student portfolio of learning opportunities polo ward 9 paediatric ...

STUDENT
PORTFOLIO OF
LEARNING OPPORTUNITIES
P.O.L.O
WARD 9
PAEDIATRIC SURGERY
RVI
THE NEWCASTLE HOSPITALS NHS FOUNDATION TRUST
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JOAN MORRIS SISTER
GAIL CONN SISTER
RACHEL ALLCOAT STAFF NURSE
HELEN SHIPLEY STAFF NURSE
Reviewed June 2012

Dear Student,
Welcome to Ward 9.During your allocation to the ward your
mentor will be _____________ and your associate mentor will
be _________________ Every effort will be made to ensure that
you will work with either your mentor or associate mentor, but
in certain circumstances this may not always be possible.
However, there will always be a named member of staff to work
with you .We hope you will enjoy your allocation with us and
that you will find it a rewarding experience.
If you have any questions or concerns regarding your allocation,
please discuss these with your mentor or education link nurse.
The direct number for the ward is 0191 2826009 and the dect
phone is 0191 2829017
Gail Conn
Senior Sister/Manager
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THE NEWCASTLEHOSPITALS NHS FOUNDATION
TRUST
WARD 9 RVI
Our ward nursing philosophy reflects the beliefs and goals of our nursing
staff in caring for children in hospital. We aim to offer a friendly relaxed
atmosphere in order to minimise stress and promote optimal health.
Our beliefs and aims:
1. We recognise that your child and family are unique and that the interest
of your child is paramount.
2. All staff will listen to your child and strive to understand their
perspectives, opinions and feelings. We acknowledge their rights to
privacy.
3. We recognise that your child has the right to information according to
age and understanding, and will ensure appropriate information is given
to ensure informed decisions are made regarding their care.
4. We offer a family centred approach to care, and recognise the right of
the child to have their parents present during procedures and
investigations, if it is thought to be in the child’s best interest.
5. We provide holistic care and will accommodate cultural, spiritual,
social and psychological needs in a non-judgemental manner.
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6. Each child / carer will be given information in appropriate terminology
and will be kept informed and updated on their condition.
7. The nursing team encourage active participation from parents / carers.
All staff offer encouragement, support and supervision as required. We
recognise that not all parents wish to or are able to participate in the care
given.
8. Residency of parents is encouraged to minimise stress of the child
during their stay on ward 9, provided this is in the best interest of the
child.
9. We will encourage your child to maintain their usual routines. Play and
education will be provided to maximize your child’s potential and
maintain an element of normality.
10. All qualified staff are specifically trained and educated to care for
your child and aim to provide high standards of research-based care.
April 2004.
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Learning Opportunities.
Students Overview at a Glance.
Ward 9 is a regional paediatric surgical ward that cares for children from birth to 18
years of age. It comprises of 25-inpatient beds and takes both planned and emergency
surgical admissions. Ward 9 is situated in the new Victoria Wing on the 4th floor.
Ward 9 allows all levels of students the opportunity to gain many different skills
during their time on the ward. Ward staff welcome the opportunity for students to
come for a pre-placement visit and if possible to meet their mentor and associate
mentor, who will have been allocated to you prior to your placement.
Ward 9 cares for children with a variety of needs. We are the regional unit for
urological, gastrostomy, solid tumours abdominal and colorectal surgery. We also
care for some children with complex special needs.
A multidisciplinary approach to care is offered, during your time on the ward you will
be able to liaise and work with other members of the team. These are all tied in with
your learning zones and will assist in enabling you to complete your learning
outcomes.
Your off duty may already have been written for you. We try to ensure that you work
50% of your time with your mentor, spending the remainder with your associate
mentor or a named member of staff.
Our working week is 37.5 hours:
3 long days for 3weeks,
4 long days for 1 week.
Day shift is referred to as 15 on the off duty and is
07.30 - 20.00.
Night shift is referred to as 16 on the off duty and is
19.30 - 08.00.
During the shifts we have two 30-minute breaks one taken in the morning and another
in the afternoon.
Off duty is usually planned at least 4 weeks in advance around your mentor(s) off
duty to ensure a quality placement. You will be required to work weekends and night
shift, (with the exception of first year students who are not required to work nights),
as this will give you an overall view of the ward. If you require a specific request you
must inform the educational link nurse or your mentor as soon as possible.
