CORK UNIVERSTIY HOSPITAL – Cardiac Renal Centre
Coronary Care Unit (CCU)
ORIENTATION BOOKLET FOR PRE-REGISTRATION NURSING STUDENTS
2013
This Booklet is to be read in conjunction with the following guidelines:-
Supernumerary Students
 CUH Group Practice Placement Booklet for BSc. General Nursing Students
 CUH Group Practice Placement Booklet for BSc Children’s & General (Integrated)
Pathway Students
(You can locate a copy of these books in the BSc. Nursing Students on UCC Website)
STUDENT NAME:-
PRECEPTOR:-
ASSOCIATE PRECEPTOR:-
MISSION STATEMENT
The Cork University Hospital group is committed to providing
high quality care for those we serve with a focus on clinical
excellence, patient safety and continuous improvement through
clinical education and research.
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WARD AND PATIENT RELATED INFORMATION
WELCOME NOTE
Welcome to CCU we hope you enjoy your allocation with us. This booklet has been complied
to assist you during your placement on CCU. This booklet will be reviewed annually to
ensure that the information is current and accurate. The information provided in this booklet
is not exhaustive. If you have any questions please direct them to the Clinical Nurse
Manager, your Preceptor, Nursing Staff or the Clinical Placement Co-ordinator.
CCU is an acute medical ward and it specialises in Cardiology. The main aim of this clinical
placement is to link the theory you learned in the classroom to nursing practice. It is
recommended that you observe and participate in the delivery of individualised and holistic
patient care with your allocated preceptor. It is suggested that you reflect on practice at the
end of each shift to enhance your learning experience.
UNIT PHILOSOPHY
TBC
WARD PROFILE
CCU is an 8 bedded unit. Patients are admitted to the unit via the emergency department,
cardiac catheterisation laboratory (cardiac catheterisation laboratory) or transferred from
another ward or hospital with various cardiac problems, requiring specialist cardiac
treatment, intervention and care.
The nursing complement comprises of an Assistant Director of Nursing (ADON), Clinical
Nurse Manager (CNM) 2, CNM 1, registered general nurses and supernumerary students
(2nd & 3rd Year students). The educational background of the registered nurses varies from
post-registration certificates, Diploma in Nursing, BSc. Nursing Degree and Postgraduate
Diploma in Cardiac and Intensive Care Nursing, Postgraduate Nursing Students undertaking
the Higher Diploma in Intensive and Critical Care. Internal Rotation of staff may occur
between Cath.lab., 3D Ward, the Step down Unit and CCU.
GEOGRAPHY OF UNIT
Unit Location
CCU is situated on level 3 of the Cardiac Renal Centre.
Access is via the main front door of Cork University Hospital which is located on Level 1. At
the main reception desk turn right, go through double doors and take the public lift to level 3.
On exiting the lift turn left and proceed straight ahead, entrance to CCU is on the right.
Rooms
There are 8 single rooms with individual intensive cardiac monitored beds in CCU. Rooms 1
and 8 are ensuite.
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Staff Base
The staff base is located in the centre of the unit. The staff base extends to incorporate the ward clerk
at the visitors access point to the unit. The telemetry monitors are also positioned at the staff base
Other services located at the staff base include:
 The fire panel
 A pneumatic shoot for the transportation of clinical samples directly to the laboratory.
 One of the cardiac resuscitation trolleys is also stored here.
 The team room is located directly behind the staff base.
 The clean utility is located directly behind the staff base. It is here that sterile stores are
kept using the Kan ban system. All medications and schedule II drugs are stored in this
utility room.
To the right of the staff base on the right hand side of the corridor is:
 Linen Bay and fire extinguishers
 Equipment Sore
 Dirty Utility which contains bedpan washer, macerator and hazardous waste storage
cabinet.
 General store
 Entrance and exit for staff
To the left of the staff base on left side of the corridor is:
 Staff Toilet facilities
 Patients bathroom
 Fire extinguishers
 Staff Rest room
 Medical staff Office
 Staff entrance to Step Down Unit
 At the end of the CCU there is a radiology protected procedure room and the CNM
office.
