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Shortened placement handbook updated sept 2011


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Shortened placement handbook updated sept 2011

  1. 1. Community Placement for AdultBranch Nursing Students2011/2012Revised September 2011 AHCommunity Preparation Handbook (Adult Branch) 2010/11
  2. 2. Primary Health CarePrimary care describes community based health services that are usually the first, andoften the only, point of contact that patients make with the health service. It covers servicesprovided by family doctors (GPs), community and practice nurses, community therapists(such as physiotherapists and occupational therapists), community pharmacists,optometrists, dentists and midwives (DH, 2010, next year General Practice will take the lead role in commissioning the majority ofcare for patient. In the White Paper, Equity and Excellence: Liberating the NHS (DH, 2010)the PCTs (in England) will pass their provider and commissioning roles over to collectivegroups of GP practices, known as consortia. It is expected that nurses will be representedwithin the consortia.The community services, that you as students in the community setting may be involvedwith, will need to work closely with their consortiums to ensure that capability and capacityare all recognised and that a partnership approach to decision making is fostered.Many people, living in the community, have multiple chronic health problems that weclassify as long term conditions. They may, for example, suffer with rheumatoid arthritis,urinary incontinence and hypertension. They may receive care from many different servicessuch as the GP, the rheumatologist, the pain control clinic, physiotherapy, continencespecialist nurse, dietician and the hypertension nurse. To co-ordinate these complex needsa case management approach has been developed in the community supported by casemanagers and community matrons. On your placement explore who is caring for patientswith multiple needs, who is coordinating their care and how does this approach benefit thepatient.As students you will notice a difference in the way that health and social care staff promoteself management and partnership working in the community. This approach supports theconcept of the individual and their right to autonomy. It is also bourn out of necessity withprimary health services providing the majority of health care and caring for increasinglycomplex needs. Remember self-care does not mean ‘no care’, but rather supporting peopleto know when to contact the health services and ask for help and when they shouldmanage their own health needs. For example, a person troubled by a cough for 3 daysshould self-care but if that cough persists for 3 weeks they should seek advice.What services provide care in the communityHealth care that provided in the community is from many diverse professionals, agenciesand independent sector workers.In your placement you may meet or liaise with general practitioners, community matrons,practice nurses, school nurses, physiotherapists, speech therapists, dentists, opticians,pharmacists and many more.You may be in contact with NHS walk-in centres, NHS Direct and community based minorsurgery clinics. You may learn more about community based screening or keeping healthyinitiatives such as run4life.Community Preparation Handbook (Adult Branch) 2010/11
  3. 3. As you familiarise yourself with your clinical area consider how the patient or individualaccesses services, how integrated you find community care and the ways in which needsare met.Community (or district) nursesCommunity nurses are responsible for nursing people in their homes or other communitysettings such as clinics, health centres or residential care homes. They commonly providecare for patients with chronic diseases such as diabetes or multiple sclerosis or patientswith palliative care needs, also patients who require continuing care following dischargefrom hospital. Community nurses are employed by primary care trusts and are normallybased in local clinics or health centres.Practice nursesPractice nurses are responsible for providing clinical nursing care in general practitioners’surgeries but their role also includes responsibility for health promotion and themanagement of long term conditions. They may run clinics for patients with long termconditions such as asthma, diabetes, chronic obstructive airways disease and hypertensionand clinics designed to reduce the prevalence of coronary heart disease, cigarette smokingand obesity. Other clinics managed by practice nurses include well man clinics, familyplanning and cervical cytology clinics.Palliative carePalliative care nurses are specialist practitioners who provide advice and support topatients with palliative care needs often, but not exclusively, related to cancer. They mayalso provide pain control and support to non-cancer patients with complex conditions suchas motor neurone disease or end stage multiple sclerosis.Community matronsCommunity matrons are experienced, skilled nurses who case manage patients in need ofhighly intensity health and social care. With special intensive help, these patients are ableto remain at home longer and to have more choice about their health care.Sexual health clinicSexual health clinics provide comprehensive open access sexual health and HIV care. As amatter of policy, local sexual health clinics will see all urgent cases on the day ofpresentation to the clinic. Sexual health services are confidential and this confidentialityextends to patients under the age of 16. Generally clinic staff would only consider passingon information about a patient if it might protect the patient or someone else from harm.You will be allocated a mentor and possibly also a co-mentor during your communityplacement. You will have plenty of opportunity to work with either your mentor oranother member of the team.It is your responsibility to ensure that the Practice Learning Document is completed. For allplacements it is essential that the learning opportunities are explored with your mentorCommunity Preparation Handbook (Adult Branch) 2010/11 3
