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  1. 1. Matron Orderlies Consultants and Specialist Nurse Medical Staff Ward 1 Radiographers BMT 23 Ward 3 Social Services PICU Oncology Ward 4 UNN NGH 24 + 26 Gastroenterology ENT Airways Ward 5 Orthopaedics Paediatric Neo Ward 6FINANCE Community Burns and Theatres Natology Plastics RVI General Ward 7 Out Surgery Patients Intensive STERILE SERVICES Care Cardio FRH Technical Services Ward 16 ie. Medical Physics, Ward 9 DIRECTORATE Electronics, Anaesthetic Ward 35 MANAGER Technician Created by Staff Nurse Hennon 1 Chaplain SENIOR THEATRE NURSE
  2. 2. PAEDIATRIC THEATRES VICTORIA WING ROYAL VICTORIA INFIRMARYDEPARTMENT PROFILEWelcome to paediatric theatres. We are part of the Peri-Operative and Critical CareDirectorate within the Newcastle Upon Tyne Hospital Trust, and also have close links withChildren’s Services. The department is split into three separate theatres. We are based withinthe Victoria wing of the hospital, where all the paediatric wards are situated, and is split ontwo floors.The department covers a broad spectrum of specialities, e.g. general surgery, plastics andreconstructive surgery, and so on. We also cover paediatric surgical emergencies on a 24-hour basis.The department is made up of three theatres. Theatre 31 can be found on the second floornext to ward 9. This theatre predominantly specialises in paediatric general surgery. Theatre33 can be found on the ground floor between ward 2 and ward 3, and predominantlyspecialises in plastic and reconstructive surgery, but also covers some general surgery andoncology sessions. Theatre 32 is also based on the ground floor and can be found betweenward 4 and ward 3, and is the dedicated emergemncy theatre. The latter covers 6 electivegeneral surgery and plastics sessions, four emergency sessions, plus out of hoursemergencies.The theatres comprise of anaesthetics, theatre, and recovery areas within all. Changing andrest room facilities are available in each area. Staff work in teams, with rotation into eachspeciality at intervals.The department is the regional centre for paediatric surgery, therefore within it there is greatscope for the development of your knowledge and skills. We welcome all levels of studentnurse to the department and hope that you find your placement enjoyable and worthwhile.Before commencing your placement you will be allocated a mentor who will work with youthroughout your placement. However, during your placement you will also be allocated co-mentors who you will work with so that you have a whole picture of the department. Thereare many skilled nurses working within the department who can pass on their knowledge andexpertise to you.Shift Times/Off DutyThe department operates on a number of shift patterns. It is preferable that you work thesame shifts as your mentor ( at least 50% of the time), however there is flexibility if rrquired.We tend to work one long day a week (7.30am-8.30pm) and three altering shifts. Two earlyshifts operate, the first being 8am-4pm, and the second being 8am-5.30pm. The last shiftyou may be allocated is the late shift, which is 12.30pm-8.30pm. If you have any problemswith these shifts it is advisable that you liase with your mentor, and they will try to solve theproblem/UniformAs every person in the theatre needs to conform to infection control regulations, you will alsowear the theatre blues with a pair of clogs and a hat, these are all supplied by thedepartment. You will change in the individual theatre you are placed in, and there is no needto wear your student nurse uniform to placement.Created by Staff Nurse Hennon 2
  3. 3. IdentificationAt all times you are expected to wear your university identity badge, and the theatreenvironment is no exception to this rule.Created by Staff Nurse Hennon 3
