NHS TAYSIDE
Student Nurse Orientation Pack
Plastic Surgery & Oncology/Neurosurgery/Neurology Outpatient
Department
Area 3A
Ninewells Hospital
Dundee
01382 660111
Ext. 352013
Student’s Name
Mentor
Date of Placement
Initial Interview date …………………….
Midway assessment date………………....
Final assessment date…………………….
Revised by Edna O’Connor
Date: April 2012
Review Date: April 2012
1
Student Nurse Orientation pack
Contents
Page
Welcome
3
Staff Members
4
Philosophy
5
Introduction
6
Specialist Clinics in Area 3A
7
Criteria for mentorship
8
Quality of standards for students
9
Patients Referral System
10
First Day of Placement
11-12
Learning Opportunities
13-15
Blank page for students own objectives
16
Student Evaluation Form
25
Appendix 1 – Commonly used terms and abbreviations in Plastic Surgery
Appendix 2 – Commonly used terms and abbreviations in Neurosciences
Appendix 3 – Staff tutorial subjects
References and useful Website / e-mail addresses
2
Welcome to Outpatient Department Area 3A.
This package has been developed by the clinic nursing staff to help you achieve your
objectives and give you a basic understanding of what to expect from your placement.
On the first day please report to Area 3a out-patient clinic, situated on level 7 of the
polyclinics, this is found by entering the hospital via the main entrance and taking the
2nd corridor on the right.
You are required to come appropriately dressed as per uniform policy for seeing
patients in a clinical area.
Staff Shift pattern
Mon-Fri 8.45 am – 16.45 pm
Staff facilities available:
Student changing rooms on level 5 (Ask at reception)
Canteens on level 5 & 9 for meals.
Fridge and micro wave available in clinic for use.
Bag locker in clinic area
Common room level 7 for breaks.
3
The Nursing Team
Charge Nurse
Marilyn Finnegan
Band 5/Registered Nurse
Edna O’Connor
Jennifer Grieg
Maureen Colston
Linda Kinney
Evelyn Campbell
Health care assistant
Susan Christie
Maggie Gordon
Outpatient Assistant
Alison Penman
Receptionist
Kirsteen McFarlane
Academic Placement Contact (APC)
Tony Barr
4
Area 3A Philosophy

We endeavour to treat students as individuals.

We do expect students to assist with their own learning by
developing a questioning approach and we shall encourage you to do so.

We shall endeavour to answer questions or at least make an effort to find an
answer/explanation.

We encourage students to feel part of the Multidisciplinary Team by involving
them in the assessment, planning, implementing and evaluation of patient care.

We recognise and value the contribution of all students in the
process of planning and undertaking patient centred care.

All staff will endeavour to assist students in achieving and
maintaining the knowledge base and skills needed in order to
provide safe, effective and competent nursing care.

We look forward to hearing students’ views and suggestions
about how we can improve the learning experience.
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Introduction
Area 3A is an interesting and exciting placement with a wide variety of learning
experiences. We hope that you will enjoy your placement here and that you will
quickly feel part of the team. We will assign you a mentor who will support and
guide you through your placement. We will try to ensure that you will spend at least
40% of your time being supervised directly or indirectly by a mentor (NMC 2008).
If you have not been allocated or been introduced to one of your mentors within
48hours of commencing your placement it is your responsibility to address this issue
by speaking to the charge nurse or another member of the nursing team. Any
mentoring issues should be highlighted as quickly as possible.
On your first day, your mentor will discuss your learning objectives with you. A
learning contract will then be negotiated between you and your mentor within 48
hours of starting your placement (NHS 2008).
It is your responsibility to ensure your assessment documentation (Ongoing
Achievement Record) is completed at the appropriate times.
6
Specialist Clinic in Area 3A
In this placement you will find a wide range of learning experiences due to the variety
of specialist clinics held in this area.
Specialities include:
Burns, Plastic surgery & Hand Clinic.
Plastic surgery and nurse led dressing clinics are held daily in area 3a. You will be
expected to spend a large portion of your placement at these clinics. You will be
given ample opportunity to gain an insight into plastic surgery and also to increase
your knowledge and skills in wound management. These skills can be transferred to
any clinical situation.
Neurology
This Neurology team cover medical disorders of the brain and spinal cord.
As well as Neurology Consultants there are Specialist Nurses who run clinics.
Neurosurgery
This Neurosurgical team also covers disorders of the brain and spinal cord which can
dealt with through surgical intervention.
Pain Team
The pain team is a multi-disciplinary team of Doctors, Nurses and Psychologists
providing a wide range of treatments/therapies for patients with chronic pain. They
also provide information, education and support for patients, their families and carers.
Your mentor will try to arrange for you to spend time at each of these clinics.
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Criteria for mentorship
The nurses allocated as your mentor have fulfilled the following criteria:
 They are registered in the same part or sub part of the register and in the same
field as the student they are to mentor i.e.1st level adult branch.
 They have developed there own knowledge, skills and competence post
registration i.e. at least 1years experience
 They have completed a NMC approved mentorship preparation programme
and attended annual mentor updates.
 They have the ability to select, support and assess the learning opportunities
for the students appropriate to their stage of learning.