  4. 4. during the first few days. These learning opportunities can then married with your ownlearning needs and turned into learning objectives.Some placements will be four weeks. You should ensure that your mentor is clear aboutthis and plan your placement experience and the timings of your assessment accordingly.Do speak with your mentor and negotiate a time for the mid-way and the final assessmentto happen. This is especially important on a four week placement when time can soon runout.If you experience any problems with the placement then remember there are link lecturers,from the University, who can support you. Their details should be displayed in each clinic.AttendanceThe team leaders will submit a record of attendance each week, to the UniversityAbsenceYou should ensure that both the clinical placement and the placement office her aware ofyour absence. It may not always be possible to make up the time you have been absent. Allqueries should be referred to the link lecturer.Final placement studentsMiddlesex University students with a special interest in developing their skills in thecommunity setting will be offered the chance to undertake their final placement in one of thecommunity placement areas.You will need to be assigned a ‘sign-off mentor’. That is, an experienced mentor who hasgained further experience in mentoring final placement students, as stipulated by the NMC ( Opportunities/Objectives for Pre-Registration Students in Sexual HealthPlacementsPlease noteSTUDENTS ARE ISSUED WITH A SEXUAL HEALTH PLACEMENT WORKBOOK ATTHE START OF THEIR ALLOCATION WHICH THEY ARE EXPECTED TO COMPLETEUNDER THE SUPERVISION OF THEIR MENTOR. Completion of this workbook ismandatory in order to complete the placement. 1. The organisation of a sexual health clinic including meeting the needs of the different types of clients accessing these services e.g. gay men, adolescents 2. How the roles of the members of the multi-disciplinary team within this setting work together to provide a holistic service 3. Understand the principles of partner notification 4. Assisting in clinical procedures, specific to area, e.g. cryocauteryCommunity Preparation Handbook (Adult Branch) 2010/11 4
  5. 5. 5. Instruction and supervision in specialised techniques such as speculum insertion, specimen collection, slide preparation, staining and phlebotomy; depending on specific placement 6. The range of Sexually Transmitted Infections (STIs) including symptoms, treatment and follow-up 7. The importance of confidentiality and communication skills 8. Assessments including sexual history taking undertaken within this setting 9. Health and safety procedures appropriate to a sexual health clinic including handling and disposal of infected or potentially infected materialLearning opportunities for pre-registration students in practice nursingplacements 1. The day to day organisation of a general medical practice. 2. The roles of the members of the multi-disciplinary team in general practice. This team usually consists of the general practitioners and practice staff including practice manager, receptionists and practice nurses. Employees of the primary care trust such as district nurses, practice nurses and healthcare assistants may also be attached to one or more practices. 3. The organisation of a treatment room. 4. Clinical procedures carried out by the practice nurses. These procedures are likely to include wound management, blood pressure monitoring, ear care, immunisations, urine testing and blood glucose monitoring. 5. Carry out selected clinical procedures under supervision. 6. Health and safety precautions including clinical waste disposal, moving and handing and personal safety. 7. Instrument sterilisation and storage. 8. Policies and clinical guidelines. 9. Screening for diseases. 10. The management of long-term conditions. 11. Health promotion clinics. 12. Patient referral processes to both health and social care organisations.Community Preparation Handbook (Adult Branch) 2010/11 5
  6. 6. 13. The work of health care professionals who may visit the practice or undertake clinics there. These may include district nurses, palliative care nurses, diabetes nurse specialists, physiotherapists and specialist community public health nurses (also known as health visitors).Learning opportunities for pre-registration students placed with specialistcommunity public health nurses (also known as health visitors) 1. The role of the specialist community public health nurse. 2. Multi-disciplinary teamwork in child protection. 3. Child and parental mental health needs and healthy relationships. 4. Social and environmental influences on health. 5. The health needs of diverse populations. 6. Teenage pregnancy and single parenthood. 7. Health needs associated with low income, social and geographical dislocation and homelessness. 8. Child development. 9. Monitoring child development through developmental checks. 10. Promoting child health through immunisation, and family health education. 11. Principles of caseload management. 12. The role of the health visitor in promoting community health and wellbeing. 13. Policies and guidelines relating to health and safety for community staff, particularly about “lone working” and aggressive behaviour. 14. Working relationships especially those with midwifery and school health services.Learning opportunities for pre-registration students in community nursingplacements 1. Nursing assessment, care planning and nursing care carried out in the home environment. 2. The implications of providing nursing care as a guest in the patient’s home.Community Preparation Handbook (Adult Branch) 2010/11 6