SICKNESS
You must report any sickness or absence from work to the nurse in charge as soon as
possible, similarly when returning back to work. You should also report any sickness
or absence to the university as per policy.
Infectious illness should be reported initially to the nurse in charge then if required
occupational health. Anyone suffering from diarrhoea must not return to work for
48hrs following your last episode.
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UNIFORMS
Uniform policy can be found on the trust intranet and in the student handbook.
General neatness and tidiness is required at all times. Recommended practice is that
decorative jewellery should not be worn, with exception of wedding rings. Also nailvarnish
and false nails are not acceptable.
SECURITY
The entrance and exit door is locked and is accessible by swipe card, which you will
have to obtain from general office.
Parents and visitors gain entry by ringing the buzzer and waiting for entry, which is
given by using the release button at the nursing station, identification must verified at
all times. Whilst on placement student identification must be worn at all times.
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Portfolio of learning opportunities
Learning opportunities Relevant personnel
Interpersonal skills
Use of telephone
� Making/answering calls Nurses
� Transferring calls/ring back Ward clerk
� Bleep system Health Care Assistant
� Patient self referrals
� Fire/resuscitation call
Use of ward computer
� Hospital intranet Nurses
� Patient blood results Doctors
� Internet access/email Ward clerk
� PAS system IT dept
�
Patient Placement
� Admission/discharge Procedures Nurses
Short/long stay Doctors
Day cases Ward clerks
� Documentation
� Bed allocation
� Use of cubicles Infection control
I.e. infection control, privacy
� Patient transfer to other areas of
The directorate.
� Patient transfer to other hospitals Ambulance service
� Accessing patient notes Secretaries
Pas system
Planned / emergency
Communication
Play and recreation
� Parents/carers/families Nursery Nurse
� Patients/ special needs child Nurses
� Diversional play therapy. Support workers
Teaching staff
Interpreters
Communicating/ working with other examples of MDT
Multidisciplinary team (MDT) members:
� Ward staff Physiotherapist
� Medical staff: ward rounds dietician
Wednesday grand round Chaplain
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Pharmacist
� Ward clerk radiologist
� Paediatric continence advisor. Interpreters
� Paediatric community nurses. Social workers
� Other MDT members. Psychologists.
� Other directorate wards/ department.
� Directorate management team
Airway / Breathing.
� Assessment of airway Nurses
� Care of postoperative airway Doctors
� Administration of oxygen therapy Anaesthetist
Via nasal cannula, face/tracheal mask
� Suctioning of airway Ward 12
� Care of tracheostomy physiotherapist
Teaching parents/ carer
Delivery of care
� Patient assessment Nurses
� Care planning Doctors
� Implementation of care MDT
� Evaluation of care
Monitoring and recording observations
� Temperature, blood pressure, pulse, apex, weight, height, respiration’s Blood
glucose monitoring
� Oxygen saturation Nurses
� Urinalysis Medical staff
� Patient controlled analgesia Anaesthetic team
� Stoma assessment Pain team
� Wound checks Continence advisor
� Ace washout results
� Neurological observations
� Cannula (ivac pressure)
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Monitoring dietary intake /TPN /IVT / Nasogastric / gastrostomy
� Calculating, checking, and administration of medicines
Oral
Subcutaneous Nurses
Intramuscular Doctors
Intravenous Pharmacist
Per rectum Dietician
Per gastrostomy / nasogastric route
Controlled drugs
� Care of peripheral, central venous devices
Portacath
CVC line
Pic line
Renal line
� Care of nasal gastric tubes
Passing of
Aspiration of
Removal of
Nasogastric feeding: use of feeding pumps
� Care of gastrostomy tubes
I.e., AMT button, PEG, Mic G
Changing of AMT Button
Feeding / aspiration of
� Administration of IVT and TPN
Preparation of lines
Connection of
Line flushing
Use of ivac / syringe driver
Monitoring of IV cannula
� Administration of blood products
� Accessing iv devices
� Taking blood samples
� Aseptic technique
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Elimination and Hygiene
� Skincare
� Mouth care Nurses
� Pressure area care Doctors
� Tracheostomy care Tissue viability
Catheter cares Continence nurse
: Urethral advisor
: Supra pubic
: Mitrofanoff Pharmacy
: Bladder washouts Support worker
: Self-catheterization
� Stoma care
Fluid balance
: Ileostomy
: Colostomy
: Ace washout
: Mitrofanoff
� Toilet training
� Accurate recording of charts Nurses
� Monitoring fluid intake Doctors
I.e. via oral Dieticians
Gastrostomy Lab technicians
Nasogastric
Ace washout
Intravenous therapy
Blood products
� Monitoring fluid output
I.e. Stool (stomas, ace,)
Urine (catheter: suprapubic, urethral, stents, nephrostomy.)