Emergenc y Equipment
Resuscitation Trolleys x
2
Suction Machine
One trolley is at the Staff Base
2 n d trolley located adjacent to staff WC on
entry to the CCU.
All bed spaces have access to wall suction
Suction available on resuscitation trolleys
NURSING CARE DELIVERY SYSTEM
The Clinical Nurse Manager (CNM) or Nurse-in-Charge co-ordinates the overall running of
the unit. The registered Nurses take responsibility for the delivery of direct patient care i.e.
patient allocation. The registered Nurses take responsibility for the delivery of direct patient
care i.e. patient allocation. Patient allocation is dependant on patient acuity. A registered
nurse will be delegated responsibility for monitoring the telemetry system.
Telemetry is a sophisticated monitoring system that enables staff to continuously monitor
patients' heart rhythm, even as they move around the unit and hospital. Patients wear a
portable transmitter that links to a bank of monitors at the nurses’ station.
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ETIQUETTE TOWARDS CLIENTS
All patients are to be referred to as Mr./Mrs./Miss unless the patient requests otherwise as
per hospital policy.
SAFETY, HEALTH AND WELFARE IN THE CLINICAL AREA
For further information please refer to the practice placement guidelines
MANUAL HANDLING OF PATIENTS
Aids available on ward CCU Include
Hoist (shared with step down unit)
Located in equipment room
Roller Slide
Located in CCU equipment store room
Maxi Slides
Located in CCU equipment store room
It is the responsibility of each Nurse to use the available manual handling and lifting aids
available on each ward.
FIRE SAFETY
For further information on fire prevention please refer to your practice placement
booklet.
Fire Panel
Adjacent to ward clerk/reception desk, CCU 12 at
nursing base
Fire Blanket
In pantry (CCU -24) and staff rest (CCU -12)
Refuge point and dry riser
Located outside CCU in step down unit opposite ward
pantry through double doors at CRC – 3 - 108
Fire Extinguisher
Located opposite fire point 2, beside patient shower/WC
3 – CCU -19,Across from ward pantry (entry to
procedure room), beside linen bay, on back corridor
opposite double doors to CCU (opposite patient lifts)
Exit Doors
Leave via back corridor leading to patient lifts, turn right
through double doors and down the stairs and exit to the
road outside the building. Proceed to refuge point CRC3 – 108 through the double doors down the stairs and
exit onto the road outside building, Exit via main
entrance to CCU turn left to visitor lifts, turn right and
continue to link corridor to 3B continue down back stairs
to ground level and exit onto outside.
Fire Doors
Main entrance to CCU
Equipment store
General stores
Dirty utility
Double doors between CCU and step down unit
Staff rest
Ward pantry
Double doors leading from CCU to back corridor across
from patient lifts
Fire Plan for CCU
Displayed in CCU behind nursing base
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PATIENT DOCUMENTATION
PATIENT PERSONAL PROFILE DOCUMENT
The patient personal profile document contains information regarding the patient and their
medical/surgical history, obtained by the nurse on admission. Assessment is based on
Roper, Logan and Tierney’s Activities of Daily Living (ADL). It also includes a discharge
planning section, multi-disciplinary team involvement, investigations and a signature and
initials log.
N.B. All Patients on admission to CCU must have a Waterlow Score, and a Body Mass Index
documented in their Patient Profile Document. Complete the trigger questions in the Personal
Cleansing and Dressing section and the Eating and Drinking section of the patient profile
document to ascertain if a Nutritional Assessment and an Oral Hygiene assessment are
required. Remember to open core care plans where indicated through your ADL assessment.
IMPORTANT CONSIDERATIONS WHEN DOCUMENTING PATIENT CARE
 It is advised that students read the Recording Clinical Practice Guidelines 2002 issued by
An Bord Altranais before clinical placement.
