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Kompetence sester při podávání léčivých přípravků na pracovištích intenzivní péče
HECZKOVÁ, Jana
Medication management is important and very complex part of health care, which is ensured by many healthcare professionals. Intensive care specifics include not only extensive pharmacotherapy but also the administration of medication that can directly and very promptly affect vital signs. This fact brings huge demands on safety during providing care. Traditionally, it is assumed the medication is prescribed by physician, and the nurse ensure administration based on physician?s detailed written prescription. However, activities related to this part of healthcare are currently much more complex. The nurses are expected to be fully competent to fulfil their role in this area at the point of graduation, even in the specialized environment. In addition, it seems that the formal nurses? competencies in medication management are not, in spite of heavy regulation, clearly specified. Although the close relationship between medication management and quality of provided healthcare is obvious, the role of nurses including expected and required demands of current practice have not been analysed in detail yet. The aim of the thesis was to analyse the competencies and nursing role in medication management at intensive care units.Mixed methods design was chosen. Quantitative techniques were used to analyse extent of education and nurses? knowledge in this area, and qualitative techniques were used to analyse current practice and requirements on competence of nurses. There is no difference in formal nurses? clinical competencies in the field of medication management in the Czech Republic depending on the level of education. There is also no difference in extent of pharmacology education during qualifying study at diploma and degree level. However, the current practice in medication management at intensive care units is hugely multifaceted. In some respects its demands greatly exceed the expectations that can be derived from formal set of nurses? clinical competencies in medication management. Although the previous medical doctor?s prescription, especially in case of medication with systemic effect, is considered to be the necessity, the experience of administering this medication in certain circumstances without previous medical doctor?s prescription has been also described. Patient assessment and dose titration of certain medication according to its effect or e.g. laboratory values were described as relatively common part of complex nursing care at this type of workplace, as well as adherence to specific procedures during administration. Particular procedures were workplace related and varied among units but the importance of quality of care was emphasized. The administration of topical medication in specific circumstances, such as eye, oral or skin care in patients with decreased level of consciousness, was perceived more as basic nursing care than medicine administration. However further research will be necessary to verify the extent of this practice. The nurses? knowledge in medication management varied according to the specific topic, but also according to the level of education or previous work experience including previous practice at intensive care environment, although formal competencies in medication management do not differ. Due to the complexity of the medication management and increasing demands on the competence of all healthcare professionals including nurses, it is essential to consider a fundamental revision of the formal nurses? competencies to be necessity at least in this area. Consequently, it could be possible to address the scope, form and content of nursing pharmacology education so that set requirements are met.
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