Заграничный опытОперационные сестры: работа в качестве хирургов

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Операционные сестры: работа в качестве хирургов

Сообщение Сергей Л. » 08 июн 2018, 20:53

Решил тут почитать британскую прессу и натолкнулся на вот такую древнюю статью:
https://www.independent.co.uk/life-styl ... 69408.html
ANNABEL FERRIMAN
Tuesday 24 January 1995 01:02

While the country appeared to reel in shock at the news that an operating theatre sister in Cornwall had removed a patient's appendix, allegedly unsupervised by a consultant, another nurse, Suzanne Holmes of the John Radcliffe Hospital, Oxford, quietly operated for about the 2,000th time. Her job is to remove veins from patients' legs for use in coronary artery bypass surgery. She has been doing it since 1990, in one of the first and most successful experiments in training nurses in certain surgical techniques.

So as Sister Valerie Tomlinson of Treliske Hospital, Truro, faced a disciplinary tribunal on Friday, Ms Holmes was busy operating in Oxford. But how common is it for nurses to carry out surgical procedures?

Brendan Devlin, of the council of the Royal College of Surgeons, said: "I was amazed that this episode regarding the appendix hit the headlines. A very experienced theatre nurse who has been working with a surgeon for a long time will undertake large chunks of the operation, with the surgeon by her side.

"When it comes to nurses doing procedures independently, if they are properly trained, it is not an unreasonable idea. The issue needs speeding up. We need better evaluation and better facilities to train non-medical and non-surgical staff to do routine work."

Suzanne Holmes is one of about 10 nurses who have been trained to strip out leg veins. She followed a six-month course in Cleveland, Ohio, in the US, where many nurses and technicians carry out medical and surgical procedures to contain health-care costs. Her work has helped to reduce the cost of heart surgery in Oxford.

"We do 1,400 heart operations a year here with only two heart surgeons, whereas other leading centres do about 1,200 cases a year with seven or eight. It makes us very cost effective. That is partly because of our use of nurses," said Stephen Westaby, consultant cardiac surgeon at the hospital, who pioneered the scheme.

"The idea that properly trained nurses cannot master these surgical techniques is ridiculous. There has been a great deal of hysteria about the Cornwall case. With training and supervision, nurses could do much more than they do at the moment."

The scheme aimed to improve the quality of vein removal by introducing continuity; until Ms Holmes came, the operation was done by junior doctors, who change jobs every six months. While the heart surgeon is opening the patient's chest, Ms Holmes removesthe long saphenous vein in the leg to replace part of the diseased coronary artery. Since her arrival, the surgeons receive the veins more quickly and in better condition. Her salary,advertised as up to £16,400, is equivalent to that of a junior doctor,so the financial savings are not huge.

"But the quality is much better," says Mr Westaby. "Most junior doctors don't want to be heart surgeons, so might not be well motivated, and with the reduction in their hours, we could not perform as many operations as we do without non-medical staff."

But while Mr Westaby thought the experiment's success was apparent after six months, it took four years for the Royal College of Surgeons to give its approval and allow similar schemes elsewhere.

Nurses are extending their surgical skills in other areas, as well. Jean Thomas, the Royal College of Nursing's assistant director of nursing policy, says: "There is a pilot scheme in the East Midlands, where nurses are removing sebaceous cysts and ganglions [bumps on the back of the wrist]. It has been going five months and appears to be working out fine.

"There are nurse practitioners in many accident and emergency departments who do suturing [stitches] and other minor surgery. In some departments, such as St Charles Hospital, west London, patients do not see a doctor at all.

"Suturing a wound with jagged edges or on a child's eyelid is much more difficult than doing appendectomies, which mainly involve sewing up many layers of muscle "Nurses now put fine tubes to deliver drugs or intravenous feeding into veins.These tubes goin a long way and it is very skilled work.

"Some nurses also do gastroscopies and sigmoidoscopies [procedures in which flexible tubes are inserted into the stomach or bowel for diagnostic investigations].

"There is no limit to learning. There is a huge mystique surrounding medicine, and the British public has an enormous respect for surgeons, but many of these techniques can be acquired through training and experience.

"Many nurses, however, do not want to do this sort of work. They did not go into nursing because they were not clever enough to be doctors or surgeons but because they do not want to fiddle about with veins or arteries. They went into nursing to care forpeople who are vulnerable and in need of help."

Nurse practitioners are being employed in the new minor treatment centre that is replacing the accident and emergency department at St Bartholomew's Hospital, London, and running a minor treatment centre at the South Westminster Centre for Health in central London, set up when the casualty department at Westminster Hospital closed.

One experiment in which nurses undertook surgical work was carried out at the Southampton Eye Hospital, where they were trained to remove cysts from patients' eyelids. The project was recently abandoned, however. "It was felt that knife-to-skin work was not part of the nurses' role," says Professor Andrew Elkington, consultant ophthalmologist at the hospital.

It is not just nurses who are undertaking more sugical procedures, however. Podiatrists (chiropodists who have gone through advanced training) now remove bunions; GPs are responsible for the removal of lumps and bumps, and midwives have long been responsible for episiotomies (cutting the perineum during childbirth to prevent extensive tearing).
Интересно, есть ли нынче какие-то запреты или разрешения по этой теме?
Живя с соседями-волками,
Овечки тоже -
все с клыками.

