word document icon Walkergate Hospital, All Wards.doc

Completed July 2006Review Date July 2008

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WALKERGATE HOSPITAL

Welcome to Walkergate and your placement here for the next few weeks.

The hospital was originally built in 1888 and reflects the growing changes in Healthcare over the century.

Initially built to cope with the growing problems of infections diseases it expanded rapidly over the years and in the early 1950’s provided care for over 10,000 patients predominately suffering from Tuberculosis. As this illness declined the hospital was used for ophthalmology and ENT.

However since 1988 it has been used to provide care and rehabilitation for the older population of Newcastle.

Today 4 wards remain with the patients receiving a high standard of care in a therapeutic environment.

Walkergate remains an integral part of The Newcastle Upon Tyne Hospitals and I hope your experience here will strengthen your knowledge and understanding of caring for elderly patients.

Maureen WaterstonMatron Care of the Elderly

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Contents Page

Forward from Matron Page 3

Who’s Who Page 4

Map of Walkergate Page 5

Learning Zone Page 6

Introduction to the Wards Page 7

Ward 1 Profile Page 8




Core Elements Page 12

Glossary of Terms Page 24

Suggested Reading Page 25

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WHO’S WHO AT WALKERGATE

Directorate Manager Andrew Potts

Nursing & Operations Manager

Jean Applegarth

Matron Care of the Elderly Maureen WaterstonSenior Nursing Staff Ward 1 Sister Gill Cockburn

Sister Jane PerkinsWard 2 Sr Gwen Hollingsworth

Sister Pat LambertWard 3 Sister Sue Dawson

Sister Dot MidgleyWard 4 Sister Rowena Horne

Care of the Elderly Consultants

Dr Stephen LouwDr Thien T WynnDr John Davison

Dr Richard Frearson

General Office Jackie Proud

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WALKERGATE HOSPITAL

LEARNING ZONE

Psychiatrist

Psychiatric LiaisonNurse

ContinenceAdvisor

Discharge LiaisonNurse

Housing Liaison Office

Ward 2

Falls – Syncope Service

Medical Staff

Dietician

Acute Pain Service

Ward 3

Stoma Nurse

Chiropodist/Podiatrist

Wheelchair Services

Appliances

Occupational Therapist

PhysiotherapistPALS

Vascular Nurse

Radiographer

Ward 4

Chaplaincy Team

Tissue ViabilityNurse

Speech LanguageTherapy

Moving & HandlingCo-ordinator

Ward 1

Palliative Care

Integrated Bed ManagementFor Older People

Social Worker

Newcastle Alzheimer'sSociety

Diabetic Team

GP’sDistrict Nurses

PSC

Orthodontist/Dental Services

Opticians

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INTRODUCTION TO CARE OF THE ELDERLY SERVICES AT WALKERGATE HOSPITAL

Ward 1

A 23 bedded ward providing rehabilitation and assessment of patients from all units throughout the trust.

Ward 2

A 22 bedded unit also providing rehabilitation and assessment of patients from all units throughout the trust.

Ward 3

A 19 bedded nurse and therapy led unit, which provides an opportunity for patients to regain skills and abilities, following an acute hospital stay, to give them the confidence to return home. Should this not be achievable then full support is given to facilitate a smooth transition into a care setting.

Ward 4

A 20 bedded unit, which provides care for patients too dependent for discharge. The majority of patients are long stay and require frequent medical intervention. The ward also caters for a small number of respite beds, which provides respite, care for short periods while carers are on holiday or are themselves unwell.

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PROFILEWARD 1

WALKERGATE HOSPITAL

Ward 1 is a 23 bedded inpatient ward within the directorate of elderly care services and is part of the Newcastle upon Tyne NHS Foundation Trust. The ward is situated at the front of the hospital.

Ward 1 provides rehabilitation for patients who have a variety of acute and chronic illnesses. They will generally have been admitted to acute wards throughout the trust and are now at a point where they require rehabilitation and assessment to maximise their potential fro discharge. Sometimes patients do not achieve this level of rehabilitation and it is necessary for them to transfer to an appropriate level of care to meet their needs.

