ARBROATH INFIRMARY
MINOR INJURIES / ILLNESS UNIT AND OUT OF HOURS SERVICE
PLACEMENT/ORIENTATION PACK
FOR STUDENT NURSES IN THE DEPARTMENT
My docs/Newstaff/welcome pack student STUDENT NURSE
Name: ...... ………………….
Date Commenced ...... Date Finished ......
Mentor Associate Mentor
Name: ...... Name: ......
Designation: ...... Designation: ...... …… PHILOSOPHY IN THE MIIU SETTING OF VALUES IN RELATION TO THE EDUCATION OF STUDENTS
We encourage students to ask questions and will always try to answer them. However, we will expect the students to assist with their own learning by developing a questioning approach. We look forward to sharing their views and suggestions about how we can improve the learning experience for our students.
We will treat students as individuals acknowledging their needs and encouraging their participation in patient care, promoting reflective and evidence based practice.
We will encourage students to feel part of the MIIU team by involving them in assisting and directing care with the professionals providing the patient care.
We will recognise and value the contribution of all students in the process of planning and carrying out patient care and assist them to achieve/maintain knowledge and skills
CONTENTS 1. Introduction to Arbroath and Arbroath Infirmary
2. Practical Information
2.1 Starting work
2.2 Entrance to and layout of the building
2.3 Introduction to staff
2.4 Security
2.5 Staff amenities
2.6 “Good housekeeping”
2.7 Fire and electrical safety
2.8 Smoking at work police
3. Procedural Information
3.1 Communications
3.2 Who’s Who
3.3 What to do if...
3.4 Trust policies and procedures
3.5 Shifts worked in the M.I.U
3.6 Suggested reading prior to commencement in the M.I.U
3.7 Departmental aims and objectives
3.8 Learning opportunities/skill development within the department
3.9 Student centred learning
3.10 Types of patients attending the department
SECTION 1: INTRODUCTION TO ARBROATH AND ARBROATH INFIRMARY The Royal and Ancient Burgh of Arbroath has an important place in Scottish history, perhaps most notably for its now ruined abbey. The Declaration of Arbroath, which appealed to the Pope for recognition of Scotland as an independent nation was drawn up in 1320, and the Scottish Declaration of Independence was signed within the abbey by Robert the Bruce.
Nowadays Arbroath thrives as one of the main population centres within the county of Angus, and its history, leisure facilities and coastal location make it a popular destination for holiday makers. The town is easily accessible, being on the main Aberdeen to London rail and bus routes, with a station for both facilities. Regular bus services also connect outlying housing areas to the town centre. The current population is almost 25, 000.
Arbroath Infirmary (an integral part of Tayside Primary Care Trust) enjoys a coastal location within the town, and it was established around 1945 as a community hospital. Approximately 150 staff work at the Infirmary, and its 58 beds comprise:
22 General Medicine beds with one respite suite
26 Old Age Psychiatry beds
6 Obstetric beds
1 Minor Injuries Unit/Primary Care Emergency Centre
1 Outpatients Department
1 X-Ray Department
1 Physiotherapy Department
1 Renal Unit
SECTION 2: PRACTICAL INFORMATION 2.1 Starting work
When you come to work on your first day, please bring the following with you:
Proof of I.D, e.g. college name badge Student Nurse welcome pack, as this will identify who to report to
2.2 Entrance to and layout of the building
Arbroath Infirmary can be accessed from both Rosemount Road and Roseberry Place, although the main entrance and car-park are at the Rosemount Road end. The main building is open 24 hours a day.
Appendix A gives a detailed map of the site’s layout.
2.3 Introduction to the department
On your first day in the department you should report to the senior nurse on duty, who will then introduce you to your mentor and of course the rest of the staff.
You will also receive a guided tour of the department as well as the hospital.
2.4 Security arrangements
You will be given the key to your own locker, which you can use for the safekeeping of your personal possessions.
2.5 Staff amenities
To begin with your supervisor / mentor will take you to lunch, and you can take half an hour for your lunch or tea. Meals, snacks and drinks can be bought at the staff dining room.
