Penarth district nurse team
STUDENT NURSE INFORMATION PACK
Welcome to Penarth District Nurse team
Your designated mentor will be:
…………………………………………………………………………
Penarth District Nurse (DN) team’s philosophy of care:
 To deliver the highest standard of holistic care, in a safe and
friendly environment.
 To promote wellbeing and independence to all our patients in an
understanding and approachable way.
 To provide the most appropriate care, working alongside, families,
carers and other agencies within primary care.
The DN service is committed to:
 Understanding human behaviour and how to influence it.
 Understanding diverse cultural and religious needs and adapting
care appropriately
 Understanding families and carers and encourage their involvement
where appropriate
 Understanding community services and resources and how to use
these in the patients’ best interest.
We hope you find the following information helpful during your
placement.
Avon house
While on placement at Avon house we politely ask that you refrain from
parking in the staff car park. This is due to the lack of spaces available
and staff needing to be in and out of the office.
You will be out with mentors in their vehicles throughout your
placement. If however you have a problems with this due to specific
needs etc then please inform your mentor.
While out on visits please ensure that mobile phones are on silent again
however if there is a circumstance that requires you to keep it on just let
your mentor know.
Who’s who?
 The clinical teacher for Penarth is Venetia Yarr. Telephone number
for Venetia- 02920 716387/ 07966440657.
Team members
Job Title
Team Leader
Name
Contact no
Wendy Simmonds
07976050238
Deputy Team Leader
Lynne Thomas
07976050214
Deputy Team Leader
Vicky Manfield
07976050245
Staff Nurse
Barbara Dewey
07976050410
Staff Nurse
Sue Holman
Staff Nurse
Ian (Spike) Banks
07976050444
Staff nurse
Jenny Wragg
07976050099
Staff Nurse
Wendy Murray
07976050310
Staff Nurse
Helen Mapstone
07976050871
Staff Nurse
Helen Lowney
07976050405
07976050197
Staff Nurse
Connie James- Conibear
07976050134
Staff Nurse
Joanne Clarke
07976050158
Staff Nurse
Robert George
07976050426
Staff Nurse
Sarah Higgins
07976050402
Staff Nurse
Lynne Mathias
07976050272
Staff Nurse
Julie Powell
07976050065
Staff Nurse
Stephen Strange
07976050410
Staff Nurse
Amy Owen
07976050244
Staff Nurse
Vicky Teere
07976050436
Michelle Coombes
HCSW
07976050013
Jasmine Pascoe
HCSW
07976050028
GP Surgeries
We have roughly 600 patients on our caseload, which are divided
between six GP surgeries. They include:
 Albert Road surgery, Penarth. Telephone number- 08444775191
 Station Road surgery, Penarth. Telephone number- 02920 702301
 Stanwell Road Surgery, Penarth. Telephone number- 02920
703039
 Redlands road Surgery, Penarth. Telephone number- 02920 706043
 Sully Surgery. Telephone number- 02920 530255
 Dinas Powys Health Centre. Telephone number 02920 512293.
We receive referrals daily from GP practices, patients, carers, hospitals
and residential homes.
Shift Patterns
Day shift: 08.30-16.30
Late shift- 12.00- 20.00
We all return for handover at 13.00pm and this usually takes around 3045 minutes.
Breaks
You will have a half hour lunch break every day. You can stay in and eat
with the team, or you are free to go out for your break.
Door codes (please keep these safe)
You will need to use the buzzer intercom to enter Avon House. Press the
‘vale locality’ button and you will be let in.
Sickness
If you are unable to attend your placement at any time due to sickness (or
any other reason), please inform your mentor and the University sick line.
Fire alarm
Please sign in and out of the fire register (located in the hallway on the
third floor) every time you enter/ leave the building. If your name is not
on the list of staff, please add it.
On hearing the alarm you should make your way through the fire exits (as
marked) and down the stairs, not using the lift, and assemble at the front
of the building.
Uniform
Students should wear their All Wales uniform and adhere to the All
Wales Code policy (as well as their own university policy) at all times.
(http://www.cardiffandvaleuhb.wales.nhs.uk/document/170124
Duties we perform
We carry out a number of nursing duties including dressings- simple and
more complex, e.g. compression bandaging, venepuncture, catheter care,
palliative care, injections (B12/ insulin ), continence assessments, care of
various types of drains, Care of HICC/ PICC lines and post operative
care- e.g. removal of sutures etc.
