Folder Nursing General Structure

A rational way to address the design of a folder nursing care for a company, be it computer, paper or mixed content provides for the subdivision into two structural "macro areas". The first is a basic / common core, containing four modules (or parts divided, but the folder can not be separated) whose presence is necessary at all offices:
Personal data form;
Nursing History Form;
Form Care Plan;
Nursing Journal module.

The second macro-area is composed of a variable number of cards. Some of these are common in many situations, such as the registration of vital signs. Many others will be used only

occasionally or even should be designed on the basis of the specific operational context:

For the control of respiratory cards, cards for the determination of the trauma, the water balance cards, cards with instructions for medication, evaluation boards Global assistance provided, cards for the transmission of the care plan to other teams, and so on.

Each reality can decide how many and which cards to take, extending and customizing your own folder. The first four modules (Personal details, medical history, nursing care plan, nursing diary), may also be information only, and indeed, it is desirable that they are the computing power offered by the instrument, and will eventually be printed later, to store the folder with all its cards.

An exception is the reality at home, where it is preferable that the diary is printed user to stay at home, as it should be updated and / or consulted by all the professional care team. During the hospitalization of the user every single card can be collected in folders or binders common, adapting to the working methods of the department.

May be used where you need them: around visiting, shopping therapy, the medication cart. They can be left at home user, for example, during intravenous home therapies.

Folder Nursing Personal information Form

In the paper version also serves as a "container", as usually placed on the cover of the folder. With the software version but will require an additional interface, a first screen that functions from the main menu to be able to move within the contents of the folder.

In this case the screen with their personal data will be accessible by indicating the name of the user, and is likely to exploit a database company, with the basic content that will be supplemented or corrected during the interview (always check the address and numbers phone).

Are transcribed medical diagnoses known if verified (obtained from medical records , or communicated by the physician), invalidating any conditions, allergies notes that, for methodological correctness, should be recorded in "Nursing History Form", but given their importance is always preferable to place them in the "front page".

Better is always well marked, so that no operator make some

errors (eg, not realizing that someone is diabetic or allergic to kiwi fruit). If the folder is at home, also evaluate the condition of family housing functions and the presence of media and social welfare.

This may indicate a relative reference to the need to contact or, in the home, a care-giver who will serve as an alternative to ' nurses in the process. Always consider an area "Notes", useful for all events and contingencies.

Nursing Folder multiprofessional

The "user folder" multiprofessional, unique as a tool for sharing and comparing the various health professionals, it is frequently the subject of interest, especially at the administrative level, but clashes with the complexity of the "coexistence" of the data.

Not only the extent of nursing focus is so broad as to make it difficult to document the same synthesis, but the medical and nursing records, even if aimed both at the same goal, the following theories, methods and strategies are very different, which can also intersect and interact, but which can not coexist in the documentation.

The only instrument that has no contraindications of cohabitation, which could and should interact with all health professionals, is the diary. It should unite the nurses and the doctor, merging to create a "diary user" unique, open to the entire health care team.

Whether it be a piece of paper or a screen software, is the most simple and powerful interactive multi-document. It must be emphasized that, although stored in a different place during use, the folder is still nursing to be considered an integral part of the medical record , as complete documentation of the user / client, and will reunited with the filing, by the nursing coordinator / charge nurse, responsible for archiving documents.

Folder Nursing Compilation Rules

Never use a pencil or correction fluid to change the writings. Do not correct medications and dosages "rehearsing" with the pen, to correct and avoid hiding place too, with markers or other. To err is human, to cover up a mistake is criminal. Just pull one or two lines above the part to be deleted, so that the error is still readable. Also applies to existing treatment. If the changes are minimal, one draw a line above the previous one, so that it is still readable after the fact, then write the new prescription in the spaces below.

Record the data in a clear, legible, which admits of no doubt, avoiding handwriting style "doctor's prescription."

