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Orientationandfamiliarisationclinicalp

racticedevelopmentprogramme















General

Surgery and

Vascular

Specialty

(Ward 29)

STUDENT NURSE ORIENTATION

MidCentral District

10/9/2016

Developed by: MDHB Nurse Educators

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Compassionate Courageous Respectful Accountable

CONTENTS

GENERAL SURGERY AND VASCULAR SPECIALTY ...............................................................................4

EXPECTATIONS OF THE STUDENT NURSE .........................................................................................5

ORIENTATION TO CLINICAL AREA .....................................................................................................8

ORIENTATION TO KEY PEOPLE AND ROLES ......................................................................................9

EMERGENCY RESPONSE ...................................................................................................................9

WARD ROUTINE ............................................................................................................................. 10

COMMON PRESENTATIONS........................................................................................................... 14

COMMON MEDICATIONS .............................................................................................................. 15

DOCUMENT MANAGEMENT SYSTEM CONTROLLED DOCUMENTS ............................................... 16

ESSENTIAL SKILLS: SUGGESTIONS .................................................................................................. 16

SCENARIO # 1: ISBAR Template ..................................................................................................... 17

EVALUATION OF YOUR PRECEPTOR .............................................................................................. 19

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Ki mai ki ahau, he aha te mea nui o tenei ao

Maaku e ki atu

He tangata, he tangata, he tangata

If you ask me what is the most important thing in the world,

My reply is this,

It is people, it is people, it is people

DOCUMENT CONTROL

Version Issue & Circulation Date Brief Summary of Change

1. 28th November 2016

2.

3.

Authors Lisa Clince; Yvonne Stillwell;

Location MDHB: student

Contact Lisa Clince

Approved November 2016

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GENERAL SURGERY AND VASCULAR SPECIALTY

Welcome to the General Surgery and Vascular specialty, ward 29. We trust you will enjoy your

experience here, applying your theory to practice and further developing your clinical skills. We

hope that you will develop great working relationships with the patients, family/whānau and the

interdisciplinary team to both yours and the organisation’s benefit.

The General Surgery and Vascular specialty ward provides secondary surgical and vascular

services to a population of approximately 158,000 people living in the Manawatu, Horowhenua

and Tararua region. The 27-beded ward provides acute and elective surgical services to

patients. This includes:

SURGERY (ACUTE AND ELECTIVE)

General Surgery

Breast Surgery

Abdominal Surgery

Bowel Surgery

TRAUMA

Head Trauma

Chest Trauma

Abdominal Trauma

CANCER

Bowel Cancer

Breast Cancer

Gastric Cancer

Other conditions

Abdominal Pain

Disorders of the Bowel, Gallbladder and Pancreas

Rectal or Vaginal bleeding

Infection or Abscess

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Key contacts:

Ward 29 Reception 350 9159 ext 7290

Clinical Nurse Educator

Lisa Clince (Mon-Fri ) 06 350 9159 ext7298 Page 218

[email protected]

Charge Nurse Dorothy Chimwayange 06 350 9159 ext 7295 Page 514

Associate Charge Nurses Donna Williams

Kaye Allardice-Green

Margaret Singh

350 9159 ext 7290 Page 514

Please contact the Charge Nurse or Clinical Lecturer to confirm your starts dates and times. If

you are unable to attend your placement, please ring the ward and advise the ward shift leader

and your clinical lecturer.

PRECEPTOR

You will be allocated one main preceptor who will be responsible for helping you to identify and

meet your objectives. We will endeavor to ensure that you work mainly with this preceptor.

However due to shift work this is not always possible. It is your responsibility to ensure the

nurse you are working with is aware of your objectives for the day/week. You must provide

evaluations and/or other paperwork to your preceptor in a timely fashion (i.e. not on the due

date). Your preceptor will not complete any evaluations if you give it to them on your last days

in the unit. Usually there are 5-6 nurses on every shift. Depending on the acuity of the patients,

you and your preceptor will be allocated 4-6 patients to look after. If you have any concerns or

questions do not hesitate to contact the Clinical Lecturer.

