Theory? There care
Description of the context The context for which you try to analyze a model of care is that of a Unit of Orthopedic Traumatology from where they are all performance-related and orthopedic trauma, particularly in elderly patients.
Consideration should pay particular attention and nursing care for the moral and psychological support to be given to the patient, the management of pre and post-operatively.
Psychological support is very important, as depression and anxiety for the future affecting these patients who are taken away from their housing and social context.
Older people, more 'than any other, must be supported psychologically, because in them in addition to depression and anxiety takes over the fear of death related to surgery and also by the thought of not being able to poter riprendere la loro autonomia.
Il paziente ortopedico anziano è un paziente ad alto rischio,deve essere monitorato per evitare che subentrino complicazioni.
Supportarlo nelle sue decisioni ed aiutarlo a reagire alla nuova situazione, infondendogli speranza e fiducia, evitare di fargli assumere degli atteggiamenti passivi nei confronti dell’assistenza, ma stimolarlo a mantenere il più possibile il proprio grado di autonomia ( compatibilmente con le condizioni cliniche ed il tipo di trauma subito).
Il paziente va informato puntualmente su qualsiasi attività gli venga fatta, al fine di alleviare l’ansia e la paura, soprattutto nella gestione di eventuali trazioni transcheletriche e apparecchi gessati.
E’ important to consider that the patient is sottrattodall'ambiente family and his social life, and must adapt to an unusual pace of life (the hospital organization which provides a different pace than the patient).
In this context, the 'nurse must:
· Have advanced skills to manage trauma patients, as high-risk
· Manage priorities care, anxiety and fears of the user,
· Management of symptoms related to pain and possible complications,
· administration and monitoring of therapies, accurate and timely
· Information the patient and family about all the benefits that will be made,
· Focusing on the welfare goals to be achieved,
· Use tools for detection and monitoring of the user,
· multidisciplinary care and treatment,
· Plan they focus on actions (educational, preventive, curative),
· Personalize and quality assurance of nursing care, support
• Be patient and family, stimulate the recovery after surgery,
· Managing continuity of care, both pre-and post- surgery, and also cover the post hospital, for reintegration into family or in nursing homes and centers for functional rehabilitation.
APPLICATION OF THE MODEL The model of care to which I referred and that of Dr. Patricia Benner, who has identified seven areas of competence that are particularly applicable in advanced nursing practice in Orthopedic and Traumatology, to Prendes patient care in its entirety without the technicality that nurses away from the centrality of the patient.
The reference model oriented to individuality of the patient, the therapeutic relationship has to be one of constant 'a novice nurse be an expert to raise caring and competence.
The areas examined are:
1. The role of aid
2. Teaching and coaching
3. Diagnostic and monitoring function
4. The effective management of situations subject to rapid change
5. Administration and monitoring of interventions and treatment regimens
6. Monitoring and quality assurance of health care activities
7. Organizational and management skills related to job role.
Description of the seven areas of competence of 'nursing care: The role
help:
· Understanding how the therapeutic relationship, create a suitable climate for establishing a therapeutic commitment,
• Be present near the patient,
· Interpretation and monitor post-traumatic pain,
· Ensure emotional and informational support to the patient and family, because family members have a role fundamental in the revival of a spouse.
Teaching and coaching:
· to verify if the patient is willing to talk and inform about the management and control of deans of immobilization by informing it of the complications which might be encountered,
· Information on ' implementation of any diagnostic procedures, the information makes the patient less anxious and more participatory,
• Make sure the level of learning of the patient and thereby modulate the communication, do not use words too technical and incomprehensible, the feedback must always be positive,
· Information Check both the patient and family members about the prescription of drugs at home, the route of administration, tips for using medical devices such as alzawater, use of comfortable clothing such as suits and comfortable shoes.
Function Monitoring and Diagnostics:
· Observation and monitoring of patient conditions, follow the patient in the care pathway to detect evidence of possible amendment of the conditions of the patient,
• Be able to anticipate critical situations even before the appearance of diagnostic signs,
· Identify the problems and report them to the doctor,
· Function of coping with patients on aspects related to the trauma by giving them accurate explanations so as to alleviate anxiety and facilitate functional recovery.
The effective management of situations subject to rapid change
· The nurse must be able to identify and manage situations of immediate risk of life for patients, in the instance where unexpected complications such as anaphylactic shock (allergic reaction to drugs used for regional anesthesia or painkillers) or other situations related to other trauma-related complications,
• Be able to prioritize and to make choices and therapeutic care in chaotic situations .
administration and monitoring of interventions and treatment regimens
· administration of any pain in precisely and accurately, monitor side effects, incompatibilities and toxic effects. Giving information to patients about the therapeutic effects and toxic effects of drugs, especially the implementing rules for anticoagulant therapy a base e eparina,
· Prevenzione dei rischi da immobilità forzata, insegnare la ginnastica isometrica onde evitare ipotrofia marcata dei muscoli con relativa inerzia nel recupero funzionale,
· Informazione circa il controllo dell’irrorazione delle estremità, dire all’utente di far presente immediatamente eventuali alterazioni della sensibilità, della sensazione di caldo e freddo,
· Monitoraggio e controllo e valutazione della ferita chirurgica,
· prevenire le lesioni da decubito, delle complicanze da gesso,
· Informarlo circa il buon utilizzo dell’apparecchio gessato, di non inserirvi dei corpi estranei, onde evitare lesioni da grattamento that may become infected (pay more attention if the patient is diabetic), creating ideal breeding ground for infections more 'dangerous (such as osteomyelitis in the case of fractures)
• Management of pain post-traumatic and post surgical.
monitoring and quality assurance of health care activities:
· Consider a system to ensure an effective level of security on the provision of safe medical care and nursing.
· act competently to offer a service that increases the quality of care and whether there are conditions conducive to self-handling of the patient.
Organisational skills and related to the work role
· Establish priorities to answer the needs and problems of patients, not to mention other needs or requirements of the patient,
· Build and maintain motivation in the professional group to have more therapeutic approach with the patient, be supportive for the other members of the group and be supported by others,
· Let addressing the shortcomings organic
· plan, predict and prevent the periods of work overload,
· Maintaining and cultivating the spirit of the group (working groups, shared objectives assistance, sharing of protocols, guidelines, conflict management, and create a climate of collaboration and support among professionals),
· Answering quickly to the request of meeting the needs of patients.
• Be flexible to patients, new technology and bureaucracy.
Bibliography:
· Benner P., "Excellence in Clinical Practice", trans. C. and L. Calamandrei Rasero, Mc Graw Hill, 2003.
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