Shortened placement handbook updated sept 2011

Community Placement for Adult
Branch Nursing Students

2011/2012

Revised September 2011 AH

Community Preparation Handbook (Adult Branch) 2010/11

Primary Health Care

Primary care describes community based health services that are usually the first, and
often the only, point of contact that patients make with the health service. It covers services
provided by family doctors (GPs), community and practice nurses, community therapists
(such as physiotherapists and occupational therapists), community pharmacists,
optometrists, dentists and midwives (DH, 2010, http://www.dh.gov.uk).

From next year General Practice will take the lead role in commissioning the majority of
care for patient. In the White Paper, Equity and Excellence: Liberating the NHS (DH, 2010)
the PCTs (in England) will pass their provider and commissioning roles over to collective
groups of GP practices, known as consortia. It is expected that nurses will be represented
within the consortia.

The community services, that you as students in the community setting may be involved
with, will need to work closely with their consortiums to ensure that capability and capacity
are all recognised and that a partnership approach to decision making is fostered.

Many people, living in the community, have multiple chronic health problems that we
classify as long term conditions. They may, for example, suffer with rheumatoid arthritis,
urinary incontinence and hypertension. They may receive care from many different services
such as the GP, the rheumatologist, the pain control clinic, physiotherapy, continence
specialist nurse, dietician and the hypertension nurse. To co-ordinate these complex needs
a case management approach has been developed in the community supported by case
managers and community matrons. On your placement explore who is caring for patients
with multiple needs, who is coordinating their care and how does this approach benefit the
patient.

As students you will notice a difference in the way that health and social care staff promote
self management and partnership working in the community. This approach supports the
concept of the individual and their right to autonomy. It is also bourn out of necessity with
primary health services providing the majority of health care and caring for increasingly
complex needs. Remember self-care does not mean ‘no care’, but rather supporting people
to know when to contact the health services and ask for help and when they should
manage their own health needs. For example, a person troubled by a cough for 3 days
should self-care but if that cough persists for 3 weeks they should seek advice.

What services provide care in the community

Health care that provided in the community is from many diverse professionals, agencies
and independent sector workers.

In your placement you may meet or liaise with general practitioners, community matrons,
practice nurses, school nurses, physiotherapists, speech therapists, dentists, opticians,
pharmacists and many more.
You may be in contact with NHS walk-in centres, NHS Direct and community based minor
surgery clinics. You may learn more about community based screening or keeping healthy
initiatives such as run4life.

Community Preparation Handbook (Adult Branch) 2010/11

As you familiarise yourself with your clinical area consider how the patient or individual
accesses services, how integrated you find community care and the ways in which needs
are met.

Community (or district) nurses
Community nurses are responsible for nursing people in their homes or other community
settings such as clinics, health centres or residential care homes. They commonly provide
care for patients with chronic diseases such as diabetes or multiple sclerosis or patients
with palliative care needs, also patients who require continuing care following discharge
from hospital. Community nurses are employed by primary care trusts and are normally
based in local clinics or health centres.

Practice nurses
Practice nurses are responsible for providing clinical nursing care in general practitioners’
surgeries but their role also includes responsibility for health promotion and the
management of long term conditions. They may run clinics for patients with long term
conditions such as asthma, diabetes, chronic obstructive airways disease and hypertension
and clinics designed to reduce the prevalence of coronary heart disease, cigarette smoking
and obesity. Other clinics managed by practice nurses include well man clinics, family
planning and cervical cytology clinics.

Palliative care
Palliative care nurses are specialist practitioners who provide advice and support to
patients with palliative care needs often, but not exclusively, related to cancer. They may
also provide pain control and support to non-cancer patients with complex conditions such
as motor neurone disease or end stage multiple sclerosis.

Community matrons
Community matrons are experienced, skilled nurses who case manage patients in need of
highly intensity health and social care. With special intensive help, these patients are able
to remain at home longer and to have more choice about their health care.

Sexual health clinic
Sexual health clinics provide comprehensive open access sexual health and HIV care. As a
matter of policy, local sexual health clinics will see all urgent cases on the day of
presentation to the clinic. Sexual health services are confidential and this confidentiality
extends to patients under the age of 16. Generally clinic staff would only consider passing
on information about a patient if it might protect the patient or someone else from harm.

You will be allocated a mentor and possibly also a co-mentor during your community
placement. You will have plenty of opportunity to work with either your mentor or
another member of the team.
It is your responsibility to ensure that the Practice Learning Document is completed. For all
placements it is essential that the learning opportunities are explored with your mentor

Community Preparation Handbook (Adult Branch) 2010/11 3

during the first few days. These learning opportunities can then married with your own
learning needs and turned into learning objectives.

