Division of Clinical Support Services and Tertiary Medicine
Surgical High Dependency Unit (H6)
Welcome to the SHDU
The staff of the surgical high dependency unit will make every effort to make your placement
educational and enjoyable. We aim to help you develop knowledge and skills that you will be able to
utilize throughout your nursing career. This pack will hopefully provide the information needed to help
ease you into the HDU environment.
The function of the twelve bedded surgical high dependency unit is:
The early detection of organ dysfunction, that leads to early intervention before organ failure
supervenes
As advised by the Royal College of Anaesthetists, patients admitted to high dependency units are
nursed on a one nurse to two patient ratios. The method of care delivery on the Surgical High
Dependency Unit (SHDU) is that of patient allocation. Patients are allocated to nurses by the
coordinator of each shift, taking into account: continuity of care, skill mix and the experience and
learning needs of individual nurses.
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Philosophy of Care
The staff of the Surgical High Dependency Unit believes that each patient is an individual with the
right to appropriate skilled nursing care and that each person has the freedom to choose regarding
their own care. All staff will strive to provide a service that is personal and respectful to the individuals
needs.
All patients have a right to up to date information about their condition, including the risks, benefits
and probable outcomes of treatment, to enable them to make an informed choice. These rights
extend to all patients regardless of age, sex or ethnicity and are summarised below.
The patient has a right to:

Be treated as an individual and be afforded respect, dignity and equity of access to service and
care.

Have choices in his/her care and be given enough knowledge to enable him/her to make an
informed decision

Be provided with appropriate written information

Receive skilled care by all members of the hospital team to meet his/her individual needs

Be provided with the knowledge and skills to enable where able self care and independence

Have their care organised in such a way that enables a therapeutic relationship to exist
between the patient, family and all staff involved in their care

Be involved in the assessment of their needs and in the planning, implementation and
evaluation of their care.
We believe that all staff within the directorate should act as a resource for imparting relevant
knowledge and skills to other colleagues. We recognise the need for new staff and students to be
provided with an appropriate induction and a mentor who will facilitate learning by recognising and
discussing the learners individuals needs, whilst working in partnership, setting realistic goals and
formulating personal/professional development plans, with ongoing clinical supervision.
Finally we recognise the need to continually assess ourselves and take every opportunity to update
our own knowledge and skills in order to improve and maintain high standards of care and service
delivery reviewed at appraisal.
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Nursing Structure
The nursing establishment for SHDU consists of the Unit Manager, Band 6 sisters, Band 5 nurses
(some of these nurses work part time), support workers and nursing auxiliaries. There is also a house
keeper, a ward clerk and a regular domestic.
Complete the table of other members of the MDT:
ADNS Surgery
Lead Nurse Surgery
Matron HDU / ICU
Infection Control Nurse
Colorectal Nurse Specialist
Colorectal Nurse Specialist
Colorectal Enhanced Recovery Nurse
(ERAS)
Urology /Gynae Enhanced Recovery
Nurse (ERAS)
Upper GI Nurse Specialist
Practice Trainers
Academic in Practice
Stoma Nurses
Pain Nurse Specialists
Head Pharmacist
Head Physiotherapist
Domestic
Dietician
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Surgical Structure
The clinical director for SHDU is Consultant Surgeon Mr. J Vickers. Each patient admitted to the unit
remains under the care of their admitting Consultant: Mr. Anderson
Consultant Colo-rectal Surgeon
Prof. Carlson
Consultant Colo-rectal Surgeon
Mr. Lees
Consultant Colo-rectal Surgeon
Mr. D. Slade
Consultant Colo-rectal Surgeon
Mr. Vickers
Consultant Upper Gastrointestinal Surgeon
Miss. Formella
Consultant Upper Gastrointestinal Surgeon
Mr. Ammori
Consultant Bariatric Surgeon
Mr. Akhtar
Consultant Upper Gastrointestinal Surgeon
Mr. Senapati
Consultant Upper Gastrointestinal Surgeon
Prof. Clarke
Consultant Urologist
Mr. Betts
Consultant Urologist
Mr. O’Flynn
Consultant Urologist
Mr. Shackley
Consultant Urologist
Mr Pantilides
Consultant Urologist
Mr Lau
Consultant Urologist
Mr. R. Slade
Consultant Gynaecologist
Miss H Doran
Consultant Endocrinologist
Miss Saad
Consultant Breast Surgeon
Patients can also be admitted under the care of Orthopaedics and Medics with the authorisation of
the surgical consultant on call.
Surgical HDU is part of the Critical Care Directorate and is closely linked with the Surgical wards
wards, medical gastroenterology wards, ICU, A&E, and theatre either as an emergency or electively.
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Unit Profile
Patients admitted to the high dependency unit for level 2 care are admitted for varying reasons,
examples would include: 
Close observation and monitoring following major complex surgery either with invasive or noninvasive methods

