Descrizione del contesto assistenziale
Il contesto per il quale si tenta l’analisi di un modello assistenziale è quello di una U.O. di Ortopedia Traumatologia dove vengono effettuate tutte le prestazioni legate alla patologia traumatica ed ortopedica, ed in particolare a pazienti anziani.
Si deve analizzare e porre particolare attenzione all’assistenza infermieristica,per il supporto morale e psicologico da dare al paziente, alla gestione del pre e del post-operatorio.
Il supporto psicologico è molto importante, in quanto la depressione e l’ansia per il futuro colpiscono questi pazienti i quali vengono sottratti dal loro contesto abitativo e sociale.
Le persone anziane, piu' di ogni altra, vanno supportate psicologicamente, in quanto in loro oltre alla depressione e all’ansia subentra anche la paura della morte legata all’intervento chirurgico e anche dal pensiero di non essere più in grado di 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’ importante tener conto che il paziente viene sottrattodall’ambiente familiare e dalla sua vita sociale, e deve adattarsi ad un ritmo di vita inusuale (l’organizzazione ospedaliera che prevede ritmi diversi da quelli del paziente).
In questo ambito l’ infermiere deve:
· Avere delle competenze avanzate per poter gestire il paziente traumatizzato, in quanto ad alto rischio,
· Gestire le priorità assistenziali,l’ansia e le paure dell’utente,
· Gestione di sintomi legati al dolore e ad eventuali complicazioni,
· Somministrazione e monitoraggio delle terapie,
· Informazione precisa e puntuale al paziente e ai famigliari su tutte le prestazioni che verranno effettuate,
· Focalizzare gli obiettivi assistenziali da raggiungere,
· Utilizzare strumenti per l’accertamento e il monitoraggio dell’utente,
· Multidisciplinarità dell’assistenza e dei trattamenti,
· Pianificare gli interventi da attuare ( educativi, preventivi, curativi),
· Personalizzazione e assicurazione di un’assistenza infermieristica di qualità,
· Essere di sostegno al paziente e alla famiglia, stimolarlo nella ripresa post intervento chirurgico,
· Gestire la continuità assistenziale,sia nel pre che nel post chirurgico, ed occuparsi anche della fase post ricovero, per il reinserimento famigliare o in RSA o centri per la riabilitazione funzionale.
APPLICAZIONE DEL MODELLO
Il modello assistenziale al quale ho fatto riferimento e quello della dottoressa Patricia Benner, che ha individuato sette aree di competenza che ben si applicano nella pratica infermieristica avanzata nell’ambito Ortopedico e Traumatologico, per poter prendesi cura del paziente nella sua totalità evitando il tecnicismo infermieristico che allontana dalla centralità del paziente.
Il modello di riferimento orienta all'individualità del paziente, alla relazione terapeutica che deve essere una costante dell' infermiere sia novizio sia esperto per poter elevare il caring e la competenza.
Le aree prese in esame sono:
1. Il ruolo di aiuto
2. Insegnamento e coaching
3. Funzione diagnostica e di monitoraggio
4. La gestione efficace di situazioni soggette a rapidi cambiamenti
5. Somministrazione e monitoraggio di interventi e regimi terapeutici
6. Monitoraggio e assicurazione della qualità delle attività di assistenza sanitaria
7. Competenze organizzative e relative al ruolo lavorativo.
Descrizione delle sette aree di competenza dell’ assistenza infermieristica:
Il ruolo di aiuto:
· Intesa come relazione terapeutica, creare un clima idoneo per stabilire un impegno terapeutico,
· Essere presenti accanto al paziente,
· Interpretare e monitorare il dolore post traumatico,
· Assicurare sostegno emozionale e informativo al paziente e ai familiari, in quanto i membri della famiglia hanno un ruolo fondamentale nella ripresa del proprio congiunto.
