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District Nurses

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PUP Policy Information Session

please click below to access the presentation

News

React to Red

We have launched a new initiative for all of our District Nursing staff to React to RED.  What this means is that if you see any of the following, you should report this immediately to your Nurse Team Leader (NTL): 

  • Grade 1 Pressure Damage
  • Red / Discoloured skin (especially around boney prominences)
  • Moisture Damage (or concerns)
  • Any patients with vulnerable areas of skin you feel are of concern

What your NTL will then do is have a discussion with the DN Caseload holder, and take a look at current care plans and actions, and make suggestions on additional measures that should be put in place or considered. 

The aim is to have a Multidisciplinary approach to patient care, reduce any unintentional patient harm, distress or stress.  

Remember – preventing pressure ulcers is everyone’s business Let’s all work together to improve patient care!

Preventing and Managing Skin Damage Cause by Pressure and Moisture

New Presentations now available to our Pressure Ulcer Prevention awareness session

Important assessment information for first visits to a Community Patient

At first you must do the following:

  • SKIN CHECK – At first visit patients skin must be observed and assessment documented in notes.
  • Assessment – Nursing assessment to be completed including condition of skin and level of risk and Pain.
  • Waterlow – Must be completed on first visit and again as patient condition changes
  • SSKINS – To be commenced if Waterlow is 10 or above (Good Practice can be to do SSKINS for all patients with exception on once only visits.)You will need to be explicit in your skin checking instructions i.e. document who will be observing the skin and how often. Examples – the nurse will check at each visit, or weekly, or carers will check daily and report to DN.
  • Skin Care plan – commenced if nursing need identified. Clearly document planned wound care including frequency of planned visits. Patient Pressure Ulcer prevention leaflet –Verbal instructions as well as written instructions to be provided to patients at risk. This must be documented on the SSKINS (Good prevention to provide all patients with leaflet.)

Further Information

New Red Day Review Tool

Use link below to access the new Red Day Review Tool (RDRT).

Annual Competency

Please access the Annual competency tool here. This tool must be completed with support form your line manager. Once completed supplied copy to your Nurse Team Leader as this must be retained. This should be completed every year to maintain your competency in Pressure ulcer Prevention

To support your learning please use the TVN link below for their voiced over presentation.

LearnPro Module – Pressure Ulcer Prevention

GGC:080 Prevention of Pressure Ulcers

2 modules

  • Understanding Pressure Ulcer
  • Prevention and Management of Pressure Ulcer
Podiatry Resources

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March 2022

Update from Non Medical Prescribing team

Wound management: Discontinuation of  AQUACEL® Ag and AQUACEL® Ag Extra™ dressings and replacement with Aquacel Ag +

In theory no action should be required since previous notification of this has been sent out. However we do continue to note prescribing activity with old non formulary dressing titles prescribed.

 Wound Formulary

Prescribing implications (apart from loss of rebates)

  • “Ordinary” Aquacel flat dressings (not ribbon) are discontinued and Aquacel Extra is the only one available. This information has previously been circulated and should be widely known. We do see this starting to be reflected in prism data.
  • Aquacel Ag as noted is being discontinued and the only range will be formulary Aquacel Ag+ Extra.
  • Over this year as transition takes place clinicians should try not to inadvertently miss out the all-important “+” sign for silver products!  If not prescribed accurately (attached) this could result in the pharmacists contacting NMP to inform them the product has been discontinued and asking for an alternative. This will may cause confusion and risk delays in patients commencing treatment.
  • FYI the “extra” part accounts for greater absorbency potential and sequestering proteases – whereas the  “+” sign for Ag range denotes surfactant has been included.

Please click on the relevant box below to directly access the information.

Prescribing Support

In each of the localities within Glasgow City HSCP, there are support groups available to community nurses who hold the V100, V150 or V300 prescribing qualifications.  Please see the main contact below for each location and feel free to email them to ask for dates and times of meetings you will be able to link in to for support and guidance.