There are staff toilets throughout the building, although you may need a key to access some of them. Sanitary protection is to be found in the Minor Injuries Unit and there is a condom dispenser in the public toilets.
2.6 “Good housekeeping”
It is the responsibility of each member of staff to be economical in their use of resources, such as stationery. Please also remember to conserve heat and energy where possible, by switching off lights if they are not in use and shutting doors to keep the heat in.
2.7 Fire and Electrical Safety.
The reduction and prevention of accidents can only be achieved with the involvement and commitment of all employees. It is the responsibility of all employees as well as the Trust to ensure that a healthy and safe working environment is created and maintained. This section does not intend to cover all aspects of safety, but rather to draw attention to some of the more general aspects of safety.
Fire Safety Training
A programme of Fire Safety Training is in operation, which all employees must attend as required by their manager. This is intended to provide all staff with basic awareness of hazards associated with fire, and how to react in the event of a fire incident. As this programme is for your safety and that of others, it is compulsory for you to attend when required.
General Fire Safety Precautions
Familiarise yourself and keep up to date with the fire precaution arrangements in your work area. Familiarise yourself with the location of fire exits and extinguishers around the building, including the assembly point for all staff, which is..... Observe No Smoking signs. If you smoke, please only do so in the designated areas. Keep fire exits, points and corridors clear. Switch off and remove plugs from sockets on any electrical appliances which are not considered necessary. Do not leave combustible articles, flammable liquids or aerosols near any source of heat. Dispose of waste correctly.
Fire Drill and Alarm.
The fire alarms are tested on a regular basis and fire drills will be carried out without prior notification.
If you discover a fire, the following procedure should be carried out:
Keep calm. The nearest break-glass point should be broken to raise the alarm. Summon the Fire Brigade. (usually done by the duty receptionist). Close all doors and windows. Switch off all electrical appliances. Evacuate the building and report to the assembly point. Do not stop to collect personal possessions. DO NOT attempt to attack the fire
Precautions for Electrical Equipment.
Always check that switches are “OFF” before connecting or disconnecting any appliance. Do not handle electrical equipment with wet hands. Do not over-stretch leads. Do not remove plugs by pulling the lead. Report frayed or damaged cables. Never tamper with electrical equipment. Report any faults immediately. All repairs must only be carried out by suitably qualified personnel. If a person suffers from an electric shock, turn off the electricity supply and seek urgent medical assistance.
2.8 Smoking policy Smoking is not permitted in any NHS building
SECTION 3: PROCEDURAL INFORMATION
3.1 Communications The value of effective communication cannot be underestimated in creating and maintaining job satisfaction and the quality of care we provide to users of the service. In order to make communications effective within the Infirmary and throughout the Trust, the following methods are in place and will be clarified to you during the induction period.
1. “Face to Face” communication
Staff meetings Local Consultative Groups
2. Written communication
Communication book Minutes of the staff meetings Circulation file Notice boards Patient records Trust Newsletter detailing minutes of Board meetings
Good communication must, however, be a two-way process, so if you think something could be improved, or if you have good news, let us know! If you have other ideas for communication which you think could be used, we would be glad to hear of them. Please be assured that all feedback from staff is valued, and it does make a difference.
Confidentiality is of the utmost importance in the department. We endeavour to uphold and respect patient information.
3.2 Who’s Who The following is a list of people in the department whom you may need to contact, or who may contact you. The list is not exhaustive, so you might find it helpful to add other names, or make your own list to refer to.
