Transforming Nursing Practice: Barriers and Solutions

All nurses should practice to the full extent of their education and training. This key message from the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health, applies to all RNs. Barriers need to come down that prevent nurses from reaching their full potential at a time when the US health care system needs to be operating at full capacity. With the focus of US health care shifting toward promoting wellness, preventing disease, and managing chronic conditions better, the role that nurses play in coordinating care will increase. As key members of health care provider teams, nurses’ contributions to the delivery of safe, high-quality, cost-effective, and patient-centered care must be recognized and valued. For nurses to realize their full potential in new models of health care delivery, a transformation of nursing practice will need to occur. This overview demonstrates how professional nurses should prepare and contribute to critical changes needed in health care reform.     

Implementing AORN Recommended Practices for a Safe Environment of Care,Part II

Construction in and around a working perioperative suite is a challenge beyond merely managing traffic patterns and maintaining the sterile field. The AORN “Recommended practices for a safe environment of care, part II” provides guidance on building design; movement of patients, personnel, supplies, and equipment; environmental controls; safety and security; and control of noise and distractions. Whether the OR suite evolves through construction, reconstruction, or remodeling, a multidisciplinary team of construction experts and health care professionals should create a functional plan and communicate at every stage of the project to maintain a safe environment and achieve a well-designed outcome. Emergency preparedness, a facility-wide security plan, and minimization of noise and distractions in the OR also help enhance the safety of the perioperative environment.     

围产期协同护理模式的应用

目的 探讨协同式护理在围产期应用的效果。方法 对临产孕妇施以协同式护理，检测其主要生理、心理指标。同时设对照组。结果 实验组孕妇产前血压、心率、焦虑程度均较平稳，与对照组比较，产程缩短，产后乏力性出血发生率低。结论 协同式护理可以使临产孕妇主要生理、心理指标平稳，增加了孕妇产前认知，提高了对临产孕妇的护理质量。     

围产期协同护理模式的应用

目的探讨协同式护理在围产期应用的效果.方法对临产孕妇施以协同式护理,检测其主要生理、心理指标.同时设对照组.结果实验组孕妇产前血压、心率、焦虑程度均较平稳,与对照组比较,产程缩短,产后乏力性出血发生率低.结论协同式护理可以使临产孕妇主要生理、心理指标平稳,增加了孕妇产前认知,提高了对临产孕妇的护理质量.     

Site-Neutral Payment for Postacute Care: Framing the Issue

This commentary evaluates the merits of proposals in the United States to create a site-neutral payment system for postacute care for patients with select rehabilitation-related conditions. Under a site-neutral payment system, Medicare would pay providers based on patients' clinical needs, not on the peculiarities of individual postacute settings such as skilled nursing facilities and inpatient rehabilitation facilities. This commentary frames the policy choices by taking into account the research evidence on setting costs and outcomes, the policy tools and preconditions needed for an effective site-neutral payment system, and the overall direction of American health and postacute policy.     

Reframing the Patient Experience in a Post-COVID Health Care Environment

The health care industry, and most especially nursing, has arrived at a moment when transformation is the only path forward. Transformation feels messy and uncertain. We must not leave our patients and customers out of the loop. They have always presented to us with anxiety, and we were challenged to make them feel safe and comfortable. World class service was our aspiration but that can be hard to deliver when our leaders and teams are not feeling comfortable and safe. It is time for us to be honest and compassionate with patients about what they can realistically expect from us and how we will continue to meet their needs. Other industries have done it during times of transformation and so can we.     

Holistic Healers in the United States and the Changing Health Care Environment

Holistic health care increased in the United States in the 1970s partly as the result of a 'massive crisis' in the health care system. However, the Reagan administration, with its emphasis on reducing Government involvement in the marketplace, has created an environment in which many holistic practitioners find it more difficult to practice. To achieve greater acceptance in the 1980s, holistic (especially 'alternative') therapists will have to educate the public, form themselves into appropriate alliances, and become more involved in the politics of health care.     