 Student Nurses record keeping should be monitored by the preceptor or supervising
nurse. Entries should be co- signed by a registered nurse.
 Abbreviations should only be used as per National Hospitals Office Guidelines (2007).
 Time of entries should be the 24 hour clock.
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LEARNING OUTCOMES TO BE ACHIEVED ON CCU
EDUCATION RESOURCES
The CPC and preceptor during your ward orientation will direct you to the available learning
resources on CCU e.g. Clinical Staff, Educational Folders on Computer in team room, patient
information leaflets, Royal Marsden, Nursing Text Books, BNF etc.
It is advisable that you revisit the anatomy and physiology of the cardiac systems.
In addition, develop an understanding of and participate at your level of learning in the
following:
Admission of a patient including activating appropriate care plans
 Assessment of activities of daily living in Patient Profile Document
 BMI
 Waterlow score
 Oral Care Trigger Questions
 Nutrition Trigger Questions
 Urinalysis (obtaining, performing and interpreting results)
Taking and recording of patients’ vital signs. Reporting abnormalities
The taking and recording of vital signs should be utilised as an opportunity for carrying out a
holistic patient assessment where students and staff share responsibilities, skills and
knowledge. If assessment of patient was not possible (e.g. patient was at x-ray) the student
must inform named nurse and check observations of the patients return

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

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
Manual and automated blood pressure
Temperature
Respirations
Manual pulse
Pulse oximetry for Oxygen saturations
Capillary blood glucose monitoring
Fluid balance
 Accurately completing and updating Intake -both intravenously and oral fluids
 Accurately completing and updating Output - consider catheter drainage, patients’
mobilising out to toilet
 Consider patients’ fasting-nil per mouth
 Consider patients’ on fluid restrictions
 Consider wound, naso-gastric drainage and vomitus
 Total fluid balance every 12 and 24 hours
 Recognise and report abnormalities/changes
Medications
 Ascertain patient allergies; drug, food, dressings, latex.
 Consider the drug, route, purpose, dose, indications, contra-indications and side
effects
 Be aware of the safe practices in relation to medication administration and the storage
of medications, including Schedule 2 medications
 Participate in medication administration under direct supervision of Registered Nurse
 Observe and report any abnormalities to intravenous access sites
 Observe the checking process for blood/blood products
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Personal Cleansing and Dressing
 Assess patients’ level of dependence/independence
 Assist patient as necessary
 Promote patients’ independence
 Ensure privacy and dignity for the patient
 Prepare environment and gather necessary equipment and products
 Assess the patients’ skin integrity
 Use this opportunity to talk and develop therapeutic relationship with the patient
Eating and Drinking
 Assess patients’ level of dependence/independence
 Assist patient as necessary
 Promote patients’ independence
 Complete food chart
 Consider patients’ food preferences and diet restrictions eg. Low salt, diabetic diet
 Ensure instructions from Multidisciplinary team, for e.g., Clinical Nutritionalists and
Occupational Therapist are carried out for e.g., weekly weights, high calorie high
protein drinks and use of eating aids.
Elimination
 Assess patients’ level of dependence/independence
 Assist patient as necessary
 Promote patients’ independence
 Catheter care, stoma care
 Daily recording of patients’ bowel patterns-reporting abnormalities
 Collect samples, performing tests and sending samples to appropriate laboratory
Pre-procedure nursing care
 Ensure patients are prepared for their procedures and that the CUH pre-operative
checklist is completed if required (patient going to theatre department from CCU).
– ensure patient has had shower/bed bath, gown, TEDS, name band, has
been fasting if appropriate,
 Establish the patient has made an informed consent
 Ensure patients medical notes and x-rays are available to accompany patient
 Ensure patient has been given pre & post procedure education and has been given an
opportunity to express any worries or anxieties
 Prepare the patients bed space to receive patient post procedure – make post
operative bed, ensure oxygen and suction are present and functioning, have drip
stand and infusion pump beside bed, catheter stand if required.
