RESUMO
Although physician and nurse relationships have traditionally been a challenge, evolving changes in health care delivery offer the advanced practice nurse (APN) on opportunity to redefine the scope. Several issues will have an impact on this course. Initially, the condition of employment, as well as the physician's perception of the APN's role and the physician's commitment to role preservation, will be primary influences. Secondary factors include defining the role, scope of practice, and mechanisms for practice evaluation. This process will require and ongoing dialogue and selected strategies to develop and maintain physician relationships.
Assuntos
Descrição de Cargo , Enfermeiros Clínicos , Relações Médico-Enfermeiro , Humanos , Enfermeiros Clínicos/organização & administração , Enfermeiros Clínicos/psicologiaRESUMO
The historical, demographic and pre/post treatment behavioral profiles of a Health Maintenance Organization's (HMO) encopresis patients were studied. The efficacy of two maintenance treatments were also compared. Management included an initial bowel evacuation, high fiber diet, behavior modification program, and random assignment to maintenance on oral laxatives or conditional rectal cathartics. Of the 136 patients evaluated, 61 completed treatment (oral 24; rectal 37). Significant behavioral problems were identified. However, the majority (65%) of patients were managed without psychosocial intervention and successful completion of treatment significantly improved most behaviors. There were no significant differences in efficacy between the oral laxative or conditional rectal cathartic maintenance groups completing treatment. In 87% success continued 6 to 12 months post-treatment.
Assuntos
Comportamento Infantil , Encoprese/psicologia , Encoprese/terapia , Administração Oral , Adolescente , Terapia Comportamental , Catárticos/administração & dosagem , Criança , Pré-Escolar , Fibras na Dieta , Encoprese/fisiopatologia , Enema , Feminino , Humanos , Masculino , SupositóriosRESUMO
Encopresis (soiling in the clothing) is a complex condition presenting a treatment challenge for health care providers. It is a disruptive event, placing both the child and family at risk for crisis. The definition, incidence, etiology and relevant medical, behavioral and developmental theory are discussed. A multi-dimensional encopretic evaluation and management model is presented that addresses encopresis at developmental, behavioral and physiological levels. This system includes a detailed historical, demographic, behavioral and school-performance profile of the child; appropriate physical and laboratory examinations; and a treatment approach that incorporates bowel evacuation, a high-fiber diet, techniques of behavior modification, and maintenance on either contingent rectal cathartics or oral laxatives. If there are significant behavioral concerns and/or the family is dysfunctional, collaborative psychiatric management can be arranged.
