Introduction

This chapter aims to give you a basis on which to begin to build your learning outcomes for a medical placement. It will help you to start to understand the role of the nurse in medicine and the other key professionals involved. It is also an opportunity to ensure that your knowledge of medical conditions is up to date in preparation for the many varied and exciting opportunities that await you in your medical placement.

Reflections of a newly qualified nurse

Working on a medical ward, no one day is the same. There is not one set ‘type’ of patient that we look after, and although the medical ward on which I work is meant to be a respiratory medical ward, there is a huge and varied range of conditions and illnesses that we treat. When coming on duty, there is always the anticipation of not knowing what patients I will be looking after, what skills I will need to look after them and overall what my day will be bringing.

Caring for patients with a variety of illnesses, some of which can be acutely ill having come straight from A&E or ITU, is challenging, interesting and rewarding, and continuously develops my nursing skills and knowledge.

Medicine and medical nursing

Medicine and medical nursing can be characterised by the non-invasive nature of its diagnostic investigations and treatments. Advancing technology in imaging techniques has meant that many conditions can be diagnosed by X-ray or scanning leading to prompt treatment and care. The ever increasing development of drug therapies has also meant that many previously untreatable acute and long-term conditions can now be cured or managed much more successfully. This has resulted in a better quality of life for many of those living with long-term conditions.

Activity

The following online resource follows the development of significant advances in medicine such as medical imaging, the discovery of penicillin, insulin and other drug therapies. Spend some time looking through the resources and developing your knowledge of what medicine is all about.

http://resources.schoolscience.co.uk/abpi/history/history10.html (accessed July 2011).

Who’s who on a medical placement

Nursing patients with medical conditions requires a team approach, therefore it is important that you begin to understand the roles of all the different professionals who may be involved in the care of the medical patient in your placement area. Table 1.1 explains some of the main healthcare professionals you will be working alongside. In order to complete your learning outcomes and competencies for your medical placement, you will need to work with a range of professionals and with different members of the nursing team in your placement area. This will not only ensure that you succeed in achieving your outcomes but will also ensure that you have a rounded and varied experience within your medical placement. The following quote from a third-year final placement student shows the benefit of working as part of a team:

When my mentor was away I would then work with any senior member of staff. This made me realise that there is a pool of knowledge in these qualified nurses. For one to get this knowledge, one needed to take initiative, be proactive and challenging. This also enabled me to be able to work in a multidisciplinary team which I found very interesting as we exchanged ideas.