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What to do if you are concerned someone is at risk?

If you are worried that you or someone you know is being harmed, is suffering from neglect, or is being abused, it is important to tell someone. Your report will be treated in confidence. Everyone has a right to be safe.

Make sure they are safe – If immediate help is required phone 999.

During office hours, you can contact Social Care Direct by phone (0141 287 0555) or email socialcaredirect@glasgow.gov.uk.

Outwith office hours you can phone Glasgow and Partners Emergency Social Work Services on 0300 343 1505.

  • For Glasgow City please call 0300 343 1505
  • For Eastwood please call 0141 451 0866
  • For Barrhead please call 0141 800 7850 
  • For East Dumbartonshire please call 0300 343 1505

You can also phone Scottish Police non-emergency on 101.

You can also speak to a health professional (for example your doctor or a health visitor) or the police. They will take your concerns seriously.

If you know or suspect that an adult is being harmed then you need to report your concerns. Don’t assume that someone else has already reported it. The person being harmed or neglected may not be able to report it themselves. Remember, the person who did this may be doing it to others too.

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Basic Life Support
Continence
District Charge Nurse – Day 2 Introduction to MicroStrategy

Day 2 – Will look at Microstrategy Clinical Quality Indicators – SSKINS, MUST & Cauti

All sessions will start 1:00pm prompt 

All sessions will now be delivered via MSTeams, Please access link below to attend. No need to book a place.

EQUIP-U

Training is provided by the staff within EQUIP-U, currently conducted via MS Teams, however, this may change with the current regulations. Please check details upon booking.

To Book or join waiting list please click HERE

HICC/PICC Care

Maintenance sessions are carried out periodically throughout the year, depending on demand. If you find there are no dates available, please contact the PDN team via email to find out more.

Important Note

Prior to booking, please ensure you have the support of your Line Manager to attend as these are carried out in the afternoon.

Next dates for these sessions are listed below and will be held within the QEUH.

To book onto the training session, simply click on the preferred date below.

Thursday 28th September

Monday 30th October

23rd November

18th December

Hypoglycaemia Management
Leg Ulcer Management
Record Keeping

Record Keeping Sessions

Currently, sessions are On – Demand, which means you can access the training online at anytime.

Record Keeping for District Nursing

All Staff within District Nursing (bands 3 – 7) are expected to undertake this training annually and ensure their competence within record keeping.  Any additional record keeping support can be accessed by emailing David.McCrohon@ggc.scot.nhs.uk

There are 3 steps to completing this training.

1) Watch the on-demand video

2) Read and understand the ‘Standards for Professional Record Keeping’ policy

3) Sign the declaration that you have completed both of the above.

If you have not completed all 3 steps, this may flag your name to indicate training incomplete.

Record Keeping

Step 1

You should now access the on-demand Record Keeping training video here.

Topics covered include : 

  • Principles of good Record Keeping
  • Excellence in Care
  • Expectations from DN staff
  • Nursing Assessments 
  • Risk Assessing
  • Care Planning
  • Specialist Forms (wound charts, leg ulcer pathways, waterlows etc)
  • Recording visits
  • White Cards
  • Agile Working

Step 2

Staff should familiarise themselves with this policy and understand what is expected of them in relation to Record Keeping within the organisation.

Step 3

This will be shared with your Nurse Team Leader and can be used for Revalidation and CPD purposes.

Safer Sharps

Welcome to the Safe Use of Clinical Sharps training page.

Sol Care Needles

With the introduction of the new Insulin syringes within Community, please ensure you access the training material provided below.

Below is the relevant important information for Sol-Care Insulin Safety Syringe. Please read the material below prior to using the instruments.

Should you have any further concerns or questions please do not hesitate to contact the Practice Development Team.

Completing your safer sharps training

There are 5 key components to this training that must be completed prior to using any sharps devices within the clinical environment.

