WELCOME TO ORTHOPAEDICS
Welcome to the orthopaedic wards 7 & 8 at Perth Royal Infirmary. Ward 7 is a 24
bedded elective/trauma admission unit and includes a small, but well-equipped area,
which has been designated for use by both the physiotherapy and occupational
therapy departments. The close proximity of this area allows for greater input by the
specialist therapists who provide an essential and integral element in the overall
recovery and rehabilitation process for the orthopaedic patient. Ward 8 is a 30
bedded elective/trauma admission unit which also has a specialised area called the
Wishbone Library. This relatively new facility is to provide on-hand, up-to-date
orthopaedic literature and computer access for both medical and nursing staff. This
area also doubles as a valuable focus point for important meetings where the multidisciplinary team can review the orthopaedic patient and discuss optimal treatment
choices. Interlinking the two orthopaedic wards, are offices, staff toilet facilities and
a Day Room for the patient who wishes to find a place to read or watch television, or
to just escape the busy ward environment for a short period.
The orthopaedic patient comprises of both ‘Waiting List Admissions’ and ‘Trauma
Admissions’. Depending on the orthopaedic consultant, ‘Admission Days’ and ‘On
Call Days’ take place by prearrangement and the tow wards are advised of dates in
advance. Changes to admissions for both trauma and waiting lists may depend on
bed availability.
All ‘Waiting List Admissions’ will have begun their journey by first being clinically
reviewed by an Orthopaedic consultant/Registrar in the Outpatient Department after
an appropriate referral by the GP. The initial consultation will reveal if the findings
are significant; if so, they will be added to a waiting list prior to being selected for
admission for surgery. Most patients will be suffering from disease processes such
as Osteoarthritis and Rheumatoid Arthritis, and will be looking for relief of pain or
correction of deformity. It is important to remember that these disease processes are
debilitation but few patients are ‘ill’ in the true sense of the word and with
appropriate treatment, the patient will hopefully, return to an independent, relatively
pain free functioning lifestyle, and to a better quality of life.
‘Trauma Admissions’ range in age from the young to the old and involve normally
healthy individuals who have sustained accidental injury to the musculoskeletal
system. This may or may not, require some form of surgical/non surgical
intervention. It is hoped that they too should return to an independent, pain free and
functioning lifestyle. Unfortunately, it is the frail and elderly population who are all
too often at risk of sustaining orthopaedic trauma and it is this patient group who
represent the majority of admissions to our orthopaedic wards. Many of these
patients will be suffering form a multi-pathology of disease processes, which
requires a diverse range of expertises. Prevention here is better than the cure; and as
directed by Scottish Intercollegiate Guidelines Network, this is an area that requires
continued research and development for improved management.
With reflective practice, it is hoped that the two types of orthopaedic admissions will
provide the student with a good foundation in the provision of holistic nursing care
and prove to be both interesting and challenging.
1
STUDENT PLACEMENTS
During your time spent in the ward, we aim to introduce you to the acute
orthopaedic environment, which should equip you with the basic skills, and
knowledge required to safely assess and plan for the appropriate individualised care
of the orthopaedic patient.
One of the desired learning outcomes of your placement is that you will learn to
assess, plan, implement and evaluate holistic care of the orthopaedic patient form
admission and preoperative care to postoperative care and rehabilitation with the
ultimate goal being a safe and uneventful discharge form hospital.
The second specific learning outcome is to recognise early changes in the patient’s
observations both physically and psychologically. This clinical picture should help
in determining a significant deterioration or indeed improvement in the patient’s
condition.
During your time in the orthopaedic ward you will be expected to be aware of the
valuable resources made available to you from all members of the multidisciplinary
team; to enhance your knowledge and skills by utilising appropriate learning
opportunities; to be aware of the importance of research based evidence and
reflective practices.
At the commencement of your placement you will be allocated a mentor and
possibly a co-mentor, either of who will be able to complete your assessments. We
are aware that personalities do not always suit, but mentors can be changed if
difficulties arise on either side of the mentor/student relationship.
If it is not possible to work with your mentor, it is important to use the experience of
other staff members including the nurse in charge, to help you to achieve your
objectives and goals during your stay. Mentors are experienced staff and are a
valuable resource with a wealth of information. Do remember that there are many
schools of thought within the nursing environment and occasionally you may be
given what appears to be conflicting information, however, this may be that there is
no singular acceptable answer. If in doubt, ask. ~Should you remain unsure, this
should be documented in your reflective diary so that you can qualify it with the
School of Nursing.
It is important that you feel supported during your stay and that you receive regular
feedback. It is up to you to ensure that you have set your times and dates with your
mentor for initial discussion, mid-placement discussion and final assessment. The
emphasis will be on self-motivation, seeking out learning opportunities and
experiences available in the ward. We will assist you in gaining experience but it
will remain up to you to monitor what you need to learn. There will be opportunity
given to you to visit the operating theatres and orthopaedic clinics at a later date so
that you can consolidate your learning experiences, however, this is not the main
objective.
Remember to bring your CAP Booklet and objectives to the ward but they will
remain your responsibility. We will endeavour to support you but what you gain
will be guided by your enthusiasm and self-motivation.
2
The off-duty is made up by the Charge Nurse and if you have a specific request or
study day please submit this in writing in advance. If you are absent, please inform
the ward and the School of Nursing we will also inform them.
We hope that you enjoy your placement in the orthopaedic ward and that you gain
knowledge and experience in this specialty, but before carrying out any procedure
do remember to check first and always ask!
WHAT? WHERE? WHY? HOW?
