O.J.

T
PROGRAMME
• Advance Gynae
Nursing
 Course Particulars

 Course: Advance Gynae

Nursing
 Duration: 13 weeks
 Institute: NHS Grampian-
Aberdeen Royal Infirmary.
 Course Facilitators:
Gynaecologist Dr S. Bhatta, Dr
 A Kerrigan, Dr O.Shaughness
and Dr.Maheshwar
 Aims
 I came here with my objectives to learn about:
• Invasive surgery
• Reproductive health

• Advanced Gynae Nursing .

 Introduction to country:
United Kingdom
 It is a group of islands which together form Great Britain.
 London is the 1st most popular attraction site, followed by Edinburgh, whilst
Aberdeen is 28th in the charts.

 Scotland
 London is the 1st most popular attraction site, followed by Edinburgh, whilst
Aberdeen is 28th in the charts.
 I was able to visit Glasgow and Edinburgh on my days off.
 I carried out my observer ship at the NHS- Grampian- Aberdeen royal infirmary.
 Robert Gordon university
 Aberdeen Royal Infirmary (ARI)
 Aberdeen Royal Infirmary (ARI) is the largest hospital in NHS Grampian, located
on the Foresterhill site in Aberdeen. ARI is a teaching hospital with around 900
inpatient beds, offering tertiary care for a population of over 600,000 across the
North of Scotland. . It offers all medical speciallities with the exception of
heart and liver transplal..

 Pak army views

 My OJT was related to laparoscopic surgery in Gynae.
 Previous experience was carried out in Baluchistan and Karachi, where
laparoscopic surgery in Gynae is very rare, hence laparotomy is carried out in
minor or major surgeries.
 Disadvantages of laparotomy includes increased healing time, increased loss of
blood and increased rate of recurrent infections, so recovery rate is not good.
 In the UK, the techniques and procedures are exceptional, so recovery rate is
very fast.
 Extra emphasis is placed o ln sterilisation and patient preferences.
 Most importantly, the level of honesty and the staff’s commitment to the welfare
of all, is the most important lesson from this OJT.
 We should all strive to the same level of honestly, trust, integrity and knowledge
within all areas of the forces.
 Medical standards

 I spent two months in short stay surgery unit:

Where I saw a strong system of sterilisation &how to follow
sterilisation protocol.
Excellent and safe surgery.
Excellent management of OT staff.
Control managed anaesthesia.
How to confirm patient identification.
 I also learned how invasive surgery use in Gynae. It is used for:
 Diagnostic purposes [infertility, recurrent abortion, worse menorrhagia and
malignancy].
 Removal of ovarian cyst
 Treatment the ectopic pregnancy.
 Treatment of menorrhagia as Ablation
 Treatment of endometriosis
 Hysterectomy/oophorectomy
 Treatment of PID
 Sterilisation.
 Mirena as contraceptive use.
 Novasure [treatment of heavy menstrual bleeding]
 Essure [Permanent birth control]
 Treatment of incontinence of urine [use of Botox injection]

 Course syllabus
1. IN SURGERY:
Laparoscopic surgery is very delicate prevent the pt. from infection; big scaring;
excessive blood lost ‘worse pain. Surgeon provide standardised surgery &care to the
patient. During working in OT Learned
What are the instruments use in invasive surgery.
 How to gather them.
 How to separate them and then send for sterilization
 How to prepare the trolley for different op.

 2. PAIN MANAGEMENT
 Patient-controlled analgesia (PCA) is a method
 of pain control that gives patients the power to
 control their pain. In PCA, a computerized pump
 called the patient-controlled analgesia pump,
 which contains a syringe of pain medication as
 prescribed by a doctor, is connected directly to
 a patient's intravenous (IV) line.
 Cont……
Inhalation anaesthesia
Entonox is a mixture of two gases,oxygen50%
&nitrous oxide50%.It is commonly used as a
method of control by woman in labour &for
 dental procedures
 Someother pain relive are
 Oral Morphine
 Oxycodene

. REPRODUCTIVE HEALTH
 is defined as a state of physical, mental,
 and social well-being in all matters relating to the reproductive
 system, at all stages of life.
 Treatment options
 There are three main types of fertility treatment:
 medicines to assist fertility
 surgical procedures
 assisted conception
ASISTED REPRODUCTIVE UNIT.
TREATMENT OF IVF &ICSI & CRYPREERVATION OF EMBRYO
SPERM&EGG STORAGE
SURGICAL SPERM RETRIEEVAL
EGG DONATION
FERTILITY PRESERVATION
DONOR INSEMINATION
SUPEROVULATION&INNTRA UTRIAN INSEMINATION

ASISTED REPRODUCTIVE UNIT.