Patients needing resuscitation prior to going to theatre, or patients developing post-operative
complications

Patients may be admitted to the unit directly from A&E with conditions such as pancreatitis,
upper or lower gastrointestinal bleeding, perforated ulcers or bowel.

A patient with fractured ribs, with chest drains insitu.

Trauma

Step down surgical patients from intensive care, who still require monitoring and close
observation.

Patients who may still be very oxygen dependent or who still need frequent suctioning from
tracheostomies.

Complex post operative pain management
The unit has specific observation charts and utilises “core care planning”.
The observation charts incorporate the Early Warning Scoring system and bed area check list for
each shift.
Infection Control

Gloves and apron to be worn in patient area when providing cares.

Gloves and apron to be removed when leaving patient area and hands washed using soap &
water or alcohol hand gel.

All patients are swabbed for MRSA on admission to the unit – check coordinator for up to date
protocol.

All patients are prescribed Prontoderm foam & Prontoderm gel whilst in the High Dependency
Unit.

ANTT to be followed for all invasive/wound care procedures

Personal hand gel to be attached to uniform
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Shift Patterns
Early half
Late half
Long Day
Nights
07.00 – 13:30
13.00 – 19:30
07.00 – 19:30
19.30 – 07.30
You will be expected to follow your mentor’s shift pattern wherever possible.
You will be allocated two half hour break. Tea and coffee is provided, please bring your own packed
lunch. There is a toaster and microwave available to use.
Here on SHDU scrubs are worn that will be provided on a daily basis. It is advisable to wear your
uniform to placement, for study days and spoke placement’s elsewhere in the trust. Footwear is
black or white trainers/shoes that are not worn outside. These can be left in the changing rooms at
the end of the shift. Were in the process of securing a student’s locker, in the meantime bags can be
left in the sister’s office. Please try not to bring valuables onto placement.
Car parking, students are allowed to park on the staff multi-storey car park from 16:30pm onwards.
Nights and weekends included. All other times it is advisable to pop along and speak with the car
parking office (Hope Building opposite Lloyds Pharmacy). Who will give best advice where to park for
the duration of your placement and costs included?
Unit telephone numbers:
0161 206 1194
0161 206 5729
Emergency Number (Crash Call):
2222
Your First Day
You will be introduced to your mentor, orientated to the unit and introduced to the staff on duty. There
will be time for you to read this pack and familiarise yourself with some of the common conditions
within the speciality as well as reasons for admission to the SHDU. Learning opportunities and
learning contracts will also be discussed.
Activity Levels
The unit is generally very busy and you will be expected to work closely with your mentor, observing,
but also assisting where appropriate in direct nursing care. If the unit is quiet you will be encouraged
to take the opportunity to study using locally held education materials.
The unit has specific observation charts and utilises “core care planning”. There is a file kept in the
resource filling cabinet that contains evidence based and research articles, which underpin the care
we have “prescribed” on our core care plans. A modified Roper Logan & Tierney model of nursing
has been adopted for the assessment of patients.
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Many of the other staff employed within the SHDU have specific skills, knowledge and interests and
these people can also be used as a resource to you and will be identified to you during your
orientation to the unit.
Learning Opportunities
Holistic care of the critically ill patient and his/her family: 
Preparation of the bed area to receive an admission