Nasogastric/ gastrostomy aspirate
Wound drains
Rectal drains
� Fluid replacement
� Normal/ disturbances in electrolyte balance
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Care of surgical wound
� Aseptic technique
� Removal of sutures, drains (Yates, redivac, stents, suprapubic -catheters,
chest drain)
Infection control
� Isolation/ barrier nursing
� Hand washing
� Screening: specimen collection: faeces
Urine
Culture/virology swabs
Nps
Blood cultures
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Doctors
Tissue viability
Nurse
� Aseptic technique Nurses
Microbiology
Doctors
Pharmacy
Infection control
� Source of infection
: Transmission
: Treatment
Moving and handling
� Use of aids / devises Nurses
� Post operative patient Porters
� Special needs / immobile child Occupational
Therapist
Physiotherapist
Moving and
Handling
Medical devices
� Ivac pumps
� Syringe drivers
� Patient controlled analgesia Nurses
� Oxygen saturation monitor Anaesthetists
� Feeding devices Electronics
� Reporting faulty equipment

Legal / ethical
� Patient advocacy Nurses
� Family centred care / partnership Doctors
� Child protection Child protection
� Parental responsibility nurse
� Consent: Gillick competency Social worker
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STUDENT LEARNING RESOURCES
We hope you will experience many opportunities for learning that are both exciting
and challenging.
Teaching is a large part of the day-to-day nursing practice within the ward, which is
performed on an informal basis.
Formal teaching sessions are arranged and you will be informed of these. Each
member of the nursing team is responsible for a specific learning issue.
A number of resource files are available on ward 9 for your use. Parent information
booklets are also available that you may access. (See mentor for list).
As a student you are able to use the library facilities, and the hospital intranet
provision. The RVI has a library that all trust staff can use. The library stocks current
and past journals, books and professional documents. You may also have access to
Internet and databases.
We hope that you enjoy your placement with us. If you experience any
problems/difficulties, please discuss these with a member of staff. We welcome any
ideas you may have to improve your placement/ experience of the ward.
QUALITY IMPROVEMENT PROJECTS
These projects are carried out in order to improve nursing practice and patient care.
This sometimes includes audits and research projects in order to provide higher
standards of care.
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USEFUL INFORMATION
In special circumstances, siblings under the age of 16 years may be resident on the
ward, but their parents must also be resident and take full responsibility for them, this
is negotiated with the nurse in charge.
CRAWFORD HOUSE
This is a charity funded residential accommodation attached to the RVI. The facility is
accessible to all families whose child is a patient within the hospital. There is an
initial voluntary small charge requested. Accommodation is available on a first come
first served basis and can be booked via the ward clerk. Bookings can’t usually be
made until the day of admission. All rooms have an internal phone extension for
parents to contact the ward and vice versa. For this reason it is essential to record each
family’s extension no in their child’s assessment sheet.
LEAGUE OF FRIENDS ROOM
This is a charity based accommodation within the RVI and it is the next option for
parents to stay within the hospital, if Crawford House is fully occupied. There are not
many rooms available and it is also on a first come first served basis. To see if there
are any rooms available you have to contact Leazes reception and if there are you
must get authorisation from patient services coordinator.
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PARKING
Parents may park in the multi storey car park, and they are entitled to discount if their
child has been an inpatient for 7 days or more, if they live further away or if they are
critically ill. The car park passes are at the nurse station and you need the patients
name, MRN and car registration.