TREATMENT OF IVF &ICSI & CRYPREERVATION OF EMBRYO
SPERM&EGG STORAGE
SURGICAL SPERM RETRIEEVAL
EGG DONATION
FERTILITY PRESERVATION
DONOR INSEMINATION
SUPEROVULATION&INNTRA UTRIAN INSEMINATION

 4. IVF
 In-vitro fertilisation (IVF)
 During in-vitro fertilisation (IVF), the fertilisation of the egg
occurs outside the body. The woman takes fertility medication
to encourage her ovaries to produce more eggs than normal

. Eggs are then removed from her ovaries and fertilised with sperm
in a laboratory dish. A fertilised embryo is then put back inside the woman's body

5. ICSI
 ICSI is an acronym for intracytoplasmic sperm injection
 A fancy way of saying "inject sperm into egg"
 ICSI is a very effective method to fertilize eggs in the IVF
 lab after they have been aspirated from the female
 Its main use is for significant male infertility cases

 Last week I spent in reproductive health. Where I met with infertility Nurses who
treat the infertile patients with medicine and learned those methods and
transfer to doctor only those pt who faild to treatment and need for embryo or
sperm treatment by artificial method.


6. TEACHING PRACTICE
ROBERT GORDEN UNIVERSITY ABERDEEN;
 ; Ireally feel proud to say that I have attended some lectures about
 Maternal History.
 Infant feeding
 Introduction to medicine
 Non-Medical prescribingby nurses
 Medicine care planning
 Medicine related issues and problems
 Prescribing management and guidelines and formularies.
 Professional practice model
 Preparation for practice
 Antenatal care
 Teaching practice .
 Mind fullness excercises (All teachers with us attended this exercis lecture)
 Ward administration

 Post op ward.
 In 9thweek I went to post op ward, where a new nurse is welcomed by a written
briefing in which each and everything is mentioned. This contains:
 Contents:
 Staff information
 No. of beds in the wards
 List of abbreviations and procedures used within the ward
 Health and safety
 This is a part of good working practise and all employers have responsibility
towards you. This also means an individual and people who all work within the
ward all have this responsibility.

 This also includes following of gold standard for equipment such as:
 Body fluids
 Discarding sharps/ needles
 Handling intra venous antibiotics
 It is compulsory to addend a fire lecture annually and to be aware of the fire
plan, situated outside the ward.
 It is essential to attend training regarding basic life support/ resuscitation, Blood
transfusion, moving and handling updates on a regular basis.

 Good house-keeping policies

 All staff are asked to follow a ‘clean as you go’ rule in which any damage
equipment/ furnishing is removed of informed of to the manager.
 The directorate of Obstetrics and gynaecology has a Health & Safety committee,
which is adhered to by all members
 Risk assessment
 This is carried out to:
 Protect employer and employee
 Assess potential dangers and preventions of these dangers
 Ensure a safe environment
 Reduce both health costs and financial costs
 To comply with law

 Clinical risk management

 The aim is:
 To provide the best care
 To promote safe practice and to encourage that all policies and protocols
are adhered to
 Risk management process
 This is completed by staff members dealing with the event
 Select appropriate category once case is identified
 Complete a brief factual account of the event, preferably in an electronic
format and sent
 If the account is handwritten, it is places in the holders and the nurses
station in each ward
 All these regulations, policies, protocols etc., are reviewed and updated on a
regular basis to ensure paramount safety and compilation of the law

 Fire Quiz
 This is a short quiz given out to all members to ensure all the standards are
known and understood. This quiz contains questions related to fire management
and health and safety
 Aim and objectives of the ward:
 Drug administration
 Wound care
 Care of bladder/ bowels

 Tests, investigations & procedures

 Management of blood transfusion
 Management of intravenous transfusion
 Pre-operative patient care
 Post-operative patient care

 Moving and handling

 Management skills
 Care of dying, deceased and bereaved relatives
 Other skills
 Personal development.

