http://www.enotes.com
Definition
Urinary catheterization is the insertion of a catheter through the urethra into the urinary bladder for withdrawal of urine. Straight catheters are used for intermittent withdrawals; indwelling (Foley) catheters are inserted and retained in the bladder for continuous drainage of urine into a closed system.
Purpose
Intermittent catheterization is used for the following reasons:• To obtain a sterile urine specimen for diagnostic evaluation; to empty bladder content when the patient is unable to void (urinate) due to urinary retention, bladder distention, and obstruction, or to measure residual urine after urination.
* To instill medication for a localized therapeutic effect and to instill contrast material (dye) into the bladder through the urethral catheter for cystourethralgraphy (x ray of the bladder and urethra).
* To empty the bladder for increased space in the pelvic cavity to protect the bladder during labor and delivery and during pelvic and abdominal surgery.
* To strictly monitor the urinary output and fluid balance of critically ill patients.
Indwelling catheterization is:
* Indicated as palliative care for terminally ill or severely impaired incontinent patients, for whom bed and clothing changes are uncomfortable, and as a way to manage skin ulceration caused or exacerbated by incontinence.
* Used to maintain a continuous out flow of urine for patients undergoing surgical procedures that cause a delay in bladder sensation, and for persons with chronic neurological disorders that cause paralysis or loss of sensation in the perineal area.
* Indicated for urologic surgery, bladder outlet obstruction, and for patients with an initial episode of acute urinary retention to allow the bladder to regain its tone.
Precautions
Because the urinary tract is normally a sterile system, catheterization presents the risk of causing a urinary tract infection (UTI). The catheterization procedure must be sterile and the catheter must be free from bacteria.
Urinary catheterization aids or replaces the body's normal ability to urinate. Intermittent use of the procedure can stimulate normal bladder function, however frequent and continuous catheterization can lead to total dependency. Catheterization is invasive and has the potential of injuring the urethra and bladder, inviting urinary tract infections. Therefore aseptic techniques should be use in all catheter management activities.
The normal flow of urine from the kidneys through the ureters, bladder, urethra prevents the movement of bacteria up through the urinary system. The antibacterial properties of the bladder wall, urethra lining, and low urine pH also serve as protective barriers to urinary tract infections. Urinary tract infections occur when bacteria invade the protective barriers of one or more urinary structures.
Infection control
Every attempt should be made to keep the urinary drainage system closed. Breaks in the system invite infections. Health care workers and patients should wash their hands before and after manipulation of the patient's catheter or collection system to control UTI. Cross-contamination is the most frequent cause of nosocomial (hospital acquired) catheter related infections. Good hand washing practices are the best prevention measure.
The extended portion of the catheter should be washed with a mild soap and warm water to keep it free of accumulated debris.
Frequent intermittent catheterization and long term use of indwelling catheterization predisposes the patient to UTI. Care should be taken to avoid trauma to the urinary meatus or urothelium (urinary lining) with catheters that are too large or inserted with insufficient use of lubricant. Patients with an indwelling catheter must be reassessed periodically to determine if alternative treatment will be more effective in treating the problem.
Description
The female urethral orifice is a vertical, slit-like or irregularly ovoid (egg shaped) opening, 4 or 5 mm in diameter, located between the clitoris and the vagina. The urinary meatus (opening) is concealed between the labia minora, which are the small folds of tissue that need to be separated in order to visualize the opening and insert the catheter. With proper positioning, good lighting and gloved hands, these anatomical landmarks can be identified. If necessary, provide perineal care to ensure a clean procedural environment.
Catheterization of the female patient is traditionally performed without the use of local anesthetic gel to facilitate catheter insertion. But since there are no lubricating glands in the female urethra (as found in the male urethra), the risk of trauma from a simple catheter insertion is more likely; therefore, ample supply of an anesthetic or antibacterial lubricant should be used.
Preparation
Health care practitioners performing the catheterization should have a good understanding of the anatomy and physiology of the urinary system, trained in antiseptic techniques and in catheter insertion and catheter care.
Determine the primary purpose for the catheterization and give the patient and/or caregiver a detail explanation. Patients requiring self-catheterization should be instructed and trained in the technique by a qualified health professional.
Sterile disposable catheterization sets are available in clinical settings and for home use. These sets contain most of the items needed for the procedure, such as antiseptic agent, perineal drapes, gloves, lubricant, specimen container, label, and tape. Anesthetic or antibacterial lubricant, catheter, and drainage system may need to be added. It is always wise to review the content of the pre-packaged catheterization set while assembling the materials.
Catheter choices
TYPES. Silastic catheters have been recommended for short-term catheterization after surgery because they are known to decrease incidence of urethritis. However, due to lower cost and acceptable outcomes, latex is the catheter of choice for long-term catheterization. Silastic catheters should be used for patients who are allergic to latex products.
There are also additional types of catheters:
* PTFE-coated latex Foley catheters
* hydrogel-coated latex Foley catheters
* pure silicone Foley catheters
* silicone-coated latex Foley catheter
SIZE. The diameter of the catheter is measured in millimeters. Authorities recommend the "narrowest and softest tube" that will serve the purpose. Rarely is a catheter larger than size 18 F required, and sizes 14 or 16 F are used more often. Catheters greater than size 16 F have been associated with patient discomfort and urine bypassing. A size 12 catheter has been successfully used in children and female patients with urinary restriction.
LENGTH. Female adult patients should be given the choice of a short, female length or a standard length catheter for urethral catheterization.
BALLOON SIZE. Select a catheter with a balloon-filling volume of 0.33 fl oz (10 ml) for routine drainage. Sterile water must always be used to inflate the balloon as other fluids may contain particles, which could block the inflation channel. Some indwelling catheters are manufactured pre-filled with 0.33 fl oz (10 ml) of sterile water, ready for balloon inflation after catheter insertion.
DRAINAGE SYSTEM. Review the design, capacity, and emptying mechanism of the variety of urine drainage bags with the patient. Select the system that is most adaptable to the patient's lifestyle and her ability to manage the device independently. For women with normal bladder sensation, a catheter valve for intermittent drainage may be an acceptable option.
Procedure
The standard technique for catheter insertion is:
* Explain the procedure to the patient, position the patient and ensure privacy and good lighting.
* Wash hands, remove outer tray wrapper and put on sterile gloves before opening the sterile inner packet. Prepare a sterile field and place a specimen collection vessel between the patient's legs.
* Cleanse the labia according to established guidelines and identify the urethral meatus. If an anesthetic lubricating gel is used, instill approximately 0.16 fl oz (5 ml) of 2% lignocaine hydrochloride gel into the urethra or apply the gel to the meatus to achieve surface anesthesia within three to five minutes.
* Hold the catheter in the dominant hand and gently insert it into the urethral meatus; pass it slowly through the urethra and into the bladder. If the catheter is accidentally inserted into the vagina or the tip is contaminated, discard it and take new sterile catheter before proceeding.
* Once the urine starts to flow, collect the specimen and pass the catheter an additional 2 inches (5 cm) to ensure that the balloon is in the bladder before slowly inflating the balloon with 10 ml sterile water.
Aftercare
Patients using intermittent catheterization to manage incontinence may require a period of adjustment as they try to establish a catheterization schedule that is adequate for their normal fluid intake.
Antibiotics should not be prescribed as a preventative measure for patients at risk for urinary tract infections. Prophylactic use of antibacterial agents may lead to the development of drug-resistant bacteria. Patients who practice intermittent self-catheterization can reduce their risks for UTI by using antiseptic techniques for insertion and catheter care.
Attach the indwelling catheter to the drainage system, slightly curve the tubing, and anchor it to prevent urethral traction. In women the catheter should be secured to the anteromedial thigh with non-allergenic adhesive.
Complications
Complications that are liable to occur include:
* Trauma and/or introduction of bacteria into the urinary system, leading to infection and, rarely, septicemia.
* Trauma to the urethra and/or bladder from incorrect insertion or removal of the catheter with the balloon inflated. Repeated trauma may cause scaring and/or stricture, or narrowing of the urethra.
* Bypassing of urine around the catheter. Inserting a smaller catheter size can minimize this problem.
Sexual activity and menopause can also compromise the sterility of the urinary tract. Irritation of the urethra during intercourse promotes the migration of perineal bacteria into the urethra and bladder, causing UTIs. Postmenopausal women may experience more UTIs than younger women. The presence of residual urine in the bladder secondary to incomplete voiding provides an ideal environment for bacterial growth.
Results
Urinary catheterization should be avoided whenever possible. Clean intermittent catheterization, when practical, is preferable to long-term catheterization.
Catheters should not be changed routinely. When each patient is monitored for indication of obstruction, infection, or complications before the catheter is changed, some patients require catheter changes weekly, and others may need a change in several weeks. Fewer catheter changes will reduce trauma to the urethra and reduce incidence of UTI.
Health care team roles
Observation
Before commencing with the catheterization, the nurse should observe the patient's general condition, pal-pate the pubic area to note gross distension. The patient should be monitored for indications of infections and encourage adequate fluid intake.
The nurse should seek medical advice if the catheter cannot be inserted easily, or if the patient complains of undue pain or bleeding other than that associated with minor trauma.
Patient education
The patient and/or caregiver should be taught to use aseptic technique for catheter care. Nursing interventions and patient education can make a difference in the incidence of urinary tract infections in the hospital and nursing homes and home care units.
The sexuality of the patient with an indwelling catheter for continuous urinary drainage is seldom considered. If a patient is sexually active, the practitioner must explain that intercourse can take place with the catheter in place. The patient or her partner can be taught to remove the catheter before, and replace it with a new one following intercourse.
KEY TERMS
Catheterization—A procedure of inserting a catheter through the urethra into the bladder to remove urine.
Catheter—A tube for evacuating or injecting fluid.
Contaminate—To make an item unsterile or unclean by direct contact.
Foley catheter—A double channel retention catheter. One channel provides for the inflow and outflow of bladder fluid, the second (smaller) channel is used to fill a balloon that holds the catheter in the bladder.
Intermittent catheterization—Periodic catheterization to facilitate urine flow. The catheter is removed when the bladder is sufficiently empty.
Perineal area—The genital area between the vulva and anus in a woman.
Urinary incontinence—The inability to retain urine or control one's urine flow.
Urinary retention—The inability to void (urinate) to discharge urine.
Urethritis—Inflammation of the urinary bladder.
Resources
BOOKS
Nettina, Sandra M. Lippincott Manual of Nursing Practice. 7th edition. Philadelphia: Lippincott, 2001, pp.692-697.
PERIODICALS
Colley, Wendy. RGN, DNCret. FETC. "Know How." Nursing Times (July 2, 1997).
Cravens, David D., Steven Zweig. "Urinary Catheter Management." American Family Physicians 61, no. 2 (January 15, 2000): 369.
Sanyay Saint, Joann G. Elmore, Sean D. Sullivan, Scott S. Emerson, Thomas D. Koepsell, "The efficacy of silver alloy-coated urinary catheters in preventing urinary tract infection: a meta-analysis." American Journal of Medicine 105, no. 3 (September 1998): 236.
Aliene S. Linwood, B.S.N., RN, D.P.A., FACHE
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Showing posts with label NURSING. Show all posts
Showing posts with label NURSING. Show all posts
Friday, January 15, 2010
Catheterization, Male
http://www.enotes.com
Definition
Urinary catheterization is the procedure of inserting a catheter through the urethra into the bladder to remove urine. Intermittent catheterization is performed for periodic relief of bladder distension; indwelling (Foley) catheters are inserted and retained in the bladder for continuous drainage of urine into a closed system.
Purpose
Intermittent catheterization is recommended to obtain a sterile urine specimen, to relieve urinary retention, for urologic surgery or surgery on contiguous structures, for critically ill patients requiring accurate measurement of intake and output, and for temporary obstruction of the bladder opening due to injury.
Indwelling catheterization is recommended for continuous drainage of urine when the bladder outlet obstruction can not be corrected by medical or surgical intervention; in cases of intractable skin ulceration caused or exacerbated by exposure to urine; and as palliative care for terminally ill or severely impaired incontinent patients.
Precautions
The urinary tract is normally a sterile system. The normal flow of urine from the kidneys through the ureters, bladder, and urethra prevents the migration of bacteria up through the urinary system. Antibacterial properties of the bladder wall, urethra, low pH of urine, and the prostatic fluid in men also inhibit bacteria growth. Urinary tract infections (UTI) usually result from bacterial invasion of the protective barriers of one or more urinary structures. As a result, urinary catheterization should be avoided whenever possible. Precautions must be taken to keep the procedure sterile and the catheter free from bacteria. The extended portion of the catheter should be washed with a mild soap and warm water to keep it free of accumulated debris.
Frequent intermittent catheterization and long-term use of indwelling catheters predisposes the patient to UTI. Care should be taken to avoid trauma to the urinary meatus and urothelium (urinary lining) with catheters that are too large or inserted with an insufficient amount of lubricant. Further medical advice should be sought if the catheter cannot be inserted easily, or the patient complains of undue pain or bleeding other than that associated with minor trauma.
Every attempt should be made to keep the urinary drainage system closed. Breaks in the system invite infections. Health care workers and patients should wash their hands before and after manipulation of the patient's catheter or collection system to control UTI. Cross-contamination is the most frequent cause of nosocomial (hospital acquired) catheter related infections. Good hand washing practices are the best prevention measure. Patients with indwelling catheters should be re-evaluated periodically to determine if an alternative treatment method will be more effective.
Description
Intermittent catheterization is preferable to chronic indwelling catheterization in certain patients with bladder dysfunction. It has become the standard care for patients with spinal cord injuries. Elderly patients, following surgical repair of hip fractures, regain the ability to control urination more quickly on a program of intermittent catheterization every six to eight hours compared to the use of indwelling catheters.
Intermittent catheterization may be performed four or five times a day by the health care practitioner or care-giver. Patients who are interested in self-catheterization should be instructed and trained by a qualified health professional. This is also true for patients who require indwelling catheterization, as the procedure for insertion is similar to that for intermittent catheterization, with added responsibility of inflating the balloon.
Preparation
Health care practitioner performing the catheterization should have a good understanding of the male urinary system anatomy and physiology and should be trained in aseptic technique, catheter insertion technique, and catheter care.
Sterile disposable catheterization sets are available in clinical settings and for home use. These sets contain most of the items needed for the procedure, such as antiseptic agents, perineal drapes, gloves, lubricant, specimen container, label, and adhesive strips. Local anesthetic gel, antibacterial lubricant, catheter, and drainage system may need to be added. It is wise to check the content of the pre-packaged catheterization set when assembling materials and supplies.
Catheter choices
Silastic catheters have a decreased incidence of urethritis and are recommended for short-term and intermittent catheterization. Latex is the catheter of choice for long-term catheterization. Silastic catheters are recommended for patients who are allergic to latex products.
There are additional types of Foley catheters:
* PTFE-coated latex
* hydrogel-coated latex
* silicone-coated latex
* pure silicone
Select the smallest and softest catheter available. Catheters larger than 18 F are seldom used. Catheters size 14 or 16 F are used more frequently. A size 12 F catheter has been used successfully in catheterizing men with acute urinary retention. When indwelling catheters are required, select a catheter that can be inflated with 5 to 10 ml of sterile water.
Review the design, capacity, and emptying mechanism of a variety of urine drainage systems available. Select the system that is most adaptable to the patient's lifestyle and ability to manage the device independently. For patients with normal bladder sensation, a catheter valve for intermittent drainage may be an acceptable option.
Procedural precautions
Before starting the catheterization, observe the patient's general condition and palpate the suprapubic area to detect gross distension. The genital area should be washed with a mild soap and warm water and patted dry.
Phimosis is constriction of the prepuce (foreskin) so that it cannot be drawn back over the glans penis. This may make it difficult to identify the external urethral meatus. Care should be taken when catheterizing men with phimosis to avoid trauma from forced retraction of the prepuce or by incorrect positioning of the catheter.
The male urethra is longer than the female urethra and has two curves in it as it passes through the penis to the bladder, which makes catheter insertion more difficult. One curve can be straightened out by lifting the penis; the other curve is fixed. The penis should be held upright, at right angle to the patient's body when the catheter is inserted. The male urinary meatus is located at the end of the penis and is exposed by retracting the prepuce in uncircumcised patients. Men with a retracted penis can be even more difficult to catheterize. Gentle finger pressure on both sides of the penis will often cause the penis to emerge and extend from the body to facilitate the catheterization.
To perform the procedure:
* Position the patient in a horizontal recumbent position.
* Place the opened catheterization tray on the bedside stand in comfortable reaching distance.
* Retract the foreskin. Using an aseptic technique, clean the prepuce and insert anesthetic gel to anesthetize the glans penis and dilate the prepuce exposing the meatus. Anesthetic gel can then be introduced into the urethra and catheterization can commence.
* Use two or three aseptic swabs to clean the meatus with circular motion, beginning with the center of the opening and rotating outwards.
* Lubricate about 8 inches (20 cm) of the catheter.
* Hold the penis in the dominant hand and pull it upward and slightly backward to straighten the urethra.
* Gently insert the catheter with a smooth continuous motion until urine begins to flow. Do not force.
* Once the urine starts to flow, collect the specimen. Advance the catheter an additional 5 cm before inflating the balloon with 5 to 10 ml of sterile solution to hold the catheter in place.
* Connect the indwelling catheter to the drainage system. Put a slight curve in the catheter and anchor it to the upper outer thigh with hypoallergenic adhesive to prevent urethral traction.
Aftercare
Patients using intermittent catheterization as treatment of incontinence or retention will have a period of adjustment as they try to establish a catheterization schedule adequate for their normal fluid intake. The urinary drainage system should be kept closed. Breaks in the drainage unit may result in an infection. Avoiding cross-contamination is important in controlling catheter-related UTIs. Practitioners and caretakers should always wash their hands before and after handling a patient's catheter or urine collection unit.
The extended portion of the catheter should be washed with a mild soap and warm water to remove accumulated debris. Patients with indwelling catheters should be re-evaluated periodically to determine if an alternative treatment method will be more effective.
Catheters should not be changed routinely. Each patient should be monitored for indication of obstruction or complications before changing the catheter. Some patients require catheter changes weekly, and others may need a change in several weeks.
In summary, the following guidelines are recommended for male catheterization:
* Catheterize the patient only when it is absolutely necessary.
* Secure the catheter properly.
* Maintain a closed sterile urine collection system and unobstructed urine flow.
* Avoid catheter irrigation unless it is needed to prevent or relieve bladder obstruction.
* Always use the smallest effective catheter.
* Do not change the catheter as an elective treatment option.
* Isolated minor episodes of UTI should not be treated with antibiotics. Antibiotic prophylaxis promotes emergence of drug-resistant bacteria.
* Provide continuing education in catheter care for practitioners and caretakers.
