Advocacy can be defined as “the act of pleading or supporting”; to advocate is to “plead in favor of.” Nurse advocacy may be thought of as “speaking out and speaking for patients.” But how does advocacy occur in nursing practice? How does an individual nurse provide a voice on behalf of patients that is heard? This article reviews the concept of patient advocacy and the role of nurses. Challenges to advocacy activities are presented and strategies for effective advocacy practice are discussed.
Nurses must actively participate in influencing the future of health care and the nursing profession. Involvement in the legislative process is an effective way to influence access to health care, health care costs, and the role of nursing in the health care environment. Read and research the legislation being presented; formulate a personal plan for your own involvement. Know your legislators and communicate with them consistently. As informed, committed, and enthusiastic supporters of legislation that furthers our objectives, 3.1 million registered nurses can educate and influence legislators and promote the future in which we believe.
The current and future generations of nurses will replace the aging perioperative workforce. New nurses must be welcomed into the operating room and their success as perioperative team members facilitated. Old habits, strong personalities, and unprofessional bullying must not occur without opposition. Professionals need to support every member of their surgical teams, embrace process changes, learn from failures, and celebrate successes. A concerted effort must be made to change so-called eating our young behaviors into practices that empower our new perioperative nurses.
Four East is a 24-bed burn progressive care unit (BPCU) located in the burn center of the Institute of Surgical Research, San Antonio Military Medical Center, Fort Sam Houston, Texas. Patients in the BPCU are transferred from the burn ICU (intensive care unit, BICU), admitted through the emergency department or the burn clinic, or are readmissions for surgical scar revisions. BPCU patients may arrive accompanied by the burn center’s dedicated burn flight team, or SMART team (special medical augmentation response team), or with civilian personnel as transfers from other area hospitals. Criteria for direct admission to the BPCU are total body surface area (TBSA) burn of less than 20% with stable vital signs and lab values and minimal oxygen requirements.
For young adults treated in burn centers in developed nations, the lethal area 50%—that is, the burn size lethal to one-half of a given population—has almost doubled since World War II from 43% of the total body surface area (TBSA) to 75% TBSA. This achievement reflects many factors, of which improvements in wound care, perioperative care, and surgical technique have figured prominently. The challenge deployed military health care providers face is how to translate these advances to the relatively austere and unforgiving environment of the combat zone. Thermal injuries are present in 5% to 20% of combat casualties. Thus, on the attlefield, role IIb (forward surgical teams) and role III (combat support hospitals) acilities frequently care for patients with burns. Most of these patients fall into two ategories: US military casualties and local national casualties. US military casualties ndergo emergency treatment and preparation for aeromedical evacuation to the nited States. Local national casualties, under the rules of engagement for the urrent conflicts in Iraq and Afghanistan, cannot be evacuated to the United States; hese patients must receive care locally. Because local resources in both theaters are imited, US field hospitals often are responsible for providing not only emergency reatment but also definitive care. Here, the author reviews the surgical care of atients with thermal injuries as it is practiced on the current battlefield. Conceptually, urn care can be divided into three distinct, albeit closely overlapping, phases: esuscitation, wound closure, and reconstruction. Operative management may be equired during each of these phases.
One of the challenges faced by military healthcare providers in Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) is the treatment of severely burned Wounded Warriors and local civilians. As with the management of other combat-related injuries sustained during the overseas contingency operations, modern-day burn care reaps the benefits of recent advancements in evacuation times from point of injury through Landstuhl Regional Medical Center in Germany to the US Army Institute of Surgical Research (USAISR) Burn Center at Brooke Army Medical Center, Fort Sam Houston, Texas. The USAISR Burn Center is the Department of Defense’s only military facility treating severely burned soldiers. The burn center has a dedicated operating suite (operating room [OR]) and OR staff to include an independent anesthesia department and a surgical team consisting of 11 surgeons and six physician assistants. The burn center also provides care to patients of the US Department of Veterans Affairs, several federal agencies, and civilians in the south Texas region. Burn patients have perioperative anesthesia concerns that are distinct from other surgical populations. These issues require consideration and planning by the surgical team and the anesthesia provider (anesthesiologist or nurse anesthetist) in order to
Reconstruction within the head and neck is challenging. Defects can be anatomically complex and may already be compromised by scarring, inflammation, and infection. Tissue grafts and vascularised flaps (either pedicled or free) bring healthy tissue to a compromised wound for optimal healing and are the current gold standard for the repair of such defects, but disadvantages are their limited availability, the difficulty of shaping the flap to fit the defect and, most importantly, donor site morbidity. The importance of function and aesthetics has driven advances in the accuracy of surgical techniques. We discuss current advances in reconstruction within oral and maxillofacial surgery. Developments in navigation, three-dimensional imaging, stereolithographic models, and the use of custom-made implants can aid and improve the accuracy of existing reconstructive methods. Robotic surgery, which does not modify existing techniques of reconstruction, allows access, resection of tumours, and reconstruction with conventional free flap techniques in the oropharynx without the need for mandibulotomy. Tissue engineering and distraction osteogenesis avoid the need for autologous tissue transfer and can therefore be seen as more conservative methods of reconstruction. Recently, facial allotransplantation has allowed whole anatomical facial units to be replaced with the possibility of sensory recovery and reanimation being completed in a single procedure. However, patients who have facial allotransplants are subject to life-long immunosuppression so this method of reconstruction should be limited to selected cases.