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Re: Операционные сестры: работа в качестве хирургов

Сообщение Майкл » 09 июн 2018, 18:44

Я думаю в 90% наших клиник сестры давно уже не сестры, а полноценные ассистенты, так как народу везде не хватает.
Просто у нас к этому отношению немного другое...
И я думаю от любого хирурга можно услышать истории «как меня учила операционная сестра»...
И т.д.
Вопрос просто юридический больше. Во многих типичных случаях «рутинную” операцию сделает и сестра. Но отвечает за пациента все равно врач...

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Re: Операционные сестры: работа в качестве хирургов

Сообщение Сергей Л. » 09 июн 2018, 19:12

Майкл:
09 июн 2018, 18:44
Вопрос просто юридический больше. Во многих типичных случаях «рутинную” операцию сделает и сестра. Но отвечает за пациента все равно врач...
Первый случай про аппендэктомию, выполненную операционной сестрой без наблюдения врача, меня несколько ошарашил. Второй, про рутинное исполнение сестрой флебэктомии для аортокоронарного шунтирования, просто удивил, при всем моем уважении к профессору Уэстаби. То, что студенты, работающие медсестрами, сами шьют, для меня не новость - я это видел у нас своими глазами (самому пробовать на больном мне, правда, не предлагали). То, что у нас это формально не полагается, я знаю. Раз тема про заграницу, мне просто интересно, ввели ли в цивилизованных государствах какие-то разрешения или запреты по этой теме на данный момент - статья все же от 1995 года.

Отправлено спустя 7 минут 4 секунды:
Вот, кстати, подробности случая про аппендэктомию.
https://www.independent.co.uk/news/nurs ... 67753.html
NURSE SUSPENDED AFTER 'TAKING OUT MAN'S APPENDIX'
Celia Hall
Friday 13 January 1995 01:02


A doctor has been sent on leave while an inquiry is conducted at a Cornish hospital after allegations that a theatre nurse conducted an appendix operation two weeks ago.

It is alleged that Sister Valerie Tomlinson, an experienced nurse, removed a male patient's appendix. He has made a full recovery and Sister Tomlinson has been suspended.

The incident happened at Treliske Hospital, Truro. Commenting on it, Dr Brian Milstead, chief executive of the Royal Cornwall Hospitals Trust, said yesterday: "We have never come across an allegation of this nature before."

Sister Tomlinson is alleged to have started the surgery when a locum registrar, Tahir Bhatti, left the operating theatre. Mr Bhatti is said to have returned to oversee the operation.

Mr Bhatti went on paid leave yesterday. His employers, the South and West Regional Health Authority, had originally said that Mr Bhatti was to carry on his duties as normal.

A later statement said: "In the present circumstances and because of the difficulties involved in Mr Bhatti carrying out his present duties at Treliske Hospital it has been agreed that Mr Bhatti takes paid leave of absence from today for the duration of the current investigation.

However Dr Milstead said Mr Bhatti was "fully involved" and was in the theatre during the whole of the procedure.

But the health chief would not say who did what in the operating theatre, and added: "The details of exactly what happened are why we have established a very thorough investigation."

Dr Milstead continued: "We are obviously concerned at the serious nature of the allegations. We need to get the facts as quickly as possible.

"If the allegations are proven and found to true I will be extremely surprised. There are very clear protocols and guidelines."

Health unions are demanding a public inquiry into the incident. Trevor Parsons, regional officer for Unison, said: "She is alleged to have actually made an incision, taken the appendix out and sewn up the patient."

Details of the incident are thought to have come to light after a member of the team made a written complaint.

The trust said in a statement: "We are currently carrying out a full investigation into allegations of an appendix operation in one of our theatres at Treliske Hospital." It is expected to last ten days.

A Royal College of Nursing spokeswoman said: "We would not want patients all round the country to get the idea there were have-a-go nurses going around trying out operations."

Sir Norman Browse, president of the Royal College of Surgeons, said that the whole area of health workers, who are not doctors, performing invasive procedures was causing real concern.

"There is confusion in the law, but our position is that all surgery should be conducted by someone medically qualified or by a supervised assistant," he added.

In the UK a select group of about ten nurses do conduct surgery following training and strict protocols. They are called surgeons' assistants.

The rules laid down by the Royal College of Surgeons and approved by the Department of Health stipulate the surgery must be supervised, performed in the presence of a consultant and that the patient must have given prior consent. Approval was also given by the British Medical Association and the Medical Defence Union.

Stephen Westaby, consultant cardiac surgeon at the Oxford Heart Centre,Radcliffe Hospital, Oxford, who has pioneered the training of nurses in this country said: "On the whole an appendectomy is not difficult. You learn how to do it partly by watching."
Отправлено спустя 10 минут 7 секунд:
И продолжение:
https://www.independent.co.uk/news/uk/a ... 69915.html
Appendix nurse to keep surgery job
GLENDA COOPER
Friday 27 January 1995 01:02

A hospital nurse who breached guidelines by removing a patient's appendix has kept her job and could be back in an operating theatre within six months, it was announced yesterday.

