Profile of Learning Opportunities

Integrated Critical Care Unit Ward 37

Institute of Transplantation Freeman Hospital

January 2012

Contents

1. Specific Introduction to the Unit 2. Critical Care Philosophy 3. Critical Care Learning Zone 4. Common Critical Care Learning Opportunities:

Key element 1: Interpersonal Skills

Key element 2: Clinical Skills

Key element 3: Pathophysiology Processes

Key element 4: Health Development Opportunities

Key element 5: Management of Care

Key element 6: Organisational and Managerial Issues

Key element 7: Specific Learning Opportunities

Student Information

Hi there, and welcome to Critical Care. Before we go any further, there is just one thing we have to say;

DO NOT PANIC!!!!!

A Critical Care Unit can be a very daunting and scary place but our aim, whilst you are here on placement, is to make this if possible, one of your most enjoyable and productive learning experiences during your training. This information aims to give you a brief description of the Integrated Critical Care Unit and the way the unit it runs, so you have some idea of what you are letting yourself in for and what you can achieve whilst you are here. All the information here will be re-enforced by your mentor so, if you have any questions JUST ASK!! We like that in students. The Critical Care Unit is an integrated unit, this means that both Intensive Care patients (level 3) and High Dependency patients (level 2) are cared for within the same clinical area and are run by the Anaesthetic Team. At present, the unit has 9 Level 3 beds and 6 Level 2 beds. However, there is a potential capacity to expand up to 22 beds and we are flexible on these beds depending upon the patient dependency. Shifts So, let us start with the shifts. Most of us work 11.5-hour shifts but there are some staff that, on occasions, do 8-hour shifts. Day: 07.30 - 20.00. Night: 19.30 - 08.00. Early: 07.30 - 15.30. Late: 12.00 - 20.00.

Visiting:

Visiting is limited to set times; these are subject to change so check with your mentor when they are. We only allow two members of the family at the bedside at any one time and this should be limited to immediate family only.

Liver transplantation patients should have the same two designated visitors only; other members of the family can only see the patient through the cubicle windows, unless otherwise approved by the Liver Team. Children may visit following prior arrangement with the nurse in charge Visiting hours are between 14.00-and 22.00hrs Helpful phone numbers include: Critical Care Unit: 01912231176

0191 223 8927 01912238926 Cardiac Arrest Bleep: 2222. Fire Bleep: 333.

Clinical Nurse Educator: 0191 244 8765 To aid security there is an entry system into the unit, which, can be accessed via the use of a swipe card and selective access with the use of a camera ID, which is located at the nurses station. Off-duty As there is so many staff (approx 100), we are allocated into teams. Consequently, we work 2 weeks days and 2 weeks nights, which works out at 13 shifts per month 3 weeks of 3 shifts and 1 week of 4 shifts. E-record You can ring ext 2100 to have access to e-record so that you can check results and order investigations Meal Breaks Another important factor when considering shifts are breaks - an extremely important part of the day. Breakfast: 20 mins. Approx 08.30 - 09.30. Lunch: 30 mins. Approx 12.00 - 13.30. Tea: 30 mins. Approx 16.00 - 17.30.

Unit staff There always seems to be a large amount of hospital employees present on the unit, many of them are linked to other areas of the hospital. Below is a list of the majority of staff involved within the unit and other members of the Multidisciplinary Team you will become familiar with by the end of your placement.

Ward Clerk.

Ward Administrator.

Health Care Assistant.

Critical Care Assistant

Staff Nurse.

Sister/ Charge Nurse.

Matron

Doctors.

Consultants: Dr Andy Kilner, Dave Cressey, Joe Cosgrove, Ian Nesbitt, Jon Walton, Dr. Suzie O’Neill, Dr. Steve Wright, Ian McCulloch, John Davidson.

