PROFILE OF LEARNING OPPORTUNITIES. St Oswald’s Hospice

Last updated Oct 09

GUIDANCE FOR MENTORS AND STUDENTS. This profile of learning opportunities is a document which details learning opportunity within your community placement. This file is a growing and dynamic document, with staff and students being responsible for keeping it updated and relevant for their clinical area. It is intended that mentors and students utilise this resource to select appropriate learning opportunities to help students meet their specified competencies. It is expected that students will use this file as a resource and be proactive in identifying their learning needs. Most of these learning opportunities will take place with staff nurses however there will also be opportunity to work with other allied health care professionals. Despite the diversity in learning opportunities within Specialist Palliative Care not all of these opportunities will be accessible during placement. However, this resource gives an overview of the professional contacts which students may encounter during their placement. On the first day of practice placement within Specialist Palliative Care the student must have an induction into their practice area. Please ensure that the induction checklist is completed and retained in this portfolio. Following placements, student evaluation forms will be returned to the practice area. These should be used to reinforce good mentor practice and developmental opportunities. Please retain student evaluations in this portfolio for audit purposes.

Jeannette Wilkinson. Practice Placement Facilitator. Tel: 0191 2915934. (Copyright Lynn Dracup December 2003)

2

CONTENTS

1. AREA PROFILE. 2. LEARNING ZONES. 2.1. St Oswald’s Hospice 2.2. The Team

3. LEARNING OPPORTUNITES. 4. ADDITIONAL LEARNING OPPORTINITIES SPECIFIC TO AREA OF PRACTICE.

3

1. AREA PROFILE.

CLINICAL AREA (DESCRIPTION) Specialist Palliative Care, Adult in patient unit.The unit has 15 beds. Patients with life limiting illness ( malignancies and nonmalignancies) are referred to St Oswald’s Hospice for symptom control, rehabilitation and end of life care. Emphasis is on provision of patient -centred, individualised and holistic care which means addressing physical, psychological, social, and spiritual needs.

LOCATION St Oswald’s Hospice, Regent Avenue Gosforth, Newcastle Upon Tyne, NE3 1EE. TELEPHONE NUMBER 0191 2850063 SHIFT PATTERNS Early shift 8.00am – 4.00pm Late shift

13.15pm – 21.15pm

Night shift 20.45pm - 08.15am

4

PHILOSOPHY OF CARE WE: Value each patient as an individual Put quality of life first Provide care without discrimination Facilitate integrated care Provide appropriate support for families and carers Value those working for the hospice Provide a quality service Provide a major resource in Palliative care Manage the hospice effectively

NURSING MODEL USED Roper,N. Logan, W. Tierney, A. (1996) The elements of nursing, A model for nurses based on a model of living. Fourth Edition, New York, Churchill Livingstone.

5

MENTORS Valerie Forster Lynn Bell Vivienne Whillis Catherine Tetley Amanda O’Connell Elizabeth Canning Annie Fitzsimmons

NAMED PERSON RESPONSIBLE FOR POLOValerie Forster – In Patient Unit Manager DATE POLO REVIEWED- June 2009 POLO REVIEW DATE – June 2010

6

STUDENT NURSE INDUCTION CHECKLIST

Student Name: Start Date: This programme is a guide to assessors to aid the integration of student nurses into the working environment. It is good practice to have the document completed within the first two days of the placement. Student nurses must be allocated an assessor at least one week before the commencement of the placement. Within the school health service, the mentor will arrange to be with the student on their first day of placement. NB It must be remembered that the student must work 50% of the week with her/his assessor. ORIENTATION CHECKLIST Shown around the working environment

SIGNATURE

DATE

Introduction to team members Working hours discussed Parking & Transport discussed Procedure for reporting sick Discuss dress code Given student nurse profile & philosophy Dining room or lunch arrangements

TO BE SHOWN Health & safety file Door entry codes Control of infection policies Clinical/ operational policy file MDT care plan Emergency exits Fire drill & procedure Fire extinguishers 7

LEARNING ZONES.