WARD AIMS
To develop skill and evidence based practice to enable the student nurse to perform
competently at their own level of training
To encourage and support the acquisition of new knowledge
To ensure delivery of quality care
To ensure safety for students, patients and colleagues
To provide support and guidance for students
RESOURCES
There are information folders and leaflets available in the ward, and library facilities
within PRI, which is available to all NHS staff and students on production of an
appropriate ID badge
YOUR RESPONSIBILITIES AS A STUDENT NURSEPROFESSIONAL AND ETHICAL
To manage self, one’s practice and that of others, in accordance with the NMC’s
Code of Conduct, to recognise one’s own abilities and limitations.
To practice within an ethical and legal framework that ensures the primacy of patient
interest and well-being
To maintain patient confidentiality
To practice in a fair and anti-discrimatory way, acknowledging the differences in
beliefs and cultural practices of individuals and groups.
3
CARE DELIVERY
The student nurse should provide patient care under the supervision of a registered
nurse, appropriate to their level of training.
The student should ensure safe nursing practice with the support of a registered
nurse based on best available evidence.
The student should be able to create and utilise opportunities to promote the health
and well being of the patient.
The student should endeavour to develop the interpersonal skills required within a
specialised therapeutic environment.
CARE MANAGEMENT
To contribute to public protection by creating and maintaining a safe environment of
care delivery as directed by ‘Trust’ protocols, procedures and guidelines; to be
aware of their differences and where these documents are kept.
To respect and utilise the valuable contribution of all members of the multidisciplinary care team.
To demonstrate skills in literacy, numeracy, problem solving and accurate record
keeping.
PERSONAL/PROFESSIONAL DEVELOPMENT
The student should demonstrate a commitment to the need for supervised practices
and continuing professional development so to enhance knowledge, skills, values,
attitudes and beliefs that are required for safe and effective nursing practice.
LEARNING OBJECTIVES
The student nurse/mentor will set their own learning objectives during their
placement in the orthopaedic ward; however; depending on the level of experience
and as opportunity dictates we suggest the following:
 Preparing the environment for the waiting list/trauma admission
 Assessment of the pre-operative and post operative patient
 Monitoring; invasive non/invasive
 Interpretation of monitoring
 Planning the care for the waiting list/trauma admission – appropriate
documentation/pathways etc
 Fundamental safety aspects of patient care
 Early detection and management of potential complications
 Therapeutic interventions/activities
 Planning patient discharge/referral to community care i.e. ICHAS etc
4
ORIENTATION CHECKLIST
The following objectives should be carried out by your mentor on day one of your
placement and reinforced over the following week.

















Introduction to staff – staff rooms – storage of bags etc
Layout of the ward – equipment location, notes, x-rays etc
Fire fighting equipment and exits
Fire policy and evacuation procedures
Telephone and bleep systems
Emergency and commonly used bleep numbers
Location of resuscitation equipment/CPR trolley
Location of policy/procedure manuals – Trust Policies, Manual Handling, Safe
Use of Equipment
Patient reports/handovers
Introduction to ward documentation – admission procedures – Integrated Core –
care pathways – care plans
The bay areas – rehabilitation areas – facilities
Laboratory results and recording
Ward routine
Laundry systems
Reporting On/Off duty
Patient Safety and confidentiality
The importance of observation and feedback to a trained member of staff
THE TEAM
At present the team comprises of 5 consultants, in Ward 7 there are Mr A Innes and
Mr G McLeod who both cover their own waiting lists and trauma admissions:
Mr B Singer covers for his waiting list admissions only. Based in Ward 8 are
Mr W Hadden and Mr J MacLean who both cover their own waiting lists and trauma
admissions; Mr B Singer covers for his trauma admissions only. We also have 3
Dundee consultants who alternate fortnightly operating on elective surgery.
On a rotational basis of usually 6 months, there are Orthopaedic Registrars, Senior
House Officers and Junior House Officers who work under close supervision of the
Consultant Orthopaedic surgeons.
The Clinical Team Manager of the Musculoskeletal Unit is Mrs Margaret Bowman.
Ward 7 is headed by Senior Charge Nurse, Kate Smith
Ward 8 is headed by Senior Charge Nurse, Marina Ferguson
There are several Staff Nurses, Enrolled Nurses, Health Care Assistants, Nursing
Auxiliaries and Ward Assistants between the 2 wards who will make every effort to
welcome you to the orthopaedic department; it is hoped that you will, given time,
feel a valued member of the nursing team.
5
Other members of the team consists of the Physiotherapists and their assistants,
Occupational Therapists and their assistants, Pharmacists, ECG Technicians,
Phlebotomists, Speech Therapists, dieticians, Clinical Support Nurses, Theatre Staff
and Anaesthetists, Orthopaedic Out Patient Department Staff and Laboratory
Services, Domestics and Porters; all of whom provide a vital role in the smooth
running of the orthopaedic department.
IMPORTANT THINGS TO REMEMBER
Cardiac Arrest – Emergency Buzzer System
Emergency Telephone Number – 2222 ‘Adult Cardiac Arrest’ Ward Number – PRI
VISITING TIMES
1500 hours – 1700 hours
1900 hours – 2000 hours
SHIFT HOURS
0730 hours – 1530 hours
1400 hours – 2200 hours
2145 hours – 0745 hours
INFECTION CONTROL
It is asked of students that they remember that they have entered the orthopaedic
area where awareness of infection control is paramount. Whenever dealing with any
aspect of patient care, it is requested that they practice and respect the universal
methods for infection control.
6