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

This is a synopsis of the presentation delivered at the Society of Otorhinolaryngology and Head-Neck Nurses' Annual Congress and Nursing Symposium, September 11, 2012 in Washington, DC. We all have imperfections in our faces and bodies that we would like to change. Consider, though, the cancer patient or the trauma victim who must deal with a facial disfigurement that completely changes their appearance, and often, their ability to function normally. Anaplastology, which combines art and science through creativity and functionality, can make monumental improvements in the quality of a person's life by giving acceptable appearance back to the patient. Custom-made appliances and prosthetic creations can bring hope and confidence back to the patient. Individualized adaptations can make the prosthetic a true work of art. Nurses work closely with patients who are benefitting from this creative process. Arriving at a successful and pleasing outcome is extremely satisfying for the entire team, the patient and family.

Work-related airway symptoms are very common. Occupational asthma may be present in up to 11 million American workers, and many more may also have occupational rhinitis. These illnesses can be related to both allergic and non-allergic mechanisms, and can be difficult to characterize and diagnose. A multidisciplinary approach to diagnosis and management is important to optimize recognition and treatment of these complex patients. The ORL nurse plays a key role in the workup and management of patients with work-related airway diseases.

This is a companion paper to two previous publications on recommended practices for cleaning and reprocessing flexible endoscopes used in Otolaryngology (Burlingame, Arcilla, & McDermott, 2008; Adams & Baker, 2010). In this paper we capture and expand upon the audience question and answer session in which the Society of Otorhinolaryngology and Head-Neck Nurse (SOHN)--endorsed the Association of periOperative Registered Nurses (AORN) recommended practices were presented to the SOHN membership (Adams & Waddington, September, 2010). We include additional background information to assist readers in understanding some of the science behind the recommendations and share successful implementation strategies from Otorhinolaryngology (ORL) outpatient nurses and published references.

Objective: Universal newborn hearing screening (UNHS) has been implemented for several decades to screen for congenital hearing loss; however, the lost to follow-up (LFU) rate for newborns with a failed screen is nearly 50%. Many studies have examined risk factors rendering infants susceptible to being LFU, but there are no quality improvement studies using evidence-based practice that aim to improve follow-up rates. This study utilized a nurse practitioner (NP) to provide a teaching intervention to educate parents on recommended follow-up after a failed hearing screen, including the Healthy People 2020 objectives.

Methods: Seventeen newborn/mother couplets were recruited to participate in a multi-site quality improvement project over a six week period prior to hospital discharge. At the bedside with the NP, mothers completed a demographic survey and were provided education on Georgia's UNHS Program and recommended follow-up based on the Healthy People 2020 objectives. An appointment with the hospital's audiologist was given to the mother in writing. A retrospective chart review was performed three months after the newborn's birth to document follow-up with audiology or to see if the infant was lost to follow-up for audiologic evaluation (LFUAE).

Results: Of the 17 newborns enrolled, 14 had adequate follow-up with audiology within three months of birth. Hospital A showed statistical significance with one newborn that was LFUAE when compared to the nation LFU rate (n=12, p=0.01). Prior to project intervention, Hospital B had a 70% LFUAE rate; however, its post intervention LFUAE rate decreased to 40% (n=5). Statistical significance was unable to be obtained due to small sample size. Two mothers reported smoking during pregnancy and both of their newborns were LFUAE.

Conclusions: This project suggests that education by the NP prior to hospital discharge was statistically significant at Hospital A. Health care providers should actively engage in educating parents regarding expected follow-up guidelines and incorporating the Healthy People 2020 objectives. Further studies are needed that can also examine the six month follow-up with pediatric otolaryngology for hearing aid fitting and early intervention.