2.1 St Oswald’s Hospice

2.2 The team

8

Day Hospice Lympho edema care

Principles of pain /symptom control

Home visits

Spiritual care

Carer support group.

Specialist palliative care

St Oswalds Hospice

Holistic assessment

Bereave ment support group

Outpatients clinic

Communication skills Comple mentary therapy

Domicillarty visits

Others include, Acupuncture clinic Outreach sessions Review and planning meeting Oncology Unit

9

2.2 The team

Catering staff

Social worker chaplain

Community pharmacist

Health care assistant

Complementary therapist

doctor

Patient and family staff nurse

physiotherapist

volunteers

Carer support group House keepers

Occupational therapist Ward clerk

10

3.LEARNING OPPORTUNITIES. INTERPERSONAL SKILLS. LEARNING OPPORTUNITY

RESOURCE/PERSONNEL.

Effective communication, talking/ interaction with patients/clients /carers/relatives/staff in a variety of settings.

Nursing team/MDT

Awareness of own communication skills both verbal and non-verbal.

Admin support. Nursing team/ MDT

Use of telephone/answering calls/ Use of computer, email and internet

Nursing team / ward clerk

Multi-disciplinary and multi agency meetings.

Nursing team/MDT/ Macmillan nurse/ community and hospital palliative care teams

Discussions with other relevant professionals involved in patients care.

District nursing team / Macmillan team/ community and hospital palliative care teams

Holistic care of different groups of people eg. cancer, non malignancies, young, old

Nursing team/ Health professionals in other specialities

Promotion of informed choice regarding treatment/ medications/health promotion strategies

Nursing team/ Macmillan team/ oncology team/ Professionals Allied to Medicine (PAMS)

Nursing team/ Medical team/ PAMS Demonstrate sensitivity for patients/carers in relation to distressing information. Nursing team/Medical team/ PAMS Support and enable patients/carers to take action and prioritise health needs.

Demonstrate effective communication between Palliative care/oncology networks

Macmillan teams/ hospital and community palliative care teams /oncology unit

11

Bereavement support.

Bereavement support volunteers/ chaplain/ nursing team

Interpreter service Experiences with clients from a variety of ethnic backgrounds

12

CLINICAL SKILLS. LEARNING OPPORTUNITY

RESOURCE/PERSONNEL.

Aseptic/ clean dressing techniques

Nursing team

TPR, BP, weight & height, pulse oximitry, urinalysis, fluid balance, blood glucose, fluid balance, monitoring, recording, and interpreting.

Nursing team

Observation of venepuncture.

Medical team

Drug administration in palliative care

Nursing team

Management of subcutaneous therapies (including syringe drivers)

Nursing team

Awareness of nutritional needs for patients.

Dietician/ catering staff/ Staff nurse Catherine Ward/ nursing team

Promotion of continence and Management of continence and use of appropriate aids (Indwelling and external).

Stoma care link nurse/ nursing team

Apply knowledge of pharmacology to patients. Nursing team/ medical team/ community pharmacist Assessment and Management of patients with pain (pharmacological and nonpharmacological)

Medical team/ nursing team/ nursing team/ medical team/ acupuncture clinic/ complementary therapist

Awareness of patient handling assessment Moving and handling facilitator/ physiotherapist/ nursing team Awareness of pressure risk scores. Tissue viability link nurse/ nursing team Awareness of psychosocial/ spiritual needs Nursing team/ medical team/ hospice chaplain/ cognitive behavioural therapist

13

HEALTH PROMOTION OPPORTUNITIES. LEARNING OPPORTUNITY

RESOURCE/ PERSONNEL

Network with professional and nonprofessional agencies involved with health promotion/ education in this care setting Health education topics include: Hygiene Dental health Lifestyle First aid National targets for cancer care, eg cancer plan (2000) Sexual health topics related to altered sexuality and health promotion include: Contraception Sexually transmitted diseases Impact of disease/treatment Psychosexual assessment/ support / information needs

Hospital dietician/ community dentist/ optician/ nursing team / medical team

Information available from In-Patient Unit Manager. Network with professional and nonprofessional agencies involved with health promotion/health education./ BACCUP

14

CARE MANAGEMENT OPPORTUNITIES. LEARNING OPPORTUNITY

RESOURCE/PERSONNEL.