Insegnamento e coaching :
· verificare se il paziente è disponibile al dialogo ed informarlo circa la gestione e controllo di presidi di immobilizzazione, renderlo edotto delle eventuali complicanze alle quali potrebbe andare incontro,
· Informarlo sull’esecuzione di eventuali procedure diagnostiche, l’informazione rende il paziente meno ansioso e maggiormente partecipativo,
· Verificare il grado di apprendimento del paziente e modulare di conseguenza la comunicazione, non utilizzare vocaboli troppo tecnici ed incomprensibili, il feed back deve sempre essere positivo,
· Informazione accurata sia al paziente che ai familiari circa la prescrizione di farmaci a domicilio, le modalità di somministrazioni, consigli per l’utilizzo di presidi sanitari quali alzawater, uso di indumenti comodi quali tute e scarpe confortevoli.
Funzione diagnostica e di monitoraggio:
· Osservazione e monitoraggio delle condizioni del paziente, seguire il paziente nel percorso assistenziale in modo da rilevare i segni di eventuali modificazioni delle condizioni del paziente stesso,
· Essere in grado di prevedere le situazioni critiche ancor prima della comparsa dei segni diagnostici,
· Identificare i problemi e segnalarli al medico,
· Funzione di coping verso i pazienti, sugli aspetti legati alla patologia traumatica, dando loro accurate spiegazioni in modo da mitigare l’ansia e facilitare il recupero funzionale.
La gestione efficace di situazioni soggette a rapidi cambiamenti
· L’infermiere deve essere in grado di identificare e gestire situazioni di rischio immediato della vita dei pazienti, in caso sopraggiungessero complicanze inaspettate, come shock anafilattico ( allergie a farmaci utilizzati per l’anestesia locoregionale o antidolorifici) oppure altre situazioni legate a altre complicanze trauma correlate,
· Essere in grado di dare delle priorità e poter compiere delle scelte terapeutiche ed assistenziali anche in situazioni caotiche.
Somministrazione e monitoraggio di interventi e regimi terapeutici
· Somministrazione di eventuali antidolorifici in modo preciso ed accurato, monitorarne gli effetti collaterali, le incompatibilità e gli effetti tossici. Dare informazione al paziente circa gli effetti terapeutici ed effetti tossici dei farmaci, modalità di esecuzione soprattutto per la terapia anticoagulante 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 che potrebbero infettarsi ( porre maggiore attenzione se il paziente è diabetico)creando terreno ideale per eventuali infezioni piu' pericolose ( quali l'osteomielite in caso di fratture esposte)
· Gestione del dolore post-traumatico e post chirurgico.
Monitoraggio e assicurazione della qualità delle attività di assistenza sanitaria:
· Prevedere un sistema che garantisca un efficace livello di sicurezza sulla erogazione di una sicura assistenza medica e infermieristica.
· Agire con competenza per offrire un servizio che aumenti la qualità delle cure e favorisca se ci sono le condizioni per l’autoassistenza del paziente.
Competenze organizzative e relative al ruolo lavorativo
· Stabilire delle priorità alla risposta dei bisogni e problemi dei pazienti, senza dimenticare altri bisogni o esigenze del paziente,
· Costruire e mantenere motivazione nel gruppo professionale per poter avere sempre approccio terapeutico con il paziente, essere supportivi per gli altri membri del gruppo ed essere supportati dagli altri,
· Far fronte alle carenze organiche,
· Pianificare, prevedere e prevenire i periodi di sovraccarico lavorativo,
· Mantenere e coltivare lo spirito di gruppo ( gruppi di lavoro, condivisione degli obiettivi assistenziali, condivisione di protocolli, linee guida, gestione dei conflitti, e creare un clima collaborativi e di sostegno tra i professionisti),
· Rispondere rapidamente alla richiesta del soddisfacimento dei bisogni dei pazienti.
· Essere flessibili verso i pazienti, le nuova tecnologia e alla burocrazia.
Bibliografia:
· BENNER P., “L’eccellenza nella Pratica clinica”, trad. di C.Calamandrei e L. Rasero, Mc Graw Hill, 2003.
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