The varied clinical applications for hyperbarics have led to the development of a unique, highly skilled nursing specialty: Hyperbaric Nursing. Hyperbaric nurses are responsible for the practical implementation of patient care during hyperbaric treatments. Because this is a relatively new and rapidly growing field, the need for a textbook and Nursing Standards of Care was essential. Virtually no published work in this area had been accomplished until the Baromedical Medical Nurses Association (BNA) published a textbook “Hyperbaric Nursing” in 2002. The BNA has also made a copy of their Nursing Standards of Care available on our web site. This Standard of Care provides hyperbaric nurses with exact criteria against which patient care can be evaluated for effectiveness and appropriateness. This document is based on the “American Nurses Association” Standards for Nursing Practice and was developed to reflect the goals of that organization. In addition, professional criteria established by The Joint Commission and the Undersea Hyperbaric Medical Association have been integrated into this document. These standards reflect expertise in hyperbaric nursing, affirming the nurse’s responsibility for quality assurance and patient safety in regards to clinical practice.
Patients undergoing hyperbaric oxygen therapy represent a wide range of acuity from chronically ill outpatients to critically ill inpatients and range in age from pediatrics to geriatrics. For this reason the hyperbaric nurse must be knowledgeable and experienced in the care of a multi-faceted population of patients. Application of the nursing process is essential to the appropriate planning and delivery of nursing care in the hyperbaric environment. The hyperbaric nurses have knowledge of human responses to actual or potential problems related to an altered health status (physiological, psychological, sociological and cognitive). They possess a fundamental knowledge of the application of the nursing process in the development of a patient care plan. Hyperbaric nurses understand the pharmacology and complex interaction or alteration of drug effects in the hyperbaric environment. Finally they have a comprehensive knowledge of wound healing and adjunctive therapies that stimulate and/or enhance the healing process.
Hyperbaric nurses start with a comprehensive nursing history and physical assessment which always includes the assistance of the potential hyperbaric patient and their significant others if possible. This process should be systematic and continuous. The data collected is documented, and communicated to all health team members involved in the care of the patient. This information is used to develop a nursing diagnosis. All nursing diagnosis for hyperbaric patient problems are derived from collected health status and developed in accordance with North American Nursing Diagnosis Association (NANDA) guidelines. This provides a nursing diagnosis which is a concise statement based on a patient problem or problems identified via the health assessment. A nursing diagnosis is expressed as the sum of three (3) parts: problem, etiology, and signs/symptoms. The nursing diagnosis should focus nursing personnel on critical elements of care, stimulate the establishment of goals, and drive nursing interventions. As a result, nursing diagnoses must be continuously prioritized, reviewed, and revised as appropriate throughout the continuum of care. The nursing diagnosis should describe the consequences of medical problems and serve as a catalyst for devising, individualizing, and implementing the nursing care plan. The nursing care plan, including patient centered goals is the end result of the nursing data collection/assessment process. The provision of quality patient care requires careful planning and evaluation. The nursing care plan is a tool that provides centralized direction of patient care. It focuses the activities of the nursing care team and provides the framework against which evaluations of patient care can be made. The nursing care plan should be continuously evaluated for its impact on patient response to goal achievement. This evaluation is an integral element of the nursing process. The validity of hyperbaric nursing practice is validated through assessing the patient’s response in comparison to observable outcomes, specified in treatment goals. Nursing action should be designed to accomplish established goals which are initiated based on the nursing plan of care. Nursing actions are designed to enhance the patient’s response to his/her health status. In the end, nursing actions are designed to promote, maintain, and restore health. It is important to understand that hyperbaric oxygen treatments and patient goal achievement are the results of the collaborative efforts of the patient care team, patient, and their significant others. The hyperbaric nurse provides professional nursing care and actions which significantly impacts patient goal achievements and final outcomes.