Use of computer to access patient information both written and electronic if available.

Ward clerk /nursing team

Patient/ client handovers/information sharing both written & verbal between teams.

Multidisciplinary team

Undertake assessment based on patients/clients holistic needs.

Nursing team/ multidisciplinary team

Participate in ongoing assessment of holistic health needs

Multidisciplinary team

Patient documentation/care assessment/ planning/implementation and evaluation.

Nursing team

Identify timescales related to patient outcomes ( goal setting)

Nursing team

Identifying the role of non professional, voluntary and statutory agencies in patient care.

Nursing team / volunteer co-ordinator

Analyse and interpret information to inform care delivery and take appropriate action.

Nursing team/ medical team

Clinical audit.

Nursing team/ medical team

Health promotion opportunities.

Nursing team

Working with ethnic minorities.

Nursing team/ social worker/ interpreter

15

ORGANISATIONAL/MANAGEMENT OPPORTUNITIES. LEARNING OPPORTUNITY

RESOURCE/PERSONNEL.

Use of computer systems/ email/internet/intranet.

Admin support. Nursing team/ ward clerk

Accessing patient results and planning appropriate action.

Nursing team

Time management/ prioritising needs.

Nursing team

Interprofessional working.

Nursing team/ Professionals Allied to Medicine

Holistic assessment

Nursing team.

Effective team management including appropriate delegation of duties.

Nursing team

Awareness of knowledge base and skill mix.

Nursing team

16

4. ADDITIONAL LEARNING OPPORTUNITIES SPECIFIC TO AREA OF PRACTICE. LEARNING OPPORTUNITY

RESOURCE/PERSONNEL.

Awareness of lymphoedema assessment and management

Lymphoedema nurse

Assessment and Management of symptoms other than pain

Nursing team/ medical team/complementary therapist

Management of palliative care emergencies

Nursing team/ medical team/ oncology unit

Palliative radiotherapy and chemotherapy

Nursing team/ medical team/ oncology unit

Understanding of the grieving process

Nursing team/ medical team/ chaplain/ bereavement support group

Integrated care pathway for the dying

Multidisciplinary team

Working with volunteers

Nursing team/ volunteer co-ordinator

Rehabilitation in palliative care

Nursing team/ physiotherapist/ occupational therapist

Information and support needs of palliative care patients and their family

Nursing / multidisciplinary team/ BACCUP

17

18

5. REFERAL PATHWAYS.

See Hospice clinical policies and procedures situated in the ward office

19

6. RELEVANT STANDARDS OF PRACTICE. See clinical and operational policies and procedures situated in the ward office

20

Student’s Visiting Specialist Nurses / Professionals Form. Date of visit: During the allocated time with the Specialist Nurse / Professional, the student will discuss the objectives that they would like to achieve. What do you expect from the day (please complete before attending):

Furthermore, at the end of the placement visit the student will demonstrate: AIMS

EVIDENCE GATHERED

REFLECTION / EVALUATION

Name of Student:

Name of Specialist Nurse/ Professional:

Date:

Signature of Student:

Signature of Specialist Nurse / Professional:

Date:

21

STUDENT DUTY ROTA DATE W/C

MON MENTOR

TUE MENTOR

WEDS MENTOR

THUR MENTOR

FRI MENTOR

22

MAD students 2nd year Adult/Child Branch Placement Guidelines.

