June 2005, N°7

ACHOBEL Belgium Haux-Life- Support - Germany Hytech BV - The Netherlands Hyperbaric Centre – Brussels (B) Instituut voor hyperbare geneeskunde – Hoogeveen (NL)

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E E B B A A s s N eew ss N w

A discussion of the scope of hyperbaric nursing practice p2 Eine Diskussion über die Rolle des Pflegepersonal in der Hyperbarmedizin p6 Une discussion sur le rôle du personnel infirmier hyperbare p7 Una discussione al fine di definire l’esercizio della professione infermieristica iperbarica p8 The safety zone p10 News from the Board of Directors p p11 Instructions for authors p11 Are you safisfied ? p12



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EBAss News n° 7 – June 2005


Unchecked expansion of the scope of nursing practice may cause more problems than the extra roles will solve. The experience or skills required by a hyperbaric nurse are many. education. Melbourne. This list is not exhaustive and as research into the field continues and the speciality matures is likely to grow. remuneration or satisfaction. innovative or having taken responsibility from areas previously the domain of other health professionals.A discussion of the scope of hyperbaric nursing practice Gordon Bingham Hyperbaric Service. Australia As hyperbaric oxygen therapy gains popularity within mainstream medical culture. Conway 1990. If we accept the skills required in hyperbaric nursing are ‘advanced’ and possibly beyond the scope of traditional nursing. lung function testing. such as technicians undertaking nursing tasks. The Alfred hospital. The need for role definition is examined by the Commonwealth Department of Education. EBAss News n° 7 – June 2005 2 . Scrutiny of the literature finds development of advanced nursing roles well reported. multi-skilling within the context of the multidisciplinary team and accountability. Harvey (1995) suggests that these problems may be due to an increase in workload without concurrent rises in autonomy. drug administration. extended roles and the nurse as a practitioner. are aware of and are working within their limits. know what they are doing. patient numbers and acuities will doubtless rise. counselling. social issue management. minor surgical procedures such as debridement. Levenson & Vaughan 1999). Ball 1999. wound. The debate over nursing roles and extent of practice is not new. They go on to note that any care delivered must be from people who are properly qualified. pain. however due to word limit constraints this essay will discuss arguably three of the most important: role definition and the phenomenon of role extension. This essay will discuss the scope of hyperbaric nursing practice and the factors influencing it. the hyperbaric nurse needs to be experienced in all areas of nursing” McHowell (2002 p122).1) who state that protection of the public is the principle reason for defining the scope of ones practice. (Manley 1998. Levenson & Vaughan (1999) for example suggest the evolution of advanced roles will continue to occur not only in nursing but also throughout the health service due to the service as a whole having the responsibility for explaining how quality of healthcare may be improved. including primary care of patients. For nursing staff in the hyperbaric field the growth of their speciality raises many professional issues and is an opportune time to critically consider their area of practice. nutritional input and ear. nose and throat (ENT) knowledge. acuity and diagnosis. DEST 2001. In examining the scope of practice one finds it inexorably linked to the issue of role definition and although not a new issue it should not be ignored. Further support for advanced roles comes from the United Kingdom Department of Health (DOH 1999) paper outlining a strategy supporting extension of nursing roles to enable the workforce to operate more efficiently and with better use of skills and knowledge. their place within it and the direction it should take in the future. This is particularly relevant to the hyperbaric field “because as patients seen in the hyperbaric unit are from various backgrounds. The nursing profession appears to have embraced role extension with Read et al (1999) purporting that there now exists at least three thousand new nursing roles defined as non-traditional. Science and Training (DEST 2001 Section 2. Many of these factors are identified in the literature. closer examination of extended roles is required. Molbo’s seminal study of 1967 examined the role of the nurse in relation to hyperbaric therapy and highlighted several arguments which still resound throughout the profession today.

