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Master Thesis

Permanence de soins infirmiers nocturnes en établissement d’hébergement pour personnes âgées dépendantes : un moyen de contribuer à la continuité des soins en médecine générale

Abstract : Introduction: continuity of ambulatory care is essential. It mainly depends on care availability, which is unequally distributed across the country. Moreover, medical desertification and the absence of on-call nurses in nursing homes (Ehpad) outside of opening hours lead to an increase in elderly people hospitalization in emergency departments. Those observations have led the Regional Health Agency (ARS) to develop a night-working nursing care service at Bergerac Hospital. With this program, a nurse works every night at the hospital and can go to one of the 4 nursing home located around Bergerac if needed, in order to examine a resident and determine whether this resident needs to be admitted to the emergency department. The purpose of this study is to describe the activity of theses nurses. Material and methods: a descriptive observational study was carried out to report on the activity of this night-working care service. Its objective was to describe the requests for interventions and to analyze how these interventions were managed by nurses. Included patients were residents of the 4 nursing homes around Bergerac, for whom telephone advice or nurse examinations were provided at night. For every intervention, the following data were collected and reported in an intervention record : patient demographic characteristics, information on the call, type of intervention, technical acts performed, call to the Centre 15 and patient outcome. Comparison of variables was performed using Chi 2 and Fischer exact tests. Results: from June 26. to October 31., 2019 : 453 interventions were performed, with a proportion of 50.3% urgent care, 35.3% scheduled care, and 14.4% for a request of information on a patient. The main reasons for intervention were monitoring of vital parameters (16.2%), the need for paramedical care (15.8%) and telephone enquiries (12.8%). In the majority of cases (85,6%), the nurses went to the nursing home. They could ask for a medical opinion at the Centre15 in case of emergency. Thus, for 6.1% of patients, a phone call was made to the Centre 15, and 4% of them were transferred to the Bergerac Hospital’s emergency department. Moreover, having high blood pressure during the intervention was significantly associated with the decision to transfer the patient to the hospital (p=0.002). Nurses performed various technical acts such as measuring vital parameters (34.1%), administering medication (32.5%), local care and infusions (9.6%) according to the attending physician's anticipated medical prescriptions. At the time of blood glucose measurements, 37% of patients were hyperglycemic, and 75% of them were treated with insulin. Patients were more likely to be treated when examined early in the night by the nurse (p<0.01). Conclusion: the night-working nursing care system in the Bergerac region allows for comprehensive patient care, but requires adjustments in the use of emergency procedures and in the training of nurses to communicate with the Centre 15. General practitioners also need to be more involved in this care system in order to facilitate patient management at night by means of anticipated medical prescriptions and individualized protocols. Another study of this system could evaluate the reduction of resident hospitalizations in the emergency department, which are often harmful for them, thus avoiding disruptions in their care.
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Master Thesis
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Submitted on : Monday, May 31, 2021 - 3:03:48 PM
Last modification on : Thursday, July 8, 2021 - 3:16:00 AM


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  • HAL Id : dumas-03243254, version 1



Alice Mougin. Permanence de soins infirmiers nocturnes en établissement d’hébergement pour personnes âgées dépendantes : un moyen de contribuer à la continuité des soins en médecine générale. Médecine humaine et pathologie. 2021. ⟨dumas-03243254⟩



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