Effectiveness of Transmucosal Sedation for Special Needs Populations in the Ambulatory Care Setting

Transmucosal is an alternative route for administering medications (ie, dexmedetomidine, midazolam, naloxone) that can be effective for procedural or moderate sedation in patients with special needs when other routes are not practical or are contraindicated. Special needs populations include children, older adults, pregnant and breast-feeding women, and people with disabilities or conditions that limit their ability to function and cope. Understanding the perioperative nurse’s role in the care of patients receiving medications via the transmucosal route can lead to better clinical outcomes. Successful use of the transmucosal route requires knowledge of when to administer a medication, how often and how much of a medication should be administered, the onset and duration of action, the adverse effects or contraindications, and the key benefits. In addition, a case study approach suggests that transmucosal sedation can decrease patient stress and anxiety related to undergoing medical procedures or surgery in the ambulatory care setting.     

Using an Age-Specific Nursing Model to Tailor Care to the Adolescent Surgical Patient

A surgical experience can be stressful for any patient. When the patient is an adolescent, however, the surgical experience can create significant stress, which is related to normal adolescent development. Perioperative nursing care should address what adolescent patients perceive as stressful and should provide a safe environment so that a successful surgical outcome can be achieved. To accomplish this, a nursing model specific to perioperative nursing practice should be developed to guide nurses when providing care to adolescents. The Adolescent Perioperative System Stability Model based on the Neuman Systems Model provides a framework for defining scope of practice and organizing nursing care that is appropriate for the adolescent during a surgical experience. In addition to guiding nursing practice, this model provides direction and guidance for future studies of adolescents in the perioperative setting.     

Special Needs Populations: Perioperative Care of the Patient With Creutzfeldt-Jakob Disease

Creutzfeldt-Jakob disease (CJD) is a rare but lethal prion disease. The worldwide mortality rate of CJD is 1.67 per one million people, although 90% of cases will lead to death within one year of symptom onset. Rapid, progressive dementia is the cardinal sign of CJD. Other early symptoms include deterioration of muscle coordination, memory, judgment, and vision, as well as personality changes, insomnia, and depression. It occurs in two types, classic and new variant, and classic CJD can be further divided into three subtypes: sporadic, familial (ie, genetic), and iatrogenic (ie, health care associated). Surgery often requires using instruments that come in contact with high-infectivity tissue, especially during neurosurgical procedures and diagnostic biopsies. To reduce the risk of disease transmission, infection control practices should include identification of the risk of infection, implementation of safety protocols (eg, use of personal protective equipment), proper selection and use of instrumentation, and adequate disinfection and sterilization practices. Silent carriers, risks of iatrogenic infection, and the possibility of inadvertent exposure of healthy patients may carry great liability to public health and hospital stability.     

Safety Culture and Care: A Program to Prevent Surgical Errors

Surgical errors are under scrutiny in health care as part of ensuring a culture of safety in which patients receive quality care. Hospitals use safety measures to compare their performance against industry benchmarks. To understand patient safety issues, health care providers must have processes in place to analyze and evaluate the quality of the care they provide. At one facility, efforts made to improve its quality and safety led to the development of a robust safety program with resources devoted to enhancing the culture of safety in the Perioperative Services department. Improvement initiatives included changing processes for safety reporting and performance improvement plans, adding resources and nurse roles, and creating communication strategies around adverse safety events and how to improve care. One key outcome included a 54% increase in the percentage of personnel who indicated in a survey that they would speak up if they saw something negatively affecting patient care.     

Disorders of Consciousness: Outcomes,Comorbidities, and Care Needs

Over the last decade, research on patients with disorders of consciousness (DOC) has suggested that their prognosis for functional recovery early after injury is surprisingly positive, particularly for those with traumatic etiologies; that meaningful recovery proceeds for longer intervals than previously appreciated; and that such individuals are often medically complex and challenging to manage. However, access to intensive specialty rehabilitation is limited for most individuals with DOC in the United States. The evolving understanding of DOC calls for a reconsideration of appropriate models of care. This collection of articles provides insight into the functional recovery of individuals with DOC, new tools for assessing prognosis, and the patterns of comorbidity that complicate the recovery process. In addition, models of care from the United States and Europe that attempt to address the needs of patients as well as their caregivers are presented.