Returning to Molbos’ (1967 p528) study. This can lead to a loss of the holistic approach to patient care. The failure of hyperbaric nurses in establishing and defining their role in the multi disciplinary team. in the litigious nature of today’s society when we consider the paper by DEST (2001). Leathard 1994. Rawson 1994. As with role definition this argument is not new. unresolved issues can quickly become problematic. examination of teamwork is beneficial. may be easier said than done. can push practitioners in the team inward towards their own profession to the exclusion of others and cause monoprofessionally focused practice. This. Parkin (1995) suggests that in a situation of confusion such as this occupational groups may claim ownership of ambiguous areas of healthcare intensifying existing power struggles. however. which suggests that determination of ones scope of practice results in the legal protection of oneself. This is an idea supported by Baker (2002) who believes it is important for hyperbaric employees to have some degree of cross training. Nolan (1995) cites the Nursing Times (1995) in reporting that the United States of America has quasimedical tasks such as catheter insertion. To be effective in multi-skilling. they note. This includes open channels of communication and regard for all team members. Vincent (1996) suggests this argument has received a contemporary angle since the 1990’s when interest arose in the utilisation of unlicensed personnel and the notion of multi-skilled health workers to aid in cost containment and working with limited resources. offshore and paramedic backgrounds. As the current assault on traditional boundaries within the health care arena continues and the nursing profession evolves with it. may cause an absence of the notion of ‘teamness’. The notion of the ‘team’ is important in hyperbaric nursing as hyperbaric units typically have a small number of permanent staff within the multi disciplinary team. This. To avoid this occurring the nursing profession can look to the literature where the functioning of the multi disciplinary team and multi-skilling has received close scrutiny (Read et al 1999. Freeman et al (2000) suggest that to make inter-professional teams effective the shared team culture must be allowed to prosper. as while a small unit allows for transfer of information quickly and accurately. have generally completed a high level of first aid and/or life support training in their previous or supplementary roles and it could be argued these skills might be used for the provision of some aspects of patient care. with consideration for their input towards the goal of the team. Christiansen (2000) however concludes that untrained personnel do not have the educational preparation to undertake complex functions should the need arise. such as technicians. she notes some hyperbaric units utilised a technician in place of a nurse. The typical hyperbaric team consists of highly trained individuals from medical.The need for role definition in hyperbaric nursing seems undeniable. attention should be drawn to the areas affected by these indistinct practice boundaries. as in role definition. it appears the onus is on the nursing profession to participate in determining their own role within the hyperbaric field. within the multi disciplinary team and in setting boundaries for multiskilled practice. EBAss News n° 7 – June 2005 3 . The non-medical staff. Spilsbury et al (2001) warn of the lack of coherence in definition of advanced roles profession wide. That is roles previously the domain of nurses being undertaken by untrained staff. nursing. Freeman et al 2000). In the hyperbaric field this equates to technical staff assisting in delivery of patient care at varying levels. who suggest the increasing diversity of nursing is testing boundaries of inter and intra-professional practices making them indistinct. In the hyperbaric field at the moment this is possibly one of the most contentious areas. and increasingly relevant. This complexity is further explored by Daly & Carwell (2003). military. Scholes & Vaughan (2002) suggest. Thus. This is a double-edged sword. injection of intravenous drugs and suturing already undertaken by non-nursing personnel. suggesting this may be a reflection of the complexity of nursing itself. The hyperbaric nursing profession cannot afford to be lackadaisical with regards to these issues. which Wrenford-Brown (2002) suggests has always been a prime nursing function. Miller et al 2001.

their registration board and ultimately to society. can have far reaching ramifications beyond the actual delivery of care. within the hyperbaric multidisciplinary team. knowledge and evaluation. As nursing workload increases it is likely that advanced or extended roles will become more prevalent. or other non-nursing personnel. They must ensure that. nursing staff should exercise caution. If non-nursing trained colleagues begin to participate in patient care to increase effectiveness of hyperbaric units. Thus we can appreciate any decision to make changes in work practices. one area of concern is highlighted by Cott (1997) who observes that whilst much has been published on how to set up teams there has been very little study of the outcomes of functioning teams. technology advances rapidly and the need for legal protection increases. nurses within the speciality are in an ideal position to guide and EBAss News n° 7 – June 2005 4 . skill. staffing and management for future debate. require nurturing and the ability for staff to interact away from the clinical care setting. The Department of Health (DOH 1993) paper also urges caution and explores the possibility of a “super technician” emerging with the consequent decline of nursing staff ultimately being replaced by care assistants. Wrenford-Brown (2002 p229) notes that “hyperbaric nurses have the rare opportunity to be involved in a field that is still defining itself”. As such. The definition of ones role is paramount as nursing staff absorb more tasks. Three: the core elements of what nursing is must be articulated and reflected in nursing development. which has effects on accountability. Bergman (1981) suggests accountability is one of the key tenets of nursing practice. She suggests it is the responsibility of the nurse to identify their place within the hyperbaric environment and if it transpires their “chief responsibility and role” falls within the technology surrounding the patient then a technician should replace them. we maintain our professional integrity and ensure the use of non-nursing staff becomes a “complement” to nursing care and not a “substitute” for it. their use must be monitored carefully to ensure nurses do not ‘over-extend’ their role and ignore basic less glamorous aspects of nursing. This in itself raises issues of workload. but also their employing organisation. Chambers (1998) further argues that determining accountability is an essential requirement for an occupation to receive professional status. As such. Whilst the pursuit of a “team friendly” culture is laudable. but also questions of accountability in regards to patient care.This culture will not occur overnight but will. as Chaboyer et al (1998 p249) caution. With the increasing awareness of healthcare costs and the inherent flexibility of nursing this seems inevitable. Two: that having control of the delivery systems brings with it the necessity for professional accountability with regards to personal competence. However she further notes that if their role falls within the therapy regime and environment then there is a place for nurses. into traditional nursing areas raises not only fears for the future of the hyperbaric nurse. If. One: nurses who retain control of their care-delivery systems will be better able to respond to changes in the healthcare arena in the future. Kitson (1997) makes three recommendations worthy of note for the profession in regards to decisions relating to care delivery. Miller et al (2001) suggest. Molbos’ (1967 p58) opinion is worthy of note. nursing staff must be involved in the decision making process at this level. In conclusion. Chamber (1998) describes accountability as being ‘multi-faceted’ in that nurses are not only accountable to their patients. it is apparent from the literature that scope of nursing practice is closely linked to role definition. technical staff begin to participate in patient care in a regular manner. a notion supported by Chambers (1998) who states that the establishment of modern nursing as a profession is dependant on the profession being able to give account of itself. The encroachment of technical staff.