NAME POSITION ROOM PHONE EXT
Sister W Meldrum Senior Charge Nurse MIIU 21229 Sister I Wilson Charge Nurse MIIU 21229
S/N R Munro Senior Staff Nurse MIIU 21229 S/N A Phillips Senior Staff Nurse MIIU 21229 S/N A Cairns Senior Staff Nurse MIIU 21229 S/N C Farquhar Senior Staff Nurse MIIU 21229 S/N M Millar Senior Staff Nurse MIIU 21229 S/N J Hogg Staff Nurse MIIU 21229 S/N F Bell Staff Nurse MIIU 21229 S/N J McGregor Staff Nurse MIIU 21229 S/N C Hayes Staff Nurse MIIU 21229 S/N C Murray Staff Nurse MIIU 21229 S/N K Robson Staff Nurse MIIU 21229
HCA C Mitchell Health Care Assistant MIIU 21229 HCA M Munro Health Care Assistant MIIU 21229 HCA J McDougall Health Care Assistant MIIU 21229 HCA M Jarret Health Care Assistant MIIU 21229 HCA S Creagh Health Care Assistant MIIU 21229 HCA C Whamond Health Care Assistant MIIU 21229 HCA A Henderson Health Care Assistant MIIU 21229
Dept Michelle Ross Ward Clerkess Office 21269 Dept Deirdre Moffat Ward Clerkess Office 21269
Who’s who in Arbroath Infirmary
NAME POSITION ROOM PHONE EXT Admin Hazel Forbes OOH/MIIU Service Manager Office 21238
Mrs Wendy Meldrum Senior Change Nurse, MIIU/OOH MIIU 21229 Admin Mrs L Ramsay Site Manager Office 21258 OPD Sister A Cuthill OPD Manager Office 21247 Wd 1 S.C.N. A Longmuir Ward I Manager-Old Age Psychiatry Office 21200 Med 21211 or Sister S Pudney Medical Floor Manager Office 21212 Maty Sister C Field Maternity Manager Office 21235
Ms A Murphy Physiotherapy Manager Office 21214 Mrs L Dickerson X-Ray Mrs E Aitken Senior Radiographer Dept 21224
Mrs E Tainsh Occupational Therapist Office 21210 Cash Caroline Ruxton Cashier Office 21242
USEFUL CONTACT NUMBERS Name / Location Telephone Mobile
Arbroath MIIU 01241 822529 N/A
Arbroath PCEC 01241 822569 N/A Hazel Forbes Service Manager, Arbroath 01241 822538 Wendy Meldrum Senior Charge Nurse, MIIU, Arbroath 01674 832170 Isobel Wilson, Charge Nurse, MIIU, Arbroath 01241 822569 0773 916 0581
Brechin MIIU 01356 666076 N/A Ann Black, (Home) Senior Staff Nurse, MIIU, Brechin 01356 666076 01356 625822 Alexis Grewar, Educational Facilitator, Base at Brechin N/A 0797 906 4017 Wendy Meldrum, N/A Senior Charge Nurse, MIIU, Montrose/Brechin 01674 832170
Forfar MIIU 01307 475255 N/A Peter Croll, Senior Charge Nurse, MIIU, Forfar 01307 475255 N/A
Montrose MIIU 01674 832170 N/A Elaine Simpson, Senior Staff Nurse, MIIU, Montrose 01674 832170 N/A Lorraine Blair Nurse Practitioner 0788 184 7863 Orthopaedic Support Service
3.3 What to do if...
You’re ill (a) at home
Should you be unable to come to work due to sickness, you must notify your Supervisor before 10 am on the first day of your absence. (Full details of the Absence From Work policy are supplied at Appendix B, but this will be explained during your induction period.)
(b) at work
Tell your supervisor how you feel, and action will be taken.
You’re upset
Again, tell your supervisor how you feel. It may be more appropriate for you to go home than to stay at work.
If you feel you can’t go to your supervisor for whatever reason, several other channels are open to you if you have a problem of any kind (personal or professional) - never feel that you have to suffer in silence. The following can be approached:
Personnel
Based at Trust Headquarters in Dundee Royal Liff Hospital the Personnel Department can be contacted at any time for help, and can provide a wide range of impartial, confidential advice and counselling. Personnel Advisers can come to you if you are unable to, or do not want to go to Liff Hospital.
Occupational Health Service
Like Personnel this service is available to all members of staff. Employees who feel they have suffered any form of unacceptable behaviour in the workplace, or are accused of such behaviour can refer themselves directly to OHS. Self-referrals are always treated in the strictest confidence, and no-one else will be informed of the referral
3.4 Trust policies and procedures
These are held in the department and can be easily accessed by all staff. Policies are written to indicate the Trust’s statement of intent regarding an issue or procedure, and to offer guidance to managers and staff on how to behave in relation to the Trust’s position on such matters.