Complications
A few complications that may rise during the procedure are:
* urinary tract infections and catheter obstruction
* trauma and/or the introduction of bacteria into the urinary system, leading to infection and, rarely, septicemia
* trauma to the bladder, urethra, and meatus caused by incorrect insertion of the catheter or forceful removal with the bladder inflated by confused patients
* scaring, stricture and/or narrowing of the urethra due to repeated trauma
* urine bypass around the catheter (A smaller catheter size may minimize leakage.)
* leakage around the catheter due to forceful bladder spasms that overwhelm the catheter's drainage capacity
Results
Urinary catheterization aids or replaces the body's normal ability to urinate. Intermittent use of the procedure can stimulate normal bladder function. However frequent and continuous catheterization can lead to total
dependency. Practically every patient with chronic catheterization and frequent intermittent catheterization will develop bacteriuria. Some physicians do not recommend antibiotic therapy for asymptomatic bacteriuria. When symptomatic infections are treated in patients with indwelling catheters, the catheter is removed and a fresh urine specimen is obtained for culture to determine the source of the infection and direct the medical therapy.
Health care team roles
The physician orders the catheter and a registered nurse performs the procedure and provides patient education. Catheterization is a rather simple procedure, but female nurses are sometimes reluctant to perform urethral catheterization on male patients despite established patient care guidelines and advice on the male catheterization procedure. However, both intermittent and indwelling male catheterization is required to achieve optimum quality of life; therefore nurses should make the best possible practice and techniques available. Before commencing with the catheterization, the health care professional observes the patient's general condition, palpates the pubic area to note gross distension, monitors the patient for indications of infections, and encourages adequate fluid intake.
Patient education
The nurse usually teaches the patient and/or caregiver to use aseptic technique for catheter care. Nursing interventions and patient education can make a difference in the incidence of urinary tract infections in the hospital, nursing homes, and home care units.
The sexuality of the patient with an indwelling catheter for continuous urinary drainage is seldom considered. If a patient is sexually active, the patient or her partner can be taught to remove the catheter before inter-course, and replace it with a new one following inter-course.
KEY TERMS
Bacteriuria—Bacteria in the urine (asymptomatic or symptomatic).
Foley catheter—A double channel retention catheter. One channel provides for the inflow and outflow of fluid; the second and smaller channel is used to fill a balloon that holds the catheter in the bladder.
Phimosis—Tightness of the foreskin, which cannot be drawn back from the glans penis.
Prepuce—A fold of cutaneous tissue over the glans penis.
Urinary catheterization—The insertion of a catheter through the urethra into a patient's bladder.
Urinary incontinence—The inability to retain urine or control one's urine flow.
Urinary retention—The inability to void (urinate) to discharge urine.
Resources
BOOKS
Nettina, Sandra M. Lippincott Manual of Nursing Practice. 7th edition. Philadelphia: Lippincott, 2001, pp.692-697.
PERIODICALS
Cravens, David D. and Steven Zweig. "Urinary Catheter Management." American Family Physician 16, no. 12 (January 15, 2000): 369.
Marchiondo, Kathleen. "A New Look at Urinary Tract Infection." American Journal of Nursing 98, no. 3 (March 1998):p34-39.
Pomfret, Ian. "Women at Work." Nursing Times 95, no. 6 (February 10, 1999): 59-60.
Aliene S. Linwood, BSN, RN, D.P.A., FACHE
Read More ..
Definition
Urinary catheterization is the procedure of inserting a catheter through the urethra into the bladder to remove urine. Intermittent catheterization is performed for periodic relief of bladder distension; indwelling (Foley) catheters are inserted and retained in the bladder for continuous drainage of urine into a closed system.
Purpose
Intermittent catheterization is recommended to obtain a sterile urine specimen, to relieve urinary retention, for urologic surgery or surgery on contiguous structures, for critically ill patients requiring accurate measurement of intake and output, and for temporary obstruction of the bladder opening due to injury.
Indwelling catheterization is recommended for continuous drainage of urine when the bladder outlet obstruction can not be corrected by medical or surgical intervention; in cases of intractable skin ulceration caused or exacerbated by exposure to urine; and as palliative care for terminally ill or severely impaired incontinent patients.
Precautions
The urinary tract is normally a sterile system. The normal flow of urine from the kidneys through the ureters, bladder, and urethra prevents the migration of bacteria up through the urinary system. Antibacterial properties of the bladder wall, urethra, low pH of urine, and the prostatic fluid in men also inhibit bacteria growth. Urinary tract infections (UTI) usually result from bacterial invasion of the protective barriers of one or more urinary structures. As a result, urinary catheterization should be avoided whenever possible. Precautions must be taken to keep the procedure sterile and the catheter free from bacteria. The extended portion of the catheter should be washed with a mild soap and warm water to keep it free of accumulated debris.
Frequent intermittent catheterization and long-term use of indwelling catheters predisposes the patient to UTI. Care should be taken to avoid trauma to the urinary meatus and urothelium (urinary lining) with catheters that are too large or inserted with an insufficient amount of lubricant. Further medical advice should be sought if the catheter cannot be inserted easily, or the patient complains of undue pain or bleeding other than that associated with minor trauma.
Every attempt should be made to keep the urinary drainage system closed. Breaks in the system invite infections. Health care workers and patients should wash their hands before and after manipulation of the patient's catheter or collection system to control UTI. Cross-contamination is the most frequent cause of nosocomial (hospital acquired) catheter related infections. Good hand washing practices are the best prevention measure. Patients with indwelling catheters should be re-evaluated periodically to determine if an alternative treatment method will be more effective.
Description
Intermittent catheterization is preferable to chronic indwelling catheterization in certain patients with bladder dysfunction. It has become the standard care for patients with spinal cord injuries. Elderly patients, following surgical repair of hip fractures, regain the ability to control urination more quickly on a program of intermittent catheterization every six to eight hours compared to the use of indwelling catheters.
Intermittent catheterization may be performed four or five times a day by the health care practitioner or care-giver. Patients who are interested in self-catheterization should be instructed and trained by a qualified health professional. This is also true for patients who require indwelling catheterization, as the procedure for insertion is similar to that for intermittent catheterization, with added responsibility of inflating the balloon.
Preparation
Health care practitioner performing the catheterization should have a good understanding of the male urinary system anatomy and physiology and should be trained in aseptic technique, catheter insertion technique, and catheter care.
Sterile disposable catheterization sets are available in clinical settings and for home use. These sets contain most of the items needed for the procedure, such as antiseptic agents, perineal drapes, gloves, lubricant, specimen container, label, and adhesive strips. Local anesthetic gel, antibacterial lubricant, catheter, and drainage system may need to be added. It is wise to check the content of the pre-packaged catheterization set when assembling materials and supplies.
Catheter choices
Silastic catheters have a decreased incidence of urethritis and are recommended for short-term and intermittent catheterization. Latex is the catheter of choice for long-term catheterization. Silastic catheters are recommended for patients who are allergic to latex products.
There are additional types of Foley catheters:
* PTFE-coated latex
* hydrogel-coated latex
* silicone-coated latex
* pure silicone
Select the smallest and softest catheter available. Catheters larger than 18 F are seldom used. Catheters size 14 or 16 F are used more frequently. A size 12 F catheter has been used successfully in catheterizing men with acute urinary retention. When indwelling catheters are required, select a catheter that can be inflated with 5 to 10 ml of sterile water.
Review the design, capacity, and emptying mechanism of a variety of urine drainage systems available. Select the system that is most adaptable to the patient's lifestyle and ability to manage the device independently. For patients with normal bladder sensation, a catheter valve for intermittent drainage may be an acceptable option.
Procedural precautions
Before starting the catheterization, observe the patient's general condition and palpate the suprapubic area to detect gross distension. The genital area should be washed with a mild soap and warm water and patted dry.
Phimosis is constriction of the prepuce (foreskin) so that it cannot be drawn back over the glans penis. This may make it difficult to identify the external urethral meatus. Care should be taken when catheterizing men with phimosis to avoid trauma from forced retraction of the prepuce or by incorrect positioning of the catheter.
The male urethra is longer than the female urethra and has two curves in it as it passes through the penis to the bladder, which makes catheter insertion more difficult. One curve can be straightened out by lifting the penis; the other curve is fixed. The penis should be held upright, at right angle to the patient's body when the catheter is inserted. The male urinary meatus is located at the end of the penis and is exposed by retracting the prepuce in uncircumcised patients. Men with a retracted penis can be even more difficult to catheterize. Gentle finger pressure on both sides of the penis will often cause the penis to emerge and extend from the body to facilitate the catheterization.
To perform the procedure:
* Position the patient in a horizontal recumbent position.
* Place the opened catheterization tray on the bedside stand in comfortable reaching distance.
* Retract the foreskin. Using an aseptic technique, clean the prepuce and insert anesthetic gel to anesthetize the glans penis and dilate the prepuce exposing the meatus. Anesthetic gel can then be introduced into the urethra and catheterization can commence.
* Use two or three aseptic swabs to clean the meatus with circular motion, beginning with the center of the opening and rotating outwards.
* Lubricate about 8 inches (20 cm) of the catheter.
* Hold the penis in the dominant hand and pull it upward and slightly backward to straighten the urethra.
* Gently insert the catheter with a smooth continuous motion until urine begins to flow. Do not force.
* Once the urine starts to flow, collect the specimen. Advance the catheter an additional 5 cm before inflating the balloon with 5 to 10 ml of sterile solution to hold the catheter in place.
* Connect the indwelling catheter to the drainage system. Put a slight curve in the catheter and anchor it to the upper outer thigh with hypoallergenic adhesive to prevent urethral traction.
Aftercare
Patients using intermittent catheterization as treatment of incontinence or retention will have a period of adjustment as they try to establish a catheterization schedule adequate for their normal fluid intake. The urinary drainage system should be kept closed. Breaks in the drainage unit may result in an infection. Avoiding cross-contamination is important in controlling catheter-related UTIs. Practitioners and caretakers should always wash their hands before and after handling a patient's catheter or urine collection unit.
The extended portion of the catheter should be washed with a mild soap and warm water to remove accumulated debris. Patients with indwelling catheters should be re-evaluated periodically to determine if an alternative treatment method will be more effective.
Catheters should not be changed routinely. Each patient should be monitored for indication of obstruction or complications before changing the catheter. Some patients require catheter changes weekly, and others may need a change in several weeks.
In summary, the following guidelines are recommended for male catheterization:
* Catheterize the patient only when it is absolutely necessary.
* Secure the catheter properly.
* Maintain a closed sterile urine collection system and unobstructed urine flow.
* Avoid catheter irrigation unless it is needed to prevent or relieve bladder obstruction.
* Always use the smallest effective catheter.
* Do not change the catheter as an elective treatment option.
* Isolated minor episodes of UTI should not be treated with antibiotics. Antibiotic prophylaxis promotes emergence of drug-resistant bacteria.
* Provide continuing education in catheter care for practitioners and caretakers.
Complications
A few complications that may rise during the procedure are:
* urinary tract infections and catheter obstruction
* trauma and/or the introduction of bacteria into the urinary system, leading to infection and, rarely, septicemia
* trauma to the bladder, urethra, and meatus caused by incorrect insertion of the catheter or forceful removal with the bladder inflated by confused patients
* scaring, stricture and/or narrowing of the urethra due to repeated trauma
* urine bypass around the catheter (A smaller catheter size may minimize leakage.)
* leakage around the catheter due to forceful bladder spasms that overwhelm the catheter's drainage capacity
Results
Urinary catheterization aids or replaces the body's normal ability to urinate. Intermittent use of the procedure can stimulate normal bladder function. However frequent and continuous catheterization can lead to total
dependency. Practically every patient with chronic catheterization and frequent intermittent catheterization will develop bacteriuria. Some physicians do not recommend antibiotic therapy for asymptomatic bacteriuria. When symptomatic infections are treated in patients with indwelling catheters, the catheter is removed and a fresh urine specimen is obtained for culture to determine the source of the infection and direct the medical therapy.
Health care team roles
The physician orders the catheter and a registered nurse performs the procedure and provides patient education. Catheterization is a rather simple procedure, but female nurses are sometimes reluctant to perform urethral catheterization on male patients despite established patient care guidelines and advice on the male catheterization procedure. However, both intermittent and indwelling male catheterization is required to achieve optimum quality of life; therefore nurses should make the best possible practice and techniques available. Before commencing with the catheterization, the health care professional observes the patient's general condition, palpates the pubic area to note gross distension, monitors the patient for indications of infections, and encourages adequate fluid intake.
Patient education
The nurse usually teaches the patient and/or caregiver to use aseptic technique for catheter care. Nursing interventions and patient education can make a difference in the incidence of urinary tract infections in the hospital, nursing homes, and home care units.
The sexuality of the patient with an indwelling catheter for continuous urinary drainage is seldom considered. If a patient is sexually active, the patient or her partner can be taught to remove the catheter before inter-course, and replace it with a new one following inter-course.
KEY TERMS
Bacteriuria—Bacteria in the urine (asymptomatic or symptomatic).
Foley catheter—A double channel retention catheter. One channel provides for the inflow and outflow of fluid; the second and smaller channel is used to fill a balloon that holds the catheter in the bladder.
Phimosis—Tightness of the foreskin, which cannot be drawn back from the glans penis.
Prepuce—A fold of cutaneous tissue over the glans penis.
Urinary catheterization—The insertion of a catheter through the urethra into a patient's bladder.
Urinary incontinence—The inability to retain urine or control one's urine flow.
Urinary retention—The inability to void (urinate) to discharge urine.
Resources
BOOKS
Nettina, Sandra M. Lippincott Manual of Nursing Practice. 7th edition. Philadelphia: Lippincott, 2001, pp.692-697.
PERIODICALS
Cravens, David D. and Steven Zweig. "Urinary Catheter Management." American Family Physician 16, no. 12 (January 15, 2000): 369.
Marchiondo, Kathleen. "A New Look at Urinary Tract Infection." American Journal of Nursing 98, no. 3 (March 1998):p34-39.
Pomfret, Ian. "Women at Work." Nursing Times 95, no. 6 (February 10, 1999): 59-60.
Aliene S. Linwood, BSN, RN, D.P.A., FACHE
Read More ..
Advanced Practice Nurse
Definition
Advanced practice nurses are typically those nurses prepared at the master's or doctoral level, and they fall into four categories of clinicians: clinical nurse specialists, certified registered nurse anesthetists, nurse practitioners, and certified nurse-midwives.
Description
Clinical nurse specialists
Clinical nurse specialists (CNSs) are licensed registered nurses (RNs) with additional master's or doctorate-level training in CNS. These advanced practice nurses are clinical experts in theory-based or research-based nursing, focusing on specific specialty areas.
CNSs have broadened patient care roles because of their advanced training. In some states, they have the authority to prescribe medications.
CNSs assume many roles within the health care delivery system. While many are in the clinical setting, others work as educators, administrators, consultants, researchers, change agents, and case managers. CNSs can become specialized in the areas of adult psychiatry, child psychology, community health, home health, gerontology, and medical-surgical, as well as oncology, perinatal critical care, critical care, and rehabilitation. Some nurses in areas of specialty certification classify themselves as CNSs, others use the umbrella term of advanced practice nursing
In March 2000, the number of RNs prepared to practice in at least one advanced practice role was estimated to be about 7.3% of the total RN population. The largest group among the advanced practice nurses was the nurse practitioners, followed by the CNSs. These two groups together made up about 80% of all advanced practice nurses. Although about 36.9% of the CNSs were employed in nursing, only about 24% were practicing under the position title of CNS. Nearly 25% of CNSs reported working in nursing education positions.
Certified registered nurse anesthetist
Nurse anesthesia is the oldest of the advanced nursing specialties. These advanced clinical nurses, called certified registered nurse anesthetists (CRNAs), administer about 65% of the anesthetics given to patients annually in the United States.
Nurse anesthetists make up the third largest group of advanced practice nurses, and were the first professional group in the United States to provide anesthesia services in the 1800s. Their role in surgery is to keep patients as comfortable, pain free, and safe as possible. Nurse anesthetists perform patient physical assessments; take part in preoperative teaching; develop, prepare, and implement the anesthesia plan; select, obtain, and administer anesthesia and other medications and fluids needed to manage the anesthetic; maintain anesthesia throughout the operation and manage the patient's airway and pulmonary status; respond as necessary to emergency situations ensuring airway management, administering emergency fluids or medications, and performing cardiac life support techniques; and follow patients through recovery and into the patient care unit. Essentially, they take care of patients before, during, and after having surgery or giving birth.
CRNAs can sub-specialize in pediatric, obstetric, cardiovascular, plastic, dental, or neurosurgical anesthesia. Some have credentials in critical care nursing and respiratory care.
Nurse practitioner
Nurse practitioners (NPs) are registered nurses who have advanced academic and clinical experience. Because of this additional training, NPs can diagnose and manage common and chronic illnesses, independently or as part of a health care team. Nurse practitioners often can provide primary care previously offered only by doctors and, in many states, they prescribe medications. While in many cases NPs work in collaboration with physicians, NPs have the authority to practice without a physician collaboration or supervision in 18 states.
NPs perform physical exams; diagnose and treat many acute illnesses and injuries; provide immunizations; manage high blood pressure, diabetes, and other chronic conditions; order and interpret x rays and other lab tests; and counsel and educate patients about how they can live healthy lifestyles. NPs focus much of their practice on health maintenance, disease prevention, patient education, and counseling. While they have a strong emphasis on primary care, NPs practice in a wide variety of specialties, including neonatology, obgyn, pediatrics, school health, family and adult health, mental health, home care, geriatrics, and acute care.
Certified nurse-midwife
Certified nurse-midwives (CNMs) focus on the independent management of women's health care, particularly on pregnancy, childbirth, the postpartum period, care of the newborn and the family planning, and gynecological needs of women. They have the authority to write prescriptions. CNMs deliver babies in all types of health care settings, as well as in private homes, and provide primary health care to women, often helping them to realize personal fulfillment through labor and birth. CNMs work independently and in collaboration with other health care providers. They also teach and conduct research.
The trend seems to be that more people are choosing CNMs. As of 1998, there were nearly 278,000 CNM-attended births in the United States. About 400 nurse-midwives pass the national certification exam each year. The practice of nurse-midwifery is legal in all states and the District of Columbia. These advanced practice nurses have prescription-writing ability in 50 states and jurisdictions. Ninety percent of all visits to CNMs are for primary and preventive care. Seventy percent of that was for care during pregnancy and after birth, while 20% was for care outside of the maternity cycle.
Work settings
Clinical nurse specialists
CNSs work in the acute care, long-term care, and intermediate care settings. They work in clinical education within health care facilities, as well as in nursing education programs as faculty teaching nursing. Other settings in which CNSs work include outpatient and ambulatory care, private practice, home health, physician office practice, sub-acute care, government or military service, community health centers, health care administration, private industry (working for drug companies or manufacturers, in managed care and other areas of the private sector), and nurse-managed centers. Within these categories, CNSs work in assisted living facilities; specialized hospital areas, such as cardiac catheterization labs; correctional facilities; dialysis units; parish nursing; and psychiatric hospitals.
