1
,Inhoud
Table of Contents
Intervisie faciliteren..............................................................................................................................15
Stap 1-Een situatie beschrijven.........................................................................................................16
Stap 2-Betekenis geven....................................................................................................................18
Stap 3-Onderzoeken.........................................................................................................................18
Stap 4-Alternatieve formuleren........................................................................................................19
Literatuurlijst....................................................................................................................................21
Bijlage 1-Intervisie methode leren van successen op pagina........................................................23
Invloed sociale context op zorgvrager in stresssituaties.......................................................................32
Inleiding............................................................................................................................................32
Mentale functies...............................................................................................................................33
Somatisch; signalen en klachten (bio-fysiologische dimensie).........................................................33
Cognitief (psychologische dimensie)................................................................................................34
Emotioneel en gedragsmatig (psychologische dimensie).................................................................36
Sociaal systeem (sociale dimensie)...................................................................................................37
Toepassing in de praktijk 3 november..................................................................................................37
Korthagen model..................................................................................................................................37
Stap 1-Handelen...............................................................................................................................37
Stap 2-Tergublikken..........................................................................................................................38
Stap 3-Bewustwording van essentiële aspecten...............................................................................38
Stap 4-Alternatieven ontwikkelen en daaruit kiezen........................................................................39
Stap 5-Uitproberen...........................................................................................................................39
Literatuurlijst....................................................................................................................................39
Zorg verlenen bij licht agressief gedrag................................................................................................50
Inleiding............................................................................................................................................51
A-Aanleiding: Wat is er gebeurd?.....................................................................................................51
B-Belangrijk?: Wat was er belangrijk voor jou?................................................................................53
C-Conclusie: Welke conclusie trok je over wat de mogelijke oorzaken? & D-Doen: Handelde je hier
ook naar?..........................................................................................................................................54
E-Effect: Wat was het effect van jouw handelen?............................................................................55
F-Feedback: Ben je tevreden over hoe je hebt gehandeld?..............................................................55
Literatuurlijst....................................................................................................................................56
Ethisch dilemma: crisisopname............................................................................................................66
Inleiding............................................................................................................................................66
Dilemma verkennen.........................................................................................................................67
Ontwikkelde situatie.........................................................................................................................69
Morele vraag formuleren.................................................................................................................70
2
, Betrokkenen en argumenten analyseren.........................................................................................70
Argumenten afwegen.......................................................................................................................72
Besluit nemen...................................................................................................................................72
Proces evalueren..............................................................................................................................73
Literatuurlijst........................................................................................................................................73
Inhoudsopgave.....................................................................................................................................77
Inleiding................................................................................................................................................82
Stap 1: Gestructureerde vraag..............................................................................................................83
Vraagstelling PICO............................................................................................................................83
Achtergrond......................................................................................................................................84
Stap 2: Zoeken naar bewijs...................................................................................................................85
Zoek strategie en uitkomst...............................................................................................................85
Significant improvement in sleep in people with intellectual disabilities living in residential settings by
non-pharmaceutical interventions.......................................................................................................87
Interventions for sleep difficulties in adults with an intellectual disability...........................................87
Can sensory integration have a role in multi‐element behavioural intervention? An evaluation of
factors associated with the management of challenging behaviour in
community adult learning disability services........................................................................................88
Stap 3-Kritische beoordeling van het bewijs.........................................................................................88
Stap 4: Conclusie met vertaling naar de praktijk..................................................................................90
Conclusie..........................................................................................................................................90
Aanbeveling......................................................................................................................................91
Klinische relevantie met vertaling naar de praktijk...........................................................................91
Afbeelding 1-Actiwatch.................................................................................................................93
Inzetten in de praktijk..........................................................................................................................93
Uitleg Actie-watch............................................................................................................................93
Afbeelding 2-Slaapanalyse............................................................................................................94
Literatuurlijst........................................................................................................................................94
Casus..................................................................................................................................................108
Stap 1- Oriëntatie op de situatie/klinisch beeld.................................................................................109
Tijdsperiode 14:30 uur tot 19:00 uur- 16 november......................................................................109
Figuur 1-Buikpijn.........................................................................................................................109
Tijdsperiode 19:00 uur tot 21:15 uur-18 november.......................................................................110
Stap 2-Klinisch redeneren: klinische probleemstellingen...................................................................111
Figuur 2-Scoliose.........................................................................................................................111
(Buik)pijn.......................................................................................................................................111
....................................................................................................................................................111
Benauwdheid..................................................................................................................................111
Tabel 1-Salbutamol en Fluimucil.................................................................................................112
Tabel 2-Fluimucil.........................................................................................................................112
3
, Parameters.....................................................................................................................................112
Tabel 3-Parameters....................................................................................................................112
