The Aim of Nursing - Essay Example

Ophthalmic Nursing Introduction The aim of nursing is to develop health and social services with an aide range of skills and competencies in order to enhance care and maintenance to patients and clients. It enables the patients to meet head on the challenges of health care and development after exposing the nurses into proactive and reflexive stance in developing clinical skills, and knowledge (Springgay, 1925). The intrinsic belief of nursing program is to make a platform for making competent and reflective experts, who can be exposed in evidence-based practice and manage change constructively, to make a good impact on health and social care. Ophthalmic patients need more care than any other eye related diseases. Nursing procedure of those patients varies to some degrees between hospitals or units. In addition to specialized cognitive and technical skills several generic core competencies are expected of ophthalmic and other problems. It has been broadcasted publicly by Unites States Accreditation Council for Graduate Medical Education (ACGME). The core competencies for patient care include: Patient care Medical knowledge System-based practice Communication skills and, Practice-based learning and improvement. This paper mostly concentrates on the ophthalmic patients: their health needs, consequences of this problem if certain remedies are not taken care of and, preventative polices and strategies for their caring. Nursing Procedure Ophthalmic patients suffer from visual field defects. These defects mostly related to the diagnosis of glaucoma (Lee et al, 2003). As said, ophthalmic nursing strategies are not standard and area specific that varies in accordance with location and hospitals hence, listing some of the guidelines does not assure the best ( Shaw et al, 2000). But, some of the effective ways are discussed below: Infection control: Though it seems to have little effect but, extra-ocular and intra-ocular infections have a destructive effect on the ocular diagnosis of patient especially, hand washing before and after each patient contact. Hence, infection control measures need to be undertaken. Adequate Education to patient: Inadequate education to the patient sometime lead to degradation of patients' condition making it worse. Most of the nursing and medical procedures seem extremely horrible to the patients and a major percentage of them can easily upset to any measure involving their eyes without any adequate knowledge. That's why it is recommended to make the patient aware of the nature and process of their treatment. Awareness should take into account the patients' learning ability and remembering capability; their physical and emotional state and, sensory deficits. Health and safety issues: The other name of nursing is caring and so, safety issues must be avoided as far as possible. Patient's head should always be well supported to prevent any accidental damage. Well lighting is preferred and as well as magnification. Ophthalmic instrument should be cleaned properly before its usage. These all are some of the points that require to be considered while nursing ophthalmic patients (standard number 1). The skills required to organize the liberation of care are listed below (Education of the Ophthalmic Specialist, 2006): Skills for critical appraisal: It provides the nurses to enhance their critical, analytical and appraisal skills which aim to develop research oriented knowledge and mind efficiency. This sort of activities also provides students with the chance to explore the relationship between education, research and knowledge etc. It also enhances the questioning approaches for health care. Exploring leadership: It mainly restricts the development of individual as a leader and investigates a range of issues that are vital in existing political and economic climate. This improves management performance in the work environment. Practice based project: During the period of study this approach integrates the learning undergone. An issue is selected by the students from practice and then negotiates supports from their managers so that the change gets effected. But, point to be noted over here is that the issue which has been selected from practice must ensure benefit from change. The nursing students will select, plan and implement a strategy for change, as well as identifying an evaluation strategy. Evidence based practice: Through critique ands proper evidence application, practice improving is carried out and that skill is addressed by evidence based practice. Various definitions and understandings of the nature are also explored by this module. Finally, it enables the nursing students to identify evidences and crucially assess their value and making recommendation. Leadership and influencing practice: Practitioner and manager get helped to develop their leadership role within and between the organizations by this module. Its primary purpose is to bring about change and influence practice (standard number 2). The entire module discussed above have a formative and summative assessment. Formative assessment includes critical incident, oral presentations, and skill analysis etc. whereas summative assessments are based on variety of formats like (Education of the Ophthalmic Specialist, 2006): Portfolio compilations Structured reflective accounts Critical incident analysis Experiential learning Critical appraisal Clinical competencies Folders of evidence Patient care studies. As most of the patient can be performed on an outpatient basis hence, nurses especially for ophthalmic purposes work in ambulatory surgery. But, they are not restricted to that only; they are also allowed to work in refractive surgery or laser centers, research, industry, eye banks, home health and charitable organizations etc. ORBIS Flying Eye Hospital is one such example which works for charity. In ambulatory settings education is provided and pre-operative assessments are performed like, acquiring information about patients' overall health, systematic conditions, meditation that has been prescribed, allergies to other meditation etc. Assessment is also done on whether they suffer from any anxiety-provoking factors such as claustrophobia. Ophthalmic nurses work either as a circular or a scrub nurse in the operating room. Circulators are one that places the patient safely and provides the best access platform. Other than that, the surgical site, necessary paperwork and trouble shooting the technical instrumentation are also verified by them. Scrub nurses can only anticipate the needs of the surgeon if they have an in-depth knowledge of ocular anatomy. In the operating room surgery is made less stressful for the patient. It makes easier on the surgeon and cost efficient. Ophthalmic nurses are essential for helping the patients to understand the disease process clearly. For diabetes patients the importance of regular ophthalmic check ups and taught by them (Clouser, 2005). Nurses clarify how strictly monitoring and controlling of blood sugar can slow the progress of diabetic retinopathy which can lead to blindness. Eyes bear a great importance to human lives; even patients are ready to deal with cancer or lose a limb than go to blind and lose much of their independence. If the patients are provide with a general awareness program in preventing that from happening then the problem can be controlled to a great extend. Effective way to learn about ophthalmic nursing is through self-study, continuing and on-the-job training (standard number 4). Competencies relating to patient care are outlined here. Gather essential and accurate information about their patients so that patients' taste, learning capability and intellectual level can be guessed. It is important while conducting some training program for ophthalmic patients. Trainees are required to provide patient care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health. It's not the doctors who presents all the moment with patient rather the nurses who need to take care of them constantly. Providing different workshop and health care services that should be aimed at preventing health problems or maintaining health. These programs can be made available weekly or monthly depending upon the patient awareness level. Information technology is one effective tool for any industry in this era of information. Information system has made the solution more effective and interactive. No matter whether it is a financial institution, construction industry or hospital system. Creating an effective communication tool for demonstrating the caring behavior with patients and their families. Communication must be effective in the sense that, there should be sharing of information. Ineffective communication does not only serve the purpose but sometimes lead into confusion. Educate patients and also their members of families. Family members play another vital role in their maintenance other than nurses (standard number 3). American Society of Ophthalmic Registered Nurses, (ASORN) is already set up which includes membership for anybody on the ophthalmic team including medical personnel, opticians, ocularists and administrators. Their aim is to promote excellence in patient care who is suffering from ophthalmic disease and also for supporting the team through education and individual development (standard number 4). Case Study Ms X is a 42 years old who has been suffering from diabetic mellitus type one for 21 years. She is on insulin humalog pump with dose of 30 units morning and 10 units before bed time. As per the record she is suffering from diabetic retinopathy and has had several lasers on both eyes. In this state some clinical Observation are needed to be done. Visual acuity is the vision clearness and it mostly depends on the sharpness of retinal focus. Vision acuteness also depends on interpretative faculty of brain and somehow sensitivity of nervous elements (Cline D. et al, 1997). This test determines the recognizing capability of black figures with white background. The distance of the object from human being is kept at a predefined distant apart after considering the figure sizes. Heinrich Kuechler, a German Ophthalmologist first felt the need of measuring he visionary power of human body. Snellen chart is an invaluable tool by which visual acuity is measured. This is done after observing the letters on Snellen chart. Other than Snellen chart, LogMAR is also used; it is scaled in logarithmic scale and converts log scale