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June 2005, N°7
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Content

Editorial

A discussion of the scope of
hyperbaric nursing practice

Eine Diskussion über die Rolle des
Pflegepersonal in der
Hyperbarmedizin

Une discussion sur le rôle du
personnel infirmier hyperbare

Una discussione al fine di definire
l’esercizio della professione
infermieristica iperbarica

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EBAss News n° 7 – June 2005 1
 A discussion of the scope of hyperbaric nursing practice
Gordon Bingham
Hyperbaric Service, The Alfred hospital, Melbourne, Australia

As hyperbaric oxygen therapy gains popularity within mainstream medical culture, patient numbers and
acuities will doubtless rise. For nursing staff in the hyperbaric field the growth of their speciality raises
many professional issues and is an opportune time to critically consider their area of practice, their place
within it and the direction it should take in the future.

This essay will discuss the scope of hyperbaric nursing practice and the factors influencing it. Many of these
factors are identified in the literature, however due to word limit constraints this essay will discuss arguably
three of the most important: role definition and the phenomenon of role extension, multi-skilling within the
context of the multidisciplinary team and accountability.

The debate over nursing roles and extent of practice is not new. Molbo’s seminal study of 1967 examined the
role of the nurse in relation to hyperbaric therapy and highlighted several arguments which still resound
throughout the profession today, such as technicians undertaking nursing tasks, extended roles and the nurse
as a practitioner.

In examining the scope of practice one finds it inexorably linked to the issue of role definition and although
not a new issue it should not be ignored. The need for role definition is examined by the Commonwealth
Department of Education, Science and Training (DEST 2001 Section 2.1) who state that protection of the
public is the principle reason for defining the scope of ones practice.

They go on to note that any care delivered must be from people who are properly qualified, know what they
are doing, are aware of and are working within their limits.

This is particularly relevant to the hyperbaric field “because as patients seen in the hyperbaric unit are from
various backgrounds, acuity and diagnosis, the hyperbaric nurse needs to be experienced in all areas of
nursing” McHowell (2002 p122).

The experience or skills required by a hyperbaric nurse are many, including primary care of patients,
education, counselling, pain, wound, social issue management, minor surgical procedures such as debridement,
drug administration, lung function testing, nutritional input and ear, nose and throat (ENT) knowledge. This
list is not exhaustive and as research into the field continues and the speciality matures is likely to grow.

If we accept the skills required in hyperbaric nursing are ‘advanced’ and possibly beyond the scope of
traditional nursing, closer examination of extended roles is required. Scrutiny of the literature finds
development of advanced nursing roles well reported. (Manley 1998, DEST 2001, Conway 1990, Ball 1999,
Levenson & Vaughan 1999).

Levenson & Vaughan (1999) for example suggest the evolution of advanced roles will continue to occur not only
in nursing but also throughout the health service due to the service as a whole having the responsibility for
explaining how quality of healthcare may be improved.

Further support for advanced roles comes from the United Kingdom Department of Health (DOH 1999) paper
outlining a strategy supporting extension of nursing roles to enable the workforce to operate more efficiently
and with better use of skills and knowledge.

The nursing profession appears to have embraced role extension with Read et al (1999) purporting that there
now exists at least three thousand new nursing roles defined as non-traditional, innovative or having taken
responsibility from areas previously the domain of other health professionals.

Unchecked expansion of the scope of nursing practice may cause more problems than the extra roles will
solve. Harvey (1995) suggests that these problems may be due to an increase in workload without concurrent
rises in autonomy, remuneration or satisfaction.

EBAss News n° 7 – June 2005 2

The need for role definition in hyperbaric nursing seems undeniable, and increasingly relevant, in the litigious
nature of today’s society when we consider the paper by DEST (2001), which suggests that determination of
ones scope of practice results in the legal protection of oneself. This, however, may be easier said than done.

Spilsbury et al (2001) warn of the lack of coherence in definition of advanced roles profession wide,
suggesting this may be a reflection of the complexity of nursing itself. This complexity is further explored by
Daly & Carwell (2003), who suggest the increasing diversity of nursing is testing boundaries of inter and
intra-professional practices making them indistinct.

As the current assault on traditional boundaries within the health care arena continues and the nursing
profession evolves with it, attention should be drawn to the areas affected by these indistinct practice
boundaries. That is roles previously the domain of nurses being undertaken by untrained staff.

In the hyperbaric field this equates to technical staff assisting in delivery of patient care at varying levels.
Nolan (1995) cites the Nursing Times (1995) in reporting that the United States of America has quasi-
medical tasks such as catheter insertion, injection of intravenous drugs and suturing already undertaken by
non-nursing personnel. In the hyperbaric field at the moment this is possibly one of the most contentious
areas.

The typical hyperbaric team consists of highly trained individuals from medical, nursing, military, offshore
and paramedic backgrounds. The non-medical staff, such as technicians, have generally completed a high level
of first aid and/or life support training in their previous or supplementary roles and it could be argued these
skills might be used for the provision of some aspects of patient care.

As with role definition this argument is not new. Returning to Molbos’ (1967 p528) study, she notes some
hyperbaric units utilised a technician in place of a nurse. This is an idea supported by Baker (2002) who
believes it is important for hyperbaric employees to have some degree of cross training. Christiansen (2000)
however concludes that untrained personnel do not have the educational preparation to undertake complex
functions should the need arise.

