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
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lect
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Ph
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Spe
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Nu
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Pra
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ion
er
Tran
spla
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coo
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ato
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Occ
up
atio
nal
Th
era
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Tiss
ue
Via
bili
ty N
urs
e
Die
tici
an
Nu
trit
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pe
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ist
M&
H N
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e
Tran
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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
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taff
CC
A
HC
A
Mic
rob
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gist
Infe
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on
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am
Ph
arm
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ph
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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
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gist
Infe
ctio
n c
on
tro
l te
am
Ph
arm
acis
t
ph
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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
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gist
Infe
ctio
n c
on
tro
l te
am
Ph
arm
acis
t
ph
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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
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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
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