EXPECTATIONS OF THE STUDENT NURSE

The shifts are: AM shift: 0700-1530 PM shift: 1430-2300 Night shift: 2245-0715

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On the first day please complete the Student contact details form (page 20) and give it to

the Charge Nurse or nurse in charge of the shift.

It is expected that you arrive on time and if you are going to be late or unwell and cannot

come in please ring the ward on 350 9159 ext 7290 and ask to speak to the Charge

Nurse/nurse in charge of the shift.

We endeavor to give you a fair roster with continuity of preceptor(s) wherever able. If you

are unable to work the shifts that you have been rostered, you need to discuss this with the

Charge Nurse or Clinical Lecturer.

You must complete the full shift that you are allocated to work. If you are unable to do so,

please discuss this with your preceptor and inform your Clinical Lecturer.

The preceptor you are working with should be aware of your learning objectives. Please

discuss these at the start of your shift.

Your preceptor will work with you to help you learn about assessment and management of a

variety of conditions relevant to the setting.

If you are not achieving your objectives, please see you Clinical Lecturer.

A working knowledge of drug calculations is essential.

It is essential that you review your knowledge of normal temperature, pulse, respiration

rate, blood pressure and blood glucose levels.

Third year nursing students that are commencing their final placement need to identify early

in their placement which preceptor will be completing their documentation requirements

and ensure their preceptor has an adequate timeframe to complete this.

Please ensure that your uniform meets your institution standards and that your uniform is

clean, jewelry removed and hair tied back.

Please complete the Preceptor Evaluation Form (Page 19) and give this to the Charge Nurse.

DOCUMENTATION

Nurses are responsible for recording assessment data and the care their patients have

received throughout the shift. Student nurses may wish to consult with their preceptor for

guidance in documenting patient care. All entries must be written clearly, signed, dated, a

time of writing given and designation (student nurse) given.

Preceptors must countersign all entries in patient records

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Focus Charting is a systematic approach to documentation. It is intended to make the client

and client concerns the focus of care

Focus: Identifies the content or purpose of the narrative entry and is separated from the

body of the notes in order to promote east data retrieval and communication

Assessment: Is the subjective and/or objective information supporting the stated focus or

describing the observations at the time of a significant event

Intervention: Describes the interventions past, present or future of the health care team

member

Evaluation: Describes the patient outcome/response to interventions or describes how the

care plan goals have been attained.

OBJECTIVES

Before you start on the ward please consider what you want to achieve on this placement.

Bring to the ward a list of objectives, remembering that these need to be realistic. Please

share with your preceptor/s at the beginning of your placement the documentation that

must be completed while on that placement. Use your initiative to make the most of your

placement.

Ask lots of questions, ask to do and see things, e.g. dressings, drain removal, priming of IV

lines, watch any procedure that may be happening in the ward that you have not see, even

if it’s not your patient.

In your second or third week you may take care of one or more patients with supervision.

You will be expected to plan and carry out all cares for your patient with the support and

supervision of your preceptor. Any care that you are not able to do, you must negotiate with

your preceptor a time for him/ her to carry them out. All cares will be demonstrated to you

before you are expected to carry them out. If you do not feel safe with your patient

allocation, please say so.

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Objectives may include but are not limited to:

Gain an understanding of the multidisciplinary team

Practice good infection control measures

Patient assessment-including risk assessments

Pain management

Fluid management/Fluid balance

Wound management

Management of stomas

Vital signs – accurate recording and interpretation

Admission and discharge processes

IV therapy – including calculating drop factors

Indwelling catheter insertion and management

Nutritional management and recording

Removal of IVC’s / IDC’s / Drains

Documentation and handover

ORIENTATION TO CLINICAL AREA

It is important that you have an awareness of the environment in which you will be working to

ensure the safety of both yourself and that of the client and other staff members. You are

required to complete a clinical area orientation checklist. This is provided by your academic

institute -once completed give this to your Clinical Lecturer.

