Induction Activity Book - Practice Development … the can be felt at certain points of the body...

For HCAs

Version: 2016 v1.1

Induction Activity Book

#Hellomynameis

Royal Surrey County Hospital

HCA Care Certificate Induction Activity Book for HCAs 2016 v1.1

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Original Book Content

J. Ashfield (rtd) Practice Development Sister

L. Bowller Acute Learning Disability Liaison Nurse

G. Chapman Head of Speech & Language Therapy

S. Cummings Nurse Trainer, Safeguarding & Mental Health

F. Gallagher Named Nurse Childrens Safety

E. Hambly Student Nurse (University of Surrey)

G. Hickman Infection Control Lead Nurse

R. Ho Occupational Therapist

H. Hopkins Diabetes Specialist Nurse

A. Lambert Falls Nurse Practitioner

J. Rigby Lead Nurse (EAU)

E. Ripley Team Lead, Occupational Therapy

M. Slater Tissue Viability Clinical Nurse Specialist

S. Towers Superintendent Physiotherapist

B. Tuthill Diabetes Specialist Nurse

N. Waldron Senior HR Adviser, Policy & Advice

F. Wright Practice Development Nurse Specialist in Dementia Care

K. Wright Infection Control Nurse

New Content

J. Bowler Practice Development Sister

S. Whitehouse Senior Practice Development Sister

Images, Graphics & Design

S. Pawlin Senior Charge Nurse Practice Development



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Contents Introducing Bob ......................................................................................................................... 6

Bobs Basic Admission Details .................................................................................................. 7

How the Body Works ................................................................................................................. 8

Bobs Bones ................................................................................................................................ 10

Hospital Hunt ............................................................................................................................ 11

Age Simulation Empathy Suit Reflection ............................................................................. 15

Sit & See .................................................................................................................................. 16

Communication ...................................................................................................................... 20

Communication Wordsearch ............................................................................................... 23

Nutrition ..................................................................................................................................... 24

Nutrition Station Reflection .................................................................................................... 26

Infection Control ...................................................................................................................... 27

Team Working (lego excersise) ............................................................................................. 29

Hygiene, Privacy & Dignity ..................................................................................................... 30

Falls Prevention, Movement & Enablement ....................................................................... 32

Occupational therapy ........................................................................................................... 40

Patient Assessment .................................................................................................................. 42

Vital Signs & N.E.W.S ................................................................................................................ 44

NEWS Chart .............................................................................................................................. 45

24 hour Fluid Balance Chart .................................................................................................. 48

Pressure Ulcer Learning ........................................................................................................... 50

HCA Induction Supernumery Learning Objectives ........................................................... 52

Reflection as a learning tool ................................................................................................. 55

Your Reflection ......................................................................................................................... 56

Diabetes .................................................................................................................................... 58

Risk Assessment ........................................................................................................................ 61

Record Keeping ....................................................................................................................... 66

Admission & Discharge ........................................................................................................... 71

Safeguarding ........................................................................................................................... 80

Learning Disability .................................................................................................................... 84

Caring For Patients With Dementia ...................................................................................... 86

Poem ......................................................................................................................................... 89


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Your Development .................................................................................................................. 90

Managing Your Time ............................................................................................................... 91

Ward Handover ....................................................................................................................... 92

Managing Your Time Reflection ........................................................................................... 93

Journal Review ......................................................................................................................... 94

Glossary Quiz ............................................................................................................................ 96

What next? ............................................................................................................................... 97



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Introducing Bob

This is Bob Whitehouse. You will get to know him rather well over the course of the induction as he features in some of the training scenarios and simulations you will undertake. Bob is a figment of our imagination and is not based on a real-life person. We invented him to help you visualise and relate different aspects of your training to a single patient journey.


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Bobs Basic Admission Details



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How the Body Works Fill in the blanks

The words in the table are all words you will commonly hear in your clinical area. Complete the following article and fit the words into the correct blank space. All the words are used at least once, and some will be used more than once.

Blood is pumped around the body by an organ called the .

Oxygenated blood is carried around the body by a system of blood vessels

called . Blood is returned to the by blood vessels

called .

The artery, carries blood from the heart to the . This is

where it picks up oxygen before returning to the to be pumped

around the body. Blood pressure is a measure of the pressure on the walls of

the . It is the force the blood needs to get through these vessels.

When the heart contracts, we get the top reading of the blood pressure

called the reading. The relaxed period of a contraction gives the

bottom blood pressure reading, which is called the reading.

When the heart contracts and beats, the surge of that is pushed

through the can be felt at certain points of the body when we

place our fingers over the .

These beats are known as the and are counted as the number of

beats per minute. It can tell us the rate of which the is beating,

how strongly it is beating, and if it is beating in a regular or irregular pattern.

HEART ARTERIES VEINS PULMONARY LUNGS SYSTOLIC RESPIRATION

STOMACH OESOPHAGUS URETERS BLADDER URETHRA DIASTOLIC BLOOD

PULSE HEARTBEAT INSPIRATION EXPIRATION INTESTINES KIDNEYS


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When we breathe in we are taking air into the , this is known as

. When we breathe out it is called . This cycle, in and

out is called . We count this by looking, listening and feeling the

chest rise and fall for a full minute.

When we eat and drink, the food and fluid goes down the and into

the where it is digested.

Digestion releases nutrients and fluid, which are then taken into the blood

stream. The digested food then moves into the , before being

eliminated as waste.

The fluid part is transported via the blood stream to the where it is

filtered. The soluble waste then travels down the to the ,

before being passed out of the body via the .

The above is a very brief overview of some of the body functions, to help you understand what is happening within the body, there are many books in the library if you are interested to look into things more deeply.



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Bobs Bones

Look at Bobs X-ray. Below is a list of bones. Write which numbered circle is nearest where that bone would be in his body.

Ulna Femur

Mandible Humerus

Vertebrae Tarsals

Ilium Ribs

Carpels Clavicle

Tibia Cranium

1

3 4

6

5

2

7

8

9

10

12

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Hospital Hunt Starting at the Restaurant on Level A, use the following information to navigate your way around the Hospital Wards and Departments.

Level A Come out of the restaurant and turn right.

1) What is the name of the first department on your right?

Keep walking down the corridor, past the pre-operative assessment unit (which is on your right), walk around the bend and turn right into the management corridor.

2) What is the name of the department immediately on your right?

Action: collect your work contract Now

Continue down the corridor

3) What are the names of the departments indicated on the purple hanging sign?

Walk past the green sign that says workforce and out of the door on the left marked with an exit sign above it.

The first door on the left is marked Specialist Nurse Office. This is where the Practice Development team live.

4) What is the room number for this office?

Continue past this office and turn left into a new corridor. Halfway up this corridor are the main West wing lifts. Look at the directory on the lift walls

5) On what level is;

A. Delivery suite?

B. Onslow ward?

C. Tilford ward?

Go back into the corridor and turn left. The graphics and photography department is the last (blue) door on the right.

6) What are the drop-in times for the staff I.D. badge sessions?

Follow the corridor around to the left.

Keep walking past the Surrey Bowel Screening Centre, past the purple overhead signs to the management corridors and back past the restaurant

7) What is the restaurant called?

Past the restaurant is a pair of white double doors with a doorbell outside.



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This is the kitchens and where you can collect meals/snack boxes for patients.

Continue along the corridor.

On your left, you will soon see a large green sign over a set of double doors saying Purchasing and Supplies.

Just past this department is the door to the EME department bed workshop. This is where you will be going for your session on the beds we use in the trust with Robert Samson.

Continue down the corridor into the section of the corridor marked Staff only and Chapel of rest.

Along this corridor is a window hatch.

8) What does it say on the window hatch?

Further up the corridor is a white door with a combination lock on it and a sign saying uniforms,

turn left into the smaller corridor which leads to the back exit. The third door on the right is the Air Mattress Store.