C. Going Inter-Professional: Working Together for Health and Welfare. London.au/highered/nursing/pubs/scoping-nursing/3.’ Department of Health. A. Collins. (1998) ‘A conceptual framework for advanced practice. (1984) ‘Methods of interprofessional work: likely theories and possibilities. A.’ American Journal of Nursing. Department of Health’. C. (1967) ‘The nurses role in hyperbaric therapy. C. However. K. Sheffield. Sheffield. UK [online]. (1998) ‘Diluting nurses’ scope of practice.[viewed 22/07/2003] http://www... Louis.uk/scharr/guide/levensonvaughan.’ School of Health and Related Research (ScHAAR). (1994) ‘Inter-professional developments in Britain: an overview. & Ross. 12 : p158-167 Department of Health (1993) ‘The challenges for nursing and midwifery in the 21st century. (1997) ‘We decide. London [online]. Vaughan.. (1998) ‘Some issues in the assessment of clinical practice: a review of the literature. R. W.[viewed 22/07/2003] http://www. (ed). & Scholes. A. S. 28(2) : p53-59 Bruser. London. S. S. McDonnell. N.. R..’ In Leathard.M.’ Journal of Clinical Nursing. (1981) ‘Accountability-definitions and dimensions. C. Arnold. Bergen et al (eds) Current Concepts in Clinical Nursing.’ Journal of Clinical Nursing. & Whittaker. Jones. p118-135 Miller. K. UK [online]. you carry it out: a social network analysis of multidisciplinary long-term care teams.doh. (1996) Nursing expertise and advanced practice. (2002) ‘Care of the patient receiving hyperbaric oxygen therapy. p91-103 Molbo.. J. M. M. p57-75 Nolan. 45(9) : p1411-1421 Daly. (1999) ‘The changing role of acute-care hospitals. Routledge. K. References. M. N. K. midwifery and health visiting contribution to health and health care.’ Social Science and Medicine.. 7(3) : p201-208 Christiansen. A.’ Medical Journal of Australia. (1999) ‘Revealing higher levels of nursing practice. A. A. P. specialist and advancing nursing practice.htm Conway.ac.’ In Larson-Cohr. & Ross. London Department of Health (1999) ‘Making a difference. (2000) ‘Is the role of circulating in an OR within the scope of practice for the RPN?’ Canadian Operating Room Nursing. Advancing Nursing Practice. A. School of Health and Related Research (ScHAAR).K. S. H. Going Inter-Professional: Working Together for Health and Welfare. London. S. Butterworth-Heinmann. G.shef. 15(2) : p65-76 Bergman.’ 91(16) : p18 Rawson. [viewed 22/07/2003] EBAss News n° 7 – June 2005 5 . (eds).S.gov. Challenging the Shared Learning Agenda. B. Dowling. University of Sheffield.’ In Rolfe. Strengthening the nursing. V. 3(92) : p33-36 Kitson. Cameron...’ [online]. 311: p305-307 Nursing Times (1995) ‘Warned in the USA. Furlong. Best Publishing Compnay. S. (ed). Science and Training (2001) ‘The scope of nursing practice: the implications for contemporary nursing education and practice.’ Journal of International Professional Care. p134-149 Levenson.’ Nursing Standard. R.’ Nursing Times. J. R. CV Mosby. Freeman. (1998) ‘The perceptions of registered nurses on role expansion. Ball. 120(7) : p325-328 Hopkins. Miller. Flagstaff. M. 12(2) : p33-37 Leathard. (2000) ‘The impact of individual philosophies of teamworking on multiprofessional practice and the implications for education. 98(10) : p59-60 Carver. University of Sheffield.. U. Doyle. (1995) ‘Towards an ethos of interdisciplinary practice. Executive summary. (2003) ‘Nursing roles and levels of practice: a framework for differentiating between elementary.’ Intensive and Critical Care Nursing. Quay Books.gov. 18(1) : p14-19 Commonwealth Department of Education. (eds). [viewed online 22/07/03] http://www. Oxford. D. (2001) Interprofessional Practice in Health and Social Care. & Fulbrook. 14(3) : p237-247 Hillman.dest. V. B.’ International Nursing Review..mould it into a speciality to be envied profession wide.htm Freeman. & Vaughan. C. it may be possible they are condemning themselves to eventually having no role at all.’ Intensive and Critical Care Nursing. p121-146 Manley. D. St. 14(12) : p82-90 Chambers. Hyperbaric Nursing. p38-63 Read. (1997) ‘Developing excellence in nursing practice and care. if hyperbaric nursing staff are not proactive in defining their role. W. (1999) ‘Exploring new roles in practice: implications of developments within the clinical team (ENRIP)’. Masterton. M. Routledge.pdf McHowell.uk/nurstrat.. & Carwell.’ British Medical Journal. (1996) ‘Junior doctor’s hours and the expanding role of the nurse. Cott.’ In B. & Norvell. (1999) ‘Developing new roles in practice: an evidence based guide.’ In Leathard. Jones.