Post – procedure nursing care
 If necessary, take the emergency bag containing the necessary equipment with you
when collecting patient under supervision of Registered Nurse. It is essential that you
are familiar with this equipment
 Collect patient from cardiac catheterisation laboratory / x-ray department etc. ensuring
that you have obtained the necessary information:
 what procedure was performed and any complications
 what anaesthetic (local, sedation), analgesia or any other medications patient received
 volume and type of intravenous fluids or blood/blood products received
 determine if patients vital signs within normal limits – is patient requiring oxygen and if
so what percentage?
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 what wound/drains does the patient have – is there any ooze or haemorrhage from the
wounds/drains
 are there any specific post procedure instructions
 Assist patient into bed using pat slide
 Nurse patient in appropriate position taking into account any specific post procedure
instructions
 Monitor vitals signs, observe wounds/drains
 Complete pain assessment and administer analgesia as prescribed under direct
supervision of registered nurse and monitor side effects
 Administer anti-emetics as prescribed under direct supervision of registered nurse, if
patient is experiencing nausea/vomiting
 Monitor patients urinary output – provide bedpan/urinal, assist patient to mobilise out
to toilet (if appropriate) or measure catheter drainage
 Monitor and update fluid balance
 Assist patient with oral care needs and oral fluids/diet when patient is able to tolerate
same
Discharge Planning
 Recognise the importance of discharge planning on and during admission
 Liaise with appropriate personnel, for e.g., Discharge Co-ordinator, Public Health
Nurse and General Practitioner
 Ensure discharge section of patient profile document is fully completed
 Complete transfer form if being transferred to ward within CUH
Handover Report
 Nursing students should document all nursing care given
 Students’ must avail of all opportunities to give report on patients’ in their section
Patient Diagnosis / Procedures / Tests
Cardiac
Procedures/Tests
 Myocardial Infarction
 Echo
 Coronary Artery Disease
 ECG
 Angina & unstable angina
 Exercise Stress Test
 Atrial fibrillation
 Percurtaneous Transluminal
Coronary angiogram / angioplasty /
 Pulmonary oedema
stent insertion
 Congested cardiac failure
 Cardioversion
 Complete Heart Block
 Blood levels – troponin levels, cardiac
 Supraventricular tachycardia
enzymes
(SVT)
 Ventricular tachycardia /
fibrillation (VT/VF)
Student must participate in maintaining a safe, clean environment for patients and for
colleagues
Students should be able to discuss the rationale for all nursing interventions undertaken
These learning opportunities are not an exhaustive list, and students’ are encouraged to avail
of any other opportunities which may arise.
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PRECEPTOR/ ASSOCIATE PRECEPTOR ALLOCATION
The Student Nurse is allocated to a Preceptor on commencing placement. If the Preceptor is
not on duty or absent then the Clinical Nurse Manager (CNM), Nurse-in-Charge or the
Clinical Placement Co-ordinator (CPC) will allocate the student to an associate preceptor.
The student will actively participate in assessing, planning, implementing and evaluating
nursing care under the supervision of the preceptor.
STUDENT ASSESSMENT AND CPC ROLE
STUDENT ASSESSMENT AND IMPORTANT CRITERIA
 Students should review their Clinical Learning Outcome (CLO)/Competency books prior to
commencing clinical placement. On commencing the placement it is expected that students
can identify what they would like to achieve. The CPC will offer advice on what
CLOs/Competencies are achievable in each clinical area.
 The CLO/Competency Booklet must be available for review every day on placement.
 It is the responsibility of the student to arrange suitable interview times with the preceptor.
 N.B. The student must have reflective notes written prior to scheduled interview with their
preceptor. Reflective notes form part of the assessment/interview.
 The CPC should be contacted as soon as possible if there is a possibility that outcomes
may not be achieved.
CPC ROLE
 Support and guide the pre-registration nursing students within CUH, CUMH, St. Finbarr’s
Hospital, and External Mental Health sites.