 The Multidisciplinary Team

 In which doctors and nurses together in a week and discuss the pt related
problems and find out the solution.
 WARD ROUTINE: During ward working, I saw that for every task, a check list or
protocol is present and we have to work according to this check list.
 Patient Admission Assessment document: inthis form,we fill personparticular:
 Hospital and ward name
 Admission and pre-assessment date
 Time (24hr clock)
 Place of admission
 Family doctor/ GP details
 Does the GP know of the patient’s condition
 Estimated date of discharge
 Reading for; BP, HR, RR, Temp, SP02, blood glucose, AMT 10 score

 PATIENT DETAILS:
 Surname
 Forename
 Preferred name
 Occupation
 Consent to discuss your treatment with others
 Age, date of birth
 Gender
 Height
 Weight
 Five MUST ( what and who matters to you, what info do you need, personalised
contact, nothing about me without me)
 Primary language, is interpreter required
 Details of diagnosis
 Primary and alternative contact person and no.
 Support requires- carers
 address, postcode
 disability
 community health index
 next of kin,
 religion,
 take drinks[alcohol],
 diet preferences
 Height and weight.
 BMI.
 Marital status.
 Consent.
 Allergies.
 Medical history.

 Home circumstances/social /lifestyle.

 Daily living core assessments (maintenance of a safe environment, in cognation ,
pain assessment, infection, prevention and control, communication, signage*,
breathing, Nutritional Assessment, eliminating- urine, personal hygiene, control
of body temperature, mobilising, falls risk, pressure ulcer assessment, wound
assessment and management, social activity, expressing sexuality, spiritual care,
palliative care and end of life, discharge planning, special equipment and
valuables, admissions summary, and personal centre goal of care). This form is
altered every day and all this heading are re-evaluated and noted on the patient
observation record book.
 And disease related many information questionnaire that provide each and every
Information of pt.

 Personal care record:

 Patient particulars: treatment plan discussed with patients, total nursing care is
recorded and put on record sheets.
 ,
Peripheral venous cannula: date plan started, date plan discounted reason of
plan discounted, cannula location, printed name of person with cannula,
signature of inserting cannula, hand hygiene performed, absence of
inflammation, VIP SCORING, PVC-dressing intact.
 BMI record documents: height and weight recorded to calculate BMI, height
measured by the ulna length,.
 Swiss scoring documents: Scotland early warning sign, in which we check
respiration 02 saturation, temperature, blood glucose, heart rate, neuro-
response,

 Fluid balance document:

 Wound assessment documen t:
 The wound assessment continuum, the wound infection continuum, the wound
exudate continuum. In these we also record treatment objective, treatment
choice and additional notes.

 Personal carerecord.This give information about nursing care, treatment. And
improvement of general heath of pt.
 PT DAILLY DIARY; this diary is provided along with a leaflet which explains about
the enhanced recovery programme. In diary include each and every thing like

 DAY BEFORE SURGERY

 Ask to ptDid you receive clear information when u should stop eating and drink
before your surgery? Yes or no
 You should have been given nutritional drinks to have at home before your
surgery
 Did u receive these drinks before your surgery? Y or n
 If yes were u able to finish u drinks 2hours before u surgery y or n,
 Did u receive the following leaflets before u surgery?
 Did u receive the following leaflet before u surgery? Y or n
 Enhanced recovery
 Patient controlled analgesia Info .