Ward 1 presents an excellent opportunity to see the work of the multidisciplinary team which consists of Doctors, Nurses, Physiotherapists, Occupational Therapists and Social workers. We also liase with Elderly Mental health team and Specialist nurses as well as Speech therapists and Dieticians.Social rounds are held on a Monday at the beginning of Consultants’ ward round where patients future care is discussed by the Multidisciplinary Team [MDT].

Sister Gill Cockburn is the Senior Sister and is supported by Junior Sister Jane Perkins. Our Physio is Jean McGowan and our Occupational Therapists are Ruth Quinn and Kate Ross. Social Workers allocated to Ward 1 are Doreen Crossland and Angie Worrall. Claire Brannigan from the Community Resource Team regularly attends the MDT meeting

Our regular shifts are

Early……..07.30-16.00Late……...12.45-21.15Early half...07.30-13.20Nights……21.00-07.37Long day…07.30-21.15

Some staff have elected to do long days but you are not required to do so unless you wish to.

MENTOR

You will be allocated a qualified nurse to be your mentor during your placement. Your Mentor will provide guidance; support and supervision throughout your placement, helping you gain the maximum achievement from this area.We hope you will enjoy your placement within Ward 1. The Care of the Elderly services will enable you to learn more about caring for the elderly and the impact illness and disability has upon them and their carers.

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WARD TWO WALKERGATE HOSPITAL PROFILE

Ward 2 is a 22-bedded rehabilitation for the elderly patient. Our patients are admitted from medical, surgical, orthopaedic and cardiothoracic wards at Freeman Hospital, RVI and Newcastle General Hospital.

We nurse patients with a variety of conditions such as C.V.A, dementia, Parkinson’s disease, terminal illness, diabetes and malnutrition. We work as part of a multi-disciplinary team, which includes nursing and medical staff, physio and occupational therapy staff, social workers, dieticians and speech therapists. We have ward medical and social rounds every Thursday.

Ward 2 can offer a wide range of learning opportunities, which will assist you in achieving your learning outcomes.

Ward Philosophy:Staff seek to promote quality of care in safe and comfortable surroundings. Our aim is to enable the individual patient to live to his or her full potential within the limes of their ability. This involves providing help from a multi-disciplinary team of professional carers.

At the same time, we recognise the person’s needs for privacy and fellowship and their right to be consulted on all matters regarding their welfare.

Who’s Who: Sister Gwen HollingsworthJunior Sister Pat LambertConsultants Dr John Davison and Dr Stephen Louw Physiotherapist Sue Haley Social Worker Margaret Rowntree

Shift Patterns:

Early 7.30 – 16.00Late 12.45 – 21.15Early Half 7.30 – 13.15 Nights 21.00 – 7.40 Long Day 7.30 – 21.00

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Walkergate Ward 3

Ward 3 is a therapy and Nurse led Intermediate Care Unit. We provide an opportunity for patients to regain skills and abilities that will enable them to have a better chance to return home from an acute hospital stay with a feeling of confidence and security.

The unit has been operating since September 2000 and very much advocates patient choice and involvement in all aspects of their care. Patients admitted onto the ward are ideally medically stable and have therapy and nursing needs. They will always be in of further rehabilitation before a sound judgement of discharge destination can be made.

As the patients are medically stable and in a non acute environment it allows all the staff ample opportunity to work with and include patients in all decision-making. This ability is often lost through the acute phases of any hospital admission. The extent of decision making ranges from choosing and preparing breakfast or supporting patients in self medication whilst in hospital.

A unique aspect of the unit is the generic development of Health Care Assistants. [HCA] The HCA’s spend rostered time as Physiotherapy and Occupational Health assistants as well as Nursing assistants. All staff are actively encouraged to develop personal interests related to the patient group. Study time and training opportunities for all levels of staff are readily available within work time. Several HCA’s have undertaken foundation courses and some have gone on to work as Health Care Professionals.

Experienced qualified nurses are able to use their expertise to provide an ongoing monitoring of chronic health problems and to evaluate new health problems and instigate appropriate referrals or treatment.

The collaborative emphasis is also reflected in the choice of interdisciplinary documentation utilised within the unit whereby all staff use the same documentation. Staff from all disciplines work together with patients and their carers to assess, plan, implement and evaluate care. The intervention they receive highlights the innovative and pro-active nature of the unit.