Nursing Handovers
(Morning and Nightshift)
WARD ROUTINES
Team nursing is carried out on the ward. Individual staff will hand over their own
patients to the relevant team for the next shift, either verbally or via a digital voice
recorder. Any management issues are handed over to the nurse in charge.
Ward Rounds
The morning ward round is usually carried out at approx 9am. The registrar, SHO and
nurse in-charge conducts the ward round. Each individual nurse responsible for their
patients is encouraged to be present for their patient. It is normal practice for
parents/carers to be present unless they are unable to be there or chooses not to be
present. It is the nurse’s responsibility to act as the child/parent advocate during ward
rounds. They should also inform absent parent of any changes in nursing or medical
care proposed. Individual consultants may see their patients at any time.
A grand ward round takes place every Wednesday morning. The ward consultants,
registrars, SHO’s and nurse in charge are present.
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This provides an opportunity for care of each patient to be discussed. If you wish to
observe this ward round, please discuss with your mentor who will decide as
appropriate.
Day Cases – Ward 8 surgical day unit
ADMISSIONS
Day surgery is performed Monday to Friday. If admission is for the morning list, the
patient arrives at 8am, via admissions. For an afternoon list it is 11 – 11.30am. If
during your time on ward9 you would like to spend some time there, your mentor can
arrange this.
Inpatients
Routine in-patient admissions arrive between 7.30 and 2pm.
Emergency admissions usually arrive via ward 6 day unit, where they have had a
surgical assessment. Occasionally admissions via other hospitals will arrive direct to
the ward. Any call requesting admission from other areas must be referred to the nurse
in charge, who can assess the bed status.
Self Referrals
A number of our long term patents may have been given by their consultant the right
to self refer. Any call from a parent again should be referred to the nurse in charge.
Out patients
A number of children return to the ward to be seen by the registrar or consultant, for
the removal of drains/catheters.
As we are a regional unit for gastrostomy care children will attend for change of their
gastrostomy tube. Nursing staff usually carries this out. You will have the opportunity
to observe this procedure if appropriate.
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Cubicles
Priority for admission to a cubicle is given to a child requiring isolation, a very ill
child or children under 2 years old. We also give consideration to adolescents and a
child /young person whose surgery may result in changes in body image i.e., stoma.
Playroom
The play specialist is on the ward from 7.30am – 6.30pm for 3 days and 7.30am –
2.30pm for 1 day Monday – Friday. Outside these hours parents are responsible both
for supervision of their children in the playroom and for tidying up afterwards.
All play station games and DVD’s are locked away, the play specialist has keys that
are required to change the games. When dvd’s are being used they need to be signed
out on the sheet in the dvd cupboard and back in when returned.
Televisions/portable games consoles
Each cubicle has a hospedia television in them, with a phone attached. If patients and
parents wish to use the phone they will have to pay for a card, which are available
from the hospedia machines on each floor in the victoria wing. If required portable
televisions, with dvd players can be given for the patients to use as well as games
consoles.
Facilities for parents/carers
Parents Room
The parent’s room has both lounge and dining facilities. It is the only room on the
ward that parents may make and drink a hot drink unless they are in a cubicle. Parents
must use a flask when transporting hot water from the parents room to their cubicles,
these flasks are kept in the main ward kitchen and need to be signed in and out. Hot
drinks are not permitted in the ward/ playroom area.
Children are not allowed in the parent’s room at any time.
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Tea and Coffee are available to buy from the nurse’s station. A cold water dispenser is
situated in the kitchen.
Food/beverages
Only patients are supplied with meals from the hospital food trolley, unless they are
breast feeding mothers when they are entitled to meals from the food trolley and
cereals, juice etc from the kitchen. Patients must fill out a menu to choose what they
would like, but these are given out 2 days in advance.
Dinner 12 noon
Tea 17.00 hours
A newsagents is available on the 1 st floor of the victoria wing, which has a cash
machine in the shop. There are vending machines also on level 1 and several places
on level 2 for hot and cold food. A fridge is situated in the ward kitchen for patients
own meals. Parent’s room fridge is for the parent’s food only. All food must be
labelled and dated and parents are warned that out of date products will be disposed
of. Parents are responsible for washing and putting away all crockery and utensils
used by their own family or visitors.
