cardio

Created by Staff Nurse Hennon 1

Technical Servicesie. Medical Physics,

Electronics, Anaesthetic Technician

Paediatric Theatres

RVI

Oncology

Gastroenterology

ENT Airways

Intensive Care

General Surgery

Neo Natolog

yBurns and Plastics

Ward 1Ward 3

Ward 4

Ward 5

Ward 6

Ward 7

Ward 9Ward

35

Ward 16

Out Patient

s

Community

NGH24 + 26

BMT 23

PICU

Consultants and Medical Staff

Radiographers

Orderlies

Chaplain

Social Service

s

Specialist Nurse

Matron

UNN

FINANCE

DIRECTORATE MANAGER

SENIOR THEATRE NURSE

STERILESERVICES

Cardio

Orthopaedics

FRH

PAEDIATRIC THEATRESVICTORIA WING

ROYAL VICTORIA INFIRMARY

DEPARTMENT PROFILEWelcome to paediatric theatres. We are part of the Peri-Operative and Critical Care Directorate within the Newcastle Upon Tyne Hospital Trust, and also have close links with Children’s Services. The department is split into three separate theatres. We are based within the Victoria wing of the hospital, where all the paediatric wards are situated, and is split on two floors.

The department covers a broad spectrum of specialities, e.g. general surgery, plastics and reconstructive 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 floor next to ward 9. This theatre predominantly specialises in paediatric general surgery. Theatre 33 can be found on the ground floor between ward 2 and ward 3, and predominantly specialises in plastic and reconstructive surgery, but also covers some general surgery and oncology sessions. Theatre 32 is also based on the ground floor and can be found between ward 4 and ward 3, and is the dedicated emergemncy theatre. The latter covers 6 elective general surgery and plastics sessions, four emergency sessions, plus out of hours emergencies.

The theatres comprise of anaesthetics, theatre, and recovery areas within all. Changing and rest room facilities are available in each area. Staff work in teams, with rotation into each speciality at intervals.

The department is the regional centre for paediatric surgery, therefore within it there is great scope for the development of your knowledge and skills. We welcome all levels of student nurse 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 you throughout 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. There are many skilled nurses working within the department who can pass on their knowledge and expertise to you.

Shift Times/Off DutyThe department operates on a number of shift patterns. It is preferable that you work the same 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 early shifts operate, the first being 8am-4pm, and the second being 8am-5.30pm. The last shift you may be allocated is the late shift, which is 12.30pm-8.30pm. If you have any problems with these shifts it is advisable that you liase with your mentor, and they will try to solve the problem/

UniformAs every person in the theatre needs to conform to infection control regulations, you will also wear the theatre blues with a pair of clogs and a hat, these are all supplied by the department. You will change in the individual theatre you are placed in, and there is no need to wear your student nurse uniform to placement.


IdentificationAt all times you are expected to wear your university identity badge, and the theatre environment is no exception to this rule.


PROFILE OF LEARNING OPPORTUNITIES FOR PAEDIATRIC THEATRES

KEY ELEMENT:

INTERPERSONAL SKILLS

LEARNING OPPORTUNITIES

RESOURCE/RELEVANT PERSONEL/DEPARTMENT

Use of Telephone:Answering callsMaking callsRing back, etc.Bleep & Telephone systems

Use of the Computer:Tray tracking systemPatient investigation resultsPatient informationInternet & Trust intranetE-mail

Talking to:PatientsRelativesMulti-disciplinary team membersColleagues

Ancillary staff

Multi-disciplinary meetings & Medical ward rounds

Facilitating investigations

Nursing handovers

Managerial structure within the Trust

Team working

Patient transfer within the Trust

Patient transfer outside the Trust

Nursing staff/Medical staff/Health care assistants/Orderlies

Nursing staff/Medical staff/Health care assistants

Theatre & Ward sisters/Registered nurse/ Health care assistant/Medical staff/Multi-disciplinary team/Specialist nurses/Research sisters/Orderlies

