WELCOME TO E4INFORMATION FOR STUDENT NURSES

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Expectations of Mentors

As a student you can expect ……. An appropriately qualified nurse to act as your mentor/ associate

mentor A minimum of 3 formal meetings per placement to complete your

assessment documentation Time and patience to facilitate your learning at a comfortable pace

appropriate to your particular stage of experience Respect for your individual learning needs and capabilities Learning opportunities to achieve the objectives assigned by the

University Help liaising with the different MDT to achieve appropriate

learning experiences Assistance arranging spoke placements appropriate to the

placement Openness and honesty regarding your progress both clinically and

professionally Reporting to and liaison with the university regarding any

untoward incidents

Expectations of student nurses

As a practice placement, we would expect you ………. To treat patients with dignity and respect To work as a team member, demonstrating respect for your

colleagues through respect, honesty and a willingness to learn To be punctual To work a 37.5 hr week (excluding breaks) or appropriate part time

hours To experience 24 hour cycle of care via a variety of shifts e.g.

Long days, weekends and nights appropriate to your stage in the course

To complete assignments in your own time. To arrange any part-time work around your placement shift

patterns, not visa- versa To adhere to Trust and University dress codes To take responsibility for reporting sensitive information disclosed

by patients To work within your own capabilities and if in doubt ask Acknowledge the work load of staff and appreciate your needs

cannot always be met immediately

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Acknowledge that you have super nummary status but you are expected to work as part of our team and be involved in patient care

An Introduction to Ward E4 for Student Nurses.

Welcome to ward E4, the ward is general surgical patients. We do take other specialities but this is dependent on the bed situation within the hospital. It is an extremely busy ward as we have theatre lists nearly every day and can receive patients from list admissions, clinics emergency admissions and critical care step down patients at any time of the day.

The ward has a multi-disciplinary approach and utilises many specialities to give the best patient care we can. We are committed to an education programme and to a high standard of nursing care and we hope that you find this allocation an enjoyable and rewarding experience.

We are a 25 bedded mixed sex ward comprising of 3, 7 bedded bays and 4 side wards. The ward is divided into 3 areas SW 1 &SW 2 and Bay 1 = femaleSW 3 and Bay 2 = maleSW 4 and Bay 3 = male

The current ward staff have an excellent knowledge base to teach during your surgical experience on E4, they have a variety of clinical experiences and all doing or completed further courses of studies in their areas of interest. There are also packs available to explain each speciality specific to the ward.

Current staff members are:

Our team of consultants:- Mr P Harris Mr J Varghese Mr S Uzair Miss L Lee Mr M Pantalides Mr D Smith Miss G Faulkner Mr J Pollard

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Mr R Zadeh MR Y Akthar Mr A Gentize

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Senior Sister/Ward Manager: Louise Gill

Junior Sister: Terri Wareing, Amy Winstanley

Staff Nurses: Andrea Breithaupt Beverley Robinson Emma Skett Joythi Gomnes Leanne Clugston Lauren Winrow Nicola Hindle Mariam Mehmood Fadumo Hussan Jess Hallworth Dora Chizah Shannon Merrick Kate Smith Francis Gondwe Teresea Macatangy

HCA: Rebecca Bracey Abbey Clayton Michaela Eweka Katie Gibney Leah Lafferty Samantha King Samantha Matheson Hari Mehta Caroline Pendlebury Kellie Pollard Ginette Pritchard Zoe Rogerson Christine Smith Amy Thornhill Gillian Urmson

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Prav Vara Thomas Wilding

Ward Clerk: Carole Bolton

Current Shifts: Early: 07.30 – 13:45

Late: 13.45 - 20.00. Night: 19.30 – 20.00

Long Day: 07.30 – 20:00

Requests will be taken into consideration when the off-duty is done. You will be able to negotiate your off duty, as long as it meets your statutory requirement to complete your training. There is a variety of literature and information available on the ward for you to access if you choose.

You will have an assessor/mentor assigned to you during your allocation. It will not always possible to work with your assessor, therefore you will work with another member of staff, as we have a team mentorship approach. You will also have the opportunity to complete a theatre induction (if not already done so) and follow a patient to theatre during your allocation on E4.

If there is anything else you want to see or do whilst on E4 then please let your mentor or assessor know and we will do our best to arrange this.