Receiving the patient onto the unit from their source of admission, including the wards, A&E,
theatres and ICU

An understanding of the psychological support and help our patients and their families need
regarding the environment they have been admitted to, remembering that often these patients
have been diagnosed as having cancer, or have been suffering from very debilitating
gastrointestinal disease.

An understanding of the type of surgery the patients undergo

Become familiar with the documentation used on the SHDU and be aware of the need to practice
defensible documentation

Gain a basic understanding of the monitoring system, including attaching the patient to the
monitor, invasive monitoring, pulse oximetry and ECG

Obtain basic understanding of oxygen therapy, including high flow, warmed, humidified and
nebulised, tracheostomy care

Become familiar normal blood values e.g. FBC, U & E’s, and of normal haemodynamic
measurements such as urine output, blood pressure, central venous pressure, oxygenation, and
normal sinus rhythm.

Develop clinical skills of manual pulse recording & respiration (Rate, rhythm, depth etc) along side
invasive monitoring skills.

Basic understanding of fluid balance, intravenous fluid replacement and total parental nutrition.

Become familiar with certain methods of intravenous fluid administration using IVAC pumps and
syringe drivers, as well as enteral feeding pumps.

Basic understanding of commonly used drugs within gastrointestinal surgery
When agreed with your assessor/mentor it may be possible for you to care for your own patient
(under supervision)
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Learning Resources
There are many learning resources throughout the unit. These include:

Patients – Patient history and presenting conditions including investigations etc; talking to
patients can provide information about the symptoms of illness; their journey from home to
hospital

Mentors - Many of the trained nurses on the unit are trained mentors. You will be allocated a
mentor and you will also be given a second named person to identify with. Alongside this the
whole staff team has a huge resource of knowledge & skills to be utilised.

Equipment - What equipment is used on the Unit & why?

Placement Educational Lead - This role is carried out by Polly Hamlett & Jane Clutton who
are responsible for the overall quality of the learning environment and are available if there are
any major problems with your placement.

Pre-registration Practice Education Facilitator – Mike Hollinshead will provide support for
students & mentors & also provide us with feedback from your evaluation forms.

University Link Lecturers – Sue Walker: 0161 295 7276. E-mail: s.h.walker@salford.ac.uk
Melanie Stephens: 0161 295 2877. E-mail: m.stephens@salford.ac.uk.

General Notice Boards

Trust Library

Student Information folder ( Pod e office) -

Teaching and Learning Aids - There are a number of information packages available through
out the unit. Your mentor will be able to direct you to these & encourage you to search for
information via Athens, Google etc. Study sessions are delivered on a variety of subjects
relevant to the unit. We also have Link Nurses on the unit who can offer you more information
in these areas. They include:
 Infection Control / ANTT
 Pain control
 Wound Care
 Food Hygiene
 Nutrition
 Health & Safety
 Resuscitation
 Palliative care
 Alcohol
 Risk assessment
 Dementia care
 Productive ward
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Associate Departments:

Surgical Wards – The wards provide a quality service for patients requiring investigations,
diagnosis and surgery. There is a multi-disciplinary approach to care, coordinated by six teams
of nurses covering two wards.

Surgical Assessment Unit – Acute admissions either directly from here or via theatre.

Endoscopy Unit – This offers a comprehensive range of investigations and therapeutic
facilities.

Intestinal Failure Unit (Nutrition Unit) – A unit with an international reputation in dealing with
individuals with varying degrees of intestinal failure, the staff on the unit support patients from
around the country who have Parenteral Nutrition at home.