Have at least a minimum of one years experience in area 3a
They are motivated to teach
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Quality of Standards for Student nurses
Students have a responsibility to:
 Recognise the purpose of the placement experience and ensure that they
are clear about the expectations of the placement provider
 Ensure that they have some theoretical knowledge relating to the
placement
 Contact the placement and mentor prior to starting
 Highlight any support needs to the mentor
 Act professionally with regard to punctuality, attitude and image, and



dress according to uniform policy
Maintain confidentiality
Maintain effective communication with patients, mentors, and link
personnel from both the placement and HEI(Health Care Environmental
Inspectorate)
Adhere to the NMC Guide for students of nursing and midwifery (NMC
2006b).
Supernumerary status
All students undertaking pre-registration nursing and midwifery programmes have
supernumerary status while on practice placements. This means that they are
additional to the workforce requirement and staffing figures.
The student is present in the placement setting as a learner and not as a member of
staff. However, they must make an active contribution to the work of the practice
area to enable them to learn how to care for patients
(RCN, 2007a).“Supernumerary status means that the student shall not, as part of
their programme of preparation, be employed by any person or body under a
contract to provide nursing/midwifery care.” (NMC, 2004b; NMC,
2004c)
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Patient Referral system
As a student you may not be aware of the patient referral system for out patient
clinics. It is an intricate system that plays an important role in mineralising the waiting
time for patients to be seen in the outpatient department.
A patient must be referred by either their General Practitioner or Consultant from the
same or another hospital. With computer technology most are referred by an
electronic referral system. This is much faster as the referral is received by the
hospital that same day.
Alternatively the G.P./Consultant can send a referral through the postal system which
takes quite a bit longer to process.
In both cases the Medical Records Department then acts upon the referral and directs
it to the appropriate directorate where the Consultant examines (vets) it. The letter is
then categorised into two sections; urgent or routine. The Consultants secretary then
returns the vetted referral to Medical Records Department and an appointment letter is
sent to the patient.
In some urgent cases a referral can be made by phone to one of the on call doctors and
the patient comes with a hand written letter.
The appointment itself depends on the waiting list for that consultant and the urgency
of the patient’s condition. Also with government policies aimed at bringing waiting
lists down i.e. patients have to be seen within12 weeks, patients are receiving their
clinic appointments much sooner than previously.
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First day of placement
During day one student will be orientated to directorate. Please tick box
when achieved
ORIENTATION

Meet members of the multi-disciplinary team.

Identify and meet with your mentor.

Provide and discuss Student Orientation Pack

Become familiar with unit layout, including toilets, changing
room, staff room, waiting room and common room.

Identify emergency procedures and locate emergency
TICK BOX
equipment.

Locate fire exits.

Discuss off duty and endeavour to have students and mentor
working together. Mentor must take responsibility for this.

Locate Unit Protocols/Guidelines folders.

Discuss and demonstrate hand-washing technique.

Discuss hand washing in relation to visitors.

Discuss use of aprons and personal protective equipment.

Be aware of Trust MRSA and C.difficile guidelines and their location.

Discuss daily routine.

Discuss safety and daily checks.

Discuss nursing role within the clinic

Introduce to nursing documentation: wound charts

Discuss procedure for referral of patients to clinic. (Refer to
patient journey)

Discuss the learning resources available to you books/references/
DVDs / article folders.