BASIC HOUSEKEEPING

The uniform policy must be adhered to at all times. A locker room is located off the ward for your personal belongings.

Please ask a member of staff for the security code for the door. Staff breaks are allocated between 10:00 and 11:00 on an early

shift and 15:00 and 16:00 on a late shift.

Emergency and Fire procedures will be explained to you at the start of your allocation as well as the emergency equipment and fire exits.

Spoke placements

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Students are encouraged to participate in spoke placements – above is a selection of what is available. Please discuss with your mentor which would be beneficial for your learning.Spoke placements should link in with the placement – please discuss with your mentor if you wish to spend time with a speciality not listed above.From Sept 2011 cohort – spokes will be formalised and will take place during the middle four weeks of placement.

IMPORTANT NUMBERS

E4

endoscopy

critical care outreach/ Night

nurse practioners

physio, OT, dietican, social

workers

wardpharmasist

Pain teamstoma nurses

TVN infection control

Radiology

Theatre

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CARDIAC ARREST 2222 FIRE 2222 FAST BLEEP 2222 WARD 01204 390623

TO BLEEP A DOCTOR – Dial 8 then the bleep number then the extension number from which you are calling.

Your Practice Education Lead for the ward is Terri Warring. Please feel free to speak to us or your allocated mentor anytime if you have any questions or concerns. Alternatively you can contact the Practice education Facilitator on 5984. We want you to feel relaxed and enjoy your placement on E4 and will ensure that your supernumerary status is maintained whilst on placement.We hope that you have an enjoyable allocation on E4 ward and utilise the ward as an excellent acute surgical experience. If you should have difficulties please lets us know.

EmergenciesIt is important that you are aware of the following in the event of an emergency:-

Emergency phone numbersLocation of crash trolleyHow to fast bleep a doctorWhat to do in the event of a fireLocation of fire exits

ABOUT THE WARD

E4 is a busy acute surgical ward, comprising of 25 beds. The staff on E4 are committed to giving a high standard of patient care and provide students with a learning environment to fit their needs. This profile will describe E4 and the learning experiences available to you.

NURSING PHILOSOPHY

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Caring is a major focus of nursing within the directorate of General Surgery. By using a recognised Model of Nursing and the Nursing Process, the appropriately trained qualified and unqualified staff aim to fill the self deficits within patients’ activities of daily living, brought on by ill health.

All relevant aspects of hospital care will be explained to ensure informed consent is obtained and a duty of care is achieved. Whenever possible promotion of health will be emphasised.

Where death is the expected outcome, we will endeavour to ensure that it is dignified, peaceful and pain free.

All care will be delivered with respect regardless of age, race, culture, gender, sexuality and social status.

Staff of all grades will be encouraged to develop their professional skills and are accountable for nursing care that they give in accordance with the Nursing and Midwifery Council.

ORGANISATION OF CARE

The organisation of Ward E4 reflects the beliefs and values, which we on E4 hold. It puts patients and their families at the centre of care helping to promote individualised holistic care. This takes into account the person as a whole and places a greater value on the psychological components of care, rather than just the physical needs. Nurses are assigned to a group of patients and are completely responsible for their care. A philosophy of care and our organisation designs a patient centred approach to the delivery of care and gives the individual nurses responsibility for the care that they give. All nurses exercise freedom to practice and are autonomous and accountable.The philosophy of care promotes enhanced interaction between patients and nurses. All nurses set their own priority of care and are accountable for patients as well as being answerable for their own decisions.

Nurses are allowed to professionally develop and enhance their communication skills and their interpersonal skill. There is an anti-hierarchical structure, and responsibilities are often shared with all the multidisciplinary team.

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CommunicationCommunication with patients and relatives form a large part of a nurses’ role, how we communicate with people reflects upon the whole profession.Good communication helps to promote patient confidence at what can be a very difficult time for them; poor communication can lead to impressions of incompetence and loss of confidence in nursing staff.While it is important to keep relatives informed of a patients progress, it must be remembered that confidentiality is an important issue, always confer with a qualified member of staff before disclosing any information. Never give any information out over a telephone.Remember that it is very easy to give misleading information which can lead to disastrous results.If in doubt ask – but make sure the time is appropriate to do so.Students who speak more than one language must be mindful that they must not utilise these skills to act as a translator – official Trust sources should be utilised.