Resident parents
Each of the cubicles has a parent’s bed. In the two bed and four bedded bed areas a
reclining chair is provided for parents use. Resident parents may sleep on any unused
beds in these areas provided they vacate them by 7am or if an admission requires the
bed. This is on a first come first served basis.
Other family members or friends may be resident with child providing they are over
18 years and have consent of the patient/carer. One person only is allowed to stay
overnight with the child, except in special circumstances. This decision will be made
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y the nurse in charge. If more than one person requests to stay overnight with the
child, the nurse in charge will make the ultimate decision.
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COMMON TERMONOLOGY
Oscopy at the end of a word usually indicates: looking inside something. E.g.
Bronchoscopy: the bronchus, Laryngoscopy; the larynx and tracheoscopy, to name
but a few.
Otomy at the end of a word usually means an opening into. E.g. Tracheotomy,
Laparotomy.
Ectomy at the end of a word usually means removal of. E.g., appendicectomy,
nephrectomy, colectomy.
Laparotomy
This is used to access the abdominal organs. It involves the surgeon making an
incision through the abdominal wall into the abdominal cavity.
Laparoscopy.
Instead of a laparotomy, the surgeon may just want to look into the abdomen. In this
case he will use a ‘scope’, a thin tube with fibre optics, which he can use to look into
the abdomen.
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Bowel operations
Ace
Ante grade colonic enema.
Reason for surgery: chronic constipation. Used to give daily enemas directly into the
colon to remove and prevent the build up of constipated faeces.
The appendix is used to form a tract that goes from the abdominal wall through into
the bowel. A catheter is usually left in situ for approx eight weeks. After eight weeks
the tract would have healed to form a tube into which a catheter can be passed daily
and enemas given as required to clear out the bowel.
The muscle of the abdominal wall prevents leakage from the bowel to the surface of
the abdomen.
Caecostomy Tube.
In a similar operation, using the appendix, a tract is made through the abdominal wall
into which a tube is inserted into the caecum. An enema can then be given as required
directly into the caecum.
Colostomy.
This is performed for a variety of reasons where the child’s bowel is not functioning,
e.g. Hirschprungs disease, Ulcerative Colitis or necrosis.
Sometimes the colostomy is permanent whilst other times it is used as a method to
rest the bowel and later reversed.
An incision is made through the abdominal wall and a section of the bowel, colon, is
brought to the surface off the abdomen, and sutured into place.
The bowel then performs its function, passing faeces into a colostomy bag, instead of
passing through the whole large bowel and out through the rectum.
An ileostomy is where part of the small bowel, ileum, is brought to the surface in a
similar manner, for similar reasons.
Anastamosis of the bowel.
This operation is performed through a laparotomy to remove part of the bowel, which
is diseased or necrotic and join up the ends, thus avoiding a colostomy.
Appendicectomy
This operation is required if the child shows signs of appendicitis.
Appendicitis is the inflammation of the appendage of bowel that is attached to the
lower portion of the ascending colon. If it becomes inflamed it can cause severe
abdominal pain. If left un-treated it may become infected, necrotic and eventually
rupture, spilling pus into the peritoneum, causing possible life threatening peritonitis.
The appendix is removed either laprascopically or through a laparotomy incision.
Gastroschisis
Unprotected intestine protruding through a defect in the abdominal wall. Treatment
involves replacing the protruding bowel into the abdominal cavity and repairing the
defect. The baby will require IVT until the bowel is working effectively and this may
take several weeks or longer.
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Exomphalos
Is similar to gastroschisis, but the herniated abdominal contents are covered with
peritoneum or abdominal membrane. This may include liver, intestine and stomach.
Intussusception
Obstruction of the intestine caused by one portion ‘telescoping’ inside another.
Symptoms may include intermittent severe abdominal pain where the baby draws up
his/her knees and is inconsolable, vomiting, the passing of blood, mucus stool
resembling red currant jelly, shock and pyrexia. May be treated by air or barium
enema which is pumped into the bowel, otherwise surgery is required.
Necrotising Enterocolitis
The lining of the bowel dies and sloughs off, possibly as a result of bacterial infection.
This condition is primarily seen in premature babies. Symptoms include the passing of
blood in the stool, abdominal distension, vomiting, feeding intolerance and pyrexia.
Sometimes surgery is needed to remove the dead bowel and the child may need a
temporary colostomy.