Be aware of the procedure for reporting sickness/ absence and
resuming back to work.

Discuss the professional behaviour and the importance of
confidentiality.
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

Discuss the importance of good time keeping.
Sign student assessment book
STUDENT SIGNARURE MENTOR SIGNATURE -
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Learning Opportunities
We will strive to help you to achieve as many learning opportunities as possible
but due to short placements it is impossible to say that you will achieve all of
them.
Please tick box if achieved.
Plastic surgery
TICK BOX
Recognise the role of the nurse in the plastic surgery clinic.
Be acquainted with the variety of surgical conditions and the surgery carried out.
Be aware of the psychological factors in relationship to plastic surgery e.g.
altered body image.
Revise skin anatomy and physiology.
Recognise and understand the importance of stages in the wound healing
process.
Observe and carry out wound assessment.
Recognise the physical characteristics of wounds, their types and classification
Discuss wound management to optimise patient healing
Discuss various dressings used in clinic
Familiarise themselves with Tayside wound formulary
Identify wound complications.
Carry out nursing procedures:

Set up an aseptic dressing trolley

.Removal of sutures

Removal of staples

Removal of tie over’s dressings

Care of skin graft

Care of donor site

Obtain a swab for culture

Various bandaging technique

Use of various wound dressings
Observe and carry out procedures

Fine needle aspiration (FNA)

Application of single use negative pressure (PICO’S)

Botox therapy

Filler therapy
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
Steroid therapy

Seroma drainage

Tissue expansion

Removal of K-wires
Spend time with specialist nurses
NEUROSURGERY
TICK BOX
Obtain an introduction to neurosurgery by shadowing Consultant Neurosurgeons
in clinics
Discuss neurosurgical conditions and surgical procedures