Für das personal in hyperbaren Zentren erhöht das Wachstum ihrer Kompetenzen ihre beruflichen Aussichten. & Vaughan. (Eds). & Norvell. welches weiß was es tut. Dies ist besonders wichtig in hyperbaren Zentren. sowie dem festlegen der Grenzen ihrer Fähigkeiten und Kompetenzen aktiv mitarbeitet. Australia. & Meyer. kleine Chirurgische Eingriffe wie Wunddebridement. Aus den USA wird berichtet dass dort das legen von peripheren Venenkathetern. 11 : p399-408 Spilsbury. V. The Alfred hospital . Die Erfahrung oder Fähigkeiten die ein „Hyperbarpfleger“ sind mannigfaltig und beinhalten die Pflege des Patienten. welche über die klassiche Role der Pflegekraft gehen ist eine nähere Betrachtung der Rolle der Pflegekraft noetig Im hyperbaren Umfeld wird es dem technischen Personal gleichgestellt welches bei der Pflege assistiert. 10(1) : p3-14 Vincent. sich dessen bewusst ist und vor allem seine Grenzen kennt. B. 7(4) : p198-208 Wrenford-Brown.pdf Scholes. Wenn in einem multi-disziplinären Team. Reproduced with the authorisation of the editors. H. die Patientenzahl sowie das Wissen über die Hyperbarmedizin steigt kontinuierlich. Aus diesem Grunde ist das Pflegepersonal in der idealen Position ihr neues Berufbild EBAss News n° 7 – June 2005 6 . Da die Arbeitsbelastung steigt ist es normal dass die erweiterten Kompetenzen in den Vordergrund rücken.uk/scharr/execsumm/clinicalroles. da die Patienten alle verschiedenen Probleme und Pathologien haben muss sich die Pflegekraft hier in allen Bereichen der Pflege sehr gut auskennen. Lungenfunktionsteste durchführen. Arizona. Best Publishing Company. C. Melbourne. Gordon Bingham – Hyperbaric Service.http://www. Hyperbaric Nursing. Jede Pflege sollte von gut ausgebildetem Personal geleistet werden. J. Es ist jetzt ein günstiger Zeitpunkt ihren Arbeitsbereich kritisch zu untersuchen und ihren Platz zu definieren und zu schauen wie er in Zukunft aussehen soll. p227-239 First publication in Offgassing – Journal of the Hyperbaric Technicians and Nurses Association – Australia . Anleitung und Beratung. Sie müssen dafür sorgen dass ihr Beruf nicht abgewertet wird. Ernährungslehre.’ Canadian Oncology Nurses Journal. (2002) ‘Hyperbaric Nursing research’ In Larson-Lohr. Medikamenten Verabreichung. Daher ist es sehr wichtig dass das Pflegpersonal bei der Definition ihrer Rolle in der Hyperbarmedizin. L. K. die intravenöse Medikamentenapplikation von Nicht-Pflegepersonal durchgeführt wird.ac.C. HNOWissen: Diese Liste ist nicht begrenzt und je weiter die Forschung auf dem Gebiet der Hyperbarmedizin fortschreitet umso mehr reift diese zu einer eigenen Spezialität Die Rolle und das Wissen des Pflegepersonal wächst dadurch stetig.N° 41 – February 2005. (2002) ‘Cross boundary working: implications for the multidisciplinary team.’ Journal of Clinical Nursing. skill mix and changing roles. das technische Personal regelmäßig in der Patientenbetreuung eingesetzt wird müssen die Pflegekräfte acht geben.shef. Übersetzung Daniel Winterdorff Eine Diskussion über die Rolle des Pflegepersonal in der Hyperbarmedizin Die hyperbare Sauerstofftherapie wird immer populärer in der Medizin. (1996) ‘Work redesign and re-engineering: a challenge for professional nursing practice. Wissen uebr Schmerz und Wunden. technisches Personal soll als Hilfe und nicht als Ersatz in der Patientenpflege gelten. Nehmen wir die erweiterten Anforderungen in der hyperbaren Pflege an. (2001) ‘Defining the nursing contribution to patient outcome: lessons from a review of the literature examining nursing outcomes. J. Jedoch das das Personal ihre Rolle nicht überbewerten und die Basispflege nicht vergessen Hyperbarpersonal haben die Ehre in einem Arbeitsbereich zu arbeiten der sich noch dabei ist sich selbst zu formen und definieren.’ Journal of Clinical Nursing.