  1. All community nursing staff should first access and complete the below Learnpro modules
  • GGC: Managing Skin Care for Responsible Persons
  • Management of Needlestick & Similar Injuries
  • Prevention & Management of Occupational Exposure

2. You must read the Safer Sharps Policy and sign to confirm you understand your roles and responsibilities with your Nurse Team Leader.

3. You must access the Safe Use of Clinical Sharps theory video

(This can only be accessed via an NHS device).

4. You must complete the practical demonstration with your line manager (Nurse Team Leader, District Charge Nurse, Treatment Room Coordinator).

5. Once you have completed Steps 1-4, you must now fill out this online form to evidence your training.  

SCIT app

What is SCIT?

Secure Clinical Image Transfer

The Secure Clinical Image transfer (SCIT) app is the approved method for capturing clinical photographs securely on a registered mobile device in acute and community settings.

The SCIT is an application of which is located on your professional mobile phone. Patients images are taken and immediately transferred to the server, when this occurs the images are no longer accessible from the mobile phone.

To apply for the SCIT app please click HERE

The images can be viewed within 24 hours on Clinical Portal or the Medical Image Manager (M.I.M) software

What is M.I.M?

Medical Image Manager

Medical Image Manager is a purpose-built database solution which allows healthcare professionals to access clinical photographs at workstations in their clinic or ward, using a simple web browser. Medical Image Manager enables all users’ access to the relevant image, in the relevant place, at the relevant time to support patient care. The system has been fully implemented within the acute hospitals of NHS Greater Glasgow and Clyde, and now welcomed by community nursing.

Accessing your patients images

Access can be via M.I.M or/and Clinical Portal.

Via Clinical Portal: Within your patient record, from the list noted on the left, click on “images”, you will see a drop down box appear, click on “photographs”. From this you will access all photographs captured by all services for your patient.

Via M.I.M:

When Applying for the M.I.M software please download and complete the required form, please note this cannot be completed and sent electronically, it must be signed by your Nurse Team Leader and sent to the correct department for approval. To apply for M.I.M please click HERE.

Training Material

Please familiarise yourself with the useful information below.

Venepuncture

Venepuncture training is offered from Acute, therefore practical session is given within the Royal Infirmary, Glasgow.

Prior to booking onto the training, please read the information provided below:

LearnPro (mandatory prior to training)

Practitioners must complete the NHSGGC 157: Venepuncture and Cannulation e-learning module on NHS LearnPro.

Failure to complete this before attending training will result in practitioner being refused entry and asked to book once this has been completed.

Practical Training

  • Practitioners attend a 2 hour practical workshop (this is not a drop-in session). Sessions available are:
  • Venepuncture only
  • Cannulation only
  • Venepuncture and cannulation

All staff wishing to attend this training must have approval from their Line Manager as the Nominator.

Places for these workshops are booked by completing the Nomination form and emailing to practicedevelopmentnominations@ggc.scot.nhs.uk.

Click Here to access the form.

Practitioners must work in an area where there is a clinical need for the skill.

Competency Assessment

A 2 month period of supervised practice and competency assessment follows attendance at the practical session.

Individuals are not deemed competent until they have received their completion certificate from Practice Development.

It is the responsibility of the individual to review and maintain their competence thereafter.

Competency booklets will be supplied during the training session.

Completed competency booklets should be emailed to practicedevelopment.enquiries@ggc.scot.nhs.uk

Important

If practitioners have already completed venepuncture training and achieved competence in another health board, and are able to provide documentary evidence of this, they should contact Practice Development to confirm this training and competence is transferrable to NHSGGC.

These practitioners should still complete supervised practice using the NHSGGC venepuncture competency book.

A copy of this completed booklet, signed off by your line manager, should be kept in appropriate training files at local level as evidence.

They should also access and complete the NHSGGC 157 venepuncture and cannulation module on NHS LearnPro.

LearnPro – MUST

This training is for Glasgow City HSCP for ALL Community Nursing Staff

New to LearnPro is the following modules.

These modules are for all community staff, it is expected that these modules are completed in full by 31st May.