Vincent (1996) suggests this argument has received a contemporary angle since the 1990’s when interest
arose in the utilisation of unlicensed personnel and the notion of multi-skilled health workers to aid in cost
containment and working with limited resources.

Thus, as in role definition, it appears the onus is on the nursing profession to participate in determining their
own role within the hyperbaric field, within the multi disciplinary team and in setting boundaries for multi-
skilled practice. The hyperbaric nursing profession cannot afford to be lackadaisical with regards to these
issues.

The notion of the ‘team’ is important in hyperbaric nursing as hyperbaric units typically have a small number
of permanent staff within the multi disciplinary team. This is a double-edged sword, as while a small unit
allows for transfer of information quickly and accurately, unresolved issues can quickly become problematic.

The failure of hyperbaric nurses in establishing and defining their role in the multi disciplinary team, Scholes
& Vaughan (2002) suggest, may cause an absence of the notion of ‘teamness’. This, they note, can push
practitioners in the team inward towards their own profession to the exclusion of others and cause mono-
professionally focused practice. This can lead to a loss of the holistic approach to patient care, which
Wrenford-Brown (2002) suggests has always been a prime nursing function.

Parkin (1995) suggests that in a situation of confusion such as this occupational groups may claim ownership of
ambiguous areas of healthcare intensifying existing power struggles. To avoid this occurring the nursing
profession can look to the literature where the functioning of the multi disciplinary team and multi-skilling
has received close scrutiny (Read et al 1999, Rawson 1994, Miller et al 2001, Leathard 1994, Freeman et al
2000).

To be effective in multi-skilling, examination of teamwork is beneficial. Freeman et al (2000) suggest that to

make inter-professional teams effective the shared team culture must be allowed to prosper. This includes
open channels of communication and regard for all team members, with consideration for their input towards
the goal of the team.

EBAss News n° 7 – June 2005 3

This culture will not occur overnight but will, Miller et al (2001) suggest, require nurturing and the ability for
staff to interact away from the clinical care setting. This in itself raises issues of workload, staffing and
management for future debate.

Whilst the pursuit of a “team friendly” culture is laudable, one area of concern is highlighted by Cott (1997)
who observes that whilst much has been published on how to set up teams there has been very little study of
the outcomes of functioning teams.

If, within the hyperbaric multidisciplinary team, technical staff begin to participate in patient care in a
regular manner, nursing staff should exercise caution. They must ensure that, as Chaboyer et al (1998 p249)
caution, we maintain our professional integrity and ensure the use of non-nursing staff becomes a
“complement” to nursing care and not a “substitute” for it.

The Department of Health (DOH 1993) paper also urges caution and explores the possibility of a “super
technician” emerging with the consequent decline of nursing staff ultimately being replaced by care
assistants.

Molbos’ (1967 p58) opinion is worthy of note. She suggests it is the responsibility of the nurse to identify
their place within the hyperbaric environment and if it transpires their “chief responsibility and role” falls
within the technology surrounding the patient then a technician should replace them. However she further
notes that if their role falls within the therapy regime and environment then there is a place for nurses.

The encroachment of technical staff, or other non-nursing personnel, into traditional nursing areas raises not
only fears for the future of the hyperbaric nurse, but also questions of accountability in regards to patient
care.

Chamber (1998) describes accountability as being ‘multi-faceted’ in that nurses are not only accountable to
their patients, but also their employing organisation, their registration board and ultimately to society.

Bergman (1981) suggests accountability is one of the key tenets of nursing practice, a notion supported by
Chambers (1998) who states that the establishment of modern nursing as a profession is dependant on the
profession being able to give account of itself. Chambers (1998) further argues that determining
accountability is an essential requirement for an occupation to receive professional status.

Thus we can appreciate any decision to make changes in work practices, which has effects on accountability,
can have far reaching ramifications beyond the actual delivery of care. As such, nursing staff must be
involved in the decision making process at this level.

Kitson (1997) makes three recommendations worthy of note for the profession in regards to decisions
relating to care delivery. One: nurses who retain control of their care-delivery systems will be better able to
respond to changes in the healthcare arena in the future. Two: that having control of the delivery systems
brings with it the necessity for professional accountability with regards to personal competence, skill,
knowledge and evaluation. Three: the core elements of what nursing is must be articulated and reflected in
nursing development.

In conclusion, it is apparent from the literature that scope of nursing practice is closely linked to role
definition. The definition of ones role is paramount as nursing staff absorb more tasks, technology advances
rapidly and the need for legal protection increases.

As nursing workload increases it is likely that advanced or extended roles will become more prevalent. With
the increasing awareness of healthcare costs and the inherent flexibility of nursing this seems inevitable.

If non-nursing trained colleagues begin to participate in patient care to increase effectiveness of hyperbaric
units, their use must be monitored carefully to ensure nurses do not ‘over-extend’ their role and ignore basic
less glamorous aspects of nursing.

Wrenford-Brown (2002 p229) notes that “hyperbaric nurses have the rare opportunity to be involved in a
field that is still defining itself”. As such, nurses within the speciality are in an ideal position to guide and

EBAss News n° 7 – June 2005 4

mould it into a speciality to be envied profession wide. However, if hyperbaric nursing staff are not proactive
in defining their role, it may be possible they are condemning themselves to eventually having no role at all.