Two important policies that you should be aware of are:
1. Harassment At Work Policy
The Trust will not tolerate sexual harassment at work, and when it occurs it will be dealt with where appropriate as a disciplinary matter. The full policy and procedure is available from the Personnel Department, and members of staff finding themselves in such a situation should use it.
2. Equal Opportunities Policy
It is the Trust’s policy to treat job applicants and employees in the same way regardless of their sex, race, ethnic origin, disability or any other discriminatory factors. The Trust monitors the composition of its workforce and will act if it appears that this policy is not fully effective. All employees are requested to co-operate with this policy and ensure that it is implemented in full. These documents are also available from the Personnel Department.
3.5 Shifts pattern in the MIU
The department works 3 basic shifts for full time staff. These are:
1. 07.45 to 15:15 2. 13.45 to 21.15
3. 21.00 to 08.00 Main Entrance
Out-Patient’s waiting hall
Colour Code:
MIU Room Sluice Emergency Room Waiting Area Middle Room Doctor Consulting Room/Sister’s Office Reception Window Domestics room OOH HUB Store Cupboard PROFILE OF THE DEPARTMENT
The department is based around 3 main areas:
1. The Casualty Room This is where the majority of the patients that present to the MIU will be seen. There is the capacity to treat a maximum of 3 patients at any one time depending on the injuries etc.
The eye chart along with the x-ray reader box are situated here, along with the wound packs, dressing trolleys etc.
2. The Emergency Room The few emergency cases that are brought into the department are treated in this room, therefore all the emergency equipment i.e. the defib, ECG machine, oxygen etc are all stored here. There is also sutures, surgical gloves, specimen bottles etc stored around this room.
3. Out of Hours This area comprises of 1 room. This room is where the phone system and the triage nurse is situated out of hours. This room also doubles up as the department office during the day.
The other rooms in the M.I.I.U are:
The sluice room As well as the sluice this room acts as a store room for clean laundry, towels, poly bags, paper towels and cleaning materials.
The middle room As the name suggests this room is situated between emergency room and the casualty room. The cupboards in this room are stocked with drugs, lotions, creams etc. The minor injuries library of books are also stored here. This room is also where the reception window and the attendance record book are situated.
The DSR room This room has the hoovers, brushes, mops etc for the domestics use.
The Store Room This room holds the stationery supplies along with the CSSD supplies and order books.
OOH Doctor Consulting Room/Sister’s Office This room is situated at the entrance to the department. It is used Out of Hours as the Doctor’s Consulting Room and during the day as Sister’s Office. 3.6 Suggested reading prior to commencement in the MIU Department algorithms and drug formulary Cardiac arrest procedures Fire procedure Health and safety policy Wound care policy Department nursing articles
1. Anatomy a. Soloman E, Schmidt R, Adragna P (1990) Human Anatomy and Physiology 2nd Edition, Harcourt Brace Jovanovich College Publishers, USA b. Watson R, (1998) Controlling body temperature in adults, Nursing Standard, 20 (12) Pg 49 - 53
2. Orthopaedics/Orthopaedic anatomy a. Soloman E, Schmidt R, Adragna P (1990) Human Anatomy and Physiology 2nd Edition, Harcourt Brace Jovanovich College Publishers, USA b. Hooper G, (1997) Orthopaedics, Churchill, Livingston, Edinburgh