Each sheet, especially if part of a multi-user must bear full name and serial number, in order

to return home quickly after the passage of operators "messy".
Each nurse must complete the folder itself and never on behalf of others, taking responsibility for your own records.

The problems identified are described in his diary nursing timely, accurate and essential, avoid forgetting information, noting accurately the user's symptoms and feelings, actions and possible outcome.

For reference later, if the diary is updated several times during the same turn, the date should be marked only on the first note, while the time is updated on all the notes below.

Sensations and symptoms should not be interpreted, but transcribed in "quotation marks" to indicate that the words quoted by the user. Should never be confused with the observations of ' nurses .

The unexpected behavior of a user, such as refusal to take a drug or perform a diagnostic test, it should be noted on the nursing diary, highlighting the reasons.

Abbreviations and symbols are used only if they are known to all members of the team. In places where they make extensive use, provide a legend available separately. Avoid "coined" abbreviations and acronyms of fantasy: the notations should be understandable to all operators.
Use technical terminology, correct and verified. Never irony in his diary: maintain a proper professional detachment, even describing events that can enhance the hilarity.

Folder Nursing Optional content

The computer version of the folder can reach levels of excellence if it manages to integrate the modules described above within a software tool that turns into a much more complete and articulated. The software interface can provide many other resources of the operator.

Although not essential to a nursing folder, could allow you to attach photos on the course of an injury, to connect to the lab tests done to check the responses of blood tests, using dozens of computerized assessment scales and indexes.

Can turn into a real "digital desk", reminding us also of any deadlines for the replacement of bladder catheters, or allowing us to print the handbook for the user with "rules of conduct" or "diet" to follow, with customized its data. The hardware to do this are already present in almost all the realities of healthcare.

Where it is not already present in the documentation of medical records , you must also include a forms of "Privacy Statement" and "Declaration of consent to medical treatment", is formulated to protect the users and operators.

Folder Nursing Cards

Each type of card should bring up his name, even avoiding any "a", "the", "the", "of", eg "water balance Registration Form", followed by the usual data that identifies you. Each course will have a different structure, suitable content to be recorded.

The "registration card prescription" for example, can be very similar to a diary, with simple lines which indicate: the date, time, prescription, initials of prescriber, space to indicate the successful execution.

The "Registration Form vital signs" can have a table structure, and a header with date, time, pulse (beats / minute), temperature (° C), blood pressure (mm / Hg), respiration (breaths / minute), glucose (mg / dl), weight (kg), bowel (+), diuresis (ml), and anything else that might be of interest to the department or service that uses it.

Will then be compiled only the parameters that are relevant to the client (if you are diabetic, you will only use for blood glucose). The "Registration Form therapy" is one of the most delicate and complex to manage. In many departments the card or the "notebook" of therapy are no longer used, because the drugs are to be read directly from the per diem completed by the physician at the time of administration.

Folder Nursing Journal module nursing

Effectively replaces the traditional "delivery", where the ' nurses at shift end, summarizing a large agenda of the conditions of the users, the interventions performed on them, and any other event worthy of note.

A nursing paper diary can be composed of pages numbered in sequence with the usual name, first name and identification number (or date of birth), and even simple layout lines, by providing more in sequence to score the date, time, comments and acronym of ' nurses compiler.

Even in this case will indicate the most significant changes in the conditions of the user, the objective and subjective data, and all the possible problems that may affect the welfare plan of care . It is not necessary to bring back to diary operations and activities that are performed routinely, such as: administration of therapy to time, blood tests or X-rays.

Instead should be reported: drugs administered 'as needed', x-rays or tests performed outside of the routine, such as investigations of falls or malaise. Avoid writing things that are absolutely useless, typical of the old "delivery".

If you pass the afternoon reading a book, you do not need that ' nurses write in his diary: "Still Afternoon."