We perform a lot of wound care to patients in the community setting.
Below is some information that will enhance your knowledge regarding
wound care.
Features of venous and arterial ulcers
History
Classic Site
Edges
Wound bed
Exudate
Level
Pain
Oedema
Venous
History of varicose veins,
Deep
vein thrombosis,
venous
insufficiency
or venous incompetence.
Over the medial gaiter
region
of the leg.
Irregular and slopping.
Often covered with slough.
Usually high.
Pain not severe unless
associated with excessive
oedema or infection.
Usually
Associated
with limb oedema.
Arterial
History suggestive
of peripheral arterial disease,
intermittent
claudication and/or rest pain.
Usually over the foot, toes
and ankle.
Punched out.
Often covered with varying
degrees of slough and
necrotic tissue.
Usually low.
Pain, even without infection.
Oedema not common.
Associated
features
Treatment
Venous
eczema
lipodermatosclerosis,
Atrophie
blanche, haemosiderosis.
Compression therapy.
Wound assessment guidance grids
Trophic changes; gangrene
may be present. Surrounding
skin shiny and hairless
Appropriate surgery for
arterial insufficiency (if patient
suitable for surgery or
disease not too far
progressed). Drugs of limited
value.
HEIDI wound assessment tool
History
(Harding et al 2007)
Indicators (expected outcomes)
If outcomes are not as
expected repeat the process
Examination
Diagnosis
Investigations
Interpreting ankle brachial pressure index (ABPI)
Index
>
0.7-1
Signs
and Symptoms
Mild
intermittent
claudication
or no symptoms.
0.7-0.5
Varying degrees of
intermittent
claudication.
0.5-0.3
Severe
intermittent
claudication
and rest pain.
Severity
Action
of the Disease
Mild arterial disease.
Reduce risk
factors and
change lifestyle
stop smoking
maintain weight
exercise regularly
consider antiplatelet
agent.
Mild
As for index>0.7-1,
to moderate arterial
Plus referral to
disease.
outpatient
vascular specialist.
Possible
arterial imaging.
(duplex
scan/or/angiogram).
Severe
As for index>0.7-1,
arterial disease.
Plus urgent referral
vascular specialist.
Possible
arterial imaging.
(duplex
scan/or/angiogram).
< 0.3
Or ankle
Systolic
Pressure
<
50mm
Hg
Critical ischaemia
(rest pain> 2
weeks)
with or without
tissue loss (ulcer
Gangrene).
Severe
arterial disease.
urgent referral
vascular
emergency
on-call team and
possible
surgical
or
radiological
intervention
An index of 1-1.1 is considered normal. The data in the table should be
used to support existing clinical examination and findings. Erroneous readings
could be because of the inability to compress the arteries secondary to leg
oedema or calcification of the vessels due underlying disease for example
diabetes. Dupplex scan may be required to establish vascular statis.
Grey et al (2006), Vowden (2001).
Comparison of gravitational eczema and cellulitis of the leg
Symptoms
Eczema
No Fever
Itching/scaly
History of
varicose veins
or deep vein
thrombosis
Increase in exudates
Signs
Normal temperature
Erythematous,
inflamed
Diffuse
and poorly demarcated
No tenderness
Vesicles
Crusting
Lesions on other parts
of the body, particularly
other leg and arms. Is
there evidence of
contact dermatitis (site
of where dressing was
clearly demarked)
Cellulitis
May have fever
Not
Itching/scaly
but Painful
shiny skin
No relevant history
No increase in
exudates
Feverish
Erythematous, inflamed
Usually well
demarcated
Tenderness
One, or a few, bullae
No crusting
No lesions elsewhere
Portal of Entry
Not applicable
Investigations
White cell count normal
CRP normal
Blood culture negative
Skin swabs (using the
lavine technique)
Staphylococcus
aureus common
Usually unknown, but
break in skin, ulcers,
trauma, athletes foot
implicated
White cell count high
CRP high
Blood
culture usually negative
Usually negative,
expect for necrotic
tissue
Reference source based on: Papafio-Quartey (1999), Clinical Resource
Efficiency Support Team (CREST): Guidelines on The Management of
Cellulitis in Adults (2005), Grey et al (2006), Nazarko (2009), Clinical
Knowledge Summary (2008).