No Smoking PolicyStudents are advised that of 1st July 2009 Royal Bolton NHS Foundation Trust became a no smoking site. This covers the entire hospital site, including cards parked in the grounds. Uniforms must be fully covered when off hospital grounds

Visiting timesVisiting times are 2-5pm and 6-7pm each day.Visiting out of these times is at the discression of the nurse in charge of the shift and should be done by prior arrangement.Visiting during meal times is not permitted.

Guidelines regarding uniformStudents are reminded that they must follow the university’s guidelines regarding uniform.

Uniform must be complete and presentable as supplied Cardigans must be removed when in clinical areas Black low heeled quiet soled plain shoes should be worn. Trainers

and boots are not permitted Trust identity badges must be worn when on duty, no other badges Hair should be tidy. Long hair should be tied back and off the face

and collar. Head scarf worn for cultural purposes must be black of white, no

large adornments or tassels

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It is not permitted to wear a long sleeved garment under uniforms Finger nails should be clean, short. No nail polish or false nails Make-up should be discrete. Aftershave or perfume should be used

sparingly No jewellery other than wedding ring and one plain small stud per

ear Dark coloured overcoat which covers length of tunic must be worn

when off hospital grounds.

Students who do not comply to uniform policy will be sent home and marked as absent

WHAT CAN YOU LEARN

On a surgical ward we nurse patients before and after surgery. Not all patient need surgical intervention, but most are admitted with problems that may require surgery. The consultants on E4 specialise in vascular surgery and urology surgery, however we also have patients who require surgery that is not necessarily related to these specialities. If during your allocation there is anything you wish to see or do, please feel free to ask and we will endeavour to ensure your request is met.

As you go through your allocation you will see patients with a variety of surgical conditions, below is a list of surgical conditions, investigations or surgery performed that you may witness whilst you are on the ward.The list is provided so if you wish you can do some background reading.

Angiograms /AngioplastyAppendectomyBowel ObstructionBowel ResectionCholecystitisCholecystectomy ColonoscopyCystoscopyGastrointestinal BleedingGastrectomyGastroscopy Incision & Drainage of abscessesLeg UlcerPancreatitis

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Repair of HerniaTURBTTURP Urinary Infections

These are only a few you will come across more. If you come across anything you do not understand please ask.

INTERPERSONAL SKILLS

On E4 you will be able to develop your own role as a student in a comfortable and secure supportive environment. You will observe staff using their decision making skills in a number of situations and you will be able to develop your problem solving skills whilst on the ward.

Surgical patients have a number of communication problems. Some of these are listed below and you will be able to develop your skills in this area.

Hearing problems Speech problems Sight problems People who do not speak the same languagePeople with learning disabilityPeople with mental health illness

All patients with communication problems need more help and may cope well in their own environment, but hospitals are unfamiliar to them.On E4 you will observe and be able to use verbal and non-verbal communication and will be able to develop your own skills.

Admission to hospital can increase anxiety in people, (Franklin 1974)Patients and relatives need support. As a student on E4 you will witness staff use communication skills to ease anxiety and support patients through what can be a very stressful experience. As a student you be encouraged to be involved in this process.

Example of when anxiety is heightened:

On admissionImmediately before going to theatre

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When a malignancy is suspected or diagnosedRelatives get anxious when a loved one is very illOn discharge, patients wonder if they can cope at homeAlter body image i.e. stoma, amputation etc

RESEARCH AND ITS APPLICATION

Research based practice is an important aspect of health care and research into the needs of the surgical patient is ever changing. We try to provide up to date evidence based care on E4 and to do this we use a number of resources.

SPECIALIST NURSES

The Trust employs a wide range of Specialist Nurses of which all wards and departments have access to. Their roles vary, but it includes education of staff and patients and implementation of the research. We have link nurses from the ward who attend meetings with the specialist nurses/teams and disseminate new knowledge and information, which in turn cascade to ward level. The aim of this is to continually improve and develop the service we offer.

Here a list of some of the Specialist nurses/teams

Acute Pain Team: Janet Roberts, Trudy Hadcroft and Alison HarrisBereavement Team: Laura Prescott Stoma Nurses: Janette Saunders & Sharon CorbettTissue Viability: Rebecca Coup & Angela Clough Critical care outreach: Anne Gerard Sarah Carden , Emma Liderth and Cassie Woodward

Please feel free to ask who the link nurses are for each topic/speciality on the ward and ask for any up to date information they may have. We also have a selection of files and teaching resources such as books, policies, articles and research papers available in the Day Room specific to each topic/speciality which are available for you to use, these are located in the dayroom.