Certified registered nurse anesthetist
Nurse anesthetists can work with an physician anesthesiologist, independently or in groups as providers of anesthetics. They work as part of a medical team or independently in any setting in which anesthesia is given, including doctors' and dentists' offices, pain clinics, operating rooms of hospitals, and ambulatory surgery settings. CRNAs who work independently or in groups might have contracts with physicians or hospitals. Some CRNAs work in private practices, while others choose the public sector or the U.S. military. They work in universities as instructors and in research settings as investigators, collaborators, consultants, assistants, interpreters, and researchers. CRNAs also work in surgical and obstetric environments in MRI units, cardiac catheterization labs, and lithotripsy units. In these environments, they provide consultation and implementation of respiratory and ventilatory care, manage emergency situations, and start or participate in airway maintenance, ventilation, and tracheal intubation during CPR.
Nurse practitioner
Nurse practitioners work in metropolitan area clinics and hospitals, as well as in rural areas, inner cities, and medically underserved locations. They work in schools, caring for children, and in nursing homes and assisted living facilities, caring for the elderly and others. NPs work in pediatric, family health, women's health, and other specialty settings. Some work in private practices or in nurse-run group practices.
Certified nurse-midwife
CNMs work in clinical practice in public, university, and military hospitals. They also work in health maintenance organizations, private practices, and birthing centers. Many practice in public heath clinic, and some provide home birth services. More than 50% of CNMs work most often in the office or clinic environment, listing a hospital or physician practice as their employer.
Education and training
Clinical nurse specialists
Nurses must have a baccalaureate degree or its equivalent to enroll in a CNS program. To use the title of CNS, the CNS must have a minimum of a master's degree from an education program that prepares CNSs. The training is graduate-level education. Some universities have a fast track program whereby they will accept individuals who do not have a baccalaureate and move them into a master's program. CNSs also take a certification exam in a specialty, offered by one of the nationally recognized certification entities.
CNS students go through advanced theory and practice training, revolving around the three areas of influence that impact on direct patient care, supervising direct patient care, and patient care systems.
The American Nurses Credentialing Center certifies CNSs as adult psychiatric, child psychology, community health, home health, gerontology, and medical-surgical CNSs. There also are other certifying bodies, including the Rehabilitation Nursing Certification Board, Oncology Nursing Certification Corporation, and American Association of Critical Care Nurses Certification.
The doctoral-level CNS typically focuses on research.
Certified registered nurse anesthetist
Nurse anesthetists are registered nurses who complete two to three years of higher education, beyond the bachelor's of nursing degree or other appropriate baccalaureate degree. They attend accredited nurse anesthesia educations programs, covering all areas of anesthesia. After completing an accredited program, nurse anesthetists must pass a national certification exam to obtain the CRNA designation.
The education for a nurse anesthetist involves about 24 to 36 months of graduate course work. It includes classroom and clinical experience.
In most cases, to be accepted into an accredited school, those who aspire to become nurse anesthetists must have an appropriate four-year degree, an RN license, and at least one year of acute care nursing experience, which varies by program.
Nurse practitioner
NPs receive their advanced educations through programs that award master's degrees. RNs who aspire to become NPs should have extensive clinical experience before applying to an NP program. NP programs include the components of an intensive preceptorship under the direct supervision of a physician or experienced NP and instruction in nursing theory. An increasing number of nurses are becoming prepared as both NPs and CNSs. Those prepared in both roles are more likely to function as nurse practitioners.
Certified nurse-midwife
CNMs are educated in the two disciplines of nursing and midwifery. They must possess evidence of certification according to the requirements of the American College of Nurse-Midwives. Being an RN is a requirement to become a certified nurse-midwife. In some cases, those with baccalaureate degrees in other fields are considered. Upon graduation, CNMs can receive MS (master's of science), MSN (master's of science in nursing), MPH (master's of public health) degrees or a doctoral degree. About 68% of CNMs have master's degrees, while 4% have doctoral degrees. There are also those who graduate with a certificate or from a nurse-midwifery education program. However, the number of states and employers who require master's-prepared CNMs is increasing. Once in the program, student CNMs receive labor and delivery experience in different types of settings. They must pass a national certification exam to call themselves CNMs.
Advanced education and training
All advanced practice nurses with master's degree can go on to get their doctorate degrees. Often, those with doctorate-level training go into research, administration, or teaching at the university level.
Future outlook
The outlook is good for all types of nurses, especially those at the RN level or higher. It is projected that if current trends continue, demand will exceed supply of RNs by about 2010. It is possible that as many as 114,000 jobs for full-time-equivalent RNs are going to go unfilled nationwide by 2015. This is due to a growing elderly population with mounting health care needs, an aging RN workforce, the expansion of primary care, and technological advances that require more highly trained nurses.
There is a growing demand for RNs with advanced clinical skills. Almost all who graduate have jobs waiting for them.
Resources
ORGANIZATIONS
American Association of Colleges of Nursing. One Dupont Circle, NW, Suite 530, Washington, DC 20036. (202) 463-6930..
American Association of Nurse Anesthetists. 222 South Prospect Avenue, Park Ridge, IL 60068-4001. (847) 692-7050..
American College of Nurse-Midwives. 818 Connecticut Ave. NW, Suite 900, Washington, DC 20006. (202) 738-9860..
American College of Nurse Practitioners. 503 Capitol Ct. NE, #300, Washington, DC 20002. (202) 546-4825..
American Nurses Association. 600 Maryland Avenue, SW, Suite 100 West, Washington, DC 20024. (800) 274-4ANA..
National Association of Clinical Nurse Specialists. 3969 Green Street, Harrisburg, PA 17110-1575. (717) 234-6799..
OTHER
The Registered Nurse Population National Sample Survey of Registered Nurses—March 2000. U.S. Department of Health and Human Services, Health Resources and Services administration. Bureau of Health Professions. Division of Nursing..
http://www.enotes.com
Read More ..
Advanced practice nurses are typically those nurses prepared at the master's or doctoral level, and they fall into four categories of clinicians: clinical nurse specialists, certified registered nurse anesthetists, nurse practitioners, and certified nurse-midwives.
Description
Clinical nurse specialists
Clinical nurse specialists (CNSs) are licensed registered nurses (RNs) with additional master's or doctorate-level training in CNS. These advanced practice nurses are clinical experts in theory-based or research-based nursing, focusing on specific specialty areas.
CNSs have broadened patient care roles because of their advanced training. In some states, they have the authority to prescribe medications.
CNSs assume many roles within the health care delivery system. While many are in the clinical setting, others work as educators, administrators, consultants, researchers, change agents, and case managers. CNSs can become specialized in the areas of adult psychiatry, child psychology, community health, home health, gerontology, and medical-surgical, as well as oncology, perinatal critical care, critical care, and rehabilitation. Some nurses in areas of specialty certification classify themselves as CNSs, others use the umbrella term of advanced practice nursing
In March 2000, the number of RNs prepared to practice in at least one advanced practice role was estimated to be about 7.3% of the total RN population. The largest group among the advanced practice nurses was the nurse practitioners, followed by the CNSs. These two groups together made up about 80% of all advanced practice nurses. Although about 36.9% of the CNSs were employed in nursing, only about 24% were practicing under the position title of CNS. Nearly 25% of CNSs reported working in nursing education positions.
Certified registered nurse anesthetist
Nurse anesthesia is the oldest of the advanced nursing specialties. These advanced clinical nurses, called certified registered nurse anesthetists (CRNAs), administer about 65% of the anesthetics given to patients annually in the United States.
Nurse anesthetists make up the third largest group of advanced practice nurses, and were the first professional group in the United States to provide anesthesia services in the 1800s. Their role in surgery is to keep patients as comfortable, pain free, and safe as possible. Nurse anesthetists perform patient physical assessments; take part in preoperative teaching; develop, prepare, and implement the anesthesia plan; select, obtain, and administer anesthesia and other medications and fluids needed to manage the anesthetic; maintain anesthesia throughout the operation and manage the patient's airway and pulmonary status; respond as necessary to emergency situations ensuring airway management, administering emergency fluids or medications, and performing cardiac life support techniques; and follow patients through recovery and into the patient care unit. Essentially, they take care of patients before, during, and after having surgery or giving birth.
CRNAs can sub-specialize in pediatric, obstetric, cardiovascular, plastic, dental, or neurosurgical anesthesia. Some have credentials in critical care nursing and respiratory care.
Nurse practitioner
Nurse practitioners (NPs) are registered nurses who have advanced academic and clinical experience. Because of this additional training, NPs can diagnose and manage common and chronic illnesses, independently or as part of a health care team. Nurse practitioners often can provide primary care previously offered only by doctors and, in many states, they prescribe medications. While in many cases NPs work in collaboration with physicians, NPs have the authority to practice without a physician collaboration or supervision in 18 states.
NPs perform physical exams; diagnose and treat many acute illnesses and injuries; provide immunizations; manage high blood pressure, diabetes, and other chronic conditions; order and interpret x rays and other lab tests; and counsel and educate patients about how they can live healthy lifestyles. NPs focus much of their practice on health maintenance, disease prevention, patient education, and counseling. While they have a strong emphasis on primary care, NPs practice in a wide variety of specialties, including neonatology, obgyn, pediatrics, school health, family and adult health, mental health, home care, geriatrics, and acute care.
Certified nurse-midwife
Certified nurse-midwives (CNMs) focus on the independent management of women's health care, particularly on pregnancy, childbirth, the postpartum period, care of the newborn and the family planning, and gynecological needs of women. They have the authority to write prescriptions. CNMs deliver babies in all types of health care settings, as well as in private homes, and provide primary health care to women, often helping them to realize personal fulfillment through labor and birth. CNMs work independently and in collaboration with other health care providers. They also teach and conduct research.
The trend seems to be that more people are choosing CNMs. As of 1998, there were nearly 278,000 CNM-attended births in the United States. About 400 nurse-midwives pass the national certification exam each year. The practice of nurse-midwifery is legal in all states and the District of Columbia. These advanced practice nurses have prescription-writing ability in 50 states and jurisdictions. Ninety percent of all visits to CNMs are for primary and preventive care. Seventy percent of that was for care during pregnancy and after birth, while 20% was for care outside of the maternity cycle.
Work settings
Clinical nurse specialists
CNSs work in the acute care, long-term care, and intermediate care settings. They work in clinical education within health care facilities, as well as in nursing education programs as faculty teaching nursing. Other settings in which CNSs work include outpatient and ambulatory care, private practice, home health, physician office practice, sub-acute care, government or military service, community health centers, health care administration, private industry (working for drug companies or manufacturers, in managed care and other areas of the private sector), and nurse-managed centers. Within these categories, CNSs work in assisted living facilities; specialized hospital areas, such as cardiac catheterization labs; correctional facilities; dialysis units; parish nursing; and psychiatric hospitals.
Certified registered nurse anesthetist
Nurse anesthetists can work with an physician anesthesiologist, independently or in groups as providers of anesthetics. They work as part of a medical team or independently in any setting in which anesthesia is given, including doctors' and dentists' offices, pain clinics, operating rooms of hospitals, and ambulatory surgery settings. CRNAs who work independently or in groups might have contracts with physicians or hospitals. Some CRNAs work in private practices, while others choose the public sector or the U.S. military. They work in universities as instructors and in research settings as investigators, collaborators, consultants, assistants, interpreters, and researchers. CRNAs also work in surgical and obstetric environments in MRI units, cardiac catheterization labs, and lithotripsy units. In these environments, they provide consultation and implementation of respiratory and ventilatory care, manage emergency situations, and start or participate in airway maintenance, ventilation, and tracheal intubation during CPR.
Nurse practitioner
Nurse practitioners work in metropolitan area clinics and hospitals, as well as in rural areas, inner cities, and medically underserved locations. They work in schools, caring for children, and in nursing homes and assisted living facilities, caring for the elderly and others. NPs work in pediatric, family health, women's health, and other specialty settings. Some work in private practices or in nurse-run group practices.
Certified nurse-midwife
CNMs work in clinical practice in public, university, and military hospitals. They also work in health maintenance organizations, private practices, and birthing centers. Many practice in public heath clinic, and some provide home birth services. More than 50% of CNMs work most often in the office or clinic environment, listing a hospital or physician practice as their employer.
Education and training
Clinical nurse specialists
Nurses must have a baccalaureate degree or its equivalent to enroll in a CNS program. To use the title of CNS, the CNS must have a minimum of a master's degree from an education program that prepares CNSs. The training is graduate-level education. Some universities have a fast track program whereby they will accept individuals who do not have a baccalaureate and move them into a master's program. CNSs also take a certification exam in a specialty, offered by one of the nationally recognized certification entities.
CNS students go through advanced theory and practice training, revolving around the three areas of influence that impact on direct patient care, supervising direct patient care, and patient care systems.
The American Nurses Credentialing Center certifies CNSs as adult psychiatric, child psychology, community health, home health, gerontology, and medical-surgical CNSs. There also are other certifying bodies, including the Rehabilitation Nursing Certification Board, Oncology Nursing Certification Corporation, and American Association of Critical Care Nurses Certification.
The doctoral-level CNS typically focuses on research.
Certified registered nurse anesthetist
Nurse anesthetists are registered nurses who complete two to three years of higher education, beyond the bachelor's of nursing degree or other appropriate baccalaureate degree. They attend accredited nurse anesthesia educations programs, covering all areas of anesthesia. After completing an accredited program, nurse anesthetists must pass a national certification exam to obtain the CRNA designation.
The education for a nurse anesthetist involves about 24 to 36 months of graduate course work. It includes classroom and clinical experience.
In most cases, to be accepted into an accredited school, those who aspire to become nurse anesthetists must have an appropriate four-year degree, an RN license, and at least one year of acute care nursing experience, which varies by program.
Nurse practitioner
NPs receive their advanced educations through programs that award master's degrees. RNs who aspire to become NPs should have extensive clinical experience before applying to an NP program. NP programs include the components of an intensive preceptorship under the direct supervision of a physician or experienced NP and instruction in nursing theory. An increasing number of nurses are becoming prepared as both NPs and CNSs. Those prepared in both roles are more likely to function as nurse practitioners.
Certified nurse-midwife
CNMs are educated in the two disciplines of nursing and midwifery. They must possess evidence of certification according to the requirements of the American College of Nurse-Midwives. Being an RN is a requirement to become a certified nurse-midwife. In some cases, those with baccalaureate degrees in other fields are considered. Upon graduation, CNMs can receive MS (master's of science), MSN (master's of science in nursing), MPH (master's of public health) degrees or a doctoral degree. About 68% of CNMs have master's degrees, while 4% have doctoral degrees. There are also those who graduate with a certificate or from a nurse-midwifery education program. However, the number of states and employers who require master's-prepared CNMs is increasing. Once in the program, student CNMs receive labor and delivery experience in different types of settings. They must pass a national certification exam to call themselves CNMs.
Advanced education and training
All advanced practice nurses with master's degree can go on to get their doctorate degrees. Often, those with doctorate-level training go into research, administration, or teaching at the university level.
Future outlook
The outlook is good for all types of nurses, especially those at the RN level or higher. It is projected that if current trends continue, demand will exceed supply of RNs by about 2010. It is possible that as many as 114,000 jobs for full-time-equivalent RNs are going to go unfilled nationwide by 2015. This is due to a growing elderly population with mounting health care needs, an aging RN workforce, the expansion of primary care, and technological advances that require more highly trained nurses.
There is a growing demand for RNs with advanced clinical skills. Almost all who graduate have jobs waiting for them.
Resources
ORGANIZATIONS
American Association of Colleges of Nursing. One Dupont Circle, NW, Suite 530, Washington, DC 20036. (202) 463-6930.
American Association of Nurse Anesthetists. 222 South Prospect Avenue, Park Ridge, IL 60068-4001. (847) 692-7050.
American College of Nurse-Midwives. 818 Connecticut Ave. NW, Suite 900, Washington, DC 20006. (202) 738-9860.
American College of Nurse Practitioners. 503 Capitol Ct. NE, #300, Washington, DC 20002. (202) 546-4825.
American Nurses Association. 600 Maryland Avenue, SW, Suite 100 West, Washington, DC 20024. (800) 274-4ANA.
National Association of Clinical Nurse Specialists. 3969 Green Street, Harrisburg, PA 17110-1575. (717) 234-6799.
OTHER
The Registered Nurse Population National Sample Survey of Registered Nurses—March 2000. U.S. Department of Health and Human Services, Health Resources and Services administration. Bureau of Health Professions. Division of Nursing.
http://www.enotes.com
Tuesday, December 29, 2009
Airway Management
enotes.com,
Definition
Airway management involves ensuring that the patient has a patent airway through which effective ventilation can take place.
Purpose
An obstructed airway means that the body is deprived of oxygen. If ventilation is not reestablished, brain death will occur within minutes. The primary purpose of airway management is to provide a continuously open airway along with a continuous source of oxygen. When a patient is critically ill and requires an artificial airway and mechanical ventilation, it is the responsibility of the healthcare professionals caring for the patient to ensure that the airway is secure.
Another goal of airway management is to provide an artificial airway that is as close to the patient's natural airway as possible. This may mean mechanically performing physiological functions such as humidifying inspired air and removing secretions.
Precautions
Airway management is a necessity for any patient who has an artificial airway. If the patient is restless or agitated, it is recommended that activities such as suctioning or endotracheal tube care be postponed until either the patient is calm or a sedative has been given. This is to avoid inadvertent removal of the airway. However, if the patient's respiratory status is unstable, suctioning or repositioning the endotracheal tube should be done if it will stabilize the patient.
Description
Airway management consists of much more than just keeping the breathing tube in the correct position. The tube must be managed so that it allows optimal ventilation with the fewest complications.
Humidification
Humidification of inspired air normally takes place in the upper respiratory tract. When this area is bypassed by an artificial airway (such as an endotracheal or tracheostomy tube), humidification must be performed out-side the body. If supplemental oxygen is used, it will require humidification to prevent drying and irritation of the respiratory tract and to facilitate removal of secretions. There are humidification devices available that can be attached to oxygen flow meters or ventilators.
Suctioning
Suctioning consists of inserting a sterile catheter into the endotracheal or tracheostomy tube in order to remove secretions. This is an extremely important part of caring for a patient with an artificial airway, since the reflex of coughing, which would normally remove these secretions, is not effective. The patient will experience respiratory distress if the tube is obstructed by sputum. Suctioning should be performed only when the patient
needs it; however, the need should be assessed at least every two hours.
A number of studies have been done to find ways to minimize the complications of suctioning. Equipment should be sterilized to decrease the risk of infection. There are now closed suction systems available that are attached to the ventilator tubing on one end and to the artificial airway on the other. The catheter remains protected inside a sterile plastic sleeve that is changed every 24 hours. This system limits the amount of times the tubing must be disconnected from the airway, thus reducing exposure of the trachea to environmental contaminants.
