ORL-head and neck nursing : official journal of the Society of Otorhinolaryngology and Head-Neck Nurses最新文献

The Kraus K-Helix Crown and Piston prostheses are novel, newly designed, MRI compatible, titanium ossicular replacement prostheses that have received U.S. Food and Drug Administration clearance in March of 2008 for ossiculoplasty. Reconstruction is indicated to restore sound conduction of the ossicular chain during tympanoplasty in chronic and non-chronic ears. The prostheses have been specifically developed for reconstruction of an eroded or absent long process of the incus and an eroded or absent stapes superstructure. They may be used with or without glass-ionomer cement. The prostheses may be implanted incus-to-stapes or malleus-to-stapes (K-Helix Crown) or may be implanted incus-to-footplatelneo-membrane or malleus-to-footplate/neo-membrane (K-Helix Piston). The K-Helix Piston is useful during revision stapedectomy when an eroded long process of the incus is encountered. By coating the K-Helix prostheses with glass-ionomer cement, it is possible to perform "endoskeletal ossicular reconstruction" which greatly enhances long-term prosthesis stability and avoids contact with the tympanic membrane. The prostheses may be custom-fit to reconstruct each individual patient's anatomy. Preliminary hearing results in a small cohort of patients at one year indicate very satisfactory hearing results with closure of the air-bone gap in the majority of patients. The ENT OR nurse plays a role in the use of specialized, adjunctive OR equipment that is used with the technology, is required for the preparation of glass-ionomer cement, and provides patients with important educational information concerning reconstructive otologic procedures.

Oral mucositis is a frequent side effect of cancer treatment and can lead to delayed treatment, reduced treatment dosage, altered nutrition, dehydration, infections, xerostomia, pain, and higher healthcare costs. Mucositis is defined as "inflammatory lesions of the oral and/or gastrointestinal tract caused by high-dose cancer therapies. Alimentary tract mucositis refers to the expression of mucosal injury across the continuum of oral and gastrointestinal mucosa, from the mouth to the anus" (Peterson, Bensadoun, & Roila, 2008, p. ii122). Evidence demonstrates that oral mucositis is quite distressing for patients. In addition, the majority of oncology nurses are unaware of available guidelines related to the care of oral mucositis. A multidisciplinary Oral Mucositis Committee was formed by the University of Iowa Hospitals and Clinics to develop evidence-based prevention and treatment strategies for adult and pediatric oncology patients experiencing oral mucositis. The first step was implementing an evidence-based nursing oral assessment. The Iowa Model was used to guide this evidence-based practice initiative. The Oral Assessment Guide (OAG) is reliable and valid, feasible, and sensitive to changing conditions. The OAG was piloted on an Adult Leukemia and Bone Marrow Transplant Unit leading to modification and adaptation. The pilot evaluation found 87% of patients had an abnormal oral assessment involving all categories in the tool. Nursing questionnaires showed that staff (8/23; 35% response) felt they were able to identify at risk patients using the OAG (3.3; 1-4 scale), and the tool accurately identifies mucosal changes (2.9; 1-4 scale). A knowledge assessment found nurses correctly identified OAG components 63% of the time. Unlike results from a national survey, most University of Iowa Hospitals and Clinics nurses (63%) were aware of national guidelines for prevention and treatment of oral mucositis. Developing an evidence-based nursing policy and updating documentation systems was done before implementation occurred. Computer-based and printed educational materials were developed for nursing staff caring for oncology patients. Team members were responsible for facilitating adoption in clinical areas. After organizational roll out, the nursing assessment was documented in all patients 87% of the time, and 99% for inpatients. The highest risk population, head and neck cancer patients receiving radiation, had documentation in 88% of audited visits. Other clinics required further work. Changing the system to the electronic medical record created an additional need for integration of the evidence-based practice with housewide documentation of oral assessment being completed 60.9% of the time. Use of an evidence-based assessment is the first step in a comprehensive program to reduce a common and highly distressing side effect of cancer treatment. Nursing documentation of oral assessment is well integrated on inpatient units. Opportunities for

The role of the Nurse Practitioner (NP) in the specialty practice of Otorhinolaryngology (ORL) continues to evolve. NPs work in a collaborative practice environment integrating nursing and the medical model. They engage in critical thinking skills, expert clinical practice, and professional leadership, and evaluate and conduct research. This article presents a literature review on the historical evolution of this specialty practice role. Examination of past and present roles in varied practice settings and diverse healthcare systems provide a historical perspective and the momentum necessary to chart future growth and development.

Uncertainty about endoscope reprocessing in the Otorhinolaryngology (ORL) office setting continues today especially regarding the care and cleaning of flexible endoscopes. In an effort to answer questions concerning how, when and how long to process endoscopes in the outpatient office, the Society of Otorhinolaryngology Nurses (SOHN) has partnered with the Association of periOperative Nurses (AORN) to establish standards for all Otolaryngology nurses to adopt and utilize, ensuring a safe and effective methodology for cleaning flexible endoscopes in the outpatient ORL office. This protocol has been approved by the SOHN Board of Directors as the recommended guideline for ORL nurses to follow when performing endoscope reprocessing in the outpatient ORL office.

Purpose: This pilot study tested the effectiveness of a head and neck surgical oncology clinical practicum on nursing students' perceptions of facial disfigurement in these patients. Hypotheses also addressed the impact of patient and student gender; patterns in perceptions based on patient gender and surgical procedure were noted.

Design: A two-group pretest-posttest repeated measures experimental design was used with King's Theory of Goal Attainment (King, 1971, 1981) serving as the framework.

Sample/setting: Thirty-seven junior-level male (n=9) and female (n=28) nursing students enrolled in a baccalaureate program's adult medical-surgical course were randomly assigned to a 5-week clinical experience in an urban university-affiliated medical center. The Experimental Group (n=19) was assigned to a head and neck surgical oncology unit and the Control Group (n=18) was assigned to a general surgical unit.

Procedures: All students completed the Demographic Data Form-Student Version (DDF-SV) and the Modified Disfigurement Scale (MDS) (Lockhart, 1992a, 1992b, 1999, 2000) prior to attending a 4-hour lecture Care of Head and Neck Surgical Patients, a 45-minute clinical conference Care of Facially Disfigured Patients, and the 5-week clinical practicum. All students repeated the MDS after their clinical practicum.

Results: A two-way repeated measures analysis of variance and analysis of covariance revealed no significant differences in ratings, irrespective of clinical group or student gender; all photos were described as being "moderately disfigured". All students rated female patients as being significantly more disfigured than male patients with identical surgical procedures. Both male and female photos were similarly rank-ordered according to severity of disfigurement; surgeries that involved the central portion of the face were rated as being more severely disfigured than surgeries that affected peripheral portions.

Otorhinolaryngologists began developing new operative techniques to minimize open surgical resections of the head and neck. While striving to reduce the morbidity and mortality associated with head and neck surgery and decrease the many psychosocial issues facing these patients, a new procedure defined as Transoral Robotic Surgery (TORS) was developed. With the development of new surgical techniques, nursing care must also change to meet the needs of the patient. As the TORS procedure becomes fully defined, so is nursing's role in the care of the patient. This paper aims to define TORS and discuss the nursing care of the patient undergoing this new surgical procedure.