  7. 7. 3. The safe adaptation of nursing procedures, including wound care, catheterisation, gastrostomy management to the home environment. The support of patients with long-term catheters. 4. Clinical skills such as ear care and phlebotomy. 5. Infection control. 6. The organisation of a community nursing team, caseload management and prioritisation of care needs. 7. Relationship with general practitioners and their staff. 8. The work of other health and social care organisations. 9. Referral criteria to the community nursing service; referral process and internal referrals, for example to twilight, night or out of hours services. 10. Links between primary and secondary care, particularly in relation to discharge planning. 11. The assessment, management and organisation of care for patients with complex care needs due to acute or long term conditions. 12. The care and management of patients with specific long term conditions such as multiple sclerosis, diabetes, hypertension and chronic obstructive pulmonary disease (COPD). 13. The supply of nursing equipment such as pressure relieving equipment, hoists and commodes. 14. Policies and guidelines relating to health and safety for community staff, particularly about “lone working”, moving and handling, disposal of clinical waste and sharps and aggressive behaviour.Learning opportunities for pre-registration students in palliative care nursingteams 1. The management and organisation of a palliative care team. 2. The role of the nurse in the palliative care team. 3. The principles of Inter-disciplinary care in the management of multiple complex symptoms. 4. Communication skills and emotional support in challenging interactions with patients, families and carers.Community Preparation Handbook (Adult Branch) 2010/11 7
  8. 8. 5. Principles of assessment of pain and other symptoms. 6. Symptom control and treatment of concurrent conditions. 7. Observation of patients and families experiencing terminal illness. 8. How health care professionals in palliative care cope with the demands of their work. 9. Clinical supervision. 10. The role of members of the palliative care team as educators and promoters of good practice. 11. Policies and guidelines relating to health and safety for community staff, particularly about “lone working”, moving and handling, disposal of clinical waste and sharps and aggressive behaviour.Guidance on home visitingIf you are placed with a community nursing team you will have the opportunity to visitpatients on your own after a suitable induction to the team, the patients and the locality.You may visit patients on your own, provided the following rules are followed: 1. Your supervising nurse must assess your abilities and be confident that the proposed visits are within your capabilities. 2. Your supervising nurse must accept that she/he remains professionally accountable for the nursing care you deliver. 3. Your supervising nurse must ensure that you fully understand the care plan and the care that may be required. 4. The number of daily visits should be negotiated between you and your mentor. 5. You should not visit any patient alone more than twice in succession. 6. Effective communication arrangements for use in emergencies should exist and you should be informed of them. 7. You should not carry out procedures for which you have not received adequate training. 8. You should ensure that your mentor or other responsible team member is aware of your daily call list and planned route.Guidance on practice nursingYou may see patients on your own in clinics provided the following rules are followed: 1. Your supervising nurse must assess your abilities and be confident that the proposed consultations are within your capabilities.Community Preparation Handbook (Adult Branch) 2010/11 8
  9. 9. 2. Your supervising nurse must accept that she/he remains professionally accountable for the nursing care you deliver. 3. Your supervising nurse must ensure that you fully understand the patients’ needs and the interventions that may be required. 4. You must have immediate access to a qualified nurse at all times and should share clinic lists with a qualified nurse. 5. You should not see any patient alone more than twice in succession. 6. You should be told of emergency procedures. 7. You may not carry out cervical smears. 8. You should ensure that you do not carry out procedures for which you have not received adequate training. 9. You may not give internal medicines unless directly supervised by a qualified nurse. 10. You may administer eye drops or apply wound care products, skin preparations and glycerine suppositories provided that you have been briefed on their use.Guidance on medicine administration in the home 1. You may not fill Dosette™ or similar medicine containers. 2. You may not give medicines of any kind by mouth or injection unless directly supervised by a qualified nurse. 3. You may administer eye drops, apply wound care products, skin preparations and glycerine suppositories provided that you have been briefed on their use. 4. During your placement you will have the opportunity to observe different methods of supplying and administrating medicines. Whilst you must never give medication unsupervised, you will have the opportunity to administer a variety of medications under direct supervision of your mentor. You should note the different prescribing and supply strategies available, including clinical management plans (supplementary prescribing), patient group directions (note: a PGD can not have their administration delegated) and conventional prescriptions (FP10s). It is important that you are aware of the legal and professional issues inherent in all aspects of medicine management and you should refer to the following document for in depth advice : NMC (updated 2010) Standards for Medicines Management, at http://www.nmc- Preparation Handbook (Adult Branch) 2010/11 9