Suctioning causes oxygen deprivation for the time that the suction is applied. Hypoxemia can be minimized by preoxygenating the patient with 100% oxygen prior to suctioning and between each pass of the suction catheter. (This can be done by either pushing the 100% oxygen button on the ventilator or by using a bag-valve-mask device.) The patient's pulse oximetry should be monitored while suctioning. The duration of each suction pass should be limited to 10 seconds and the number of passes should be limited to three or less if possible. This decreases hypoxemia and airway trauma. Studies have shown that using intermittent suction is no more beneficial than continuous suction.
Installation of a small amount of saline prior to suctioning was a common procedure in the past. It was thought that saline helped to loosen secretions and to facilitate their removal, but studies have shown this is not the case. On the contrary, saline installation has been shown to increase infection rates and to cause decreased oxygen levels for longer periods than suctioning without saline use. This procedure is no longer regarded as beneficial.
Preparation
Preparation for airway management includes explaining all procedures that will be performed to the patient. Often, patients who are receiving mechanical ventilation are kept sedated or even paralyzed to facilitate optimal ventilation. The level of sedation should be assessed. If patients are not receiving continuous infusions of a sedating drug, they may have a physician's order for sedation as needed. If they are agitated, they should be given the prescribed dose of sedation prior to performing any airway-related procedures, to ensure that the airway is not inadvertently removed.
Patients receiving mechanical ventilation also often have bilateral soft wrist restraints applied to prevent accidental removal of the artificial airway. It is recommended that these be securely fastened before starting an airway-related procedure, or that another healthcare professional be at the bedside to help calm and hold the patient. Also, all needed supplies should be at the bedside prior to starting a procedure, so as to not cause excess discomfort or stress for the patient.
Aftercare
After the procedure is finished, the patient should be reassured if necessary and their respiratory status should be reassessed. The insertion point of the airway should be confirmed to be at the same place as prior to the procedure, unless the purpose was to change the depth of the tube. If the airway has been manipulated since suctioning, the patient may require suctioning again. Any waste should be disposed of in the garbage or in a biohazard container if there is a large amount of blood. Prior to the healthcare professional leaving the room, the patient should be made comfortable, further sedation or pain medication should be administered as needed and the patient should be confirmed to be stable.
Complications
The greatest risk of airway management is that the airway may be inadvertently removed, causing the patient to have respiratory distress. Procedures that require manipulating the airway may cause fear or agitation for patients if they feel that they do not have control over their breathing. If the patient becomes combative, it can be very difficult to finish the procedure without disturbing the airway.
Results
The anticipated outcomes of airway management are a continuously open airway through which effective ventilation can take place, and prevention of infection.
Health care team roles
The nurse and respiratory therapist are equally responsible for monitoring and managing artificial airways. Both perform sterile suctioning and both document their assessment of the patient's respiratory status. The respiratory therapist is generally responsible for managing the ventilator, adding humidification, and changing ventilator tubing.
If the patient is accidentally extubated (the airway is removed), both the nurse and respiratory therapist must assist in reinsertion. This is usually done by an anesthesiologist, a certified registered nurse anesthetist (CRNA), a medical resident, or another physician. The respiratory therapist is generally responsible for ventilating the patient with a bag-valve-mask device until reintubation (reinsertion of the airway), while the nurse gathers equipment, administers medications, and monitors the patient's pulse oximetry, vital signs, and cardiac rhythm.
The nurse and respiratory therapist are also responsible for finding alternative means for the patient to communicate. Artificial airways are inserted through the vocal cords, making speaking impossible. The patient should be encouraged to try alternative methods such as mouthing words, writing, or pointing to letters, words, or pictures on a communication board. Communicating with these patients takes great patience and creativity, as well as dedication to helping them feel like their needs are being met.
KEY TERMS
Bag-valve-mask device—Device consisting of a manually compressible bag containing oxygen and a one-way valve and mask that fits over the mouth and nose of the patient.
Endotracheal tube—Tube inserted into the trachea via either the oral or nasal cavity for the purpose of providing a secure airway.
Hypoxemia—Abnormal deficiency of oxygen in the arterial blood.
Oxygen flow meter—Meter attached to a oxygen source that controls the amount of supplemental oxygen the patient receives.
Pulse oximeter—Noninvasive machine that measures the amount of hemoglobin that is saturated with oxygen.
Tracheostomy tube—Surgically created opening in the trachea for the purpose of providing a secure airway. This is used when the patient requires long-term ventilatory assistance.
Ventilator (mechanical ventilation)—Device used to provide assisted respiration and positive pressure breathing.
Read More ..
Definition
Airway management involves ensuring that the patient has a patent airway through which effective ventilation can take place.
Purpose
An obstructed airway means that the body is deprived of oxygen. If ventilation is not reestablished, brain death will occur within minutes. The primary purpose of airway management is to provide a continuously open airway along with a continuous source of oxygen. When a patient is critically ill and requires an artificial airway and mechanical ventilation, it is the responsibility of the healthcare professionals caring for the patient to ensure that the airway is secure.
Another goal of airway management is to provide an artificial airway that is as close to the patient's natural airway as possible. This may mean mechanically performing physiological functions such as humidifying inspired air and removing secretions.
Precautions
Airway management is a necessity for any patient who has an artificial airway. If the patient is restless or agitated, it is recommended that activities such as suctioning or endotracheal tube care be postponed until either the patient is calm or a sedative has been given. This is to avoid inadvertent removal of the airway. However, if the patient's respiratory status is unstable, suctioning or repositioning the endotracheal tube should be done if it will stabilize the patient.
Description
Airway management consists of much more than just keeping the breathing tube in the correct position. The tube must be managed so that it allows optimal ventilation with the fewest complications.
Humidification
Humidification of inspired air normally takes place in the upper respiratory tract. When this area is bypassed by an artificial airway (such as an endotracheal or tracheostomy tube), humidification must be performed out-side the body. If supplemental oxygen is used, it will require humidification to prevent drying and irritation of the respiratory tract and to facilitate removal of secretions. There are humidification devices available that can be attached to oxygen flow meters or ventilators.
Suctioning
Suctioning consists of inserting a sterile catheter into the endotracheal or tracheostomy tube in order to remove secretions. This is an extremely important part of caring for a patient with an artificial airway, since the reflex of coughing, which would normally remove these secretions, is not effective. The patient will experience respiratory distress if the tube is obstructed by sputum. Suctioning should be performed only when the patient
needs it; however, the need should be assessed at least every two hours.
A number of studies have been done to find ways to minimize the complications of suctioning. Equipment should be sterilized to decrease the risk of infection. There are now closed suction systems available that are attached to the ventilator tubing on one end and to the artificial airway on the other. The catheter remains protected inside a sterile plastic sleeve that is changed every 24 hours. This system limits the amount of times the tubing must be disconnected from the airway, thus reducing exposure of the trachea to environmental contaminants.
Suctioning causes oxygen deprivation for the time that the suction is applied. Hypoxemia can be minimized by preoxygenating the patient with 100% oxygen prior to suctioning and between each pass of the suction catheter. (This can be done by either pushing the 100% oxygen button on the ventilator or by using a bag-valve-mask device.) The patient's pulse oximetry should be monitored while suctioning. The duration of each suction pass should be limited to 10 seconds and the number of passes should be limited to three or less if possible. This decreases hypoxemia and airway trauma. Studies have shown that using intermittent suction is no more beneficial than continuous suction.
Installation of a small amount of saline prior to suctioning was a common procedure in the past. It was thought that saline helped to loosen secretions and to facilitate their removal, but studies have shown this is not the case. On the contrary, saline installation has been shown to increase infection rates and to cause decreased oxygen levels for longer periods than suctioning without saline use. This procedure is no longer regarded as beneficial.
Preparation
Preparation for airway management includes explaining all procedures that will be performed to the patient. Often, patients who are receiving mechanical ventilation are kept sedated or even paralyzed to facilitate optimal ventilation. The level of sedation should be assessed. If patients are not receiving continuous infusions of a sedating drug, they may have a physician's order for sedation as needed. If they are agitated, they should be given the prescribed dose of sedation prior to performing any airway-related procedures, to ensure that the airway is not inadvertently removed.
Patients receiving mechanical ventilation also often have bilateral soft wrist restraints applied to prevent accidental removal of the artificial airway. It is recommended that these be securely fastened before starting an airway-related procedure, or that another healthcare professional be at the bedside to help calm and hold the patient. Also, all needed supplies should be at the bedside prior to starting a procedure, so as to not cause excess discomfort or stress for the patient.
Aftercare
After the procedure is finished, the patient should be reassured if necessary and their respiratory status should be reassessed. The insertion point of the airway should be confirmed to be at the same place as prior to the procedure, unless the purpose was to change the depth of the tube. If the airway has been manipulated since suctioning, the patient may require suctioning again. Any waste should be disposed of in the garbage or in a biohazard container if there is a large amount of blood. Prior to the healthcare professional leaving the room, the patient should be made comfortable, further sedation or pain medication should be administered as needed and the patient should be confirmed to be stable.
Complications
The greatest risk of airway management is that the airway may be inadvertently removed, causing the patient to have respiratory distress. Procedures that require manipulating the airway may cause fear or agitation for patients if they feel that they do not have control over their breathing. If the patient becomes combative, it can be very difficult to finish the procedure without disturbing the airway.
Results
The anticipated outcomes of airway management are a continuously open airway through which effective ventilation can take place, and prevention of infection.
Health care team roles
The nurse and respiratory therapist are equally responsible for monitoring and managing artificial airways. Both perform sterile suctioning and both document their assessment of the patient's respiratory status. The respiratory therapist is generally responsible for managing the ventilator, adding humidification, and changing ventilator tubing.
If the patient is accidentally extubated (the airway is removed), both the nurse and respiratory therapist must assist in reinsertion. This is usually done by an anesthesiologist, a certified registered nurse anesthetist (CRNA), a medical resident, or another physician. The respiratory therapist is generally responsible for ventilating the patient with a bag-valve-mask device until reintubation (reinsertion of the airway), while the nurse gathers equipment, administers medications, and monitors the patient's pulse oximetry, vital signs, and cardiac rhythm.
The nurse and respiratory therapist are also responsible for finding alternative means for the patient to communicate. Artificial airways are inserted through the vocal cords, making speaking impossible. The patient should be encouraged to try alternative methods such as mouthing words, writing, or pointing to letters, words, or pictures on a communication board. Communicating with these patients takes great patience and creativity, as well as dedication to helping them feel like their needs are being met.
KEY TERMS
Bag-valve-mask device—Device consisting of a manually compressible bag containing oxygen and a one-way valve and mask that fits over the mouth and nose of the patient.
Endotracheal tube—Tube inserted into the trachea via either the oral or nasal cavity for the purpose of providing a secure airway.
Hypoxemia—Abnormal deficiency of oxygen in the arterial blood.
Oxygen flow meter—Meter attached to a oxygen source that controls the amount of supplemental oxygen the patient receives.
Pulse oximeter—Noninvasive machine that measures the amount of hemoglobin that is saturated with oxygen.
Tracheostomy tube—Surgically created opening in the trachea for the purpose of providing a secure airway. This is used when the patient requires long-term ventilatory assistance.
Ventilator (mechanical ventilation)—Device used to provide assisted respiration and positive pressure breathing.
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Friday, December 18, 2009
Administration of Medication
www.enotes.com
Purpose
The administration of medication is often a chief responsibility of the nurse. The practice of administering medication involves providing the patient with a substance prescribed and intended for the diagnosis, treatment, or prevention of a medical illness or condition.
Description
The central action of medication administration involves actual and complete conveyance of a medication to the patient. However, there is a wider set of practices required to achieve safe, effective patient outcomes and to prepare for and evaluate the outcome of medication administration.
Laws regarding medication administration vary from state to state. Doctors, physicians, physician assistants, nurse practitioners, and nurses are generally trained and authorized to administer medication, while other medical disciplines may have a limited responsibility in this area. In certain circumstances, unlicensed personnel may be trained and authorized to administer medication in residential care settings. State and federal laws also restrict the distribution of and access to medications that can be abused (called controlled substances). Responsibility for controlled substances includes accountability for any discarded substances, double-locked storage, and counting of medication supply at regular intervals by clinician teams.
Preparation for medication administration begins with the order for medication, in most circumstances written by the physician. Nurse practitioners and physician assistants are also often authorized to write prescriptions. State laws vary regarding these privileges. A record of orders for medication and other treatments is kept in the medical chart. Universally accepted safe clinical practice guidelines and state laws govern the components of medication orders in order to ensure consistency and patient safety. All orders should contain the patient's name, the date and time when the order is written, and the signature of the ordering clinician. Caregivers administering medication are responsible for checking that these components are present and clear. The name of the medication is accompanied by the dosage, or how much of the drug should be given; the route of administration, or how the medication should be given (ie, intramuscular injection); and frequency, or how often the drug is to be given. Common routes of administration are discussed below.
The most common route of administration is the oral route, or swallowing of medication. This is the easiest and safest route. The physical position and swallowing abilities of the patient should be evaluated to avoid choking. Patients may also receive medication by the buccal route (through the inner cheek or gum) or the sublingual route (under the tongue).
Administration involving a needle or syringe occurs with several drug routes. These routes are referred to as parenteral. Care must be taken to maintain asepsis with all injections and injection sites. Intramuscular medications are injected into the muscle. A special injection technique called Z-track can be used when administering intramuscular medications that can be damaging to the tissue. All intramuscular injections involve the practice of landmarking, or identifying anatomical markers that indicate the correct injection site and avoid damage to bone or nerves. Subcutaneous injections are administered under the skin. Insulin is a common medication that is usually given subcutaneously. Intradermal medications are used much less frequently than subcutaneous or intramuscular injections. They are injected into the skin. Intravenous medications are given through an intravenous line into the vein. These medications may be mixed with a large amount of solution that is being infused, given in a small solution through a port in the intravenous tubing (bolus), or attached in smaller infusion containers to the larger infusion (piggyback). In all cases of administration with a needle or syringe, rotation of injection sites is required to prevent damage to tissue. It is also important that the size of the needle is selected based on the thickness of the medication to be given and the depth of the injection, while maximizing the patients level of comfort during insertion. Needle sticks with contaminated needles are a hazard to both health professional and patient. Care is taken to dispose of needles and syringes rapidly in impervious containers. Protective systems that sheath the needle after use are commonly used to prevent inadvertent needle sticks.
Medication can also be instilled via the mucous membranes. Asepsis must be used to avoid introduction of infection. Rectal or vaginal medications are most often given in suppository form and must be introduced gently to avoid tearing or bleeding of tissue. Nasal medications are often instilled via spray or drops and often involve closing one nostril and asking the patient to inhale gently. The head should be tilted back to avoid aspiration. Ear or otic medications are given in liquid form. The patient's head is tilted to the side. Instruments should never enter the ear. If the medication is not instilled correctly, the patient may experience nausea or vertigo. Eye or ophthalmic medications may be given via drops or ointment. The container for the medication should not touch the eye, and drops are introduced into the inner canthus or corner of the eye.
Inhalational medications are inhaled via the respiratory tract, most often to treat respiratory conditions. Metered dose inhalers (MDI) are often used. MDIs involve pressing a specially designed canister to release a mist.
Topical medications are applied to the surface of the skin. The skin needs to be cleansed and assessed for breaks before administering topical medications. Topical patches that gradually release medication need to be labeled with date and time in case a second patch is inadvertently applied without removal of the first. Ointments are applied evenly. The clinician should avoid touching the topical medication, as medications that are absorbed into the system via the skin, such as nitroglycerin paste, may affect the clinician. As with all medication techniques, asepsis must be maintained to avoid introduction of microorganisms.
Frequency of administration is most often ordered on a repeating schedule (ie, every 8 hours). At times the order may be written as a STAT (give right away) order, a one-time order (give just once) or a prn (give as needed) order. Standing orders are routine hospital orders that doctors in specialized areas prescribe on admission.
Many abbreviations are used in writing medication orders. Other common abbreviations include:
* p.o.: by mouth
* IM: intramuscular injection
* SC: subcutaneous injection
* IV: intravenous
* PR: per rectum
* h.s.: at hour of sleep (bedtime)
* ac: before meals
* pc: after meals
* q: every, ie, q 8 h means every 8 hours
* q.d.: every day
* b.i.d.: twice/day
* t.i.d.: three times/day
* q.i.d.: four times/day
* q.o.d.: every other day
Some examples of medication orders using these abbreviations are:
* digoxin 0.25 mg p.o. q.d.
* diphenhydramine 25 mg p.o. q h.s. prn.
If orders are illegible, ambiguous, or confusing, the author of the order should be consulted to clarify the order before any medication administration occurs. When the order is clear, it often needs to be transcribed to another document reserved for recording administration of medications. Health care institutions have specific policies regarding methods with which to check medication orders and ensure proper transcription. Policies also dictate parameters for order renewal or medication discontinuation. Poor penmanship, misunderstanding of penmanship, and errors in transcription often contribute to medication errors. It is increasingly common for medical facilities to use a computerized system that lowers the risk of error by reducing steps in the process and validating information automatically.
Once the order has been read and verified, the care-giver needs to evaluate the order in the context of the individual patient. Some factors to consider include:
* pharmacodynamics: how the drug works in the body
* interactions: possible effects of other medication or food on the ordered medication
* allergies: patient history of hypersensitivity to drug or drug class
* contraindications: medical conditions that preclude the use of the ordered drug
* side effects: potential adverse reactions to the drug
* toxic effects: dangerous effects that often occur due to build up of drug in body or impaired metabolism
* tolerance: certain drugs require increasing doses over time to achieve the same effect
* physiological variables: sex, age, size, and physical condition may alter how a drug is processed in the body
* diet: certain foods, liquids, or nutritional states may alter the drug's effect on the body
Due to the large number of medications available and the large body of information required for appropriate drug administration, it is important to have access to a current medication reference such as the Physician's Desk Reference or other reference handbooks about medication. The package insert that comes with every medication is also a good resource. Pharmacists are knowledgeable resources and can answer many questions regarding medication. It is important to be familiar with the medication ordered before attempting to administer it. Procedural manuals by the institution or medical reference publishers detail the step-by-step techniques for administering various types of medication.
The patient should be notified of the order for the drug and provided with education about the medication they are to receive. Before administration, five factors often referred to as the "five rights" should be addressed. Medication records should be on hand at time of administration to ensure safe administration.
Right patient. Identify patient by name badge or bracelet. Avoid simply asking patient's name or checking the name on the door as miscommunications can sometimes occur.
Right drug. Check record for name of drug and compare with drug on hand. As many drugs have similar spellings, this needs to be checked carefully. For prevention of error, it is often recommended that three checks of the drug to be administered are made: when reaching for the package that contains the drug, when opening the drug, and when returning the packaging to its storage area. It is also recommended that clinicians only administer drugs that they have prepared, versus those prepared by another clinician.
Right route. Check medication record for how to administer the drug and check labeling of drug to ensure it matches prescribed route.
