
Hastanelerde yoğun bakım ünitesi sayısı arttı. Diğer servislerden hemşireler yoğun bakımda hizmet vermeye başladı. Deneyimli hemşire oranı yüzde 25’e düştü. Deneyimli hemşireler, zamanı unuttu. Yoğun bakım hemşireleri meslektaşlarına rehberlik için çalışma saatlerinin ötesine geçti.
Covid-19 salgınında pandemi hastaneleri, mevcut yoğun bakım ünitelerine yenilerini ekledi. Mevcut sağlık personeli yetersiz kalınca diğer servislerden yoğun bakım ünitelerine takviye yapıldı. Türk Yoğun Bakım Hemşireleri Derneği’nin raporuna göre, yoğun bakımlardaki deneyimli yoğun bakım hemşiresi oranı yüzde 25’e düştü. Derneğin başkanı Ebru Kıraner, deneyimli hemşirelerin rehberlik etmek için mesai saatlerini uzattıklarını belirterek, "Türkiye'nin yoğun bakımdaki başarısında sağlık personelinin üstün gayretinin payı var. Deneyimli hemşireler, hastalarını yalnız bırakmamak için mesai saatinin dışında da saatlerce çalışıyor" dedi.
HEMŞİRELERİN YARISININ YOĞUN BAKIM EĞİTİMİ YOK
Yoğun bakım, hastanelerin en hassas alanı. Yoğun bakım hemşireleri, temel hemşirelik eğitiminin yanı sıra bir de yoğun bakım hemşireliği için eğitim alıyorlar. Bu eğitimi almak da yetmiyor. Yoğun bakım hemşireliği deneyim gerektiriyor. Pek çok ülke yoğun bakım hemşiresi sıfatını beş yıllık deneyimin ardından veriyor. Yoğun Bakım Hemşireleri Derneği’nin raporunda salgın döneminde deneyimli yoğun bakım hemşirelerinin ünitedeki oranının yüzde 25’e düştüğü belirtildi. Dernek Başkanı Ebru Kıraner, yoğun bakım hemşirelerinin çok özel bir eğitimden geçtiğini anlattı: “Lisans mezunları yoğun bakımlarda çalışmak için Sağlık Bakanlığı’nın sertifika programına katılıyor. Yoğun bakımlarda çalışan hemşirelerin yaklaşık yarısının sertifikası yok. Dünyada bu eğitimle ilgili öneri bin 200 saatin altına düşmemesi. Türkiye’deki koşullarda bu eğitim 240 saat. Eğitime katılanlar bir sınava giriyorlar ve kazanmaları halinde sertifika hakkı elde ediyorlar. Sağlık Bakanlığı 2019 bitmeden bütün hemşirelerin bu sertifikaya sahip olmasını hedefledi ancak bu hedef gerçekleşmedi. Hemşireler bu programda, yoğun bakımda kullanılan solunum cihazı, karaciğer destek, böbrek destek cihazlarıyla ilgili ve normal hastane servislerinde olmayan yüksek riskli ilaçların kullanımıyla ilgili eğitim alırlar. Kendini hiç ifade edemeyen, bütün ihtiyaçlarının hemşireler tarafından karşılandığı hastalardan söz ediyoruz. Sonuç olarak temel hemşirelik eğitiminin üstüne kritik hastaya nasıl bakılır eğitimi de yoğun bakım için gerekiyor.”
TEMEL İHTİYAÇLAR İÇİN BİLE ZAMAN YOK
Salgın döneminde hemşireler, eğitim almaksızın yoğun bakım ünitelerinde görevlendirildi. Ebru Kıraner, bu hemşirelerin desteğe ihtiyacı olduğunu söyledi. “Yetkin hemşireler, diğer servislerden yoğun bakıma gelen meslektaşları için de çaba harcamak zorunda. 8 hastalı bir ünitede bir tek deneyimli hemşire var. Bu hemşire, yemek, tuvalet gibi insani ihtiyaçlarını karşılayamayacak durumda. Çünkü, yoğun bakım şartlarında her an ani ve acil bir durum gelişebilir. Deneyimsiz hemşire, cihazdan alarm sesi geldiğinde doğru olanı yaptığını sanarak aslında hata yapabilir.”
