Developing nursing leadership in an ambulatory surgical center through shared responsibility

As health care continues to change at an unprecedented pace, so must nursing models of leadership. Nurse managers must look at successful models of leadership from the past and build successful components into new models of nursing health care leadership. The bureaucratic hierarchical system of the past does not keep today's nurse satisfied, nor are there monies in our current health care system for multiple layers of management. The leadership skills inherent in every professional staff nurse must be used and developed within the new health care arena for fiscal responsibility as well as professional satisfaction. Presented is one model used at our ambulatory surgical center. It is based on the premise of "shared responsibility" in which each person functions as a manager and a leader instead of one individual functioning to lead all who must be managed. Duties and responsibilities are divided among staff members, and each person has authority, responsibility, and accountability for specific tasks and functions with the ambulatory surgical center (ASC).     

Surgery: not just for hospitals anymore. Part 2: EMS response to postoperative complications

Patients who have undergone a surgical procedure at an ambulatory surgery center, hospital or physician's office may experience postoperative complications. This article examines the types of postoperative complications that can occur following outpatient procedures, with recommendations for EMS patient care and issues related to patient transport.     

Adverse effects of fluoroscopically guided interlaminar thoracic epidural steroid injections

OBJECTIVES: To assess the prevalence of adverse effects or complications from fluoroscopically guided thoracic interlaminar epidural steroid injections. DESIGN: A retrospective study with independent observer review. Patients presenting with thoracic radicular pain, caused by either herniated nucleus pulposus or thoracic spondylosis as confirmed by magnetic resonance imaging, received an interlaminar thoracic epidural steroid injection as part of a conservative-care treatment plan. The study was performed in a multidisciplinary spine care center. All injections were performed over a 5-yr period. An independent observer reviewed medical charts, which included a 24-hr postprocedure standardized questionnaire completed by telephone by an ambulatory surgical center nurse. Ambulatory surgical center operative reports and physician follow up office notes up to 3 mos after the procedures, along with epidurograms, were also reviewed. RESULTS: A total of 21 patients who received 39 injections were reviewed. Adverse effects or complications per injection observed included three with increased pain at injection site (7.7%), two with facial flushing (5.1%), one transient nonpositional headache (2.6%), one episode of insomnia the night of the injection (2.6%), and one episode of fever the night of the procedure (2.6%). Statistical analysis revealed no significant difference based on diagnosis (herniated nucleus pulposus vs. spondylosis, P = 0.9156), and age was not linked to higher prevalence of adverse/effects complications (P = 0.3137). CONCLUSIONS: No major complication arose. Adverse effects did occur with a rate of 20.5%. All adverse effects resolved without morbidity. No statistical difference was observed in the rate of adverse effects in patients with herniated nucleus pulposus or spondylosis.     

Client characteristics and practice patterns of nurse practitioners and physicians

This study's purpose was to describe the practice patterns of nurse practitioners (NPs) in Tennessee--specifically, the demographic characteristics and health problems of their clients and the therapeutic services they provide. A random sample of NPs practicing 20 or more hours per week in primary care in Tennessee provided data on a total of 680 clients seen during one selected day of care. An instrument adapted from the National Ambulatory Medical Care Survey (NAMCS) allowed comparison of the NP findings with a national survey of office-based physicians in five areas: client demographics, client health status, diagnostic tests ordered, therapeutic interventions provided, and client disposition. Although many similarities were seen, differences included the tendency of NPs to care for more younger and female clients, to perform fewer office surgical procedures, and to provide more health teaching/counseling interventions.     

Patient care after discharge from the ambulatory surgical center

An important and often forgotten aspect of postoperative care occurs after the patient is discharged from the ambulatory surgical center. With more than 60% of all surgeries and procedures occurring on an ambulatory basis, what happens after the patient is no longer in continuous professional care is of concern to the ambulatory nurse. Numerous physical postoperative complaints are common and expected sequelae of anesthesia and surgery in the ambulatory patient. In this article, important postdischarge complications are reviewed and contemporary management options discussed. The information contained in this review article is valuable to the provider in educating patients regarding their anticipated course of postoperative recovery. OBJECTIVES: -Based on the content of this article, the reader should be able to (1) identify important postdischarge complications to provide patients with comprehensive discharge instructions regarding their continued recovery at home; (2) discuss contemporary management options available to treat postdischarge complications; (3) realize the incidence of specific postdischarge complications and how that relates to patient satisfaction with the surgical experience; (4) recognize signs and symptoms of postdischarge complications; and (5) identify risk factors of patients for developing specific complications in the postoperative phase.     

Patient teaching in the ambulatory setting

Tremendous growth in the ambulatory setting has made patient education an integral part of health care in that setting. Numerous factors can hinder the implementation of patient education. Institutional variables include time, environment, and money. Acuity, psychosocial issues, and available resources are patient-centered variables. In order to promote effective patient education in an ambulatory setting, nurses need to be involved actively in planning and presenting material and in evaluating patient learning. In addition, nurses should be knowledgeable about the content being presented. The type of environment in which the teaching occurs and the strategies utilized in patient education facilitate the information exchange. The nurse and client must develop trusting relationships built on effective communication skills by both client and nurse. The trend toward fostering the patient as an active partner in health care can be accomplished through the teaching of communication skills as well as prevention, management, and self-care skills.     