References.

Ball, C. (1999) ‘Revealing higher levels of nursing practice.’ Intensive and Critical Care Nursing. 15(2) : p65-76
Bergman, R. (1981) ‘Accountability-definitions and dimensions.’ International Nursing Review. 28(2) : p53-59
Bruser, S. & Whittaker, S. (1998) ‘Diluting nurses’ scope of practice.’ American Journal of Nursing. 98(10) :
p59-60
Carver, J. (1998) ‘The perceptions of registered nurses on role expansion.’ Intensive and Critical Care
Nursing. 14(12) : p82-90
Chambers, M. (1998) ‘Some issues in the assessment of clinical practice: a review of the literature.’ Journal of
Clinical Nursing. 7(3) : p201-208
Christiansen, K. (2000) ‘Is the role of circulating in an OR within the scope of practice for the RPN?’ Canadian
Operating Room Nursing. 18(1) : p14-19
Commonwealth Department of Education, Science and Training (2001) ‘The scope of nursing practice: the
implications for contemporary nursing education and practice.’ [online],[viewed 22/07/2003]
http://www.dest.gov.au/highered/nursing/pubs/scoping-nursing/3.htm
Conway, J. (1996) Nursing expertise and advanced practice. Quay Books, U.K.
Cott, C. (1997) ‘We decide, you carry it out: a social network analysis of multidisciplinary long-term care
teams.’ Social Science and Medicine. 45(9) : p1411-1421
Daly, W. & Carwell, R. (2003) ‘Nursing roles and levels of practice: a framework for differentiating between
elementary, specialist and advancing nursing practice.’ Journal of Clinical Nursing. 12 : p158-167
Department of Health (1993) ‘The challenges for nursing and midwifery in the 21st century. Department of
Health’, London
Department of Health (1999) ‘Making a difference. Strengthening the nursing, midwifery and health visiting
contribution to health and health care.’
Department of Health, London [online],[viewed 22/07/2003]
http://www.doh.gov.uk/nurstrat.htm
Freeman, M., Miller, C. & Ross, N. (2000) ‘The impact of individual philosophies of teamworking on
multiprofessional practice and the implications for education.’ Journal of International Professional
Care. 14(3) : p237-247
Hillman, K. (1999) ‘The changing role of acute-care hospitals.’ Medical Journal of Australia. 120(7) : p325-328
Hopkins, S. (1996) ‘Junior doctor’s hours and the expanding role of the nurse.’ Nursing Times. 3(92) : p33-36
Kitson, A. (1997) ‘Developing excellence in nursing practice and care.’ Nursing Standard. 12(2) : p33-37
Leathard, A. (1994) ‘Inter-professional developments in Britain: an overview.’ In Leathard, A. (ed), Going
Inter-Professional: Working Together for Health and Welfare. Routledge, London, p134-149
Levenson, R. & Vaughan, B. (1999) ‘Developing new roles in practice: an evidence based guide.’ School of Health
and Related Research (ScHAAR), University of Sheffield, Sheffield, UK [online], [viewed online
22/07/03]
http://www.shef.ac.uk/scharr/guide/levensonvaughan.pdf
McHowell, W. (2002) ‘Care of the patient receiving hyperbaric oxygen therapy.’ In
Larson-Cohr, V. & Norvell, H. (eds), Hyperbaric Nursing. Best Publishing Compnay, Flagstaff, p121-146
Manley, K. (1998) ‘A conceptual framework for advanced practice.’ In Rolfe, G. & Fulbrook, P. (eds), Advancing
Nursing Practice. Butterworth-Heinmann, Oxford, p118-135
Miller, C., Freeman, M. & Ross, N. (2001) Interprofessional Practice in Health and Social Care. Challenging the
Shared Learning Agenda. Arnold, London,
p91-103
Molbo, D.M. (1967) ‘The nurses role in hyperbaric therapy.’ In B.S. Bergen et al (eds) Current Concepts in
Clinical Nursing. CV Mosby, St. Louis, p57-75
Nolan, M. (1995) ‘Towards an ethos of interdisciplinary practice.’ British Medical Journal. 311: p305-307
Nursing Times (1995) ‘Warned in the USA.’ 91(16) : p18
Rawson, D. (1984) ‘Methods of interprofessional work: likely theories and possibilities.’ In Leathard, A. (ed),
Going Inter-Professional: Working Together for Health and Welfare. Routledge, London, p38-63
Read, S., Jones, M., Collins, K., McDonnell, A., Jones, R., Doyle, C., Cameron, A., Masterton, A., Dowling, S.,
Vaughan, B., Furlong, S. & Scholes, V. (1999) ‘Exploring new roles in practice: implications of
developments within the clinical team (ENRIP)’, Executive summary, School of Health and Related
Research (ScHAAR), University of Sheffield, Sheffield, UK [online],
[viewed 22/07/2003]

EBAss News n° 7 – June 2005 5

 http://www.shef.ac.uk/scharr/execsumm/clinicalroles.pdf
Scholes, J. & Vaughan, B. (2002) ‘Cross boundary working: implications for the multidisciplinary team.’ Journal
of Clinical Nursing. 11 : p399-408
Spilsbury, K. & Meyer, J. (2001) ‘Defining the nursing contribution to patient outcome: lessons from a review
of the literature examining nursing outcomes, skill mix and changing roles.’ Journal of Clinical Nursing. 10(1) :
p3-14
Vincent, L. (1996) ‘Work redesign and re-engineering: a challenge for professional nursing practice.’ Canadian
Oncology Nurses Journal. 7(4) : p198-208
Wrenford-Brown, C. (2002) ‘Hyperbaric Nursing research’ In Larson-Lohr, V. & Norvell, H.C. (Eds),
Hyperbaric Nursing. Best Publishing Company, Arizona, p227-239

First publication in Offgassing – Journal of the Hyperbaric Technicians and Nurses Association –
Australia - N° 41 – February 2005. Reproduced with the authorisation of the editors.