Pyloric Stenosis
A narrowing of the pylorus (the outlet from the stomach to the small intestine caused
by a thickening of the pylorus muscles). This can prevent the stomach emptying into
the small intestine, so symptoms include vomiting/projectile vomiting becoming more
forceful. Failure to gain weight/weight loss, dehydration, diarrhoea, peristaltic motion
of abdomen. Treatment is a surgical division of some of the thickened muscle to
enlarge the opening- pylormyotomy.
Abscess
A localised collection of pus-fluid, white blood cells, dead tissue, bacteria or other
foreign matter. An abscess can occur almost anywhere on the body as a result of
infection. Most common abscesses are perianal and neck ones. Symptoms include
swelling, pain, and maybe oozing of pus and warmth around the site. Antibiotics may
be appropriate or the abscess may need a surgical incision and drainage.
Hirschsprungs Disease
The absence of the nerve supply to part of the bowel prevents peristalsis and so
digested matter may not pass through. Milder cases may not be diagnosed until later
in infancy or childhood. Symptoms may include failure to pass meconium or to pass a
first stool within 24-48 hours of birth, abdominal distension, constipation, and
vomiting, explosive watery stool. Surgery removes the affected part of the bowel, the
child may require a temporary colostomy before the bowel is rejoined.
Diaphragmatic Hernia
The diaphragm is a curved muscle that separates the contents of the chest from the
abdomen. Diaphragmatic hernias occur when the diaphragm does not form
completely, leaving a hole. The hole can be on either side but in most children it is on
the left side. This allows part of the intestine to develop in the chest, which can squash
the lungs, and stop them developing before birth. They are more common in boys than
girls and inevitably require treatment for repair under general anaesthetic.
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Spina Bifida
The condition covers a range of degrees of severity, it is defect of the brain and spinal
cord where bones of the spine do not form completely and the spinal canal is
incomplete, allowing spinal cord and it’s membrane to protrude-myelomeningcele.
Spina bifida occulta is where spinal bones do not close, the spinal cord and meninges
remain in place and skin usually covers the defect. Meningocele is where the spinal
cord remains in place and the meninges protrude through the defect. The position and
severity may affect the bladder and bowel control and there may be lack of sensation
or paralysis in the lower limbs. Surgical repair may be necessary.
Cloacal Anomalies
Cloacal anomalies encompass a wide array of complicated defects that occur during
development of the female foetus during pregnancy. Normally, the reproductive,
gastrointestinal and urinary tracts merge to drain out of one common channel. But if
this place where they come together is low, a child has no visible anus, even though
the remaining anatomy appears normal. In these patients urinary tract obstructions are
unusual because the tract typically opens into a wide common channel that drains
freely. If the coming together of these structures is high, then the common channel is
long and urinary tract infections are common. The clitoris looks like a penis, causing
gender confusion. Cloacal related anomalies can also result in multiple vaginas, a
malformed anus and other defects of the upper urinary tract and kidneys. Cloacal
anomalies require surgical repair.
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Kidney operations
Nephrectomy
This is the surgical removal of a kidney that is not working or diseased. The kidney is
removed through an incision, made over the kidney area.
Ureterectomy
This is the surgical removal of the ureter that drains the urine from the kidney into the
bladder.
Nephroureterectomy
This is the surgical removal of both the kidney and the ureter.
Pyelolithotomy
This is a surgical removal of stones in the kidney.
Nephrostomy.
This is an opening into the kidney; a tube is inserted to drain of accumulated urine
from around the kidney.
Pyeloplasty.
In this operation, the outlet of the kidney is refashioned in an attempt to make it drain
more efficiently
Mitrofanoff
This operation is performed on children who are unable to pass urine due to some
mechanical problem e.g., Spina bifida.
The appendix is used to make a tract in through the abdomen and into the bladder.
The children will learn how to catheterise themselves regularly throughout the day.
This operation helps to eliminate incontinence in these children.
Cystoscopy
This is a procedure where a scope is passed in through the urethra to investigate the
bladder.
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Other operations
Gastrostomy.
A gastrostomy is usually performed on children who are either unable to take food
orally or who need supplementary feeding e.g. Overnight feeds, directly into the
stomach.
