Acute placement settings

Examples

Emergency care 

Such as emergency department and medical / surgical or orthopaedic admonitions.

A placement in an emergency area, other areas involves priority treatment for possible life threatening illness / injury, although you will observe the staff dealing with emergencies daily, this setting is also where you can enhance observation and assessment skills. Using the tools available to assess a patient’s status and then the handing over of that information in an appropriate manner to other health care professionals. As with many other clinical areas, you could be involved with an emergency one minute, and sitting quietly holding a patient’s hand the next.

Skills that can developed in this placement setting include:

• ABCDE assessment tools 
  
• History taking
  
• Vital signs, concise levels, pain assessment
  
• Communication 
  
• SBAR systematic handover
  
• Pain and nausea control

Planned/urgent surgery

Such as general or specialist such as orthopaedics, neurosurgery, or vascular. 

• Skills that can developed in this placement setting include:
  
• Pre-operative assessments and preparation
  
• Post-operative assessments vital signs A-E assessment clinical decision making and reporting and specific post-operative care
  
• Recognising post-operative complications and early warning systems
  
• Communication, information giving and health promotion
  
• Discharge planning
  
• Medicines management, pain management
  

Medicine

Such as cardiac, respiratory, renal, rehabilitation, gastro-intestinal.

Medical Units cover a multitude of conditions and cater for long term conditions, patients undergoing investigations and awaiting diagnosis, ongoing treatments and addictive conditions. Allocation to a specialist area will provide you with in-depth understanding of that specialism. There will be scope to develop your understanding of how conditions can manifest, what behaviours can contribute to changes in lifestyle and the various methods of treatment.

Skills that can developed in this placement setting include:

• Symptom awareness
  
• Trigger and coping mechanisms
  
• Understanding of laboratory results
  
• Medications for specific illnesses
  
• Holistic care for the individual
  
• Nutrition / hydration / elimination needs
  
• Care planning / onward care
  
• Vital signs / assessment

Specialist Nurses

Such as heart failure, stroke care, infection control, diabetic, research, oncology, haematology.

Specialist nursing teams provide specialist advisory care to clinical areas and patients many of them are consultant nurses with advanced skills in their field. Many of them lead nursing services, run clinics and hold a caseload of patients that they may see as outpatients as well as referrals of new clinical cases. Some teams work as speciality advisors such as infection control team. In the hospital environment they will teach and advise staff across all care settings. In addition, an insight in to telehealth and telemedicine.

Skills that can developed in this placement setting include:

• Deeper understanding of the pathophysiology, life impact and long term condition management
  
• Communication skills
  
• History taking advance care planning,
  
• Facilitating self-care management and health promotion
  
• Medicines management and shared decision making

High Dependency

Such as theatres, coronary care, critical care.

High dependency areas are for patients requiring more close observation than would be available on a ward. This could be in a dedicated unit or in an area designated for this care temporarily. Once again, assessment skills are paramount in this setting and learning will be enhanced of all assessment tools and frameworks to augment clinical decision making. Looking after unstable patients requires more observation and that entails a high staff to patient ratio.

Skills that can developed in this placement setting include:

• Vital signs
  
• ABCDE assessment
  
• Recognition of a deteriorating patient
  
• Documentation of relevant pathways (i.e. Sepsis / Pain / Fluid Balance)
  
• MDT communication and interprofessional working 
  
• SBAR / handover to other staff
  
• Pain and nausea control

Theatre and recovery 

These placements normally allow you to experience both environments emphasis will be focused on surgical interventions and post-surgery protocols. There should be ample opportunity to observe surgery, with local, spinal and general anaesthesia. Pain and nausea control are priorities in the recovery setting and of course patients come for surgery with varying levels of fitness, so existing conditions need consideration making assessment the major skill in this setting.

Skills that can developed in this placement setting include:

• Knowledge of the anatomy
  
• Use of anaesthesia and pain control
  
• Vital sign assessment
  
• Use of various monitoring tools such as ABCDE
  
• Post-operative recovery assessment and monitoring
  
• Interprofessional communication

Interface

Such as X-Ray / radiology, day unit or ambulatory care, where patients attend for short periods for consultations, investigations and interventions.

There will be opportunity to gain understanding of the nature of the investigations or test – apply concepts of pathophysiology.

Skills that will be developed in this placement include: 

• Vital sign assessment
  
• Use of various monitoring tools such as ABCDE
  
• Understanding and developing empathetic communication skills around patients 
  
• Understanding and interpretation of prospective prognosis and potential life impact.