Faeces.............................................................................................................................................113
Tabel 4-Voedingstoffen...............................................................................................................113
Stap 3-aanvullend klinisch onderzoek................................................................................................114
Lichamelijk onderzoek....................................................................................................................114
Tabel 5-Symptomen klysma........................................................................................................114
Voedingsadvies...............................................................................................................................115
Tabel 6-Alternatieven sondevoeding..........................................................................................115
Bloedonderzoek..............................................................................................................................115
Stap 4-Klinisch beleid..........................................................................................................................115
Obstipatie.......................................................................................................................................115
Tabel 7-Mircolax.........................................................................................................................116
Ontlasting schema..........................................................................................................................116
Stap 5-Klinisch verloop.......................................................................................................................116
Ontlasting.......................................................................................................................................116
Medicamenteuze interventies........................................................................................................117
Stap 6-Nabeschouwing.......................................................................................................................118
Zorgverlening..................................................................................................................................118
Verpleegtechnische handeling: Medicatie via PEG-sonde..............................................................118
Samenwerking....................................................................................................................................118
Communicatie....................................................................................................................................118
Kwaliteit van zorg...........................................................................................................................119
Literatuurlijst......................................................................................................................................120
Bijlage 1-Macrogol klaarmaken..........................................................................................................124
Inleiding..............................................................................................................................................132
Casus..................................................................................................................................................132
Samenvatting psychologisch onderzoek.........................................................................................133
1.Anamnese........................................................................................................................................133
11 patronen van Gordon................................................................................................................133
2. Verpleegkundige diagnoses............................................................................................................135
Pes 1...............................................................................................................................................136
Pes 2...............................................................................................................................................136
Pes 3...............................................................................................................................................136
3.Planning, doel en resultaten............................................................................................................137
PES 1- Gebrek aan afleiding............................................................................................................137
3.1-a Planning.................................................................................................................................137
3.2-b Doel.......................................................................................................................................138
3.3-c resultaten...............................................................................................................................138
PES 2- risico op zelfverminking.......................................................................................................138
4
,Inhoud
Table of Contents
Intervisie faciliteren..............................................................................................................................15
Stap 1-Een situatie beschrijven.........................................................................................................16
Stap 2-Betekenis geven....................................................................................................................18
Stap 3-Onderzoeken.........................................................................................................................18
Stap 4-Alternatieve formuleren........................................................................................................19
Literatuurlijst....................................................................................................................................21
Bijlage 1-Intervisie methode leren van successen op pagina........................................................23
Invloed sociale context op zorgvrager in stresssituaties.......................................................................32
Inleiding............................................................................................................................................32
Mentale functies...............................................................................................................................33
Somatisch; signalen en klachten (bio-fysiologische dimensie).........................................................33
Cognitief (psychologische dimensie)................................................................................................34
Emotioneel en gedragsmatig (psychologische dimensie).................................................................36
Sociaal systeem (sociale dimensie)...................................................................................................37
Toepassing in de praktijk 3 november..................................................................................................37
Korthagen model..................................................................................................................................37
Stap 1-Handelen...............................................................................................................................37
Stap 2-Tergublikken..........................................................................................................................38
Stap 3-Bewustwording van essentiële aspecten...............................................................................38
Stap 4-Alternatieven ontwikkelen en daaruit kiezen........................................................................39
Stap 5-Uitproberen...........................................................................................................................39
Literatuurlijst....................................................................................................................................39
Zorg verlenen bij licht agressief gedrag................................................................................................50
Inleiding............................................................................................................................................51
A-Aanleiding: Wat is er gebeurd?.....................................................................................................51
B-Belangrijk?: Wat was er belangrijk voor jou?................................................................................53
C-Conclusie: Welke conclusie trok je over wat de mogelijke oorzaken? & D-Doen: Handelde je hier
ook naar?..........................................................................................................................................54
E-Effect: Wat was het effect van jouw handelen?............................................................................55
F-Feedback: Ben je tevreden over hoe je hebt gehandeld?..............................................................55
Literatuurlijst....................................................................................................................................56
Ethisch dilemma: crisisopname............................................................................................................66
Inleiding............................................................................................................................................66
Dilemma verkennen.........................................................................................................................67
Ontwikkelde situatie.........................................................................................................................69
Morele vraag formuleren.................................................................................................................70
2
, Betrokkenen en argumenten analyseren.........................................................................................70
Argumenten afwegen.......................................................................................................................72
Besluit nemen...................................................................................................................................72
