Wednesday, 18 June 2008
Yesterday was my very first session for teaching nurses in Japan.
The lecture concentrated on physical examination of the chest with emphasis on basic treatment of the patient such as using a semi-recumbent position rather than prostrate position to reduce aspiration pneumonia and to improve ventilatory function in patients with COPD and cardiac failure.
The reason for such physical examination training? Well, doctors are not always around when you need them and it is useful for nursing staff to make an initial basic assessment so that when they inform the doctors, the urgency of a particular problem can be better understood.
For example, knowing whether the JVP is raised in a breathless patient, counting the respiratory rate using a 'old fashioned watch' rather than relying on machines (which can sometimes be inaccurate), feeling the pulse rate and volume, knowing the signs for CO2 retention, knowing the difference between fluid or consolidation on basic examination of the patient's chest.
You may say that these are the job of the doctor. To some extent yes. However, doctors do not have a monopoly on physical examination and the fact is, there are simply not enough doctors in Japan per head of population. Hence, for nursing staff to be able to aid the doctors and spot the deteriorating patient early is essential, especially in a busy hospital.
Traditionally, there has been a separation between the job of the doctor and the job of the nurse. That separation is not practical or logical in today's society. In the UK, it is now becoming commonplace for emergency nursing staff to be able to take a history and perform a physical examination which helps the doctors see the patients more quickly after such an initial assessment. There are emergency specialist clinics for cellulitis and DVT which are run by nursing staff following a strict protocol.
There is no reason why such specialist nurses with higher level skills and motivation should not be able to help with initial patient assessments.
The nursing staff were amazed to hear that examination of the chest starts by just observing the patient and of course, looking at the hands for clubbing!
The photo below shows the nurses checking for the normal diamond shape created when the two index fingers are put together back-to-back which is lost in advanced clubbing of the fingers. It would have been a good time to play the famous music from YMCA :-)
Teaching will continue monthly covering various aspects of physical examination, radiology, dermatology, diabetes medicine and so forth.
Luckily, I have an excellent translator to help me! :-)
Posted by ブランチ先生 at 12:42 am