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

Introduction The care of head and neck cancer patients is complex and requires the expertise of professionals from across the allied health spectrum. Perioperative nurses play a crucial role in ensuring that head and neck cancer patients receive high-quality care, but are not afforded the opportunity to witness preoperative and postoperative management decisions. We hypothesized that shadowing a senior head and neck surgeon in an outpatient setting would result in improved understanding of clinical decision making and pathophysiology with the ultimate goal of improving patient care. Methods Nurses who specialize in perioperative care at the author's home institution spent one day in the outpatient clinic with the senior author. Educational goals included improving understanding of clinical decision making and pathophysiology and answering any questions participants posed. A structured questionnaire that included Likert-type scale questions was given to all participants to assess whether the initiative achieved its goals. Results Twenty-seven perioperative nurses participated in the exercise. Twenty-five of the 27 participants (92%) agreed that the experience would allow them "to provide better care to head and neck patients,", and 24 (89%) agreed that the experience helped improve "[their] understanding of the complex nature of4he care needed for head and neck patients." All participants would recommend the experience to a colleague. Conclusion Multidisciplinary care forms the foundation of head and neck cancer care, and therefore collaboration is an essential component for achieving high-quality care. Perioperative health professionals form a crucial part of the broader multidisciplinary team. We found that an interprofessional educational exercise between a senior surgeon and perioperative nurses resulted in an improved degree of comfort in the care and understanding of head and neck cancer. Future efforts should attempt to better understand the effect of similar collaborations on team dynamics and patient outcomes.

Aim: The aim of this review was to assess and synthesize current literature evaluating caregiver education and coping after children were discharged with a tracheostomy.

Background: Tracheostomy tube placement is a transformative event for the child who receives it and the family members who care for the child. As a result, it is imperative to provide caregivers a comprehensive and effective education on how to care for the tracheostomy and how to cope with a tracheostomy.

Design: A systematic review of literature was conducted to explore practices associated with tracheostomy education among caregivers of pediatric patients with a tracheostomy.

Methods: A search of PubMed, CINAHL, and Web of Science revealed potential 501 articles using keywords, tracheostomy, tracheotomy, education, discharge, caregiver, and family coping. After reviewing them in a systematic fashion, 12 articles were identified that were pertinent to tracheostomy education.

Findings: This review of literature showed that discrepancies existed in how discharge education was provided and the lack of knowledge regarding tracheostomy care among caregivers despite formal education. Moreover, the caregivers reported variations in their coping capabilities and quality of life while caring for their children with a tracheostomy tube.

Conclusion: Literature on discharge education regarding tracheostomy management among caregivers of children with a tracheostomy tube is limited. Studies report poor coping strategies and quality of life among caregivers of children with a tracheostomy tube. Studies have significant limitations. Further research is warranted to understand the current practices with discharge education and follow-up of these patients at home settings.

Human papilloma virus (HPV) infection is now recognized as a major risk factor for the development of oropharyngeal head and neck cancers, specifically HPV type 16. HPV-16 positive oropharyngeal cancer may in fact represent a distinct disease entity which is associated with improved prognosis and survival (National Cancer Institute, 2016). In this study, we examined the characteristics of patients with early stage HPV-16 positive oropharyngeal squamous cell carcinoma and their post-operative course contrasting the findings to patients with HPV-16 negative tumors. Overall, it was noted that 30-day readmissions and surgical site infections are not affected by the HPV status of the tumor. Robotic surgery is used more frequently with patients who were positive for the HPV infection, and the data suggest that there is a trend toward shorter length of hospital stays as well as a difference in postoperative complications.

Approximately 1,500 tonsillectomies are performed annually at a large pediatric academic medical center each year. Families need to be educated on how to care for their child after this surgery. Most tonsillectomy patients are discharged home either the same day as surgery or after one night of observation, resulting in post-operative tonsillectomy recovery and care falling upon the patient's family. Multiple quality improvement efforts to improve family education post tonsillectomy surgery have been performed over the last several years at a large pediatric academic medical center. None of these efforts, however, have focused on the use of technology to provide innovative patient education. The purpose of this project is to provide information to parents via text messages and videos to improve patient experience and outcomes following tonsillectomy. Families provided positive feedback, including that the texts were helpful, easy to understand, and reduced pre-operative and recovery anxiety. Also, none of these families needed to call the ENT clinic for any other questions or concerns. The recovery from tonsillectomy is not easy and this pediatric otolaryngology practice is always searching for new ways to improve care and education. Use of technology is an innovative approach and likely one that will be used more often in the future.

Background: The complication rates for tracheostomy patients could be serious and life threatening. As a result, length of stay (LOS) increases and patient outcomes can be negatively impacted. Examples of complications include accidental decannulation, bleeding and total occlusion. Studies suggest there is an inconsistency in tracheostomy care among providers and institutions. Other studies suggest stronger patient outcomes can result from improved staff training and appropriate protocols.

Purpose: The purpose of this study was to develop and test a clinical care pathway (CCP) and nursing education program to improve tracheostomy patient outcomes.

Hypotheses: The use of a CCP and nursing education program at a tertiary VA Medical Center will: decrease length of stay (LOS). decrease 30 day tracheostomy readmissions. increase patient's readiness for discharge. increase nurses' comfort level with performing tracheostomy care. increase nurses' overall competence with performing tracheostomy care.

Method: A quasi-experimental pilot study examining the effect of a CCP compared LOS and complication rates of tracheostomy patients from admission to discharge. The population included veterans from a mid-Atlantic VA Medical Center. This study involved three phases. Phase 1: Administer the Readiness for Hospital Discharge Scale (RHDS) to tracheostomy patients' preintervention. Phase 2: Provide nurses with an educational program pre and post test assessment. Phase 3: Implement the CCP and evaluate patients' readiness for discharge.

Results: Comparing the pre-intervention sample of veterans (n = 10) to the post-intervention sample (n = 6), there was an increase in LOS by 1 day. There was a 15 point increase in RHDS from 165 (SD 25.8) to 180 (SD 14.42). This pilot was underpowered with an n = 6, so there was no significant difference in LOS and 30 day readmission rates. Bootstrapping of sample resulted in RHDS p = . 039 and readmission p = .007. A paired-samples t-test was conducted to assess nurses' competence in performing tracheostomy care and nursing comfort level in regards to providing tracheostomy care and discharge education. There was a significant increase in the post-test scores, nursing comfort level providing tracheostomy care and nurses' comfort level providing patient tracheostomy discharge education.

Conclusions and implications: The significance of this project improved overall tracheostomy care offered at a mid-Atlantic VA Medical Center. Standardizing tracheostomy care and properly educating nurses and patients, increased patients readiness for hospital discharge and decreased their readmission rates related to tracheostomies.