Adult nursing placement settings

Find out about the different settings for practice placements

To maximise the range of experience you will gain throughout your course we offer practice placements in a variety of settings including acute, community, GP practice and nursing home settings. Placements are based throughout the South West region and therefore you may need to live away from home during your placement. 

Acute placement settings

A practice placement within a hospital care setting will give you access to a wide range of inpatient, day case (interface) and outpatient (interface and community) care services. Most areas specialise or are part of a wider group of care settings; many have specialist nursing services operating with multi-professional teams.

Within a hospital environment there will be a number of other students working across various departments. You may be working as a lone student in your area, or be one of several students allocated at the same time. Other students can contribute to or enhance your learning as peers. For example, third year students are expected to lead and teach others meaning you will be able to support their development as they are contributing to yours.

Emergency care

Emergency department and medical / surgical or orthopaedic admonitions.

A placement in an emergency area 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

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

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

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

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

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.

Community placement settings

Settings such as Community hospitals, clinics and hubs are local areas that usually cater for patients nearer to home.

Working within specific hubs, such as sexual health, dermatology and podiatry, enables you to focus on treatment alongside health promotion and self -management behaviours.

Community hospitals are often where patients are looked after prior to being referred onwards or to a home. These placements offer plenty of scope to be more involved with person centred care and rehabilitation.  Working within multi-disciplinary teams these smaller units can offer a range of learning pathways to widen your knowledge of patient care in delivering a holistic approach to person centred planning.

Community Nursing Teams

Community nurses visit people in their own homes or in residential care homes, providing care for patients and supporting family members. As well as providing direct patient care, they also have a teaching role, working with patients to enable them to care for themselves or with family members teaching them how to give care to their relatives. Community teams also play a vital role in keeping hospital admissions and readmissions to a minimum and ensuring that patients can return to their own homes as soon as possible.

Skills that can developed in this placement setting include:

  • holistic assessment
  • time management
  • clinical decision making
  • communication skills
  • health promotion and learning about living with long term conditions
  • clinical skills such as ANTT, BGM, injections and vital signs
  • palliative care

Community matrons

The Community Matron possesses a variety of skills in dealing with clients/patients holistic needs in their own homes, fields of expertise may include; chronic disease management, COPD, diabetes, medication management, palliative care, tissue viability, continence and bowel management and urological disorders.

When assessing clients, they may identify health and social care needs that require holistic management; referral to other multidisciplinary agencies may then be required. Patients under the care of a community matron require advanced assessment, diagnosis; clinical decisions made and advanced care planning. This requires collaborative working with a GP/Hospital Consultant to plan and implement treatment for acute illness/injury/chronic illness as required, using skills in nurse prescribing and medicines management.

In addition Community Matrons indicators of chronic disease, anticipating possible decline and proactively managing this to enhance well-being and promote independence. Plan interventions in light of patients’ express wishes and goals of care, facilitating discussion with the family and significant others.

Skills that can be developed in this placement setting include:

  • holistic assessment
  • time management
  • clinical decision making
  • interprofessional communication skills
  • health promotion teaching self-care management

Health visiting team

Health visiting teams may consist of health visitors, community public health nurses, community nursery nurses, family health workers and community clerical officers. They work in partnership with local GP practices and children’s centre staff. They visit families in their own homes, facilitate community based groups and run clinics in health centres and community settings. Health visitors are in a unique position to deliver government policies in relation to the public health agenda, working in partnership with families, education, social care and other allied professionals to assess for health needs and facilitate early intervention. Health visitors are ideally placed to provide ongoing support, playing a key role in bringing together relevant local services to help families with continuing complex needs, for example where a child has a long-term condition.

Health visitors offer universal core services to all families with children under five years old and targeted support to families with additional needs such as post-natal depression, substance misuse, domestic abuse, teenage parents and those living in disadvantaged circumstances. This way of working is set out by the Healthy Child Programme (Department of Health, 2009) and the 4-5-6 Model of Health Visiting (Department of Health, 2015). Health visitors work in partnership with families and communities to improve access, experience and outcomes and to reduce health inequalities. They consider individual community needs including asylum seekers, travelling communities, religious and culturally diverse groups.

Key learning opportunities

This setting will provide a wide range of opportunities for the student to complete the learning criteria across all the domains.

The student will have the opportunity to develop his/her communication skills to a high level in order to promote therapeutic, reciprocal relationships with families.

  • The student will develop skills in holistic assessment, family-centred care planning, evaluation of care and health promotion.
  • The student will learn about child development, milestones and deviations and develop an understanding of how a child’s experience and environmental factors can influence their physical and emotional development.
  • The student will learn about the public health agenda for children, young people and families including healthy weight, perinatal mental health, school readiness and safeguarding of children and vulnerable adults.
  • The student will be working in a multi-agency arena and may have the opportunity to explore the role of other community professionals.
  • These may include; school nurses, specialist nurses, speech therapists, children’s centre workers and professionals from other community services that are used by children and families.

GP Practice placements

General practice is one of the largest branches of healthcare, being the first point of care for the majority of the population. A general practice placement will give you an opportunity to be involved and participate in the fundamentals of patient centred care, whilst fostering an understanding of patient perceptions of living with long term conditions, illness and minor ailments.
 