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ORIENTATION TO KEY PEOPLE AND ROLES

WHO/WHAT (√) when completed

(x) Not applicable

Chaplins

Charge Nurse(s) and Associate Charge Nurse(s) Clinical Nurse Specialists Exec Director of Nursing and Midwifery Duty Nurse Managers Multi - disciplinary Team Members Nurse Directors Nurse Educators Occupational Health Preceptors

EMERGENCY RESPONSE

The emergency number for Fire, Cardiac Arrest and Security is 777. In an emergency

situation, please follow the direction of the nursing and medical staff. Locate the following: WHAT (√) when completed (x) if not applicable

Duress Button Procedure

Emergency Bells

Emergency Equipment

Emergency Phone Number

Emergency Response Flip Chart

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Fire Extinguishers

Fire Hoses

Portable Oxygen

Red Phone (fire emergencies)

Suction

WARD ROUTINE

TIME ACTION

0700

For AM Shift Handover from night staff to AM staff in the handover room,

followed by bedside handover. Ensure patient beside board is up to date.

0715

Introduce self to patients/staff. Ensure all risk assessment are completed and prevention

measures are in place. Check oxygen, suction and equipment in working order. Make your plan of care for the shift. Attend doctors ward rounds. Ensure medical staff discuss the

plan of care for the patient with you. Prepare medications to administer at appropriate times. Check your drug infusions and fluid balance charts. Take blood sugar levels on patients with diabetes prior to

breakfast.

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0800-0900

Do a complete assessment for skin integrity, dressing changes needed and hygiene needs e.g. shower, bed bath and hair wash.

Document Ensure patients required to be nil by mouth for diagnostic tests

are aware and signs are attached to the bed to inform others. Take vital signs as noted in Care Plan.

0900-1030

Consultant ward round begins: Ensure you are with your patient(s) when the team arrives. Morning tea –at the beginning of the shift liaise with your buddy

nurse to organise tea and meal breaks. Attend to patient’s hygiene needs. Delegate to HCA’s as

appropriate. Liaise with Allied Health professionals at the MDT meeting and

complete necessary referrals. Update documentation. Complete TrendCare categorisations & predictions by 0930hrs.

1100-1330

Ensure Trend Care is up to date. Dressings – CVL, wound dressings. Check IV lines. Pressure area care – turn/reposition patient and document. Half-hour lunch break should occur at this time. Handover your

patient to your preceptor before leaving the unit.

1400-1530

Check results of any routine blood tests. Bedside handover to afternoon staff following handover in

handover room. Negotiate with your preceptor to attend clinical teaching

sessions/tutorials. Total fluid balance charts for the shift. Empty drainage bags. Check linen and rubbish bags. General clean and restock of own work area – report low stocks.

TIME ACTION

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1445-1700

For PM shift Bedside handover to afternoon staff following handover in

handover room. Introduce self to patients. Check infusions. Ensure all risk assessment are completed and

prevention measures are in place. Check oxygen, suction and equipment all in working order at the

head of each bed. Initial patient head to toe assessment and documented in notes. Make your plan of care for the shift. Ensure patient beside board is up to date.

1700-1900

Half-hour dinner break –at the beginning of the shift liaise with your buddy nurse to organise tea and meal breaks.

Vital signs/fluids/ monitoring as per care plan. Document any changes in the plan in the notes. Ensure Trend Care is up to date.

1930-2100 Settle patients for the night. Do a complete assessment for skin

integrity, dressing changes as needed. Vital signs/fluids/monitoring as per care plan.

2100-2300

Dim lights on ward Check results of any routine blood tests. Vital signs/fluids checks as required. Update clinical record.

2245-2315

Empty Rubbish bags Catheter bags Linen Skip General clean and restock of own work area – report any low

stocks. Handover to night staff followed by beside handover.

Time Action

2245-2400

For Night Shift Introduce self to all patients. Ensure all risk assessments are completed and prevention

measures are in place. Check oxygen, suction and equipment. Make your plan of care for the shift. Check infusions. Total previous 24 hour fluid balance.

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2400-0300

4 hourly vital signs/fluid checks. Ensure Trend Care is up to date We encourage periods of rest and sleep for patients during the night where this is possible. If your patient is stable, please allow them to rest. Turn the lights as low as possible and minimise external sources of noise.

0400-0600

Review medications for all patients – fax morning requirements to pharmacy.

Full range of routine blood tests sent to lab now – if requested. Toilet all high risk of falls patients. Empty catheter bags. Check linen skip and rubbish has been emptied. Discard any reconstituted drugs at the end of your shift. General clean and restock of own work area – report low stocks.