into linear one. It is states as the logarithm of the minimum angle of resolution and measures the visual acuity loss. A negative value indicates normal vision. Though potential diagnosis glaucoma is mostly responsible for visual defect but, the patient under study must undergo several other clinical examinations. Glaucoma is a complex disease which results into loss of retinal ganglion cells and degeneration of optic nerve cells (Ritch et al, 1996). It produces a characteristic excavation of the optic nerve head and this Glaucoma results into blindness for a significant proportion of people worldwide (Thylefors, B. & Negrel, A., 1994). Intraocular pressure is a major factor for glaucoma risk. Intra Ocular Pressure is not the solely responsible risk factor. Even person with high IOP do not develop nerve damage while many individual with nominal IOP comes with optical problem. With a malfunctioning of anterior segment of eye glaucomas develop. Regarding anterior segment dygenesis, multiple tissues are affected. If anterior segment dysgenesis becomes severe then, it may lead into iris hypoplasia, hazy corneas and attachment of cornea to iris etc., finally affecting the visionary power of patient. Among the factors that contribute to this problem include, different number of genes like PAX6, PITX2, PITX3, FOXC1 etc.; specific mutant genes result in different phenotypes; and factors underlying phenotypic heterogeneity (standard number four). Patient is suspected to be effected from pupillary cause for field defect. It can be confirmed from pharmacogical manipulation of the pupil resulting in a normal visual field. After examining anterior segment and gonioscopy any inferior limbal scar if present can be inferred. It comes into existence from losing of iris tissue and inferiorly-displaced pupil. Gonioscopy is done in order to check whether any abnormal angle over the inferior is present or not. Fundi examination might give information about ptosis or prominent brow (standard number three). After undergoing Fundus Fluoresceine Angiogram, recurrent vitreous haemorrhage of the right eye has been revealed. The patient needs to be hygiene so that eyes are protected from bacteria or any other germs. She must undergo her regular doses with bed time. In glaucoma therapy, treatment of two drugs or more is preferred. Prostaglandins or cholinergics are drugs that increases outflow and are applied with a drug that reduces aqueous humor inflow like beta-adrenergic antagonists or carbonic anhydrase inhibitors. From nursing point of view, eyedrops from only one dropper bottle is favorable fro patient. Timolol and latanoprost can be combined into one bottle to get more advantage. The proportion of timolo (0.5%) and latanoprost (0.005%) has been observed to reduce IOP predominantly (standard number one). Conclusion This paper describes the importance of nursing to ophthalmic patients: their scope, way of living and taking care. It has been referred that nursing to them can be started from infection control and education to safety issues. Apart from those, organizing regular awareness program once in a week or in a month can make them familiar with its harmful events and the prevention procedure. A flexible and innovative approach has been developed to practice to the appropriate needs to patient or client group. After that one case study is presented to strengthen the nursing viewpoint which has been stated. Finally, it can be concluded with the statement that, ophthalmic patients needs more care and regular inspection with proper control from infection and only by this way, their health can be taken care of. References Principles and Guidelines of a Curriculum for Education of the Ophthalmic Specialist (2006). International Task Force on Resident and Specialist Education in Ophthalmology. Vol. 223. S5. pp. S1-S19. Principles and Guidelines of a Curriculum for Education of the Ophthalmic Specialist (2006). International Task Force on Resident and Specialist Education in Ophthalmology. Vol. 223. S4. pp. S1-S48. Principles and Guidelines of a Curriculum for Education of the Ophthalmic Specialist (2006). International Task Force on Resident and Specialist Education in Ophthalmology. Vol. 223. S7. pp. S1-S23. Shaw, M., Stollery, R. and, Lee, A. (2000). Ophthalmic Nursing. Clouser, S. (2005). Ophthalmic Nursing: How and Why to Choose this Specialty. American Society of Ophthalmic Registered Nurse. Professional Practice with Ophthalmic Nursing. Professional and Nursing Practice. pp 228. Springgay, M. (1925). Ophthalmic Nursing. 67 illustrations Price 5s. net. Methuen & Co. Ltd., 36 Essex St., London W.C.2. Cline D., Hofstetter, H and, Griffin, J. (1997). Dictionary of Visual Science. 4th ed. Butterworth-Heinemann, Boston. Lee, A., Wang, J., Rochtchina, E., Healey, P., Chia, E. and, Mitchell, P. (2003). Patterns of glaucomatous visual field defects in an older population: the Blue Mountains Eye Study. Clin Experiment Ophthal . 331-5. Ritch, R., Shields, M. and, Krupin, T. (1996). The Glaucomas, Clinical Science, 2nd ed. Mosby-YearBook,St.Louis,MO. Thylefors, B., and, Negrel, A. (1994). The global impact of glaucoma Bull. World Health Organ., 72,323-326. Read More

 

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