Eine Diskussion über die Rolle des Pflegepersonal in der Hyperbarmedizin

Gordon Bingham – Hyperbaric Service, The Alfred hospital , Melbourne, Australia.

Übersetzung Daniel Winterdorff

Die hyperbare Sauerstofftherapie wird immer populärer in der Medizin, die Patientenzahl sowie das Wissen
über die Hyperbarmedizin steigt kontinuierlich. Für das personal in hyperbaren Zentren erhöht das
Wachstum ihrer Kompetenzen ihre beruflichen Aussichten. Es ist jetzt ein günstiger Zeitpunkt ihren
Arbeitsbereich kritisch zu untersuchen und ihren Platz zu definieren und zu schauen wie er in Zukunft
aussehen soll.

Jede Pflege sollte von gut ausgebildetem Personal geleistet werden, welches weiß was es tut, sich dessen
bewusst ist und vor allem seine Grenzen kennt. Dies ist besonders wichtig in hyperbaren Zentren, da die
Patienten alle verschiedenen Probleme und Pathologien haben muss sich die Pflegekraft hier in allen
Bereichen der Pflege sehr gut auskennen.

Die Erfahrung oder Fähigkeiten die ein „Hyperbarpfleger“ sind mannigfaltig und beinhalten die Pflege des
Patienten, Anleitung und Beratung, Wissen uebr Schmerz und Wunden, kleine Chirurgische Eingriffe wie
Wunddebridement, Medikamenten Verabreichung, Lungenfunktionsteste durchführen, Ernährungslehre, HNO-
Wissen: Diese Liste ist nicht begrenzt und je weiter die Forschung auf dem Gebiet der Hyperbarmedizin
fortschreitet umso mehr reift diese zu einer eigenen Spezialität Die Rolle und das Wissen des Pflegepersonal
wächst dadurch stetig.

Nehmen wir die erweiterten Anforderungen in der hyperbaren Pflege an, welche über die klassiche Role der
Pflegekraft gehen ist eine nähere Betrachtung der Rolle der Pflegekraft noetig

Im hyperbaren Umfeld wird es dem technischen Personal gleichgestellt welches bei der Pflege assistiert. Aus
den USA wird berichtet dass dort das legen von peripheren Venenkathetern, die intravenöse
Medikamentenapplikation von Nicht-Pflegepersonal durchgeführt wird. Daher ist es sehr wichtig dass das
Pflegpersonal bei der Definition ihrer Rolle in der Hyperbarmedizin, sowie dem festlegen der Grenzen ihrer
Fähigkeiten und Kompetenzen aktiv mitarbeitet.

Wenn in einem multi-disziplinären Team, das technische Personal regelmäßig in der Patientenbetreuung
eingesetzt wird müssen die Pflegekräfte acht geben. Sie müssen dafür sorgen dass ihr Beruf nicht
abgewertet wird, technisches Personal soll als Hilfe und nicht als Ersatz in der Patientenpflege gelten. Da die
Arbeitsbelastung steigt ist es normal dass die erweiterten Kompetenzen in den Vordergrund rücken. Jedoch
das das Personal ihre Rolle nicht überbewerten und die Basispflege nicht vergessen

Hyperbarpersonal haben die Ehre in einem Arbeitsbereich zu arbeiten der sich noch dabei ist sich selbst zu
formen und definieren. Aus diesem Grunde ist das Pflegepersonal in der idealen Position ihr neues Berufbild

EBAss News n° 7 – June 2005 6

mit auszuarbeiten und formen. Sollte das Personal hier nicht aktiv mitarbeiten kann es sein dass kann es sein
dass andere ihre Rolle definieren und ueberhaupt keine Rolle mehr in der Hyperbarmedizin spielt

Übersetzung einer englischen Zusammenfassung des Originalartikels

Erstpublikation – Journal of the Hyperbaric Technicians and Nurses Association – Australia - N° 41 – Februar
2005. Reproduziert mit Genehmigung des Verlegers.

A discussion of the scope of hyperbaric nursing practice

Une discussion sur le rôle du personnel infirmier hyperbare - résumé
Gordon Bingham – Hyperbaric Service, The Alfred hospital , Melbourne, Australia.

Traduction par R. HOUMAN

L’oxygénothérapie hyperbare gagne en popularité dans la culture médicale traditionnelle, on peut donc
s’attendre à ce que le nombre de patients et l’activité iront croissant. Pour le personnel infirmier hyperbare,
la croissance d’activité soulève beaucoup de questions professionnelles et c'est le moment opportun de
réfléchir en considération critique leur secteur d’activités, leur place à l’intérieur de ce secteur et la
direction qu'il souhaite prendre à l'avenir. L’auteur (Gordon Bingham) développe son article sur trois axes
essentiels: la définition des rôles et le phénomène d’extension de ceux ci, la polyvalence dans le contexte d’une
équipe multidisciplinaire et les responsabilités.