  10. 10. Checklist for community placementsSome items in this checklist apply to all kinds of community placement. Some items onlyapply to home visiting. It is not exhaustive and if you think you have something useful toadd to it please send an email to Alison Harris at 1. Contact your placement well in advance and check arrival time. The best times to telephone community nurses are generally between 08.30 and 09.00 and after 2.30pm. If a member of the nursing team is not available when you ring leave a message and your contact details. 2. Ask whether you need to wear a uniform. Not all community nurses wear uniforms. If uniforms are not worn find out what kind of clothing is appropriate. When in your own clothing ensure it is appropriate to the role and job i.e no false nails, stud earrings and wedding rings only (no other jewellery), modest and clean clothing and hair is clean and tied back. 3. Check where you are to meet your mentor/member of staff on the first day. Timekeeping is essential part of your professional conduct and you will be assessed for your punctuality and time management. Turn up in the morning on time and ensure you are back at clinic at the stipulated time. 4. On the first day check your route to your placement area. Be sure you know which tube or bus stop to get off at. If travelling by car, check if you are able to park. 5. If you have a car you may choose to use it to get to your placement. You are strongly advised NOT to use your car for undertaking visits to patients. Your insurance may not cover you if you use your car for anything that could be interpreted as work. 6. You may claim expenses for journeys between patients. A claim form can be obtained from the University Student Offices. a. Travel expenses - You may be able to claim a refund of travel costs to and from your placement. To do this, get a travel claim form from the Student Office or from Steve Wells in the Cash Office. Tel: 020 8411 6634. 7. Wear your name badge and student ID card. Get into the habit of showing them to patients without being asked. 8. Wear comfortable shoes. In some areas most visits are done on foot, as parking is not possible. In other areas you may find that parking spaces are located at some distance from your destination. 9. Take a waterproof coat or jacket and umbrella. If you get wet you will be uncomfortable all day. You will also give a bad impression if you turn up at someone’s door wet through. 10. If you are frightened of dogs let your mentor know. Patients are usually obliging and will put the dog in another room.Community Preparation Handbook (Adult Branch) 2010/11 10
  11. 11. 11. On your first day take a packed lunch with you as there may not be a convenient place to purchase lunch – many clinics and health centres are in residential areas. 12. If you have a mobile phone, turn it off when doing visits or clinics. 13. Make sure that you always carry the contact number of the clinic or health centre with you. Often your mentor will have a mobile phone or bleep number. Make a note of these as well. You may wish to give your mentor your own mobile phone number in case s/he needs to contact you while you are on your rounds. 14. If you are sick or are going to be late always contact the clinic as well as the placement office and inform both of them when you are well enough to return. If you have to take time off from the placement for any reason you will have to make up the time. It is best to do this during the placement, with the agreement of your mentor. If this is not possible you must contact the placement office and they will arrange for the time to be made up. 15. When you do unaccompanied visits always make sure that your mentor, associate mentor, or designated deputy knows your call list, your intended route and the likely time of your return to the clinic or health centre. 16. On your first day you should have an orientation tour of the clinic or health centre including fire exists, emergency arrangements etc. Some buildings have number coded security locks on internal doors. Make sure you know what they are and make sure that you do not disclose them to anyone. Clinics and health centres are public places so do not leave valuables unattended. 17. You are expected to attend your placement on any Bank Holiday and University closure days that may occur during the allocated period. You are not entitled to any time off from your placement for submission of assignments, meetings with tutors or similar reasons. 18. At the end of your placement make sure that you complete one of the evaluation forms that are held in every clinic and health centre. These forms are used during the annual placement quality review which is carried out by University and Trust staff. 19. All placement areas have University link teachers who are responsible for dealing with problems arising during the placement. These problems may be educational, related to patient care or arise from difficulties within the nursing team. A laminated notice with the link teacher’s contact details should be prominently visible on the placement notice board. 20. As with all other placements you will be expected to present your practice learning document to your mentor as soon after your arrival as possible and agree on your learning needs in relation to the available learning experiences. The intermediate and final meetings with your mentor must also take place in accordance with the University requirements. Note that your learning needs should be determined by the nature of the placement, for example learning needs connected with wound management should take account of the fact that woundCommunity Preparation Handbook (Adult Branch) 2010/11 11
  12. 12. management in the community setting differs in important ways from wound management in the hospital. Your mentor will advise. 21. You may have a “hub and spoke” placement where your mentor may arrange for you to spend periods of time with other services while remaining under your mentor’s general supervision. If you are in this position you will need to obtain from your mentor some additional record sheets for your practice learning document.Link teacher contact detailsCamden PCTKate Brown Archway CampusInstitutional Link 020 8411 6930 Lincoln Archway Campus 020 8411 5961 PCTCatrina Donegan Archway CampusInstitutional Link 020 8411 2632 Harris Archway Campus 020 8411 4681 Bradford Archway Campus 020 8411 6708 PCTVenetia Brown Archway CampusInstitutional Link 020 8411 6732 Preparation Handbook (Adult Branch) 2010/11 12