les procédures chirurgicales mineures telles que le débridement. la gestion des origines sociales. le personnel technique et aide soignant commence à participer régulièrement EBAss News n° 7 – June 2005 7 . au sein d’une équipe multidisciplinaire d’oxygénothérapie hyperbare. à des niveaux variables.mit auszuarbeiten und formen. Traduction par R. la polyvalence dans le contexte d’une équipe multidisciplinaire et les responsabilités. la croissance d’activité soulève beaucoup de questions professionnelles et c'est le moment opportun de réfléchir en considération critique leur secteur d’activités.résumé L’oxygénothérapie hyperbare gagne en popularité dans la culture médicale traditionnelle. Au sein de l’oxygénothérapie hyperbare. Il est signalé qu’aux Etats-Unis d'Amérique de nombreuses tâches comme la pose de cathéter. L’oxygénothérapie hyperbare est probablement un secteur controversable. comprenant les soins primaires des patients. Si. ceci implique que du personnel technique. on peut donc s’attendre à ce que le nombre de patients et l’activité iront croissant. En effet. The Alfred hospital . l’examen du travail d'équipe est salutaire car il stimulera une émergence inter-professionnelle dans laquelle l’équipe partagera une culture commune nécessaire à un développement harmonieux. Cette liste n'est pas exhaustive car la recherche dans ces champs continue. S’il est accepté que les qualifications exigées dans l’oxygénothérapie hyperbare sont `avancées' et probablement au delà de la portée des soins traditionnels. aidant-soignant. précédemment. l'injection de médicaments intraveineux et la suture sont déjà réalisés par du personnel non infirmier. les plaies. leur place à l’intérieur de ce secteur et la direction qu'il souhaite prendre à l'avenir. L'expérience et qualifications exigées du personnel infirmier hyperbare sont nombreuses. Ceci inclut des canaux de communications ouverts. soient acteurs. Pour le personnel infirmier hyperbare. le respect pour chaque membre de l'équipe. Pour une équipe multidisciplinaire efficace. HOUMAN A discussion of the scope of hyperbaric nursing practice Une discussion sur le rôle du personnel infirmier hyperbare . les conseils. savent ce qu'elles font. les rôles et l'expertise sont susceptibles de se développer. quant aux soins aux patients. Ceci peut mener à une perte de l'approche holistique des patients qui est depuis toujours une fonction principale des soins infirmiers. la spécialité mûrit. Australia. Certains rôles qui. L’auteur (Gordon Bingham) développe son article sur trois axes essentiels: la définition des rôles et le phénomène d’extension de ceux ci. Les frontières traditionnelles dans l’exercice des métiers de la santé évoluent et les professions des soins évoluent avec elles. Melbourne. Gordon Bingham – Hyperbaric Service. sont responsables et fonctionnent dans leurs limites de compétences. Tout soin délivré doit être réalisé par des personnes qui sont qualifiées. la douleur. C’est ainsi que la responsabilité du personnel infirmier est engagée afin de déterminer son propre rôle dans le champ de l’oxygénothérapie hyperbare et dans l'équipe multi disciplinaire par la pose de limites dans la pratique polyvalente. Sollte das Personal hier nicht aktiv mitarbeiten kann es sein dass kann es sein dass andere ihre Rolle definieren und ueberhaupt keine Rolle mehr in der Hyperbarmedizin spielt Übersetzung einer englischen Zusammenfassung des Originalartikels Erstpublikation – Journal of the Hyperbaric Technicians and Nurses Association – Australia . C'est particulièrement vrai dans le champ de l’oxygénothérapie hyperbare. Une attention particulière doit être apportée dans les secteurs affectés par ces évolutions des frontières. Reproduziert mit Genehmigung des Verlegers. la considération pour son apport au sein de cette équipe. administration de médicaments.N° 41 – Februar 2005. connaissance ORL. les patients rencontrés dans les centres hyperbares proviennent de milieux divers et des diagnostics variés. L’auteur note que cela peut pousser des praticiens vers une pratique focalisée et mono-professionnelle qui mène à l'exclusion des autres professions de la santé. etc . étaient du domaine infirmier sont repris par du personnel aide soignant. un examen plus approfondi des rôles est exigé. Un échec du personnel infirmier à l’établissement et aux définitions de leur rôle dans l'équipe multi disciplinaire peut causer une absence de la notion de complémentarité. donc le personnel infirmier hyperbare doit être expérimenté dans tous les domaines des soins.