Folder Nursing Form Care Plan

Contains the written formulation of the entire nursing process , the aims and objectives of the services provided to the user, based on the needs identified and diagnoses derived from these. Evaluate the residual capacities of the individual and determines the activities required to attain the set goals, expressed in terms of expected results.

Be drafted in a clear, flexible, well-defined, must consider the human and material resources available and should include the criteria for evaluating the effectiveness of the intervention (performance indicators). Apply the scientific method of problem solving ( problem solving ) and used as a starting database of the history of nursing.

Graphically it can be summarized into four "pillars": nursing diagnosis (or problem related to the need), Objective (expected result in the short, medium or long term, with the adoption of performance indicators), Intervention (related to the problem and made ​​dependent on 'objective, planned activities in the individual and at the time of execution) and Verify (analysis of performance indicators and possible return to the previous phases, with the reassessment of objectives and interventions).

In some areas, such as emergency room (where the speed of action is essential to ensure health same user), or as the specialist clinic (where you are stationed only a few minutes), the possibility of establishing a care plan with its history is absolutely out of question.

However, a team that works in these areas of care plans can use "pre", in the form of standardized procedures or simple operating instructions, which, while not reaching the level of sophistication and customization tool that would allow, enable a practical response, perhaps essential and minimalist, but correct in its application and more effective.

Folder Nursing History Form

Place where you collect the data considered relevant to the identification of needs and residual abilities. Almost impossible to practice in some hectic work environments, it is also the most difficult to design. In order not to turn the investigation into a mere exercise, then not being able to use it on the field, you must decide very clearly what we really need.

The conceptual model helps us a lot, but it can distract from the real issue, shifting the focus of the compiler on issues of little importance. It is likely that the draft requires two or more printed pages. This is different from the medical history, however, like the latter, may be recorded in an "unstructured", ie by writing their observations on a simple sheet of paper (perhaps using a lookup table in which to choose data collection).

But this gives rise to two problems, related to the skills of individual nurses and the inability to use, then the data in computer. A data collection with multiple-choice items to be ticked, in addition to greatly simplify the lives of those who work in the department (where the pace of work and the environments do not allow space for reflection), allows entry into a relational database like SQL and then a subsequent revision of statistical data. There are dozens of rating scales that could be used to enrich the "Nursing History Form." There are lots of useful but not essential.

If the resulting score is an indication for any influence with the care process, well, otherwise they are only further loss of time. Instead, they can be very useful planning tools that allow you to calculate the workload.

Folder Nursing Personal information Form

In the paper version also serves as a "container", as usually placed on the cover of the folder. With the software version but will require an additional interface, a first screen that functions from the main menu to be able to move within the contents of the folder. In this case the screen with their personal data will be accessible by indicating the name of the user, and is likely to exploit a database company, with the basic content that will be supplemented or corrected during the interview (always check the address and numbers phone). Are transcribed medical diagnoses known if verified (obtained from medical records , or communicated by the physician), invalidating any conditions, allergies notes that, for methodological correctness, should be recorded in "Nursing History Form", but given their importance is always preferable to place them in the "front page". Better is always well marked, so that no operator make some

errors (eg, not realizing that someone is diabetic or allergic to kiwi fruit). If the folder is at home, also evaluate the condition of family housing functions and the presence of media and social welfare. This may indicate a relative reference to the need to contact or, in the home, a care-giver who will serve as an alternative to ' nurses in the process. Always consider an area "Notes", useful for all events and contingencies.

Folder Nursing General Structure

A rational way to address the design of a folder nursing care for a company, be it computer, paper or mixed content provides for the subdivision into two structural "macro areas". The first is a basic / common core, containing four modules (or parts divided, but the folder can not be separated) whose presence is necessary at all offices:
Personal data form;
Nursing History Form;
Form Care Plan;
Nursing Journal module.