Right dose. Compare ordered dose to dose on hand. At times, calculations may need to be performed to ascertain the correct dose. For example, a scored tablet, or one that is designed and intended for dividing, may need to be halved or quartered in order to administer the correct oral dose. This requires simple division. Common situations requiring calculation include calculation of intravenous infusion rates and the conversion of measurement units, for example, determining how many milliliters (mL) are required to give the ordered number of milligrams.
The formula for this calculation can be applied to many situations:
* dose ordered/dose on hand × amount on hand = amount to administer
Using the above medication question, 25 mg/100 mg × 2 ml = 0.5 ml (amount to administer)
Intravenous medications also require frequent calculation. For example, an intravenous anticoagulant such as heparin may be ordered as "1000 units per hour," and the clinician may need to calculate how many drops are needed per minute or hour based on how the intravenous solution is prepared. These calculations may vary according to the infusion equipment used, for example, varying drop factor ratings or use of a device called a buretrol that carefully measures infused medication. Often a mechanical pump is used to control intravenous infusion rates.
Right time. Verify that frequency or time ordered matches current time.
All medications should be handled to ensure that they do not come into contact with potentially contaminated objects or surfaces. Medications of any sort should not be left unattended, and patients should be observed taking the medication. This avoids the disposal, hoarding, abuse, or misuse of the medication, and assures the safety of the patient.
Documentation of medication administration is an important responsibility. The medication record tells the story of what substances the patient has received and when. Like other health care records, it is also a legal document. Various institutions have policies and procedures regarding documentation. The initials of the administering nurse or other health care provider and the time and date should be documented on the record next to the appropriate order. Other information may be required, such as location and severity of pain when administering a pain medicine (analgesic) or pulse rate when administering certain heart medications (i.e., digoxin). Patient refusals of medication also need to be documented, and the prescribing clinician should be informed.
Medication errors need to be documented as well. The prescribing clinician should be notified of errors. Institutional policies usually require filing a separate form to document errors. Errors can include administering the wrong drug, wrong dose, at the wrong time, or via the wrong route. Omissions of medication are also considered errors.
It is important to evaluate the patient following medication administration and document effect. For example, many hospitals dictate that a note be written regarding pain relief within several hours after analgesic administration. Any adverse effects from medication should be reported.
Preparation
Preparation for safe medication administration requires a background of education and hands-on training. New nurses and other professionals should be supervised until they demonstrate an appropriate level of knowledge and competent skills for independent medication administration.
Aftercare
The patient should be monitored to make sure the medication has had the desired effect.
Health care team roles
In addition to the clinician who administers medication, other members of the health care team play vital roles surrounding the medication administration process. Doctors or other prescribing clinicians are responsible for writing clear, legible orders and for monitoring the response of the patient to medication. They are also responsible for responding to potential adverse effects and concerns by the patient or other clinicians. Pharmacists are responsible for evaluating the medication order for potential problems, correctly filling the order, and monitoring the medication supply. All health care professionals are responsible for complying with medication-related policies designed to protect the patient and/or staff and for maintaining current knowledge regarding medication and medication administration.
Resources
Read More ..
Purpose
The administration of medication is often a chief responsibility of the nurse. The practice of administering medication involves providing the patient with a substance prescribed and intended for the diagnosis, treatment, or prevention of a medical illness or condition.
Description
The central action of medication administration involves actual and complete conveyance of a medication to the patient. However, there is a wider set of practices required to achieve safe, effective patient outcomes and to prepare for and evaluate the outcome of medication administration.
Laws regarding medication administration vary from state to state. Doctors, physicians, physician assistants, nurse practitioners, and nurses are generally trained and authorized to administer medication, while other medical disciplines may have a limited responsibility in this area. In certain circumstances, unlicensed personnel may be trained and authorized to administer medication in residential care settings. State and federal laws also restrict the distribution of and access to medications that can be abused (called controlled substances). Responsibility for controlled substances includes accountability for any discarded substances, double-locked storage, and counting of medication supply at regular intervals by clinician teams.
Preparation for medication administration begins with the order for medication, in most circumstances written by the physician. Nurse practitioners and physician assistants are also often authorized to write prescriptions. State laws vary regarding these privileges. A record of orders for medication and other treatments is kept in the medical chart. Universally accepted safe clinical practice guidelines and state laws govern the components of medication orders in order to ensure consistency and patient safety. All orders should contain the patient's name, the date and time when the order is written, and the signature of the ordering clinician. Caregivers administering medication are responsible for checking that these components are present and clear. The name of the medication is accompanied by the dosage, or how much of the drug should be given; the route of administration, or how the medication should be given (ie, intramuscular injection); and frequency, or how often the drug is to be given. Common routes of administration are discussed below.
The most common route of administration is the oral route, or swallowing of medication. This is the easiest and safest route. The physical position and swallowing abilities of the patient should be evaluated to avoid choking. Patients may also receive medication by the buccal route (through the inner cheek or gum) or the sublingual route (under the tongue).
Administration involving a needle or syringe occurs with several drug routes. These routes are referred to as parenteral. Care must be taken to maintain asepsis with all injections and injection sites. Intramuscular medications are injected into the muscle. A special injection technique called Z-track can be used when administering intramuscular medications that can be damaging to the tissue. All intramuscular injections involve the practice of landmarking, or identifying anatomical markers that indicate the correct injection site and avoid damage to bone or nerves. Subcutaneous injections are administered under the skin. Insulin is a common medication that is usually given subcutaneously. Intradermal medications are used much less frequently than subcutaneous or intramuscular injections. They are injected into the skin. Intravenous medications are given through an intravenous line into the vein. These medications may be mixed with a large amount of solution that is being infused, given in a small solution through a port in the intravenous tubing (bolus), or attached in smaller infusion containers to the larger infusion (piggyback). In all cases of administration with a needle or syringe, rotation of injection sites is required to prevent damage to tissue. It is also important that the size of the needle is selected based on the thickness of the medication to be given and the depth of the injection, while maximizing the patients level of comfort during insertion. Needle sticks with contaminated needles are a hazard to both health professional and patient. Care is taken to dispose of needles and syringes rapidly in impervious containers. Protective systems that sheath the needle after use are commonly used to prevent inadvertent needle sticks.
Medication can also be instilled via the mucous membranes. Asepsis must be used to avoid introduction of infection. Rectal or vaginal medications are most often given in suppository form and must be introduced gently to avoid tearing or bleeding of tissue. Nasal medications are often instilled via spray or drops and often involve closing one nostril and asking the patient to inhale gently. The head should be tilted back to avoid aspiration. Ear or otic medications are given in liquid form. The patient's head is tilted to the side. Instruments should never enter the ear. If the medication is not instilled correctly, the patient may experience nausea or vertigo. Eye or ophthalmic medications may be given via drops or ointment. The container for the medication should not touch the eye, and drops are introduced into the inner canthus or corner of the eye.
Inhalational medications are inhaled via the respiratory tract, most often to treat respiratory conditions. Metered dose inhalers (MDI) are often used. MDIs involve pressing a specially designed canister to release a mist.
Topical medications are applied to the surface of the skin. The skin needs to be cleansed and assessed for breaks before administering topical medications. Topical patches that gradually release medication need to be labeled with date and time in case a second patch is inadvertently applied without removal of the first. Ointments are applied evenly. The clinician should avoid touching the topical medication, as medications that are absorbed into the system via the skin, such as nitroglycerin paste, may affect the clinician. As with all medication techniques, asepsis must be maintained to avoid introduction of microorganisms.
Frequency of administration is most often ordered on a repeating schedule (ie, every 8 hours). At times the order may be written as a STAT (give right away) order, a one-time order (give just once) or a prn (give as needed) order. Standing orders are routine hospital orders that doctors in specialized areas prescribe on admission.
Many abbreviations are used in writing medication orders. Other common abbreviations include:
* p.o.: by mouth
* IM: intramuscular injection
* SC: subcutaneous injection
* IV: intravenous
* PR: per rectum
* h.s.: at hour of sleep (bedtime)
* ac: before meals
* pc: after meals
* q: every, ie, q 8 h means every 8 hours
* q.d.: every day
* b.i.d.: twice/day
* t.i.d.: three times/day
* q.i.d.: four times/day
* q.o.d.: every other day
Some examples of medication orders using these abbreviations are:
* digoxin 0.25 mg p.o. q.d.
* diphenhydramine 25 mg p.o. q h.s. prn.
If orders are illegible, ambiguous, or confusing, the author of the order should be consulted to clarify the order before any medication administration occurs. When the order is clear, it often needs to be transcribed to another document reserved for recording administration of medications. Health care institutions have specific policies regarding methods with which to check medication orders and ensure proper transcription. Policies also dictate parameters for order renewal or medication discontinuation. Poor penmanship, misunderstanding of penmanship, and errors in transcription often contribute to medication errors. It is increasingly common for medical facilities to use a computerized system that lowers the risk of error by reducing steps in the process and validating information automatically.
Once the order has been read and verified, the care-giver needs to evaluate the order in the context of the individual patient. Some factors to consider include:
* pharmacodynamics: how the drug works in the body
* interactions: possible effects of other medication or food on the ordered medication
* allergies: patient history of hypersensitivity to drug or drug class
* contraindications: medical conditions that preclude the use of the ordered drug
* side effects: potential adverse reactions to the drug
* toxic effects: dangerous effects that often occur due to build up of drug in body or impaired metabolism
* tolerance: certain drugs require increasing doses over time to achieve the same effect
* physiological variables: sex, age, size, and physical condition may alter how a drug is processed in the body
* diet: certain foods, liquids, or nutritional states may alter the drug's effect on the body
Due to the large number of medications available and the large body of information required for appropriate drug administration, it is important to have access to a current medication reference such as the Physician's Desk Reference or other reference handbooks about medication. The package insert that comes with every medication is also a good resource. Pharmacists are knowledgeable resources and can answer many questions regarding medication. It is important to be familiar with the medication ordered before attempting to administer it. Procedural manuals by the institution or medical reference publishers detail the step-by-step techniques for administering various types of medication.
The patient should be notified of the order for the drug and provided with education about the medication they are to receive. Before administration, five factors often referred to as the "five rights" should be addressed. Medication records should be on hand at time of administration to ensure safe administration.
Right patient. Identify patient by name badge or bracelet. Avoid simply asking patient's name or checking the name on the door as miscommunications can sometimes occur.
Right drug. Check record for name of drug and compare with drug on hand. As many drugs have similar spellings, this needs to be checked carefully. For prevention of error, it is often recommended that three checks of the drug to be administered are made: when reaching for the package that contains the drug, when opening the drug, and when returning the packaging to its storage area. It is also recommended that clinicians only administer drugs that they have prepared, versus those prepared by another clinician.
Right route. Check medication record for how to administer the drug and check labeling of drug to ensure it matches prescribed route.
Right dose. Compare ordered dose to dose on hand. At times, calculations may need to be performed to ascertain the correct dose. For example, a scored tablet, or one that is designed and intended for dividing, may need to be halved or quartered in order to administer the correct oral dose. This requires simple division. Common situations requiring calculation include calculation of intravenous infusion rates and the conversion of measurement units, for example, determining how many milliliters (mL) are required to give the ordered number of milligrams.
The formula for this calculation can be applied to many situations:
* dose ordered/dose on hand × amount on hand = amount to administer
Using the above medication question, 25 mg/100 mg × 2 ml = 0.5 ml (amount to administer)
Intravenous medications also require frequent calculation. For example, an intravenous anticoagulant such as heparin may be ordered as "1000 units per hour," and the clinician may need to calculate how many drops are needed per minute or hour based on how the intravenous solution is prepared. These calculations may vary according to the infusion equipment used, for example, varying drop factor ratings or use of a device called a buretrol that carefully measures infused medication. Often a mechanical pump is used to control intravenous infusion rates.
Right time. Verify that frequency or time ordered matches current time.
All medications should be handled to ensure that they do not come into contact with potentially contaminated objects or surfaces. Medications of any sort should not be left unattended, and patients should be observed taking the medication. This avoids the disposal, hoarding, abuse, or misuse of the medication, and assures the safety of the patient.
Documentation of medication administration is an important responsibility. The medication record tells the story of what substances the patient has received and when. Like other health care records, it is also a legal document. Various institutions have policies and procedures regarding documentation. The initials of the administering nurse or other health care provider and the time and date should be documented on the record next to the appropriate order. Other information may be required, such as location and severity of pain when administering a pain medicine (analgesic) or pulse rate when administering certain heart medications (i.e., digoxin). Patient refusals of medication also need to be documented, and the prescribing clinician should be informed.
Medication errors need to be documented as well. The prescribing clinician should be notified of errors. Institutional policies usually require filing a separate form to document errors. Errors can include administering the wrong drug, wrong dose, at the wrong time, or via the wrong route. Omissions of medication are also considered errors.
It is important to evaluate the patient following medication administration and document effect. For example, many hospitals dictate that a note be written regarding pain relief within several hours after analgesic administration. Any adverse effects from medication should be reported.
Preparation
Preparation for safe medication administration requires a background of education and hands-on training. New nurses and other professionals should be supervised until they demonstrate an appropriate level of knowledge and competent skills for independent medication administration.
Aftercare
The patient should be monitored to make sure the medication has had the desired effect.
Health care team roles
In addition to the clinician who administers medication, other members of the health care team play vital roles surrounding the medication administration process. Doctors or other prescribing clinicians are responsible for writing clear, legible orders and for monitoring the response of the patient to medication. They are also responsible for responding to potential adverse effects and concerns by the patient or other clinicians. Pharmacists are responsible for evaluating the medication order for potential problems, correctly filling the order, and monitoring the medication supply. All health care professionals are responsible for complying with medication-related policies designed to protect the patient and/or staff and for maintaining current knowledge regarding medication and medication administration.
Resources
Read More ..
Nephrostomy Tube Care
enotes.com
Definition
A percutaneous nephrostomy tube (PNT) is a urinary diversion system comprised of a collection bag, a nephrostomy tube at an exit site (usually in the skin over the flank area), and a nephrostomy tube that enters and ends in the renal pelvis of the kidney. This allows for direct drainage of urine from the kidney when normal urinary flow is impeded. The PNT is most often used for a urinary obstruction such as a calculus.
Purpose
The purpose of PNT care is to prevent complications when a PNT is in use.
Precautions
Aspiration of fluid from the nephrostomy tube is prohibited as such action will damage the renal pelvis. Gravity drainage is used to collect specimens, and the nurse should never use force when irrigating the tube. A tube should never be irrigated with more than 5 ml of solution, since the capacity of the renal pelvis is between 4 and 8 ml. The nurse must avoid dislodging the tube while removing the dressing.
Preparation
The nurse should wash hands prior to beginning the procedure, then assemble all of the following equipment:
* disposable underpad
* clean gloves
* measuring tape
* sterile gloves
* sterile cotton tip applicators (4)
* sterile 0.9% NaCl or povidone-iodine solution or sponges
* sterile 4×4 pad or transparent dressing
* sterile 2×2 pads
* tape
* pouch belt
Description
The nurse should provide privacy for the patient in preparation for the procedure. He or she should position the patient on the side opposite the tube site with the nephrostomy site up. This provides better viewing of the tube and allows an easier dressing change.
The nurse should put on clean gloves and place a disposable underpad beneath to the patient to absorb any drainage. To minimize tension at the site and to prevent dislodging, the nephrostomy tube should be anchored with a small piece of tape. The collection bag must be emptied. The old dressing can be removed by carefully loosening the edges, and then moving to the center of dressing. Care should be taken to avoid dislodging the tube while removing the dressing. A sterile cotton-tip applicator placed on the catheter will help stabilize the catheter while removing the dressing. The site is then assessed for signs of infection, any moisture, or other drainage. The PNT is then measured from exit site to tip. If the PNT length is longer than the measurement at time of insertion, the catheter may have migrated out, and the physician should be notified at that point. The nurse should remove the soiled gloves at this time and replace with sterile ones. The exit site should be cleansed with the agent of choice (0.9% saline or povidone-iodine solution), using sterile 2×2 pads. Each pad can only be used once. Cleansing should start at the exit site and work outward in a circular motion; this action should be repeated twice. If there is any crusted matter at the site, this must be loosened and removed by using a cotton-tip applicator moistened with 0.9% saline. Then, sterile dressing should be applied. After removing the old tape, the tube must be secured with new tape to the skin below the dressing, approximately 2.5 inches (6.5 cm) from the exit site. The patient will need to be assisted in the application of the pouch belt. Anchoring the PNT with tape reduces trauma and minimizes the possibility of dislodging or kinking the tubing; adding the belt further secures the PNT. The nurse may remove gloves at this point and wash hands. The patient's dressing needs to be dated and initialed, and will need to be changed daily, or more often if necessary.
Aftercare
The used equipment needs to be disposed of properly. Upon completion of the procedure, the nurse should again wash hands. Then the nurse will need to document observations and the techniques used, including the assessment of the site, the external catheter length, the type of dressing applied, and the devices used to secure the PNT.
Complications
There is an increased risk of infection because the PNT provides a direct pathway to the kidney. There is also a risk for dislodging the PNT during this procedure.
Patient education
The patient may shower 48 hours post-insertion. The patient should be given all of the following instructions:
* Cover the dressing and exit site with a waterproof covering before showering.
* Empty the collection bag prior to showering.
* Securely tape the PNT at the exit site and use a belt for the collection bag in the shower to prevent tube migration.
* Generally, after 14 days, if there are no complications, the site may be left uncovered when showering.
The patient should notify the doctor if any problems arise such as:
* signs of infection at the exit site of the PNT, including warmth, redness, swelling, tenderness, and discharge
* drainage from the PNT
* decreased urine output
* inability to flush the PNT
* presence of any bleeding, clots, stones, sediment, and odor
* incontinence or inadequate bladder emptying
* inadequate pain control, nausea, or vomiting
* fever
* accidental dislodgement of the PNT, or suspected migration of the PNT
Results
The site should not display any signs of infection. PNT measurement should be consistent with the baseline value. Abnormal findings are signs of infection, suspected migration, or a dislodged PNT. In the collection bag, any bleeding, clots, stones, sediment, and odor are all abnormal findings.
Health care team roles
Registered nurses (RNs) and licensed practical nurses (LPNs) may perform this procedure. After returning home, the patient may simply cleanse the insertion site with soap and water, and change the dressing daily. In an inpatient setting, an aseptic technique must be maintained.
Nurses are responsible for:
* dressing changes
* proper disposal of equipment
* documentation of the procedure
* patient education
Read More ..
Definition
A percutaneous nephrostomy tube (PNT) is a urinary diversion system comprised of a collection bag, a nephrostomy tube at an exit site (usually in the skin over the flank area), and a nephrostomy tube that enters and ends in the renal pelvis of the kidney. This allows for direct drainage of urine from the kidney when normal urinary flow is impeded. The PNT is most often used for a urinary obstruction such as a calculus.
Purpose
The purpose of PNT care is to prevent complications when a PNT is in use.