EBAss News n° 7 – June 2005 8 . non dovrebbe più essere ignorato. L’augmentation de la charge de travail allant toujours croissant. il dolore. C’est également un des objectifs de EBAss. la ferita. il est probable que l’évolution précitée des rôles se répandra. Article original reproduit avec l’autorisation des éditeurs.N° 41 – February 2005. il maintient son intégrité professionnelle et assure l'utilisation du personnel non infirmier qui devient un "complément" aux soins et pas à un "produit de remplacement". elementi di procedure chirurgiche. la fomazione. L’esperienza e le conoscenze richieste per svolgere questa professione sono molte. The Alfred hospital .Journal of the Hyperbaric Technicians and Nurses Association Australia . Esaminando le finalità dell’esercizio di questa professione si deduce chiaramente che sono collegate con la definizione del ruolo della stessa. Se accettiamo i titoli richiesti per l’assistenza siamo in una fase “avanzata” anche oltre il tradizionale scopo dell’assistenza. si le personnel infirmier hyperbare n’est pas proactif. il court le risque d’être condamné par la suite à n'avoir plus aucun rôle du tout. Pourtant. includendo la prima assistenza ai pazienti. notamment en définissant son rôle. l’amministrazione dei farmaci. traduzione : Valeria Campanaro Una discussione al fine di definire l’esercizio della professione infermieristica iperbarica. le personnel infirmier doit rester attentif à ne pas étendre à l’infini son rôle en courant le risque d’ignorer ou de perdre les aspects de base des soins. prove di funzionalità respiratoria. Ball 1999. attire néanmoins notre attention et suscite une réflexion sur l’absolue nécessité d’une bonne définition des rôles et tâches de chaque acteur au sein d’une équipe OHB. il fattore umano. Cependant. Questa è una caratteristica rilevante “siccome i pazienti osservati dal gruppo iperbarico hanno diverse storie. Melbourne. Conway 1990. la gestione amministrativa della terapia. e sebbene non sia una novità. Nel campo iperbarico è indispensabile che ogni competenza e responsabilità sia impiegata da persone propriamente qualificate. lo smaltimento dei rifiuti. Levenson &Vaugham 1999). Dest 2001. naso e gola. Commentaire: Cet article. Nell’ambito dell’attuale cultura medica. accenni all’apparato digerente e conoscenze su orecchie. Ce faisant. Tuttavia è da rilevare che per quanto concerne lo sviluppo della specializzazione del personale infermieristico in questo campo sono presenti molti problemi professionali. saranno previsti esami specifici per poter ampliare i ruoli richiesti. le personnel infirmier se doit d’exercer une supervision responsable.aux soins. Robert HOUMAN Première publication dans Offgassing . diverse patologie e diagnosi. De même. il progredire dell’applicazione dell’ossigenoterapia iperbarica oltre a produrre un rilevante incremento del numero dei pazienti stimola la conoscenza e la divulgazione della stessa materia. Gordon Bingham – Hyperbaric Service. Australia. i ruoli e la pratica verosimilmente si stanno sviluppando. il loro ruolo e quale direzione potrebbero prendere nel futuro. è necessario che l’infermiere iperbarico sia esperto in tutte le aree dell’assistenza” ( McHowell 2002 p122). ( Manley 1998. questa è un’opportunità per considerare criticamente il loro campo di competenze. Questo elenco non è completo e siccome la ricerca nel campo continua e la specializzazione sta maturando. qui semble volontairement alarmiste. Néanmoins. Traduction réalisée sur la base d’un résumé en anglais de l’article original. la croissante des coûts de soins de santé et la flexibilité inhérente au travail infirmier semblent rendre ce futur inévitable. Le personnel infirmier d’oxygénothérapie hyperbare a rarement l'occasion de s’impliquer dans un domaine qui se définit toujours. ce personnel spécialisé est dans une position idéale pour guider et développer cette spécialité qui sera alors enviée par d’autres spécialités. che sanno quello che fanno e consapevoli di svolgere un lavoro con i suoi limiti. Levenson & Vaughan (1999) suggeriscono di sviluppare avanzati ruoli per il vantaggio non solo dell’assisteza ma del servizio stesso per migliorarne la qualità.

Baker (2002) e Chrisiansen (2000) osservano che per lo sviluppo dell’iperbarica è necessario un riconoscimento di provata formazione professionale per tutto lo staff. Harvey (1995) suggerisce che questi problemi potranno essere debitamente risolti con riconoscimenti di autonomia. La tipica squadra iperbarica possiede un’esperienza di alto livello di addestramento individuale: medica. La seconda: gli infermieri impiegati dovrebbero approfondire la propria competenza attraverso la formazione continua. appare indispensabile che l’impegno degli infermieri sia di partecipare attivamente alla stesura del propria identità nel campo iperbarico. Comunque. Vincent (1996) ammette che questo argomento è di suo interesse dal 1990 quando per incrementare l’attività fu necessario utilizzare personale senza requisiti e lavoratori esperti in sanità per aiutare il contenimento dei costi e lavorare con risorse limitate. La prima: gli infermieri che sono impiegati dovrebbero avere la possibilità di ricambio nello scenario dell’assistenza del futuro. il rispetto tra tutti i membri della squadra e la piena considerazione dei loro punti di vista tesi a raggiungere lo scopo della stessa. Infatti questo si verifica al personale in assistenza tecnica durante la consegna di pazienti ai vari livelli. lo staff tecnico comincia a partecipare con regolarità. esso ha generalmente un piccolo numero permanente di persone in una squadra multidisciplinare. nel team multidisciplinare con i limiti imposti per la pratica stessa. il personale infermieristico dovrebbe usare molta cautela (circospezione).58) che suggerisce che l’identità dell’infermiere nel centro iperbarico sta nella sua “principale responsabilità e nel suo ruolo” finisce quando la tecnologia prevede l’intervento del tecnico per poi riprendere nell’atto terapeutico. A questo proposito è degno di nota l’opinione di Molbos’ (1967 p. Ciò può provocare una perdita dell’approccio olistico verso l’assistenza del paziente che è sempre stata la prima funzione infermieristica (Wrenford-Brown 2002). Lo staff non medico. come l’applicazione di un catetere. militare. Nursing Times 1995) che gli Stati Uniti d’America prevedono nella loro normativa di affidare compiti pressocchè medici. Questo potrebbe favorire i professionisti medici verso le proprie professioni all’interno della squadra escludendo le altre determinando così un’attenzione concentrata su un’unica professione. Questo include l’apertura di canali di comunicazione. Dest (2001) propone che ognuno nell’esercizio delle proprie funzioni venga protetto da un rappresentante legale. infermieristica. Comunque Molbos’(1967 p528). remunerazione e soddisfazione. Per formare squadre multidisciplinari è necessario fare prosperare tra di esseuna cultura condivisa (Freeman 2000). Dovrebbe assicurarsi che la professione infermieristica rimanga integra e che la pratica del personale non infermieristico possa essere di sostegno non di “sostituzione”(Chaboyer 1998 p249). Spilsbury (2001) coerentemente con la definizione di avanzamento di ruolo suggerisce che questo può essere un riflesso della complessità dell’assistenza stessa. Questa complessità è piuttosto esplorata da Daly &Carwell (2003) osservando che l’aumento della diversità dell’assistenza è prova dei limiti delle pratiche inter e intra professionali. Se. EBAss News n° 7 – June 2005 9 . Al momento nel campo iperbarico questo è certamente uno dei maggiori argomenti di contenzioso. offshore e sanitaria. Tuttavia è da chiedersi quale ruolo dovrebbe essere previsto per gli infermieri in un contesto in cui lo staff non è addestrato. La nozione del team è importante sia per il personale di assistenza che per tutto il gruppo iperbarico. siccome il ruolo dovrà essere definito. così come i tecnici. sarebbe da porre attenzione alle aree interessate a questa limitata e confusa pratica. La necessità di definire un ruolo per l’assistenza infermieristica sembra inconfutabile e rilevante. hanno generalmente completato un elevato livello di addestramento di prima assistenza e /o life support nel loro ruolo si potrebbe ipotizzare le prestazioni per alcuni aspetti di assistenza del paziente. Questo però è più facile dirlo che farlo. iniezioni endovenose e suture a personale impiegato non infermieristico.Sulla stessa posizione si trova il Dipartimento della Salute del Regno Unito (DOH1999) che in una pubblicazione propone di estendere i ruoli degli infermieri promuovendo anche programmi di esercitazioni e di formazione. Siccome l’attuale assalto ai limiti tradizionali nello scenario dell’assistenza sanitaria continua e la professione infermieristica evolve con essa. L’insuccesso dell’infermiere iperbarico nello stabilire il suo ruolo nel team multidisciplinare potrebbe essere causato da un’assenza di conoscenza del team stesso (Scholes & Vaughan 2002). Il Dipartimento della Salute (DOH 1993) in una pubblicazione propone di porre attenzione nell’ esplorare la possibilità di fare emergere un “super tecnico” con la conseguenza di un declino dell’assistenza infermieristica. E’ riportato (Nolan. Kitson (1997) suggerisce tre raccomandazioni degne di nota in relazione all’assistenza infermieristica. ma considerando la natura litigiosa della società di oggi. nell’ambito della squadra multidisciplinare. La terza: L’essenza del ruolo e come deve essere articolato e i riflessi nello sviluppo dell’assistenza.