The linen room is the 2nd to last doors on the left before the exit.

Turn back around and turn right back into the main corridor, take the first turn left into another corridor. The fourth door on the left is the equipment library. Use the code 1523 to enter the Clean Store of the Equipment Library.

Please read the posters directly in front of you on the glass windows

9) When taking a piece of equipment from the Equipment Library, what must you do?

10) Where is the box that is labelled

completed yellow tracking labels?

11) Which department should you

contact if a piece of equipment is faulty?

12) What should you not leave in

the Clean Store of the Equipment Library?

13) What do you do once you have

finished using the piece of Equipment?

Please take a HCA Induction hand-out and exit ensuring the door is fully closed behind you.

Continue to the end of this corridor there are lifts. Looking at the Lift Level directory;

14) On what level is;

A. CCU? (Coronary care Unit)

B. Compton Ward?

To the right of this corridor are stairs leading upwards.


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15) What is written on the hanging green sign above these doors?

Go up the stairs one flight onto

Level B

16) What department is directly opposite the stair doors?

17) What department is through the doors at the end of the corridor to the right?

Turn left and walk to end of this corridor and turn left again.

18) What is housed behind the first door on the left?

On the opposite side of the corridor, directly opposite this is a window hatch.

19) What does the sign above the window hatch say?

Further along this corridor is a sign saying A&E Majors.

Opposite this is another sign that points to doors that lead to the reception for radiology

Next to this door is a poster.

20) What is this poster about?

Turn around and walk to the lifts with the purple signage.

21) What department is on level H?

22) What is the name of the outpatients department on level H?

Continue down the corridor and Turn left at the next junction into the main entrance Hall

Walk straight ahead toward the exit/entrance doors?

23) What is the department on the left-hand side of the big red post box?

Now walk through the first set of automatic doors to the exit/entrance. On the wall on the right is a board with photos of some of our senior members of the Trust staff.

24) Who is the Director of Nursing?

25) Who is the Medical Director?

Turn and walk back into the hospital

26) What is the name of the shop next to Costa Coffee?

27) What hours do Costa Coffee open on Sunday?



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Now walk toward the giant hospital map and Turn left onto the West Wing corridor

28) What gender patients are seen in outpatients Department (OPD) 1?

Walk toward the pharmacy.

29) What are the pharmacy opening hours?

Opposite the Pharmacy is Outpatients 2.

30) What type of patient is seen in OPD 2?

Continue down the corridor past outpatients 3,4 and 5.

31) What patients are seen in;

A. OPD 6?

B. OPD10?

As you reach the end of this corridor walk outside the exit doors.

32) What is the building opposite?

Go back inside the building

Well done you have completed the tour! Have a quick break if you havent already but be sure to be on time for your next activity.


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Age Simulation Empathy Suit Reflection Reflection involves taking our experiences as a starting-point for learning. By

thinking about them in a purposeful wayusing reflective processes we can come to understand them differently and take action as a result. Jasper M (2003)

What was the nature of the activity you are reflecting on? Describe.

How did this experience make you feel?

What did you learn from this experience?

How will this experience influence/change the way you will care for patients?



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Sit & See On the Ward

Outpatient based HCAs see next section (p14)

Please use this opportunity to sit and watch and listen to what is going on around you in the bay. Make a note of the following about the patients, staff and what is happening in the bay you are in: -

Approximately what are the ages of the patients?

Are the patients mobile?

What can you see?

What noises do you hear?

What can you smell?

What members of staff are coming in and out of the room? Identify them by uniform colour.


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What do you like about what you see?

What do you not like about what you see?

How would you feel if you were a patient in a bed in the cubicle?

Where would you find the following?

A. Bed Pan Masher

B. New water jugs

C. New measuring jugs

D. Observation machine

E. Nearest Shower

F. Staff room



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In Outpatients

Please use this opportunity to sit and watch and listen to what is going on around you in Outpatients. Make a note of the following about the patients, staff and what is happening in the area you are in: -

Approximately what are the ages of the patients?

Are the patients mobile?

What can you see?

What noises do you hear?

What can you smell?

What members of staff are coming in and out of the room? Identify them by uniform colour.


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What do you like?

What do you not like?

How would you feel if you were a patient waiting in this area?

Where would you find the following?

A. Patient booking in monitor

B. Vital signs monitoring equipment

C. Weighing scales and height measuring equipment

D. Urine testing equipment

E. Patient Progress screen

F. Staff room



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Communication Post workshop objectives

During the following seven days, notice yours and other peoples body language, eye contact and non-verbal communication. Observe what you think is being said with and without words. Notice your non-verbal communication, when you are in unfamiliar or uncomfortable surroundings.

An example of my own verbal communication was:

An example of verbal communication I noticed in others was:

An example of my own non-verbal communication was:

An example of non-verbal communication I noticed in others was:

Ask a member of your team to comment on your communication. What did they say was good? What can you work on?


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Strengths & Weaknesses

My verbal strengths as a communicator

1

2

3

My verbal weaknesses as a communicator

1

2

3



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Strengths & Weaknesses Continued

My non-verbal strengths as a communicator

1

2

3

My non-verbal weaknesses as a communicator

1

2

3


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Communication Wordsearch S N I N G O G F N T I P E N U T T E R A N C E N E J K I Z O T O Q L O B N E A Y X O A Y C A U N K O Y L G H P N Q I P I I B T F N L C F P I X T A L K I N G U E J I I T J T T T E B N C O L J G R T T H T T H E A C H O M Y B E P A R A O K N I L I G L E R I C N B A C I L P N J S E R C S U C V G N I D N O P S E R R O C E D P U H K C O H C N R E I W E I C S G B N S S U D C C A E E I E B A P C O R E N L S Z B U N N O I I S Q K N T F H R D N K I C S M W V S B N E T O H I C T O A M E I D W J G E N Y E K G M E N O U S C I Y N O G P N O G O G I E D G C N P N N M U I O Q P E T L U R N B Z N I N H L O H W C L I E I T S N W C H P N V M R I K W Z L R K R I L J L D A N L S A X I C X P E P M E T R L F L I E S J M E A V A R I Z M W Z C V G M T O S A E X A E O D E R W E S T Z M A R E F S N A R T E C P L V K C T A F K Q R L I G S A R T I C U L A T I O N O S E D H N G Y N U X O J N Y N G N I S O L C S I D G N N L E Z I U W B U N E A Y G X O X V O P G A A I O S D A A L W B I S C E S R U O C R E T N I N J D E J K N E R T I R J M Z Z Q T I O E Y P V P I A D V I S E M E N T I V I B F A V G R D J R X K B P U F I D V I J B J C M O E T D P Q R O K X Z O F J B K Z C Y N M L Y P N E S N R I H C T Y M R B C Z D E U C E J W I M W V L L E M Z Y N L P I U D P F U J U H Y C C A R G N B E T U D B T U G J W J Q G A V H T N Q D Q S Y W L J G O I N J J V M D H Q H E

Words

ADVICE ADVISEMENT ANNOUNCING ARTICULATION ASSERTION COMMUNION CONNECTION CONTACT CONVERSATION CONVERSE CORRESPONDENCE CORRESPONDING DECLARATION

PUBLICATION READING RECEPTION REVELATION TALK TALKING TELLING TRANSFER TRANSLATING TRANSMISSION UTTERANCE WRITING

DELIVERY DISCLOSING DISSEMINATION ELUCIDATION EXPRESSION INTELLIGENCE INTERCHANGE INTERCOMMUNICATION INTERCOURSE LINK MENTION NOTIFYING



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Nutrition Feeding & Swallowing Experience Activities

Activity 1 Try to drink a full cup of

thickened water.

Does it quench your thirst? Does it still taste like water?

How does it look? Could you drink this every day?