See below for the New Modules available:

  • GGC:270 An Overview of Malnutrition.
  • GGC:271 Assessing Risk of Malnutrition
  • GGC:273 Food First Strategies – Community.

To access these, please log in to your LearnPro account below. 

Mandatory Training Requirements for all Community Staff Members

As part of your role, you are required to complete all relevant statutory and mandatory training via Learnpro. 

Below is a full list of all statutory & mandatory LearnPro modules you must complete.  Theses should be prioritised and must be completed within the first 12 weeks of your employment.

Accordion item 1

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The induction programme is for all community staff working within the Glasgow City area. For Induction information in your area, please contact your line manager.

To access the Induction documentation please email susan.kenmore@ggc.scot.nhs.uk

The 6 steps of Induction

Welcome to the District Nursing Induction portal for Glasgow City HSCP.

If you are a new member of staff, working within a District Nursing team within Glasgow City HSCP, you’ve come to the right place!

A new member of staff includes both ‘new to the organisation’, ‘new to the role’ or if you have moved to the same role within a different base/locality.

Getting Started

There is a lot to get your head around when starting in a new role within District Nursing.  For this reason, we run monthly induction sessions which all new members of staff must attend.

You can access the booking information below.

Once you have completed your induction day, you may wish to come back to this page to get the most up to date induction documents, or to use as a point of reference.

Everything you need to know is below

The 6 steps of Induction

Step 1

Step 1 of induction is an organisational welcome video. This should be watched by all new staff, irrespective of previous roles or experience. The video is approx. 6 minutes long and can be accessed below

Click here for the video 

Learning Needs Analysis is a self assessment of your transferrable skills and competencies which you should complete alongside your line manager on your first 2 weeks of starting your new post. All new staff must complete a Learning Needs Analysis. A completed copy of this should also be sent to your NTL.  

Important: To download the Learning Needs Analysis, please right click and
select ‘save link as…’ on the following link: Learning Needs Analysis

Step 2

From day 1, you and your line manager will begin working through the induction checklist.  This discusses everything from department orientation, health & safety, professional development, PDP, job role, information governance, confidentiality, awareness of policies & NHSGGC expectations of staff.

You will have 12 weeks to complete the induction checklist and it can be accessed here.

Step 3

As part of your role, you are required to complete all relevant statutory and mandatory training via Learnpro. You can access Learnpro here.

Below is a full list of all statutory & mandatory learnpro modules you must complete.  Theses should be prioritised and must be completed within the first 12 weeks of your employment.

Name of ModuleLocation on LearnProFrequency
GGC: 001 Fire SafetyStatutory / Mandatory2 years
GGC: 002 Health and Safety, An IntroductionStatutory / Mandatory3 years
GGC: 003 Reducing Risks of Violence & AggressionStatutory / Mandatory3 years
GGC: 004 Equality, Diversity and Human RightsStatutory / Mandatory3 years
GGC: 005 Manual Handling Theory 
(Link in with your local Moving & Handling assessor as you will need to do annual practical competencies each year)
Statutory / Mandatory3 years
GGC: 006 Public Protection (Adult & Child)Statutory / Mandatory3 years
GGC: 007 Standard Infection Control PrecautionsStatutory / Mandatory3 years
GGC: 008 Security & ThreatStatutory / Mandatory3 years
GGC: 009 Safe Information Handling – FoundationStatutory / Mandatory3 years
GGC: 061 Management of Needlestick & Similar InjuriesRole Specific Mandatory Modules           2 years
GGC: 063 Managing Skin Care for Responsible PersonRole Specific Mandatory Module2 years
Scottish IPC Education Pathway – Foundation: Prevention and Management of Occupational ExposureInfection Prevention and ControlNot Specified
Scottish IPC Education Pathway – Foundation: Hand HygieneInfection Prevention and ControlNot Specified

GGC: 270 An Overview of Malnutrition Role Specific Not Specified

GGC: 271 Assessing Risk Of Malnutrition Role Specific Not Specified

GGC: 273 Food First Strategies – Community Role Specific Not Specified

Step 4

Step 4 only needs to be completed by HCSW staff.  If you are not a HCSW, move on to Step 5.