Valerie Tomlinson, 53, was given a final written warning by the Royal Cornwall Hospital Trust after a disciplinary hearing she attended last week.

The theatre sister carried out three parts of the operation on 19 December at Treliske hospital in Truro. The surgeon, Tahir Bhatti, carried out the most difficult elements. He supervised Mrs Tomlinson, who was acting as his first assistant, and was present at all times.

Brian Milstead, the trust's chief executive, said Mrs Tomlinson, of Roseannon, near St Wenn, had demonstrated an insufficient understanding of trust and professional practice policies and would have to undergo a period of professional development and clinical supervision. However, if she received a satisfactory assessment she could be back in the operating theatre in six months.

Mrs Tomlinson, a nurse for more than 30 years, was "very relieved at what I think is a fair decision. I am glad it is all over, it has been a bit of an ordeal." She said that what happened took place "as a result of mutual trust and understanding" between her and Mr Bhatti.

The inquiry established she had breached guidelines of the National Association of Theatre Nurses, and Mrs Tomlinson admitted she was wrong to carry out parts of the operation, for which she had not been formally trained. The safety of the male patient -who was told about what happened - was not compromised. He has not complained.

Howard Catton, regional officer for the Royal College of Nursing, said Mrs Tomlinson had an exemplary career with no disciplinary record. "This was not a have-a-go nurse beside the operating table having to be restrained," he said.

How she came to carry out part of the operation was not discussed as the report has to be considered by Mr Bhatti's employers, South and West Regional Health Authority. He is on paid leave.

Libby Campbell, National Association of Theatre Nurses chairman, said: "It was an unfortunate thing to happen but if anything good has come out of it, it isthe opportunity for raising the whole issue of developing theatre nurses' role."

She said experienced theatre nurses could be just as able as medical students. "But any change in role must include proper education, assessment and monitoring and the employer and nurse must agree a job description."

The Royal College of Nursing added that it was already quite routine for nurses to perform post-operative stitching. Those in intensive care administering drugs were doing something more complicated than an appendix operation.
Живя с соседями-волками,
Овечки тоже -
все с клыками.

kapa
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Re: Операционные сестры: работа в качестве хирургов

Сообщение kapa » 09 июн 2018, 20:47

Как мне рассказывали медсестры, работающие в свое время в Германии, операционная медсестра там действительно наподобие ассистента, помимо этого в обязательном порядке должна вести научно-практическую работу и в соответствующих изданиях печатать определённое количество работ в год. Насчёт проведения операций без врача информации не было.

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Re: Операционные сестры: работа в качестве хирургов

Сообщение Новенький » 09 июн 2018, 22:11

В прошлом году проходил практику. Так вот, операционная медсестра(я её принял сперва за хирурга) самостоятельно сняла(врача не было) штифты , наложила швы.
У больного-МОС(металлоостеосинтез).
Это я потом офигел:-О, как!...

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Re: Операционные сестры: работа в качестве хирургов

Сообщение Сергей Л. » 09 июн 2018, 22:30

Новенький:
09 июн 2018, 22:11
Так вот, операционная медсестра(я её принял сперва за хирурга) самостоятельно сняла(врача не было) штифты , наложила швы.
У больного-МОС(металлоостеосинтез).
МОС какой кости?
Живя с соседями-волками,
Овечки тоже -
все с клыками.

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Re: Операционные сестры: работа в качестве хирургов

Сообщение Новенький » 09 июн 2018, 22:37

Лучевой или локтевой. Не помню.
Штифт примерно 15-20 см.

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Re: Операционные сестры: работа в качестве хирургов

Сообщение Ж.В. » 09 июн 2018, 23:50

https://docviewer.yandex.ru/view/0/?*=N ... I5fQ%3D%3D

Посмотрите доклад Казбан О.О. ВВС в прошлом году рассказывал нам об этом опыте. Наши врачи до сих пор не верят что это могут делать сестры.

В Японии роль операционной сестры (да и других сестер тоже) очень ограничена. Операционная сестра только подает инструменты. У хирурга 2-3 ассистента.

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Re: Операционные сестры: работа в качестве хирургов

Сообщение Sockeye » 30 авг 2018, 15:51

Все очень сильно зависит от места, ситуации и людей.

В одном месте где я работаю мне положено уметь и я, как медсестра должен делать при необходимости интубации, торакотомии и крайкотайротомии. Зашивать раны и прочее.
В другом моем рабочем месте от таком перечне функций не идет и речи, но зато я самостоятельно снимаю людей с вентиляции.

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Re: Операционные сестры: работа в качестве хирургов

Сообщение Сергей Л. » 30 авг 2018, 16:39

Sockeye:
30 авг 2018, 15:51
и я, как медсестра должен делать при необходимости интубации, торакотомии и крайкотайротомии. Зашивать раны и прочее.
И ребра при торакотомии сами резецируете, как медсестра? И грудину пилите, и попутно коагулируете?
Живя с соседями-волками,
Овечки тоже -
все с клыками.

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