The second macro-area is composed of a variable number of cards. Some of these are common in many situations, such as the registration of vital signs. Many others will be used only

occasionally or even should be designed on the basis of the specific operational context: For the control of respiratory cards, cards for the determination of the trauma, the water balance cards, cards with instructions for medication, evaluation boards Global assistance provided, cards for the transmission of the care plan to other teams, and so on. Each reality can decide how many and which cards to take, extending and customizing your own folder. The first four modules (Personal details, medical history, nursing care plan, nursing diary), may also be information only, and indeed, it is desirable that they are the computing power offered by the instrument, and will eventually be printed later, to store the folder with all its cards. An exception is the reality at home, where it is preferable that the diary is printed user to stay at home, as it should be updated and / or consulted by all the professional care team. During the hospitalization of the user every single card can be collected in folders or binders common, adapting to the working methods of the department. May be used where you need them: around visiting, shopping therapy, the medication cart. They can be left at home user, for example, during intravenous home therapies.

Folder Nursing Design

Each operating company should actually elect one or more referents that, even before active as a working group will analyze the forms already in use, assessing the possible non-compliance and / or structural deficiencies, in order to obtain not only a ' instant as more detailed documentation of their situation, but also a summary of the expectations and suggestions provided by colleagues. In the structural design and drafting, you should observe the following points:

Choosing a theoretical model. Indispensable for a correct formulation of the content, the choice of one of the many theories of nursing (or nursing ). We can consider, for example, the simplicity "model of nursing care" by Marisa Chanterelle , or completeness of the "functional models of health" by Marjory Gordon .

Preference for relevant data. Limit the information of "data collection" or tracking cards to those who really can affect the care process. The items "hobby" or "Religion", although certainly useful for a holistic understanding of the user, are unlikely to have feedback on nursing care. Likewise, an "emotional state" established at admission: hard to meet someone "Quiet".

Avoid duplication or unnecessary complications. In addition to full name of the user / client / patient and a possible identification number (or date of birth), one should not increase the demand on various boards of compilations that are obvious or duplication that could be made more easily. Simplicity is prerequisite for reliability. A simple structure is always preferable, because it improves: accessibility, readability, consistency, stability, and functionality.

Do not exceed the single page / screen. Is especially true for add-in cards, but also to the registry or medical history. Having the entire contents of a card at your eyes on a single sheet of paper or on screen, without having to leaf through other pages or click on the right and left with the mouse, is an incentive to smile.

Set the page with the synthesis and harmony. In the realization of media, whether printed pages or software applications, it is essential structuring a harmonious, orderly and condensed as possible. Every single page has to give the viewer the impression of having "everything under control" at a glance. The ideal would be to turn to graphics professionals.

Folder Nursing

The folder is a nurse on paper and / or computer system, which contains the recording of data and all documents pertaining to nursing on the case / user. Certifies and logically organized and effectively all the information and assistance activities of the person, collected and / or performed by ' nurses , fostering empowerment. It is used for writing history , for the definition of charitable objectives, for the annotation of the interventions and evaluation of results. The core of the folder is the nursing care plan customized. Formally recognized by art. 69 of DPR 384/90, is legally considered a public document, compiled by a person appointed as a public service. While not possess the same probative force, for greater completeness of health records to be stored as part of the medical record .

Premises

The 90s saw a proliferation of "nursing folders" with many different features. Initially placed all their attention to data collection, interviews with medical history, pre-compiled modules to be ticked and rating scales, but failed almost completely nullified the plan of care and, therefore, their main purpose. The folder is currently nursing a mature tool, which fully meets the criteria of effectiveness and efficiency required by companies, but arises from the need to fill a cultural void in those situations where no provision is made ​​for medical "problem oriented" (with annotations of different professionals in order, subject to individual user problems, communicating and interacting with each other). The recordings are therefore mainly "aimed at the source" (eg on printed forms with separate sections, reserved for professionals of different interventions, parallel to each other but not interacting). In addition to this, each operating reality then the document needs specific intensive care nurses, for example, have a need for additional documentation very different from that of a psychiatry nurses. After these premises, it is evident that you may encounter difficulties in conceiving and implementing a nursing business directory.

