On a somatic ward clients often have several conditions at once, with complex clinical nursing care. The nurse keeps an overview, recognises deterioration early and makes sure agreements and reporting are right.
The care needs on somatic wards have become heavier in recent years. Clients stay at home longer and only move to a nursing home when it really is no longer possible. That makes somatic care a setting where clinical reasoning and overview are central. In this article you can read what this involves.
A client with heart failure, diabetes and a pressure ulcer calls for a nurse who sees the connections. Fluids, nutrition, blood sugar, skin condition and medication all affect each other. Anyone looking at only one problem misses the bigger picture. Clinical reasoning here means combining signals and involving the right discipline in good time.
This also includes taking a critical look at the care agreements as a whole. Do the measures for the different conditions still fit together, and with what the client himself considers important? I ask that question regularly, together with the team and the treating doctor. That way care stays tailored to the individual needs of clients and their loved ones.
In frail older people, deterioration is often subtle. Someone eats less, is drowsier than yesterday or has a slightly higher breathing rate. A nurse who knows the client and observes well picks this up. Just as important is that the agreements on escalation are clear, so no time is lost.
Complex wounds are common on somatic wards. It is precisely there that I often see different staff members using different materials or methods. That slows healing and makes the reporting unclear. One wound policy per client and reporting that shows how the wound develops make the difference. On the page improving wound reporting you can read how to tackle this in practice.
A somatic shift can be busy: medication rounds, wound care, doctor's visits, family conversations. I keep an overview, even in dynamic situations, by prioritising and communicating clearly with the team. What needs doing now, what can wait, who needs what? That calm carries over to colleagues and clients. A team that knows who does what makes fewer mistakes and feels less pressure.
Overview also means knowing what you do not know. If I am unsure about a situation, I consult the doctor or a colleague rather than leaving it.
When a somatic ward is short-staffed, it is important that a temporary nurse has a good command of clinical nursing care and quickly fits in with the way of working. How to prepare well for such cover in a nursing home is explained on the page about a freelance nurse in the nursing home.
I help with this through nursing cover and wound care and reporting. Want to know what that means for your organisation? Schedule an introduction.
Briefly discuss complex clients with the whole team at the start of each shift. That way everyone knows who needs extra attention.
Yes, somatic care is one of my areas of experience, alongside psychogeriatric care and rehabilitation care, among others.
I am a nurse registered in the BIG register (the Dutch register of healthcare professionals). Which procedures fall within an assignment, we agree in advance, within your organisation's agreements.
Yes, wound care and reporting is one of my services within practical quality improvement.
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