February 2005. E. filled with approximately 100% pure oxygen. certamente poco nobili. L’EBAss sta cercando di operare in quest’ottica. Senza entrare nelle motivazioni. So I would like to warn you for this. che spingono “chi ha il potere” a non volere la soluzione dei problemi legati allo staff che ruota attorno al mondo iperbarico. V. è ipotizzabile che si condannino da soli all’eventualità di non avere alcun ruolo in questo campo.htna.com. In OFFGASSING No. L. If anyone of our members wants more detailed information. all are safety related and of some importance. That’s it for the Safety-zone this time around and don’t forget. For the second time we will keep you posted on facts. Eftedal. Flook. N° 41 – Febbraio 2005. M. multi-skilling within the context of the multidisciplinary team and accountability.org EBAss News n° 7 – June 2005 10 . Wrenford-Brown (2002 p229) nota che “Gli infermieri iperbarici hanno l’eccezionale opportunità di essere coinvolti in un campo che si deve ancora definire”. 4 Winter 2004. This essay will discuss the scope of hyperbaric nursing practice and arguably three of the most important factors influencing it: role definition and the phenomenon of role extension. Englund. se gli infermieri non si attivano nella definizione del proprio ruolo. Credo che così potremmo risolvere il contenzioso tra le figure professionali che dovrebbero operare nello stessa squadra. As you all know the inside of an hood is. It concludes that chamber attendants assisting HBO treatment at 240 kPa for ~ 115 min are exposed to a significant decompression stress using the profiles tested in the present study. che peraltro sembra lontano da una “reale” soluzione. Comunque. Aanderund. “Venous gas embolism in chamber attendants after hyperbaric exposure. Gli infermieri nella loro specializzazione sono in un’ideale posizione per guidarla ed ampliarla per farla diventare un’invidiabile professione in espansione. you will find the summeries of some articles. Riflessione Questo articolo esprime il contenzioso che da sempre vive la medicina iperbarica in Italia. In many centres the headset is used inside the oxygen hood. studies and other safety-related issues. Se il personale non infermieristico addestrato comincia a partecipare all’assistenza dei pazienti effettivamente per incrementare il gruppo iperbarico. O. the road and the private life.au Undersea & Hyperbaric Medicine Society. Yoerik – President of the Safety Committee Welcome in the EBAss Safety-zone. as possible sparks occurs in an very explosive atmosphere. Thorsen.” by J. Risberg. Prima pubblicazione in Offgassing – Giornale dell’Associazione dei Tecnici e degli infermieri – Australia . Web links: Hyperbaric Technicians and Nurse Association: http://www. like the inside of a monoplace hyperbaric chamber.Siccome il carico di lavoro dell’assistenza aumenta è verosimile che l’ampliamento e l’estensione dei ruoli diventerà più rilevante. Published in Undersea & Hyperbaric Medicine Society (UHMS) Journal Volume 31 No. Gordon Bingham published the essay “A discussion of the scope of hyperbaric nursing practice”. il loro utilizzo deve essere monitorizzato attentamente per assicurare che gli infermieri non soffrano “eccessivo carico” del loro ruolo e ignorino gli aspetti meno qualificanti dell’assistenza. think safety in everything we do. Next. developments. Valeria Campanaro The safety zone by Neirynck. Any contribution to this segment will be gratefully received. http://www. Riprodotto con l’autorizzazione degli editori. on the job. Sono convinta che conferendo più potere alle nostre Associazioni potremmo trovare una soluzione perché vengano distribuiti i ruoli e le competenze alle professionalità che ne posseggono i requisiti. please feel free to get in touch. vorrei fare una piccola riflessione.uhms. Con l’incremento dei costi dell’assistenza è inevitabile la flessibilità del ruolo infermieristico. 41.