The guidelines, procedures and protocols: the role of Nursing Coordinator

All operators, the primary nurse, they are required to follow some essential tools to coordinate action. They are: guidelines , procedures , protocols .

The Guidelines provide recommendations and guidance of clinical behavior whose purpose is to help stakeholders to decide on how best to apply in all circumstances. The guidelines do not restrict freedom of speech, but orient the choice of professionals.

In this context, the role of the coordinator is crucial. In fact, according to their knowledge and experience in the field, he must choose the most appropriate recommendations for each clinical case. They are classified according to five levels of scientific evidence (a, b, c, d, e) and, if it considers that none of these is valid and effective, may decide to edit them or create new ones. This decision is made, usually at the level of team work in which it is inserted. The procedures are internal rules of operation involving the activities of multiple people or functions. For the formalization process we understand a sequence of behaviors, however small, to standardize nursing activity. They are therefore examples of 'objects of Procedure': placement of a catheter indwelling in the adult male, the hygiene of hair in a person undergoing chemotherapy, as well as the interview at the time of nursing care of the client or the distribution of meals in an operational unit.

Even the ISO 9000 certification in health care has given rise to debates about the relationship between procedure and protocol: this is of more general, while the first is that part of the protocol which is used to detail the ways in which nursing takes place a certain action.

There are two types of procedures: those organizational, prepared under the supervision of the quality, and operational, written by professionals involved in the field and made operational by the directors of the department. Those of the second type take into account the legislation, guidelines and / or protocols of scientific societies. There are sometimes related to the procedures work instructions: These are detailed tasks, connected to specific situations. The procedures are approved by an Ipasvi based provincial / national level or through the national association of college of nursing.

The protocol, however, consists of a document that transfers at the level of professional conduct scientific knowledge gained. It is not, therefore, a statement of work, which takes care clinical content. The activity is divided into a sequence of behaviors: the operator remains free in the way in which to perform the individual steps, but this freedom must not compromise the consistency of performance.

The protocol is then encoded nursing course of action to be preferred in providing a given service in a given situation. The protocol can be considered as such only when, in its various components, is able to detail:

the patient's clinical situation for which the protocol can or must be activated;
the problem (or problems) pertaining to nursing that the protocol aims to address and manage and / or, again, the results to be achieved;
actions (which are also known in the literature acts, actions, behaviors, techniques, etc..) and the procedures to be activated;
indicators and standards for the evaluation of effectiveness.

The coordinator shall establish protocols that will be implemented in his department, assisted by a team of his choice. This work is done through the creation of ad hoc working groups, which he supervised, it is essential that the review, and any changes in procedural innovations are implemented with tight deadlines usually monthly.

Coordinator of Nursing

The coordinator is a professional nursing organization and material resources, both human ones, which coordinates, a business unit within a department or hospital, nursing all the figures.

Contributes to achieving organizational goals through a help function and stimulation of the members of his team, responds to the area coordinator and director of nursing. Collaborate in the drafting of guidelines, procedures and protocols. It combines professional management skills, leadership, and nursing skills.

The figure has become highly specialized with the Law February 17, 2006, No. 43. This law states that to become a nurse coordinator should have the following characteristics:

Master's degree in management for the coordination functions in the membership; at least three years experience in the membership profile. Is again recognized the valid certificate of competency to an executive position in nursing (courses for ex-nurse). Currently however, is not recognized the Master of Science in Nursing and Midwifery as the title to access the role.

Functions of the nursing coordinator
Guidelines (2001) provide training in the nursing coordinator for the acquisition of skills, as well as the promotion of lifelong learning and planning, even the direct management of training activities. The capacity to be developed include the identification of own training needs and those of his collaborators, the design and evaluation of training and testing the impact of training activities. The same Federation , in 2007, said that between the technical and professional skills that define the profile you are the Nurse Coordinator for the design, delivery and monitoring of training programs.