Steroid treatment regime/prescription guide for varicose eczema (Grey
et al 2006)
Severe Eczema
Very potent corticosteroids for 3-4 weeks (such as clobetasol propionate): also
emollient *
Infected
Eczema
Combination of
highly potent
corticosteroids,
antiseptic and
astringent agent
such as
potassium
permanganate
(1 in 10,000):
and oral
antibiotics.
Mild Eczema
Moderately
potent
corticosteroids
for 3-4 weeks:
(Such as
clobetasone
butyrate): also
emollient.*
No Eczema -Daily emollient*
Weeping
Eczema
As for infected
eczema but
without oral
antibiotics
*Such as aqueous cream or liquid and white soft paraffin (50/50)
Glossary
Haemosiderin: Pigmentation skin changes, often looks dirty brown in colour.
Caused by leakage of blood constituents into the surrounding tissues which
activates fibroblasts and inflammatory cells causing skin changes and
damage.
Lipodermatosclerosis: Can be misdiagnosed as cellulitis or phlebitis.
Hardened, red or brown skin, affecting the lower limb. The subcutaneous
tissue becomes hard and depressed. Often results in a ‘champagne bottle’
shaped leg.
Atrophie Blanche: ‘White’ star shaped ‘flare’ pigmentation of the skin. Often
sited where previous ulceration has occurred. Can appear indented.
Referenced from: Clinical Knowledge Summary (2008) (CKS)
Opportunities for learning
 Health Visitor
- Birth visits
- Child care clinics
- Assessment and evaluation of families
- Health promotion
- Child protection issues
 Practice Nurse
- Health promotion/ smoking cessation
- Over 75 Assessment
- Diabetic reviews
- Asthma clinic
- Immunisations
 Tissue Viability Nurses
 General practitioners
 Diabetic nurses
 Palliative care nurses
 Leg ulcer clinic
Discuss with your mentor what visits you may wish to make.
RELEVANT LEGISLATION
As you will be aware, our work as care providers is governed and guided
by legislation from the health service’s governing bodies and relevant UK
Government and Welsh Assembly Government departments. Some of
these are particularly relevant to primary care and the role of the District
Nurse. A brief summary of these is included below, alongside links to the
full documents (which would be usefully explored by students).
Fundamentals of care (2003)
http://www.wales.nhs.uk/documents/booklet-e.pdf
A Welsh Government initiative to the improve consistency and quality of
social care and health. Consists of 12 aspects of care which have been
identified by patients and relatives as the most important in care delivery,
mirroring many of the activities of daily living (Roper et al 1980),
including:











Communication and information
Respecting people
Ensuring safety
Promoting independence
Relationships
Rest, sleep and activity
Ensuring comfort and alleviating pain
Personal hygiene foot care and appearance
Oral health and hygiene
Toilet needs
Preventing pressure damage
Free to lead, free to care (2008)
http://www.wales.nhs.uk/documents/cleanliness-report.pdf
Sets out 35 proposals aimed at improving the patient’s experience of
hospitals. Key recommendations include:
 All Wales uniform to improve infection control and staff
identification.
 Introduction of an all Wales audit tool to monitor compliance with
the ‘Fundamentals of care’ (Welsh Government care quality
standards).
 All Wales nutritional care pathway (now in place).
 All Wales food and fluid charts to monitor patient nutrition and
hydration.
 All Wales charge/sister development programme to develop
management and leadership skills. This will ensure they are
empowered to run wards more effectively using evidence-based
practice and reflective practice.
All Wales ward sister/charge nurse development programme (2008)
Preparation for leadership ensuring ward sisters/charge nurses are:
 Politically aware of the strategies, policies etc. that underpin
practice.
 Developing strategic skills that empower them to manage the
clinical and educational environment.
 Using effective language skills that ensure they can manage staff
and resources effectively.
 Confident to be empowered.
 Developing their careers for leadership and wider roles.
 Trained to perform specific tasks.
 Delivering the ‘Fundamentals of care’.