Surgery: not just for hospital anymore. Part I: Responding to the surgical patient in distress

The number of surgical and diagnostic procedures performed on an outpatient basis continues to grow in the U.S. These procedures are often performed in an ambulatory surgery center (ASC) or physician's office. While outpatient surgery is typically safe, a wide variety of complications can occur. When an emergency occurs in these facilities, the patient requires emergency treatment and may need to be transferred to a hospital for additional care. This article examines the types of emergencies that occur and the associated patient care requirements, including the special needs of intraoperative and postoperative patients and their interactions with healthcare providers.     

The ambulatory endoscopy center (AEC): what it can do for your gastroenterology practice

Endoscopy accounts for most of the gastroenterologist's professional time and revenue. The thoughtful gastroenterologist in practice must understand the potential sites of service for endoscopy, including either the hospital endoscopy unit or an ambulatory endoscopy center (whether an office endoscopy suite or a licensed, certified, and accredited ambulatory surgery center). Out-of-hospital endoscopy centers have advantages for patients, including convenience, efficiency, economy, and more pleasant surroundings than the hospital. Payers appreciate improved access and reduced costs. For gastrointestinal practices, ambulatory endoscopy centers, particularly ambulatory surgery centers, provide significant advantages, including enhanced reimbursement and cost management, control, efficiency and convenience, quality control, opportunities for clinical research, and marketing and competitive strengths.     

Safety of ambulatory surgery

Elective surgical procedures are moving from hospital-affiliated and freestanding ambulatory centers to the physician office. Anesthetic risk has decreased dramatically during the past decade; however, perioperative safety is ill defined when the surgical procedure is performed in the physician office. Perioperative risk may vary depending on the surgical location (hospital, freestanding unit, or physician office). Regulation of office-based surgery is now being addressed by specialty organizations and Departments of Health or Boards of Medical Examiners. A comprehensive study of perioperative risk for patients receiving office-based surgical care is needed.     

Recognizing borderline personality disorder in the primary care client

The nurse practitioner is responsible for the diagnosis and treatment of a great variety of physical and psychological disorders in the ambulatory client. Frequently the diagnosis of personality disorder is missed, ignored or not even considered. This article will introduce the nurse practitioner to the various personality disorders. The main focus, borderline personality disorder, is estimated to affect 5 to 15 percent of the general population. A picture of the borderline client from etiology to treatment as well as recent research findings and suggestions for history taking and physical exam are covered. Borderline has been a difficult and confusing diagnosis to make because in the past the term has had several different meanings. This article will clarify what this diagnosis means, and will assist the nurse practitioner in the recognition, diagnosis and management of all clients with personality disorders.     

The challenging role of the perianesthesia nurse in the office-based surgical suite.

Office-based surgery is increasing in popularity because of technological advances, economic benefits, and convenience to the patient and surgeon. The peri-anesthesia nurse practicing in the office surgical suite assumes an increasingly complex role which may include (1) quality assurance oversight, (2) office staff education, (3) implementing and monitoring infection control measures, (4) providing medical equipment upkeep by means of scheduled maintenance, and (5) overseeing of medical supplies inventory. These responsibilities may be expected in addition to the traditional role of the nurse during the preoperative, intraoperative, and postoperative period. Recent recommendations will be reviewed regarding practice considerations applicable for the peri-anesthesia nurse designed to improve patient care and safety.     

Abdominal aortic aneurysm treated by endovascular surgery: a case report

An aneurysm is an abnormal dilation or irreversible convex of a portion of an artery. The most common site of aneurysms is the abdominal aorta and their appearance is often due to degeneration of the arterial wall, associated with atherosclerosis and favored by risk factors such as smoking and hypertension, among others. Left untreated, aneurysm of the abdominal aorta usually leads to rupture. Treatment is surgical, consisting of the introduction of a prosthesis, composed basically of a stent and an introducer, into the aorta. We report the case of a person diagnosed with abdominal aortic aneurysm in a routine examination who was admitted for ambulatory surgical treatment. We designed a nursing care plan, following Virginia Henderson's conceptual model. The care plan was divided into 2 parts, a first preoperative phase and a second postimplantation or monitoring phase. The care plan contained the principal nursing diagnoses, based on the taxonomies of the North American Nursing Diagnosis Association (NANDA), nursing interventions classification (NIC) and nursing outcomes classifications (NOC), and collaboration problems/potential complications. The patient was discharged to home after contact was made with his reference nurse in the primary health center, since during the hospital phase, some NOC indicators remained unresolved.     