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Welcome to Ward 4

We hope that you enjoy your placement and find the experience gained here will be helpful to you in the future. We aim to assist you to meet your learning outcomes by appointing a qualified nurse to guide you through your placement. For student nurses out ward is a very good learning environment. You will learn the basic nursing care.

The ward has 20 beds allocated to continuing care. We do allocate two beds for respite care. Most of the patients remain here for the remainder of their lives, and rely heavily on the nursing care they receive. Sometimes we may move patients to another environment if their needs change – this may very occasionally include discharge home.

We have input from other disciplines as when required by the needs of the individual patients (transferring them to a residential or a nursing home or their own house.

Before the patients are allocated to our ward they are assessed on acute wards in hospitals throughout the Trust (NGH, Cherry Burn, RVI and Freeman Hospital). Their levels of improvement or deterioration can decide the appropriate future placement in specialised care (palliative care or continuing care).

Referrals regarding the individual patients’ needs are sent to different elderly care consultants and then they will decide the appropriate place for the patient.

On our ward, we have a ward round every Friday afternoon. The rest of the week, we can always bleep the doctor when the need arises.

We do hope you enjoy your stay on the ward.

Out ward sister is Rowena Horne.

The nearest Metro to the hospital is Walkergate Metro, which is only a few minutes walk away.

Our regular shifts are

Early 07.30 – 16.00Late 12.45 – 21.15Early half 07.30 – 13.20Nights 21.00 – 07.37Long day 07.30 – 21.15

Some staff may prefer to do long days but you are not required to do so unless you wish to.

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CARE OF THE ELDERLY SERVICES AT WALKERGATE HOSPITAL

CORE ELEMENTS

LEARNING OPPORTUNITIES RESOURCE/RELEVANT PERSONNEL/DEPARTMENT

INTERPERSONAL SKILLS

Use of the telephone: -Answering callsMaking callsRing back etcBleep system

Use of computer to access: -Patient investigation resultsPatient informationInternetEmail access

Communication with: -PatientsRelativesDoctorsNurses including specialist nursesMembers of multidisciplinary teamAncillary staff

Observation/ participation: -Nursing handoversWard roundsMDT meetingsTeam workingFacilitating investigationsManagerial structureBooking transportPatient transfer within trustPatient transfer outside trust

Ward clerk/ward staff

Ward clerk/ ward staff

Registered nurses/ Health care assistantsWard Sister/ Charge nurseDoctors/multidisciplinary team/Specialist nurses/dietician/OT/Physiotherapist/Social worker/Pharmacist/Domestics/porters

Registered nursesConsultants/Registrars/ Dietician/ social worker

Observation of rolesSisters/ward managers/speciality managerWard clerk/ambulance liaisonRegistered nurses/ bed manager/portersAmbulance crew

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CORE ELEMENTS

LEARNING OPPORTUNITIES RESOURCE/REVOLVING PERSONNEL/DEPARTMENT

CLINICAL SKILLS

Patient hygiene

Mouth careHair/nail careSkin carePressure care/ prevention (Braden scoring)

Recording of physiological observations

BP, TPR, Weight O2 SatsBlood glucoseUrine outputFluid balanceMEWS ChartMaintaining accurate charts

Administering medications

Oral/ intramuscular/ subcutaneous/rectalIntravenousIV infusionsCannulation/ care of IV cannulaeMedical devicesAdministration of blood and blood productsPhlebotomy

Infection control / Aseptic techniques Isolation of patientsCatheter insertion & careUrinalysisDressingsManagement of temporary access/ iv, sub-cut

Nutritional intake

Risk managementBMIMUST Tool

Registered Nurses/ Health Care Assistants

Registered Nurse/ HCA/ DoctorsRegistered Nurse/diabetic specialist nurseRegistered Nurse/ HCARegistered Nurse/HCARegistered Nurse/ HCA

Registered Nurse/Pharmacist/Doctor

Registered Nurse/ Infection control nurseRegistered Nurse/ Medical electronicsRegistered Nurse/Phlebotomist/ Laboratory