The procedure involves an opening in through the abdominal wall into the stomach. A
gastrostomy tube is passed into the stomach through the opening and left in situ for
eight weeks until the hole becomes semi permanent. The initial tube is then replaced
in theatre with a gastrostomy tube that can be changed on the ward as required,
without anaesthetic.
Tracheostomy.
This is an operation that is required to assist the child in breathing. If for some reason
the trachea is not patent, an incision is made surgically into the trachea and a
Tracheostomy tube is put into the hole. This tube allows air to enter the lungs,
bypassing the obstruction. A Tracheostomy can be either temporary or permanent.
Depending on the reason for needing it.
Thyroidectomy
This operation is the removal of the thyroid gland in the neck. It is usually required
for an over active thyroid gland which produces excessive amounts of thyroxin or a
swollen thyroid gland which presses on the neck, or is unsightly. The patient who has
their thyroid gland removed will need to take oral thyroxin for the rest of their life.
Splenectomy.
This is the surgical removal of a spleen that is either damaged or for a child with
sickle cell anaemia. The job of the spleen is to break down any damaged red blood
cells ready for the bone marrow to produce healthy ones to take their place. A child
with sickle cell anaemia produces sickle shaped red blood cells, which the body sees
as, damaged cells, therefore it breaks them down at a rate too fast for the bone marrow
to keep up with. The Splenectomy solves this problem and the liver takes over the job
to a lesser degree.
Oesophageal Atresia
In oesophageal atresia, the baby is born with a pouch at the top of its oesophagus
which prevents food from reaching the stomach. Prior to surgery, this pouch can fill
up with food and saliva which can eventually overflow into the baby’s trachea,
entering the lungs and causing choking.
Tracheo-Oesophageal Fistula
In trachea-oesophageal fistula, the bottom end of the baby’s oesophagus is joined to
the trachea. Without surgical intervention, this causes air to pass from the trachea to
the oesophagus and stomach. It can also allow stomach acid to pass to the lungs.
Tracheo-oesophageal atresia and oesophageal atresia are rare congenital conditions
that affect one in every 3,500 babies. They need intensive neo- natal care prior to
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corrective surgery, normally within days of birth. Whilst many children born with
TOF/OA will experience only a few problems, others may have difficulty with
swallowing and digesting food, gastro oesophageal reflux and respiratory problems.
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Day surgery
Circumcision
This is an operation to remove surgically, the foreskin for either medical reasons or
religious practice.
Herniotomy
This is an operation to repair a weakening in the muscle of the abdomen through
which the organ beneath it protrudes and causes pain.
Orchidopexy
This is an operation to ‘bring down’ one or both of the testes which have not
descended into the scrotum. If left in the abdomen the child may become infertile or
the testes may become malignant.
Orchidectomy.
This is the removal of a testis that is either necrotic or damaged in some way.
Hydrocelectomy.
This operation is required for a boy whose testicle is swollen, filled with fluid. The
fluid is from a patent channel that connects the peritoneum with the testes, usually in
combination with a hernia. When standing, peritoneal fluid drains into the testes
causing the swelling. The repair is that of an inguinal hernia where the weakening has
been caused when the testes descended into the scrotum in utero.
Hypospadias
Hypospadias is where the urethral opening is found down the shaft of the penis. This
results in spraying, when passing urine and may cause complications when older, on
ejaculation.
This operation is required, sometime in stages, to move the urethral opening to the tip
of the penis.
27

STUDENT NURSE INDUCTION CHECKLIST
NAME: START DATE:
STUDENT INTAKE
This programme is a guide to assessors to aid the integration of student nurses into the
working environment. It is good practice to have the document completed within the
first week of the placement.
Student nurses must be allocated a mentor at least one week before the
commencement of the placement. At this time, the students shifts will be given to be
the same as the mentors shifts to allow the first day of placement to be together. NB.
It must be remembered that the student must work 50% of the week with her/his
mentor.