Tout soin délivré doit être réalisé par des personnes qui sont qualifiées, savent ce qu'elles font, sont
responsables et fonctionnent dans leurs limites de compétences. C'est particulièrement vrai dans le champ de
l’oxygénothérapie hyperbare. En effet, les patients rencontrés dans les centres hyperbares proviennent de
milieux divers et des diagnostics variés, donc le personnel infirmier hyperbare doit être expérimenté dans
tous les domaines des soins.
L'expérience et qualifications exigées du personnel infirmier hyperbare sont nombreuses, comprenant les
soins primaires des patients, les conseils, la douleur, les plaies, la gestion des origines sociales, les procédures
chirurgicales mineures telles que le débridement, administration de médicaments, connaissance ORL, etc .
Cette liste n'est pas exhaustive car la recherche dans ces champs continue, la spécialité mûrit, les rôles et
l'expertise sont susceptibles de se développer.
S’il est accepté que les qualifications exigées dans l’oxygénothérapie hyperbare sont `avancées' et
probablement au delà de la portée des soins traditionnels, un examen plus approfondi des rôles est exigé.

Les frontières traditionnelles dans l’exercice des métiers de la santé évoluent et les professions des soins
évoluent avec elles. Une attention particulière doit être apportée dans les secteurs affectés par ces
évolutions des frontières. Certains rôles qui, précédemment, étaient du domaine infirmier sont repris par du
personnel aide soignant. Au sein de l’oxygénothérapie hyperbare, ceci implique que du personnel technique,
aidant-soignant, soient acteurs, à des niveaux variables, quant aux soins aux patients. Il est signalé qu’aux
Etats-Unis d'Amérique de nombreuses tâches comme la pose de cathéter, l'injection de médicaments
intraveineux et la suture sont déjà réalisés par du personnel non infirmier. L’oxygénothérapie hyperbare est
probablement un secteur controversable.

C’est ainsi que la responsabilité du personnel infirmier est engagée afin de déterminer son propre rôle dans le
champ de l’oxygénothérapie hyperbare et dans l'équipe multi disciplinaire par la pose de limites dans la
pratique polyvalente. Un échec du personnel infirmier à l’établissement et aux définitions de leur rôle dans
l'équipe multi disciplinaire peut causer une absence de la notion de complémentarité. L’auteur note que cela
peut pousser des praticiens vers une pratique focalisée et mono-professionnelle qui mène à l'exclusion des
autres professions de la santé. Ceci peut mener à une perte de l'approche holistique des patients qui est
depuis toujours une fonction principale des soins infirmiers.

Pour une équipe multidisciplinaire efficace, l’examen du travail d'équipe est salutaire car il stimulera une
émergence inter-professionnelle dans laquelle l’équipe partagera une culture commune nécessaire à un
développement harmonieux. Ceci inclut des canaux de communications ouverts, le respect pour chaque membre
de l'équipe, la considération pour son apport au sein de cette équipe. Si, au sein d’une équipe multidisciplinaire
d’oxygénothérapie hyperbare, le personnel technique et aide soignant commence à participer régulièrement

EBAss News n° 7 – June 2005 7

aux soins, le personnel infirmier se doit d’exercer une supervision responsable. Ce faisant, il maintient son
intégrité professionnelle et assure l'utilisation du personnel non infirmier qui devient un "complément" aux
soins et pas à un "produit de remplacement".
L’augmentation de la charge de travail allant toujours croissant, il est probable que l’évolution précitée des
rôles se répandra. De même, la croissante des coûts de soins de santé et la flexibilité inhérente au travail
infirmier semblent rendre ce futur inévitable. Néanmoins, le personnel infirmier doit rester attentif à ne pas
étendre à l’infini son rôle en courant le risque d’ignorer ou de perdre les aspects de base des soins.

Le personnel infirmier d’oxygénothérapie hyperbare a rarement l'occasion de s’impliquer dans un domaine qui
se définit toujours. Pourtant, ce personnel spécialisé est dans une position idéale pour guider et développer
cette spécialité qui sera alors enviée par d’autres spécialités.
Cependant, si le personnel infirmier hyperbare n’est pas proactif, notamment en définissant son rôle, il court
le risque d’être condamné par la suite à n'avoir plus aucun rôle du tout.

Traduction réalisée sur la base d’un résumé en anglais de l’article original.

Commentaire:
Cet article, qui semble volontairement alarmiste, attire néanmoins notre attention et suscite une réflexion sur
l’absolue nécessité d’une bonne définition des rôles et tâches de chaque acteur au sein d’une équipe OHB.
C’est également un des objectifs de EBAss.

Robert HOUMAN

Première publication dans Offgassing - Journal of the Hyperbaric Technicians and Nurses Association
Australia - N° 41 – February 2005. Article original reproduit avec l’autorisation des éditeurs.