Level 1 & 3 Theatres – This provides a 24-hour service delivered by a dedicated multidisciplinary team. Ideally we would like you to watch an operation during your stay to
consolidate the pre and post-operative care you will observe & participate in providing.

Post Anaesthetic Care Unit (PACU) Level 1 & 3- Initial post operative care & assessment
prior to transfer to the relevant ward area.

Surgical Out-Patients Department – The department provides a quality service to patients
and their families, led by our Specialist Nurses, providing support during procedures,
explanations, counselling and some nurse led clinics.

Intensive Care Unit
A visit to all of these areas of the gastroenterology unit is highly recommended in order to make you
placement educational and interesting. It will also provide you with the opportunity to follow an
individual patient around these areas.
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Expectations of Students
What students can expect from staff:

To be welcomed as “part of the team”

An appropriately timed orientation to the placement including, layout, routines, staff policies
and procedures.

A named mentor

To receive off-duty at least one week in advance

To have provisional dates for mid point & final assessments identified on initial meeting

Continuous feedback on progress and any problems/issues as perceived by staff will be raised
as soon as possible ( documented on communication sheet)

Students will not be regarded as “extra pair of hands” and their role as learner will be
respected.

Students will have the opportunity to learn and participate in new skills whilst acknowledging
any limitations in their knowledge or competence.

Students will be made aware of appropriate learning opportunity before/as they arise.

Students will be aware of their role during emergency procedures (fire, crash call)
Expectations of Staff
What staff expect from students:

Students will arrive punctually on shift, and inform the nurse in charge as soon as possible if
they are ill or delayed. Students are requested to provide a contact number on commencement
of their placement.

Students are expected to show initiative to learn and participate in care, whilst acknowledging
any limitations in their knowledge and competence.

Clinical skills should be ideally learned within the context of holistic patient care.

Should any personal or professional problems arise during placement, these must be raised as
soon as possible with an appropriate member of staff, to prevent the problem escalating.

Students must adhere to the uniform policy a set by the School of Nursing.

Students will work at least two shift with their mentor with the exception of night duty in the
students first year of training. This includes weekends. A minimum of 1 weekend in 4 and a
maximum of 2 in 4 are recommended.
Polly Hamlett 22/04/2014

Students should bring relevant documentation (assessment of practice documentation, action
plans, profile) on a daily basis for use at appropriate times.

Feedback is provided at the end of the placement in the form of a copy of the learning
summary.

Delegation of duties & level of supervision of students – directly or indirectly will be at the level
according to the student’s competency.

Year 2 students:

Year 3 students:
Demonstrate becoming an ‘Advanced Beginner’
o Be able to explain your actions
o Repeatedly practice skills
o Demonstrate acceptable performance
o Plan care under supervision
Becoming a ‘competent & effective’ practitioner
o Demonstrate understanding & application of skills to practice
o Prioritise & plan care with relevant support & supervision
o Evaluate interventions
(Reference: Pan Manchester assessment documentation)
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Multidisciplinary Team Working
Record below all the members of the MDT you have observed in patient care.
Reflect on their input to team working &how do they impact on patient care?
Patient
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Reflection on experience:
Use this to reflect on the whole placement or particular events.
Reflective Record Using Johns (1995) Model
Description of experience
Reflection
Influencing factors
Could I have dealt with the situation better?
Learning
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Word search common abbreviations and nursing terminology
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Work out the abbreviation then find the word in search puzzle.
Example RA = Room Air
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Polly Hamlett 22/04/2014
Achieving excellence in learning and care...
Placement Charter
This Charter demonstrates the Placement’s commitment to provide a safe and high quality
learning environment for all learners to prepare them for their future roles working
collaboratively in multi-professional teams. The ‘Placement Pledges’ and the ‘Rights,
Roles and Responsibilities of learners’ instil the values embedded within the NHS
Constitution (DH 2013) and Health Education England’s NHS Education Outcomes
Framework (DH 2012).
Placement Pledges
Rights, Roles and Responsibilities of learners
Ensure all learners are welcomed, valued and
provided with an inclusive, safe, stimulating and
supportive learning experience.
Prepare adequately for the placement, including
contact with the placement in advance. Disclose
any health or learning needs that may impact on
the placement, or the achievement of learning
outcomes.
Promote a healthy and ‘just’ workplace culture built
on openness and accountability, encouraging all
learners to raise any concerns they may have about
poor practice or ‘risk’, including unacceptable
behaviours and attitudes they observe at the earliest
reasonable opportunity. Respond appropriately when
concerns are raised.
Raise any serious concerns about poor practice or
‘risk’, including unacceptable behaviours and
attitudes observed at the earliest opportunity. Be
clear who to report any concerns to in order to
ensure that high quality, safe care to patients
/service users and carers is delivered by all staff.
Provide all learners with a named and appropriately
qualified / suitably prepared mentor / placement
educator to supervise support and assess all
learners during their placement experience.
Actively engage as an independent learner, discuss
learning outcomes with an identified named mentor
/ placement educator, and maximise all available
learning opportunities.
Provide role modelling and leadership in learning
and working, including the demonstration of core
NHS ‘values and behaviours’ of care and
compassion, equality, respect and dignity, promoting
and fostering those values in others.
Observe effective leadership behaviour of
healthcare workers, and learn the required NHS
‘values and behaviours’ of care and compassion,
equality, respect and dignity, promoting and
fostering those values in others.
Facilitate a learner’s development, including respect
for diversity of culture and values around
collaborative planning, prioritisation and delivery of
care, with the learner as an integral part of the multidisciplinary team.
Be proactive and willing to learn with, from and
about other professions, other learners and with
service users and carers in the placement.
Demonstrate respect for diversity of culture and
values, learning and working as part of the multidisciplinary team.
Facilitate breadth of experience and interprofessional learning in placements, structured with
the patient, service user and carer at the centre of
care delivery, e.g. patient care pathways and
commissioning frameworks.
Maximise the opportunity to experience the delivery
of care in a variety of practice settings, and seek
opportunities to learn with and from patients,
service users and carers.
Polly Hamlett 22/04/2014
Adopt a flexible approach, utilising generic models
of learner support, information, guidance, feedback
and assessment across the placement circuit in
order to support the achievement of placement
learning outcomes for all learners.
Ensure effective use of available support, information and
guidance, reflect on all learning experiences, including
feedback given, and be open and willing to change and
develop on a personal and professional level.
Offer a learning infrastructure and resources to
meet the needs of all learners, ensuring that all
staff who supervise learners undertake their
responsibilities with the due care and diligence
expected by their respective professional and
regulatory body and organisation
Comply with placement policies, guidelines and
procedures, and uphold the standards of conduct,
performance and ethics expected by respective
professional and regulatory bodies and organisations.
Respond to feedback from all learners on the
quality of the placement experience to make
improvements for all learners.
Evaluate the placement to inform realistic improvements,
ensuring that informal and formal feedback is provided in
an open and constructive manner.
• ‘Learner’ refers to all health, education and social care students, trainees, hosted learners.
• ‘Placement’ relates to all learning environments / work based learning experiences.
• ‘Mentor’/ ‘placement educator’ relates to all trainers / supervisors / coordinators appropriately qualified / suitably
prepared to support learners.
• ‘Professional and regulatory body and organisation’ relates to standards required to ensure patient and public
safety, and professional behaviours.
Developed in the North West by healthcare learners, service users, carers,
and health and social care staff from all professions in the North West
region.
Health Education North West
Polly Hamlett 22/04/2014
Placement Evaluation
Your feedback on your learning experience is essential to let us know what we are doing well and how we can improve.
Please would you take a moment to complete our short questionnaire? Follow the link here:
https://www.surveymonkey.com/s/RTRZNVF
The survey is common to all learners on nursing and allied health professional programmes.
Polly Hamlett 22/04/2014