2 Medical placements
Introduction
The previous chapter has explored what medical nursing is and its principles, however this chapter aims to develop your understanding of what a medical placement is and what it might look like. During your pre-registration education and training you will spend 50% of your programme in placement learning, providing nursing care in a range of environments for patients with varying levels of dependency (Nursing and Midwifery Council (NMC) 2010). Many of you will experience medical placements as part of your programme of study to meet your learning outcomes specific to your field of practice. A placement should be a minimum of 4 continuous weeks of placement to meet the NMC Standards for assessment of learning but you may find that you have a placement base which facilitates a more ‘hub and spoke’ approach to learning. This approach can help you to ensure that you have a greater understanding of the patient journey within your area.
So, what is a medical placement? It could be any of the following:
Medical general, medical specialist and acute medical admissions wards
See the Guardian newspaper for a brief history of hospital wards:
http://www.guardian.co.uk/science/gallery/2009/apr/27/nhs-design?intcmp=239 (accessed July 2011).
Virtual ward
Virtual wards provide support in the community for people with complex medical and social needs and are now being introduced across many areas of the UK. People are cared for by a team of staff as they would be in hospital, however there is no physical building. The virtual ward aims to provide multidisciplinary case management and prevent admission to secondary care (acute hospital wards) and to enhance communication for all those involved in the care. The patient is at the centre of the care. There are different models for virtual wards with some being nurse led and others GP led. Doctors and the virtual ward team will agree who should be admitted to the virtual ward and risk assessments will be undertaken (Lewis 2010).
Intermediate care
Intermediate care is a term to represent a range of services, including integrated health and/or social care, which is agreed by the team to help patients recover more speedily from their illness. The aim of intermediate care is also to prevent readmission to hospital, prevent admission to residential care and to help patients to live as independently as possible (Department of Health 2010). The intermediate care service is normally time limited to 6 weeks and care is provided by a multidisciplinary team. The service aims to help patients to regain their confidence and has an active focus on therapy, recovery and rehabilitation. The service targets patients that may face long hospital stays. There are several examples of intermediate care: community hospitals, hospital at home schemes, rapid response teams, outreach teams, nurse-led units and day hospitals. An example of one of these teams is the respiratory early discharge service which is made up of nurse-led teams who liaise with the community matron. They provide holistic care for the patient with long-term respiratory conditions and will often come into a medical ward to assess a patient to determine whether they could care for them holistically at home and shorten their length of stay within the acute hospital ward. The team also provides health education to the patient at home and liaises with other support agencies.
The aim of the virtual ward and intermediate care is to help patients who have often required a high-intensity use of healthcare services to remain at home longer and to have more choice about their health care. The NHS Improvement Plan (Department of Health 2004) described a new clinical role of community matron and is central to the government’s policy for the management of people with long-term conditions.