 Assist in the creation and maintenance of a quality clinical environment that enhances
nursing student’s clinical competence and knowledge.
 Provide support, guidance and act as a resource for clinical nursing staff and preceptors.
 Actively participate in practice development initiatives in conjunction with Clinical staff.
 Facilitate many working groups involved in practice development.
CPC RECORD OF STUDENT PLACEMENT
The CPC will document the initial and subsequent contact with the BSc Nursing Student for
the duration of the practice placement. Significant issues and record of CPC interactions and
agreements reached with student will be recorded. The student may ask or be asked to cosign the record.
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PROFESSIONAL BEHAVIOUR
Cork University Hospital (CUH) Group. BSc Programmes: Supernumerary Student
Who to contact prior to and following absence on Clinical Placement
At start of scheduled shift I contact the following personnel in relevant hospital:
:::::::hhospitalhospitalrelevant hospitalfollowing personnel in must contact:
CUH
CUMH
MGH
SMOH
SFH
1. Clinical Nurse
1. Clinical Midwife
1. Clinical Nurse
1. Clinical Nurse
1. Clinical Nurse
Manager (CNM)
Manager (CNM) /
Manager (CNM) /
Manager (CNM)
Manager (CNM)
/ Nurse in charge
Midwife in charge
Nurse in charge
/ Nurse in charge
/ Nurse in charge
2. Link CPC /
CPC Main Office
2. Link CPC /
CPC Main Office.
2. CDC
2. CDC
2. Link CPC /
CPC Main Office
3. Nursing
Management Office
Medical Certificates
I forward Medical Certificate and or Fitness to Return to Resume Work Certificate to Allocations Office, UCC
On return to placement – following absenteeism I report to:
1. Clinical Nurse Manager (CNM) / Nurse in charge
2. Link CPC, (Contact CDC
if inrefer
SMOH
or MGH)
*Please
to Practice
Placement Booklet for further details
3. CUH ALO, (telephone contact)
Repayment of Clinical Hours
1. Hours may be repaid during placement if (cumulative) total of all absenteeism is less than 29 hours.
Repayment of clinical hours must be negotiated with the ALO, CPC / CDC and CNM
2. When (cumulative) hours of all absenteeism during supernumerary placements exceeds 29 hours
repayment occurs during the summer and is co-ordinated by the ALO
CONTACTS
Cork
University
Hospital
CUH
Mallow General
Hospital
MGH
St Finbarr’s
Hospital
SFH
Telephone
Bleep
Rose Hayes, Allocations Liaison Officer (ALO), General
Nursing Programme CUH
Bebhinn O’Sullivan, Allocations Liaison Officer (ALO),
Integrated Children’s and General Nursing Programme CUH
CUH Duty Office / Night Sisters Bleep
CUH Clinical Placement Co-ordinators (CPC’s), Bleep CPC
linked to relevant area
Main CPC Office
Fiona Willis, Clinical Development Co-ordinator (CDC), Mallow
General Hospital (MGH)
Nursing Management Office
021 – 4922072
691
021 – 4922060
702
021 – 4922108
021 – 4546400
703
Assistant Director of Nursing Office, St. Finbarr’s Hospital (SFH)
021 - 4923269
021 - 4922059
022 – 21251
022 – 30384
206
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PUNCTUALITY
The student must report to the Clinical Nurse Manager or nurse in charge on arrival to the
area and prior to leaving the area daily. The student is expected to be present in the area at
least five minutes prior to commencement of the patient hand-over report
DRESS CODE/UNIFORM
For further information on dress code please refer to practice placement booklet
Regarding:Uniforms (please read CUH uniform policy 2011)
Hair
Nails and nail decoration
Jewellery
Footwear
Identification
GENERAL INFORMATION
Please refer to your
 CUH Group Practice Placement Booklet for BSc.General Nursing Students
 CUH Group Practice Placement Booklet for BSc Children’s & General (Integrated) Pathway