The HCSW Induction Book is designed to support you in your new role and should be completed within the first 12 weeks of employment.  You can access this book here.

Step 5

Once you have completed Steps 1-4, your line manager should now sign off the first part of your induction here.

Steps 1 – 5 should be completed within the first 12 weeks of your employment.  If there are any reasons why this cannot be achieved, you must inform your Nurse Team Leader at the earliest opportunity.

Step 6 – District Nursing Only

Steps 1 – 5 represent a basic induction which is completed by all staff within NHS Greater Glasgow and Clyde. Step 6 is the final part of your induction process which is geared towards a more ‘role specific’ approach within District Nursing . Within this final part of induction will be a more detailed approach to knowledge and skills required for this specific speciality within nursing.

This document should be started from Day 1 of your employment, however you have 12 months to complete this part of your induction.

Please access your book here  (Important: To save this to your computer, right click this link, and select “Save link as” – save this somewhere on your computer that is easy to find.  You can then open it on your computer and fill this in as you go.  If you fill this in online, it may not save properly). Access your Community District Nursing Specific Booklet HERE.

Available Dates and New Staff Member Guidance

My name is Susan Kenmore and I am the Practice Development Support Nurse who is here to support you through the next 12 months of your induction. My main aims are to get you started on your induction journey, giving you the confidence and tools you need to get the best start out of your new career.  

As you’ll see from the illustration above, there is a lot for you to get through and in a fairly short space of time. With this in mind, below, is a list of sessions available for Induction Study Dates, and I would recommend you or your line manager book you onto the date closest to your start date of your new post to ensure you achieve everything with plenty of time to spare.

Staff Induction Training Dates

The Induction Study Day will be held within Pollok Health Centre. When you have successfully booked onto the Induction Study Day, you will receive a confirmation email containing further information.  

To book a space, simply click on the preferred date below.

Training times: 9.30am – 4.30pm

2023 Dates

29th September

27th October

30th November

13th December

Spaces are limited to 10 so be quick!

What’s included in the Induction Training Days?

If you have any problems accessing any of these dates, or any induction queries, please send me an email at susan.kenmore@ggc.scot.nhs.uk

Manager Guidance

As a line manager, there are 4 key steps to inducting your new member of staff. Click on the link below and follow the guidance to begin the induction process. You should begin these steps once you have a start date for your new member of staff.

Please use the Manager support document to prepare for the new staff Guidance for District Charge Nurses To induct new members of staff. You should start to plan induction post interview in order to prepare robust induction for first 4 weeks. This document will also give you a suggested induction template. 

Need any help, support or advice?  Please feel free to contact Susan Kenmore (Practice Development Support Nurse) via email on susan.kenmore@ggc.scot.nhs.uk

Line Manager Guidance

As a line manager, your first step is to book your new staff member onto the Induction Training day with Practice Development.  Try to book the date closest to your staff members start date via the link below.

The Induction day will run from 9.30am – 4.30pm

What’s included in the Induction Training Day?

  • 6 Steps of Induction (see banner at top of page)
    This will get your staff member started on their mandatory completion of the 6 steps. Steps 1 – 5 should be completed within 12 weeks of employment/Study day, and step 6 must be completed within 12 months.
  • Safe Use of Clinical Sharps Training
  • SEPSIS Training
  • Record Keeping Training
  • CNIS Training
  • NHS Principals and Values (previously Values & Behaviours)
  • NHSGGC Policies (including Datix, Fair Warning, Safe Use of Clinical Sharps)
  • Specialist Subjects including:
    • Tissue Viability (Pressure Ulcer Prevention, Wound Formulary, First Dressings, Basic Wound Care)
    • Vascular (Introduction to leg ulcers)
    • Palliative Care (Introduction & Documentation)
    • District Nursing Medication Administration (DTA, Stock Recording, Medication Administration sheets)
Line Manager Steps 2 – 4

Step 2

Your next step, is to download and save a copy of the Learning Needs Self Assessment.  This should be done within your new staff members first 2 weeks of employment.  This is aimed at finding out what skills and competencies your staff member brings with them to the role, and what they need further support with.  Your staff member should complete this themselves, and you should review this with them and plan training according to their needs, and the needs of your caseload.