Una discussione al fine di definire l’esercizio della professione infermieristica

iperbarica.
Gordon Bingham – Hyperbaric Service, The Alfred hospital , Melbourne, Australia.

traduzione : Valeria Campanaro

Nell’ambito dell’attuale cultura medica, il progredire dell’applicazione dell’ossigenoterapia iperbarica oltre a

produrre un rilevante incremento del numero dei pazienti stimola la conoscenza e la divulgazione della stessa
materia.
Tuttavia è da rilevare che per quanto concerne lo sviluppo della specializzazione del personale infermieristico
in questo campo sono presenti molti problemi professionali; questa è un’opportunità per considerare
criticamente il loro campo di competenze, il loro ruolo e quale direzione potrebbero prendere nel futuro.
Esaminando le finalità dell’esercizio di questa professione si deduce chiaramente che sono collegate con la
definizione del ruolo della stessa, e sebbene non sia una novità, non dovrebbe più essere ignorato.
Nel campo iperbarico è indispensabile che ogni competenza e responsabilità sia impiegata da persone
propriamente qualificate, che sanno quello che fanno e consapevoli di svolgere un lavoro con i suoi limiti.
Questa è una caratteristica rilevante “siccome i pazienti osservati dal gruppo iperbarico hanno diverse storie,
diverse patologie e diagnosi, è necessario che l’infermiere iperbarico sia esperto in tutte le aree
dell’assistenza” ( McHowell 2002 p122).
L’esperienza e le conoscenze richieste per svolgere questa professione sono molte, includendo la prima
assistenza ai pazienti, la fomazione, il fattore umano, il dolore, la ferita, la gestione amministrativa della
terapia, elementi di procedure chirurgiche, lo smaltimento dei rifiuti, l’amministrazione dei farmaci, prove di
funzionalità respiratoria, accenni all’apparato digerente e conoscenze su orecchie, naso e gola.
Questo elenco non è completo e siccome la ricerca nel campo continua e la specializzazione sta maturando, i
ruoli e la pratica verosimilmente si stanno sviluppando.
Se accettiamo i titoli richiesti per l’assistenza siamo in una fase “avanzata” anche oltre il tradizionale scopo
dell’assistenza, saranno previsti esami specifici per poter ampliare i ruoli richiesti. ( Manley 1998, Dest 2001,
Conway 1990, Ball 1999, Levenson &Vaugham 1999).
Levenson & Vaughan (1999) suggeriscono di sviluppare avanzati ruoli per il vantaggio non solo dell’assisteza ma
del servizio stesso per migliorarne la qualità.

EBAss News n° 7 – June 2005 8

Sulla stessa posizione si trova il Dipartimento della Salute del Regno Unito (DOH1999) che in una
pubblicazione propone di estendere i ruoli degli infermieri promuovendo anche programmi di esercitazioni e di
formazione.
Harvey (1995) suggerisce che questi problemi potranno essere debitamente risolti con riconoscimenti di
autonomia, remunerazione e soddisfazione.
La necessità di definire un ruolo per l’assistenza infermieristica sembra inconfutabile e rilevante, ma
considerando la natura litigiosa della società di oggi, Dest (2001) propone che ognuno nell’esercizio delle
proprie funzioni venga protetto da un rappresentante legale. Questo però è più facile dirlo che farlo.
Spilsbury (2001) coerentemente con la definizione di avanzamento di ruolo suggerisce che questo può essere
un riflesso della complessità dell’assistenza stessa. Questa complessità è piuttosto esplorata da Daly &Carwell
(2003) osservando che l’aumento della diversità dell’assistenza è prova dei limiti delle pratiche inter e intra
professionali.
Siccome l’attuale assalto ai limiti tradizionali nello scenario dell’assistenza sanitaria continua e la professione
infermieristica evolve con essa, sarebbe da porre attenzione alle aree interessate a questa limitata e confusa
pratica.
Tuttavia è da chiedersi quale ruolo dovrebbe essere previsto per gli infermieri in un contesto in cui lo staff
non è addestrato.
Infatti questo si verifica al personale in assistenza tecnica durante la consegna di pazienti ai vari livelli.
E’ riportato (Nolan, Nursing Times 1995) che gli Stati Uniti d’America prevedono nella loro normativa di
affidare compiti pressocchè medici, come l’applicazione di un catetere, iniezioni endovenose e suture a
personale impiegato non infermieristico.
Al momento nel campo iperbarico questo è certamente uno dei maggiori argomenti di contenzioso.
Comunque, siccome il ruolo dovrà essere definito, appare indispensabile che l’impegno degli infermieri sia di
partecipare attivamente alla stesura del propria identità nel campo iperbarico, nel team multidisciplinare con i
limiti imposti per la pratica stessa.
La tipica squadra iperbarica possiede un’esperienza di alto livello di addestramento individuale: medica,
infermieristica, militare, offshore e sanitaria. Lo staff non medico, così come i tecnici, hanno generalmente
completato un elevato livello di addestramento di prima assistenza e /o life support nel loro ruolo si potrebbe
ipotizzare le prestazioni per alcuni aspetti di assistenza del paziente.
Comunque Molbos’(1967 p528), Baker (2002) e Chrisiansen (2000) osservano che per lo sviluppo dell’iperbarica
è necessario un riconoscimento di provata formazione professionale per tutto lo staff.
Vincent (1996) ammette che questo argomento è di suo interesse dal 1990 quando per incrementare l’attività
fu necessario utilizzare personale senza requisiti e lavoratori esperti in sanità per aiutare il contenimento dei
costi e lavorare con risorse limitate.
La nozione del team è importante sia per il personale di assistenza che per tutto il gruppo iperbarico, esso ha
generalmente un piccolo numero permanente di persone in una squadra multidisciplinare.
L’insuccesso dell’infermiere iperbarico nello stabilire il suo ruolo nel team multidisciplinare potrebbe essere
causato da un’assenza di conoscenza del team stesso (Scholes & Vaughan 2002). Questo potrebbe favorire i
professionisti medici verso le proprie professioni all’interno della squadra escludendo le altre determinando
così un’attenzione concentrata su un’unica professione. Ciò può provocare una perdita dell’approccio olistico
verso l’assistenza del paziente che è sempre stata la prima funzione infermieristica (Wrenford-Brown 2002).
Per formare squadre multidisciplinari è necessario fare prosperare tra di esseuna cultura condivisa (Freeman
2000). Questo include l’apertura di canali di comunicazione, il rispetto tra tutti i membri della squadra e la
piena considerazione dei loro punti di vista tesi a raggiungere lo scopo della stessa.
Se, nell’ambito della squadra multidisciplinare, lo staff tecnico comincia a partecipare con regolarità, il
personale infermieristico dovrebbe usare molta cautela (circospezione). Dovrebbe assicurarsi che la
professione infermieristica rimanga integra e che la pratica del personale non infermieristico possa essere di
sostegno non di “sostituzione”(Chaboyer 1998 p249).
Il Dipartimento della Salute (DOH 1993) in una pubblicazione propone di porre attenzione nell’ esplorare la
possibilità di fare emergere un “super tecnico” con la conseguenza di un declino dell’assistenza
infermieristica.
A questo proposito è degno di nota l’opinione di Molbos’ (1967 p.58) che suggerisce che l’identità
dell’infermiere nel centro iperbarico sta nella sua “principale responsabilità e nel suo ruolo” finisce quando la
tecnologia prevede l’intervento del tecnico per poi riprendere nell’atto terapeutico.
Kitson (1997) suggerisce tre raccomandazioni degne di nota in relazione all’assistenza infermieristica. La
prima: gli infermieri che sono impiegati dovrebbero avere la possibilità di ricambio nello scenario
dell’assistenza del futuro; La seconda: gli infermieri impiegati dovrebbero approfondire la propria competenza
attraverso la formazione continua; La terza: L’essenza del ruolo e come deve essere articolato e i riflessi nello
sviluppo dell’assistenza.