The unit is run on a 1 patient to 1 nurse ratio for Level 3 patients, and 2 patients to 1 nurse for Level 2 patients. So, in an ideal situation per shift there should be; the Nurse in Charge, 14 Nurses and 2 Health Care Assistants/Critical Care Assistants. This should then hopefully allow for the smooth running of the unit - if that is at all possible!!! Multidisciplinary Team:

Nursing Team

Medical Team

Outreach Team.

Visiting Medical / Surgical Teams.

Physiotherapist.

Dietician.

Pain Team.

Medical Students.

Clinical Nurse Educator

Occupational Therapist.

Speech Therapist.

Tissue Viability Nurse.

Chiropodist.

Transplant Co-ordinator

Equipment Around the unit, you will find numerous pieces of electrical / technical equipment. Try not to be baffled by it. At every bed-space, there is some basic equipment you should be aware of:

Ventilator - assists with the patient breathing.

Monitor - allows us to continually monitor the patient i.e.; blood pressure, heart rate and central venous pressure.

Drip stand - used to support infusion devices.

Bed.

Hoist.

Transducer and Pressure Bag - enables us to monitor BP and CVP via lines through electronic cables.

Infusion devices - Syringe driver - administer drugs via a syringe at rates per hour. Volumed pump - administer IVT and drugs in infusion fluids at a rate per hour. Enteral feed pump - administer feed NG, NJ or JEJ at a certain rate per hour.

Bedside drawers - contains most of the equipment required to use at a bed space i.e.; needles, syringes and drug labels.

This equipment is available at every bed space. This allows the nurse to be at the patient’s bedside for the optimum amount of time, therefore minimal time away from the patient. Types of patients We care for a variety of patients with numerous different medical conditions and problems but, generally, there are some specific types of patients we look after on the unit, some of which are specialist areas.

RESPIRATORY FAILURE - anyone who has difficulty breathing or maintaining their airway.

ENT / RADICAL NECK DISSECTIONS - most ENT surgery interferes with your airway therefore most cases need to come to ITU to protect their airway.

CARDIAC ARREST - someone whose heart has stopped beating. The patient may be admitted pre or post arrest.

LIVER TRANSPLANTS - any patient requiring a liver transplant, this can be pre and post transplant.

LIVER FAILURE - caused by a variety of reasons. People suffering from this condition are normally very sick when they come to us and in most cases require a transplant.

PARACETAMOL OVERDOSE - someone who has taken an excessive overdose can have great consequences on their health status, often fatal, and can consequently require a liver transplant due to liver failure.

RENAL FAILURE - anyone whose kidneys has stopped working and in turn has affected other major organs within their body. On the unit, we provide 24-hour dialysis CVVH and they can also receive Intermittent Haemodialysis.

POST OP - anyone who needs to come to ITU following an operation where there has been complications i.e.; long time on the table or difficult procedure.

ANEURYSM - this is a balloon like swelling in the wall of an artery. These can be either identified and the patient can come in for an elective operation or they can rupture and leak causing significant cardiovascular instability.

PANCREATITIS - inflammation of the pancreas, which can in severe cases cause diabetes and mal-absorption, associated with gallstones and alcoholism.

HAEMATOLOGY- patients with haematological malignancies and disorders So what will you see whilst you are here on placement and how can these help you achieve your objectives? Below are just some of the things you are likely to see. You can then see how these can associate with your objectives and formulate your action plan / agreed goals. ADMISSION DISCHARGE INTUBATION LINE INSERTION TRACHEOSTOMY ECG ULTRASOUND SCAN ECHO CHEST X RAY SUCTIONING CPR THEATRE DIALYSIS CARE PLANNING There are numerous procedures you can observe but, due to safety reasons, you will be unable to assist in whilst you are here on placement. However, it is also up to the discretion of your mentor to the amount of responsibility they will give you in practice. When you are unable to work with your mentor, you will be allocated an associate mentor, so you are never working on your own. But most of all, and what is vitally important, is that you