Weeks 1 - 2 The student requires a comprehensive orientation into the clinical area and to complete an induction checklist in the POLO. During this important formative period the foundations for the placement will be laid. The student and mentor will discuss the required learning outcomes, negotiate a learning contract and agree an action plan, utilizing the POLO file and student portfolio. The student’s role during this initial period will be mainly one of observation, shadowing the district nurse, health visitor and other members of the community and practice nursing team. The student will be introduced to PHCT members and practice support staff, including surgery receptionists and admin staff at the locality base, and will start to become familiar with practice routines and regular channels of communication.

The student will be introduced to patients and should begin to develop a general awareness of both the practice profile and the current district nursing caseload.

Weeks 2 – 4 This period will be used to consolidate relationships and clinical practice and to address targets outlined in the action plan at the commencement of the placement. The student and mentor will be expected to participate in reflective discussions with the mutual expectation that any areas of concern or confusion will be identified promptly and resolved in an open and professional manner.

It is expected that the student will take a progressively more active part in care under supervision and negotiation with mentor.

Weeks 4 – 8 During this period the student will be expected to participate in patient care and to demonstrate progress in terms of the acquisition of knowledge, skills and attitudes relevant to community health care. Any issues raised during placement must be addressed with the student’s guidance facilitator and the PPF so that an action plan can be agreed to facilitate further progress and achievement of competencies. The summative assessment and final marking of the student by the mentor will be completed. The student evaluation of their placement must be photocopied and retained in the POLO for audit purposes.

23

MAD students 3 rd year Adult/Child Branch Internship Placement Guidelines. Weeks 1 - 2 During this important formative period the foundations for the placement will be laid. The student and mentor will discuss the required learning outcomes, negotiate a learning contract and agree an action plan. The student’s role during this initial period will be mainly one of observation, shadowing the district nursing sister and other members of the community and practice nursing team. The student will be introduced to PHCT members and practice support staff, including surgery receptionists and admin staff at the locality base, and will start to become familiar with practice routines and regular channels of communication.

The student will be introduced to patients and should begin to develop a general awareness of both the practice profile and the current district nursing caseload. Weeks 2 - 4 This period will be used to consolidate relationships and clinical practice and to address targets outlined in the action plan at the commencement of the placement. The student and mentor will be expected to participate in reflective discussions with the mutual expectation that any areas of concern or confusion will be identified promptly and resolved in an open and professional manner.

It is expected that the student will take a progressively more active part in patient care in negotiation with mentor. Weeks 4 - 6 During this period the student will be expected to participate fully in patient care and to demonstrate progress in terms of the acquisition of knowledge, skills and attitudes relevant to community health care. The student will be expected to commence independent visits delegated by the mentor, or a designated supervisor. The student will be encouraged to discuss patients suitable for inclusion in their personal caseload of patients and negotiate with mentor regarding final selection. Weeks 6 - 18 During the final part of the placement the student will follow an internship model of practice. They will continue to work thorough their competencies and devise action plans based on their individual learning needs. The aim is to achieve a balance of responsibility somewhere between the levels of 3rd year student and first year D grade staff nurse, with optimum (negotiated) independence versus supervision. The student may: make independent visits to their caseload patients and to others delegated by mentor (or designated supervisor)

24

undertake full (repeat) patient assessments and complete sample care-plans for selected personal caseload patients for discussion with mentor arrange daily meetings with mentor (or designated supervisor) for supervision seek timely support and advice from mentor (or designated supervisor) as appropriate be professionally responsible with regard to limitations of practice, in accordance with the Code of Professional Conduct (NMC 2002) N.B. Mentor will provide emergency contact telephone numbers and the student must ensure that these are carried whenever on duty It is vital that the patient’s safety is assured, as well as that of the student and mentor. Therefore the above suggestions are based on the discretion of the individual mentor and their knowledge of the student’s competencies and patients within their caseload.

Student assessment will be carried out during the final week, along with student evaluation of the placement (individual and group). This feedback will assist both the mentor and the trust in planning future internship placements. N.B.

Students may find it helpful to refer to “An NMC guide for students of nursing and midwifery” (NMC 2002). Pages 4 & 5 are particularly relevant

25