WELCOME TO THE DERMATOLOGY DIRECTORATE

Review 2014 1

Acknowledgements Authors:  Anne Pitkeathley  Ian McGarry  Christine Watson  Lynda Krzyzosiak

With thanks to the Critical Care Unit Newcastle upon Tyne Hospital Trust for providing references and basic introduction, also the Nursing Staff within Dermatology who contributed to the final document.

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Contents Page

Title

Page number

Introduction

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Welcome

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Off Duty

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Philosophy

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Learning Opportunities Diagram

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Organisational and management Issues

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Interpersonal skills

10

Clinical Skills

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Management of care

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Health Development opportunities

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Pathophysiological Processes

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References

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Introduction Many people find a placement as a student to new area very daunting. In order to help students over this initial apprehension as they begin new placements all students are allocated a mentor who is a first level registered nurse who should have completed a teaching certificate. The role of the mentor is to provide support and advice to the student in developing their role, as well as helping the student to work towards mutually agreed goals and outcomes, within a supportive relationship. This can be achieved by acting as a role model and a clinical expert. This supportive individualised teaching and learning interaction enables student nurses to develop their knowledge and skills within a trusting supportive relationship. It also plays an essential part in the socialisation and professional development of nurses. (O’Malley, Cunliffe, Hunter and Breeze 200) To facilitate this process a pack was proposed, taking the form of a portfolio, which individuals could use to build up the extensive record of their practice and experience as they moved throughout dermatology. A working group was established to undertake this project, with representation from all areas, and after much hard work this portfolio was developed. References O’Malley, C. Cunliffe, E, Hunter S, and Breeze J. (2000) Preceptorship in practice. Nursing standard 14(28): 45-49

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WELCOME TO THE DERMATOLOGY DEPARTMENT The dermatology department at the RVI is divided into the following areas, all of which you will rotate through whilst working with a preceptor in order to reach the appropriate aims.      

Phototherapy . Treatment/Biopsy room Patch test area Clinics Surgical Day Unit Ward 5

General information The outpatients department is open Monday to Thursday 8.30am-5.00pm and Friday 8-30am-4-30pm and is closed Saturday/Sunday and all Bank Holidays Approximately 50,000 patients pass through the Out patients department per year and as we are a teaching hospital we are closely connected with the university. You will therefore be in contact with many medical students, GP’s, visiting nurses and doctors including our own Consultants, Senior Registrars and SHO’s. The patient’s charter is adhered to and the named nurse is implemented throughout the department. The Ward Ward 5 comprises of 8 beds all individual rooms with en suite facilities.The ward caters for both male and female patients all above the age of 16 years. There is also a day care centre which treats out patients on a daily basis ( Mon- Fri). The day care centre also carries out treatments on patients on other wards who need dermatology input. Children The Department has a close relationship with the paediatric wards on which we have access to five beds. Any child needing treatment for a skin condition is however treat in the paediatric area by the paediatric dermatology nurse during weekdays and by the ward staff at the weekend. Uniform Please note it is hospital policy that uniform is not worn whilst travelling to and from the hospital

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Off Duty and Holiday Every effort is made to ensure that off duty is prepared 4 weeks in advance. There is a request book available whereby special requests can be noted, although every effort is made to honour these requests it is not always possible to meet every staff members preferences. Please refer to the Trust Health at Work document on the intranet regarding sickness/ absence from the work place.

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The Dermatology Department Nursing Philosophy  We aim to provide a patient centred service that is research based and in line with essence of care.  We regard each person as an individual and respond to their needs accordingly  We believe that as dermatology nurses we must endeavour to use our specialist knowledge and skills to provide a secure an empathetic environment for all our patients  It is our practice to provide health education which will enable each individual to attain a greater level of independence and understanding  We appreciate the person as part of the family unit and for this reason we encourage their involvement in care  Each patient whether receiving inpatient or outpatient treatment will be allocated a named nurse  We have adopted a system of nursing on Ward 5 in which we seek to provide individualised nursing care utilising the Roper, Logan and Tierney model of nursing care the activities of Living (1990)  We will ensure that there is a suitable learning environment for all grades of nurse. We believe that the continuing education of nurses is essential  We aim to work as part of a multi-disciplinary team to provide quality care and believe that audit is essential in ensuring quality of care  We believe we should promote a feeling of collaboration and mutual respect between patients and nurses

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Ward 5 8 in patient & 8 day case beds Mixed 5 Children’s beds

Theatre Main theatre Biopsy Nurse Led

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Treatment room Dermojet Cryotherapy Sutures Warts Leg Ulcers Biopsy Eczema Care

Student Learning Opportunities within Dermatology Directorate

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Clinics Camouflage PDT Melanoma Screening clinic Paediatric Nurse Led Clinics