The nursing coordinator responds to the area coordinator and director of nursing.

Clinical Nurse Specialist

The Clinical Nurse Specialist (ISC) is an advanced practice nurse with a postgraduate training (clinical masters). The ISC is the expert clinician in the assessment and care planning area of ​​expertise, has a thorough knowledge of diagnostic and treatment of their patients, is able to develop their interventions according to the most recent indications of ' Evidence-based nursing . The ISC works with other nurses , encouraging growth and maintenance of nursing practice, to improve outcomes of patient care and build new care strategies.

Psychiatric Nursing

Psychiatry

Psychiatry is the branch of specialist medicine that deals with the prevention , the care and rehabilitation of disorders mental , from the standpoint of theory and practice. It is defined as a "discipline of synthesis," as the preservation and the pursuit of mental health , which is the fundamental goal of psychiatry, is obtained by taking into account different areas: medical - pharmacological , psychological , sociological , political , legal.

Henry Ey ( 1900th - one thousand nine hundred seventy-seven ), a psychiatrist French , writes on the eve of his death that "the concept of mental illness must move in the orbit of biology and medicine." He defines psychiatry as "a branch of medicine which deals with the pathology of social relations at that level it ensures that the 'autonomy and' human adaptation in the conditions of his existence."

Psychiatry is a medical practice focused mainly on the use of drugs, using accessory methods otherwise typical of psychology, which instead is the discipline that studies the behavior of individuals and their mental processes.

Psychiatry is also distinguished from psychology for the different course for the training of its practitioners.

Etymology

The term derives from the greek psyche = spirit, soul and Iatros which means care (medical). Literally, the discipline should take the "care of the soul."

Diagnosis

The psychiatric diagnosis is a complex process that relies on medical history evaluations, clinical interviews, test reagents and psychopathology, and, when necessary, of other medical and psychological assessments (internistic, neurological, psychological, social).

From an epistemological point of view, the different theoretical constructs of some psychopathological disorders have led to the use of references nosographical so-called "atheoretical," such as those expressed in the classifications, based on scientific consensus, the DSM (Diagnostic and Statistical Manual of Mental Disorders, APA), in particular, the state, the DSM-IV system and the ICD -10 (International Classification of Diseases) nosographies are the most widely used internationally.

The competence of psychiatric disorders may be temporary or chronic, some psychiatric patients seeking care for a short time, while others need to be monitored and treated for long periods of time or for life, because many mental illnesses are chronic and affect so more or less serious quality (sometimes even the length) of the patient's life and, in severe cases, his family.

Therapy

The therapy usually includes a psychiatric medication or psychotherapy (or, often, a combination of both) in more severe cases usually are associated supportive treatments and rehabilitation, including social. Usually takes place in outpatient settings, as in the CSM (Mental Health Centres of the ASL), or even privately.

The majority of psychiatric patients, more severe, chronic and with severe forms of disability (usually psychotic ) is assisted in specific communities, or in groups followed by flat- ASL , and often, if possible, the patient's own home . Hospitalization, usually of a voluntary, is being implemented only in serious cases, and for defined periods.

Exceptionally, in serious cases, acute and well-defined conditions (with specific safeguards of the law), you may need an obligatory health treatment, of limited duration. The TSO is provided by the Mayor on a reasoned proposal by a doctor then countersigned by a second doctor, usually a psychiatrist, an official of a public facility. The shelter under the TSO is done in a public facility specially prepared in the General Hospital (Departments of 'Psychiatric Service of Diagnosis and Treatment, "SPDC). The TSO, which is implemented only in case of severe acute psychiatric disorders with no capacity for discernment, the law is applied only if a person present danger to himself or others, require urgent treatment and waste, and is not can take appropriate alternative measures outside hospitals, the TSO has a more precise term (one week maximum, renewable only in the presence of serious clinical problems), and can be changed at any time in a shelter volunteer.