Domestics/Porters

Medical staff/Registered nurse/ Physiotherapist/Infection control team/ Pharmacist

Registered nurse/Medical staff

Registered nurse

Registered nure/Theatre & Ward sisters/ Clinical nurse manager/Speciality manager/ Modern matron

Observation of roles with the team – all team members

Patient/Relative/Bed co-ordinator/Ward staff

Bed co-ordinator/Ward staff/Ambulance crew


KEY ELEMENT:

CLINICAL SKILLS



Patient hygiene:Skin carePressure care

Recording of physiological observations:Blood pressure, Central venous pressure, Temperature, Pulse, Respirations, Oxygen saturations, Weight, Blood glucose, Fluid balanceMaintaining accurate documentation

Administering medication:OralIntramuscularIntravenouslyRectalSubcutaneouslyIntravenous infusionsCare of cannulas & Central linesVenepuncture & CannulationNG/NJPhlebotomyAdministratin of blood & blood products

Aseptic Technique/Universal Precautions

Nutritional intake

Risk assessment:FallsHealth & SafetyCOSHHMoving & Handling – use of patslide

Infection Control:Handling blood-borne infection in the peri-operative environmentHand hygiene policyTheatre wear policy

Registered nurse/Health care assistant

Registered nurse/Anaesthetic & Recovery staff/Ward nurses/Medical staff

Registered nurse/Anaesthetic & Recovery staff/Ward nurses/Medical staff/Infection control team/Transfusion nurse/ Nutritional nurse/Dietician/Trust policies/Intranet/ Literature/Internet

Infection control policy – trust intranet

Theatre nurses/Anaesthetic & Recovery staff/ Health care assistants

Ward nurse/Nutritional nurse/Dietician

Registered nurse/Theatre, Anaesthetic, & Recovery staff/Infection control team & Link nurse/Moving & Handling link nurse/Health care assistants/Orderlies

Theatre nurse/Medical staff/Infection control team/Trusts policies – IntranetTheatre nurse/Medical staff/Health care assistants/Theatre sisters/Trusts policies - Intranet


KEY ELEMENT:

CLINICAL SKILLS CONTINUED



Catheter Insertion & Care:Procedure for inserting catheterUrinalysisCSU MSU collecting

Faecal occult blood testing

Arterial pressure monitoring:Patient safetyChecking/setting up equipmentInsertion & removalArterial blood removal

Scrubbing up Procedure:HandwashingGowning upGloving up

Disinfection Policy:Cleaning endoscopesSetting up medivator

Risk assessment

Health & Safety

Preparation for investigations:ConsentInformation

Registered nurse/Medical staffRegistered nurseRegistered nurse/Health care assistant


Registered nurse/Medical staff/Haematologist

Theatre sisters/Registered nurse/Medical staff/Intranet/Trust policies/Literature/ Internet – NATN website

Theatre sisters/Theatre nurses/Health care assistants

Theatre sisters/Theatre nurses/Medical staff/ Risk assessment officers

Theatre sisters/Theatre nurses/Medical staff/ Health care assistants/ Health & Safety officers

1Registered nurse/Medical staff/Trust policies/ Intranet/Literature

1


Invasive radiologyNon-Invasive radiology

Radiologist/Radiology nurse/Trust policies/ Intranet/Literature

KEY ELEMENT:

MANAGEMENT OF CARE



Use of Nursing ModelPhilosophy of CareDocumentation used

Nursing Process: Assessment –

Who assesses?How is assessment carried out/open or closed questions?What is assessed?Where does assessment take place?