'TEMELİMİZ SAĞLAM'
Deneyimli yoğun bakım hemşireleri çözüm için fedakarlığa hazır. Derneğin raporunda “Başka kliniklerden görevlendirilen hemşirelerin en az 40 saatlik süre ile yoğun bakım ünitelerine oryantasyonları sağlandıktan sonra, ‘ünitede yeterli sayıda deneyimli/rehber hemşire varsa’ deneyimli/rehber yoğun bakım hemşirelerine esnek mesai uygulamasının yapılmasını öneriyoruz” ifadesi yer aldı. Ebru Kıraner, yoğun bakım hemşireliğinin temelinde fedakarlık kültürünün olduğuna dikkat çekti. “Yıllardır böyle ciddi sorunlarla bu mesleği sürdürüyoruz. İhtiyacı olan insanların iyileştiğini görmekten başka maddi ve manevi hiçbir getirisi yok. 15-20 yıldır bu yalnızca bu motivasyonla çalışan hemşireler var. O temel çok sağlam. Esnek çalışma sadece hemşireler için değil hasta güvenliği açısından da riskleri daha aza indirebilir. Ama bu kadar sınırlı sayıda deneyimli hemşire ile bunun çok da mümkün olamayacağını biliyoruz. Dünya Yoğun Bakım Hemşireleri Federasyonu’nun hazırladığı rehberde onların da aynı sorumları yaşadığını gördük.”
'SAAT KAVRAMI YOK'
Kıraner’e “Yoğun bakımlarda bunca sorun Türkiye’nin başarısının nereden kaynaklanıyor?” diye sorduk. “Bu sonuç deneyimli yoğun bakım hemşirelerinin üstün gayretiyle alınıyor. Haftada 40 saat çalışması gereken deneyimli hemşireler 48 saat, 56 saat çalıştılar. Yoğun bakım bir ekip işi. Bugüne kadar da bütün yokluklara, sıkıntılara rağmen dünyadaki pek çok ülkeden iyi iş çıkarıyorduk. İnsanlar aynı kültüre sahip çıktılar. Başka kliniklerden gelen hemşirelere de rehberlik için büyük gayret gösterdiler. Saat kavramı yok oldu.”
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“We’re using it faster and faster,” said Jay Famiglietti, an Arizona State University professor and the study’s senior author.
In the past two decades, groundwater basins – or large, underground aquifers – lost more than twice the amount of water that was taken out of major surface reservoirs, Famiglietti’s team found, like Mead and Lake Powell, which themselves have seen water levels crash.
The Arizona State University research team measured more than two decades of NASA satellite observations and used land modeling to trace how groundwater tables in the Colorado River basin were dwindling. The team focused mostly on Arizona, a state that is particularly vulnerable to future cutbacks on the Colorado River.
Groundwater makes up about 35% of the total water supply for Arizona, said Sarah Porter, director of the Kyl Center for Water Policy at Arizona State University, who was not directly involved in the study.
The study found groundwater tables in the Lower Colorado River basin, and Arizona in particular, have declined significantly in the last decade. The problem is especially pronounced in Arizona’s rural areas, many of which don’t have groundwater regulations, and little backup supply from rivers. With wells in rural Arizona increasingly running dry, farmers and homeowners now drill thousands of feet into the ground to access water.
Scientists don’t know exactly how much groundwater is left in Arizona, Famiglietti added, but the signs are troubling.
“We have seen dry stream beds for decades,” he said. “That’s an indication that the connection between groundwater and rivers has been lost.”
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Deep below the surface of…
Deep below the surface of the ground in one of the driest parts of the country, there is a looming problem: The water is running out — but not the kind that fills lakes, streams and reservoirs.
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The amount of groundwater that has been pumped out of the Colorado River Basin since 2003 is enough to fill Lake Mead, researchers report in a study published earlier this week. Most of that water was used to irrigate fields of alfalfa and vegetables grown in the desert Southwest.
No one knows exactly how much is left, but the study, published in the journal Geophysical Research Letters, shows an alarming rate of withdrawal of a vital water source for a region that could also see its supply of Colorado River water shrink.
“We’re using it faster and faster,” said Jay Famiglietti, an Arizona State University professor and the study’s senior author.
In the past two decades, groundwater basins – or large, underground aquifers – lost more than twice the amount of water that was taken out of major surface reservoirs, Famiglietti’s team found, like Mead and Lake Powell, which themselves have seen water levels crash.
The Arizona State University research team measured more than two decades of NASA satellite observations and used land modeling to trace how groundwater tables in the Colorado River basin were dwindling. The team focused mostly on Arizona, a state that is particularly vulnerable to future cutbacks on the Colorado River.
Groundwater makes up about 35% of the total water supply for Arizona, said Sarah Porter, director of the Kyl Center for Water Policy at Arizona State University, who was not directly involved in the study.
The study found groundwater tables in the Lower Colorado River basin, and Arizona in particular, have declined significantly in the last decade. The problem is especially pronounced in Arizona’s rural areas, many of which don’t have groundwater regulations, and little backup supply from rivers. With wells in rural Arizona increasingly running dry, farmers and homeowners now drill thousands of feet into the ground to access water.
Scientists don’t know exactly how much groundwater is left in Arizona, Famiglietti added, but the signs are troubling.
“We have seen dry stream beds for decades,” he said. “That’s an indication that the connection between groundwater and rivers has been lost.”
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