Activity 2 Go to bed without brushing your teeth. In the morning:

How do your teeth feel? Are you conscious of your breath

smelling? Does your food taste different? Would you do this

every day?

Activity 3 Try and liquidise or mash your

favourite meal.

What does it look like? Does it taste any different? Would you

like to eat this consistency of food all the time? Did you

manage to eat it all?

Activity 4 Eat a whole meal lying down or

slightly propped up.

How easy is it eat in this position? How much food did

you spill? Did it feel safe or comfortable? Were you able to

drink in this position?


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Multiple Choice Questions

1) What is the correct term for a swallowing difficulty?

Dysphasia

Deglutition

Dysphagia

Dyslexia

2) Which of these may cause a difficulty in feeding or swallowing:

Breathing difficulties

Conditions affecting the brain or nervous system

Surgery to the mouth or teeth

Unable to sit upright

Poorly fitting dentures or dry mouth

3) If a patient is on puree diet, which of these can they eat:

Banana

Soft cake

Cornflakes

Weetabix

4) When should you give a patient mouth care?

Before and after a meal

When they are NBM

If they have food residue in their mouth

If they cant do it themselves

5) Which stage are these fluids:

needs to be given from a teaspoon cant be drunk from a cup = stage?

Can be drunk with a straw similar to a tomato juice consistency = stage?

Leaves a coating on the back of the spoon cant be drunk with a straw = stage?

6) What is the best position to feed a patient in?

Propped up with 1 pillow

Upright in bed

Upright in a chair

Lying flat on their side



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Nutrition Station Reflection Reflection involves taking our experiences as a starting-point for learning. By







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Infection Control x4580 is located on Level A next to Occupational Health.

Infection Control Good infection prevention and control practices are essential to ensure that people who use health and social care services receive safe and effective care. About 6% of inpatients have a healthcare associated infection (HCAI) at any one time.

For us at the RSCH thats 33 patients in the Trust at any one time, which is the equivalent to one whole ward!

A HCAI is defined as;

Infections that are associated with interventions, devices or procedures carried out in healthcare facilities.

It has been estimated that 300,000 HCAIs occur annually and the cost to NHS hospitals has been estimated, conservatively, as over 1 billion a year.

The most common types of healthcare associated infections (HCAIs) are respiratory infections, urinary tract infections and surgical site infections.

Each one of these infections means greater patient discomfort, an increase in length of hospital stay, a decrease in patient safety and poor publicity for the Trust.

Effective infection prevention and control must be part of every-day practice and consistently applied to everyone.

Things to remember The five moments of hand

hygiene and bare below the elbows.

Wear the appropriate personal protective equipment (PPE) for each task if required.

Decontaminate equipment before and after use with the

green Clinell sanitising wipes UNLESS dealing with patients who have diarrhoea. Take the sharps bin to the bedside and

dispose of sharps at the point of care.

Further Reading EPIC 3: GUIDELINES FOR PREVENTING HEALTHCARE-ASSOCIATED INFECTIONS IN NHS HOSPITALS IN ENGLAND, H. P. LOVEDAY ET AL. / JOURNAL OF HOSPITAL INFECTION 86S1 (2014) S1S70

ENGLISH NATIONAL POINT PREVALENCE SURVEY ON HEALTHCARE-ASSOCIATED INFECTIONS AND ANTIMICROBIAL USE. HEALTH PROTECTION AGENCY (2011)

HEALTH AND SOCIAL CARE ACT 2008: CODE OF PRACTICE ON THE PREVENTION AND CONTROL OF INFECTIONS AND RELATED

GUIDANCE, DEPARTMENT OF HEALTH (2010)

SAVING LIVES: REDUCING INFECTION, DELIVERING CLEAN AND SAFE CARE DEPARTMENT OF HEALTH (2007)

You have met Bob before;

does Bob have any infection control risks?If so, what do you think

they are?



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Across

A. What should be available at point of care? (7)

3. Infection Control is part of everyday. (8)

5. Disposable equipment like syringes are? (6,3)

6. What should you do before and after using equipment? (5)

8. What colour are the sporicidal wipes? (3)

9. Who would you call for advice? (9, 7)

10. How many W.H.O moments are there? (4)

Down

2. The single most important way of preventing healthcare acquired infections. (4,7)

3. Is a sign of infection (3)? 4. What colour is the body of a

sharps bin? (6) 7. Diarrhoea associated with

antibiotics abbreviated term? (1,4)

1 2 3

4

5

6

7

8

9

10

Infection Control Crossword


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Team Working (lego excersise)

How did we work as a team?

Did we have a plan?

Did it work?

Did people have set roles?

What worked?

What did not work?

What could we have done better?



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Hygiene, Privacy & Dignity Have a think about your routine when you get up in the morning. Do you go to the toilet, get a shower before breakfast, then clean your teeth/ or do you do things in a different order?

Write down your morning routine below What do you need?

1

2

3

4

5

6

7

8

9

10

Now imagine your routine is Bobs routine. He is totally reliant on the nurses and healthcare assistants to help him with his routine. How would he feel if the routine wasnt followed, certain things not done or delayed?


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How would you feel if;

1. You are usually an early riser, but the ward is busy and it is almost lunchtime before you are helped of bed and washed.

2. You want the toilet, but cant find your call bell to ring for help, what would you do?

3. When you finally get help to use the commode, no one offers you the means to wash your hands.

4. When they wash you, no one asks if you like soap on your face. If you are a male, no one has offered to help you shave.

5. Your favourite moisturiser is in your locker and no one has time to help you find it.

6. No-one offered you the opportunity to clean your teeth.



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Falls Prevention, Movement & Enablement

Information

Know what "signs" are used to identify falls risk patients Know meaning of bed-side whiteboard abbreviations/signs A low blood pressure (BP) or a drop in Blood Pressure on standing is a "postural

drop" = falls risk. Bed rails: use with caution - c/o patients climbing over them: if unsure, check. Bed-rails = patient safety, not to keeping a patient in bed: this = restraint. Check patients glasses are clean Check hearing aids have working batteries (Family/Care home/Audiology

department) Diabetes can increase a persons risk of falling due to circulation & foot

problems. Parkinsons disease tends to increase risk of falling -unsteady/poor balance Check patients feet for verrucas, corns, redness/soreness etc. Help patients to "call, not fall" - leave call bell in reach

Appropriate Footwear

Avoid soft, floppy, loose fitting or open backed slippers e.g. mules or slip-ons & flip-flop style sandals or "crocs"

Check for uneven heels or worn-out soles Slippers with Velcro fastening, cushioned soles, high collar at back that fits

snugly around ankle will improve patient stability Well-fitting shoes give more support than well-fitting slippers - if a patient has

had a fall or is unsteady/at risk of falling shoes may be better.


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Safe Shoes Unsafe Shoes

Firm heel collar that supports ankles & fits snugly around heels

Slip-on shoes (sling backs, moccasins) trip hazard

Low, broad heels (gives good contact with the ground) Slippery soles -e.g. leather

Flexible, lightweight, slip-resistant soles -rubber.

Heels > 1 inch or narrow heels feet will be unstable & ankles likely to turn

Shoes which are firmly secured Velcro, straps with buckles, laces

Falls Prevention, Movement & Enablement Practical Session

You are required to complete both Task 1 & 2 listed below.