Drugs We use many different medications within Critical Care. Below you will find a list of just a few of the most common drugs used; it is worth your while trying to find out about these drugs in your first few weeks to help you with your understanding of Critical Care. Propofol Midazolam Fentanyl Adrenaline Noradrenaline Antibiotics Magnesium Calcium Amiodarone Paracetamol Suxamethonium Potassium Actrapid

Glossary Below you will also find a list of some commonly used abbreviations. To help you, I have provided what they stand for but, see if you can find out some more information about what they mean whilst you are here: HR - Heart Rate: VT - Ventricular Tachycardia: AF - Atrial Fibrillation: SR - Sinus Rhythm: CVP - Central Venous Pressure: BP - Blood Pressure: MAP - Mean Arterial Pressure: BM - Blood glucose Monitoring: NJ - Naso Jejunostomy: NG - Naso gastric: JEJ - Jejunostomy: IVT - Intravenous Therapy: ETT - Endotracheal Tube: CXR- Chest X ray: ECG - Electrocardiogram: RRT - Renal Replacement Therapy: ESRF - End Stage Renal Failure: CVVH - Continuous veno - venous haemofiltration: IHD - Intermittent Haemo dialysis: ARDS - Acute Respiratory Distress Syndrome: FM - Face Mask: NC - Nasal Cannula: NP AIRWAY - Naso pharyngeal airway: There are numerous procedures you can observe but, due to safety reasons, you will be unable to assist in whilst you are here on placement. However, it is also up to the discretion of your mentor to the amount of responsibility they will give you in practice. When you are unable to work with your mentor, you will be allocated an associate mentor, so you are never working on your own. But most of all, and what is vitally important, is that you

ENJOY!!!!!

This way you will gain the most from your placement and if you have any queries, questions or problems just; ask we don’t bite you know!!!

Adult Critical Care

Philosophy of Care

Critical Care Nurse’s believe patients should receive:

A high standard of holistic individualised care that respects and supports their physical , mental, spiritual, cultural and social well being, in promotion of their health and quality of life. Through a multi-disciplinary approach provided by Nurse’s, Doctors, Physiotherapist, Dieticians and other specialists, that share knowledge, expertise and decision making, to ensure that the patient is central to the care provided.

A patient’s advocate to maintain safety, privacy, dignity and confidentiality

for that individual at all times.

Clear and open two-way communication and respect between the patient and members of the multi-disciplinary team.

Educational and information that will enable them, their family, significant

others and carers to make an informed choice, that reflects their spiritual, cultural and physical needs or beliefs.

A supportive environment for the patient, relatives, friends, and the

members of the multi-disciplinary team that allows involvement in care whenever possible.

A high standard of evidence-based practise that is supported by research and

continuing professional development, education and training, to continually update our knowledge and strive to achieve our goal of excellence.

To ensure the above are fulfilling staff, patients and families should be treated with mutual understanding and respect.

FH Transplant Teams

Lung Function Dept

Cardiology Team/ Perfusionists Echo Dept/Cath Labs

Outreach Team

Dietician

Chaplaincy

Surgeons

Medical staff

Radiography

Dept

Critical Care

Education Team

Pharmacy

Porters

Haematology

Physiotherapist

Biochemistry

Microbiology

Wards

ECG

Department

Neurology Team.

Northumbria

University District Hospitals/

Hospices

Patient Services

Coordinators

PEG

team

Speech

Therapy

G.Ps

CT/MRI

scanner

Interpreter

services

Social

Services

Colo-Rectal

nurses

Critical

Care

RVI Equipment technician

Cardiology Team

Home Ventilation

Team Oncology

Outreach Team

Burns Team

Family/carers

Mortuary

NGH Neurology

-theatres

-X-ray Home Ventilation

Team

A&E Dept

Outreach

Tissue

Viability

Infection

Control

Transplant

Co-ordinator

Nurse Consultant

Pain Team

Palliative

care

Modern Matron

Occupational therapists

PALS

Pre assessment Unit

Transplant

Co-coordinators

Theatres

Guidance for students and mentors

This profile is a comprehensive document, detailing all the learning opportunities available in a specific clinical area. It is intended that students and mentors select the appropriate opportunities to help students meet the specific competencies for particular placements. Students should not expect to access all of these opportunities while on placement. We seek to provide equal opportunities to all learners within the critical care however; it is the responsibility of individual students to advise their mentor of any particular individual requirements in accessing learning opportunities. Initially the profile gives an overview of common critical care experience available. The latter section outlines specific experience available in each critical care unit.