门诊注射室护士负性工作情绪分析及干预

目的 分析门诊注射室护士负性工作情绪的主要因素，帮助管理人员及护士本人正确，从而提高门诊注射室护理质量。方法通过座谈、发放调查表进行统计分析。结果门诊注射室护士负性工作情绪依次来源为：环境、社会、自身技术等。结论建议社会尊重护士，医院改善护士工作环境，合理配备人力资源，科室加强护士技术培训及沟通能力培养，从而减少护士负性工作情绪，提高护理质量。     

上海市市区社区护理服务的现状调查与分析

目的 通过对上海市市区(某区)社区护理服务的现状调查,了解目前上海市市区社区护理服务的现状,提出一些改进地意见和建议。方法 2012年12月—2013年6月采用自行设计的调查问卷对上海市某区五所社区卫生服务中心的50名护理人员和30名社区居民进行问卷式调查。内容：护士方面包括所在社区卫生服务中心所从事的护理岗位、中心所开展有哪些护理服务项目、对所在岗位的护理工作是否满意,以及护士的离职率以及社区护士与二、三级护士的比较。患者方面包括患者就诊时得到了哪些护理服务以及对所得到的护理服务是否满意,患者对就诊的中心所提供的护理服务项目的知晓率。结果 护理方面:(从事社区护理的工作的范围太广涉及到方方面面不是全科护士的社区护士有时力不从心,与送你、三级医院护士相比较社区护理涉及到的岗位太多护士人员偏少人力不够,社区护士角色单一,护士升职率低离职率高)。居民方面:(对就诊中心所开展的护理服务项目不清、对护士人员偏少输液、肌注等要排队等候不满)。结论 上海市市区社区护理人员的发展需要进一步完善人才的培养(全科护士),加强对社区护士实施继续教育,提高护士的满意度,降低离职率。加强护士业务水平,平时操作理论勤练习,熟练掌握各项流程减少患者排队等候时间,提高患者的满意度。     

Client and family learning in the rehabilitation setting

Learning in the rehabilitation setting, whether it be inpatient or community based, is a vital part of the client and family's role as consumers of rehabilitation care. Educational programs foster client participation in selecting appropriate modes of learning activities as they relate to the recovery process and help the client and family make a smooth transition into community living. Varied modes of instruction may be used, including practice sessions, group learning activities, computerized programs, use of videos as well as printed resources. The role of the nurse as educator coupled with a broad range of teaching strategies provides the client and family effective tools to make ongoing changes related to their functional abilities. The role of the rehabilitation nurse as an educator is an evolving one. No longer is the nurse practicing in a rehabilitative setting, whether it be inpatient or community based, guaranteed what appeared to be unending time to conduct educational programs. Past constraints, shortened stays, the client assuming an earlier role as a self-care agent, the focus on wellness, disabled individuals mainstreaming into community life, greater family involvement in rehabilitation efforts, and increased use of paraprofessionals force the nurse to strengthen and clarify her role as educator. Nurses need to value their teaching role as an integral part of the team effort. Strategies include scheduling teaching time with clients and families, recording activities and outcomes, discussing educational issues with other disciplines, and designing and promoting an environment that is conducive to learning.     

Staying alive: a client with chronic mental illness in an environment of domestic violence

This case study of a young, African American mother with chronic mental illness demonstrates the impact of domestic violence on a vulnerable population. The client was economically disadvantaged, socially isolated, stigmatized, and victimized by repeated abuse from her live-in male partner of 7 years. With this overlay of violence in the home, the client experienced a downward trajectory in health, self-esteem, economic status, personal freedom, social relationships, and legal standing. Using a public health model in the context of an urban nursing center, an advanced practice nurse provided case management and outreach services for the client.     

A continuing education program for nurse practitioners in ambulatory care

Continuing education should be an integral part of all health care providers' practice. This article discusses the recognition of this need by a group of nurse practitioners in an acute ambulatory care center. The process undertaken in developing the program of continuing education is described. The program outline can serve as a model for other NPs in similar settings.     

Complications of fluoroscopically guided caudal epidural injections

OBJECTIVES: To assess the incidence of complications of fluoroscopically guided caudal epidural injections. DESIGN: A retrospective cohort design study in which chart review was performed on patients, who presented with radiculopathy and received fluoroscopically guided caudal epidural steroid injections. All injections were performed consecutively over a 12-mo period. An independent observer reviewed medical charts, which included a 24-hr post procedure telephone call by an ambulatory surgery center nurse, who asked a standardized questionnaire about complications after the injections. Physician follow-up office notes 1 to 3 wk after injection along with epidurograms were reviewed. RESULTS: The charts of 139 patients, who received 257 injections, were reviewed. Complications per injection included 12 episodes of insomnia the night of the injection (4.7%), 9 transient nonpositional headaches that resolved within 24 hr (3.5%), 8 increased back pain (3.1%), 6 facial flushing (2.3%), 2 vasovagal reactions (0.8%), 2 episodes of nausea (0.8%), and 1 increased leg pain (0.4%). No dural punctures occurred. CONCLUSIONS: No major complications occurred. The incidence of minor complications was 15.6% per injection. All reactions resolved without morbidity and no patient required hospitalization.