IMPORTANT: To download the Learning Needs Analysis, please right click and
select ‘save link as…’ on the following link: Learning Needs Analysis

Step 3

Before your staff member attends the induction study day, they should complete the following Learnpro’s for ‘Safe Use of Clinical Sharps’ in order to be signed off for this at the induction day.  If they can’t complete this before the study day, they can still attend but you will be required to sign them off once the learnpros are completed.

  • GGC: Management of Needlestick and similar injuries
  • GGC: Managing Skin Care for Professional Persons
  • Infection Prevention and Control – NES: Prevention and Management of Occupational Exposure.

Step 4

Now that your new staff member has successfully completed the induction day, they are now fully informed of the 6 steps of induction detailed below.

Your role is now to support them over the next 12 weeks for steps 2 – 5, and 12-18 months for the Step 6 DN Role Specific Induction.

Step 2 – When your staff member returns, you will be expected to begin signing off their STEP 2 induction Checklist.  The checklist has items to be signed off on ‘Day 1’, ‘Week 1’, ‘Month 1’ etc, so please ensure you pay close attention to these timings.  This must be completed within 12 weeks of employment/attendance at induction training day.

For Step 3 – you should allocate your staff member time to complete all statutory and mandatory learnpro modules over the next 12 weeks and confirm completion.

Step 4 – HCSW’s will have been given an overview of their workbook they are required to complete within 12 weeks, and you should allocate some time each week to go through their progress and ensure they are on track to complete this.

Step 5 – At the 12 week mark, your staff member should have completed all of the above steps, and you can now CLICK HERE to go to the corporate induction sign off page.  This should take 1-2 minutes to complete.

Finally, Step 6 is the Nursing Learning Education and Development Framework – Older Adult services and has a stronger focus on clinical skills that new members of staff are expected to undertake within their role. This also forms part of their PDP / TURAS, and you should encourage them to attend training to ensure competency and sign off each skill once complete.  This should be completed within 18 months of employment.

Specialist Services

Community Nursing means linking in with various services to assist with implementing the best care into your practice. Click the button below and find out how these services can do just that.

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You can do a guideline search via the NHSGGC Clinical Guidelines Platform.

 If you experience any issues with this page please email Jill.McNeill@ggc.scot.nhs.uk or David.McCrohon@ggc.scot.nhs.uk.

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MicroStrategy Presentations

If you experience any issues with this page please email Jill.McNeill@ggc.scot.nhs.uk or David.McCrohon@ggc.scot.nhs.uk.

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Risk Assessments

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Workload Tool Demonstration Video

Please note: This demonstration video will ask you to use CHI numbers as unique identifiers, however, as per training, please note current guidance in GGC is not to include CHI numbers.  Please use ‘patient 1’, ‘patient 2’ etc instead.

Timeline

This timeline has been developed to give an overview of the workload tool run, and provides information on local support available throughout the tool’s run for 2021. 

For any questions or assistance, please contact Linda Brennan (linda.brennan@ggc.scot.nhs.uk

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Awareness presentations for Pre-registration Student Nurses in Community Settings

Further Information

Student Induction Pack
Student Workbook

The workbook will be owned by yourself and we would hope it will assist you with reflective conversations with your practice Assessor/ supervisor. We hope that you will gain practical experiences of the scenarios we have provided and the Student workbook will give you additional direction of what to consider when supporting a patient in the community .

They will also highlight that it will be through discussion between the practice supervisor / assessor and the student that will identify if part or all of the document is to be completed. 

