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

Clinical practice guidelines (CPG) are developed to inform clinical decision-making and standardize care based on scientific evidence, benefits and harms of treatment, and patient preferences to achieve optimal health outcomes. This survey study explored the level of awareness of otorhinolaryngology (ORL) nurses in using CPGs in clinical practice. The study sought to answer the following: (1) How aware are ORL nurses of CPGs developed by the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF)? (2) Which CPGs are most widely identified by ORL nurses? and (3) Do ORL nurses perceive that AAO-HNSF guidelines can benefit their practice? An online survey was developed, piloted, and launched to all eligible registered nurse SOHN members in October 2015. A total of 146 nurses (29%) completed the survey. Over 60% of respondents were in nursing for more than 20 years, 20% were in ORL for 5 years or less, and 40% worked in the hospital, 25% were aware of one or less of the guidelines, with 75% aware of 2 or more specialty guidelines. Nurses were most aware of the tracheostomy care (64%), tonsillectomy in children (47%), and tympanostomy tubes in children (46%) guidelines. The majority of ORL nurses was aware of specialty CPGs and used them to help guide their clinical practice on a regular basis. They also perceived support by their organizations to engage in evidence-based practice. Increasing nurses' awareness and knowledge of CPGs will likely increase guideline use and advance clinical practices based on these recommendations. Strategies to enhance evidence-based guideline recommendations into practice will also be discussed.

A 13-year-old boy with Down syndrome (DS) presents to the pediatric otolaryngologist after being lost to follow-up for several years. The child is accompanied by his stepmother, who has recently been granted full custody together with his father. The stepmother states that the child's mother was non-compliant with his medical care and now, as she describes it, they are "playing catch-up." According to his stepmother, he has a history of recurrent ear infections and had tympanostomy tubes inserted in the past (date(s) unknown). The child has several other co-morbidities including severe obstructive sleep apnea (OSA), premature ventricular beats and possible hypothyroidism. He receives services in school for his speech and language delays in addition to regular physical and occupational therapy. The child was referred by his pediatrician who initially sent him for an audiological evaluation after failing a hearing test in the office. The child's audiogram is consistent with bilateral, severe mixed sensorineural (SNHL) and conductive hearing loss (CHL) and reveals small canal volumes consistent with bilateral middle ear effusions (MEE). The physical exam also reveals bilateral MEE and possible cholesteatoma in the right ear, consistent with chronic otitis media. This case highlights the need for early education of families in the primary care setting when the diagnosis of DS is made, in order to ensure that the child receives adequate care to maximize developmental potential and quality of life.

The risk of opioid misuse for the treatment of chronic pain requires nurses to understand the societal impact of chronic pain and prescription opioid misuse. Patient safety is imperative while managing pain, including orofacial pain. When opioids are required, identifying risk to the patient through thorough assessment using opioid risk tools, monitoring using toxicology screens, and using state prescription drug monitoring databases, will help reduce risk for misuse or abuse. Treatment plans must be balanced using multimodal and interprofessional approaches in order to capitalize on the diverse knowledge of the healthcare team to provide the best care to patients.

Pain is a prevalent global health concern, and pain assessment and treatment is a patient right. This evidence-based practice project targeted translating pain management interventions into practice for adult and pediatric patients undergoing needle stick procedures in ambulatory settings. Evidence-based interventions should consistently be offered to patients who often experience procedural pain or discomfort. Implementation of the practice change included multiple interactive, reinforcing strategies. Pre/post-implementation evaluation measures included clinician knowledge, perceptions, and current practices. A pain-related question was added to the institution's ambulatory patient satisfaction survey. Ongoing reinfusion efforts are aimed at promoting sustainability and integration of the practice change.

All health care professionals want to provide their patients with the best care possible. In order to accomplish this, the most current research must be incorporated into their daily practice. Many medical specialty societies have developed clinical practice guidelines to help facilitate achievement of safe, high quality patient care. This manuscript highlights the recommendations from the clinical practice guidelines developed and published through the American Academy of Otolaryngology-Head and Neck Surgery Foundation. Dissemination of clinical practice guidelines, to a broad audience, is essential to ensure implementation and adoption into practice. The key action statements and recommendation strength of each from the clinical practice guidelines are highlighted to help achieve these goals.

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.