TASK 1:

Pretend that you are Bob, trying to put on a pair of pyjamas trousers. At the end of the session, please share with us;

your experience as the patient the difficulties or issues which you may have encountered in the task what you would like the HCA to do or not to do to promote your

independence in the task

TASK 2:

Pretend that you are the HCA supervising the Bob to put on a pair of pyjamas trousers. At the end of the session, please share with us;

your experience as the HCA what you have done or not done to promote the patients independence in

putting on a pair of pyjamas trousers



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Falls Prevention, Movement & Enablement Practical Session Feedback

Task 1

Task 2


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Getting Bob Out of Bed Safely

Bob needs your assistance (and the use of a frame) to get out of bed and onto his chair

Number the boxes from 1 10 in order of what you would do first to last

Help Bob stand by the bed

Give Bob a call bell and position his table close

by

Get walking frame (if required)

Get a second person if required

Help Bob sit on the edge of the bed

Get Bob to march on spot

Check Bobs Vital Observations

Talk to Bob, does he understand you?

Sit Bob in a chair by the bed

Check Bobs manual handling risk assessment.



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Assessing for a walking aid guide (Refer to How to assess if someone is safe to get out of bed before supplying with walking aid)

Check in the medical notes / speak to the patient / gain collateral information

What walking aid / equipment did they normally use before coming into hospital?

Do they normally require physical assistance, if so, of how many people? How far can they normally mobilise? Do they normally wear glasses and are they clean?

Provide the correct equipment, examples are shown below:

3 wheeled walker(3WW)

4 wheeled Walker(4WW)

Wheeled Zimmer Frame (WZF)

Walking stick(W/S)

If a patient is not able to walk, alternative methods of transfer can be found below:

Full Hoist (FH) Standing Hoist (SH) ETAC Rotunda

How to measure for a WZF or walking stick Ask patient to stand as tall as comfortable (with support if needed) Frame handles should be level with their wrist crease Ensure you adjust all 4 corners

Where to find a frame:

Level C - Bramshott Orthopaedic gym Level D - Hindhead gym Level E - Neuro Gym (Millbridge Bay 10) Level F - Tilford physio gym

http://www.google.co.uk/url?url=http://mountsidemobility.co.uk/healthcare/wheeled_walkers_rollators.html&rct=j&frm=1&q=&esrc=s&sa=U&ved=0ahUKEwjUmtW4hZXLAhVGeg8KHdBHC7EQwW4IHjAE&usg=AFQjCNGOQhJQ1gtxek6EZILa5OBCb26FFQhttp://www.google.co.uk/url?url=http://www.islandmobility.co.uk/walkers/walkers/&rct=j&frm=1&q=&esrc=s&sa=U&ved=0ahUKEwjCh5LihZXLAhUCIQ8KHWKiAIMQwW4IKDAJ&usg=AFQjCNGVNeVtqrVGXjPPI3WQ-QNqlZLylghttps://www.google.co.uk/url?url=https://www.ableworld.co.uk/rollators---walking-frames.aspx&rct=j&frm=1&q=&esrc=s&sa=U&ved=0ahUKEwiZ05-GhpXLAhWBlQ4KHbMDBWk4FBDBbgg2MBA&usg=AFQjCNHwTwUQV-lKBKEnGZV9YKh1IMg6CQhttp://www.google.co.uk/url?url=http://www.123rf.com/photo_13784080_walking-stick.html&rct=j&frm=1&q=&esrc=s&sa=U&ved=0ahUKEwjp47r2iJXLAhWGhQ8KHeRTDCY4PBDBbggaMAI&usg=AFQjCNHLiqQ86jBNVIY0G4kBQh-QqefVzwhttp://www.google.co.uk/url?url=http://www.ebay.co.uk/bhp/patient-hoist&rct=j&frm=1&q=&esrc=s&sa=U&ved=0ahUKEwj-kZGN_8fLAhUJzRQKHVmwC0g4KBDBbggiMAY&usg=AFQjCNEpYYrqXP6aNsmAPKYJhEbfjzDXoQ


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How to asses if a patient is safe to get out of bed

Assess the person: Is patient well enough to get out of bed? Check if they are medically well and alert and able to follow commands or

gestures? Do they suffer from postural hypotension or dizziness when standing? (Check nursing fall risk assessment and medical notes) Are they free from pressure ulcers? (may need TVN review/pressure cushion) Know what signs are used to identify patients at risk of falling

Before you assess Ensure you have established the patients previous mobility level - If they

normally use a walking aid and dont have it with them or you feel they need one then refer to Assessing for a walking aid guide)

Ensure the patient has had a manual handling risk assessment completed

Assess the patient Can they safely sit on the edge of bed with their usual level of support? Do they have the strength to straighten each leg in turn out in front of them?

Trial standing Try standing the patient keep the patients close at all times Can they march their feet on the spot while holding on to their walking aid?

If the answer is YES to all above, then it is safe for you to transfer the patient from bed to chair or a commode (follow manual handling assessment guidance)

If the answer is NO to any of the above, then please place the bed into a chair position and nurse patients sat up (unless told otherwise). Check with a RN or Nurse in Charge if patient could be full hoisted out of bed for short periods (e.g. meal times).

Please refer to the ward physiotherapist if patient is not at normal level of mobility.

http://www.google.co.uk/url?url=http://www.ecg-professionals.com/ge-carescape-v100-vital-signs-monitor.html&rct=j&frm=1&q=&esrc=s&sa=U&ved=0ahUKEwjD5q-Oi8jLAhWGtRQKHX2DBpAQwW4IJDAH&usg=AFQjCNFdO--H-NyxShMuWIICrjNiraUoCAhttp://www.google.co.uk/url?url=http://paramedicine101.blogspot.com/2009/09/electrocardiogram-part-iv.html&rct=j&frm=1&q=&esrc=s&sa=U&ved=0ahUKEwjqjfiMu8rLAhUGORQKHVShAWw4FBDBbggaMAI&usg=AFQjCNH3Lhxuhd57spbYbq-9wzydcxE0_whttp://www.google.co.uk/url?url=http://www.jamesspencer.co.uk/chairs-suites-legrests-and-tables-c-1.html?show_all=true&rct=j&frm=1&q=&esrc=s&sa=U&ved=0ahUKEwiX9p7TgsjLAhVJaRQKHZBVC6g4UBDBbggcMAM&usg=AFQjCNHIoFTuFhZRIeBtMrYQNT_txfDheghttp://www.google.co.uk/url?url=http://www.amazon.co.uk/NRS-Healthcare-Wheeled-Commode-L22056/dp/B006J7GP2K&rct=j&frm=1&q=&esrc=s&sa=U&ved=0ahUKEwj0jIHfi8jLAhVIVxQKHXJjA88QwW4IHjAE&usg=AFQjCNHZjex-HkJJvA4dmlx8WG0Kih3Wew



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Falls Crossword 1 2 3

4

5

6 7

8 9

10 11

12

13 14 15 16

17

18

19 20

21 22

23 24

25


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ACROSS 5 This is a common cause for falls in the elderly. which is

why items such as bedside tables should be kept close to Bob. (12)

9 The most common cause of injury for the over 75's (5) 10 Bed-rails should never be used to do this (8) 12 A member of the MDT team who can give advice to

Bob and his family about raised seats, bath rails etc. (19,9)

17 What is the missing word in the following sentence? 'Bob should be given time, encouragement and help to wash and dress himself. This will help him be ......... (11)

19 A condition Bob has that makes him prone to poor circulation and feet problems (8)

20 One of Bobs senses that must be good to help prevent him from falling. (7)

21 Bob should always be able to reach which item when on the ward? (4,4)

22 A vital source of information that would allow you to find out Bobs mobility level and care/safety needs - especially at the beginning of every shift! (8, 5)

23 What is the missing word in the following sentence? 'Half of those who suffer a hip fracture following a fall ....... regain their former level of mobility'. (5)

24 What are the missing words? 'Many falls result in ....... ......... (6, 5)

25 Complete the sentence. 'For older people the consequences of falls can be devastating both physically and.........' (11)

DOWN 1 Which area of Bobs body is especially important to

check during washing and dressing to help prevent him from falling (4)

2 Which long-term medical condition does Bob suffer from that will affect his walking & safety? (10, 7)

3 An item which Bob needs to help improve his vision and help prevent him from falling? (7)

4 An MDT professional who could help Bob improve his balance & strength. (15)

6 People who fall often lose their '.........' (10) 7 What should be seen at (Bobs) bedside to tell staff he

has had fall or is at risk of falling, (5,6) 8 It is important that Bob has 'what' before he starts to

walk anywhere? (6, 8) 11 What is the missing word in the following sentence? 'Falls

are the second leading cause of accidental or unintentional injury deaths ....... after traffic related injury. (9)

13 What is the missing word in the following sentence? 'Due to his diabetes and age Bob may have problems with his .......' This may increase his risk of falling. (6)

14 A part of equipment that may increase Bobs falls risk (if left up?) (3,5)

15 A report that must be completed should a patient have a fall, even if there is no adverse outcome. (8, 4)

16 A neurological state that increases the likelihood of Bob falling (9)

18 Something you need to leave close to bob so he can reach his drinks and personal belongings (3,5)



40

Occupational therapy What client groups need help with feeding?