: For burn patients, the day of surgery can come as quickly as hours or as late as days, possibly even weeks, after the initial injury. With reconstructive and scar revision procedures the patient's surgical journey may not end until years after the burn. It is the first few surgical procedures that concern the burn intensive care unit (BICU) nursing staff the most. After a large burn encompassing 30% total body surface area or greater, the first excision and grafting (E&G) procedures are the most critical. Experienced burn surgeons and BICU staff know that there is no substitute for early, aggressive excision of the burn wound in patients with large burns. Deep or Full thickness burns produce an inflammatory response where the eschar (the deep cutaneous necrotic tissue produced by thermal burn or corrosive application) and the viable tissue meet. This area is where bacterial growth in the eschar attracts polymorphonuclear leukocytes (neutrophils) that release large amounts of proteolytic enzymes and inflammatory mediators. As a result, these mediators start separating eschar from the granulating tissue that produces nonsurgical burn scars. These untreated burns result in limited mobility and disfiguring scars. By removing the burned and devitalized tissue, burn surgeons are able to save the patient's life as well as improve appearance and function.
The most significant action that nurses can take to manage the changing health care environment is to advocate for patients, for the profession of nursing, and for each other. The Institute of Medicine (IOM) report To Err is Human started a groundswell of concern for patient safety. The IOM then released their report Keeping Patients Safe : Transforming the Work Environment of Nurses , acknowledging that nurses have a major impact on patient safety. This article argues for a culture of safety in the nursing workplace.
All deep second and third degree burns are at risk to develop hypertrophic scars which can severely undermine the quality of survival. To assess the severity of scarring, several technical devices or tools have been introduced to evaluate one or more aspects of the scar, enabling comparison of different treatment protocols and allowing an objective follow-up. The objective of this study was to review which tools can be used in objective burn scar assessment.The Systematic literature search involving PubMed, the Web of Science (incl. Science Citation Index).51 articles with burn scar assessment as main topic were found. Several characteristics of the scar can be assessed, such as color, metric features and elasticity, but none of the available tools covers the whole aspect of the scar. Especially subjective factors such as pain and itching cannot be assessed with those tools, in spite of their great impact on the patient's quality of life.Scar tools enable objective and reproducible evaluation of scars, which is essential for scientific studies and medico-legal purposes, and in selected cases for the clinical follow-up of an individual patient. Further studies to evaluate these tools on scars are nevertheless required.
March 2012 marked the second anniversary of the Affordable Care Act (ACA), landmark legislation designed to transform health care delivery in the United States. Understanding how the ACA will impact care delivered in the hospital setting is essential for perioperative nurses if they are to influence and lead change to improve the quality, efficiency, and effectiveness of care.
KEY POINTS • The evaluation of websites can be made easier by using relevancy and reliability criteria. • The contents of webpages are relevant when they meet the needs of the viewers in terms of content purpose, coverage, language, and timeliness. • Reliability can be assessed when there is information about the author and hosting site along with contact data, good spelling and grammar, and the date of creation. • Most importantly, viewers have to trust their knowledge and determine if the information is accurate, objective, and supported by appropriate references and links. • Use of a tool can make systematic evaluation of websites consistent, particularly when these resources are needed as information support in a perioperative nursing project.
This article proposes that ethics is the framework that supports quality and that nurses are central in this interdependence. A brief history of the nursing profession's concern with quality and ethics is presented. A discussion of ethical principles, virtue ethics, and the ethics of care is provided. Implications of the principles and virtue/care approaches for practice and leadership and their impact on quality care are suggested. An example of ongoing collaboration between staff nurses and leadership to improve quality care through development of a nursing ethics council and unit-based ethics steward program is presented.
KEY POINTS • Formal analysis of a research problem can help structure a literature search. • Different Internet search engines have many useful features for focusing the search. • Understanding the provenance of documents also focuses the search. • Search engines and literature databases use special commands called Boolean operators to combine search terms. • Using these techniques when searching in Internet search engines, Google Scholar, and specialized databases including PubMed, CINAHL, and PsycInfo yields excellent results. • In addition to immediate full-text or purchase there are several other options that perioperative nurses can use to obtain discovered resources.
To some nurses of a certain age and/or aptitude, terms such as Twitter, blog, and Facebook are part of their native tongue. For others, these terms are part of a foreign language that they struggle to comprehend. However, no matter how familiar or foreign the Internet and social networking sites are for nurses, many are making bad professional judgment calls that are leading to termination from employment, discipline by their licensing boards, and even embarrassment in the witness seats at trials. There are several common legal complaints that may be made against a nurse who uses social networking sites in an inappropriate manner. These include defamation, violation of the Health Insurance Portability and Accountability Act (HIPAA), and violation of a state’s nursing practice act or a licensing board’s rules or regulations. Whereas many employers now have policies and procedures to guide their nurse employees as to what the employer considers acceptable use of social networking and the Internet in the workplace, these policies can vary widely as to what is viewed as appropriate. In one facility, a nurse-employee may be instructed that while at work he/she may not have any access to his/her personal smartphone, at another facility the proscription may only involve not using personal phones while at the patient’s bedside or in the patient’s room. Similarly, Internet access may be very restricted for employees in one facility and virtually without restriction at another facility.
The Association of periOperative Registered Nurses (AORN) advocates for the 160,000 perioperative nurses practicing in the United States. AORN establishes practice recommendations and legislative priorities for its 40,000 members and the perioperative nursing field in general.