Lumbar surgery
Cervical Surgery
Craniotomies
Neurological assessment
Spinal injuries
Head injuries
Discuss neurological assessment
Discuss tests to be carried out: MRI, Bloods & ECG
Discuss how to arrange for tests to be carried out
Be familiar with location of investigation clinics/areas
Observe and discuss advance practitioner nursing role.
Neurology
TICK BOX
Obtain an introduction to neurology by shadowing Consultant Neurologist in clinics
Discuss neurosurgical conditions and surgical procedures
Discuss and observe neurological assessment.
Discuss tests to be carried out: Bloods, ECG , urine tests, clinical neurophysiology,
human genetics
Discuss how to arrange for test to be carried out
Be familiar with location of investigation clinics/areas
Spend time with specialist nurses:
 Dystonia
 Epilepsy
 Multiple Sclerosis (MS)
 Movement Disorder (MD)
 Motor Neurone Disease (MND)
Pain team
Obtain an introduction to neurology by shadowing pain Team
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Student’s signature
Student comments
Mentors signature
Mentors comments
15
The remainder of this page is left blank should you wish to add your own,
specific outcomes.
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Appendix 1
Commonly used terms and abbreviations in Plastic Surgery
Abdominoplasty (Tummy Tuck)
Is a cosmetic surgery procedure used to make the abdomen more firm. The surgery
involves the removal of excess skin and fat from the middle and lower abdomen in
order to tighten the muscle and fascia of the abdominal wall.
Basal-cell carcinoma (BCC)
Is a very common type of skin cancer. It rarely metastasizes or kills. However,
because it can cause significant destruction and disfigurement by invading
surrounding tissues, it is still considered malignant. The tumour comprises of cells
from the basal layer of the skin. It is commonly known as a rodent ulcer.
Breast augmentation
Breast augmentation denotes the breast implant procedures for correcting the defects,
and for enhancing the size, form, and feel of a woman’s breasts. The implant is
inserted behind or in front of the pectoralis major muscle in the chest wall. Silicone
implants are still the most commonly used type.
Bowen’s Disease (BD) (squamous cell carcinoma in situ)
Is a neoplastic skin disease, it can be considered as an early stage or intraepidermal
form of squamous cell carcinoma.
Breast reconstruction
Is the rebuilding of a breast, usually in women. It involves using autologous tissue or
prosthetic material to construct a natural-looking breast. Often this includes the
reformation of a natural-looking areola and nipple. This procedure involves the use of
implants or relocated flaps of the patient's own tissue.
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Breast Reduction (BBR) (reduction mammoplasty)
Is the plastic surgery procedure for correcting over-sized breasts.
Carpal Tunnel Syndrome (CTS)
Is an entrapment median neuropathy, causing paraesthesia, pain, numbness, and other
symptoms in the distribution of the medial nerve due to its compression at the wrist in
the carpal tunnel.
Dupuytren's contracture ( morbus Dupuytren’s, Dupuytren's disease or palmar
fibromatosis)
Is a fixed flexion contracture of the hand where the fingers bend towards the palm and
cannot be fully extended (straightened). It is an inherited proliferative connective
tissue disorder which involves the palmar fascia of the hand.
Donor Site.
The donor site most commonly used is the autograft, when the donor and recipient of
the skin graft is the same person, for example when a patient has a skin graft taken
from their thigh and applied to a wound on their lower leg.
Skin Flaps.
The terms free flap and free tissue transfer are synonymous labels used to describe
the movement of tissue from one site on the body to another. "Free" implies that the
tissue, along with its blood supply, is detached from the original location ("donor
site") and then transferred to another location ("recipient site"). This is in contrast to a
"pedicled" flap in which tissue is left attached to the donor site and simply transposed
to a new location keeping the "pedicle" intact as a conduit to supply the tissue with
blood. Various types of tissue may be transferred as a free flap including skin and fat,
muscle, nerve, bone, or any combination of these. An example of the latter would be a
"free toe transfer" in which the 1st or 2nd toe is transferred to the hand to reconstruct
a thumb. For all free flaps, the blood supply is reconstituted using microsurgery to
reconnect the artery (blood into the flap) and vein (allows blood to flow out of the
flap). The free flap requires microsurgical techniques and is utilised during
reconstructive surgery.
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Full Thickness Skin Grafts (FTSG)
Is a full-thickness skin graft consists of the epidermis and the entire thickness of the
dermis. The donor site is either sutured closed directly or covered by a split-thickness
skin graft.
Hypospadius
Is a birth defect of the urethra in the male that involves an abnormally placed urinary
meatus (the opening, or male external urethral orifice). Instead of opening at the tip of
the glans of the penis, a hypospadic urethra opens anywhere along a line (the urethral
groove) running from the tip along the underside (ventral aspect) of the shaft to the
junction of the penis and scrotum or perineum.
Malignant Melanoma (MM)
Is a malignant tumor of melanocytes. Melanocytes are cells that produce the dark
pigment, melanin, which is responsible for the color of skin. They predominantly
occur in skin, but are also found in other parts of the body, including the bowl and the
eye (see uveal melanoma). Melanoma can originate in any part of the body that
contains melanocytes.Melanoma is less common than other skin cancers. However, it
is much more dangerous if it is not found early. It causes the majority (75%) of deaths
related to skin cancer.