You will be completing the following exercises during the training session

Cognition

Motivation

Do they have safety awareness i.e.

Temperature / use of knife

Can they preparing, organise & sequencing

Can they remember what your doing?

Do they understand?

Are they concentrating?

Are they awake?


41

What are the key points to remember when helping someone with feeding?

Key Points to Remember



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Patient Assessment

THE IMPORTANCE OF PATIENT ASSESSMENT

Assessing patients is a fundamental part of a healthcare workers role.

If you deliver direct care or interact with patients you will be assessing them, either consciously or subconsciously. This is important because being able to spot changes in a patients condition could prevent them becoming very unwell and in extreme circumstance could mean the difference between life and death.

You will gain a better insight into the types of assessment skills you will develop when you undertake the BEACH course during your induction training.

The following information is a guide to the basics of patient assessment elements of which you will experience and develop as part of your working role.

A Structured Approach to Assessing Patients (ABCDE) A = Airway Can the patient talk to you? Does it look or sound as if they are struggling to breathe or get air in or out of their lungs? What noise (if any) do they make when they breathe?

Stop do you need help?

B = Breathing How does their breathing look and sound? How many breaths are they taking over the period of one full minute? (Respiratory Rate). What is the pulse oximetry reading? (SaO2)


C = Circulation When you take a manual heart rate, how many beats are there over the period of one full minute? (Heart Rate) How does the pulse feel; strong or weak, regular or irregular? Does the patient look pale? What is the patients manual blood pressure? Temperature? Capillary refill rate?



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D = Disability (i.e. central nervous system function) What is the patients AVPU status? What are the patients current blood glucose levels?


E = Exposure (full patient examination) Look at the whole of your patient. Is the bleeding from somewhere that is hidden by the bedding?

USING LOOK - LISTENFEEL

These 3 simple things can tell you a huge amount about a patient.

By looking at your patient you can take

note of the following things Is your patient conscious?

If not, do they respond to voice, pain or no response at all?

Is your patient looking purple or blue along the lips or fingertips?

Is your patient breathing normally?

Are they sweaty? Are their extremities warm and

well perfused? Do they appear to be in pain?

By asking how they feel

You can see/hear if the patient talks in full sentences

If the patient responds appropriately

If they appear orientated to time and place

If they tell you they are in pain Identifying symptoms

By following a structured ABCDE approach

and by taking a full range of Vital Signs, you can obtain a complete Early Warning

Score. The Vital signs recorded include:

First and foremost an accurate respiratory rate for one minute

Pulse rate (tone and rhythm - (regular or irregular can also be captured)

Manual Blood Pressure Oxygen Saturations Temperature Capillary refill time Urine Output AVPU status



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Vital Signs & N.E.W.S National Early Warning Score (NEWS) Information

The National Early Warning Score is a tool for bedside evaluation based on six physiological parameters: systolic blood pressure, pulse rate, respiratory rate, oxygen saturations, temperature and level of consciousness.

A number of Early Warning Scoring systems are currently in use across the NHS, however, the approach is not standardised.

Put simply, when assessing acutely ill patients using these various scores, we are not speaking the same language and this can lead to a lack of consistency in the approach to detection and response to acute illness.

Building upon recommendations in the Royal College of Physicians Acute Medicine Task Force report, Acute medical care: the right person, in the right setting first time, published in 2007, the RCP commissioned a multidisciplinary group to develop a National Early Warning Score (NEWS).

NEWS SCORE FREQUENCY OF MONITORING

CLINICAL RESPONSE

0 Minimum 12 hourly Continue routine NEWS monitoring with

every set of observations;

Total: 1-4

Minimum 4-6 hourly

Inform registered nurse who must assess the patient;

Registered nurse to decide if increased frequency of monitoring and / or escalation of clinical care is required;

Total: 5 or more

Or 3 in one

parameter

Increased frequency to a minimum of 1 hourly

Registered nurse to immediately inform the medical team caring for the patient;

Urgent assessment by the clinician with core competencies to assess acutely unwell patients;

Clinical care in an environment with monitoring facilities;

Total: 7 or more

Continuous monitoring of vital signs

Registered nurse to immediately inform the medical team caring for the patient- this should be at least at specialist registrar level;

Emergency assessment by a clinical team with critical care competencies, which also includes a practitioner(s) with advanced airway skills;

Consider transfer of Clinical care to a level 2 or 3 care facility; i.e. higher dependency or ITU;


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NEWS Chart



46

Using the vital observations data provided and the early warning scoring system on the next page, work out the early warning score for Bob.

9:15 am 10:59 am 3:10 pm 3:56 pm

HR 68 HR 99 HR 108 HR 56 BP 103 / 62 BP 101/50 BP 91/45 BP 78/45

TEMP (C) 37.5 TEMP (C) 38.2 TEMP (C) 35.9 TEMP (C) 35.4 SaO2 (%) 92 SaO2 (%) 91 SaO2 (%) 87 SaO2 (%) 86

RR/min 15 RR/min 18 RR/min 20 RR/min 9 CNS A CNS V CNS P CNS U

U/O (ml/hr.) 40 U/O (ml/hr.) 32 U/O (ml/hr.) 22 U/O (ml/hr.) 6

NEWS NEWS NEWS NEWS

What actions will you take?





47



48

24 hour Fluid Balance Chart


49



50

Pressure Ulcer Learning Pressure Ulcer Categories

There are 4 Categories of Pressure Ulcer. The following pictures are jumbled up. Can you draw a line from the picture to the correct category? (The definitions below will help)

Category 1 Category 2 Category 3 Category 4

List 5 risk factors or medical conditions that could lead to developing Pressure Ulcers.

1

2

3

4

5

Category/Stage I: Non-blanchable redness of intact skin

Intact skin with non-blanchable erythema of a localized area usually over a bony prominence. Discoloration of the skin, warmth, oedema, hardness or pain may also be present. Darkly pigmented skin may not have visible blanching. Further description: The area may be painful, firm, soft, warmer or cooler as compared to adjacent tissue. Category/Stage I may be difficult to detect in individuals with dark skin tones. May indicate at risk persons.

Category/Stage II: Partial thickness skin loss or blister

Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured blister.


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Further description: Presents as a shiny or dry shallow ulcer without slough or bruising. This category/stage should not be used to describe skin tears, tape burns, and incontinence associated dermatitis, maceration or excoriation.

Category/Stage III: Full thickness skin loss (fat visible)

Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Some slough may be present.

Category/Stage IV: Full thickness tissue loss (muscle/bone visible)

Full thickness tissue loss with exposed bone, tendon or muscle.