Nursing in Mental Health

The concept of mental health refers to a condition of normality and / or emotional stability, emotional, neurobiological, mood, cognitive and behavioral, but it hardly lends itself to a single definition, shared: 's World Health Organization (WHO), there is no "official" definition of the concept of mental health.

Each definition depends on cultural differences, and subjective evaluations by different theories. Most experts agree however that "mental health" on one side and "absence of mental illness," "normal," "social adjustment", "happiness" on the other are not synonyms or concepts directly related: in other words, the absence of mental illness does not necessarily mean the condition of mental health. In this connection it may be recalled that the WHO definition given of " health "in general:" a state of complete well-being physical, psychological and social, not merely the absence of disease or infirmity "

According to the dictionary definition Merriam-Webster , mental health is "a state of emotional and psychological well-being in which the individual is able to exploit its emotional or cognitive skills, carry out its role within society and respond to daily needs of everyday life. "

Some of the skills requirements of the state of mental health are:

• Establish satisfactory relationships with others and mature
• Participate positively in the changing environment
• Develop their personality by investing their own instinctual drives in social relations
• Resolve their conflicts in a balanced way
• Adapt to external conditions and internal conflicts
• Having a good self-image
• Emotions.

Palliative Care in Nursing

Palliative Care

According to the World Health Organization definition of palliative care ("palliative care") are working in an active and full of patients suffering from a disease that does not respond to specific treatments and whose direct consequence is death. The control of pain and other symptoms of the psychological, social and spiritual needs is of paramount importance. The goal of palliative care is to achieve the best possible quality of life for patients and their families. Some palliative interventions are also applicable as early in the disease, in addition to cancer treatment.

The term is derived from "ball", or cover, concealment of a pallium , which in ' Ancient Greece and in the ' Ancient Rome was the woolen cloth that rested on his shoulder and draped around the body, above the tunic.

What are the goals of palliative care?

The main purpose of palliative care is to give meaning and dignity to the patient's life until the end, first relieving his pain, and helping with the holders of not strictly medical, which are equally necessary, as shown by the above definition. Still, Dr. Saunders, he loved to repeat to his patients, "You are important because you are and you are important to the end." This type of medicine, therefore, is not just a simple medical treatment, but it can provide a path of reconciliation and peace than the patient's life and the people around him. Therefore, it is unanimous opinion among international experts that palliative care is the best answer to euthanasia.

The goals of palliative care are well summed up thus:
• Affirm the value of life, whereas death as a natural event;
• do not extend or shorten the life of the patient;
• to provide relief from pain and other symptoms;
• also consider the psychological and spiritual aspects;
• offer a support system to help patients live as actively as possible until death;
• help the family of the sick to live with the disease and then with the mourning.

Who needs it?

It is estimated that every year, about 250 000 people that should be followed with a palliative approach is well 160 000 cancer patients, while the other 90,000 would be part of the sphere of chronic degenerative diseases. These are designed to grow with the continued aging of the population. Therefore, we must turn very soon, when a diagnosis is communicated by the medical prognosis, the palliative care approach. This choice, not to reduce palliative care, as it often still happens, the so-called care of the last days, usually no more than two weeks, requires a synergy between the family doctor, oncologist and medical experts in palliative care (it is noted that does not exist yet defined a postgraduate degree, but you get to do palliative care from locations as diverse as oncology, anesthesia or geriatrics)

The total pain

So Dr. Saunders called the total pain, as an approach to care that affects not only the physical pain of the patient, but all aspects that contributed to acute. The Saunders realized he was treating the wounded of World War II. From here, he had developed, through rigorous study and clinical observation, that if given a regular pain medication could have provided an extremely beneficial to patients. But the single medical therapy was then added to a concrete psychological, social and spiritual: these, together with medical therapy are the four pillars of palliative care. The total pain is a core concept of palliative care, you need to know to understand the wealth. It is an approach in a sense revolutionary, because you can look at the whole person.