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Patch testing Prick Testing Patch Testing

PUVA Hand and Foot Immersion PUVA Dressings PUVA TL01 UV6 Arm Testing

Student learning opportunities within the directorate of

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Dermatology Organisational and management Issues Learning Opportunities

Resources

Managing a team  Organisational skills  Delegation Skills  Prioritising skills  Time management  Leadership  Off Duty  Managing patient workload  Quality/Standards of care  Implementing change Communication  Staff  Doctors  Patients  Relatives  Multi disciplinary team  Other departments

Registered Nurse/Nurse Manager Registered Nurse Registered Nurse Registered Nurse Sister/Nurse in charge Sister/grade 5 staff Nurse Registered Nurse Audit tools/Registered Nurse Registered Nurse Registered Nurse Registered Nurse Registered Nurse Registered Nurse Registered Nurse Registered Nurse

Resource management  Stock control  Drugs  Materials management  Non-stock  Staff Skill mix

Registered Nurse Registered Nurse Registered Nurse Registered Nurse Registered Nurse

Risk Management  Policies procedures  Equipment checks  Quality control  Environmental checks  Infection control  Moving and handling Emergency Situations  Cardiac arrest  Violent Incidents  Fire  Patient falls Staff Development  Clinical Supervision  Reflective practice

Sister Registered Nurse Registered Nurse Health Care assistant Registered Nurse Moving and handling co coordinator Cardiac arrest team/Registered Nurse Registered Nurse/security officer Fire Officer/Registered Nurse Registered Nurse Registered Nurse Registered Nurse

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Student learning opportunities within the directorate of Dermatology Interpersonal skills Learning Opportunities Use of the telephone Answering calls Making calls Ring back etc Bleep system Use of the computer to get Patient investigation results Patient information Internet F mail access Talking to Patients Relatives Doctors Other nurses including specialist nurses Multi disciplinary team referrals Ancillary staff MDT meetings Doctors ward rounds Consultants ward round Booking transport Facilitating investigations Nurses handovers Managerial structure in Trust Team working Patient transfer in Trust Patient transfer outside the Trust

Resources Ward Clerk

Ward Clerk

Registered Nurse

OT/Physio/Social workers Domestics Registered Nurses Doctors/registered Nurses Ward Clerk Registered Nurses Registered Nurses Sister Observation of roles Registered Nurse

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Student learning opportunities within the directorate of Dermatology Clinical Skills Learning Opportunities                     

Mouth care Hair/nail care Skin care Pressure area care Recording of observations, BP, Temp, Pulse, Weight, Blood Glucose Urine output Maintaining accurate Charts Giving medications, Orally, Intramuscularly, Sub cutaneous, Rectal Care of venflons Medical devices Aseptic technique Nutritional intake Risk assessment Moving and handling Use of hoists and aides Infection control Catheter care Urine testing Patient safety Preparation for investigation Consent Radiology

Resources Registered Nurse Registered Nurse Registered Nurse Registered Nurse/Tissue viability Nurse Registered Nurse

Registered Nurse Registered Nurse Registered Nurse Registered Nurse Registered Nurse Registered Nurse Moving/ handling facilitator Registered Nurse Registered Nurse Registered Nurse Registered Nurse Registered Nurse Registered Nurse Dr Radiologist

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Student learning opportunities within the directorate of Dermatology Management of care Learning Opportunities Use of Nursing models Philosophy of care Documentation Used Nursing process  Assessment  Planning  Implementation  Evaluation  Care planning  Care pathways  Risk assessment tools  Multi disciplinary learning  Discharge planning  Referrals to other agencies Physiotherapists Social Workers District nurse Patients property valuables Protocols Policies Self discharge Religious needs Ward Rounds

Resources

Registered nurse

Registered Nurse Registered Nurse/Sister Sister/Registered Nurse Registered Nurse/Doctor Registered Nurse/Chaplin Registered Nurse/Doctor

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Student learning opportunities within the directorate of Dermatology Health Development opportunities Learning Opportunities

Resources                

Healthy lifestyle strategies in relation to: Smoking cessation  Alcoholic liver disease  Bowel disorders  Cancer  Obesity  Diabetes  Eating for a healthy heart  Healthy eating  Drug abuse  Promotion of exercise  Stroke rehabilitation  Pulmonary rehabilitation  Models of health promotion  Counselling  Understand the role on anti TNF drugs in the treatment of Psoriasis namely Infliximab and Etanercept.