Some placements will be four weeks. You should ensure that your mentor is clear about
this and plan your placement experience and the timings of your assessment accordingly.
Do speak with your mentor and negotiate a time for the mid-way and the final assessment
to happen. This is especially important on a four week placement when time can soon run
out.

If you experience any problems with the placement then remember there are link lecturers,
from the University, who can support you. Their details should be displayed in each clinic.

Attendance
The team leaders will submit a record of attendance each week, to the University

Absence
You should ensure that both the clinical placement and the placement office her aware of
your absence. It may not always be possible to make up the time you have been absent. All
queries should be referred to the link lecturer.

Final placement students
Middlesex University students with a special interest in developing their skills in the
community setting will be offered the chance to undertake their final placement in one of the
community placement areas.
You will need to be assigned a ‘sign-off mentor’. That is, an experienced mentor who has
gained further experience in mentoring final placement students, as stipulated by the NMC
(www.nmc-uk.org).
.

Learning Opportunities/Objectives for Pre-Registration Students in Sexual Health
Placements

Please note

STUDENTS ARE ISSUED WITH A SEXUAL HEALTH PLACEMENT WORKBOOK AT
THE START OF THEIR ALLOCATION WHICH THEY ARE EXPECTED TO COMPLETE
UNDER THE SUPERVISION OF THEIR MENTOR. Completion of this workbook is
mandatory in order to complete the placement.

1. The organisation of a sexual health clinic including meeting the needs of the different
types of clients accessing these services e.g. gay men, adolescents

2. How the roles of the members of the multi-disciplinary team within this setting work
together to provide a holistic service

3. Understand the principles of partner notification

4. Assisting in clinical procedures, specific to area, e.g. cryocautery


5. Instruction and supervision in specialised techniques such as speculum insertion,
specimen collection, slide preparation, staining and phlebotomy; depending on
specific placement

6. The range of Sexually Transmitted Infections (STIs) including symptoms, treatment
and follow-up

7. The importance of confidentiality and communication skills

8. Assessments including sexual history taking undertaken within this setting

9. Health and safety procedures appropriate to a sexual health clinic including handling
and disposal of infected or potentially infected material

Learning opportunities for pre-registration students in practice nursing
placements

1. The day to day organisation of a general medical practice.

2. The roles of the members of the multi-disciplinary team in general practice. This
team usually consists of the general practitioners and practice staff including
practice manager, receptionists and practice nurses. Employees of the primary
care trust such as district nurses, practice nurses and healthcare assistants may
also be attached to one or more practices.

3. The organisation of a treatment room.

4. Clinical procedures carried out by the practice nurses. These procedures are
likely to include wound management, blood pressure monitoring, ear care,
immunisations, urine testing and blood glucose monitoring.

5. Carry out selected clinical procedures under supervision.

6. Health and safety precautions including clinical waste disposal, moving and
handing and personal safety.

7. Instrument sterilisation and storage.

8. Policies and clinical guidelines.

9. Screening for diseases.

10. The management of long-term conditions.

11. Health promotion clinics.

12. Patient referral processes to both health and social care organisations.


13. The work of health care professionals who may visit the practice or undertake
clinics there. These may include district nurses, palliative care nurses, diabetes
nurse specialists, physiotherapists and specialist community public health nurses
(also known as health visitors).

Learning opportunities for pre-registration students placed with specialist
community public health nurses (also known as health visitors)

1. The role of the specialist community public health nurse.

2. Multi-disciplinary teamwork in child protection.

3. Child and parental mental health needs and healthy relationships.

4. Social and environmental influences on health.

5. The health needs of diverse populations.

6. Teenage pregnancy and single parenthood.

7. Health needs associated with low income, social and geographical dislocation
and homelessness.

8. Child development.

9. Monitoring child development through developmental checks.

10. Promoting child health through immunisation, and family health education.

11. Principles of caseload management.

12. The role of the health visitor in promoting community health and wellbeing.

13. Policies and guidelines relating to health and safety for community staff,
particularly about “lone working” and aggressive behaviour.

14. Working relationships especially those with midwifery and school health services.

Learning opportunities for pre-registration students in community nursing
placements

1. Nursing assessment, care planning and nursing care carried out in the home
environment.

2. The implications of providing nursing care as a guest in the patient’s home.


3. The safe adaptation of nursing procedures, including wound care, catheterisation,
gastrostomy management to the home environment. The support of patients with
long-term catheters.

4. Clinical skills such as ear care and phlebotomy.

5. Infection control.

6. The organisation of a community nursing team, caseload management and
prioritisation of care needs.

7. Relationship with general practitioners and their staff.

8. The work of other health and social care organisations.

9. Referral criteria to the community nursing service; referral process and internal
referrals, for example to twilight, night or out of hours services.

