Transitioning the older adult in the ambulatory care setting

Transitions between care settings are periods of vulnerability for patients. This is especially true for older adults, for whom comorbidities and functional impairments can increase the complexity of care and the need for multiple caregivers can compromise safety. Poor care transitions can result in costly hospital admissions. For this reason, leading health care organizations have initiated programs to improve the quality of transitions; however, to date, the ambulatory surgical setting has not been a focus of these initiatives. The ambulatory setting serves an increasingly complex patient population and provides the majority of elective surgeries, and adapting some of the transition tools that have been tested in other settings will benefit health care providers and patients in the ambulatory setting. Identifying periods of transition and risk, implementing electronic health records across all phases of patient care, and using evidence-based tools at each transitional stage can optimize the quality and safety of patient care.     

Weight management practices among heart and vascular health care providers in an ambulatory setting

In this study, health care providers' assessment, intervention practices, and perceived barriers to weight management approaches in an ambulatory adult heart and vascular setting are reported. Their knowledge of the National Institutes of Health National Heart, Lung and Blood Institute's The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults are also described.     

Reporting of hazards and near-misses in the ambulatory care setting

The purpose of this study was to describe the frequency and types of hazard and near-miss events in the ambulatory setting. Nursing students (N = 566) submitted 9272 reports while in their ambulatory care rotation. Of these, 1624 were hazards and 985 were near-misses. The most commonly reported hazards and near-misses were related to infection (20.0%) and medication (19.1%), respectively. The most frequent category of open-ended comments was related to administrative problems.     

Acute seroconversion of HIV infection in the ambulatory care setting

Patients frequently visit ambulatory care settings with acute human immunodeficiency virus (HIV) seroconversion illness, but the illness is often misdiagnosed. This acute viral syndrome, or seroconversion illness, occurs after initial exposure to the HIV virus; it is often resolved before the development of HIV-specific antibodies. Primary HIV infection refers to the 12 months following infection; it includes an acute time period after exposure when routine HIV antibody testing is negative. Primary HIV infection is recognized with the help of a detailed screening history. Diagnosis is confirmed through laboratory tests that detect virus presence. The accurate diagnosis of primary HIV infection can have a beneficial effect on the patient's clinical course and also on public health prevention efforts.     

Use of herbal therapies by adults seen in an ambulatory care research setting: an exploratory survey

OBJECTIVE: To identify and characterize patterns of use of herbal products among patients participating in selected research clinics. DESIGN: Survey of three National Institutes of Health (NIH) ambulatory care research clinics. SUBJECTS: Convenience sample of 490 adult patients (168 male, 322 female) attending rheumatology, liver, and endocrinology/metabolic research clinics. RESULTS: Of the patients surveyed, 16.7%: (n = 82) reported using herbs. There were no significant sociodemographic differences between herb and nonherb users. Indications for herb use differed among the disease groups; patients in the endocrine and rheumatology clinics were taking herbs predominantly for "energy" or "wellness"; those attending the liver clinic tended to use herbal therapies as treatment for their disease. Mean and median monthly expenditure for herbal products was $30 and $10, respectively. There was a significant positive correlation between number of herbs used and use of other dietary supplements (p < 0.0001). CONCLUSIONS: One in six patients in ambulatory clinical research settings may be taking herbal products in addition to prescribed treatment. This figure is lower than in the general population, possibly because the patients may stop using herbs when participating in a research project. Although empirical evidence on the beneficial or adverse effects of herb therapy alone or in combination with drug therapies is limited, clinical researchers should be aware of the potential for confounding clinical trial results.     

Development of professional practice based on the McGill model of nursing in an ambulatory care setting

This paper describes the efforts of nurses to explore, develop and implement professional nursing practice, based on the McGill model of nursing, within an existing ambulatory paediatric setting. The model facilitated the development of a unique role for nurses in a multidisciplinary team, as it served as the framework for the conceptualization of the nursing role, assessment of families' needs, and the development of a nursing knowledge base. Strategies utilized to develop a 'complemental role' and its inherent professional practice are described. The issues and obstacles which arose as nurses developed their practice are discussed and the outcomes of this development for clients, nurses and the profession are highlighted.     

Testing a classification instrument for the ambulatory care setting

The purpose of this study was to evaluate the construct validity, generalizability, and interrater reliability of an instrument designed to measure the complexity of nursing care in the ambulatory care setting. The conceptual framework for the development of the classification instrument was adapted from a theory of organizations and is based upon knowledge technology. Previous research using the Delphi methodology delineated 44 activity categories for the classification instrument. These categories were organized under six literature-based responsibility areas. The instrument was tested in seven areas of one hospital-based ambulatory care setting. A total of 641 valid patient ratings were used for the analysis. Results indicate the instrument has beginning construct validity and high interrater reliability with training. It is not generalizable across services unless the effect of clinic type on nursing care complexity is considered.