3. Bone healing a. Soloman E, Schmidt R, Adragna P (1990), Human Anatomy and Physiology 2nd Edition, Harcourt, Brace Jovanovich College Publishers, USA. Pg 173 - 175 b. Brooker C, Human Structure and Function , Mosby, London Pg 422
4. Wounds/Wound Care a. Brooker C, Human Structure and Function, Mosby, London Pg 503 - 506 b University of Dundee (1993) The Wound Handbook, The Centre for Medical Education/Prespective, Singapore c. Benbow M, (1998) Methods of wound debridement, Nursing Times April 22 Volume 94, No 16, Pg 78 d. Courtney M, (1998) Choosing wound dressings, Nursing Times, March 4, Volume 94, No 9, Pg 46 - 48. e. Professional Nurse Study Supplement, (1997) Volume 12, No 12 f. Understanding Wound Cleansing, Nursing Times, 20 (11) pg 47 - 57 g. Cutting K, (1997) Wounds and evidence of infection, Nursing Standard 25 (11) Pg 49 - 52 h. Gould D, (1997) Pilonidal Sinus, Nursing Times, 93 (32) Pg 59 - 62
I. Gilchrist B, (1997) Should Iodinebe reconsidered? Nursing Times, 20 (12) Pg 49 - 53 j. Jones M, (1998) Dressing Wounds, Nursing Standard, 7 (13), Pg 47 - 52 k. Colley F, (1998), Tissue Viability, The facts and the law, Nursing Times. 94 (24) Pg 63 - 64
5. Communication a. Kagan C, Evans J, Kay B, (1989) A Manual of Interpersonal Sills for nurses, An experiential approach, Harper and Row publishers, London b. Roper N, Logan W, Tierney A (1990) The Elements of Nursing, Churchill, Livingston, Edinburgh
6. Stages of Development/Coping mechanisms a. Atkinson R, Atkinson R, Smith E, Bem D, (1993) Introduction to Pyscology Eleventh Edition, Harcourt Brace Jovanovich College Publishers, USA
7. Health Promotion a. Naidoo, J Wills,J (1994) Health Promotion, Foundations for Practice, Balliere, Tindall, London
8. Miscellaneous a. Dunn L, Oxygen Therapy, Nursing Standard 7 (13) Pg 57 - 60
9. UKCC Guidelines a. UKCC, 1987, Confidentiality, UKCC London b. UKCC, 1989, Exercising Accountability, UKCC London c. UKCC 1992, Code of Professional Conduct, UKCC London d. UKCC 1992, The Scope of Professional Practice, UKCC London e. UKCC 1992, Standards for the administration of medicines, UKCC London f. UKCC 1993, Complaints about professional practice, UKCC London g. UKCC 1993, Standards for records and record keeping, UKCC London h. UKCC 1998, Guidelines for records and record keeping, UKCC London
3.7 Departmental Aims and Objectives 1. Aim: To provide a warm and friendly environment for the student
Objective:
Staff should introduce themselves to the student by name Staff should involve the student in any conversations
2. Aim: To provide adequate support to ensure a learning and experiential environment
Objective:
Ask student about past experiences and expectations from placement Discuss learning objectives e.g. learning contracts, personal aims and objectives Ensure student has opportunity to ask questions/seek explanations Demonstrations of skills e.g. bandaging, wound care Ensure periods of reflection with the student Give positive instruction, praise and constructive criticism Preceptor evaluation - student questionnaire
3. Aim: To enhance and develop students existing knowledge
4. Aim: To ensure that the department staffs’ knowledge meets the needs of the student 3.8 Learning opportunities/skill development within the Minor Injuries Unit
1. Increased knowledge of communication skills.
Reception/documentation/triage, history taking, verbal/non-verbal communication skills/language line Clear instructions Special needs of patients Stressful situations Difficult patients/relatives
2. Knowledge of emergency situations.
Emergency procedures e.g. CPR, anaphylaxis Emergency transfer to other hospitals
3. Knowledge of priority situations
Asthmatic, Burns Chemical splash Epistaxis Hypothermia.