Hospices


Hospice is a residential facility where the incurably ill and his family can find relief for a limited period and then return home or live in comfort for the last days of life. It has some specific features: free access for family members (the rooms are equipped with beds for them to sleep, when necessary, within the structure), the possibility of sharing some spaces, such as the so-called herbal teas, the heat of ' furniture (usually in the rooms there is written the name of the patient, and have never designated number with a cold). There are either in hospitals or in specific sites, characterized by being immersed in a scenery of nature.

The home care


You can activate the same type of care you receive hospice care at home also. It is recognized that any person is in the final phase of life certainly prefer to spend it at home. It is important that there are some basic requirements, however, first and foremost the presence of a family member who assumes the role of caregiver (from ' English : "he who gives assistance"), which is formed by the operators of the patient care operations easier. A home is going to visit periodically, depending on the stage of disease may be more or less frequently, the so-called home palliative care team, which includes palliative care doctor, nurse, the ' social workers , psychologist . But beyond the periodic visit to a good team of palliative care home shall ensure the availability in the 24-hour telephone availability.

Laws
The basic laws for the movement of palliative care are two. The first had as its primary purpose the financing of hospice care in order to encourage the birth and development, then actually took place in 2000. The second law has instead wished to sanction the establishment of the network of palliative care, or the integration of hospice care and home.

Volunteering

Important role in palliative care has the world of volunteering. The main symbols are grouped under the Federation of palliative care . A true pioneer in this field was the Floriani Foundation , working in Milan in this field since the mid-70s.

In Oncology Nursing

Oncology

Oncology (from greek óncos, mass and logos, study) is the branch of medicine that concerns the study and treatment of cancer .

Nomenclature

Neoplasia, Tumor, Cancer
Neoplasia (from the greek new, new, and Plas, training) is the abnormal and uncontrolled proliferation of cells in a tissue or an organ of the body. Most of the malignancies proliferate to form masses (more or less) distinct from the area in which they arise. In this sense, the term cancer is used synonymously with cancer (from the Latin Tume, swollen).

Malignant tumors show a high degree of anaplasia, and have the ability to invade adjacent structures and the ability to spread to other organs through the lymphatic system and bloodstream.

The term cancer is usually used as synonymous with malignancy. The most common form of cancer is the cancer , a class of malignant tumors that arise from the epithelial cells in the skin, gastrointestinal tract and other internal organs (when it comes glandular epithelia interests of adenocarcinoma ).

As an example of cancers other than cancer, may be mentioned the sarcomas that arise from cells of the soft tissues (muscles, blood vessels, adipose tissue) and bone, gliomas , resulting from the processing cell glial cells of the system CNS , the lymphomas , which arise from neoplastic transformation of lymphocytes.

Alcohol and staging
At the clinical level the "degree" and "stage" of the tumor are important additional factors that influence the choice of treatment and allow the formulation of a prognosis.

The grade is based on a combination of histological features, in particular the level of atypia, nuclear and cell differentiation, reflecting the aggressiveness of a tumor. Is numerically controlled (grade 1-4) or descriptively ("high" level, "low" level). In general, including nuclear atypia and differentiation there is an inverse correlation, the higher the degree of nuclear atypia, are less differentiated tumor cells, a low-grade cancer is usually made up of well-differentiated cells.

The TNM staging system, developed and maintained by the International Union Against Cancer (UICC) , is the most widely used for classifying the extent of a cancer. The system is based on the size of primary tumor (T), the absence or presence of lymph node metastasis of the primary organs involved (N), and the absence or presence of distant metastases (ie, in other organs) (M). Besides the three principal axes T, N, M, the system allows the encoding accessory elements of the extension of the disease: the invasion of lymphatic vessels (L axis), the invasion of the venous vessels (V axis), the extension residual disease after therapy (R-axis). Finally, there are several changes to allow recording of details.