Table 1.1 Who’s who on a medical placement

Matron	The matron will be a registered nurse with experience in the specialty for which they cover. They will usually have worked as a ward manager or senior sister previously. They have overall responsibility for a number of ward areas Department of Health – Modern matrons in the NHS – a progress report on the role of the modern matron: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4008127
Ward manager, senior sister, charge nurse	The ward manager/sister or charge nurse is a registered nurse with experience in the specialty of the ward. This person is in charge of the ward and you will be accountable to them during your placement. The ward manager is responsible for ensuring that the care delivered is of high quality and that the staffing and supplies are appropriate for the area. They will also be in charge of the shift when they are on duty The Nursing and Midwifery Council: http://www.nmc-uk.org/
Senior registered nurse, junior sister, senior staff nurse	A senior registered nurse or junior sister will deputise in the absence of the ward manager and will usually be in charge of the shift when they are on duty The Nursing and Midwifery Council: http://www.nmc-uk.org/
Registered nurse (RN), staff nurse	The RNs or staff nurses will make up most of the staffing establishment on the ward and will have varying levels of experience The Nursing and Midwifery Council: http://www.nmc-uk.org/
Healthcare assistant (HCA), healthcare support worker (HCSW)	HCAs/HCSWs are non-registered staff who support the RNs and provide basic care to patients. They may or may not have had any formal training NHS Careers Website detailing the role of the healthcare assistant: http://www.nhscareers.nhs.uk/details/Default.aspx?Id=485
Assistant practitioner	This is a relatively new role which requires the person to have completed a foundation degree or similar qualification. They are usually trained in a variety of clinical skills, e.g. cannulation and catheterisation, so that they can provide increased support to the RNs on the ward NHS Careers Website detailing the role of the assistant practitioner: http://www.nhscareers.nhs.uk/details/Default.aspx?Id=2030
Phlebotomist	The phlebotomist will usually attend the ward daily to take blood samples requested by doctors or nursing staff NHS Careers Website detailing the role of the phlebotomist: http://www.nhscareers.nhs.uk/details/Default.aspx?Id=252
Physiotherapist (physio/PT)	The physio may be attached to one ward or cover a number of areas. Nursing or medical staff will refer any patients to them for assessment and assistance with mobility, rehabilitation and respiratory problems The Chartered Society of Physiotherapy: http://www.csp.org.uk/
Occupational therapist (OT)	The OT will also usually cover a number of different ward areas. Their role is to maximise people’s independence through a variety of methods including adaptive equipment and home modification. Nursing and medical staff will refer patients to them for assessment of their needs while planning for discharge The British Association of Occupational Therapists: http://www.cot.co.uk/Homepage/
Speech and language therapist (SLT/SALT)	The SLT will cover a number of ward areas and will receive referrals from nursing or medical staff to assess patients who may be having problems with swallowing or communication difficulties The Royal College of Speech and Language Therapists: http://www.rcslt.org/
Ward clerk/ward receptionist	The ward clerk will be based on the ward and will usually be at a reception desk, nurses’ station or an office on the ward. They will be an invaluable source of information about anything, from knowing how to contact a member of the team to where things are kept on the ward. Their role varies but may include greeting visitors to the ward, answering telephone queries, requesting and maintaining patient notes while they are on the ward and general administrative duties NHS Careers Website explaining the role of the ward clerk: http://www.nhscareers.nhs.uk/details/Default.aspx?Id=782
Housekeeper	The ward housekeeper will be responsible for ensuring that the ward environment is kept clean and tidy (although a domestic team will also provide the cleaning). They may be responsible for ensuring that stock levels are maintained and that equipment is in good working order
Social worker (SW)	Social workers are usually allocated to individual patients but may be attached to a particular ward or area. Patients who may require support to look after themselves when they are discharged should be referred to the social worker for assessment The General Social Care Council: http://www.gscc.org.uk/
Clinical nurse specialists, e.g. tissue viability nurse, diabetes nurse specialist	A clinical nurse specialist is a registered nurse in a senior position who has developed their knowledge and skills within a particular clinical specialty to an advanced level The Nursing and Midwifery Council: http://www.nmc-uk.org/
Radiographer	A radiographer is a registered practitioner who produces images of different internal body parts using a range of techniques such as X-ray, computed tomography (CT) scanning and magnetic resonance imaging (MRI) scans The Society of Radiographers: http://www.sor.org/
Consultant physician	A consultant physician is a doctor with many years of experience and specialist knowledge and skills in a particular area of medicine, e.g. endocrinology or gastroenterology. They will have passed special exams (MRCP) to become a member of the Royal College of Physicians The Royal College of Physicians: http://www.rcplondon.ac.uk/

(All Websites last accessed July 2011)

Activity

Look at the resources alongside each profession in Table 1.1 to learn more about their roles, training and professional values.

Common medical health problems

Before you begin your medical placement it will be helpful to understand some of the common health problems patients on a medical ward may have. This will help you to know what to expect, understand some of the terminology used and have an insight into what your patient and their family/carers are experiencing. This section covers many of the common conditions you will come across and some of the basic information you will need to know.

Respiratory health problems

Activity

Begin by revising the normal anatomy and physiology of the respiratory system (see further reading list for a selection of physiology books to use).

Table 1.2 gives examples of some common respiratory health problems you may come across on your medical placement along with resources to help you learn more about each of them.

Table 1.2 Common respiratory health problems

Chronic obstructive pulmonary disease (COPD)	COPD is characterised by obstruction of airflow into the lungs. It is usually progressive and irreversible. It includes chronic bronchitis and emphysema. The main cause of COPD is smoking Chronic bronchitis is ‘inflammation of the bronchi’, resulting in increased mucus production obstructing the airways, producing phlegm and a cough Emphysema results from the alveoli in the lungs losing their elasticity causing them to narrow and obstruct the airways. Symptoms include shortness of breath National Institute for Health and Clinical Excellence (NICE) guideline – Chronic obstructive pulmonary disease: management of chronic obstructive pulmonary disease in adults in primary and secondary care: http://guidance.nice.org.uk/CG101/Guidance/pdf/English British Lung Foundation: http://www.lunguk.org British Thoracic Society: http://www.brit-thoracic.org.uk
Asthma	Asthma is a reversible obstructive disease of the lower airway, characterised by inflammation of the airways and increased mucus production. This can be caused by an internal trigger, e.g. stress, or an external trigger, e.g. pollen. Symptoms include wheezing, coughing, difficulty in breathing and chest tightness Asthma UK: http://www.asthma.org.uk
Tuberculosis (TB)	TB is a bacterial infection caused by Mycobacterium tuberculosis. Respiratory TB is the most common infection but it can affect other parts of the body. Symptoms of respiratory TB include fever, cough, night sweats, weight loss and blood-stained sputum NICE guideline – Clinical diagnosis and management of tuberculosis, and measures for its prevention and control: http://guidance.nice.org.uk/CG33/
Pneumonia	Pneumonia is inflammation of a part or all of one or both lungs, usually caused by infection NHS Choices information and video on pneumococcal disease and its effects: http://www.nhs.uk/conditions/pneumonia/Pages/Introduction.aspx NHS Choices information and patient story video on the experience of having pneumonia: http://www.nhs.uk/Conditions/Pneumonia/Pages/Symptoms.aspx