Prevention and management

Prevention and management is a high priority and you can help. Look at the hand below, which is from the Stop the Pressure national campaign www.stopthepressure.co.uk

What can you do to prevent and manage pressure ulcers?

http://www.stopthepressure.co.uk/



52

HCA Induction Supernumery Learning Objectives

Ward HCAs

Ward Based HCA to complete the following tasks during your supernumery week. (Outpatient HCAs see next section. P49)

Objective Your signature Mentor Signature

1. Contact the PDT (Ext 2041) with your weeks off duty if not previously done so.

2.

Introduce yourself by name to every member of the nursing team you are working with. Explain your weeks objectives to them.

3. Successfully complete the Trusts Hand Hygiene Assessment

4. Be assessed as competent to correctly clean a commode

5. Observe and participate in assisting a patient with

a. A full bed bath

b. An assisted wash

c. A hair wash

d. Full mouth care


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e. Catheter Care

6.

Remove a patients TED stockings. Inspect the skin and discuss your findings to the RN supervising you. Reapply the TEDS.

7.

Practice, under supervision, performing manual observations on a minimum of 6 patients completing the Early Warning Score

8. Assist with distributing food and feeding a patient.

9.

Under supervision record a patients intake and output on a fluid balance chart. Discuss with your supervising RN why a patients weight is key to their Fluid Balance.

10.

Talk to a patient about how they feel about being in hospital. Ask them how it feels? What is the hardest thing about being in hospital? What things that staff do that really make a difference?

11.

Listen to handover daily and make notes of words/ matters you do not understand. Find time during each shift to ask your mentor about key words you do not understand.

12.

Consider, and prepare brief notes, of one aspect of care you wish to discuss at the beginning of week three induction.

13. Find the Ward Learning Packs on the G: Drive (or on the Practice Development Team Website)

14. Book an empathy suit experience appointment with the Practice Development Team (if not done)



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Outpatients HCAs

Complete the following tasks during your week in Outpatients.


1. Contact the PDT (Ext 2041) with your weeks off duty if not previously done so.

2.

Introduce yourself by name to every member of the nursing team you are working with. Explain your weeks objectives to them.

3. Successfully complete the Trusts Hand Hygiene Assessment

4. To observe and practice under supervision using the patient self-check in system

5.

Practice under supervision performing manual observations on a minimum of patients and document findings.

6.

To observe and practice under supervision documenting the height, weight and BMI aspect in the Malnutrition Universal screen tool (MUST) assessment documentation

7.

To observe and practice under supervision obtaining a specimen of urine and perform urinalysis using the urinalysis machine

8.

Talk to a patient about how it feels to come to the hospital. What is the hardest thing about being in the dept.? What are the things that the staff can do that really make a difference?

9.

Consider and prepare brief notes of one aspect of care you wish to discuss at the beginning of week three induction.


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Reflection as a learning tool Remember what you learnt about reflection? Think about something that happened in your supernumery week that you could reflect and learn from. Was there a patient in pain? Did someone have to wait too long for his or her call bell to be answered? Could patients not make themselves understood? Did you say something that was misinterpreted? How did you feel providing supervised intimate care to a patient? Did you spot something and escalate appropriately to maintain a patients safety? Remember it is good to reflect on things that went well not just things that we feel we could do better with.

Look at Gibbs Cycle below

Ref:Gibbs Model of Reflection (1988)

Complete the Reflective Cycle template. What does your action plan show that you have learnt and could perhaps do differently next time to make a difference to a patient?



56

Your Reflection Reflection involves taking our experiences as a starting-point for learning. By







57

Reflection involves taking our experiences as a starting-point for learning. By thinking about them in a purposeful wayusing reflective processes we can come

to understand them differently and take action as a result. Jasper M (2003)







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Diabetes Quiz

1. What is diabetes?

2. Who is at risk of developing diabetes?

3. Is all diabetes the same?

4. On which of our hospital wards will you find people with diabetes?

5. Should people with diabetes have their feet checked daily?

6. People with diabetes should never eat cake or chocolate true or false?


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7. What is a normal blood glucose range?

8. What is a hypo?

9. How do you treat a hypo?

10. Why do we check blood glucose levels?

11. What difference does it make if blood glucose levels are high or low?

12. Why might a person with diabetes have a high blood glucose level in

hospital?



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13. Why do the diabetes nurses keep saying person with diabetes not diabetic?

14. Which parts of Bobs body are at risk from poor diabetes control?


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Risk Assessment Complete the following questions

1. It is lunchtime and Bob is sitting in a chair, he wants to go to the toilet and insists that he wants to go to the bathroom. You have not assisted Bob in this activity before, which risk assessment would you use to decide how to achieve this with Bob?

2. You are assisting Bob to wash by washing his back and bottom. You notice that his bottom is very red and he is wincing when you pat it dry. Which risk assessment would you check? What action would you take? What would you document and where?

3. Bob has been in hospital for a week and you are re weighing him and find that he has lost 3kg; which risk assessment would you check? What action would you take? What would you document and where?

4. It is late evening and you are preparing to put Bob to bed; which risk assessments will assist you to do this safely for you and for Bob? Bob is not aware of his limited mobility, what other risk assessment would help you to ensure he remains safely in his bed?



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5. Bob weighs 10 stone 11 pounds. What is this in KG?

6. Bob is 6 feet and 2 inches Tall. What is this in centimetres?

7. What is Bobs Body Mass Index Score?

8. What are your actions following the BMI score result?

9. Vera is unable to talk. The dietician has asked you to estimate her BMI using her MUAC which is 26cm. her estimated BMI is what?

10. Bob weighs 73kg but does not know his height and is unable to stand. His ulna length is 30cm. What is his estimated height?


63

Risk Assessments; when and why are these completed?

Who does the assessment? When? Why?

Weight

Height

Body Mass Index

Side Room Assessment

Side Rail Assessment

Waterlow

Manual Handling

Falls

Malnutrition Universal

Screening Tool

Continence Assessment

Change in patients

condition



64

Abbreviations Crossword

The trust allows a certain number of abbreviations to be used in record keeping. Below is a crossword made using some of the abbreviations and their meanings that are found in that list.

The clues are found on the next page.

1 2

3 4

5 6

7 8

9

10

11

12

13

14

15

16

17

18

19

20

21

22 23


65

Across 3. (BP) The pressure the blood hits your artery wall when the heart contracts (Systolic) and relaxes (Diastolic)

6. Name of a female boss you may have (abb.)

7. A bacterial infection that can affect the digestive system.

10. Do Not Attempt Resuscitation (abb). 11. You may be asked to get one of these if your patient has chest pain, for example (abb.)

12. Trial without catheter (Abb). 14. Methicillin Resistant Staphylococcus Aureus, a common type of bacteria resistant to several widely-used antibiotics. (abb).

15. No faeces passed (abb.) 16. (NBM) Your patient could be this if waiting for an operation, has an unsafe swallow or their digestive system is not functioning properly

19. The unit of measurement used to weigh a patient(kg)

21. You may be this if it is difficult to breathe (Abb.)

22. What you are, maybe? (Abb). 23. Visual Infusion Phlebitis: how you would score a cannula site (abb.)

Down 1. (Associate Practitioner) You could be one of these if you undertook your Foundation Degree

2. (RR) The rate you breathe 4. (SN) A key member of your team 5. (POD)the patient may bring them in with them, or nurses may provide them with replacements from pharmacy

7. (CN) A male version of 6 across! 8. Malnutrition Universal Screening Tool (Abb).

9. This score calculated from a set of vital observations data, may warn you that your patient is unwell. (Abb).

13. A specimen of urine obtained from a catheter (Abb).

17. Twice a day (abb). 18. (MG) unit of weight 20. She delivers babies 22. The speed your heart beats. (Abb).



66

Record Keeping Spot the Errors

The following passage contains 19 documentation errors or ambiguities. How many can you spot?