DAY OF SURGERY
Ask to pt.
 Did u completed this section 4.5.6.15
 Have u been able to finish u drinks before surgery y or n
 Have u been given either anti embolism stocking y or n
 Have u received blood thinning injection y or n.
 Have u had a chance discuss pain control with u anaesthetist before u surgery.
 Did u feel you have had enough time to ask any question before u surgery?Y or
n.
 Comments.
 DAY OF SURGERY AFTER YOUR OPERATION:
 Did someone help you to sit upright in bed after your woke up y or n.
 Have u been able to do your hourly breathing exercises? Y or n.
 Have u done your calf exercises with while in bed
 Please tell us u pain score 0.1.2.3.4.
 Have u felt sick today. Y or n
 Have u been sick to day. Y or n.
 Have u received any anti-sickness medication to day. Y or n
 FIRST POST OF DAY
 Have u able to sit out of bed for approximately 2 hour today. Y or n.
 Please circle each time uare able. 0. 1.2.3.4
 Have u been able to walk 20 meters in total today following theGold star route.
 Did u eatbreakfast? Y or n
 Pain control and sickness questionnaire

 2nd Day after our operation

 Walking and activity questionnaire.
 Eating and drinking questionnaire
 DAY OF DISCHARGE FROM WARD.
 A questionnaire about patient how can go home comfort
 UNPLANNED PREGNANCY SERVICE.
 A protocol about unplanned pregnancy is there and all termination done by this
protozoa
 PROTOCOL FOR VARIABLE RATE INTRAVENOUS INSULINE INFUSION

 GYNAE WARD

 10th week I spent in Gynae wards where I learn how community nurse play an
important role as midwife in community.
 A complete antenatal care provided by midwife and only for delivery she send
patient to hospital
 Where competent nurse present for delivery
 A full protocol in written is there that is about
 Labour &birth record confidential.
 Your combine pregnancyand postnatal record.
 Baby’s feeding diary
 A managed care system with good patient nurse ratio is present there where the
most important person is only is the patient.
 REPRODUCTIVE HEALTH
 Last week I spent in reproductive health. Where I met with infertility Nurses
who treat the infertyal patientsand learned those methods.and transfer to
docter only those pt who faild to treatment and need for embryo or sperm
treatment by artificial method.i also saw.
 Treatment of IVF+ICSI
 Cryo preservation
 Sperm and eggs storage
 Surgical sperm retrieval[save the sperm before treatment of cancer]
 Egg Donation
 Donor Insemination
 Supra ovulation and intra uterine insemination.
 Quality management manual[check list]

 REPRODUCTIVE HEALTH
 Last week I spent in reproductive health. Where I met with infertility Nurses
who treat the infertyal patientsand learned those methods.and transfer to
docter only those pt who faild to treatment and need for embryo or sperm
treatment by artificial method.i also saw.
 Treatment of IVF+ICSI
 Cryo preservation
 Sperm and eggs storage
 Surgical sperm retrieval[save the sperm before treatment of cancer]
 Egg Donation
 Donor Insemination
 Supra ovulation and intra uterine insemination.
 Quality management manual[check list]

 REPRODUCTIVE HEALTH
 Last week I spent in reproductive health. Where I met with infertility Nurses
who treat the infertile patient sand learned those methods.and transfer to
docter only those pt who failed to treatment and need for embryo or sperm
treatment by artificial method.I also saw.
 Treatment of IVF+ICSI
 Cryo preservation
 Sperm and eggs storage
 Surgical sperm retrieval[save the sperm before treatment of cancer]
 Egg Donation
 Donor Insemination
 Supra ovulation and intra uterine insemination.
 Quality management manual[check list]

 Quality policy[check list]

 SOP Gonadotropin[protocol
 SOP of basic appointment of fertility centre.
 All learned by
 Gynaecologist Dr S. Bhatta, Dr A Kerrigan, Dr O.Shaughness and Dr.Maheshwar

