Clinical haematology wards are busy places, full of very sick patients – understanding the basics will put you ahead of the game.
Clinical haematology can encompass a range of sub-specialities such as; bone marrow transplant units, general haematology wards, haematology clinics, genetic mapping centres, obstetric haematology and day case units.
Throughout your placement you will be exposed to a multitude of haematological conditions and it will be a unique opportunity to develop skills, knowledge and gain confidence in dealing with these.
Patients in these areas, generally, have very poor immune systems – so you’ll be advised to stay away or wear a mask if you arrive at placement unwell.
What to Expect from your Placement
The ward or unit routine will differ from trust to trust, but this is something you will pick up quickly – so get as involved as you can.
You will see the day-to-day management of conditions such as; leukemias, lymphoma, myeloma, sickle-cell and various clotting disorders. Over-time these patients become very knowledgeable about their conditions – so use them as a resource to learn.
Most units actively participates in clinical trials governed by the National Cancer Research Network (NCRN). This will involve patients trialling potential new treatments for heamatological conditions.
You should get plenty of experience managing a septic patient. You should familiarise yourself with ‘Sepsis 6‘ and clinical escalation within your trust; Doctors, CCOT, Emergency Medical Teams, Hospital at Night etc.
Preparing for your Placement
There are a few things you can do to prepare for your placement within clinical haematology;
Try and visit your placement before you start. Wards and units can vary greatly. Visit the area you have been assigned to before you start and ask if there is anything you should be aware of prior to starting.
Identify your learning needs and outcomes. Identify these early and be aware of the skills you want to develop or learn – this will help you get the most from your placement.
Brush up on your anatomy and physiology. Familiarise yourself with the mechanisms of bone barrow and the haematopoietic stem cell cycle.
Read up on the basics. You should read up on the basics of haematology – familiarising yourself with the different types of leukemias, lymphomas and myelomas. The MacMillian, NHS Choices, Cancer Research and Bloodwise websites are fantastic recourses to help get to grip with the basics.
Understand the social impact on patients. A cancer diagnosis can be devastating to both an individual and a family, with individuals remaining inpatients for months at a time. Consider the impact this would have on a family; emotionally, financially, spiritual, sexual, professional etc.
Learn about neutropenic sepsis. Neutropenic sepsis is a life threatening complication of anticancer treatment and a genuine medical emergency. haematology patients have a tendency to deteriorate quickly so be sure to escalate to your mentor if you discover an unwell patient.
Research area-specific medications. You should read about commonly used anti-virals, anti-fungals and antibiotics. You could also invest in the Drugs in Use (Nursing and Health Survival Guides).
Understand the risks and complications of blood transfusions. You will see patients being frequently transfused with red blood cells or platelets. Understanding the complications and reasoning behind these transfusions will put you ahead of the game.
Look at ABCDE assessments and their importance. This systematic approach is used for the assessment and treatment of patients ABCDE model.
Chemotherapy will be administered in these areas. Although it will be interesting to watch you will be limited in your involvement due to the enhanced training required to administer.
Getting the most from your placement
Haematology wards and units are usually very busy places, although you are supernumerary their will be jobs you’ll be asked to undertake independently once deemed able. There will be the chance to easily obtain learning outcomes and measures of practice.
You should use this placement to gain experience managing a patient load, managing a septic patient, clinical decision-making and, if possible, arranging insight visits with specialist areas.
The final and most important piece of advice I can give you is to ask questions and get involved.