Otoplasty( also known as pinna plasty or prominent ear surgery)
Otoplasty denotes the surgical and non-surgical procedures for correcting the
deformities and defects of the pinna (external ear); and for reconstructing a defective,
or deformed, or absent external ear, consequent to congenital conditions (e.g.
microtia, anotia, etc.) and trauma (blunt, penetrating, blast). The plastic surgeon
corrects the defect or deformity by creating an external ear that is of natural
proportions, contour, and appearance, usually achieved by the reshaping, the moving,
and the augmenting of the cartilaginous support framework of the pinna.
Split skin graft (SSG)
Is a split-thickness skin graft (STSG) is a skin graft including the epidermis and part
of the dermis. Its thickness depends on the donor site and the needs of the patient. It
19
can be processed through a skin mesher which makes apentures onto the graft,
allowing it to expand up to nine times its size. Split-thickness grafts are frequently
used as they can cover large areas and the rate of autorejection is low. You can take
from the same site again after 6 weeks. The donor site heals by re-epithelialisation
from the dermis and surrounding skin and requires dressings.
Squamous Cell Carcinoma (SCC)
Is a cancer of a kind of epithelial cell, the squamous cell. These cells are the main part
of the epidermis of the skin, and this cancer is one of the major forms of skin cancer.
20
Appendix 2
Commonly Used Terms and Abbreviations In Neurosciences
Aneurysm.
An aneurysm is a localized, blood-filled balloon-like bulge in the wall of a blood
vessel.
Botulinum Toxin (Botox)
Is an active toxin from the clostridium botulinum bacteria used in small quantities.
The toxin acts on the junctions between the nerves and the muscles, preventing the
release of one of the chemical messengers called acetylcholine from the nerve endings
which would normally cause the muscle to contract.Botox; it is used for various
cosmetic and medical procedures.
Dystonia
Is a neurological movement disorder, in which sustained muscle contractions cause
twisting and repetitive movements or abnormal postures. The disorder may be
hereditary or caused by other factors such as birth-related or other physical trauma,
infection, poisoning (e.g., lead poisoning) or reaction to pharmaceutical drugs,
particularly neuroleptics. Treatment is difficult and has been limited to minimizing the
symptoms of the disorder, since there is no cure available.
Epilepsy
Is a common and diverse set of chronic neurological disorders characterized by
seizures. Epileptic seizures result from abnormal, excessive or hypersynchronous
neuronal activity in the brain. About 50 million people worldwide have epilepsy, and
nearly 90% of epilepsy occurs in developing countries. Epilepsy becomes more
common as people age
Motor Neurone Diseases (MND)
Are a group of neurological disorders that selectively affect motor neurones the cells
that control voluntary muscle activity including speaking, walking, breathing,
swallowing and general movement of the body. They are generally progressive in
nature, and can cause progressive disability and death.
Multiple Sclerosis (MS)
MS is a common demyelating disease of the central nervous system (CNS).
Demyelation (damage) occurs to the myelin sheath which protects the nerves and
disrupts the way messages or nerve impulses or conducted to and from the brain and
hence can disrupt a range of functions.
21
Nerve Stimulators
Nerve stimulators occur when there is stimulation of the nerves by tiny electrical
pulses from a small medical device. It is implanted into the body and is powered by a
battery. It delivers electrical pulses to the brain to control conditions such as seizures,
tremors and pain.
Parkinson’s disease
A degenerative disease of the grey cells deep in the brain where the cerebrum joins
the mid-brain. A slow, progressive, disabling disease, the main features being rigidity,
difficulty in starting and continuing in voluntary actions and tremor.
22
Appendix 3
Staff tutorial subjects
Marylyn
Scar therapy/Lymphodema
Edna
Skin lesions/cancers. Grafts & donor sites.
Jennifer
Breast surgery
Maureen
The skin, healing phases & tissue types.
Linda
Hand surgery
Evelyn
Hand cleaning/aseptic technique/dressings
23
References
NURSING AND MIDWIFERY COUNCIL, 2008. Standards to support
learning and assessment in practice. London: NMC.
www.nmc-uk.org
NURSING AND MIDWIFERY COUNCIL, 2006b. Guide for students of
nursing and midwifery. London: NMC.
www.nmc-uk.org
NURSING AND MIDWIFERY COUNCIL, 2004b. Standards of
proficiency for pre-registration nursing education. London: NMC.
www.nmc-uk.org
NURSING AND MIDWIFERY COUNCIL 2004a. Code of Professional
Conduct. London: NMC.
www.nmc-uk.org
Useful e-mail /Website addresses
University of Dundee; Clinical Placement Support Unit (CPPSU)
www.cppsu.@dundee.ac.uk
NHS Education for Scotland
www.nes.scot.nhs.uk
Nursing and Midwifery Council
www.nmc-uk.org
Practice Education Facilitator – Dawn McFawns
dmcfawns@nhs.net
Literature search facility free with Athens log on details, full articles
available.
www.elib.scot.nhs.uk
24
Student Evaluation
In order for the clinic staff to assess and improve the learning environment for future
students, we invite you to complete the following questionnaire.
If you feel uncomfortable completing it in the clinic, then please send it to us via
internal mail.
Please tick the appropriate box:
5 – Strongly agree
4 – Agree
3 – Neither agrees nor disagrees
2 – Disagree
1 – Strongly disagree
5 4 3 2 1
I was made to feel welcome
I was allocated a Mentor
Educational material was available
Student orientation package was informative
I was allowed time to study and reflect on an aspects of relevant patient
care
I was given opportunities to discuss issues surrounding patient care
The unit learning outcomes were clear
A variety of learning experiences were available/provided
A three week placement is long enough to achieve objectives
Student’s comments if any
25