Registered Nurse/Infection control nurseRegistered Nurse/Infection control/ Continence advisorRegistered NurseRegistered Nurse

Registered Nurse / Dietician

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Swallowing Assessments Speech & Language Therapist


CORE ELEMENTS


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Patient safetyMoving & handlingFallsUse of aids/ HoistsEquipment checking

Preparation for investigations

Pre admissionConsentInformationBlood results & interpretation relative to specific proceduresNon invasive radiologyInvasive radiology

Registered Nurse/ moving & handling facilitator

Registered Nurse/ DoctorNurse practitioner/ DoctorDoctorRegistered Nurse/ Doctor

Registered Nurse/ Doctor/ Radiologist/ Radiology nurse

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CORE ELEMENTS

LEARNING OPPORTUNITIES RESOURCE/ RELEVANT PERSONNEL/ DEPARTMENT

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PATHOPHYSIOLOGICAL PROCESS

Infection

Inflammatory processSourceTreatment

Immunological factors

AntigensAuto antigensSuppression of immune systemDrugsAuto immune diseases

Electrolyte & water balance

Normal electrolyte balanceReading & understanding blood resultsDehydrationWater excessAcidosis

Books/ Registered Nurses/ Doctors/ Laboratory/ Infection Control Team/ Pharmacist

Books/ Registered Nurses/ Doctors/ laboratory/ Pharmacist

Books/ Registered Nurses/ Doctors/ laboratory/ Pharmacist

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CORE ELEMENTSLEARNING OPPORTUNITIES RESOURCE/ RELEVANT PERSONNEL/

DEPARTMENT

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Co Morbid complications

Heart failureCCF/ LVFMICardiac arrestHypertensionCardiac arrhythmiasAnginaECG

Respiratory system

BreathlessnessPulmonary oedemaChest infectionCOPDAsthmaDrugs/ nebulisers/ inhalers/ O2 therapy

Liver & Biliary system

Liver function testsNutrition

Blood Disorders

Blood formation and destruction processRed & white cells/ platelets/ clotting processAnaemia/ cause & treatmentBlood transfusionMalignant diseaseLymphomaLeukaemiaMyelomaHaemorrhageThrombosis

Endocrine & Metabolic diseaseDiabetes MellitusThyroid problems

Books/ Registered Nurse/ Doctor




Books/ Registered Nurse/ Doctor / Diabetic nurse specialist/ endocrine nurse

CARE OF ELDERLY SERVICES AT WALKERGATE HOSPITAL

CORE ELEMENTS

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LEARNING OPPORTUNITIES RESOURCE/ RELEVANT PERSONAL/ DEPARTMENT

Nervous System

StrokeInfectionsHeadacheEpilepsy

Connective tissue disorder

ArthritisLupus

Acute poisoning

CausesTreatmentDrugs

Oncology

MalignanciesTreatment/ chemotherapy/ radiotherapy/ Drugs

Books/ Registered Nurses/ Doctors

Books/ Registered Nurse/ Doctor/ Pharmacist

Books/ Registered Nurse/ Doctor/ Pharmacist

Books/ Registered Nurse/ Doctor/ pharmacist/ palliative care team


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CORE ELEMENTS

LEARNING OPPORTUNITIES RESOURCE/ RELEVANT PERSONNEL

ORGANISATIONAL & MANAGERIAL ISSUES

Managing a team

Organisational skillsDelegation skillsPrioritising skillsTime managementLeadershipOff dutyManaging patient workloadQuality issuesStandards of careImplementing change

Giving information to

Nursing staffMedical staffPatientsRelativesMulti-disciplinary team membersIn house departmentsOther hospitalsGeneral practitionersDistrict nurses

Resources

Establishment/ Skill mixBudget controlStock controlDrugsCSSU/ TSSUMaterials management

Risk managementPolicies & proceduresEquipment safety checkInfection controlMoving & handlingPatient safety

Registered Nurse/ MangerRegistered NurseRegistered Nurse/ doctorSister/ Senior Registered NurseSister/ Senior Registered NurseRegistered NurseRegistered Nurse/ Audit toolsRegistered Nurse/ Practise development nurse