EBAss News n° 7 – June 2005 9

Siccome il carico di lavoro dell’assistenza aumenta è verosimile che l’ampliamento e l’estensione dei ruoli
diventerà più rilevante. Con l’incremento dei costi dell’assistenza è inevitabile la flessibilità del ruolo
infermieristico.
Se il personale non infermieristico addestrato comincia a partecipare all’assistenza dei pazienti
effettivamente per incrementare il gruppo iperbarico, il loro utilizzo deve essere monitorizzato attentamente
per assicurare che gli infermieri non soffrano “eccessivo carico” del loro ruolo e ignorino gli aspetti meno
qualificanti dell’assistenza.
Wrenford-Brown (2002 p229) nota che “Gli infermieri iperbarici hanno l’eccezionale opportunità di essere
coinvolti in un campo che si deve ancora definire”. Gli infermieri nella loro specializzazione sono in un’ideale
posizione per guidarla ed ampliarla per farla diventare un’invidiabile professione in espansione.
Comunque, se gli infermieri non si attivano nella definizione del proprio ruolo, è ipotizzabile che si condannino
da soli all’eventualità di non avere alcun ruolo in questo campo.

Prima pubblicazione in Offgassing – Giornale dell’Associazione dei Tecnici e degli infermieri – Australia . N° 41
– Febbraio 2005. Riprodotto con l’autorizzazione degli editori.

Riflessione
Questo articolo esprime il contenzioso che da sempre vive la medicina iperbarica in Italia, che
peraltro sembra lontano da una “reale” soluzione.
Senza entrare nelle motivazioni, certamente poco nobili, che spingono “chi ha il potere” a non volere la
soluzione dei problemi legati allo staff che ruota attorno al mondo iperbarico, vorrei fare una piccola
riflessione. Sono convinta che conferendo più potere alle nostre Associazioni potremmo trovare una soluzione
perché vengano distribuiti i ruoli e le competenze alle professionalità che ne posseggono i requisiti. Credo
che così potremmo risolvere il contenzioso tra le figure professionali che dovrebbero operare nello stessa
squadra. L’EBAss sta cercando di operare in quest’ottica.

Valeria Campanaro

The safety zone

by Neirynck, Yoerik – President of the Safety Committee

Welcome in the EBAss Safety-zone. For the second time we will keep you posted on facts, developments,
studies and other safety-related issues.