10. Links between primary and secondary care, particularly in relation to discharge
planning.

11. The assessment, management and organisation of care for patients with complex
care needs due to acute or long term conditions.

12. The care and management of patients with specific long term conditions such as
multiple sclerosis, diabetes, hypertension and chronic obstructive pulmonary
disease (COPD).

13. The supply of nursing equipment such as pressure relieving equipment, hoists
and commodes.

particularly about “lone working”, moving and handling, disposal of clinical waste
and sharps and aggressive behaviour.

Learning opportunities for pre-registration students in palliative care nursing
teams

1. The management and organisation of a palliative care team.

2. The role of the nurse in the palliative care team.

3. The principles of Inter-disciplinary care in the management of multiple complex
symptoms.

4. Communication skills and emotional support in challenging interactions with
patients, families and carers.


5. Principles of assessment of pain and other symptoms.

6. Symptom control and treatment of concurrent conditions.

7. Observation of patients and families experiencing terminal illness.

8. How health care professionals in palliative care cope with the demands of their
work.

9. Clinical supervision.

10. The role of members of the palliative care team as educators and promoters of
good practice.

particularly about “lone working”, moving and handling, disposal of clinical waste
and sharps and aggressive behaviour.

Guidance on home visiting
If you are placed with a community nursing team you will have the opportunity to visit
patients on your own after a suitable induction to the team, the patients and the locality.
You may visit patients on your own, provided the following rules are followed:

1. Your supervising nurse must assess your abilities and be confident that the
proposed visits are within your capabilities.

2. Your supervising nurse must accept that she/he remains professionally
accountable for the nursing care you deliver.

3. Your supervising nurse must ensure that you fully understand the care plan and
the care that may be required.

4. The number of daily visits should be negotiated between you and your mentor.

5. You should not visit any patient alone more than twice in succession.

6. Effective communication arrangements for use in emergencies should exist and
you should be informed of them.

7. You should not carry out procedures for which you have not received adequate
training.

8. You should ensure that your mentor or other responsible team member is aware
of your daily call list and planned route.

Guidance on practice nursing
You may see patients on your own in clinics provided the following rules are followed:

1. Your supervising nurse must assess your abilities and be confident that the
proposed consultations are within your capabilities.


2. Your supervising nurse must accept that she/he remains professionally
accountable for the nursing care you deliver.

3. Your supervising nurse must ensure that you fully understand the patients’ needs
and the interventions that may be required.

4. You must have immediate access to a qualified nurse at all times and should
share clinic lists with a qualified nurse.

5. You should not see any patient alone more than twice in succession.

6. You should be told of emergency procedures.

7. You may not carry out cervical smears.

8. You should ensure that you do not carry out procedures for which you have not
received adequate training.

9. You may not give internal medicines unless directly supervised by a qualified
nurse.

10. You may administer eye drops or apply wound care products, skin preparations
and glycerine suppositories provided that you have been briefed on their use.

Guidance on medicine administration in the home
1. You may not fill Dosette™ or similar medicine containers.

2. You may not give medicines of any kind by mouth or injection unless directly
supervised by a qualified nurse.

3. You may administer eye drops, apply wound care products, skin preparations
and glycerine suppositories provided that you have been briefed on their use.

4. During your placement you will have the opportunity to observe different methods
of supplying and administrating medicines. Whilst you must never give
medication unsupervised, you will have the opportunity to administer a variety of
medications under direct supervision of your mentor. You should note the
different prescribing and supply strategies available, including clinical
management plans (supplementary prescribing), patient group directions (note: a
PGD can not have their administration delegated) and conventional prescriptions
(FP10s). It is important that you are aware of the legal and professional issues
inherent in all aspects of medicine management and you should refer to the
following document for in depth advice :

NMC (updated 2010) Standards for Medicines Management, at
http://www.nmc-
uk.org/Documents/Standards/nmcStandardsForMedicinesManagementBooklet.pdf


Checklist for community placements
Some items in this checklist apply to all kinds of community placement. Some items only
apply to home visiting. It is not exhaustive and if you think you have something useful to
add to it please send an email to Alison Harris at a.x.harris@mdx.ac.uk.

1. Contact your placement well in advance and check arrival time. The best times to
telephone community nurses are generally between 08.30 and 09.00 and after
2.30pm. If a member of the nursing team is not available when you ring leave a
message and your contact details.

2. Ask whether you need to wear a uniform. Not all community nurses wear
uniforms. If uniforms are not worn find out what kind of clothing is appropriate.
When in your own clothing ensure it is appropriate to the role and job i.e no false
nails, stud earrings and wedding rings only (no other jewellery), modest and
clean clothing and hair is clean and tied back.