  4. 4. PROFILE OF LEARNING OPPORTUNITIES FOR PAEDIATRIC THEATRESKEY ELEMENT:INTERPERSONAL SKILLS RESOURCE/LEARNING OPPORTUNITIES RELEVANT PERSONEL/ DEPARTMENTUse of Telephone:Answering calls Nursing staff/Medical staff/Health careMaking calls assistants/OrderliesRing back, etc.Bleep & Telephone systemsUse of the Computer:Tray tracking system Nursing staff/Medical staff/Health carePatient investigation results assistantsPatient informationInternet & Trust intranetE-mailTalking to: Theatre & Ward sisters/Registered nurse/Patients Health care assistant/Medical staff/Multi-Relatives disciplinary team/Specialist nurses/ResearchMulti-disciplinary team members sisters/OrderliesColleagues Domestics/PortersAncillary staff Medical staff/Registered nurse/Multi-disciplinary meetings & Medical ward Physiotherapist/Infection control team/rounds Pharmacist Registered nurse/Medical staffFacilitating investigations Registered nurseNursing handovers Registered nure/Theatre & Ward sisters/Managerial structure within the Trust Clinical nurse manager/Speciality manager/ Modern matron Observation of roles with the team – all teamTeam working members Patient/Relative/Bed co-ordinator/Ward staffPatient transfer within the Trust Bed co-ordinator/Ward staff/Ambulance crewPatient transfer outside the TrustCreated by Staff Nurse Hennon 4
  5. 5. KEY ELEMENT:CLINICAL SKILLS RESOURCE/LEARNING OPPORTUNITIES RELEVANT PERSONEL/ DEPARTMENTPatient hygiene:Skin care Registered nurse/Health care assistantPressure careRecording of physiologicalobservations:Blood pressure, Central venous pressure, Registered nurse/Anaesthetic & RecoveryTemperature, Pulse, Respirations, Oxygen staff/Ward nurses/Medical staffsaturations, Weight, Blood glucose, FluidbalanceMaintaining accurate documentationAdministering medication:Oral Registered nurse/Anaesthetic & RecoveryIntramuscular staff/Ward nurses/Medical staff/InfectionIntravenously control team/Transfusion nurse/ NutritionalRectal nurse/Dietician/Trust policies/Intranet/Subcutaneously Literature/InternetIntravenous infusionsCare of cannulas & Central lines Infection control policy – trust intranetVenepuncture & CannulationNG/NJPhlebotomyAdministratin of blood & blood productsAseptic Technique/Universal Theatre nurses/Anaesthetic & Recovery staff/Precautions Health care assistantsNutritional intake Ward nurse/Nutritional nurse/DieticianRisk assessment:Falls Registered nurse/Theatre, Anaesthetic, &Health & Safety Recovery staff/Infection control team & LinkCOSHH nurse/Moving & Handling link nurse/HealthMoving & Handling – use of patslide care assistants/OrderliesInfection Control:Handling blood-borne infection in the peri- Theatre nurse/Medical staff/Infection controloperative environment team/Trusts policies – IntranetHand hygiene policy Theatre nurse/Medical staff/Health careTheatre wear policy assistants/Theatre sisters/Trusts policies - IntranetCreated by Staff Nurse Hennon 5
  6. 6. KEY ELEMENT:CLINICAL SKILLS CONTINUED RESOURCE/LEARNING OPPORTUNITIES RELEVANT PERSONEL/ DEPARTMENTCatheter Insertion & Care:Procedure for inserting catheter Registered nurse/Medical staffUrinalysis Registered nurseCSU MSU collecting Registered nurse/Health care assistant Registered nurse/Medical staffFaecal occult blood testingArterial pressure monitoring:Patient safety Registered nurse/Medical staff/HaematologistChecking/setting up equipmentInsertion & removalArterial blood removalScrubbing up Procedure:Handwashing Theatre sisters/Registered nurse/MedicalGowning up staff/Intranet/Trust policies/Literature/Gloving up Internet – NATN websiteDisinfection Policy:Cleaning endoscopes Theatre sisters/Theatre nurses/Health careSetting up medivator assistants Theatre sisters/Theatre nurses/Medical staff/Risk assessment Risk assessment officersHealth & Safety Theatre sisters/Theatre nurses/Medical staff/ Health care assistants/ Health & Safety officersPreparation for investigations:Consent 1 Registered nurse/Medical staff/Trust policies/Information Intranet/LiteratureInvasive radiology Radiologist/Radiology nurse/Trust policies/Non-Invasive radiology Intranet/Literature1Created by Staff Nurse Hennon 6