Learning Opportunities

FRH

ICC

U

NG

H IC

U

NG

H H

DU

RV

I IC

CU

FRH

Car

dio

tho

raci

c IC

U (

WD

26

)

Sist

er/

Ch

arge

Nu

rse

Staf

f n

urs

e

Spe

cial

ty M

ana

ger/

Mat

ron

Pra

ctit

ion

er

lect

ure

r

Ou

tre

ach

Te

am

Me

dic

al s

taff

CC

A

HC

A

Mic

rob

iolo

gist

Infe

ctio

n c

on

tro

l te

am

Ph

arm

acis

t

ph

ysio

the

rap

ist

Spe

cial

ist

Nu

rse

Pra

ctit

ion

er

Tran

spla

nt

coo

rdin

ato

r

Occ

up

atio

nal

Th

era

pis

t

Tiss

ue

Via

bili

ty N

urs

e

Die

tici

an

Nu

trit

ion

al N

urs

e S

pe

cial

ist

M&

H N

urs

e

Tran

sfu

sio

n N

urs

e

Spe

ech

th

era

pis

t

Clin

ica

l go

vern

ance

an

d r

isk

Gu

ide

line

s an

d p

olic

ies

Use of the telephone/DECT system

Use of the computer to obtain:

Patient investigation results

Patient information

Intranet

Internet

E-mail access

Relative intercom system

Talking to:

Patients

Relatives

Doctors

Other nurses including specialist nurses

Multi-disciplinary team referrals

Other opportunities to gain interpersonal skills:

Ancillary staff (domestics, porter, catering, ward-clerks)

MDT meetings

Doctors ward rounds

Booking transport

Facilitating investigations

Nurses handover

Managerial structure in the Trust

Team working

Patient transfers in the Trust

Patient transfer outside the Trust

Key element 2 clinical skills

Learning Opportunities

FRH

ICC

U

NG

H IC

U

NG

H H

DU

RV

I IC

CU

FRH

Car

dio

tho

raci

c IC

U (

WD

26

)

Sist

er/

Ch

arge

Nu

rse

Staf

f n

urs

e

Spe

cial

ty M

ana

ger/

Mat

ron

Pra

ctit

ion

er

lect

ure

r

Ou

tre

ach

Te

am

Me

dic

al s

taff

CC

A

HC

A

Mic

rob

iolo

gist

Infe

ctio

n c

on

tro

l te

am

Ph

arm

acis

t

ph

ysio

the

rap

ist

Spe

cial

ist

Nu

rse

Pra

ctit

ion

er

Tran

spla

nt

coo

rdin

ato

r

Tiss

ue

Via

bili

ty N

urs

e

Die

tici

an

Nu

trit

ion

al N

urs

e S

pe

cial

ist

M&

H N

urs

e

Tran

sfu

sio

n N

urs

e

Clin

ica

l go

vern

ance

an

d r

isk

Gu

ide

line

s an

d p

olic

ies

Patient Hygiene:

Mouth care

Skin Care

Pressure area care (Braden scoring):

Hair/nail care

Eye care

Recording, understanding and interpretation of physiology observations:

BP, TPR, CVP and SaO2

Blood Gases

Weight

Ventilation modes and observations

Left atrial pressure

Pulmonary artery pressure

Cardiac output studies

Accurate fluid balance

Administration of crystalloid & colloid infusions

Maintaining neat & accurate charts

Interpretation of blood results/counts

Administration medication:

Oral, NG, NJ, PEG

Intramuscular injection

Subcutaneous injection

Rectal

Intravenous

IV infusions

Cannulation/care of peripheral/central lines

Administration of blood and blood products

Arterial blood sampling

Phlebotomy

Intrathecal

Aseptic techniques

Nutritional intake

Arterial pressure monitoring:

Patient Safety

Equipment checks

Insertion & removal and arterial blood sampling

Central venous pressure monitoring:

Patient safety

Checking and setting up of equipment

Insertion/removal & central venous blood sampling

Learning Opportunities

FRH

ICC

U

NG

H IC

U

NG

H H

DU

RV

I IC

CU

FRH

Car

dio

tho

raci

c IC

U (

WD

26

)

Sist

er/

Ch

arge

Nu

rse

Staf

f n

urs

e

Spe

cial

ty M

ana

ger/

Mat

ron

Pra

ctit

ion

er

lect

ure

r

Ou

tre

ach

Te

am

Me

dic

al s

taff

CC

A

HC

A

Mic

rob

iolo

gist

Infe

ctio

n c

on

tro

l te

am

Ph

arm

acis

t

ph

ysio

the

rap

ist

Spe

cial

ist

Nu

rse

Pra

ctit

ion

er

Tran

spla

nt

coo

rdin

ato

r

Tiss

ue

Via

bili

ty N

urs

e

Die

tici

an

Nu

trit

ion

al N

urs

e S

pe

cial

ist

M&

H N

urs

e

Tran

sfu

sio

n N

urs

e

Clin

ica

l go

vern

ance

an

d r

isk

Gu

ide

line

s an

d p

olic

ies

Cardiac output monitoring:

Patient safety

Checking and setting up of equipment

Insertion & removal

Pulmonary artery blood sampling

Left atrial pressure monitoring:

Patient safety

Checking/setting up of equipment

Insertion & removal

Intra Aortic Balloon Pump:

Patient safety

Checking and setting up of equipment

Insertion & removal

Infection Control:

Isolation of patients

Routine sampling

Sepsis screening

Urinary catheter insertion and care:

Urinalysis

CSU and MSU collection

24 Hour urine collection

Stool sample

Faecal occult blood testing

Preparation for investigations:

Information

Consent

Non-invasive radiology

Invasive radiology

Transfer of the critically ill patient

Risk assessment

Moving and handling - use of equipment

COSHH

Health & Safety

Falls assessment

Fire safety

Learning Opportunities

FRH

ICC

U

NG

H IC

U

NG

H H

DU

RV

I IC

CU

FRH

Car

dio

tho

raci

c IC

U (

WD

26

)

Sist

er/

Ch

arge

Nu

rse

Staf

f n

urs

e

Spe

cial

ty M

ana

ger/

Mat

ron

Pra

ctit

ion

er

lect

ure

r

Ou

tre

ach

Te

am

Me

dic

al s

taff

CC

A

HC

A

Mic

rob

iolo

gist

Infe

ctio

n c

on

tro

l te

am

Ph

arm

acis

t

ph

ysio

the

rap

ist

Spe

cial

ist

Nu

rse

Pra

ctit

ion

er

Tran

spla

nt

coo

rdin

ato

r

Occ

up

atio

nal

Th

era

pis

t

Tiss

ue

Via

bili

ty N

urs

e

Die

tici

an

Nu

trit

ion

al N

urs

e S

pe

cial

ist

M&

H N

urs

e

Tran

sfu

sio

n N

urs

e

Spe

ech

th

era

pis

t

Clin

ica

l go

vern

ance

an

d r

isk

Gu

ide

line

s an

d p

olic

ies

Inflammatory process

Infections

Source

Nature of spread

Treatment Options

Immunological factors:

Antigens

Suppression of immune system

Drugs

Rejection

Disturbances in electrolyte and acid base balance

Normal electrolyte balance

Reading and understanding blood results

Acidosis and alkalosis

Diabetes Insipidis

Oncology:

Aetiology

Pathology

Chemotherapy, radiotherapy

Radio frequency ablation (RITA)

Chemo-embolisation

Drugs

Cardiovascular System:

Anatomy and physiology

Monitoring

ECG's

Cardiac arrhythmia's

Investigations

Treatment regimes

Drug therapy

Cardiac arrest

Defibrillation

Pulmonary Embolism

Pulmonary hypertension

Left ventricular failure

Angina, MI

Heart/lung transplantation

Cardiac surgery cases

`Learning Opportunities

FRH

ICC

U

NG

H IC

U

NG

H H

DU

RV

I IC

CU

FRH

Car

dio

tho

raci

c IC

U (

WD

26

)

Sist

er/

Ch

arge

Nu

rse

Staf

f n

urs

e

Spe

cial

ty M

ana

ger/

Mat

ron

Pra

ctit

ion

er

lect

ure

r

Ou

tre

ach

Te

am

Me

dic

al s

taff

CC

A

HC

A

Mic

rob

iolo

gist

Infe

ctio

n c

on

tro

l te

am

Ph

arm

acis

t

ph

ysio

the

rap

ist

Spe

cial

ist

Nu

rse

Pra

ctit

ion

er

Tran

spla

nt

coo

rdin

ato

r

Occ

up

atio

nal

Th

era

pis

t

Tiss

ue

Via

bili

ty N

urs

e

Die

tici

an

Nu

trit

ion

al N

urs

e S

pe

cial

ist

M&

H N

urs

e

Tran

sfu

sio

n N

urs

e

Spe

ech

th

era

pis

t

Clin

ica

l go

vern

ance

an

d r

isk

Gu

ide

line

s an

d p

olic

ies

Respiratory Systems:

Anatomy and physiology

Assessment

Investigations

Infections

Oxygen therapy

Treatments

Drugs, nebuliser therapy, BIRD

Analysis of blood gas monitoring (ABG)

Respiratory Disease

Invasive ventilation

Non-invasive ventilation

Tracheostomy care

Prone positioning

Pulse oximetry

Hepato-renal system/Biliary System:

Anatomy and physiology

Symptoms of liver disease - jaundice, ascites

Hepatitis, different types

Auto-immune hepatitis

Alcoholic liver disease

Endoscopic procedures

Pancreatitis

Detox

Drugs

Nutrition

Surgical procedures:

Biliary reconstructive surgery

Renal System:

Anatomy and physiology

Chronic renal failure

Acute renal failure

Investigations

CVVH and other renal replacement therapy

Learning Opportunities

FRH

ICC

U

NG

H IC

U

NG

H H

DU

RV

I IC

CU

FRH

Car

dio

tho

raci

c IC

U (

WD

26

)

Sist

er/

Ch

arge

Nu

rse

Staf

f n

urs

e

Spe

cial

ty M

ana

ger/

Mat

ron

Pra

ctit

ion

er

lect

ure

r

Ou

tre

ach

Te

am

Me

dic

al s

taff

CC

A

HC

A

Mic

rob

iolo

gist

Infe

ctio

n c

on

tro

l te

am

Ph

arm

acis

t

ph

ysio

the

rap

ist

Spe

cial

ist

Nu

rse

Pra

ctit

ion

er

Tran

spla

nt

coo

rdin

ato

r

Occ

up

atio

nal

Th

era

pis

t

Tiss

ue

Via

bili

ty N

urs

e

Die

tici

an

Nu

trit

ion

al N

urs

e S

pe

cial

ist

M&

H N

urs

e

Tran

sfu

sio

n N

urs

e

Spe

ech

th

era

pis

t

Clin

ica

l go

vern

ance

an

d r

isk

Gu

ide

line

s an

d p

olic

ies

Blood Disorders

Blood transfusions

Blood products

Coagualopathy and DIC

Anatomy and physiology of blood

Blood Disorders

Lymphoma

DVT's/PE

Endocrine and Metabolic Disease:

Anatomy and physiology

Blood glucose analysis

Diabetes Mellitus: Type 1 and 2

Long term use of steroids

Administration of high dose steroids

Thyroid conditions

Tight glucose control

Bones:

Osteoporosis-treatment and drugs

Trauma

Arthritis

Gastro-Intestinal:

Anatomy and physiology

Nutrition; oral, enteral and parenteral

Bowel management

Pancreatitis

Oesophagectomy

Gastrectomy

Nervous System:

Seizures

Guillain Barre & associated conditions

Intracranial pressure (ICP)

Cerebral perfusion pressure (CCP)

Papillary reactions

Primary and secondary head injury

Psycho-social issues

Glasgow Coma scale

Burns

Swallow Assessment

Dying and Bereavement

Learning Opportunities FRH

ICC

U

NG

H IC

U

NG

H H

DU

RV

I IC

CU

FRH

Car

dio

tho

raci

c IC

U (

WD

26

)

Sist

er/

Ch

arge

Nu

rse

Staf

f n

urs

e

Spe

cial

ty M

ana

ger/

Mat

ron

Pra

ctit

ion

er

lect

ure

r

Ou

tre

ach

Te

am

Me

dic

al s

taff

CC

A

HC

A

Infe

ctio

n c

on

tro

l te

am

Ph

arm

acis

t

ph

ysio

the

rap

ist

Spe

cial

ist

Nu

rse

Pra

ctit

ion

er

Tran

spla

nt

coo

rdin

ato

r

Self

har

m t

eam

Die

tici

an

Nu

trit

ion

al N

urs

e S

pe

cial

ist

Ch

apla

incy

te

am

Tran

sfu

sio

n N

urs

e

Pal

liati

ve c

are

te

am

Spe

ech

th

era

pis

t

Gu

ide

line

s an

d p

olic

ies

Healthy life style strategies in relation to:

Smoking cessation

Drug and alcohol dependence

Counselling

Diet

Cancer

Obesity/All weight loss

Diabetes

Food intolerance

Eating for a healthy heart

Promotion of exercise

Health education and health promotion literature

Models of health promotion and education

Interface between hospital and community care

Spiritual support

Learning Opportunities FRH

ICC

U

NG

H IC

U

NG

H H

DU

RV

I IC

CU

FRH

Car

dio

tho

raci

c IC

U (

WD

26

)

Sist

er/

Ch

arge

Nu

rse

Staf

f n

urs

e

Spe

cial

ty M

ana

ger/

Mat

ron

Pra

ctit

ion

er

lect

ure

r

Ou

tre

ach

Te

am

Me

dic

al s

taff

CC

A

HC

A

Mic

rob

iolo

gist

Infe

ctio

n c

on

tro

l te

am

Ph

arm

acis

t

ph

ysio

the

rap

ist

Spe

cial

ist

Nu

rse

Pra

ctit

ion

er

Tran

spla

nt

coo

rdin

ato

r

Tiss

ue

Via

bili

ty N

urs

e

Die

tici

an

Nu

trit

ion

al N

urs

e S

pe

cial

ist

M&

H N

urs

e

Tran

sfu

sio

n N

urs

e

Clin

ica

l go

vern

ance

an

d r

isk

Gu

ide

line

s an

d p

olic

ies

Spe

ech

th

era

pis

t

Gu

ide

line

s an

d p

olic

ies

Nursing theories which underpin the management of care:

Use of nursing model

Philosophy of care

Documentation

Nursing process Assessment:

Who assesses

How is assessment carried out. Open or closed questions

What is assessed

Where does it take place

Planning:

Care plans

Risk assessment tools

Care pathways

Multi disciplinary planning

Discharge planning

Implementation/Evaluation:

Ward rounds

Multi-disciplinary team

Protocols, policies, guidelines, care bundles, goal directed

Communication with patients and relatives or carer's

Time management & planning priorities

Dying and Bereavement

Patient property and valuables

Self discharge

Religious needs/arranging priest/communion.

