times [online]. Available at: [Link] Department of Health.(2001) Caring for older people: A nursing priority integrating knowledge, practice and values. London: DH. Department of Health.(2001) Essence of care. Benchmarking guidelines HMSO Stationery Office. Department of Health (2003) Winning Ways: Working Together to Reduce Healthcare Associated Infection in England. London: DH. Department of Health (2007) Saving Lives: Reducing Infection, Delivering Clean and Safe Care. London: DH. Dougherty, L. and Lister, S.(2008) The Royal Marsden Hospital Manual of Clinical Nursing Procedures.(7th edn). Oxford: Wiley- Blackwell. (Student edition is also available in libraries ). Hogston, R. & [Link]. (2002) Foundations of nursing practice: making the difference: Basingstoke: Palgrave Macmillan. Jasper, M. (2003) Beginning reflective practice. Cheltenham: Nelson Thornes Ltd. National Tracheostomy Safety Project (2011) Blocked tracheostomy tube- Video [online]. Available at: [Link] deo%20-%20blocked%[Link]. National Tracheostomy Safety Project (2011) Tracheostomy and Laryngectomy Care [online] Available at: ttp://[Link]/Tracheostomy/New%20Blue%20Trachy%20Webpages/New%20Resources. htm. Nursing and Midwifery Council. (2008)The Code of Professional Conduct. London: NMC.

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Resuscitation Council UK. (2000)Advanced Life Support Course: Provider manual [online]. Available at: [Link]. London: RCUK. Rowley, S. (2001) Aseptic non-touch technique. Nursing Times; 97 (7), 6-8. Rowley, S. and Sinclair, S. (2004) Working towards an NHS standard for aseptic non-touch technique. Nursing Times.100 (8), 50. Serra, A. (2000) Tracheostomy care. Nursing Standard 14, (42) 45-52. Taylor, J. (2003) Study skills in health care. Cheltenham: Nelson Thornes Ltd. University of Nottingham (2012) ANTT- Video and Activity. [online] at: [Link] Walsh, M and Crumbie, A. (2007) Watsons Clinical Nursing and Related Sciences. (7th edn). London: Elsevier. Waugh, A. and A. Grant (2007) Ross and Wilson anatomy and physiology in health and illness (10th edn) Edinburgh. Churchill Livingstone. Waugh, A. and A. Grant (2007) Ross and Wilson anatomy and physiology colouring and workbook. Edinburgh. Churchill Livingstone.

Other Facilities
Library: Located in the Education Centre on First Floor Internet: Accessed from any Trust computer for further in-formation, care plans, policies & Procedures, Document. PPM- Clinical Skills First Floor PICS Training- PICS trainer team First Floor Student Board: Student and Staff Information Board- in staff Room
Information Pack Created By Kiran Kaur Edited and Reviewed By Rachel Price Moira Perry Sue Sharp Katherine Catty Ward Manager Sister & Student Co-ordinator PDS Senior Practice Placement Team Manager Practiceplacementt@[Link] Stephanie Dawson Practice Placement Team UHB- 4 Floor (Divison D)
th

Staff Nurse

Ward 408

EXT NO: 14059

Ward 408 Ward 408 BC/Ward 408

EXT NO: 14059 EXT NO: 14059

UHB EXT NO: 14247, 48, 49

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EVALUATION OF PLACEMENT (All Students Must Return)

How did you find your introduction to the ward?

Did you find the staff approachable during your allocation?

Did you find your Mentor helpful?

Was there any teaching on the ward, if so was it helpful?

Was the supervision you received whilst working beneficial to your learning needs?

How do you feel that you benefited from your allocation?

Any other comments or observations. Please continue on the back if necessary.

Forms to be returned 1 week prior to completion of placement to Sr Perry or SN Kiran or file into student folder. Any concerns you can raise with us in private or with your mentors. Thank You for Your Co-Operation Staff Ward 408

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