  7. 7. KEY ELEMENT:MANAGEMENT OF CARE RESOURCE/LEARNING OPPORTUNITIES RELEVANT PERSONEL/ DEPARTMENTUse of Nursing Model Registered nurse/Theatre sisterPhilosophy of Care Registered nurse/Theatre sister Registered nurse/Theatre sister/Health careDocumentation used assistantNursing Process:• Assessment –Who assesses? Registered nurseHow is assessment carried out/open or Sources of information -closed questions? Patient/Relatives/Notes/District nurse/What is assessed? Transferring nurseWhere does assessment take place? nurse/Pharmacist/Specialist nurseWard/Theatre communication concerningassessment issues Ward/Theatre personel• Planning –Care Plans Registered nurseRisk assessment tools Link nurseCare pathways Registered nurse/Specialist nurse/Medical staffMulti-disciplinary planning Multi-disciplinary teamDischarge planning Registered nurse/Medical staff/Patient/ Relatives• Referrals to other agencies –Specialist nurses (child protection, laser nurse Registered nurse/Medical staffspecialist, etc)• Implementation/Evaluation –Multi-disciplinary team Registered nurse/Medical staff/Health care assistant/Orderlies/Physiotherapist/Infection control team/Dietician/Radiologists• Documentation Registered nurse/Medical staff• Standards Registered nurse• Protocols Registered nurse/Theatre sister/Trust• Policies Intranet/Medical staff Registered nurse/Medical staff/Trust Intranet• Communication with patients & – Royal Marsden handbook relativesCreated by Staff Nurse Hennon 7
  8. 8. KEY ELEMENT:MANAGEMENT OF CARE CONTINUED RESOURCE/LEARNING OPPORTUNITIES RELEVANT PERSONEL/ DEPARTMENT• Time Management Registered nurse• Planning priorities Registered nurse/Medical staff• Dealing with difficult situations Registered nurse/Theatre sister• Deceased patients Registered nurse/Theatre sister/Bereavement officer/Chaplain/Priest• Patient property/valuables Registered nurse/Health care assistant• Refusal of operation Registered nurse/Medical staff/Ward manager/Theatre sister/Specialisty manager• Religious needs – Registered nurse/Medical staff/HospitalArranging priest, communication, etc chaplian/Priest/InterperatorCreated by Staff Nurse Hennon 8
  9. 9. KEY ELEMENT:ORGANISATIONAL AND MANAGERIAL ISSUES RESOURCE/LEARNING OPPORTUNITIES RELEVANT PERSONEL DEPARTMENTManaging a Team:Organisational skills Registered nurse/Theatre sisterDelegation skills Registered nurse/Theatre sisterPrioritising skills Registered nurse/Theatre sister/Medical staffTime Management All Theatre staffLeadership Senior nurses/Theatre sisterOff-Duty Senior nurses/Theatre sisterManaging patient work load Registered nurseQuality Registered nurse/Theatre sister/Audit toolStandards of care Registered nurse/Theatre sisterImplementing change Registered nurse/Theatre sister/Medical staffGiving information to – Theatre sister/Speciality manager/Modern• Staff matron/Registered nurse Theatre sister/Speciality manager/Registered• Medical staff nurse/Multi-disciplinary team/Theatre staff/ Ward staff• Patients & Relatives Registered nurse/Theatre sister/Medical staff/ Anaesthetics & Recovery staff/Health care assistant• Multi-disciplinary team members Registered nurse/Medical staff/Theatre sister Radiologist/Histopathology/etc• Other departmentsResources: Senior nurses/Theatre sistersStock control Registered nurse/PharmacistDrugs Senior nurses/Theatre sistersMaterials management Registered nurse/Health care assistantNon-stock Registered nurse/Theatre sistersStationary Senior nurses/Theatre sistersEstablishment/Skill-mixBudget control Theatre sisters/Speciality manager/Senior nursesManaging risk:Policies & Procedures – Safeguards for Theatre sisters/Senior nurses/MedicalInvasive procedures staff/Trust IntranetCreated by Staff Nurse Hennon 9
