Rumney District nurse team
STUDENT NURSE INFORMATION PACK
Welcome Rumney District Nurse team
Your designated mentor will be:
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Rumney 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.
Who’s who?
Your Lead mentor is Sue Matthews- 07976050157
And Susan Haywood - 07976050172
Your Practice Facilitator is Venetia Yarr- 07966440657
Team members
Job Title
Name
Team Leader
Contact no
Dianne Old
07976050375
Deputy Team Leader
07976050157
Sue Matthews
Deputy Team Leader
Shirley O’keefe 079760503187
Deputy Team Leader
Amanda Rees 07976050487
Staff Nurse
Sarah Turner
Staff Nurse
Grace Stanley
Staff Nurse
07976050437
Louise Allmark
07976050448
Staff Nurse
Sian Mercer
Staff Nurse
Kate Goldstein
Staff Nurse
07976050343
07976050371
07976050488
Robert Hawkins
07976050252
Staff Nurse
Amanda Hurst
07976050257
Staff Nurse
Liz Woods
Staff Nurse
07976050261
Emma Higgins
Staff Nurse
Eirwen Cummings
07976050312
Staff Nurse
Debbie Nethercote
07976050259
07976050497
HCSW
Doris Sullivan
07976050276
HCSW
Julie Blake
07976050256
HCSW
Lisa Keke
HCSW
Isobel Arantes
07976050198
07976050474
GP Surgeries
We have roughly 600 patients on our caseload, which are divided
between four GP surgeries currently. They include:
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Brynderwen Medical centre
Willowbrook Surgery
Llanrumney Surgery
Rumney medical practice.
We receive referrals daily from GP practices, patients, carers, hospitals
and residential homes.
PARIS Training
During your placement district nurses’ use an electronic patient database
system called PARIS to enter valuable information following their call.
The university should have allocated you two PARIS training days in
order for you to gain access to the system alongside your mentor. If you
have any issues with this please speak with the lead mentor Sue.
Shift Patterns
Day shift: 08.30-16.30
Late shift- 12.00- 20.00
We all return for handover at 12.00pm and this usually takes around 3045 minutes.
Breaks
You will have an hour lunch break every day depending on your mentor’s
hours of work. You can stay in and eat with the team, or you are free to
go out for your break. If you are planning on going out for lunch please
inform your mentor/ co-ordinator so we have record of your location for
fire purposes.
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
Upon hearing the fire alarm, we are to evacuate to the clinic’s car park.. It
is important that you inform your mentor if you intend to leave the
premises for your break etc.
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, post operative caree.g. removal of sutures etc and vaccinations during flu season.
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.
It would be beneficial if you learn some of the terminology below as
this will help you on your development and knowledge of community
nursing. Most of the information below can also be applied to other
areas of nursing as well.
Features of venous and arterial ulcers
History
Classic Site
Edges
Wound bed
Exudate
Level
Pain
Oedema
Associated
features
Treatment
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.
Venous
eczema
lipodermatosclerosis,
Atrophie
blanche, haemosiderosis.
Compression therapy.
Wound assessment guidance grids
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.
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.
Severity
of the Disease
Mild arterial disease.
0.7-0.5
Varying degrees of
intermittent
claudication.
Mild
to moderate arterial
disease.
0.5-0.3
Severe
intermittent
claudication
and rest pain.
Severe
arterial disease.
Critical ischaemia
(rest pain> 2
weeks)
with or without
tissue loss (ulcer
Gangrene).
Severe
arterial disease.
< 0.3
Or ankle
Systolic
Pressure
<
50mm
Hg
Action
Reduce risk
factors and
change lifestyle
stop smoking
maintain weight
exercise regularly
consider antiplatelet
agent.
As for index>0.7-1,
Plus referral to
outpatient
vascular specialist.
Possible
arterial imaging.
(duplex
scan/or/angiogram).
As for index>0.7-1,
Plus urgent referral
vascular specialist.
Possible
arterial imaging.
(duplex
scan/or/angiogram).
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
Signs
Portal of Entry
Investigations
Skin swabs (using the
lavine technique)
Eczema
No Fever
Itching/scaly
History of
varicose veins
or deep vein thrombosis
Increase in exudates
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)
Not applicable
White cell count normal
CRP normal
Blood culture negative
Staphylococcus
aureus common
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
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.*
Weeping
Eczema
As for infected
eczema but
without oral
antibiotics
No Eczema -Daily emollient*
*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)
COMMONLY USE CLINICAL DEFINITIONS
Colonisation: A mess of bacteria formed by multiplication of cells when
bacteria are incubated under favourable conditions.
Dehiscence: Bursting or splitting open of a wound leaving a cavity on
times.
Eschar: Dead tissues characterised by dry, crusty appearance and
sometimes black. It adheres to the wound bed.
Excoriation: Injury to the skin caused by trauma such as
scratching/rubbing/chemicals- such as urine that presents as redness.
Exudate: Translucent yellow tinged fluid. Rich in proteins and antibodies
which occurs during the inflammatory phase of the healing process.
Granulation Tissue: Red, moist and fragile connective tissue that
characterises healing process.
Healing by primary intention: Healing occurring in the wounds so that
there is little scar or granulation tissue.
Healing by secondary intention: Healing in which the edges of the
wound are separated, requiring granulation tissue to fill the gap.
Maceration: The softening of tissues due to prolonged exposure to
moisture. (Eg: keeping fingers in the bath for too long and wrinkled effect
occurs).
Necrotic: Dead, devitalized tissue often black in appearance.
Pressure ulcer/sore: Tissue destruction as a result of tissue overlying a
bony prominence, subject to prolonged pressure.
Pseudomonas: Infected exudate in a wound. Often green in colour with
offensive smell.
Slough: Shed dead tissue- often yellow and thick in appearance requiring
use of de-sloughing agents to remove.
Superficial break: Interruption of top layer of the epidermis.
Tissue viability: Sustained health, growth and repair of body tissues.
Wound: Any break in the integrity of the skin and underlying tissues.
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- including leg ulcer clinic- third year only
 General practitioners
 Diabetic nurses
 Palliative care nurses- third year only
 ART Team
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:
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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:
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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:
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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:
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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:
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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.