students
 Information for the Rostered Year 2007 BSc. General Nursing
For information on the following: Occupational Health
 Safety, Health and Welfare
 Student Practice Placement record Sheet
 Confidentiality
 Smoking, there is a no smoking policy in CUH
 Mobile phones
 Incidents and Near Misses Involving Nursing Students
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BSc NURSING ASSESSMENT OF CLINICAL LEARNING OUTCOMES AND
COMPETENCIES
YEAR 1 - EXPOSURE LEVEL
THE CUES ARE:
 The student observes the competent practitioner delivering nursing care
 The student becomes conscious / familiar of an experience or interaction
 The student responds to an invitation to participate in an experience
 The student interacts with the experience and anticipates participation in it
YEAR 2 & 3 - PARTICIPATION LEVEL
THE CUES ARE:
 Physical and mental inclusion and involvement in an experience / learning opportunity
 And / or replication of a previously exposed experience at active participation level
YEAR 3 - IDENTIFICATION LEVEL
The student / intern demonstrate:
 active participation in delivering and evaluating nursing care with less prompting and
increased confidence
 greater ability to communicate effectively, demonstrating a wish to acquire further
information
 ability to reflect on own communication skills
 ability to analyse and interpret information
 ability to apply problem solving skills and underlying knowledge to different situations
 ability to manage small case loads of patients (with minimal supervision)
YEAR 4 - INTERNALISATION LEVEL
The intern demonstrates:
 self direction in prioritizing and delivering nursing care
 effective communication skills
 ability to seek and apply new knowledge and research findings
 ability to transfer knowledge to new clinical areas and to junior colleagues
 ability to increase own professional development by way of reflection and enquiry
 ability to apply problem solving and critical analysis skills and to evaluate a situation.
 ability to manage the care of the same case load of patients as qualified staff (with
minimal supervision)
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IMPORTANT TELEPHONE NUMBERS
Name / Location
Cardiac Arrest
Fire
Security
Phone Number
Bleep Number
22555
22222
Bleep 137
USEFUL TELEPHONE NUMBERS
Name / Location
Hospital Number
Direct line to ward
Phone Number
021 4546400
021
49
+
extension
34040 / 34041
34050
22100
9
20966
Bleep Number
ward
CCU
Step down unit
Main Reception
Switchboard
Salaries
Security
Bleep 137
Duty Office
22680/22108
Porter
Bleep 586
Night Porter
Bleep 587
NURSING PERSONNEL
Assistant Director of Nursing
Betty Hickey VPN = 65319
Clinical Nurse Manager 2
Mary Crowley
Clinical Nurse Manager 1
Siobhan Collins
Clinical Placement Co-ordinator
Kathy Healy Bleep 695 / 703
CARDIAC REHABILITATION PERSONNEL
Resuscitation Officer
Michelle Ward
Clinical Facilitator - Critical Care Course
Breda Doyle
Bleep 684
Cardiac Rehabilitation Co-ordinator
Valerie O’ Sullivan Bleep 381
Health Promotion Officer
Patricia Good
Ext.22286
Cardiology Co-ordinator
Catriona O’ Donovan 086 6871340
Social Worker/Stress Management
Clinical Nutritionist
DISCHARGE CO-ORDINATORS
Jane Kelly & Pauline O Keefe (Over 65’s)
Bleep 569
Regina McCarthy (under 65’s)
Bleep 855
MEDICAL PERSONNEL
Consultant
Dr. Peter Kearney
Dr. .Eugene McFadden
Dr. Ronan Curtain
Prof. Noel Caplice
Visiting Consultants
Dr. Gerry Fahy
Dr. Peter Kelly
Dr. Tom McKiernan
Dr. Carl Vaughan
Prof. David Kierans
Speciality
Cardiology
Cardiology
Cardiology
Cardiology
Speciality
Cardiology/EP Studies
Cardiology
Cardiology
Cardiology/Heart Failure
Non-Invasive Cardiology
Hospital
SIVH
SIVH
MGH
MUH
MUH
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