 Bibliography
 Fundamentals of Obs and gynaecology by Jeremy Oats and Suzanne Abraham
 Obs and Gynae by Diana Hamilton, Fairly, 3rd ed.
 Pamphlets:
• Understanding cancer of ovary (Macmillan)
• Understanding cervical cancer (Macmillan)
• Understanding womb (endometrial) cancer (Macmillan)
• Exercises for pelvic floor muscles
• Exercise diary after open abdominal surgery
• Going home after laparoscopic surgery
• Short stay unit
• Preventing blood clots
• Going home after vulval surgery
• Going home after hysteroscopy or polypectomy
• Oral morphine
• Inhalation analgesia
• Oxycodone injections
• Patient controlled analgesia (PCA)
• Coping with spinal fractures and back pain
• Patient confidentiality
• Donor insemination (DI)
• NOVASURE (impedance controlled endometrial ablation system)
• BONEE coloplast (needle for bladder infections)
• ESSURE (permanent birth control)
• TENS (transcutaneous electrical nerve stimulation using electrodes)
• Syringe pump with patient control system
• ENTONOX (pain relief via inhalation during labour)
• Diet and the cancer patient
• Knowing about cervical cancer
• Food and fluid provision in hospital
• Sexuality and cancer
• Talking to children when an adult has cancer
 • Ectopic pregnancy
 What was learnt
o Sterilisation
o Laparoscopic instruments
o Gathering laparoscopic instruments
o Nursing care of cancer patients in Gynae
o Pre and Post operative care of Gynae
o Pain management
o Reproductive health
o Labour management
o Patient care plans
o Patient confidence
o Ward management
professional development
o Non-medical prescription
o Community nursing
o Field specialists in Nursing
o Hypertensive Nurses
o Diabetes control Nurses
o Nutritional Nurses
o Radiographer Nurses
o Rehabilitation Nurses
o Palliative care
 Any special training
 Role of nurses in Laparoscopic surgery
 Reproductive health
 Pain management

 How has this training benefitted you?

 I am able to assist in laparoscopic surgeries.
 I can manage pain.
 I am now confident in reproductive health.
 I have increased confidence in ward management.
 I have greater knowledge of pre and post operative care of the patient
 Therefore, I hope with my knowledge and nursing care patient recovery rate will
be faster.
 I have increased knowledge of professional development and nursing and can
teach new candidates.

 What equipment was required, will be needed if performed in Pak

Laparoscopic instruments:
 Laparoscope
 Disposable diathermy
 NOVASURE (impedance controlled endometrial ablation system)
 BONEE coloplast (needle for bladder infections)
 ESSURE (permanent birth control)
 TENS (transcutaneous electrical nerve stimulation using electrodes)
 Syringe pump with patient control system
 ENTONOX (pain relief via inhalation during labour)
 Storage facilities and equipment for sperms and eggs.
 ultrasound machines (IVF and infertility treatment)

 What courses undertaken to enhance this training

 Operation theatre training
 Professional development
 Antinatal care
 Non-medical prescription
 Any administrative difficulties experienced
Occupational health protocol difficult and must be filled before arrival within the
country.
Otherwise all departments are extremely co-operative.

 any cultivation or motivation

 Nursing care is very impressive.
 Patient health is at the heart of all services provided
 No discrimination of any kind, to anyone.
 Best care provided for all.
 Free health care for under 18’s and over 60’s years.
 Gold standards are undertaken in every procedure and a checklist must be
accounted for.
 Continuous training system for all, therefore enhanced, up to date knowledge
 Staff honesty with profession
 Patient to staff ratio is ideal and each staff is responsible for each task.
 recommendation
OJT duration of three months is very short to learn satisfactory because:
It is an observership, no hands experience
It takes 3-4 weeks to fully settle and arrange the timetable by one department
Nursing registration and membership is extremely important before being able to go
into OJT
Greater selection of OJT courses would be very beneficial
OJT must be a minimum of six months to be able to fully grasp every minute standard.
Departure documentation must be completed by the home station
Specific objectives selection by the Advisor
It is essential for the placement to be arranged at a GHQ level asmany forigner want
to work together with our forces.
Lastly, many forigner nurses would like to opportunity to visit Pakistan and gain
experience
At university level, many countries have contracts with them to exchange their
students after completion of general training to gain broaden their knowledge and
experiences

REMARKS
 Really thankful to Army to provide this facility especially thankfull to Sir DG
Asif who help us for placement and nice behavior. And without his help we

can’t go .
 Thanks for my respected DFNS for moral sport and help and all GHQ’s
departments who help us.