0700 Welcome morning staff Handover

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COMMON PRESENTATIONS

Below is a list of common presentations that it would be useful to have read up on before you

come for your placement with us. Patients are admitted to the service for a variety of conditions

and surgical interventions, Patients may be admitted to the service from:

Emergency Dept, theatre, ICU step down, transfer from another ward, or from another hospital.

Below is a list of common procedures / surgeries performed. Please complete the list when you

know what the meaning is:

Ivor Lewis Procedure______________________________________________________

Hartman’s procedure______________________________________________________

Colostomy_______________________________________________________________

AnteriorRepair____________________________________________________________

Hysterectomy_____________________________________________________________

Pancreatitis_______________________________________________________________

Laparotomy_______________________________________________________________

Laparoscopy______________________________________________________________

Cholecystitis______________________________________________________________

Cholecystectomy___________________________________________________________

Colectomy________________________________________________________________

Cystectomy______________________________________________________________

ERCP____________________________________________________________________

Mastectomy______________________________________________________________

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COMMON MEDICATIONS

Administration of IV therapy is in accordance with the IV & Related Therapies Policy available on

the intranet. According to the Basic Certification Standard please note “Students (nursing,

midwifery, radiologic technology, anaesthetic technology), and their respective clinical

lecturers/clinical teaching associates are expected to adhere to the standards and principles of

this document”. The main groups of drugs used in this clinical setting are:

Analgesics

Antiemetics

Antibiotics

Antihypertensives

This placement is a good opportunity for you to familiarise yourself with the mode of action,

administration, risks and nursing considerations related to a number of medications within

these drug groups.

Oral medications

You may check and give oral medications under the direct supervision of a registered nurse (RN)

if (s)he is confident for you to do so, remembering the 5 rights:

Right patient / drug / route / dose / time

Subcutaneous (SC) and Intramuscular (IM) medications

A student nurse may administer SC and IM injections under the direct supervision of a RN.

Intravenous medications

2nd year students - IV infusions may be prepared under the supervision of a RN. The 2nd year

student nurse may not administer IV infusions.

3rd year students – IV infusions may be prepared and administered under the direct supervision

of a RN after completion of the student workbook (please see the clinical lecturer for the same).

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Controlled Drugs

Controlled drugs are kept in the locked controlled drugs cupboard, inside the general drugs

cupboard at all times. Student nurses are not permitted to double check or sign for controlled

drugs.

DOCUMENT MANAGEMENT SYSTEM CONTROLLED DOCUMENTS

Once on placement you will need to access relevant policies, procedures and guidelines. Ask

your preceptor to help you find the Document Management System on the intranet. (Note: you

cannot access this outside of the organisation.)

ESSENTIAL SKILLS: SUGGESTIONS Essential Skills How to access

ABC smoking brief advice Access on-line module: https://learnonline.health.nz/login/index.php

1. Hand Hygiene

Access www.handhygiene.org.nz

Code of Conduct Access via NCNZ website: http://www.nursingcouncil.org.nz/Nurses/Code-of-Conduct

Direction and Delegation Access via NCNZ website: http://www.nursingcouncil.org.nz/Publications/Standards-and-guidelines-for-nurses

Clinitek Urinalysis Clinitek Resource Folder: Skills Assessment Tool in clinical area

Novo Statstrip MDHB-4859 (Appendix 1 page 4) Skills Assessment Tool on Document Management System

O’Shea No-lift Core Skills and Refer to MDHB-2655 on Document Management System

https://learnonline.health.nz/login/index.php

http://www.handhygiene.org.nz/

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SCENARIO # 1: ISBAR Template

ISBAR is a standard mnemonic to improve clinical communication. It is used by MDHB staff to

ensure they communicate clearly, comprehensively, and concisely.

Identify Who you are and what is your role? Who the patient is

Situation What is going on with the patient?

Background What is the clinical background/context?

Assessment What do I think the problem is?

Recommendation What would you recommend?

I IDENTIFY Patient’s NHI, Name and DOB Name and title/role of staff handing over

S SITUATION

I am calling about <patient name and location>. The problem I’m calling about is__________________.