Precautions
Aspiration of fluid from the nephrostomy tube is prohibited as such action will damage the renal pelvis. Gravity drainage is used to collect specimens, and the nurse should never use force when irrigating the tube. A tube should never be irrigated with more than 5 ml of solution, since the capacity of the renal pelvis is between 4 and 8 ml. The nurse must avoid dislodging the tube while removing the dressing.
Preparation
The nurse should wash hands prior to beginning the procedure, then assemble all of the following equipment:
* disposable underpad
* clean gloves
* measuring tape
* sterile gloves
* sterile cotton tip applicators (4)
* sterile 0.9% NaCl or povidone-iodine solution or sponges
* sterile 4×4 pad or transparent dressing
* sterile 2×2 pads
* tape
* pouch belt
Description
The nurse should provide privacy for the patient in preparation for the procedure. He or she should position the patient on the side opposite the tube site with the nephrostomy site up. This provides better viewing of the tube and allows an easier dressing change.
The nurse should put on clean gloves and place a disposable underpad beneath to the patient to absorb any drainage. To minimize tension at the site and to prevent dislodging, the nephrostomy tube should be anchored with a small piece of tape. The collection bag must be emptied. The old dressing can be removed by carefully loosening the edges, and then moving to the center of dressing. Care should be taken to avoid dislodging the tube while removing the dressing. A sterile cotton-tip applicator placed on the catheter will help stabilize the catheter while removing the dressing. The site is then assessed for signs of infection, any moisture, or other drainage. The PNT is then measured from exit site to tip. If the PNT length is longer than the measurement at time of insertion, the catheter may have migrated out, and the physician should be notified at that point. The nurse should remove the soiled gloves at this time and replace with sterile ones. The exit site should be cleansed with the agent of choice (0.9% saline or povidone-iodine solution), using sterile 2×2 pads. Each pad can only be used once. Cleansing should start at the exit site and work outward in a circular motion; this action should be repeated twice. If there is any crusted matter at the site, this must be loosened and removed by using a cotton-tip applicator moistened with 0.9% saline. Then, sterile dressing should be applied. After removing the old tape, the tube must be secured with new tape to the skin below the dressing, approximately 2.5 inches (6.5 cm) from the exit site. The patient will need to be assisted in the application of the pouch belt. Anchoring the PNT with tape reduces trauma and minimizes the possibility of dislodging or kinking the tubing; adding the belt further secures the PNT. The nurse may remove gloves at this point and wash hands. The patient's dressing needs to be dated and initialed, and will need to be changed daily, or more often if necessary.
Aftercare
The used equipment needs to be disposed of properly. Upon completion of the procedure, the nurse should again wash hands. Then the nurse will need to document observations and the techniques used, including the assessment of the site, the external catheter length, the type of dressing applied, and the devices used to secure the PNT.
Complications
There is an increased risk of infection because the PNT provides a direct pathway to the kidney. There is also a risk for dislodging the PNT during this procedure.
Patient education
The patient may shower 48 hours post-insertion. The patient should be given all of the following instructions:
* Cover the dressing and exit site with a waterproof covering before showering.
* Empty the collection bag prior to showering.
* Securely tape the PNT at the exit site and use a belt for the collection bag in the shower to prevent tube migration.
* Generally, after 14 days, if there are no complications, the site may be left uncovered when showering.
The patient should notify the doctor if any problems arise such as:
* signs of infection at the exit site of the PNT, including warmth, redness, swelling, tenderness, and discharge
* drainage from the PNT
* decreased urine output
* inability to flush the PNT
* presence of any bleeding, clots, stones, sediment, and odor
* incontinence or inadequate bladder emptying
* inadequate pain control, nausea, or vomiting
* fever
* accidental dislodgement of the PNT, or suspected migration of the PNT
Results
The site should not display any signs of infection. PNT measurement should be consistent with the baseline value. Abnormal findings are signs of infection, suspected migration, or a dislodged PNT. In the collection bag, any bleeding, clots, stones, sediment, and odor are all abnormal findings.
Health care team roles
Registered nurses (RNs) and licensed practical nurses (LPNs) may perform this procedure. After returning home, the patient may simply cleanse the insertion site with soap and water, and change the dressing daily. In an inpatient setting, an aseptic technique must be maintained.
Nurses are responsible for:
* dressing changes
* proper disposal of equipment
* documentation of the procedure
* patient education
Read More ..
Sunday, November 22, 2009
Colostomy care
Definition
A colostomy is a surgically created opening in the abdominal wall through which digested food passes. It may be temporary or permanent. The opening is called a stoma from the Greek word meaning mouth. Stool passes through the stoma into a pouch attached to the stoma on the outside of the abdomen. The pouch, stoma, and skin surrounding the stoma require care and maintenance by the patient or caregiver.
Purpose
A pouch is worn over a colostomy to collect the stool passed through the stoma. There are a variety of pouches available for use with a colostomy. Over time the patient can determine which pouch type best suits his or her needs. A colostomy pouch is normally emptied one or more times daily. The pouch itself usually needs to be changed every four to six days. The stoma and surrounding skin need to be kept clean and sanitary.
Precautions
The nurse attending to a colostomy should wash his or her hands before and after the procedure, as well as wear latex gloves while performing care.
Description
A pouching system is normally worn over a colostomy stoma. Pouches can be obtained from several different manufacturers in both disposable and reusable varieties. The enterostomal therapy ET nurse can be an invaluable resource when helping patients select a pouch system.
Colostomy pouches may be either open ended or closed. Open-ended pouches require a clamp for closure. They can be drained simply and reused after they are emptied. Closed pouches are sealed at the bottom and are usually used by patients who irrigate their colostomies or who have a regular bowel elimination pattern. Two-piece pouch systems consist of a separate flange and pouch. The pouch has a closing ring that attaches to a matching piece on the flange. One-piece systems have a connected wafer and pouch that do not separate. The portion of the pouch that is applied to the abdomen is called a skin barrier wafer. Both two-piece and one-piece systems can be either closed or open ended.
Some patients with colostomies can irrigate their stomas using a procedure similar to an enema. This cleans the stool out of the colon through the stoma. A special irrigation system is used. Sometimes a special lubricant is used to prepare for the irrigation. Irrigating often leads to increased control over the timing of bowel movements.
Removing the colostomy appliance requires gently pushing away the skin surrounding the stoma and pulling the appliance downwards. Adhesive remover wipes are available to help in the removal of the wafer. The bag is then discarded in an appropriate waste container. The stoma should be cleaned with lukewarm water and dried with a soft towel. The stoma and surrounding skin should be assessed. The stoma should be pink or red and moist-looking, and may bleed slightly when cleansed. The stoma normally decreases in size slightly during the first weeks after surgery.
The opening in the wafer should fit snugly around the stoma. An opening that is too large will allow intestinal contents to leak onto the skin. Measuring guides come with the colostomy wafers so that the hole can be cut to the proper size. Skin barrier paste can be used to help create a better seal between the wafer and the patient's abdomen. Various skin preparation products are also available to help protect the skin under the wafer and around the stoma. They also aid in the adhesion of the wafer. Using the fingertips, gentle pressure should be applied to put the wafer in place.
After the application of the barrier, the bag should be applied (if it is a two-piece system). If it is an open system, apply a clamp to the bottom of the new pouch.
Preparation
The nurse should instruct the patient and caregiver(s) about the procedure before it is performed. Many people feel anxious and nervous when first dealing with an ostomy. Encourage the patient to ask questions, and explain all steps as they are performed.
Aftercare
The nurse should assess the patient's tolerance of the procedure and response to teaching or education about the appliance.
Health care team roles
Although most members of the health care team will come into contact with patients having ostomies, it is the nurse who has the responsibility for providing ostomy care and instructing the patient and/or caregiver how to provide care independently. An enterostomal therapy (ET) nurse is specially educated in all aspects of ostomy care.
Key Terms
StomaSurgically constructed mouth or passage between the intestine and the outside of the patient's body.
Read More ..
A colostomy is a surgically created opening in the abdominal wall through which digested food passes. It may be temporary or permanent. The opening is called a stoma from the Greek word meaning mouth. Stool passes through the stoma into a pouch attached to the stoma on the outside of the abdomen. The pouch, stoma, and skin surrounding the stoma require care and maintenance by the patient or caregiver.
Purpose
A pouch is worn over a colostomy to collect the stool passed through the stoma. There are a variety of pouches available for use with a colostomy. Over time the patient can determine which pouch type best suits his or her needs. A colostomy pouch is normally emptied one or more times daily. The pouch itself usually needs to be changed every four to six days. The stoma and surrounding skin need to be kept clean and sanitary.
Precautions
The nurse attending to a colostomy should wash his or her hands before and after the procedure, as well as wear latex gloves while performing care.
Description
A pouching system is normally worn over a colostomy stoma. Pouches can be obtained from several different manufacturers in both disposable and reusable varieties. The enterostomal therapy ET nurse can be an invaluable resource when helping patients select a pouch system.
Colostomy pouches may be either open ended or closed. Open-ended pouches require a clamp for closure. They can be drained simply and reused after they are emptied. Closed pouches are sealed at the bottom and are usually used by patients who irrigate their colostomies or who have a regular bowel elimination pattern. Two-piece pouch systems consist of a separate flange and pouch. The pouch has a closing ring that attaches to a matching piece on the flange. One-piece systems have a connected wafer and pouch that do not separate. The portion of the pouch that is applied to the abdomen is called a skin barrier wafer. Both two-piece and one-piece systems can be either closed or open ended.
Some patients with colostomies can irrigate their stomas using a procedure similar to an enema. This cleans the stool out of the colon through the stoma. A special irrigation system is used. Sometimes a special lubricant is used to prepare for the irrigation. Irrigating often leads to increased control over the timing of bowel movements.
Removing the colostomy appliance requires gently pushing away the skin surrounding the stoma and pulling the appliance downwards. Adhesive remover wipes are available to help in the removal of the wafer. The bag is then discarded in an appropriate waste container. The stoma should be cleaned with lukewarm water and dried with a soft towel. The stoma and surrounding skin should be assessed. The stoma should be pink or red and moist-looking, and may bleed slightly when cleansed. The stoma normally decreases in size slightly during the first weeks after surgery.
The opening in the wafer should fit snugly around the stoma. An opening that is too large will allow intestinal contents to leak onto the skin. Measuring guides come with the colostomy wafers so that the hole can be cut to the proper size. Skin barrier paste can be used to help create a better seal between the wafer and the patient's abdomen. Various skin preparation products are also available to help protect the skin under the wafer and around the stoma. They also aid in the adhesion of the wafer. Using the fingertips, gentle pressure should be applied to put the wafer in place.
After the application of the barrier, the bag should be applied (if it is a two-piece system). If it is an open system, apply a clamp to the bottom of the new pouch.
Preparation
The nurse should instruct the patient and caregiver(s) about the procedure before it is performed. Many people feel anxious and nervous when first dealing with an ostomy. Encourage the patient to ask questions, and explain all steps as they are performed.
Aftercare
The nurse should assess the patient's tolerance of the procedure and response to teaching or education about the appliance.
Health care team roles
Although most members of the health care team will come into contact with patients having ostomies, it is the nurse who has the responsibility for providing ostomy care and instructing the patient and/or caregiver how to provide care independently. An enterostomal therapy (ET) nurse is specially educated in all aspects of ostomy care.
Key Terms
StomaSurgically constructed mouth or passage between the intestine and the outside of the patient's body.
Read More ..
Friday, October 23, 2009
Verpleegkundige
Als verpleegkundige help je mensen met een beperking, handicap of (dreigende) ziekte in hun thuissituatie of in een zorginstelling. Wat je precies doet, is afhankelijk van de afdeling of instelling waar je werkt en ook van de specialisatie die je tijdens je studierichting hebt gekozen. Je krijgt voornamelijk verzorgende en verpleegtechnische taken (mensen aankleden, een infuus aanleggen, enzovoort). Verder denk je mee over beleidszaken en werk je intensief samen met je collega’s, artsen en professionals uit andere disciplines.
Wat doet een verpleegkundige?
Verpleegkundigen komen bijvoorbeeld terecht in ziekenhuizen, verpleeghuizen, psychiatrische inrichtingen of bij de GGD. Binnen deze instellingen zijn er talrijke afdelingen waar zij werken. De onderstaande beschrijving is voornamelijk toegespitst op de werkzaamheden van een verpleegkundige in een ziekenhuis of verpleeghuis.
1. Helpt met de dagelijkse verzorging
Iedere dag verzorg je de patiënten die aan jou zijn toevertrouwd. Wat moet je je voorstellen bij het werk van een verpleegkundige?
* Je verschoont dagelijks het ondergoed en beddengoed van de patiënten.
* Je wast de patiënten, helpt hen met douchen en naar het toilet gaan. Sommige patiënten kunnen niet uit bed komen, waardoor de verzorging wordt beperkt tot het wassen met een washandje en het helpen met de po-stoel.
* Je helpt met aankleden, bijvoorbeeld door het aantrekken van steunkousen of een pyjama.
* Je ziet erop toe dat de patiënten eten en drinken krijgen. Meestal word je hierbij ondersteund door een voedingsassistent.
* Je controleert of patiënten wel de juiste medicijnen hebben gekregen en niet per ongeluk zijn overgeslagen.
* Tot slot heb je vaak nog kleine taken, zoals bestellingen opgeven aan de apotheek.
2. Verricht verpleegtechnische handelingen
Je hebt specifiek verpleegtechnische taken, die afhankelijk zijn van de afdeling of instelling waar je werkt. Op de chirurgische afdeling van een ziekenhuis verzorg je bijvoorbeeld wonden en operatieve ingrepen (een stoma bijvoorbeeld), breng je een katheter in (buisje voor het afvoeren van vloeistoffen zoals urine), leg je een infuus aan, enzovoort. Daarnaast bereid je medische onderzoeken en operaties voor door de benodigde instrumenten en apparatuur klaar te zetten. Een verpleegkundige bij de GGD zal zich bezighouden met de bestrijding van infectieziekten, inentingen en het geven van voorlichting.
3. Is verantwoordelijk voor de uitvoering van het behandelplan
Iedere patiënt in een ziekenhuis of zorginstelling heeft een eigen dossier, dat dagelijks door de verpleegkundige wordt gecontroleerd en aangevuld. In dit dossier staan de gegevens van deze persoon en het behandelplan. In het verslaggedeelte noteer je kort hoe een dag voor de patiënt is verlopen, bijvoorbeeld: "Ze deed alles zelf; geen bijzonderheden" of "Mevrouw is gevallen; wilde geen medicijnen innemen". Je bent ook verantwoordelijk voor de uitvoering van dit behandelplan, dat je in overleg met de arts of specialist hebt samengesteld. Je coördineert de zorg op jouw afdeling: je regelt allerlei zaken en geeft personeel en verpleegkundigen op lagere niveaus duidelijke instructies over wat wel en wat niet moet gebeuren.
4. Werkt samen met arts en andere professionals
Je overlegt geregeld met de artsen en specialisten en zij geven je ook instructies. Je ondersteunt hen intensief bij hun werk, bijvoorbeeld gedurende onderzoeken en behandelingen of het bezoeken van de patiënten, dat "visite lopen" heet.
5. Observeert en signaleert
Een belangrijke taak is het observeren van patiënten. Je hebt daarvoor een goed 'klinisch oog' nodig, waarmee je snel in de gaten hebt dat er iets aan de hand is. Wanneer iemand opeens bleek wordt of moeite krijgt met ademen, of bij andere ongewone veranderingen in het uiterlijk, gedrag of het ziektebeeld, grijp je meteen in. Je vraagt wat er aan de hand is en schat op basis van het verhaal van de zieke, je eigen inzicht en je ervaring, in welke (medische) behandelingen noodzakelijk zijn. Als je het niet alleen aankunt, waarschuw je collega’s. Je licht ook degene in die verantwoordelijk is voor de patiënt (meestal de arts of specialist).
Als je ziet dat er iets niet goed gaat op jouw afdeling of in de instelling, dan rapporteer je dat. Ten slotte denk je mee over het beleid tijdens vergaderingen met collega’s, artsen en andere zorgverleners.
Tineke van Dijk werkt als IC-verpleegkundige bij 't Lange Land Ziekenhuis in Zoetermeer: "Op de Intensive Care komen mensen terecht die in een levensbedreigende situatie zijn en die onder streng en continue toezicht moeten worden gesteld. Je hebt als IC-verpleegkundige daarom maar één of twee patiënten per dag onder je hoede. De patiënten liggen onder meer aan de hartbewaking of beademingsapparatuur. Via monitoren controleer je het hartritme en de bloeddruk en houd je scherp in de gaten of alle lichaamsfuncties naar behoren werken. Geeft een orgaan het plotseling op, een nier bijvoorbeeld, dan zul je direct niervervangende therapie moeten geven. Je bent voortdurend mensen aan het observeren en controleren."
6. Verstrekt inlichtingen aan patiënten en bezoekers
Je informeert de patiënt, diens familieleden en bekenden over het soort behandeling dat de persoon in kwestie moet ondergaan, of over welk soort onderzoek er wordt uitgevoerd. Ook geef je patiënten adviezen over het gebruik van medicijnen en bepaalde symptomen of klachten die bij het ziektebeeld horen. Na operaties of behandelingen licht je ze in over het verloop van de ingreep en wat de arts precies heeft gedaan. Je doet echter geen uitspraken over de resultaten van een onderzoek of de diagnose, dat is uitsluitend aan de arts voorbehouden.
7. Begeleidt mensen en vangt ze op
Je deelt lief en leed met je omgeving. Dat kan heel mooi, maar ook moeilijk zijn. Als iemand een slecht bericht krijgt, is de verpleegkundige vaak de eerste opvang. Vaak zijn er op zulke momenten geen familieleden of vrienden bij de patiënt. Denk aan mensen die veel pijn lijden en bij wie geen uitzicht op verbetering of genezing is. In een dergelijke situatie moet je toch kalm zien te blijven en de ander de mogelijkheid geven om te praten, mits hij zijn verhaal kwijt wil.
Rollen
* Zorgverlener. Je bent verantwoordelijk voor de dagelijkse verzorging van hulpbehoevende mensen.
* Regisseur. Vaak heb je meerdere coördinerende taken op een dag. Zo moet je er bijvoorbeeld op toezien dat in een kort tijdsbestek veel mensen worden gewassen, aangekleed en hun medicijnen toegediend krijgen.
* Steunpunt. Mensen kunnen bij jou hun verhaal kwijt als het moeilijk hebben, of wanneer ze gewoon een praatje willen maken. Daarnaast vang jij ze op bij klachten en problemen, of vragen over hun ziekte, de behandeling en dergelijke.
* Controleur. Je ziet niet alleen toe op de conditie van patiënten, maar ook op het werk van je collega's. Je werkt meestal in een team en bent daarom medeverantwoordelijk voor het functioneren en het gedrag van je collega’s. Immers, als een collega op jouw afdeling vergeet een patiënt zijn medicijnen te geven, kan dit ernstige gevolgen hebben. Door goed op elkaar te letten, ondersteun je elkaar.