25.09.14 Appeared to have slept well. Convene in situ. S Whitehouse (HCA)

10am

Bob did not want to get out of bed this morning. Breakfast offered. Had a wash. Sacrum pink. Teds in situ. Walked out to toilet. Bowels open. Obs done. Seems low in mood. Medications found on bedside table. Bob seems to be coughing this morning, encouraged to drink.

SW

11.30hrs: Bob asked to go back to bed. Incontinent of very offensive urine. SW

3pm:

Wife visited, unhappy that Bob had not had a shave. She helped Bob to eat food she had brought in from home. No complaints of pain. Mattress ordered at request of Ward Sister.

SW

6pm. Bob seems brighter but a bit confused. Eaten dinner. Passed urine using bottle. Obs stable. SW

9pm: Temperature 37.9C. Very sleepy SW

11.30hrs: Settled. Position changed. JA

Remember!

If its not documented Its not been done.


67

1



68


69



70


71

Admission & Discharge Exercise 1

List the routine you follow each morning to get ready for work.

A. How would you have to re-organise your plans if you were told when eating your breakfast, you had to go to hospital immediately?

B. Who would you want to contact? Could you get hold of them easily?

C. What might you be feeling?

D. Would you have the things to hand that you might need i.e. pyjamas, slippers, and wash bag?

E. How would this be different if your admission were planned?



72

Exercise 2

A. Make a list of your normal daily routine. What plans would you make if your admission were arranged in advance?

You have had a spell in hospital to have your appendix out;

B. What would you need from the hospital to take home?

C. Who would you ask to collect you?

D. What would you need to think about at home in order to return and be safe and supported?

E. What might you be worried about?


73

Admission & Discharge Scenarios

Admission Scenario 1 Louise is 29 years old. She is married and she two children aged 2 and 4yrs who are being cared for by a child minder while she is at work. When out on her lunch break, she is hit by a passing cyclist and sustains a broken leg. She is brought to hospital by ambulance which was called by a work colleague who was with her.

A. Apart from her injuries, what might Louise be worried about?

B. Who might Louise want to contact?

C. How could we help her do this?

D. If we were not able to contact her husband who else might be able to help?



74

Admission Scenario 2 Mr Johnson is a 40-year-old self-employed builder who has been referred to see a surgeon in out-patients as he has an inguinal hernia. He has never been to a hospital as a patient before. On arrival at 12.00 he is told that the clinic is running 45 minutes behind due to an emergency. What might his immediate concerns be?

A. What might Mr Johnson be feeling

B. What might his immediate concerns be?


75

Discharge Scenario 1 Mrs Edna Smith is 85 years old and lives alone in a warden controlled flat. She has a daughter who lives 30 miles away. She has carers come in morning and evening to assist her with her personal care but is otherwise independent. She has had a hip replacement as the result of a fall and is recovered enough to return home. In her personal property list, there is no mention of house keys.

A) Could Mrs Smith safely be discharged home immediately after the doctors have made the decision to discharge her?

B) What might Mrs Smith be feeling?

C) Who should we discuss the plans for Mrs Smiths discharge with?

D) How would we gain access to Mrs Smiths home?

E) What other team might we involve first to ensure Mrs Smith can mobilize safely

in her own home?



76

Discharge Scenario 2 Mr Johnson is a 40-year-old self-employed builder who has had an inguinal hernia repair in the Day Surgery Unit. It is his first time in hospital as a patient. Following Mr Johnsons procedure, the Doctors are happy to discharge Mr Johnson home.

A) Could Mr Johnson safely be discharged home immediately after the doctors have made the decision to discharge him?

B) What might Mr Johnson be feeling?

C) Who should we discuss the plans for Mr Johnsons discharge with?

D) How would we gain access to Mr Johnsons home?

E) Would Mr Johnson be able to work? Will he need a sick note?


77

Discharge Scenario 3 Jane is 38 and has recently had a caesarean section. After several days recovering in hospital the Doctors are happy to discharge Jane home. Jane is married and lives in a house with her husband and two other children who are 6 years old and 2-and-a-half-year-old.

A) Could Jane safely be discharged home immediately after the doctors have made the decision to discharge her?

B) What might Jane be feeling?

C) Who should we discuss the plans for Janes discharge with?

D) How would Jane get home and what arrangements would need to be made?

E) Who else would be involved with Janes discharge?



78

Discharge Scenario 4 (MSW) Louise is 29 years old. She is married and she two children aged 2 and 4yrs who are being cared for by a child minder while she is at work. When out on her lunch break, she is hit by a passing cyclist and sustains a broken leg. She is brought to hospital by ambulance which was called by a work colleague who was with her.

A. Could Louise safely be discharged home immediately after the doctors have made the decision to discharge her?

B. What might Louise be feeling?

C. Who should we discuss the plans for Louises discharge with?

D. How would Louise get home?

E. What other team might we involve to ensure Louise can mobilize safely in her own home?


79

Discharge Scenario 5 (ODP) Mr David Jones is a 68-year-old gentleman who lives alone. David has driven himself into the hospital today to attend his Out Patients appointment. David has been seen by the Consultant after a bit of a wait in clinic, David has sadly been given a malignant diagnosis. David has been informed of his options for treatment and his prognosis by the Consultant. David now needs to go home and decide if the surgery option is one he is willing to take.

A. How would David be feeling?

B. How could you ensure David is safe to drive home? What could you do?

C. Who could David talk to? What would you suggest?



80

Safeguarding

Adult Safeguarding Quiz

The Safeguarding section that follows (children & Adult) to be completed after the training sessions that occur during induction.

1. A patient has been admitted from A&E to the assessment area and you are reviewing on the post take ward round. The medical clerking has highlighted that they have several circular bruises to the tops of both arms and potential abuse has been raised as a concern. Do you-?

a) Contact social care team and ensure a referral form is completed

b) Ring the nursing home the patient lives in to make them aware of your concerns

c) Ensure the patient remains in the hospital until the Social Care Team has seen the patient and confirmed that they can go home

d) All the above

2. Who is the most common alleged perpetrator in adult safeguarding cases in Surrey?

a) Care home staff

b) Family members

c) Hospital Staff

d) Unknown assailant

3. If a patient discloses that they have been abused by a member of staff who comes in and provides home care, but does not want you to tell anyone

a) we should never break patient confidence

b) we can break confidentiality if there is risk of deterioration in health of the patient

c) we should inform social care regardless of the patients opinion


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d) we should ask the patients family for permission to disclose the information

4. Who has a responsibility to raise safeguarding concerns?

a) senior nurse on the ward

b) consultant in charge of the patients care

c) the patients family

d) everyone

5. What was the name of the 2000 Department of Health Safeguarding Report?

a) No Surprises

b) No Flexibility

c) No Secrets

d) No Scrutiny

6. A patient has been admitted from a care home and you notice that they have a grade 2 pressure area on their sacrum. What should you do?

a) Get a photograph of the area

b) contact the TVN

c) Complete a Safeguarding referral

d) All the above

7. If you saw a member of staff handling a patient roughly whom would you tell?

a) The nurse in charge of the ward

b) The matron of the area

c) Social Services

d) The Head of Nursing

8. A patient with dementia has been admitted and they require routine surgery. You feel that they do not have capacity to make the decision but they have no family to help them. What would you do?

a) Tell the patient they must sign the consent form or they wont get any tea

b) Contact the PALS office to request an IMCA be appointed

c) Have a discussion with the doctor and make a best interest decision between you

d) Ask the doctor to make a formal capacity assessment and record it in the notes



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Childrens Safeguarding Quiz.

A. Name the four categories of child abuse?

1

2

3

4

B. Below is a list of indicators of abuse, label with the most appropriate category of abuse

Pregnancy in an under 16-year-old

Bruising

Dental Decay

Child who regularly has responsibility that interfere with essential normal daily activities

Not attending health appointments

Injury with unknown explanation

Unusual sexualised behaviour

Fearful and withdrawn child

C. What adult behaviours potentially have the biggest negative impact on children? pick the top three from the list below:

Domestic Abuse Small House

Financial difficulties Single Parent

Unemployment Drug and Alcohol Misuse

Mental Health

D. If you had a safeguarding concern about a child what would you do, whom would you contact and where would you find the contact details?