Making a difference: providing better, fairer services (2010)
http://www.cardiffandvaleuhb.wales.nhs.uk/sitesplus/documents/864/Ma
king%20a%20difference%20Oct%202010%20%282%29.pdf
Cardiff and Vale UHB consultation document (which appears to have
partially informed ‘Together for health’), discussing:
 Delivery high quality, equitable and sustainable care to all
wherever they live to address inequalities in healthcare currently
identified from the consultation.
 Delivery of sites that are fit for purpose to address the capacity and
health needs of the population.
 Review of all services and how they deliver care, addressing
workforce issues and clinical standards.
Nursing dashboards: measuring quality
Clinical dashboards are designed to provide a real-time or as near to realtime measure of nursing quality and must be patient centred measure.
Wales is aiming to develop a set of indicators and metrics to demonstrate
the impact of nursing on patient care in wales. Main indicators include:






Hand hygiene
Healthcare acquired pressure ulcers
Nutrition score
Complaints re-nursing care
Compliance with nursing cleaning schedule
Percentage of staff PDR undertaken within 12 months.
Staff will be empowered to update information for use across Wales.
Setting the direction (2010)
http://wales.gov.uk/docs/dhss/publications/100727settingthedirectionen.p
df
Recommendations building on strengths and developments to date within
the current system whilst at the same time directly tackling some of the
existing challenges. The key underlying principles for improvement
include:
 Universal population registration and open access to effectively
organised services within the community.
 First contact with generalist physicians that deal with
undifferentiated problems supported by an integrated community
team.
 Localised primary care team-working serving discrete populations.
 Focus on prevention, early intervention and improving public
health
 Co-ordinated care where generalists work closely with specialists
and wider support in the community to prevent ill-health, reduce
dependency and effectively treat illness.
 A highly skilled and integrated workforce.
 Health and social care working together across the entire patient
journey ensuring that services are accessible and easily navigated.
 Robust information and communication systems to support
effective decision-making and public engagement.
 Active involvement of citizens and carers in decisions about their
care.
Together for health (2011)
http://wales.gov.uk/docs/dhss/publications/111101togetheren.pdf
Policy based around community services with patients at the centre,
which places prevention, quality and transparency at the heart of
healthcare. Outlines challenges facing the health service and the actions
necessary to ensure world-class performance. Factors driving the need for
reform include:





A rising elderly population.
Inequalities in health.
Increasing numbers of patients with chronic conditions.
Medical staffing pressures and.
Some specialist services being spread too thinly.
The document sets out how the NHS will look in five years’ time, with
primary and community services at the centre. The main commitments
are:
 Service modernisation, including more care provided closer to
home and specialist ‘centres of excellence’.
 Addressing health inequalities.
 Better IT systems and an information strategy ensuring improved
care.
 Improving quality of care.
 Workforce development.
 Instigating a ‘compact with the public’.
 A changed financial regime.
1000lives plus
http://www.1000livesplus.wales.nhs.uk/home
National programme seeking to improve patient safety, minimise waste
and reduce avoidable harm by benchmarking and identifying areas of
concern before measuring quality of services, including:







Preventing falls in the community.
Enhanced recovery post surgery.
Improving maternity services.
Better treatment for depression.
Improving quality of life for dementia care.
Reducing patient identification errors.
Improve stroke care.
Transforming care
http://www.1000livesplus.wales.nhs.uk/transforming-care
A drive to engage staff of all disciplines and at every level to improve the
outcome and experience of patients care, with particular focus on:
 Receiving the right care safely, reliably every time (evidence
shows that if this is done patients get better sooner, and
inappropriate lengthy stays in hospital are reduced).
 Releasing time from our everyday processes (streamlining
efficiency, preventing waste for more direct patient care).
 Empowering staff to continually improve care, quality and safety
using ‘Fundamentals of care’.
 Engaging staff at all levels to plan, test, monitor and implement.
 Providing staff with the tools, techniques and support to improve
the patient experience.
 Ensuring each change is sustainable.
 Focusing on the 5 ‘S’ = sort/sift, set, shine, standardize, sustain.
 Freeing up wasted time to do direct patient care that addresses
nutrition, infection control, falls, ward atmosphere, risk reduction.
How to access the Royal Marsden online
After logging onto computer, click onto:



My computer
Sdrive
Community District Nurses
Operational handbook
 Clinical information
 Royal Marsden
We hope you enjoy your placement and find it a valuable learning
experience.