(All Websites last accessed July 2011)

Activity

Using the resources alongside each health problem and other resources of your own, find out the following for each health problem:

1. Common signs and symptoms.

2. Treatment and prognosis.

3. An example of how it feels for a person to have the problem (see the Website list at the end of the chapter for useful examples of patients sharing experiences).

Neurological health problems

Activity

Begin by revising the normal anatomy and physiology of the brain and central nervous system.

Table 1.3 lists some of the common neurological health problems you will come across in your medical placement along with resources to help you learn more about each of them.

Table 1.3 Common neurological health problems

Cerebral vascular accident (CVA) or stroke, transient ischaemic attack (TIA)	A stroke happens when the blood supply to a part of the brain is interrupted by either a clot (ischaemic stroke) or a bleed (haemorrhagic stroke) resulting in the brain cells in that part of the brain dying. Symptoms include weakness of one or more limbs, problems with speech and facial drooping. Stroke is a medical emergency A TIA is when the blood supply to a part of the brain is interrupted temporarily and the symptoms of the stroke resolve usually within minutes or hours. A TIA is an important warning sign that a person could be at risk of a stroke The Stroke Association: http://www.stroke.org.uk NICE guideline – Stroke, diagnosis and initial management of acute stroke & transient ischaemic attack: http://guidance.nice.org.uk/CG68/NICEGuidance/pdf/English NICE quality standards for stroke: http://www.nice.org.uk/guidance/qualitystandards/stroke/strokequalitystandard.jsp The National Stroke Strategy from the Department of Health: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_081062 NHS Choices Website: look at the videos to help you spot the signs of a stroke and hear the story of a stroke survivor: http://www.nhs.uk/NHSEngland/NSF/Pages/Nationalstrokestrategy.aspx
Multiple sclerosis (MS)	Multiple sclerosis is a chronic progressive disease characterised by the destruction of the myelin sheath which surrounds the peripheral nerves, affecting the ability of the nerve cells and brain to communicate with each other. Symptoms include dizziness, fatigue, visual problems, problems with balance, numbness, pins and needles, stiffness of muscles or muscle spasms, speech and swallowing problems The Multiple Sclerosis Society: http://www.mssociety.org.uk Department of Health – The national service framework for long-term conditions: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4105361 NICE guideline – Multiple sclerosis: management and treatment of multiple sclerosis in primary and secondary care: http://guidance.nice.org.uk/CG8/NICEGuidance/pdf/English NHS Choices Website information and a video about living with MS: http://www.nhs.uk/Conditions/Multiple-sclerosis/Pages/Living-with.aspx
Epilepsy	Epilepsy is a tendency to have recurrent seizures (fits) caused by a sudden burst of electrical activity within the brain disrupting the normal communication between brain cells Epilepsy Action: http://www.epilepsy.org.uk NICE guideline – The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care: http://guidance.nice.org.uk/CG20/NICEGuidance/pdf/English NHS Choices Website for information about epilepsy and a video of a person living with epilepsy: http://www.nhs.uk/conditions/Epilepsy/Pages/Introduction.aspx
Dementia	Dementia is a progressive syndrome characterised by memory loss, problems with thinking, judgement, understanding and language. There are many different types of dementia. The most common type of dementia in the UK is Alzheimer’s disease. The second most common type in the UK is vascular dementia The Alzheimer’s Disease Society: http://www.alzheimers.org.uk NICE guideline – Dementia: supporting people with dementia and their carers in health and social care: http://guidance.nice.org.uk/CG42/NICEGuidance/pdf/English NICE dementia quality standards: http://www.nice.org.uk/guidance/qualitystandards/dementia/dementiaqualitystandard.jsp Social Care Institute for Excellence Dementia Gateway: http://www.scie.org.uk/publications/dementia/index.asp The National Mental Health Development Unit: Let’s Respect resources: http://www.nmhdu.org.uk/our-work/mhep/later-life/lets-respect/