Referrals to other agencies:

Specialist centres i.e. neuro, Hepato-renal, cardiac, burns

Occupational therapy

Social Worker

District Nurse

Specialist Nurses

Discharge Liaison

Macmillan Nurse

St Oswald's Hospice

Palliative care team

Outreach Team

Learning Opportunities FRH

ICC

U

NG

H IC

U

NG

H H

DU

RV

I IC

CU

FRH

Car

dio

tho

raci

c IC

U (

WD

26

)

Sist

er/

Ch

arge

Nu

rse

Staf

f n

urs

e

Spe

cial

ty M

ana

ger/

Mat

ron

Pra

ctit

ion

er

lect

ure

r

Ou

tre

ach

Te

am

Me

dic

al s

taff

CC

A

HC

A

Mic

rob

iolo

gist

Infe

ctio

n c

on

tro

l te

am

Ph

arm

acis

t

ph

ysio

the

rap

ist

Spe

cial

ist

Nu

rse

Pra

ctit

ion

er

Tran

spla

nt

coo

rdin

ato

r

Tiss

ue

Via

bili

ty N

urs

e

Die

tici

an

Nu

trit

ion

al N

urs

e S

pe

cial

ist

M&

H N

urs

e

Tran

sfu

sio

n N

urs

e

Clin

ica

l go

vern

ance

an

d r

isk

Gu

ide

line

s an

d p

olic

ies

Managing a team:

Organisational, delegation, prioritising skills

Leadership

Off duty

Managing patient work load

Quality and standards of care **

Implementing change

Giving information to:

Nursing staff

Doctors

Multi-disciplinary team members

Other departments

Patients and relatives:

Breaking bad news

Dying and bereavement

Interpreters

Resources:

Stock control: non-stock and stock

Drugs

Establishment/skill mix

Budget control

Managing risk:

Documentation of critical incidents

NHSLA Standards (medical devices)

Establishment and skill mix

Quality control

Infection control

Moving and Handling

Emergency situations:

Cardiac arrest 2222

Fast call system 2222

Violent incidents 2222

Fire 333

DECT phone

Switchboard

Staff development:

Clinical supervision

Reflective practise

Preceptorship

Mentorship

Learning Opportunities

Sist

er/

Ch

arge

Nu

rse

Staf

f n

urs

e

Spe

cial

ty M

ana

ger/

Mat

ron

Pra

ctit

ion

er

lect

ure

r

Ou

tre

ach

Nu

rse

me

dic

al s

taff

CC

A

ph

arm

acis

t

Tran

spla

nt

coo

rdin

ato

r

Tiss

ue

Via

bili

ty N

urs

e

Spe

ech

th

era

pis

t

Hepato-renal system/Biliary System:

Anatomy and physiology

Primary Biliary cirrhosis

Primary Sclerosing (No Suggestions)

Fulminant liver failure, encephalopathy

Paracetamol overdose

Alcoholic liver disease

Acute and or, Chronic liver disease

Trans-intrahepatic Porto systemic shunts (TIPP'S)

ERCP

Oesophageal variceal haemorrhage

Sengstaken tubes

Liver tumours

Pancreatic tumours

Pancreatitis

Hepatic encephalopathy

Surgical procedures:

Hepato-renal;

Hepatectomy

Pancreatic Necrosectomy

Biliary reconstructive surgery

Whipples procedure

Hepato trauma

Liver/renal/pancreas transplantation

Wound Vac

Gastro-Intestinal:

Pancreatitis

Oesophagectomy

Gastrectomy

Vascular

Aneurysm repairs

Carotid endatarectomy

Clinical skills

recording, understanding and interpretation of;

Glasgow Comma scale

Papillary reactions

Intracranial pressure (ICP)

Cerebral perfusion pressure (CCP)

Foot pulses

signs of haemorrhage

Management of;

Raised ICP

The compromised airway in an encephalopathic patient

Sengstaken-Blakemore tubes