* Professional. Of je nu algemeen of gespecialiseerd verpleegkundige bent: je bent ten alle tijde een professional die ontwikkelingen in het vakgebied nauwkeurig bijhoudt, deze toepast in de praktijk en overdraagt aan collega's.
Waar werk je als verpleegkundige?
Verpleegkundigen zijn in Nederland werkzaam in de volgende plekken:
* Ziekenhuizen (56 procent)
* Gehandicaptenzorg (12 procent)
* Thuiszorg (10 procent)
* Psychiatrie (9 procent)
* Verpleeghuizen (8 procent)
* GGD's (2 procent)
* Kraamzorg, schoolartsendienst en RIAGG's (1 procent) (Bron: Hogeschool van Amsterdam, 2005)
Trends en ontwikkelingen
Redelijk nieuw, maar al ontzettend populair bij zorginstellingen is de functie van nurse practitioner. Je neemt dan verpleegkundige taken en sommige medische handelingen over van de specialist of huisarts. Je doet bijvoorbeeld zelfstandig onderzoek bij een patiënt en beslist welke behandeling gegeven moet worden, ondanks dat normaal gesproken alleen de arts een diagnose mag stellen. Wel moet je altijd goed blijven overleggen met de verantwoordelijke arts en zijn er wel grenzen gesteld aan je handelen. Aangezien nurse practitioners het werk van de specialist of arts behoorlijk kunnen ontlasten, zijn ze – zeker met het oog op het tekort aan huisartsen en de overgrote zorgvraag – zeer welkom.
Wat is je plaats in de organisatie?
Collega’s of medewerkers
Met de volgende mensen werk je op hetzelfde niveau samen, of je geeft hen leiding. Dit is afhankelijk van de grootte en de inrichting van de organisatie.
* Verpleegkundigen. Dit zijn je directe collega’s.
* Verzorgenden. Zij werken in verpleeghuizen, de thuiszorg en bejaardenhuizen.
* Administratief personeel. De baliemedewerkers maken afspraken met patiënten, verstrekken algemene informatie, en ontvangen bezoekers.
* Professionals uit andere disciplines. Maatschappelijk werkers, fysiotherapeuten, psychiaters, enzovoort.
* Divers (medisch) personeel. Bijvoorbeeld operatieassistenten, voedingsassistenten, technici, de applicatiebeheerder, medewerkers van de keuken en transportdienst.
Wie is je baas?
Je directe leidinggevende is meestal je teamleider. Deze wordt op zijn beurt weer aangestuurd door de zogeheten Eerste verpleegkundige of Hoofdverpleegkundige. Er zijn echter ook 'zelfsturende teams', waarbij je elkaar coacht om op de juiste manier zorg te verlenen. Tenslotte krijg je ook instructies van artsen en andere professionals (psychologen, zorgmanagers).
Welke competenties moet je in huis hebben?
"Je moet hard kunnen werken. Als verpleegkundige werken is echt veel heen en weer rennen, veel dingen tegelijk onthouden en doen. Dus stressbestendig zijn. Tegen kritische situaties kunnen... En natuurlijk moet je goed met patiënten om kunnen gaan... Niet snel vies van iets zijn (want je komt echt vieze dingen tegen). Je moet je kunnen inleven in andere mensen."
- Persoonlijk verhaal van een propedeuse-studente Verpleegkunde in het opleidingenforum
1. Goede sociale vaardigheden
Geduld en begrip zijn onmisbaar in het contact met je omgeving. Als verpleegkundige wil je mensen graag helpen en verzorgen. Je luistert naar hun verhalen en vragen, stelt ze gerust wanneer dat nodig is, informeert ze en helpt ze met de dagelijkse verzorging. Je vangt ze op bij pijn en ander lijden. Je hebt hiervoor een sterke persoonlijkheid nodig; je bent niet bang om voor patiënten op te komen, maar anderzijds durf je ook duidelijk grenzen te stellen aan hun eisen.
2. Integriteit
Van patiënten zul je nogal eens vertrouwelijke informatie te horen krijgen. Je weet ook veel van hun situatie via het persoonlijk patiëntendossier. Ook verricht je handelingen die voor de patiënt belastend kunnen zijn, zoals het wassen van intieme delen, of een endoscopie, waarbij je een slang in de anus van de patiënt inbrengt om de darmen te onderzoeken. In dit soort gevallen is tact en een integere houding natuurlijk wenselijk. Ook inlevingsvermogen in de benarde situatie van een ander komt jou als verpleegkundige goed van pas.
3. Stressbestendig
In de verpleging werk je onder grote druk. Je krijgt bijvoorbeeld de opdracht om tien mensen te wassen, aan te kleden en aan tafel te zetten, en dat in een heel hoog tempo. Of iemand wordt plotseling onwel, en je moet hartmassage en mond-op-mondbeademing geven. Al met al heb je een zeer wisselend takenpakket, waardoor je snel moet kunnen schakelen. Bovendien krijg je met allerlei soorten mensen te maken, en niet altijd de gemakkelijkste... Je kunt te maken krijgen met agressie. Dit alles kan flink wat stress opleveren, maar een bekwaam verpleegkundige is daar tegen bestand.
4. Flexibiliteit
Je komt als verpleegkundige in zeer diverse en soms onverwachte situaties terecht. Daarvoor heb je een flexibele opstelling en doorzettingsvermogen nodig. Je past je snel aan een weet het overzicht te behouden tussen je verschillende bezigheden. Ook kun je op stressvolle momenten de juiste beslissingen nemen, bijvoorbeeld door goed in te schatten welke medische handelingen er verricht moeten worden. Verder draai je in de verpleging vaak onregelmatige diensten, hetgeen ook de nodige flexibiliteit vereist in het organiseren van je privé-leven.
5. Goede lichamelijke conditie
De verpleging is ook in lichamelijke zin een zwaar vak. Je moet veel lopen, tillen, bukken, noem maar op. Dat kan zeker bij een hoge werkdruk lichamelijke klachten opleveren. Een goede lichamelijke gesteldheid is dan ook onmisbaar. En het duurt nog tot je 55e voor je geen nachtdiensten meer hoeft te draaien…
6. Goede motoriek en verpleegtechnisch inzicht
Je moet zorgvuldig met je handen kunnen werken. Bij het verwisselen van een infuus, het inbrengen van een slangetje in iemands neus of wanneer je een injectie wilt geven, moet je bijvoorbeeld geen trillende handen hebben. Ook enig verpleegtechnisch inzicht komt van pas. Je begrijpt dan waarom je bepaalde dingen doet (wat er medisch gezien precies gebeurt) en wat de gevolgen van je handeling zijn voor geest en lichaam van de patiënt.
7. Empathie
Je moet ook een zekere mate van afstand kunnen bewaren. Als je je alles persoonlijk aantrekt, wordt het werk erg zwaar. De uitdaging is dus om empatisch te zijn en sociaal, zonder teveel bij je werk betrokken te raken.
Wat onderscheidt een top-verpleegkundige van een gewone verpleegkundige?
Als top-verpleegkundige bezit je een uitstekende vakkennis, die je ook goed op peil weet te houden. Je kunt vlot omgaan met mensen, bezit een behoorlijke dosis empathie en wordt niet snel uit het veld geslagen bij onverwachte situaties. Ook heb je je zaakjes goed op orde: je regelt de zorg voor anderen en bent in staat collega’s te coachen. Je beschikt bovendien over zelfinzicht, dus je durft te reflecteren op je eigen gedrag, en voor jezelf duidelijk te erkennen wat je wel en niet kunt.
Voorbeeld: stel, je houdt niet zo van injecteren. Op een gegeven moment moet je iemand een injectie in de arm geven, en het lukt je na een aantal pogingen niet om de ader te vinden. Wees niet te trots om toe te geven dat je dit niet aankunt, en haal er gewoon een collega bij die de klus van je overneemt.
Je hebt niettemin wel een goede klinische blik, waarmee je snel kunt afleiden uit het uiterlijk van patiënten hoe het met hen gaat. Een "lastige" patiënt ontwijk je niet, maar je gaat hem ook niet doorschuiven naar je collega. Je werkt gewetensvol en bent een betrouwbaar persoon voor je omgeving. Kortom, uit alles blijkt dat je sterk gemotiveerd bent voor dit vak, en dat straal je ook uit.
Hoe word je verpleegkundige?
Speciale opleiding als basis
De enige studie waarmee je je kunt kwalificeren als verpleegkundige, is de hbo-opleiding Verpleegkunde. Er zijn veel hogescholen die deze opleiding in het pakket hebben. De meeste van hen bieden bovendien hbo Verpleegkunde aan in zowel een voltijd-, deeltijd- en duale variant.
Mbo-vooropleiding
Met een afgeronde mbo Verpleegkunde (niveau 4) kun je al aan de slag in de verpleging, maar het is ook mogelijk te kiezen voor een speciaal doorstroomprogramma naar het hbo. Je mag dan een verkort traject volgen, waarmee je de bachelor Verpleegkunde in twee tot drie jaar kunt afronden. Samen met je studieloopbaanbegeleider schrijf je een Persoonlijk Opleidingsplan, waarin je studieplannen staan. Door het afleggen van assessments wordt duidelijk welke competenties je al beheerst en welke je nog moet ontwikkelen. Heb je een andere mbo-opleiding gedaan, dan doorloop je het volledige studieprogramma van vier jaar.
Wat ga je verdienen?
Als algemeen verpleegkundige in een ziekenhuis kun je rekenen op een aanvangssalaris van €1.640. Je kunt doorgroeien tot maximaal €2.507. Ben je gespecialiseerd verpleegkundige, dan verdien je vanzelfsprekend meer. Het maandsalaris van bijvoorbeeld een geriatrisch verpleegkundige (gespecialiseerd in de zorg voor ouderen) begint bij €1.925, en kan oplopen tot maximaal €3.165. Bovendien krijg je als verpleegkundige toeslagen voor eventueel overwerk en onregelmatige diensten (Bron: CAO Ziekenhuiswezen, 2004 – 2005).
Werk je met gehandicapten, psychiatrisch patiënten of in een ander werkveld, dan is je inkomen afhankelijk van de daar geldende CAO. Een wijkverpleegkundige die bijvoorbeeld in dienst is bij de Thuiszorg verdient minimaal €1.885, met een doorgroei tot ongeveer €2.625 (Bron: CAO Thuiszorg, 2004).
Medische tijgerWat zijn je carrièremogelijkheden?
Veel verpleegkundigen beginnen met een functie in een zorginstelling. Een aantal van hen kiest ervoor om zich – meteen na hun studie of later in de loopbaan – te specialiseren. Na de opleiding Verpleegkunde kun je terecht bij een groot aantal vervolgopleidingen, bijvoorbeeld de opleiding tot ambulanceverpleegkundige, Intensive Care-verpleegkundige, kinderverpleegkundige of arbo-verpleegkundige (bedrijfsverpleegkundige).
Wil je manager worden, dan zijn er twee mogelijkheden. Enerzijds de langzame route: je volgt naast je baan korte cursussen of een deeltijdopleiding (bijvoorbeeld de Kaderopleiding Verpleegkunde, waar echter wel een aantal jaar ervaring voor vereist is), waardoor je na verloop van tijd intern kunt solliciteren naar een leidinggevende functie als bijvoorbeeld Hoofdverpleegkundige, praktijkopleider of coördinator. Anderzijds is er de snelle route: je doet een universitaire masteropleiding als Beleid, Management en Gezondheidszorg (BMG) of Gezondheidswetenschappen. Deze studies leiden je op voor leidinggevende functies binnen de zorg, maar je kunt er bijvoorbeeld ook mee aan de slag in ministeries, het onderwijs (als docent Verpleegkunde) of op de afdeling Personeelszaken van een zorginstelling.
Een andere carrièremogelijkheid voor verpleegkundigen is kiezen voor het zelfstandig ondernemerschap. Je laat je dan inhuren door bijvoorbeeld particulieren, die afgestemde zorg nodig hebben in hun thuissituatie. Voordat je je als zelfstandige kunt vestigen, moet je wel eerst een aanvullend programma bij de Kamer van Koophandel volgen om je eigen onderneming te mogen starten.
Welke beroepen lijken erop?
* Anesthesiemedewerker
* Longfunctie-assistent
* Operatie-assistent
* Verloskundige
* Verzorgende
Aanbevolen websites
* Met de Verpleegkundige Loopbaandiagnose kun je kijken wat voor verpleegkundige je bent. Geef je graag leiding, zoek je vooral balans of werk je het liefst zelfstandig?
* Erg interessant is YouChooz.nl, een website met allerlei wetenswaardigheden over beroepen en opleidingen in de gezondheidszorg. Op deze pagina vind je ook uitgebreide informatie over alle vervolgopleidingen en carrièremogelijkheden in de zorgsector. Je kunt via de site eveneens in contact komen met studenten, docenten en verpleegkundigen.
* Op Nursing, de digitale versie van het landelijke vakblad, vind je het laatste nieuws, evenementen en dossiers (waaronder 'Agressie in de zorg') uit de gezondheidszorg. Je kunt je ook abonneren op de Nursing Nieuwsbrief.
* Verplegingenverzorging.nl biedt nieuws en themadossiers over onder andere opleidingen en beroepen in de zorg. Verder kun je onder meer een kennisdatabank raadplegen, waarin honderden scripties, onderzoeksresultaten, afstudeerprojecten, artikelen en andere documenten op het gebied van de gezondheidszorg te vinden zijn.
* Zorgportaal is een verzamelpunt voor vacatures, nieuws, een forum, agenda en andere interessante zorgonderwerpen.
* Op Verpleging Online vind je heel veel links, een vacaturebank en de CAO voor verpleegkundigen. Verder kun je via de discussiepagina in contact komen met collega's, reageren op vragen en meningen en zelf iets ter discussie stellen.
* Ook Ziekenhuis.nl biedt je links, een forum en een vacaturebank. Bovendien vind je er een medicijngids, medisch woordenboek, beschrijvingen van ziektebeelden en informatieve filmpjes.
Aanbevolen boeken
* Huilen mag (De Bruin, S., Gerrese, M. en Pollmann, J., Verpleegkunde Nieuws, 2003) bundelt achttien verhalen van verpleegkundigen over hun ervaringen met leven en dood in hun werk, aangevuld met het verhaal van een patiënte die te horen kreeg dat ze zou gaan sterven.
* In De verpleegkundige als patiënt (Odekerken, S., Bohn Stafleu van Loghum, 2004) lees je hoe een aantal verpleegkundigen 'het patiënt zijn' ervaart. Dit is een interessante invalshoek, want hoewel er in de opleiding volop aandacht wordt besteed aan empathie en patiëntgerichte competenties, krijg je pas echt inzicht als je het in de praktijk zelf meemaakt. De verhalen in dit boek zorgen ervoor dat je je als verpleegkundige in de situatie van de patiënt kunt verplaatsen. Bovendien stimuleren ze je om je werk door de ogen van de patiënt te bekijken.
* Het boek Onzichtbare zwaarte van zorg: verpleegkundigen en verzorgenden aan het woord (Bruntink, R. en Cremers, A., Elsevier Gezondheidszorg, 2005) laat twaalf verpleegkundigen en verzorgenden vertellen over hun vak. Ze zijn afkomstig uit verschillende werkvelden, en worden met situaties geconfronteerd waarvan de moeilijkheidsgraad door buitenstaanders vaak behoorlijk onderschat wordt.
Auteur: Vera van Dijk
Read More ..
Wat doet een verpleegkundige?
Verpleegkundigen komen bijvoorbeeld terecht in ziekenhuizen, verpleeghuizen, psychiatrische inrichtingen of bij de GGD. Binnen deze instellingen zijn er talrijke afdelingen waar zij werken. De onderstaande beschrijving is voornamelijk toegespitst op de werkzaamheden van een verpleegkundige in een ziekenhuis of verpleeghuis.
1. Helpt met de dagelijkse verzorging
Iedere dag verzorg je de patiënten die aan jou zijn toevertrouwd. Wat moet je je voorstellen bij het werk van een verpleegkundige?
* Je verschoont dagelijks het ondergoed en beddengoed van de patiënten.
* Je wast de patiënten, helpt hen met douchen en naar het toilet gaan. Sommige patiënten kunnen niet uit bed komen, waardoor de verzorging wordt beperkt tot het wassen met een washandje en het helpen met de po-stoel.
* Je helpt met aankleden, bijvoorbeeld door het aantrekken van steunkousen of een pyjama.
* Je ziet erop toe dat de patiënten eten en drinken krijgen. Meestal word je hierbij ondersteund door een voedingsassistent.
* Je controleert of patiënten wel de juiste medicijnen hebben gekregen en niet per ongeluk zijn overgeslagen.
* Tot slot heb je vaak nog kleine taken, zoals bestellingen opgeven aan de apotheek.
2. Verricht verpleegtechnische handelingen
Je hebt specifiek verpleegtechnische taken, die afhankelijk zijn van de afdeling of instelling waar je werkt. Op de chirurgische afdeling van een ziekenhuis verzorg je bijvoorbeeld wonden en operatieve ingrepen (een stoma bijvoorbeeld), breng je een katheter in (buisje voor het afvoeren van vloeistoffen zoals urine), leg je een infuus aan, enzovoort. Daarnaast bereid je medische onderzoeken en operaties voor door de benodigde instrumenten en apparatuur klaar te zetten. Een verpleegkundige bij de GGD zal zich bezighouden met de bestrijding van infectieziekten, inentingen en het geven van voorlichting.
3. Is verantwoordelijk voor de uitvoering van het behandelplan
Iedere patiënt in een ziekenhuis of zorginstelling heeft een eigen dossier, dat dagelijks door de verpleegkundige wordt gecontroleerd en aangevuld. In dit dossier staan de gegevens van deze persoon en het behandelplan. In het verslaggedeelte noteer je kort hoe een dag voor de patiënt is verlopen, bijvoorbeeld: "Ze deed alles zelf; geen bijzonderheden" of "Mevrouw is gevallen; wilde geen medicijnen innemen". Je bent ook verantwoordelijk voor de uitvoering van dit behandelplan, dat je in overleg met de arts of specialist hebt samengesteld. Je coördineert de zorg op jouw afdeling: je regelt allerlei zaken en geeft personeel en verpleegkundigen op lagere niveaus duidelijke instructies over wat wel en wat niet moet gebeuren.
4. Werkt samen met arts en andere professionals
Je overlegt geregeld met de artsen en specialisten en zij geven je ook instructies. Je ondersteunt hen intensief bij hun werk, bijvoorbeeld gedurende onderzoeken en behandelingen of het bezoeken van de patiënten, dat "visite lopen" heet.