Working together with a practice nurse, and other members of the multidisciplinary team, you will observe, assist and undertake a multitude of interventions contributing to the well-being of patients. There will be opportunities to learn about physical, mental and emotional health across all age ranges and healthcare spectrums, providing a platform to develop a holistic patient approach to nursing care. Experiencing this intimate environment enables you to work closely with patients and carers and requires excellent interpersonal skills and full usage of the 6 C’s.

Assessment/reviews

There are many patient assessments and reviews within a GP setting, such as:

  • Triage assessment
  • Physical assessment
  • Mental health assessment
  • Medication and treatment reviews and assessment
  • Wound assessment
  • Long term conditions
  • Travel health assessment
  • Wound assessment
  • Treatment assessment
  • Physical assessment

Clinic Appointments

General practice nursing have a variety of clinics and appointments. You will have the opportunity to observe, assist or lead clinics such as:

  • Diabetic management, including: diabetic foot checks, blood monitoring, lifestyle advice and medication reviews.
  • Asthma and COPD management, including; inhaler selection, use and technique, monitoring of exacerbations and symptoms, Spirometry, reversibility and Peak flow assessment, treatment escalation and de-escalation plan management.
  • Hypertension diagnosis, treatment and management
  • CHD monitoring and management
  • Health promotion, including: Weight management including nutritional education and monitoring, Smoking Cessation and support
  • Travel Health, including: risk assessment, travel health education, vaccinations
  • Sexual Health, including: contraception advice and monitoring, sexual health advice, young person’s advice clinics
  • Baby immunisations, including: active health promotion, identification of immunisations, routine examinations, recording and liaising with child health services
  • Cervical cytology, including; health promotion and smear testing
  • Dermatology clinics, including: Mole diagnosis clinics, other skin conditions diagnosis and treatment, and minor op procedures
  • NHS health checks
  • Urgent care/minor illness clinics, including: on the day appointments, diagnosis, treatment, management and self-care advice
  • Substance misuse clinics
  • Mental health clinics, including; advice and treatment management pathways
  • Physiotherapy appointments
  • Tissue viability, including: leg ulcer assessment and management
  • Anticoagulant clinics, including; testing, monitoring and treatment plans
  • Hormonal injections/treatment initiated by secondary care

Investigations/tests, including:

  • Venepuncture/ Blood tests/ Urinalysis/ Swabs/ INR monitoring/ Blood Glucose monitoring
  • Ecg
  • Blood pressure
  • Weight/height
  • Other investigations directly linked to general practice clinics or primary and secondary care requests

Other skills which can be achieved

  • Motivational interviewing and coaching skills
  • Leadership and management experience and skills
  • Liaison with other disciplines and organisations, such as secondary care, private and voluntary sectors

Nursing home placements

Placement opportunities within the private and independent sector can involve caring for patients/residents in a nursing home environment. This will mean that effectively you will be helping to care for people in their own ‘home’. This will require skill and diplomacy in care planning, the use of a variety of assessment tools, excellent interpersonal skills and the employment of the six c’s on a daily basis. Caring for people who are resident in a nursing home often requires patience and empathy; these are as vital a nursing intervention as any clinical procedure. Treating people as individuals, ensuring that basic needs are met in a timely manner, but also the emotional and spiritual needs, contributing to person centred care in a truly holistic way.

This is only a brief overview of the interventions that are used routinely within a nursing home setting:

Personal care

  • Assisting with baths, showers, washes, teeth or denture care, hair care, dressing
  • Risk assessment of patient/resident both personally and in the environment

Personal elimination needs

Assisting with elimination needs, such as:

  • Accompany to toilet with frame/walking aid
  • Bedpan
  • Commode
  • Use of catheter bags
  • Laxatives and suppositories
  • Stoma’s and Illiostemies

Documentation of care

An array of assessment and documentation forms are in use, such as:

  • MUST tool
  • Waterlow Chart
  • Bristol Stool Chart
  • Fluid Balance Chart
  • Dietary Intake Chart
  • Exercise Diary
  • Socialisation/Activity Record
  • DNR or other consent/refusal forms
  • Care plan in total comprising all medical/surgical/emotional and nursing information
  • Mattress/Bedrail and other necessary assessments

Manual handling

Hands on usage with various manual handling aids, such as:-

  • Hoists
  • Stand aids
  • Turntables
  • Bath seats
  • Grab belts
  • Slide sheets

Medication and pain control

Patient/Resident medication

  • Assisting with medication rounds and individual medication needs
  • Checking stock of drugs and ensuring date and storage meets requirements

Pain Control

  • Gain knowledge of patient/resident polypharmacy requirements
  • Gain knowledge of Syringe driver and IV applications
  • Become involved with end of life planning and care

More complex care needs

Nursing Home placements may often present the opportunity for complex care delivery, including:

  • Tracheostomy care
  • Naso gastric tube and Peg feeding
  • Conditions such as Parkinsons, Motor Neurone Disease, Brain Injury and other debilitating conditions that require complex care from the whole MDT.