Proces evalueren..............................................................................................................................73
Literatuurlijst........................................................................................................................................73
Inhoudsopgave.....................................................................................................................................77
Inleiding................................................................................................................................................82
Stap 1: Gestructureerde vraag..............................................................................................................83
Vraagstelling PICO............................................................................................................................83
Achtergrond......................................................................................................................................84
Stap 2: Zoeken naar bewijs...................................................................................................................85
Zoek strategie en uitkomst...............................................................................................................85
Significant improvement in sleep in people with intellectual disabilities living in residential settings by
non-pharmaceutical interventions.......................................................................................................87
Interventions for sleep difficulties in adults with an intellectual disability...........................................87
Can sensory integration have a role in multi‐element behavioural intervention? An evaluation of
factors associated with the management of challenging behaviour in
community adult learning disability services........................................................................................88
Stap 3-Kritische beoordeling van het bewijs.........................................................................................88
Stap 4: Conclusie met vertaling naar de praktijk..................................................................................90
Conclusie..........................................................................................................................................90
Aanbeveling......................................................................................................................................91
Klinische relevantie met vertaling naar de praktijk...........................................................................91
Afbeelding 1-Actiwatch.................................................................................................................93
Inzetten in de praktijk..........................................................................................................................93
Uitleg Actie-watch............................................................................................................................93
Afbeelding 2-Slaapanalyse............................................................................................................94
Literatuurlijst........................................................................................................................................94
Casus..................................................................................................................................................108
Stap 1- Oriëntatie op de situatie/klinisch beeld.................................................................................109
Tijdsperiode 14:30 uur tot 19:00 uur- 16 november......................................................................109
Figuur 1-Buikpijn.........................................................................................................................109
Tijdsperiode 19:00 uur tot 21:15 uur-18 november.......................................................................110
Stap 2-Klinisch redeneren: klinische probleemstellingen...................................................................111
Figuur 2-Scoliose.........................................................................................................................111
(Buik)pijn.......................................................................................................................................111
....................................................................................................................................................111
Benauwdheid..................................................................................................................................111
Tabel 1-Salbutamol en Fluimucil.................................................................................................112
Tabel 2-Fluimucil.........................................................................................................................112
3
, Parameters.....................................................................................................................................112
Tabel 3-Parameters....................................................................................................................112
Faeces.............................................................................................................................................113
Tabel 4-Voedingstoffen...............................................................................................................113
Stap 3-aanvullend klinisch onderzoek................................................................................................114
Lichamelijk onderzoek....................................................................................................................114
Tabel 5-Symptomen klysma........................................................................................................114
Voedingsadvies...............................................................................................................................115
Tabel 6-Alternatieven sondevoeding..........................................................................................115
Bloedonderzoek..............................................................................................................................115
Stap 4-Klinisch beleid..........................................................................................................................115
Obstipatie.......................................................................................................................................115
Tabel 7-Mircolax.........................................................................................................................116
Ontlasting schema..........................................................................................................................116
Stap 5-Klinisch verloop.......................................................................................................................116
Ontlasting.......................................................................................................................................116
Medicamenteuze interventies........................................................................................................117
Stap 6-Nabeschouwing.......................................................................................................................118
Zorgverlening..................................................................................................................................118
Verpleegtechnische handeling: Medicatie via PEG-sonde..............................................................118
Samenwerking....................................................................................................................................118
Communicatie....................................................................................................................................118
Kwaliteit van zorg...........................................................................................................................119
Literatuurlijst......................................................................................................................................120
Bijlage 1-Macrogol klaarmaken..........................................................................................................124
Inleiding..............................................................................................................................................132
Casus..................................................................................................................................................132
Samenvatting psychologisch onderzoek.........................................................................................133
1.Anamnese........................................................................................................................................133
11 patronen van Gordon................................................................................................................133
2. Verpleegkundige diagnoses............................................................................................................135
Pes 1...............................................................................................................................................136
Pes 2...............................................................................................................................................136
Pes 3...............................................................................................................................................136
3.Planning, doel en resultaten............................................................................................................137
PES 1- Gebrek aan afleiding............................................................................................................137
3.1-a Planning.................................................................................................................................137
3.2-b Doel.......................................................................................................................................138
3.3-c resultaten...............................................................................................................................138
PES 2- risico op zelfverminking.......................................................................................................138
4