3. Check where you are to meet your mentor/member of staff on the first day.
Timekeeping is essential part of your professional conduct and you will be
assessed for your punctuality and time management. Turn up in the morning on
time and ensure you are back at clinic at the stipulated time.

4. On the first day check your route to your placement area. Be sure you know
which tube or bus stop to get off at. If travelling by car, check if you are able to
park.

5. If you have a car you may choose to use it to get to your placement. You are
strongly advised NOT to use your car for undertaking visits to patients. Your
insurance may not cover you if you use your car for anything that could be
interpreted as work.

6. You may claim expenses for journeys between patients. A claim form can be
obtained from the University Student Offices.
a. Travel expenses - You may be able to claim a refund of travel costs to and
from your placement. To do this, get a travel claim form from the Student
Office or from Steve Wells in the Cash Office. Tel: 020 8411 6634.

7. Wear your name badge and student ID card. Get into the habit of showing them
to patients without being asked.

8. Wear comfortable shoes. In some areas most visits are done on foot, as parking
is not possible. In other areas you may find that parking spaces are located at
some distance from your destination.

9. Take a waterproof coat or jacket and umbrella. If you get wet you will be
uncomfortable all day. You will also give a bad impression if you turn up at
someone’s door wet through.

10. If you are frightened of dogs let your mentor know. Patients are usually obliging
and will put the dog in another room.


11. On your first day take a packed lunch with you as there may not be a convenient
place to purchase lunch – many clinics and health centres are in residential
areas.

12. If you have a mobile phone, turn it off when doing visits or clinics.

13. Make sure that you always carry the contact number of the clinic or health centre
with you. Often your mentor will have a mobile phone or bleep number. Make a
note of these as well. You may wish to give your mentor your own mobile phone
number in case s/he needs to contact you while you are on your rounds.

14. If you are sick or are going to be late always contact the clinic as well as the
placement office and inform both of them when you are well enough to return. If
you have to take time off from the placement for any reason you will have to
make up the time. It is best to do this during the placement, with the agreement of
your mentor. If this is not possible you must contact the placement office and they
will arrange for the time to be made up.

15. When you do unaccompanied visits always make sure that your mentor,
associate mentor, or designated deputy knows your call list, your intended route
and the likely time of your return to the clinic or health centre.

16. On your first day you should have an orientation tour of the clinic or health centre
including fire exists, emergency arrangements etc. Some buildings have number
coded security locks on internal doors. Make sure you know what they are and
make sure that you do not disclose them to anyone. Clinics and health centres
are public places so do not leave valuables unattended.

17. You are expected to attend your placement on any Bank Holiday and University
closure days that may occur during the allocated period. You are not entitled to
any time off from your placement for submission of assignments, meetings with
tutors or similar reasons.

18. At the end of your placement make sure that you complete one of the evaluation
forms that are held in every clinic and health centre. These forms are used during
the annual placement quality review which is carried out by University and Trust
staff.

19. All placement areas have University link teachers who are responsible for dealing
with problems arising during the placement. These problems may be educational,
related to patient care or arise from difficulties within the nursing team. A
laminated notice with the link teacher’s contact details should be prominently
visible on the placement notice board.

20. As with all other placements you will be expected to present your practice
learning document to your mentor as soon after your arrival as possible and
agree on your learning needs in relation to the available learning experiences.
The intermediate and final meetings with your mentor must also take place in
accordance with the University requirements. Note that your learning needs
should be determined by the nature of the placement, for example learning needs
connected with wound management should take account of the fact that wound


management in the community setting differs in important ways from wound
management in the hospital. Your mentor will advise.

21. You may have a “hub and spoke” placement where your mentor may arrange for
you to spend periods of time with other services while remaining under your
mentor’s general supervision. If you are in this position you will need to obtain
from your mentor some additional record sheets for your practice learning
document.

Link teacher contact details

Camden PCT

Kate Brown Archway Campus
Institutional Link 020 8411 6930
k.brown@mdx.ac.uk

Carol Lincoln Archway Campus
020 8411 5961
c.lincoln@mdx.ac.uk

Haringey PCT
Catrina Donegan Archway Campus
c.donegan@mdx.ac.uk

Alison Harris Archway Campus
020 8411 4681
a.x.harris@mdx.ac.uk

Jennie Bradford Archway Campus
020 8411 6708
j.bradford@mdx.ac.uk

Enfield PCT

Venetia Brown Archway Campus
v.brown@mdx.ac.uk


Shortened placement handbook updated sept 2011

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Shortened placement handbook updated sept 2011