Mr. The Webmaster (Mr Van der tol) informs us that the website has been translated into French (thank you Didier and Robert) and that this language is now online. Example: Mannens. All manuscripts will be evaluated for significance. Jeuneau has joined the secretariat as assistant of Mrs Mannens and Mr Van der tol. References: Authors are responsible for verifying references against the original documents. duplication of data in graphs and tables. Text: Except in unusual situations. Future participants of this program should be able to register on a first come. Mr. Mr. Eds. first serve basis. and the name. Bruges. After manuscripts have been accepted. telephone and fax numbers. To fund this exchange program a certain amount of money should be reserved. soundness. Van der Tol. and e-mail address (if any) of the corresponding author must accompany the manuscript. and identified in the text by Arabic numerals in parentheses. Practical details will be available after Barcelona meeting. All accepted manuscripts are subject to final editing in the Editorial Office to improve readability and to conserve space. Abbreviations and acronyms should not be overused. Schwarz. the names and affiliations of the authors. authors are asked to submit the final version of the paper electronically or on computer diskette. Houman. The overriding principles are that the composition is correct and unambiguous. Instructions for author's Acceptance of a manuscript is based on originality and quality of the work as well as the clarity of presentation. the manuscript should be divided into Introduction. or repetition in Discussion of information that appears in Results. clear. Mr. Specific items of information should appear only once in the manuscript. the Board of Directors decided to stimulate this program for members of EBAss. Damiens.News from the Board of Directors The Board of Directors had a meeting on 30 April in Murnau (Germany) The participants were: Mrs. a short title (running head). 2002 p 115 EBAss News n° 7 – June 2005 11 . A start has been made with Italian (thank you Valeria) and Dutch.. Andreas Kanstinger of Murnau vollunteered to become a member of the special sub-committee website and help with the translation into German. The active voice is usually preferable to the passive voice. making the total number of languages online two. Mr.. and conformance to journal format by two or more members of the Editorial Board or guest referees. Campanaro. Concerning the exchanges of personnel. address.A Hyperbaric Pan-European Technician. Balestra C. Resume of the decisions: In order to reinforce the secretariat. The German and Spanish languages are to follow. Figures should be uncomplicated and legible. there should not be verbatim repetition in the text of material that appears in a table or figure. Belgium.. C. Operator and Nurses Association: a necessity ? Proceedings of the 28th Annual Scientific Meeting of the European Underwater and Baromedical Society. Germonpre P. should be clearly defined at their first appearance in the abstract and in the text. Results. Preparation of Manuscripts Title: A cover sheet which gives the title of the paper. Houman R. Mr. and Discussion. References must be numbered consecutively in the order in which they first appear in the text. and should be avoided in the title. Methods. and concise. Kelner. Parallel construction of groups of like items or concepts aids in comprehension. Mr. .

Ebass News 7 : Are you satisfied? After 6 issues of the journal. Operators and Technicians Redaction: Robert Houman – 9 Sainte Anne – B 7880 Flobecq .houman@mil. Therefore you will find some affirmations. I wish to receive other information via the journal List of others information: 1.be or by Fax on + 32 2 264 48 61 Free participation !!! EBAss News is a publication of The European Baromedical Association for Nurses. … ☺ ☺ ☺ ☺ ☺ ☺ Please send your answers to the editor on: rob. I have no difficulties to read all the articles in english 2. 2.Belgium Readers committee: Miss Valeria Campanaro (Italy) Mr Daniel Wintersdorf (Luxemburg) Mr Steve Mc Kenna (Great Britain) Special thanks for this issue: Mr Gordon Bingham (Australia) and the HTNA for the authorisation of reproduction. 3. The information published in the journal are high quality 4. 5. Mr Yoerik Neirynck (Belgium) EBAss News n° 7 – June 2005 12 .Belgium Editor: Robert Houman – 9 Sainte Anne – B 7880 Flobecq . 4. I appreciate to receive the journal via E mail 5. I can understand the main article only via the abstract in my own language 3. we wish to know if you are satisfied by your journal. please answer and send us your answers! Affirmations 1.

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