In many centres the headset is used inside the oxygen hood. As you all know the inside of an hood is, like the
inside of a monoplace hyperbaric chamber, filled with approximately 100% pure oxygen. So I would like to
warn you for this, as possible sparks occurs in an very explosive atmosphere.
Next, you will find the summeries of some articles, all are safety related and of some importance.
“Venous gas embolism in chamber attendants after hyperbaric exposure.” by J. Risberg, M. Englund, L.
Aanderund, O. Eftedal, V. Flook, E. Thorsen. Published in Undersea & Hyperbaric Medicine Society (UHMS)
Journal Volume 31 No. 4 Winter 2004.
It concludes that chamber attendants assisting HBO treatment at 240 kPa for ~ 115 min are exposed to a
significant decompression stress using the profiles tested in the present study.
In OFFGASSING No. 41, February 2005, Gordon Bingham published the essay “A discussion of the scope of
hyperbaric nursing practice”. This essay will discuss the scope of hyperbaric nursing practice and arguably
three of the most important factors influencing it: role definition and the phenomenon of role extension,
multi-skilling within the context of the multidisciplinary team and accountability.
If anyone of our members wants more detailed information, please feel free to get in touch.
Any contribution to this segment will be gratefully received.
That’s it for the Safety-zone this time around and don’t forget, think safety in everything we do, on the job,
the road and the private life.
Web links:
Hyperbaric Technicians and Nurse Association:
http://www.htna.com.au
Undersea & Hyperbaric Medicine Society.
http://www.uhms.org

EBAss News n° 7 – June 2005 10

 News from the Board of Directors

The Board of Directors had a meeting on 30 April in Murnau (Germany)

The participants were: Mrs. Campanaro, Mr. Damiens, Mr. Houman, Mr. Kelner, Mr. Schwarz, Mr. Van der Tol.

Resume of the decisions:

In order to reinforce the secretariat, Mr.
Jeuneau has joined the secretariat as
assistant of Mrs Mannens and Mr Van der
tol.

The Webmaster (Mr Van der tol) informs

us that the website has been translated
into French (thank you Didier and Robert)
and that this language is now online, making
the total number of languages online two.
A start has been made with Italian (thank
you Valeria) and Dutch. The German and
Spanish languages are to follow. Mr.
Andreas Kanstinger of Murnau
vollunteered to become a member of the
special sub-committee website and help
with the translation into German.

Concerning the exchanges of personnel, the Board of Directors decided to stimulate this program for
members of EBAss. To fund this exchange program a certain amount of money should be reserved.
Future participants of this program should be able to register on a first come, first serve basis, Practical
details will be available after Barcelona meeting.

Instructions for author's

Acceptance of a manuscript is based on originality and quality of the work as well as the clarity of presentation. All
manuscripts will be evaluated for significance, soundness, and conformance to journal format by two or more members of
the Editorial Board or guest referees.
After manuscripts have been accepted, authors are asked to submit the final version of the paper electronically or on
computer diskette.
Preparation of Manuscripts
Title: A cover sheet which gives the title of the paper, the names and affiliations of the authors; a short title (running
head); and the name, address, telephone and fax numbers, and e-mail address (if any) of the corresponding author must
accompany the manuscript.
Text: Except in unusual situations, the manuscript should be divided into Introduction, Methods, Results, and Discussion.
The overriding principles are that the composition is correct and unambiguous, clear, and concise. The active voice is usually
preferable to the passive voice. Parallel construction of groups of like items or concepts aids in comprehension. Figures
should be uncomplicated and legible. Abbreviations and acronyms should not be overused, should be clearly defined at their
first appearance in the abstract and in the text, and should be avoided in the title. Specific items of information should
appear only once in the manuscript; there should not be verbatim repetition in the text of material that appears in a table
or figure, duplication of data in graphs and tables, or repetition in Discussion of information that appears in Results.
All accepted manuscripts are subject to final editing in the Editorial Office to improve readability and to conserve space.
References: Authors are responsible for verifying references against the original documents. References must be
numbered consecutively in the order in which they first appear in the text, and identified in the text by Arabic numerals in
parentheses.
Example:
Mannens, C., Houman R. - A Hyperbaric Pan-European Technician, Operator and Nurses Association: a necessity ?
Proceedings of the 28th Annual Scientific Meeting of the European Underwater and Baromedical Society. Germonpre P.,
Balestra C., Eds. Bruges, Belgium. 2002 p 115

EBAss News n° 7 – June 2005 11

 Ebass News 7 : Are you satisfied?

After 6 issues of the journal, we wish to know if you are satisfied by your journal.

Therefore you will find some affirmations, please answer and send us your answers!

Affirmations
1. I have no difficulties to read all the articles in english

 ☺
2. I can understand the main article only via the abstract
in my own language

 ☺

3. The information published in the journal are high

quality

 ☺

4. I appreciate to receive the journal via E mail

 ☺
5. I wish to receive other information via the journal

 ☺
List of others information:
1.
2.
 ☺
3.
4.
5.
…

Please send your answers to the editor on:

rob.houman@mil.be or by Fax on + 32 2 264 48 61
Free participation !!!

EBAss News is a publication of The European Baromedical Association for Nurses, Operators and Technicians
Redaction: Robert Houman – 9 Sainte Anne – B 7880 Flobecq - Belgium
Editor: Robert Houman – 9 Sainte Anne – B 7880 Flobecq - Belgium
Readers committee: Miss Valeria Campanaro (Italy)
Mr Daniel Wintersdorf (Luxemburg)
Mr Steve Mc Kenna (Great Britain)
Special thanks for this issue:
Mr Gordon Bingham (Australia) and the HTNA for the authorisation of reproduction.
Mr Yoerik Neirynck (Belgium)

EBAss News n° 7 – June 2005 12