Sister/ Senior Registered NurseSister/ Senior Registered NurseRegistered Nurse/ DoctorRegistered Nurse/ DoctorRegistered Nurse/ DoctorRegistered Nurse/ DoctorRegistered Nurse/ DoctorRegistered Nurse/ DoctorRegistered Nurse/ DoctorRegistered Nurse

Sister/ Senior Registered NurseSister/ Senior Registered NurseSister/ Senior Registered NurseSister/ Senior Registered Nurse/ PharmacistSister/ Senior Registered Nurse/ Stores

Sister/ Registered Nurse/Health & Safety OfficerInfection control teamMoving & handlingRegistered Nurse/Health & Safety officer

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CORE ELEMENTS


MANAGEMENT OF CARE

Use of nursing modelPhilosophy of careDocumentation usedNursing process

Assessment

Who assessHow is assessment operatedWhat is assessedVenue of assessmentPlanning

Care plansRisk assessment toolsCare pathwaysMultidisciplinary planDischarge planningReferrals to other agenciesOTPhysioSocial workerDistrict nurseSpecialist nursePatient support groupsImplementation/ Evaluation Ward roundsMDTDocumentationStandardsProtocolsPoliciesCommunication/ patients/ relativesTime managementPlanning prioritiesDealing with difficult situationsDeceased patientsPatient property/ valuablesRefusal/ withdrawal of treatmentSelf discharge

Registered Nurse/ Practice Development nurse

Registered NurseSources of informationPatient/ Relatives/ Doctor/ Pharmacist/ Notes/ District nurse/ Specialist nurse

Registered NurseRegistered NurseSpecialist nursesMDTWard procedure followedRegistered NurseRegistered NurseRegistered NurseRegistered NurseRegistered NurseRegistered NurseRegistered Nurse

Sister/ Registered Nurse/ DoctorRegistered NurseRegistered NurseRegistered NurseRegistered NurseRegistered NurseRegistered Nurse/ DoctorsRegistered NurseRegistered NurseRegistered Nurse/ Doctors/ ManagerRegistered Nurse/ Bereavement officerRegistered Nurse/ General officeRegistered Nurse/ Doctor/ Social workerRegistered Nurse/ Doctor

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Religious needs Registered Nurse/ Hospital chaplain/ Priest


CORE ELEMENTS


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Emergency situations

Cardiac arrestViolent incidentsFireSecurity issuesPatient accidents/ incidents

Staff development

Clinical supervisionReflective practise

Cardiac arrest team/ Registered NurseRegistered Nurse/ Security officerFire officer/ Registered NurseSecurity officer/ Registered NurseRegistered Nurse/ Health & safety officer

Sister/ Registered NurseRegistered Nurse

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CARE OF THE ELDERLY SERVICES AT WALKERGATE

CORE ELEMENTSLEARNING OPPORTUNITIES RESOURCE/RELEVANT

PERSONNEL/DEPARTMENT

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Nutrition: Nutritional needs of elderly patients Assisting / Helping patients with

feeding Nutritional assessment of patients Nasogastric / Peg feeding Care of patients with swallowing

deficit Appropriate use of feeding aids

Moving and handling: Safe handling of patients with

motor deficit caused by Stroke Use of appropriate mechanical aids Safe movement of patients who

have undergone amputation Safe movement of suffering from

dementia

Discharge planning: Attending multidisciplinary team

meetings Attending home visits Liaising with community care

providers Arranging discharge medications Arranging transport Liaising with family /carers Liaising with GP practise and

District nurse Liaising with nursing/ residential

home staff PATHOPHYIOLOGICAL PROCESSESReview anatomy and physiology of more common conditions found in elderly:

Stroke Parkinson’s disease Dementia Hypertension Leg ulcers Type 2 Diabetes Peripheral vascular disease Chronic obstructive pulmonary

disease

Nursing team/ Dietician/ Speech & language therapy team/ Dentist/ Doctors/ Catering dept

Nursing team/ Moving and Handling facilitator/ Physiotherapists

Nursing team/ Social workers/ Occupational therapists/ Physiotherapists/ Doctors/ Ambulance liaison/ Pharmacist/ District nurse

