What is skilled nursing?

Skilled nursing is the provision of expert medical care by licensed and registered nurses towards the care or treatment of patients. These services can be short term for rehabilitation or postoperative patients or extend over a longer period of time in cases of chronic illnesses or geriatric care. Skilled nurses are trained in proper procedures of wound care, intravenous therapy, catheter care, ostomy care, physical therapy, and overall health monitoring of the patient along with many other duties. They provide these services in various settings ranging from hospitals and nursing homes to home-based health programs.

Skilled Nursing Facility

A skilled nursing facility, sometimes also known as a nursing home or assisted living facility, is a temporary housing facility for patients recovering from post-operative procedures or undergoing rehabilitation therapy. It may also serve as a long-term residence for senior citizens requiring continued medical care and support. The facilities not only provide 24/7 nursing care but also ensure the comfort and happiness of their patients with community activities, social events, educational classes, and various other amenities and services. Some facilities even offer home health services which are especially beneficial for senior citizens and allow them to receive quality health-care in the comfort of their own home.

Services offered by skilled nurses

Skilled nurses are trained in multiple fields of health-care and these are described below:

Post-surgical care is the medical care a person needs while recovering from surgery with the type of care depending on the surgery and illness. Post-surgical care includes pain management, wound care along, monitoring of vital signs, and airway patency. Skilled nurses also assess the patient’s neurologic status, surgical site, and electrolyte and fluid balance as well as manage medication to ensure quick healing.

Medication management can be described as an evidence-based system of prescribing medication that ensures the safety, endurance, and cost-effectiveness of treatment. This approach to medicine prescription allows for all patients to receive optimal, safe, and convenient medical care. Good medicine management is a prerequisite for any skilled nurse and their role includes prescription and administration of medicine and to ensure patient adherence to medication through education.

Pain management is a branch of medicine in which doctors, pharmacists, nurses, and other health-care professionals work together to treat the pain and improve quality of life especially for patients suffering from chronic pain. Pain management uses both scientific and alternative healing methods in the prevention, diagnosis, and treatment of pain. Along with analgesic medications, pain management methods also include massage therapy, physiotherapy, epidural steroid injections, and electrophysiological agents, etc. Skilled nurses must be knowledgeable in these pain management measures and should also be able to assess the tolerance, addiction, and dependence of their patients and take appropriate steps to manage them.

Wound care is an essential and rising field of medicine making up approximately 4% of the total medical system cost. Wound care nurses are specialized in assessment, treatment, and care of patients suffering from injuries due to accidents, ostomies, and other conditions. All skilled nurses learn and experience wound care at some time in their careers with certified wound care nurses acting with a higher level of expertise in this field and help educate other nurses, staff, and health-care professionals. Wound care involves proper ways to clean, dress and treat wounds, chronic wound management, and to assess wounds for complications such as infection or ischemia.

Oxygen therapy is the use of supplemented oxygen as a medical treatment. This therapy is useful in various instances such as in patients with hypoxemia, carbon monoxide poisoning, cluster headaches, and during anesthesia for surgery. Skilled nurses not only assess the need for oxygen therapy in patients but are also qualified to administer it.

Continence care plays an important role in the training of any skilled nurse and needs to be handled sensitively and respectfully to ensure proper management of any patient suffering from bowel or bladder disorders. The goal of continence care is to help the patient maintain healthy bladder or bowel functions, manage continence, offer support, create a treatment plan, and educate the patient and their family about their illness.

Catheterization is commonly carried out for patients with urinary dysfunction and is associated with both benefits and complications if not performed properly. Skilled nurses are taught the hygiene and method for inserting a catheter along with the proper way to clean, drain, and remove the catheter. Correct procedures and catheter care can make this experience bearable for the patient and reduce the chances of complications.

A colostomy is a surgical opening made in the intestine with a stoma connecting the intestine to an external pouch for collecting feces. Colostomy care, therefore, involves the proper cleaning, changing, and emptying of this pouch. The skilled nurse responsible for this must assess patient tolerance and knowledge of the procedure, follow optimal hygiene measures, and educate the patient and their family member regarding the protocols of living with a colostomy pouch to avoid complications.

The main goal of skilled nurses taking care of diabetic patients is to maintain blood sugar levels within normal range and to reduce the risk of complications through insulin alternatives, a healthy diet, and an active lifestyle. The diabetes specialist nurses are responsible for educating their patients and ensuring patient compliance and tolerance to treatment methods. Diabetic care is necessary to provide optimal patient care, enhance diabetes screening, and support patients with diabetes.

Cardiac care nurses are specialized in chronic care of patients suffering from heart conditions and those recovering from cardiac operations. These skilled nurses are responsible for managing medication, administrating investigations, and monitoring the overall health of the patients. 

Orthopedic care involves management and treatment of patients with musculoskeletal problems such as fractures, arthritis, osteoporosis, joint replacement surgeries as well as other issues. An orthopedic care plan includes procedures for pain management, rehabilitation, and monitoring of the patient for postoperative complications like bleeding, infection, thromboembolism, etc. Orthopedic care also involves helping patients regain maximum strength and ability to perform their daily life activities.

 

Additionally, skilled nurses are also trained and qualified in antibiotic management, stroke care, infectious disease management, transplant care, as well as nutrition management, emotional support, and counseling. Skilled nursing is an integral part of a health-care system that aims to ensure the provision of quality healthcare for their patients.

References

  1. Munroe DJ. The influence of registered nurse staffing on the quality of nursing home care. Research in Nursing & Health. 1990 Aug;13(4):263-70.
  2. Munshi MN, Florez H, Huang ES, Kalyani RR, Mupanomunda M, Pandya N, Swift CS, Taveira TH, Haas LB. Management of diabetes in long-term care and skilled nursing facilities: a position statement of the American Diabetes Association. Diabetes care. 2016 Feb 1;39(2):308-18.
  3. Lamy PP, Michocki RJ. Medication management. Clinics in Geriatric Medicine. 1988 Aug 1;4(3):623-38.
  4. Tse MM, Ho SS. Enhancing knowledge and attitudes in pain management: A pain management education program for nursing home staff. Pain management nursing. 2014 Mar 1;15(1):2-11.

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