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There is other material available you may find of use is Health and Safety policies (YELLOW BINDER) Infection Control polices (RED BINDER)Quality Standards (PINK BINDER) Intranet on computer system which includes the Royal Marsden

There is more available, please have a look and see what is useful to you.

HEALTH PROMOTION

“Health Education and promotion should be a recognised part of health care. All Practitioners should develop skills and use every opportunity for health promotion”. (DOH 1989).

It is also part of rule 18 on the Nursing and Midwifery Council Code of Conduct for 1st level nurses.

Information on Health promotion can be found on the ward and intranet.

MANAGEMENT

Management on a busy ward like E4 is very important. You will be able to observe different management styles on the ward and from these you will formulate your own style. You will be able to manage the care of a patient or a whole team depending on your stage of training and experience. You will be under supervision and receive feedback from your assessor. Any staff will be happy to discuss management issues with you.

CARING AND CLINICAL SKILLS There is a vast amount of skills you can develop during your allocation. Please use this opportunity to gain them or work towards gaining them.Utilise all the resources available including members of the multidisciplinary such as physiotherapist, Specialist nurses, they are only happy to impart their wealth of knowledge.

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The team on E4 want to make your learning experience as good as we can, however, we encourage each student, along with their assessor to organise and plan what you want from this allocation, only you know what you want to learn and if you communicate your learning needs, we will do our best to meet them. If however you feel unhappy about anything or you think we can make improvement in our approach in learning, than tell us, please, we can’t change if we are not told.

Please enjoy your placement, feel free to ask questions and try to enjoy your time with us!

COMMON ABREVIATIONS

AXR – Abdo x-rayCOPD - Chronic obstructive airways diseaseCSU- Catheter specimen of urineCXR – Chest x-rayERCP – endoscopic retrograde cholangiopancreatographyHR – Heart RateINR – International ratioIVAB – Intravenous antibioticsIVI – Intravenous fluidsMI - Myocardial InfarctionMRCP – magnetic resonance cholangiopancreatographyMRI – magnetic resonance imagingMSU- Mid stream urineNAD – Nothing abnormal detectedNBM – Nil by mouthNWB – Non-weight bearingO2 – oxygenOGD- GastroscopyORAL ABX – Oral antibioticsPCA – Patient controlled analgesiaPR – Per rectumPV- Per vaginaRESPS – RespirationsRWT – routine ward testSOB – Shortness of breathTPN – Total parental NutritionTTO- Discharge medicationsTWOC- Trial without catheterUSS- Ultrasound scan

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UTI – Urinary tract infection

E4 ward learning experience feedback sheetDid you feel the placement/ mentors lived up to their roles?Please could you complete this feed back sheet and return it to TERRI WAREING, it may be anonymous if you wish.

Competencies Mentor achieved

Mentor not achieved

Ward achieved

Ward not achieved

Contribute to a supportive learning environment and quality outcomes for studentsBe approachable, supportive and aware of how students learn bestHave knowledge of the students programme of study and assessment tool

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Be willing to share knowledge of patient care

Identify specific learning opportunities available in the placement areaEnsure that the learning experience is a planned processEnsure that time is identified for interviews to assess and identify learning needsIdentify with students their core competencies and outcomes to be achievedMake time to observe students undertaking new skillsEncourage enquiry based learning and problem solvingBuild into learning opportunities the chance to experience the skills and knowledge of specialist practitionersEnsure students have adequate break times

Offer encouragement to students

Provide effective orientation

Work with the student at least 2 out of 5 shifts per weekRecognise the students supernummary status

Provide time for reflection, feedback and monitoring progressWork in a multidisciplinary team to provide holistic careSeek evaluation feedback from the student at the end of the placementBe willing to take pride in sharing the students journey on the path to becoming a registered nurse

Feedback sheet developed using RCN Role of a mentor (2002)Thank you for taking the time to complete this questionnaire.

Completed by – leave blank if wish

Cohort – leave blank if wish

Mentor – leave blank if wish

Associate – leave blank if wish

Any other comments

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Date received back to ward ………………………………

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