4. Knowledge of general nursing tasks
A. Wound Care
Preparation of patient/trolley for wound dressing Steri-strips Administering local anaesthetic Suturing Trephining of nails
B. Orthopaedic injuries and appropriate care
Application of tubigrip, Robert Jones, thumb spica, zimmer/mallet splints, boxing glove, collar n cuff, sling, tubigauze, pressure bandage
C. Ophthalmology issues
Irrigation of eye, and free flow method Installation of eye drops/ointment and application of eye pad Advice over anaesthetic
D. Nasal related injuries/problems Application of pressure/nose bag Observation of nasal pack insertion
E. Catheterisation situations
Preparation of patient, trolley, equipment Aesptic technique, carrying out procedure
F. Drug administration
Types of drugs used in the department Documentation Adverse drug reactions Preparation of patient for drug administration e.g. absorbed tetanus vaccine
G. ECG, Glucometer
Observation only
5. Enhance knowledge of anatomy
6. Knowledge of legal issues in the department
Dealing with suggestions and complaints Dealing with abusive patients Dealing with patients in custody Filling in accident forms
7. Observation of extended nursing role
8. Patient information
Issuing of post-trauma advice sheets Crutches Advice re care of wounds and review Discharge
9. Transfer procedures
Alternative hospital Orthopaedic clinic Discharge against medical advice
10. Health and Safety Safe disposal of sharps Clinical waste Wearing gloves Care/maintenance of equipment Staff patient care/safety of belongings, valuables
Ordering and Storage
Pharmacy, surgical, general, stationery and special orders
3.9 Student Centred Learning
1. Wound Care
Classification of wounds Physiology of wound healing Forms of healing Factors affecting would healing Types of wound dressings Signs of infection
2. Fractures
Types of fractures Clinical features Physiology of bone healing
3.10 Types of patients attending the Minor Injuries Unit
Several different age groups attend the unit -- from new-borns to ninety and beyond. All patients are assessed by the specialist nurse, but patients below 5 years of age must be referred to the Doctor. Patients over 70 may also be referred, especially if a medication is required, and the patient has either a complicated history or medication history
Holistic approach to patient care -- A large proportion of the patients will attend with a physical injury, but their psychological, and social needs may also require to be addressed. There will be very few patients who attend do not have emotional upset, caused by pain or disfigurement of the injury. One may also consider the social aspect of the patients needs i.e. an elderly patient, who either lives alone or with another elderly relative/spouse, may have difficulties at home, depending on the nature of their injury. Liaison with support agencies is an important part of the Minor Injuries nurse.
Patients under the influence of a substance either alcohol, drugs or glue -- As in any department, there are occasions when patients present, or are presented by the police or anxious relatives, who required treatment and who are also influenced by the substance they have taken. Tact and diplomacy are important skills these situations. In some instances treatment is not possible, when informed consent cannot be obtained. Enforced treatment would be unethical, and could be treated as an assault in a court of law.
Special Needs of patients -- All patients are special, but some have more intense needs which need to be addressed. Patients with hearing deficit, or complete hearing loss, require use of good communication skills. Do not assume that all elderly patients attending have a hearing deficit, assess appropriately, no-one likes to be shouted at!!
Similarly, patients attending with learning difficulties require special care, to ensure they fully understand their condition, and any follow up care required.
Children have special needs. Evidence from research has found that by fully explaining procedures in a language which the child understands, at their specific developmental level, will reduce anxiety, in turn reduce pain and encourage compliance. Parents need explanations too but the child is the patient.
The department has several written information sheets. It is important to verbally inform the patient of appropriate after care i.e. wound care, suture care, exercises. There are people who are illiterate, who can manage very well, but may not comply with important instructions, as they cannot read the information sheet provided.
Regular Attenders -- As in every minor injury unit and casualty department, we have a number of regular attenders. These patients may have legitimate needs, however inappropriate to this specific department, and should be treated in a non-judgmental manner. This can be very difficult when the department is extremely busy, with patients who are triaged as having more urgent need of treatment. These regular attenders cope with this situation in different ways, and can become verbally abusive and there is the risk of physical abuse, therefore these patients must be assessed carefully. It is important to acknowledge ones’ limitations in these situations.
The patients are our first priority but one must also regard the relative/support person who has accompanied them. They also have needs as they may also be distressed by their loved ones condition. Reassurance and support may be required whilst in the department.
Categories of patients attending the Minor Injuries Unit
CATEGORY OF INJURY EXAMPLE OF PROBLEM
Orthopaedic Wrist/hand/arm injury Ankle/foot injury Neurological Head injury
Ophthalmology Foreign body in eye Chemical splash to eye Surgical Burns, suturing, steristrips
Medical Chest pain, asthma
Dental Toothache, post extraction bleeding
E.N.T Epistaxis, foreign body in ear/nose/throat
Gynaecological Request for emergency contraception Lost tampon removal