Nursing team/ Doctors/ Literature/


CORE ELEMENTS

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INTERPERSONAL SKILLS

Common elements +

Patient Assessment: Physical, Psychological, Social Family involvement Activities of daily living

Communication skills with: Patients / Families / Carers Members of multidisciplinary

team-at all levels Members of nursing team-

qualified / unqualified Other wards & departments Verbal and non verbal

Counselling skills: During terminal illness /

Bereavement In chronic ill health Breaking bad news

CLINICAL SKILLS

Common core elements +

Aseptic Technique Skills: Wound care/ Products Practical aseptic skills Liaising with TVN & Community

nurse

Catheter & Stoma care: Promotion of continence Products available Liaising with continence nurse

and colorectal nurses

Nursing Staff

Nursing Team / Multidisciplinary team

Nursing team / Multidisciplinary team / Chaplaincy / Palliative care team

Nursing team / TVN / Community staff/ Pharmacist

Nursing team/ Colorectal Nurses/ Continence advisor

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CORE ELEMENTS


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Use of drug therapy in elderly care:

Common drugs used Side effects Modes of administration Patient compliance to drug

regimen

Fluid imbalance in elderly: Maintaining adequate fluid intake

in patients with swallowing / feeding deficits

Maintaining accurate fluid balance chart

Dehydration

HEALTH DEVELOPMENT OPPORTUNITIES Common core elements +

Healthy living issues: Smoking cessation Healthy eating in accordance with

dietary needs/ restrictions Control of existing diseases e.g.

diabetes/ hypertension

MANAGEMENT OF CARECommon core elements +

Ward management: Co-ordination of ward team Co-ordination between

multidisciplinary team Co-ordination within elderly care

unitLiaising with other health care workers;

Within elderly care team Within trust Community Other members of

multidisciplinary team Social work department

Nursing team/ Doctors/ Pharmacist/ BNF/Policies & procedures

Nursing team/ Doctors/ Dieticians/ Labs/ Speech and language therapy

Nursing team/ MDT/ Dietician/ Doctors

Nursing team/ MDT

Glossary of TermsABBREVIATION MEANING

BD Twice DailyBM’s Blood Glucose MonitoringBP Blood PressureC. Diff Clostridium DificileC&S Culture and Sensitivity

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Ca CalciumCOPD Chronic Obstructive Pulmonary DiseaseCPR Cardio- Pulmonary ResuscitationCSU Catheter Specimen of UrineCXR Chest X-rayIDDM Insulin Dependant Diabetes MellitusIM Intra MuscularIV Intra VenousIVAB Intra Venous AntibioticsIVT Intra Venous TherapyK PotassiumMane MorningMDT Multidisciplinary TeamMRSA Methiciilin resistant staphylococcus aureusMSU Mid Stream UrineNa SodiumNBM Nil By MouthNG Naso-gastricNocte Night timeNSAID’S Non-steroidal anti-inflammatory drugsOD Once DailyOT Occupational TherapistP PulsePRN As RequiredQDS Four times a dayR RespirationsS/C Sub CutaneousS/L Sub LingualT TemperatureTDS Thrice dailyTVN Tissue Viability NurseU&E Urea & ElectrolytesUSS Ultra sound ScanWCC White Cell Count

FURTHER READING

www.stroke.org.uk

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http://www.stroke.org.uk/

www.alzheimers.org.uk

http://www.dh.gov.uk/PolicyAndGuidance/OrganisationPolicy/IntegratedCare/NHSFundedNursingCare/fs/en

http://www.dh.gov.uk/PolicyAndGuidance/OrganisationPolicy/IntegratedCare/ContinuingCarePolicy/fs/en

http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/OlderPeoplesServices/fs/en

http://www.arthritiscare.org.uk/Home

http://www.mhilli.org/

http://www.ageconcern.org.uk/

http://www.niceguidance.org.uk/

http://www.adss.org.uk/publications/guidance/safeguarding.pdf

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http://www.adss.org.uk/publications/guidance/safeguarding.pdf

http://www.niceguidance.org.uk/

http://www.ageconcern.org.uk/

http://www.mhilli.org/

http://www.arthritiscare.org.uk/Home







http://www.alzheimers.org.uk/

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word document icon Walkergate Hospital, All Wards.doc