Ward/Theatre communication concerning assessment issues

Planning –Care PlansRisk assessment toolsCare pathways

Multi-disciplinary planningDischarge planning

Referrals to other agencies –Specialist nurses (child protection, laser nurse specialist, etc)

Implementation/Evaluation –Multi-disciplinary team

Documentation Standards Protocols Policies Communication with patients

& relatives

Registered nurse/Theatre sisterRegistered nurse/Theatre sisterRegistered nurse/Theatre sister/Health care assistant

Registered nurseSources of information -Patient/Relatives/Notes/District nurse/ Transferring nurse nurse/Pharmacist/Specialist nurse

Ward/Theatre personel

Registered nurseLink nurseRegistered nurse/Specialist nurse/Medical staffMulti-disciplinary teamRegistered nurse/Medical staff/Patient/ Relatives


Registered nurse/Medical staff/Health care assistant/Orderlies/Physiotherapist/Infection control team/Dietician/Radiologists

Registered nurse/Medical staffRegistered nurseRegistered nurse/Theatre sister/Trust Intranet/Medical staffRegistered nurse/Medical staff/Trust Intranet – Royal Marsden handbook


KEY ELEMENT:

MANAGEMENT OF CARE CONTINUED



Time Management

Planning priorities

Dealing with difficult situations

Deceased patients

Patient property/valuables

Refusal of operation

Religious needs – Arranging priest, communication, etc

Registered nurse


Registered nurse/Theatre sister

Registered nurse/Theatre sister/Bereavement officer/Chaplain/Priest

Registered nurse/Health care assistant

Registered nurse/Medical staff/Ward manager/Theatre sister/Specialisty manager

Registered nurse/Medical staff/Hospital chaplian/Priest/Interperator


KEY ELEMENT:

ORGANISATIONAL AND MANAGERIAL ISSUES


RESOURCE/RELEVANT PERSONELDEPARTMENT

Managing a Team:Organisational skills Delegation skillsPrioritising skillsTime ManagementLeadershipOff-DutyManaging patient work loadQualityStandards of care

Implementing change

Giving information to – Staff

Medical staff

Patients & Relatives

Multi-disciplinary team members

Other departments

Resources:Stock controlDrugsMaterials managementNon-stockStationaryEstablishment/Skill-mix

Budget control

Registered nurse/Theatre sisterRegistered nurse/Theatre sisterRegistered nurse/Theatre sister/Medical staffAll Theatre staffSenior nurses/Theatre sisterSenior nurses/Theatre sisterRegistered nurseRegistered nurse/Theatre sister/Audit toolRegistered nurse/Theatre sister

Registered nurse/Theatre sister/Medical staff

Theatre sister/Speciality manager/Modern matron/Registered nurse

Theatre sister/Speciality manager/Registered nurse/Multi-disciplinary team/Theatre staff/ Ward staff

Registered nurse/Theatre sister/Medical staff/ Anaesthetics & Recovery staff/Health care assistant

Registered nurse/Medical staff/Theatre sister

Radiologist/Histopathology/etc

Senior nurses/Theatre sistersRegistered nurse/PharmacistSenior nurses/Theatre sistersRegistered nurse/Health care assistantRegistered nurse/Theatre sisters


Managing risk:Policies & Procedures – Safeguards for Invasive procedures

Senior nurses/Theatre sisters

Theatre sisters/Speciality manager/Senior nurses

Theatre sisters/Senior nurses/Medical staff/Trust Intranet

KEY ELEMENT:

ORGANISATIONAL & MANAGERIAL ISSUES CONTINUED

LAERNING OPPORTUNITIES


Managing risk continued:Equipment safety checks – Bi-polar & diathermy machines, etc

Quality control

Infection control

Moving & Handling

Emergency situations:Cardiac arrest

Fast bleep system

Violen incidents

Fire

Patient falls

Staff Development:Clinical supervision

Reflective practise

Preceptorship/mentorship

Health & Safety officer/Electronics/Registered nurse/Health care assistant

Theatre sister/Registered nurse

Theatre sister/Registered nurse/Infection control team & link nurse/Health care assistant

Moving & Handling link nurse/Health & Safety advisor/Registered nurse

Cardiac arrest team/Registered nurse/Medical staff/Anaesthetist & anaesthetic nurse

Registered nurse/Switchboard

Registered nurse/Medical staff/Theatre sister/ Security officer

Theatre sister/Registered nurse/Fire officer

Registered nurse/Health & Safety officer





KEY ELEMENT:

PATHOPHYSIOLOGICAL PROCESSES



INFECTION:Inflammatory process:SourceCross infectionTreatment

IMMUNOLOGICAL FACTORS:AntigensSuppression of immune systemDrugsRejections SCIDS

DISTURBANCES IN ELECTRLYTE BALANCE:Normal electrolyte balanceAnalysing blood resultsDehydrationAcidosis

ONCOLOGY:AetiologyPathologyTreatments, Chemotherapy, Intratechal medications, Bone marrow aspirates & harvests, Bone marrow transplants, Insertion of CVC Lines & Portacaths

CARDIOVASCULAR SYSTEM:Anatomy & physiologyInvestigationsTreatment regimes

Medical staff/Registered nurse/Literature/ Internet/Trust Intranet/Infection control team/Pharmacist

Medical staff/Registered nurse/Pharmacist/ Literature/Internet/Transplant team/ Immunologists

Medical staff/Registered nurse/Laboratory staff

Medical staff/Registered nurse/Palliative care team (Ward 16 multi-disciplinary team)/ Radiologists/Haematologists/Pharmacist


Cardiac arrestDefibrillationCardiac arrhythmia’sECG’s

Medical staff/Registered nurse/Anaesthetic staff/Cardiac arrest team/Cardiology team/ Pharmacist

KEY ELEMENT:

PATHOPHYSIOLOGICAL PROCESSES CONTINUED




RESPIRATORY SYSTEM:Anatomy & physiologyInvestigationsInfectionsOxygen therapyContinuous Positive Airway Pressure (CPAP)TreatmentsDrugs, Nebuliser therapyAnalysis of blood gas monitoringCollection of B.A.L specimensTracheostomy – permanent & temporaryTracheoscopy, Laryngoscopy, & BrochoscopyLaser treatment

LIVER & BILIARY SYSTEM:Anatomy & physiologyHepatitis BParacetamol overdoseLiver tumours & biosies of these tumoursSymptoms of liver disease – jaundice, ascites, encephlopathy

NutritionTreatments

BLOOD DISORDERS:Blood formation & destruction processRed blood cellsWhite blood cellsPlateletsClotting factorsLymphomaOesophageal Variceal haemorrhage & bandingEndoscopy proceduresBlood transfusionDVT

Medical staff/Anaesthetist/Anaesthetic nurse/ Registered nurse/Medical physics officer/ Physiotherapist/Respiratory consultant/ Pharmacist

Medical staff/Registered nurse/Hepat-biliary nurse specialist/Literature/Palliative care team

Dietician/Registered nurse/Medical staffMedical staff/Registered nurse/Pharmacist

Medical staff/Registered nurse/Haematologist/Heamatology nurse/Literature/Gastroenterologists/ Endoscopy unit/Transfusion nurse/ Trust intranet – policies & procedures

KEY ELEMENT:

PATHOPHYSIOLOGICAL PROCESSES CONTINUED

LEARNING RESOURCE/RELEVANT PERSONEL/


OPPORTUNITIES DEPARTMENT

ENDOCRINE & METABOLIC DISEASE:Diabetes mellitusLong term use of steroids & administration of high dose steroids

NERVOUS SYSTEM:EncephlopathyInfectionsDrugs

SKELETAL SYSTEM:Craniofacial Procedures – Cleft palatesTreatmentsDrugsPlating/Wiring/FixationsRemoval of accessory digits

BURNS:Classification of BurnsCauses of burnsTreatment & DressingsDrugs & TherapiesSkin graftsFluid resucitation

Medical staff/Registered nurse/Diabetic nurse specialist/Diabetologist/Pharmacist/LiteratureTrust Intranet – policies

Medical staff/Registered nurse/Microbiologist/Pharmacist/Literature/ Trust Intranet – policies

Medical staff/Registered nurse/Cleft palate team/Radiology/Pharmacist/Ward staff/ Anaesthetist

Medical staff/Registered nurse/Ward staff/ Pharmacist


cardio

Documents

health

anatomy

key element

ground floor

theatre

work

ward 3