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

Context: In 2007, a tracheostomy nurse practitioner role was created to facilitate the percutaneous tracheostomy service that was established in 2005 at an urban academic tertiary care facility. The purpose of the tracheostomy nurse practitioner's role was to provide comprehensive care to tracheostomy patients.

Objective: To determine whether the addition of a tracheostomy nurse practitioner to the percutaneous tracheostomy service improves (i) standard of care (ii) efficiency of care, and (iii) patient outcomes.

Design: Retrospective electronic patient record and chart review comparing data before and after the addition of a tracheostomy nurse practitioner to the percutaneous tracheostomy service.

Methods: A total of 110 patients who underwent percutaneous tracheostomy in 2006 and 2008 (n = 55) were randomly selected for the study. Data were collected regarding standard of care, efficiency (n = 55) of care, and patient outcomes.

Setting: Urban, academic, tertiary care medical center

Outcome measures: Standard of care: (1) use of tracheostomy screening tool, 2) obtaining consent, 3) completeness of consent with patient's name, date, time, and signatures of patient/family, provider and witness, 4) performance of timeout, 5) use of tracheostomy postoperative order set, 6) documentation of a procedure note in the chart, and 7) and documentation of operative note in electronic patient record), efficiency of care: timeliness of the service, and patient outcomes: intensive care unit and hospital length of stay, and documented complications.

Results: Between 2006 and 2008, there were statistically significant improvements in 4 of 7 measures of standard of care, use of a tracheostomy screening tool, completeness of consent (documentation of time when consent was completed and presence of signature of witness), performance of time outs, and use of postoperative order set. Between 2006 and 2008, there was also a statistically significant improvement in timeliness of the service. However, there were no significant differences in the three patient outcome measures before and after the addition of the service.

Conclusions: The nurse practitioner facilitated tracheostomy service significantly improved standard of care and efficiency. Relevance to Nursing: Nurse Practitioner facilitated tracheostomy service is an innovative approach to managing tracheostomy patients. The role of the advanced practice nurse as described in this study can be adopted by other institutions to improve the standard of care and efficiency of care.

Patients with head and neck cancer experience significant treatment-related symptoms. Aging may predispose older patients to greater risk. We examined the association of age with symptom burden. Older patients may experience more symptom burden with swallowing, voice/speech, and nutrition. Nurses need to be especially aware of and monitor for these problems.

Background: Head and neck cancer is only 3 to 5% of all the cancers in the United States. The disease causes major changes in the appearance and functional ability of patients.

Purpose: To explore how caregivers communicate with head and neck cancer patients who have impaired communication abilities from the disease and from treatment.

Design: A qualitative grounded theory approach was used.

Methods: Thirty-nine caregivers of head and neck cancer patients were recruited from three east coast academic-affiliated hospitals with dedicated head and neck cancer units. Each person was interviewed, while being audiotaped for 1 1/2 hours. Open-ended questions were used to elicit comprehensive responses to the issues and concerns most important to care for these patients. The tapes were transcribed and inputted using Ethnograph v.5. The analysis of the interviews used grounded theory methods. Methods to ensure rigor and trustworthiness were incorporated into the design.

Findings: The results of the data collection revealed the majority of participants were women age 47 (average). For most, their beginning and highest education was the baccalaureate degree. The entire sample averaged 23 years in their profession and a more than 15.1 years caring for head and neck cancer patients. The sample represented caregivers from primarily the inpatient setting, but also included clinic, administrative, research and education. The results of the data analysis revealed engaging and distancing behaviors based the caregivers' level of comfort. The central topic was communication impairment. The core category was "Reading the Patient". The strategies used to identify problems, and meet the needs of the patients were "Giving Voice", "Being There", "Giving Control", "Saving Face", "Normalizing", "Relieving Pain", and "Giving Hope".

Conclusions: A hypothesis emerged from the analysis of the interviews. Successfully meeting the physical and psychosocial needs of head and neck cancer patients requires an intensive effort and the use of creative methods of communication which are primarily self-taught. Much more research needs to be done on low and high technology tools to assist caregivers of nonverbal patients to meet their needs, including understanding body image change from disfiguring facial surgery. The evidenced-based literature is still unavailable to provide direction to meet these complex patients' needs.

Clinical relevance: This study is a beginning effort to identify the complex needs of head and neck patients and suggest how to meet these needs. Lessons learned from this study might be applied to other patients with impaired communication ability.