I am afraid the patient is going to arrest. I have just assessed the patient personally: Vital signs are: Blood pressure ____/____, Pulse ____, Respiration ____ and Temperature ___ I am concerned about the:

Blood pressure because it is over 200 or less than 100 or 30 mmHg below usual. Pulse because it is over 140 or less than 50. Respiration because it is less than 5 or over 40. Temperature because it is less than 96 or over 104.

B BACKGROUND The patient’s mental status is:

Alert and oriented to person, place, and time Confused and cooperative or non-cooperative Agitated or combative Lethargic but conversant and able to swallow Stuporous and not talking clearly and possibly not able to swallow Comatose. Eyes closed. Not responding to stimulation.

The skin is: Warm and dry/pale/mottled/extremities cold/ extremities warm

The patient is not or is on oxygen. The patient has been on ____ (l/min) or (%) oxygen for ____ minutes (hours) The oximeter is reading ____ % The oximeter does not detect a good pulse and is giving erratic readings.

A ASSESSMENT This is what I think the problem is: <say what you think is the problem> The problem seems to be

cardiac infection neurologic respiratory _____ I am not sure what the problem is but the patient is deteriorating.

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The patient seems to be unstable and may get worse; we need to do something. R RECOMMENDATION

I suggest or request that you <say what you would like to see done> Transfer the patient to critical care. Come to see the patient at this time. Talk to the patient or family about resus status. Ask the on-call family practice resident to see the patient now. Ask for a consultant to see the patient now.

Are any tests needed: Do you need any tests like CXR, ABG, EKG, CBC, or BMP? Others?

If a change in treatment is ordered then ask: How often do you want vital signs? How long do you expect this problem will last? If the patient does not get better, when would you want us to call again?

CHECKLIST: WHEN CALLING MEDICAL STAFF : 1. Have I seen and assessed this patient myself before I call? 2. Have I reviewed the patient’s active orders? 3. Do I have at hand:

The chart

List of current meds, IV fluids, labs, and most recent vital signs

If reporting lab work, date and time this test was done and results of previous tests for comparison

Resus status 4. Have I read the most recent medical staff progress notes and notes from the previous shift? 5. Is there a need to discuss this call with my Charge Nurse/Duty Nurse Manager? 6. When ready to call, remember to identify:

Self, unit, patient, room #

The admitting diagnosis and date of admission

Briefly, the problem, what it is, when it happened or started, and how severe it is 7. What I expect to happen as a result of this call 8. Document whom you spoke to, time of call, and summary of conversation

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EVALUATION OF YOUR PRECEPTOR

Please return your evaluation to your Charge Nurse

Name of Preceptor_____________________________________ Date__________

Please read the following statements then tick the box that best indicates your experience

My Preceptor: E VG S NI

Was welcoming and expecting me on the first day

Was a good role model and demonstrated safe and competent clinical practice

Was approachable and supportive

Acknowledged my previous life skills and knowledge

Provided me with feedback in relation to my clinical development

Provided me with formal and informal learning opportunities

Applied adult teaching principals when teaching in the clinical environment

Describe what your preceptor did well

Describe anything you would like done differently

Signed:____________________________ Name:__________________________

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E = Excellent VG = Very Good S = Satisfactory NI = Needs Improvement

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CONTACT DETAILS

The staff on the ward care about your well-being as well as your education. They will notice and

be concerned if you don’t arrive for a planned shift, if there is illness on the ward or in the case

of an emergency. They may need to contact you to check you are okay and to let you know if

there needs to be a change to your shifts.

Please could you provide the ward with your contact details and an emergency contact using the

form below?

Your Name

Your Home Phone

number

Your mobile phone

number

Name of emergency

contact

Phone number of

emergency contact

From time to time the staff on the ward may need to contact your lecturer regarding your

progress, for support or in the case of problems.

Please could you supply the contact details of the Lecturer/CTA that will be supporting you

during this placement, in the form below?

Name of Lecturer/CTA

Phone number of

Lecturer/CTA

This information will be kept by a senior staff member for the length of this placement and then

will be destroyed. It will not be shared with anyone else without your permission unless there is

an emergency.

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