  10. 10. KEY ELEMENT:ORGANISATIONAL & MANAGERIAL ISSUES CONTINUED RESOURCE/LAERNING OPPORTUNITIES RELEVANT PERSONEL/ DEPARTMENTManaging risk continued:Equipment safety checks – Bi-polar & Health & Safety officer/Electronics/Registereddiathermy machines, etc nurse/Health care assistantQuality control Theatre sister/Registered nurseInfection control Theatre sister/Registered nurse/Infection control team & link nurse/Health care assistantMoving & Handling Moving & Handling link nurse/Health & Safety advisor/Registered nurseEmergency situations:Cardiac arrest Cardiac arrest team/Registered nurse/Medical staff/Anaesthetist & anaesthetic nurseFast bleep system Registered nurse/SwitchboardViolen incidents Registered nurse/Medical staff/Theatre sister/ Security officerFire Theatre sister/Registered nurse/Fire officerPatient falls Registered nurse/Health & Safety officerStaff Development:Clinical supervision Registered nurse/Theatre sisterReflective practise Registered nurse/Theatre sisterPreceptorship/mentorship Registered nurse/Theatre sisterCreated by Staff Nurse Hennon 10
  11. 11. KEY ELEMENT:PATHOPHYSIOLOGICAL PROCESSES RESOURCE/LEARNING OPPORTUNITIES RELEVANT PERSONEL/ DEPARTMENTINFECTION:Inflammatory process:Source Medical staff/Registered nurse/Literature/Cross infection Internet/Trust Intranet/Infection controlTreatment team/PharmacistIMMUNOLOGICAL FACTORS:Antigens Medical staff/Registered nurse/Pharmacist/Suppression of immune system Literature/Internet/Transplant team/Drugs ImmunologistsRejectionsSCIDSDISTURBANCES IN ELECTRLYTEBALANCE:Normal electrolyte balance Medical staff/Registered nurse/LaboratoryAnalysing blood results staffDehydrationAcidosisONCOLOGY:Aetiology Medical staff/Registered nurse/Palliative carePathology team (Ward 16 multi-disciplinary team)/Treatments, Chemotherapy, Intratechal Radiologists/Haematologists/Pharmacistmedications, Bone marrow aspirates &harvests, Bone marrow transplants, Insertionof CVC Lines & PortacathsCARDIOVASCULAR SYSTEM:Anatomy & physiology Medical staff/Registered nurse/AnaestheticInvestigations staff/Cardiac arrest team/Cardiology team/Treatment regimes PharmacistCardiac arrestDefibrillationCardiac arrhythmia’sECG’sCreated by Staff Nurse Hennon 11
  12. 12. KEY ELEMENT:PATHOPHYSIOLOGICAL PROCESSES CONTINUED RESOURCE/LEARNING OPPORTUNITIES RELEVANT PERSONEL/ DEPARTMENTRESPIRATORY SYSTEM:Anatomy & physiology Medical staff/Anaesthetist/Anaesthetic nurse/Investigations Registered nurse/Medical physics officer/Infections Physiotherapist/Respiratory consultant/Oxygen therapy PharmacistContinuous Positive Airway Pressure (CPAP)TreatmentsDrugs, Nebuliser therapyAnalysis of blood gas monitoringCollection of B.A.L specimensTracheostomy – permanent & temporaryTracheoscopy, Laryngoscopy, & BrochoscopyLaser treatmentLIVER & BILIARY SYSTEM:Anatomy & physiology Medical staff/Registered nurse/Hepat-biliaryHepatitis B nurse specialist/Literature/Palliative careParacetamol overdose teamLiver tumours & biosies of these tumoursSymptoms of liver disease – jaundice,ascites, encephlopathyNutrition Dietician/Registered nurse/Medical staffTreatments Medical staff/Registered nurse/PharmacistBLOOD DISORDERS:Blood formation & destruction process Medical staff/RegisteredRed blood cells nurse/Haematologist/HeamatologyWhite blood cells nurse/Literature/Gastroenterologists/Platelets Endoscopy unit/Transfusion nurse/ TrustClotting factors intranet – policies & proceduresLymphomaOesophageal Variceal haemorrhage &bandingEndoscopy proceduresBlood transfusionDVTCreated by Staff Nurse Hennon 12
  13. 13. KEY ELEMENT:PATHOPHYSIOLOGICAL PROCESSES CONTINUED RESOURCE/LEARNING OPPORTUNITIES RELEVANT PERSONEL/ DEPARTMENTENDOCRINE & METABOLICDISEASE:Diabetes mellitus Medical staff/Registered nurse/Diabetic nurseLong term use of steroids & administration of specialist/Diabetologist/Pharmacist/Literaturehigh dose steroids Trust Intranet – policiesNERVOUS SYSTEM: Medical staff/Registered nurse/Microbiologist/Encephlopathy Pharmacist/Literature/ Trust Intranet –Infections policiesDrugsSKELETAL SYSTEM:Craniofacial Procedures – Cleft palates Medical staff/Registered nurse/Cleft palateTreatments team/Radiology/Pharmacist/Ward staff/Drugs AnaesthetistPlating/Wiring/FixationsRemoval of accessory digitsBURNS:Classification of Burns Medical staff/Registered nurse/Ward staff/Causes of burns PharmacistTreatment & DressingsDrugs & TherapiesSkin graftsFluid resucitationCreated by Staff Nurse Hennon 13