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Multi-interdisciplinair samenwerking

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In dit document ga ik in op de samenwerking tussen de verpleegkundige, verzorgende en betrokken disciplines. Ik analyseer de casus waarbij ik als verpleegkundige de regie en coordinatie heb.

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  • September 21, 2022
  • 41
  • 2019/2020
  • Case
  • Veldhuis
  • 8-9

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Module 6




Multi- en interdisciplinair
samenwerken, regie,
coördinatie en afstemming
Regie voeren, interdisciplinair werken


Naam: Nicole
Koedijker
Studentnummer:
S1145510
Groep: MA19VPK21
Vak code: VPK61D17
Datum: Oktober
2020
Docent: Esther
Veldhuis
Versie: Eerste

,VOORWOORD

Mijn naam is Nicole Koedijker en ik ben vier jaar gediplomeerd als MBO verpleegkundige. In mijn
functie als verpleegkundige heb ik in verschillende sectoren van zorg ervaring op gedaan, maar ligt
mijn hart bij de geriatrische zorg. Ik ben werkzaam binnen een verpleegkundig team op de Veluwe. In
dit team voer ik verschillende werkzaamheden uit zoals: coachen, uitvoeren van triage, uitvoeren van
verpleegtechnische handelingen en ondersteunen bij palliatieve zorg. Deze zorg wordt geleverd in
verschillende zorgsettingen. In de thuiszorg, het hospice, de intramurale zorg en revalidatie zorg.

In dit product laat ik een multidisciplinaire samenwerking zien waarbij gebruik is gemaakt van een
casus uit de praktijk in de intramurale zorgsetting.

Ik ben alle betrokkenen dankbaar voor de begeleiding, enthousiasme, eerlijkheid, betrokkenheid en
het vertrouwen in mij en wil hen bedanken voor de prettige samenwerking.

Ik wens u veel leesplezier,

Zeewolde, Oktober 2020
Nicole Koedijker




1

,Inhoudsopgave
Voorwoord................................................................................................................................................................1

Inleiding.....................................................................................................................................................................4

1.Casus omschrijving.................................................................................................................................................5

1.1 De client en achtergrond informatie...............................................................................................................5

1.2 Verantwoording..............................................................................................................................................5

1.3 complexiteit van zorg......................................................................................................................................6

1.4 Beschrijving van het gezondheidsprobleem...................................................................................................6

2. Verantwoording zorgbehoeften............................................................................................................................7

2.1 Anamnese........................................................................................................................................................7

2.2 Meetinstrumenten..........................................................................................................................................7

2.3 Betrokkenen van de client en het sociale netwerk.........................................................................................7

3. Verpleegplan.........................................................................................................................................................8

3.1. Verpleegkundige diagnoses...........................................................................................................................8

3.2 Prioritering.......................................................................................................................................................8

3.3 PES / Verpleegplan..........................................................................................................................................9

4. Samenwerkingsdiagnose.....................................................................................................................................10

4.1 Verantwoording en onderbouwing samenwerkingsdiagnose......................................................................10

4.3 Doel van de samenwerking...........................................................................................................................11

4.4 Verslagen van samenwerking........................................................................................................................11

5. Evaluatie..............................................................................................................................................................12

6. Reflectieverslagen...............................................................................................................................................12

6.1 Persoonlijk reflectieverslag...........................................................................................................................12

6.2 Inhoudelijke proces evaluatie.......................................................................................................................13

Literatuurlijst...........................................................................................................................................................15

Bijlagen....................................................................................................................................................................16

Bijlage A...............................................................................................................................................................16

Bijlage B...............................................................................................................................................................19



2

, Bijlage C...............................................................................................................................................................21

Bijlage D...............................................................................................................................................................23

Bijlage E...............................................................................................................................................................25

Bijlage F...............................................................................................................................................................26

Valrisico signalering score formulier...............................................................................................................26

Bijlage G...............................................................................................................................................................29

Bijlage H...............................................................................................................................................................30

Bijlage I................................................................................................................................................................34

Bijlage J................................................................................................................................................................37

Feedbackformulier....................................................................................................................................................0

Beoordelingsformulier..............................................................................................................................................1




3

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