Student Induction
To be completed within First week of Placement
Orientation to Placement Signature of
Mentor
Introduction to Departmental Colleagues and key people
Start finish times etc
Access to changing, toilet, restaurant and library facilities
Break times, dress code etc
Explanation of Telephone facilities
and lines of communication
What to do if sick
Check wearing ID Badge and accessed IT from Trust
Induction
Discuss the importance of confidentiality and IT security
Explanation of patient call and emergency buzzer system
Share emergency contact details for student
( this needs to be destroyed at end of placement)
Policies and Procedures
Be made aware of how to access all policies and procedures
Local, Professional and Organisational.
Be aware of how to report accidents / incidents
Care of personal property and Patient property
Be aware of how to contact security and report security
incidents
28
Signature of
Mentor
Date
Date
Fire Signature of Date

Ensure have completed annual online update.
Date completed:
Identify location and how to use
extinguishers and alarms on placement
Describe action to be taken on hearing fire alarm.
Meeting point / evacuation process etc
Emergency / Cardiac Arrest Procedure
Identify the location of resuscitation equipment
Describe method of summoning relevant arrest team
Health and Safety
Disposal of waste – Student can identify correct procedure
for disposal of:
Clinical waste
Non Clinical waste
Infectious waste
Body Fluids
Sharps
Confidential waste
Manual Handling –Student should be made aware of
equipment used and its decontamination ( Types can be
listed below eg Arjo hoist )
Electronic Beds
Food Hygiene – Student should be able to demonstrate
knowledge in the safe handling and storage of food and
refrigerator care.
Infection Control – Students should be aware of how to
access infection control policies
Hand Hygiene technique Gel, Soap and water
5 Moments of Care
Saving Lives documentation
Bed Cleaning Procedure
Commode Cleaning Procedure
How to use bed pan disposal unit
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Mentor
Signature of
Mentor
Signature of
Mentor
Signature of
Mentor
Date
Date
Date

Placement specific Signature of
Mentor
GETTING TO KNOW THE WARD
Dear Student,
Once you have been shown around the ward, please complete this questionnaire and
hand it to your mentor.
30
Date
Ward 9
FIRE SAFETY
a) What is the fire alarm telephone number? _________ _________
Where is it written? _________ _________
b) Name 3 fire exit routes _________ _________
_________ _________
_________ _________
c) Identify 2 types of fire extinguisher _________ _________
_________ _________
d) When would you use Type 1? _________ _________
Type 2? _________ _________
e) Where would you find Type 1? _________ _________
Type 2? _________ _________
f) How would you know there was a fire in your area? _________ _________
1. CARDIAC ARREST
a) What is the cardiac arrest telephone number? _________ _________
Where is it written? _________ _________

) State the position of the Cardiac Arrest trolley. _________ _________
c) Find and test the bedside oxygen masks and suction apparatus.
d) Arrange with your mentor to explain the cardiac arrest procedure.
2. PATIENTS
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_________ ________
a) Identify patients on the bed location board _________ _________
b) Identify named nurse ______ _________
_________ _________
c) Identify position of patient’s nursing care plans _________ _________
Medical notes/X-Rays _________ _________
Theatre lists _________ _________
Patients’ notes for theatre _________ _________
d) Where would you find the patient’s nil by mouth times? _________ _________
3. STAFF
a) Identify mentor, associate mentor and other members of the ward team.
_________ _________
b) Identify position of on duty rota _________ _________
Off duty request book _________ _________
c) Introduce yourself to 1) ward clerk _________ _________
They will help you a lot.
4. WARD ENVIRONMENT
2) Ward domestic _________ _________
a) Identify the position of dirty utility room _________ _________
b) Identify the clean utility room _________ _________
c) Identify the position of the drug cupboard _________ _________
d) Identify position of and specimen tray
_________ _________
e) Identify position of ward textbooks _________ _________

Policy statements _________ ________
Recent article files _________ _________
If you have had any difficulty in completing this questionnaire, please discuss this
with your mentor.
32

GPs
Social Services
District Hospital
Parents/Carers
Occupational Therapist
Child Protection
Chaplaincy
PICU/Ward 12
Play specialist
Pain Team
Social Worker
Pharmacy
UNN
Out Patients
Ward 9
33
Tissue Viability Nurse
Ward 6
Paediatric Stoma and Continence Advisors
School/College/University
Physiotherapist
Dietician
Paediatric Community Nurses
Teachers
Radiology
Theatre
School Nurse
District Nurse
Health Visitor

NOTES
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