The document will be your (students) property, it is not required as part of your university work but will inform your practice supervisor / practice assessor of your progress in placement and the evidence from this will inform interim and final assessment.

Scenarios for Student Nurses

Take a few minutes to read through the following scenarios and think about what you would do as the newly qualified Staff Nurse in each scenario.  Think about how you would act at the time, what actions you would likely take, what you would do with the patient, who you would inform, and if you would follow this up with another visit/referral to specialists etc.

Discuss your answers with your Practice Supervisor or Practice Assessor. These are designed to give you scenarios to discuss are part of a reflective discussion.

Question 1

You are asked to visit a gentleman who has a sore bottom and it turns out he has a pressure ulcer on his right buttock. How would you assess this and what would your care plan consist of? What else would you do?

Assessment – Have you considered…

  • What grade of pressure ulcer this is?  Pressure Ulcer Grading Chart
  • Have you measured the wound?
  • Have you considered the reason for the patient developing this pressure ulcer and looked at ways in which to minimise further damage?  (Think SSKINS)
  • Have you informed the caseload holder?

Planning Care

  • Think about dressings – what would you likely want to use for the different grades?
  • Consider how much exudate (fluid) is coming from the wound
  • Consider how often to visit and change dressing
  • Consider what you want dressing to achieve (absorb, reduce bacterial load, protect, progress to healing etc)
  • How often would you measure the wound?
  • How often would you change / update the care plan?

Question 2

You go to visit a lady who has type one diabetes who requires the nurses to administer her insulin. What are the steps you would take prior to administering her insulin?

Have you considered…

  • Have you checked her Nursing notes to ensure no-one else has visited this patient prior to your arrival?
  • Have you checked her Direction to Administer?
  • Once you have checked the patients Blood Glucose level, have a think about what the ‘normal range’ would be for this patient – discuss with your mentor.
  • What steps would you take if the patient is hypoglycaemic / hyperglycaemic?
  • If safe to do so, are you familiar with the device used for administering insulin?
  • Is your device in line with the safer sharps policy?
  • Have you disposed of the sharps appropriately?

Question 3

One of your patients who has a wound on their leg has phoned to say his wound is very painful and his dressing has fallen off. When you saw him yesterday there was minimal pain at dressing change however you did think it was exuding more fluid than before. What things would you consider when you go to visit this man? What would your assessment include?

Have you considered…

  • Is the current dressing appropriate for the increased exudate levels
  • Frequency of visits (may need increased)
  • Are you expecting the wound to increase in pain?
  • Consider wound infection – if likely, what steps might you take?  (Remember, is it localised or systemic?)
  • Does this gentleman need referral to Vascular / TVN?
  • Would you change his care plan, nursing assessment, waterlow?

Question 4

A patient phones to advise that their catheter bag has been empty all morning and their stomach is becoming painful. What would you do? Is there any advice you can give over the phone initially?

Have you considered…

  • Asking them to change position to allow gravity to assist
  • Asking the patient about their bowels (are they regular / constipated)
  • Ask about fluid intake over past 24 hours
  • Provide reassurance
  • If requiring a visit – what would you be looking for?
  • What would indicate a change of catheter is required
  • Are there any signs of CAUTI
  • How would you record your visit?  (Think about Catheter Assessment Procedure)

Question 5

The carer of a palliative patient calls to say that their loved one has become very distressed and is trying to get out of bed. They had been administered 2mgs midazolam only an hour before hand and are on a syringe driver with diamorphine for their pain. How would you assess this situation? Is there anything else that could be causing this agitation?

Have you considered…

  • Patients’ position in bed / chair
  • Bladder
  • Bowels
  • How many breakthrough doses over past 24 hours
  • Is the breakthrough dose sufficient
  • Should we consider adding Midazolam to the Syringe Driver?
  • Medication review from GP / Independent Nurse Prescriber
  • Support for family
  • Home Care / Marie Curie
Student Resources