5. Observeert en signaleert
Een belangrijke taak is het observeren van patiënten. Je hebt daarvoor een goed 'klinisch oog' nodig, waarmee je snel in de gaten hebt dat er iets aan de hand is. Wanneer iemand opeens bleek wordt of moeite krijgt met ademen, of bij andere ongewone veranderingen in het uiterlijk, gedrag of het ziektebeeld, grijp je meteen in. Je vraagt wat er aan de hand is en schat op basis van het verhaal van de zieke, je eigen inzicht en je ervaring, in welke (medische) behandelingen noodzakelijk zijn. Als je het niet alleen aankunt, waarschuw je collega’s. Je licht ook degene in die verantwoordelijk is voor de patiënt (meestal de arts of specialist).
Als je ziet dat er iets niet goed gaat op jouw afdeling of in de instelling, dan rapporteer je dat. Ten slotte denk je mee over het beleid tijdens vergaderingen met collega’s, artsen en andere zorgverleners.
Tineke van Dijk werkt als IC-verpleegkundige bij 't Lange Land Ziekenhuis in Zoetermeer: "Op de Intensive Care komen mensen terecht die in een levensbedreigende situatie zijn en die onder streng en continue toezicht moeten worden gesteld. Je hebt als IC-verpleegkundige daarom maar één of twee patiënten per dag onder je hoede. De patiënten liggen onder meer aan de hartbewaking of beademingsapparatuur. Via monitoren controleer je het hartritme en de bloeddruk en houd je scherp in de gaten of alle lichaamsfuncties naar behoren werken. Geeft een orgaan het plotseling op, een nier bijvoorbeeld, dan zul je direct niervervangende therapie moeten geven. Je bent voortdurend mensen aan het observeren en controleren."
6. Verstrekt inlichtingen aan patiënten en bezoekers
Je informeert de patiënt, diens familieleden en bekenden over het soort behandeling dat de persoon in kwestie moet ondergaan, of over welk soort onderzoek er wordt uitgevoerd. Ook geef je patiënten adviezen over het gebruik van medicijnen en bepaalde symptomen of klachten die bij het ziektebeeld horen. Na operaties of behandelingen licht je ze in over het verloop van de ingreep en wat de arts precies heeft gedaan. Je doet echter geen uitspraken over de resultaten van een onderzoek of de diagnose, dat is uitsluitend aan de arts voorbehouden.
7. Begeleidt mensen en vangt ze op
Je deelt lief en leed met je omgeving. Dat kan heel mooi, maar ook moeilijk zijn. Als iemand een slecht bericht krijgt, is de verpleegkundige vaak de eerste opvang. Vaak zijn er op zulke momenten geen familieleden of vrienden bij de patiënt. Denk aan mensen die veel pijn lijden en bij wie geen uitzicht op verbetering of genezing is. In een dergelijke situatie moet je toch kalm zien te blijven en de ander de mogelijkheid geven om te praten, mits hij zijn verhaal kwijt wil.
Rollen
* Zorgverlener. Je bent verantwoordelijk voor de dagelijkse verzorging van hulpbehoevende mensen.
* Regisseur. Vaak heb je meerdere coördinerende taken op een dag. Zo moet je er bijvoorbeeld op toezien dat in een kort tijdsbestek veel mensen worden gewassen, aangekleed en hun medicijnen toegediend krijgen.
* Steunpunt. Mensen kunnen bij jou hun verhaal kwijt als het moeilijk hebben, of wanneer ze gewoon een praatje willen maken. Daarnaast vang jij ze op bij klachten en problemen, of vragen over hun ziekte, de behandeling en dergelijke.
* Controleur. Je ziet niet alleen toe op de conditie van patiënten, maar ook op het werk van je collega's. Je werkt meestal in een team en bent daarom medeverantwoordelijk voor het functioneren en het gedrag van je collega’s. Immers, als een collega op jouw afdeling vergeet een patiënt zijn medicijnen te geven, kan dit ernstige gevolgen hebben. Door goed op elkaar te letten, ondersteun je elkaar.
* Professional. Of je nu algemeen of gespecialiseerd verpleegkundige bent: je bent ten alle tijde een professional die ontwikkelingen in het vakgebied nauwkeurig bijhoudt, deze toepast in de praktijk en overdraagt aan collega's.
Waar werk je als verpleegkundige?
Verpleegkundigen zijn in Nederland werkzaam in de volgende plekken:
* Ziekenhuizen (56 procent)
* Gehandicaptenzorg (12 procent)
* Thuiszorg (10 procent)
* Psychiatrie (9 procent)
* Verpleeghuizen (8 procent)
* GGD's (2 procent)
* Kraamzorg, schoolartsendienst en RIAGG's (1 procent) (Bron: Hogeschool van Amsterdam, 2005)
Trends en ontwikkelingen
Redelijk nieuw, maar al ontzettend populair bij zorginstellingen is de functie van nurse practitioner. Je neemt dan verpleegkundige taken en sommige medische handelingen over van de specialist of huisarts. Je doet bijvoorbeeld zelfstandig onderzoek bij een patiënt en beslist welke behandeling gegeven moet worden, ondanks dat normaal gesproken alleen de arts een diagnose mag stellen. Wel moet je altijd goed blijven overleggen met de verantwoordelijke arts en zijn er wel grenzen gesteld aan je handelen. Aangezien nurse practitioners het werk van de specialist of arts behoorlijk kunnen ontlasten, zijn ze – zeker met het oog op het tekort aan huisartsen en de overgrote zorgvraag – zeer welkom.
Wat is je plaats in de organisatie?
Collega’s of medewerkers
Met de volgende mensen werk je op hetzelfde niveau samen, of je geeft hen leiding. Dit is afhankelijk van de grootte en de inrichting van de organisatie.
* Verpleegkundigen. Dit zijn je directe collega’s.
* Verzorgenden. Zij werken in verpleeghuizen, de thuiszorg en bejaardenhuizen.
* Administratief personeel. De baliemedewerkers maken afspraken met patiënten, verstrekken algemene informatie, en ontvangen bezoekers.
* Professionals uit andere disciplines. Maatschappelijk werkers, fysiotherapeuten, psychiaters, enzovoort.
* Divers (medisch) personeel. Bijvoorbeeld operatieassistenten, voedingsassistenten, technici, de applicatiebeheerder, medewerkers van de keuken en transportdienst.
Wie is je baas?
Je directe leidinggevende is meestal je teamleider. Deze wordt op zijn beurt weer aangestuurd door de zogeheten Eerste verpleegkundige of Hoofdverpleegkundige. Er zijn echter ook 'zelfsturende teams', waarbij je elkaar coacht om op de juiste manier zorg te verlenen. Tenslotte krijg je ook instructies van artsen en andere professionals (psychologen, zorgmanagers).
Welke competenties moet je in huis hebben?
"Je moet hard kunnen werken. Als verpleegkundige werken is echt veel heen en weer rennen, veel dingen tegelijk onthouden en doen. Dus stressbestendig zijn. Tegen kritische situaties kunnen... En natuurlijk moet je goed met patiënten om kunnen gaan... Niet snel vies van iets zijn (want je komt echt vieze dingen tegen). Je moet je kunnen inleven in andere mensen."
- Persoonlijk verhaal van een propedeuse-studente Verpleegkunde in het opleidingenforum
1. Goede sociale vaardigheden
Geduld en begrip zijn onmisbaar in het contact met je omgeving. Als verpleegkundige wil je mensen graag helpen en verzorgen. Je luistert naar hun verhalen en vragen, stelt ze gerust wanneer dat nodig is, informeert ze en helpt ze met de dagelijkse verzorging. Je vangt ze op bij pijn en ander lijden. Je hebt hiervoor een sterke persoonlijkheid nodig; je bent niet bang om voor patiënten op te komen, maar anderzijds durf je ook duidelijk grenzen te stellen aan hun eisen.
2. Integriteit
Van patiënten zul je nogal eens vertrouwelijke informatie te horen krijgen. Je weet ook veel van hun situatie via het persoonlijk patiëntendossier. Ook verricht je handelingen die voor de patiënt belastend kunnen zijn, zoals het wassen van intieme delen, of een endoscopie, waarbij je een slang in de anus van de patiënt inbrengt om de darmen te onderzoeken. In dit soort gevallen is tact en een integere houding natuurlijk wenselijk. Ook inlevingsvermogen in de benarde situatie van een ander komt jou als verpleegkundige goed van pas.
3. Stressbestendig
In de verpleging werk je onder grote druk. Je krijgt bijvoorbeeld de opdracht om tien mensen te wassen, aan te kleden en aan tafel te zetten, en dat in een heel hoog tempo. Of iemand wordt plotseling onwel, en je moet hartmassage en mond-op-mondbeademing geven. Al met al heb je een zeer wisselend takenpakket, waardoor je snel moet kunnen schakelen. Bovendien krijg je met allerlei soorten mensen te maken, en niet altijd de gemakkelijkste... Je kunt te maken krijgen met agressie. Dit alles kan flink wat stress opleveren, maar een bekwaam verpleegkundige is daar tegen bestand.
4. Flexibiliteit
Je komt als verpleegkundige in zeer diverse en soms onverwachte situaties terecht. Daarvoor heb je een flexibele opstelling en doorzettingsvermogen nodig. Je past je snel aan een weet het overzicht te behouden tussen je verschillende bezigheden. Ook kun je op stressvolle momenten de juiste beslissingen nemen, bijvoorbeeld door goed in te schatten welke medische handelingen er verricht moeten worden. Verder draai je in de verpleging vaak onregelmatige diensten, hetgeen ook de nodige flexibiliteit vereist in het organiseren van je privé-leven.
5. Goede lichamelijke conditie
De verpleging is ook in lichamelijke zin een zwaar vak. Je moet veel lopen, tillen, bukken, noem maar op. Dat kan zeker bij een hoge werkdruk lichamelijke klachten opleveren. Een goede lichamelijke gesteldheid is dan ook onmisbaar. En het duurt nog tot je 55e voor je geen nachtdiensten meer hoeft te draaien…
6. Goede motoriek en verpleegtechnisch inzicht
Je moet zorgvuldig met je handen kunnen werken. Bij het verwisselen van een infuus, het inbrengen van een slangetje in iemands neus of wanneer je een injectie wilt geven, moet je bijvoorbeeld geen trillende handen hebben. Ook enig verpleegtechnisch inzicht komt van pas. Je begrijpt dan waarom je bepaalde dingen doet (wat er medisch gezien precies gebeurt) en wat de gevolgen van je handeling zijn voor geest en lichaam van de patiënt.
7. Empathie
Je moet ook een zekere mate van afstand kunnen bewaren. Als je je alles persoonlijk aantrekt, wordt het werk erg zwaar. De uitdaging is dus om empatisch te zijn en sociaal, zonder teveel bij je werk betrokken te raken.
Wat onderscheidt een top-verpleegkundige van een gewone verpleegkundige?
Als top-verpleegkundige bezit je een uitstekende vakkennis, die je ook goed op peil weet te houden. Je kunt vlot omgaan met mensen, bezit een behoorlijke dosis empathie en wordt niet snel uit het veld geslagen bij onverwachte situaties. Ook heb je je zaakjes goed op orde: je regelt de zorg voor anderen en bent in staat collega’s te coachen. Je beschikt bovendien over zelfinzicht, dus je durft te reflecteren op je eigen gedrag, en voor jezelf duidelijk te erkennen wat je wel en niet kunt.
Voorbeeld: stel, je houdt niet zo van injecteren. Op een gegeven moment moet je iemand een injectie in de arm geven, en het lukt je na een aantal pogingen niet om de ader te vinden. Wees niet te trots om toe te geven dat je dit niet aankunt, en haal er gewoon een collega bij die de klus van je overneemt.
Je hebt niettemin wel een goede klinische blik, waarmee je snel kunt afleiden uit het uiterlijk van patiënten hoe het met hen gaat. Een "lastige" patiënt ontwijk je niet, maar je gaat hem ook niet doorschuiven naar je collega. Je werkt gewetensvol en bent een betrouwbaar persoon voor je omgeving. Kortom, uit alles blijkt dat je sterk gemotiveerd bent voor dit vak, en dat straal je ook uit.
Hoe word je verpleegkundige?
Speciale opleiding als basis
De enige studie waarmee je je kunt kwalificeren als verpleegkundige, is de hbo-opleiding Verpleegkunde. Er zijn veel hogescholen die deze opleiding in het pakket hebben. De meeste van hen bieden bovendien hbo Verpleegkunde aan in zowel een voltijd-, deeltijd- en duale variant.
Mbo-vooropleiding
Met een afgeronde mbo Verpleegkunde (niveau 4) kun je al aan de slag in de verpleging, maar het is ook mogelijk te kiezen voor een speciaal doorstroomprogramma naar het hbo. Je mag dan een verkort traject volgen, waarmee je de bachelor Verpleegkunde in twee tot drie jaar kunt afronden. Samen met je studieloopbaanbegeleider schrijf je een Persoonlijk Opleidingsplan, waarin je studieplannen staan. Door het afleggen van assessments wordt duidelijk welke competenties je al beheerst en welke je nog moet ontwikkelen. Heb je een andere mbo-opleiding gedaan, dan doorloop je het volledige studieprogramma van vier jaar.
Wat ga je verdienen?
Als algemeen verpleegkundige in een ziekenhuis kun je rekenen op een aanvangssalaris van €1.640. Je kunt doorgroeien tot maximaal €2.507. Ben je gespecialiseerd verpleegkundige, dan verdien je vanzelfsprekend meer. Het maandsalaris van bijvoorbeeld een geriatrisch verpleegkundige (gespecialiseerd in de zorg voor ouderen) begint bij €1.925, en kan oplopen tot maximaal €3.165. Bovendien krijg je als verpleegkundige toeslagen voor eventueel overwerk en onregelmatige diensten (Bron: CAO Ziekenhuiswezen, 2004 – 2005).
Werk je met gehandicapten, psychiatrisch patiënten of in een ander werkveld, dan is je inkomen afhankelijk van de daar geldende CAO. Een wijkverpleegkundige die bijvoorbeeld in dienst is bij de Thuiszorg verdient minimaal €1.885, met een doorgroei tot ongeveer €2.625 (Bron: CAO Thuiszorg, 2004).
Medische tijgerWat zijn je carrièremogelijkheden?
Veel verpleegkundigen beginnen met een functie in een zorginstelling. Een aantal van hen kiest ervoor om zich – meteen na hun studie of later in de loopbaan – te specialiseren. Na de opleiding Verpleegkunde kun je terecht bij een groot aantal vervolgopleidingen, bijvoorbeeld de opleiding tot ambulanceverpleegkundige, Intensive Care-verpleegkundige, kinderverpleegkundige of arbo-verpleegkundige (bedrijfsverpleegkundige).
Wil je manager worden, dan zijn er twee mogelijkheden. Enerzijds de langzame route: je volgt naast je baan korte cursussen of een deeltijdopleiding (bijvoorbeeld de Kaderopleiding Verpleegkunde, waar echter wel een aantal jaar ervaring voor vereist is), waardoor je na verloop van tijd intern kunt solliciteren naar een leidinggevende functie als bijvoorbeeld Hoofdverpleegkundige, praktijkopleider of coördinator. Anderzijds is er de snelle route: je doet een universitaire masteropleiding als Beleid, Management en Gezondheidszorg (BMG) of Gezondheidswetenschappen. Deze studies leiden je op voor leidinggevende functies binnen de zorg, maar je kunt er bijvoorbeeld ook mee aan de slag in ministeries, het onderwijs (als docent Verpleegkunde) of op de afdeling Personeelszaken van een zorginstelling.
Een andere carrièremogelijkheid voor verpleegkundigen is kiezen voor het zelfstandig ondernemerschap. Je laat je dan inhuren door bijvoorbeeld particulieren, die afgestemde zorg nodig hebben in hun thuissituatie. Voordat je je als zelfstandige kunt vestigen, moet je wel eerst een aanvullend programma bij de Kamer van Koophandel volgen om je eigen onderneming te mogen starten.
Welke beroepen lijken erop?
* Anesthesiemedewerker
* Longfunctie-assistent
* Operatie-assistent
* Verloskundige
* Verzorgende
Aanbevolen websites
* Met de Verpleegkundige Loopbaandiagnose kun je kijken wat voor verpleegkundige je bent. Geef je graag leiding, zoek je vooral balans of werk je het liefst zelfstandig?
* Erg interessant is YouChooz.nl, een website met allerlei wetenswaardigheden over beroepen en opleidingen in de gezondheidszorg. Op deze pagina vind je ook uitgebreide informatie over alle vervolgopleidingen en carrièremogelijkheden in de zorgsector. Je kunt via de site eveneens in contact komen met studenten, docenten en verpleegkundigen.
* Op Nursing, de digitale versie van het landelijke vakblad, vind je het laatste nieuws, evenementen en dossiers (waaronder 'Agressie in de zorg') uit de gezondheidszorg. Je kunt je ook abonneren op de Nursing Nieuwsbrief.
* Verplegingenverzorging.nl biedt nieuws en themadossiers over onder andere opleidingen en beroepen in de zorg. Verder kun je onder meer een kennisdatabank raadplegen, waarin honderden scripties, onderzoeksresultaten, afstudeerprojecten, artikelen en andere documenten op het gebied van de gezondheidszorg te vinden zijn.
* Zorgportaal is een verzamelpunt voor vacatures, nieuws, een forum, agenda en andere interessante zorgonderwerpen.
* Op Verpleging Online vind je heel veel links, een vacaturebank en de CAO voor verpleegkundigen. Verder kun je via de discussiepagina in contact komen met collega's, reageren op vragen en meningen en zelf iets ter discussie stellen.
* Ook Ziekenhuis.nl biedt je links, een forum en een vacaturebank. Bovendien vind je er een medicijngids, medisch woordenboek, beschrijvingen van ziektebeelden en informatieve filmpjes.
Aanbevolen boeken
* Huilen mag (De Bruin, S., Gerrese, M. en Pollmann, J., Verpleegkunde Nieuws, 2003) bundelt achttien verhalen van verpleegkundigen over hun ervaringen met leven en dood in hun werk, aangevuld met het verhaal van een patiënte die te horen kreeg dat ze zou gaan sterven.
* In De verpleegkundige als patiënt (Odekerken, S., Bohn Stafleu van Loghum, 2004) lees je hoe een aantal verpleegkundigen 'het patiënt zijn' ervaart. Dit is een interessante invalshoek, want hoewel er in de opleiding volop aandacht wordt besteed aan empathie en patiëntgerichte competenties, krijg je pas echt inzicht als je het in de praktijk zelf meemaakt. De verhalen in dit boek zorgen ervoor dat je je als verpleegkundige in de situatie van de patiënt kunt verplaatsen. Bovendien stimuleren ze je om je werk door de ogen van de patiënt te bekijken.
* Het boek Onzichtbare zwaarte van zorg: verpleegkundigen en verzorgenden aan het woord (Bruntink, R. en Cremers, A., Elsevier Gezondheidszorg, 2005) laat twaalf verpleegkundigen en verzorgenden vertellen over hun vak. Ze zijn afkomstig uit verschillende werkvelden, en worden met situaties geconfronteerd waarvan de moeilijkheidsgraad door buitenstaanders vaak behoorlijk onderschat wordt.
Auteur: Vera van Dijk
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