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Smoking cessation nurse Dietician/GI consultant Dietician/Nutritional nurse Macmillan nurse Dietician Diabetic nurse specialist/dietician CCU/Rehab nurse Dietician Drug and alcohol team Physiotherapist Stroke unit/ Physiotherapist Heart failure specialist Registered Nurse Registered Nurse Registered Nurse

Pathophysiological Processes Learning opportunities Infection Inflammatory process Source Nature and spread Treatment

Immunological Factors Antigens Auto antigens Suppression of the immune system Drugs Disorders

Books/registered nurse/doctors/laboratory Pharmacists

Books/registered nurse/doctors/laboratory Pharmacists

Disturbances in water and electrolyte balance Normal electrolyte balance Reading and understanding of blood results Dehydration Water excess (ADH) Acidosis

Books/registered nurse/doctors/laboratory Pharmacists

Oncology Epidemiology Aetiology Pathology Treatments chemotherapy, radiotherapy, drugs

Books registered nurse/doctors/pharmacist/Macmillan nurse/lung cancer nurse/ St Oswald’s hospice/radiotherapy unit

Cardiovascular system Heart failure CCF, LVF MI Cardiac arrest Hypertension Cardiac arrhythmia Angina ECG

CCU/Cardiographers/Angina facilitator

Registered nurse/respiratory nurse/ARAS team/pulmonary technician/doctors/pharmacist/link nurse

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Respiratory System Anatomy and physiology Investigations Treatments Infections COPD Asthma Emphysema Fibrosis Oxygen therapy Nebulisers

Kidney and genitourinary system Infections Drugs Investigations Testing urine Pyelonephritis Fluid balance 24hr urine collections

Registered nurse/doctor/books

Registered nurse/doctor/books

Registered nurse/doctors/radiology/laboratory/continence nurse/link nurse

Registered nurse/doctor/books

Diseases of the blood Blood formation ad destruction process Red blood cells White blood cells Platelets Anaemia Blood transfusions Malignant disorders Lymphoma’s Leukaemia Myeloma Haemorrhage Thrombosis

Registered nurse/doctor/books

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Theatre Malignant tumours  Basal cell carcinomas  Squamous Cell Carcinomas  Melanomas  Bowens Disease Non-Malignant  Benign moles  Polyps  Warts  Granulomas  Cysts Seborrhoeic Wart Pyogenic granuloma Actinic keratosis Viral wart Benign papular mole Skin tags Fibro-epithelial polyp

Consultant/Registrars/SHO

Nurse Led Minor Surgery List

Endocrine and metabolic disease Diabetes mellitus Thyroid problems Long term use of steroids Pituitary problems Serial blood sugars

Registered nurse/doctor/books/pharmacist/ diabetic nurse specialist

Nervous system Epilepsy Tumours Headaches CVA Infections

Connective tissue, joints bones Arthritis Lupus Osteoporosis Osteoarthritis Healing process Infection

Registered nurse/doctor/books/pharmacist/ Stroke nurse specialist Control of infection nurse

Registered nurse/doctor/books/pharmacist/physiotherapist/osteoporosis nurse

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Skin Anatomy Psoriasis Eczema Leg ulcer Skin cancers Skin swabs Scrapings Woods lamp Virology specimens Doppler’s Skin biopsy Suture removal Paediatric inpatient

Registered nurse/Doctor /student file/ Registered nurse/Doctor /student file/Lead nurse Registered nurse/Doctor /student file/Lead nurse Registered nurse/Doctor /student file/Lead nurse Registered nurse/Doctor /student file Registered nurse/Doctor /student file Registered nurse/Doctor /student file Registered nurse/Doctor /student file Registered nurse/Doctor /student file Registered nurse/Doctor /student file Registered nurse/Doctor /student file/Lead nurse Registered nurse/Doctor /student file Paediatric Lead nurse

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References Atherton DT(1995) Eczema in childhood: The facts. Oxford University Press London Brigdell etal(1996) Atopic skin Disease A Manuel for practitioners. Wrightson Biomedical Publishing Petersfield. Chambers. C(2002) Emollients – a guide to their use in eczema. Journal of Community Nursing 16(3) 20-25 Lawson. S etal(1998) The family impact of childhood atopic dermatitis. British Journal of Dermatology 138:107-113 Falany.V (2003) New concepts in wound bed preparation. Spranger Collins etal(2002) A-Z dictionary of wound care. Mark Allen publishing Graham, Brown and Burke(1998) Mosby s’ colour atlas and text of dermatology. Mosby Lachapelle.JM (1994)Atlas of dermatology. UCB Pharma Theodoer A, Thomovitch, Samuel J. etal(1989) Flaps and Grafts in dermatology surgery. Year Book medical publishing Lawrence C(2002)An introduction to dermatology surgery. Churchill Livingston Theatre Technique Balliere Tindall (2004)

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