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E. What does being an advocate for a child mean?

F. Who has a responsibility to safeguard children?

Police

Everyone

Safeguarding Team

Childrens Social Care

G. What are the key things when recording safeguarding concerns?

Contemporaneous records Document in the words of the person disclosing the abuse Differentiate between fact and opinion All the above

H. What tools do we use at the RSCH to share concerns about childrens safeguarding?

I. Where would you find the Safeguarding Children Policy?



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Learning Disability Scenario Case

Patrick is a 55-year-old man who has Down syndrome and a Severe Learning Disability. He lives in a 6-bedded residential service and has done so for 5 years. The home is staffed 24-hours a day.

Patrick has problems swallowing and now has all his nutrition and fluid via a percutaneous endoscopic gastrostomy (PEG) feeding system.

Patrick does not have any verbal communication, although he will smile when happy and grimace when he is in pain or unhappy. Staff who know him well can interpret some of his other non-verbal communication.

The Speech & Language Therapist has developed a "communication passport" for staff that work with Patrick. This consists of a small album containing single points of information about Patrick supported by pictures, e.g. "When I am anxious, I like to someone to stroke my hand which calms me".

Patrick's PEG tube has come out. He has come back in to hospital with a carer to have the tube reinserted and stitched in place.

How would consent for this procedure be gained and what factors would need to be considered?

What would you do if Patrick started to struggle and show signs of distress during this procedure?


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Learning Disability Communication Resources

Hospital communication book www.communicationpeople.co.uk/services/the-hospital-communication-book

Several sections are free to download. These can then be printed off and used for anyone with a communication difficulty.

Communication symbols www.flickr.com/photos/easy-pics/collections

Make your own communication book for an individual. There are many symbols and pictures that can be used and are free to access.

General Medical Council Learning disability communication resources www.gmc-uk.org/learningdisabilities/333.aspx

The GMC provides information on resources that can be used to enhance communication with patients with a learning disability in a hospital setting.

Ability net www.abilitynet.org.uk/factsheet/communication-aids

Provide information on electronic communication aids that helps an individual communicate more effectively with those around them.

Communication Matters www.communicationmatters.org.uk

Communication Matters is dedicated to creating a world where everyone has a right to a voice through the provision of equipment and on-going support services

Books Beyond Words www.booksbeyondwords.co.uk

Books Beyond Words use pictures to tell stories that engage and empower people, on themes such as love and relationships, health, death and dying, and crime. They are also a tool for professionals to use with people in many different teaching and counselling situations.

http://www.communicationpeople.co.uk/services/the-hospital-communication-bookhttp://www.flickr.com/photos/easy-pics/collectionshttp://www.gmc-uk.org/learningdisabilities/333.aspxhttp://www.abilitynet.org.uk/factsheet/communication-aidshttp://www.communicationmatters.org.uk/http://www.booksbeyondwords.co.uk/



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Caring For Patients With Dementia Using the headings below, please identify what you need to consider when caring for a patient with dementia, delirium or confusion.

TIP! Think about Bob although he does not have dementia, he is confused and is being cared for in hospital, which is an environment he may not be familiar with. He is surrounded by people he does not know. How would you feel in that situation?

Environment

Therapeutic engagement / provision of activities

Patient & family Centred Care

Communication Carer Support

Key things to consider about the environment

Identify a range of activities that you can undertake with patients on the ward. How can this benefit them and improve the patient experience

What is it? How can we provide patient cantered care?

Consider verbal and non-verbal list the initiatives that we are doing within the trust to identify and support carers


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Top tips for caring with patients with dementia.

A. Recognise that each person with dementia is a unique individual. Adopt a person and family centred approach to care. Utilise the This Is Me, My Care Passport (Get to know them, their likes / dislikes, personal preferences and routines, life story).

B. Take your time. C. Communicate effectively (verbally,

non-verbally and actively listen) with the patient their family and carer

D. Promote the patients privacy and dignity.

E. Respect the individuals wishes. F. Be aware that face value is not

always what it seems. G. Get into their world, go with the

flow and dont argue! H. Put compassion back into the care

you provide. I. Promote the individuals

independence by breaking tasks down into small steps and embrace a non-failure culture to rehabilitation.

J. Use activities to prevent challenging behaviour, alleviate boredom and promote rehabilitation.

K. Be aware that the individual may need extra assistance / support / time / prompting with undertaking the activities of daily living (for example eating and drinking, mobilising, toileting, communication, hygiene and dressing).

L. Minimise distractions (if appropriate).

M. Maintain a safe but personalised bed space.

N. Be aware of the carers needs ensuring that you listen to and value their input. Where appropriate utilise the carer passport for family members and signpost to voluntary/statutory services.

What does the FORGET ME NOT symbolise?

The Royal Surrey County Hospital has adopted the use of a FORGET ME NOT flower for use with patients with dementia, short term memory loss, confusion and delirium.

When should we use the FORGET ME NOT symbol?

The symbol should be used to identify patients that have the following conditions

Dementia, confusion



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Where will the symbol be used?

The FORGET ME NOT symbol is magnetic and should be placed

Next to the patients name on the multidisciplinary board on the ward.

On the board, next to the patients bed.

What does the use of the FORGET ME NOT symbol mean?

The FORGET Me NOT symbol means that: -

The patient has dementia, confusion, short term memory loss and/or delirium.

Please DO NOT move this patient to another ward or bay unless absolutely necessary.

Prior to discharge please DO NOT send the patient to the discharge lounge.

This patient requires a multidisciplinary team and

person/family centred approach to care and discharge planning.

The individual may need extra assistance / support / time when undertaking the activities of daily living (for example eating and drinking, mobilising, toileting, communication, hygiene and dressing).

The patients relatives may be appropriate to have / use the carer passport for family members.

Utilise the patients THIS IS ME / MY CARE PASSPORT document (If the patient has one or ask if the patient / relative if they would like one). The THIS IS ME / MY CARE PASSPORT promotes holistic, individualised, person centred care.

Contact Details

Fay Wright 4346

Dementia Specialist Nurse

[email protected]

Bleep 71-6421

Fay works Monday to Wednesday

Rachel Cross &Gill King 4666

Psychiatric Liaison service for older adults.

Rachel and Gill work Monday to Friday, 9am-5pm

mailto:[email protected]


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Poem When I wander dont tell me to come

and sit down. Wander with me.

It may be because I am hungry, thirsty, need the toilet.

Or maybe I just need to stretch my legs.

When I call for my mother (even though Im ninety!)

Dont tell me she has died. Reassure me, cuddle me, ask me

about her. It may be that I am looking for the

security that my mother once gave me.

When I shout out please dont ask me to be quietor walk by.

I am trying to tell you something, but have difficulty in telling you what.

Be patient. Try to find out. I may be in pain.

When I become agitated or appear angry, please dont reach for the

drugs first. I am trying to tell you something.

It may be too hot, too bright, too noisy. Or maybe its because I miss my loved

ones. Try to find out first

When I dont eat my dinner or drink my tea, it may be because Ive forgotten

how to. Show me what to do, remind me.

It may be that I just need to hold my knife and fork

I may know what to do then.

When I push you away while youre trying to help me wash or get dressed, maybe its because I have forgotten

what you have said. Keep telling me what you are doing

over and over and over. Maybe others will think youre the one

that needs the help!

With all my thoughts and maybes, perhaps it will be you who reaches my

thoughts, understands my fears, and will make

me feel safe.

Maybe it will be you who I need to thank.

If only I knew how

Royal Surre

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