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Role of advanced practice nurses over time
Role of advanced practice nurses over time
Role of advanced practice nurses over time
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Nurse-Led Central Venous Catheter Insertion
Central venous catheters (CVC) have various uses for patients in both the inpatient and outpatient settings. Their purposes range from administration of total parenteral nutrition, to administration of vesicant medication, to providing access to patients with poor peripheral vascularity, as well as hemodynamic monitoring (Alexandrou, Spencer, Frost, Parr, Davidson, & Hillman, 2009, p. 1485). Traditionally, insertion of CVCs have been performed by surgeons and internal radiologists. However, with the advancement of roles in nursing, there has been ongoing research supporting the pro stance on the practice of nurse-led central venous catheter insertion.
Before nurses began inserting CVCs, surgeons and internal radiologists inserted CVCs either at the patient’s bedside, in the intensive care units, or in operating theatres. Insertion of CVCs moved beyond critical care units and into community settings. Nurse-led CVC insertion was introduced in the community settings in response to medical work shortages and increasing demand during the development of advanced practice nurses (Alexandrou, Spencer, Frost, Parr, Davidson, & Hillman, 2009, p. 1485-86).
Kelly, Young, & Ellis (2013) studied the perceptions of nurses who insert central venous access devices (CVAD). Their research supported nurse-led central venous insertion by concluding that the nurses experience job satisfaction and feel that their advanced roles benefit their patients’ care in a positive manner. Patients appreciate the advanced role of nurses in CVC insertion because they have the ability to combine their knowledge and skills they have acquired from medicine and apply it at the patient’s bedside while providing psycholo...
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Kelly, L.J., Young, B., & Ellis, G. (2013). The experiences of nurses who insert central venous access devices. British Journal of Nursing, 22(2), p. S4-S11).
Pinkerton, C. (2009). New technology enhances expertise of vascular access team. Canadian Nurse, 105(2), 21-22.
Walker, G., & Todd, A. (2013). Nurse-led PICC insertion: is it cost effective? British Journal Of Nursing, 22(19 Supplemet), S9-s15.
Weld, K., & Garmon Bibb, S. (2009). Concept analysis: malpractice and modern-day nursing practice. Nursing Forum, 44(1), 2-10. doi:10.1111/j.1744-6198.2009.00121.x
Yacopetti, N., Davidson, P., Blacka, J., & Spencer, T. (2013). Preventing contamination at the time of central venous catheter insertion: a literature review and recommendations for clinical practice. Journal Of Clinical Nursing, 22(5/6), 611-620. doi:10.1111/j.1365-2702.2012.04340.x
Additionally, the LPN cannot push medications into a peripheral intravenous line if the patient “weighs less than 80 lbs, is prenatal, pediatric, or antepartum”, although given that the situation is on a general med-surg floor it is unlikely these patients would be under Sarah’s care at this time. (Rules and Regulations of Practical Nurses. 2015) Sarah can delegate the postoperative patients who need dressing changes and ambulating them to the LPN, but Sarah should assess the wounds for complications initially and serve as resource to the LPN if she has questions about the wounds. Additionally, she could help the nursing assistant with answering calls and serve as a reference for the nursing assistant to ask questions or help with tasks if Sarah is not available. With regards to supervision, the LPN would need continuous supervision given that the working relationship is new. (Cherry and Jacob, 2014) Sarah should be available and willing to answer any questions or address any concerns the LPN
Although nurses do not wield the power of doctors in hospital settings, they are still able to effectively compensate for a doctor’s deficits in a variety of ways to assure patient recovery. Nurses meet a patient’s physical needs, which assures comfort and dignity Nurses explain and translate unfamiliar procedures and treatments to patients which makes the patient a partner in his own care and aids in patient compliance. Nurses communicate patient symptoms and concerns to physicians so treatment can be altered if necessary and most importantly, nurses provide emotional support to patients in distress.
5), many hospitals in conjunction with the Joint Commission's 2012 National Patient Safety Goals has been rallying for hospitals to use evidenced-based practices (EBP) to the prevention of CAUTIs because evidence is growing showing that many are avoidable. Such practices such as utilizing a nurse-driven protocol to assess and evaluate the appropriateness and use of urethral catheter to determine how long a patient should have an indwelling catheter and when to discontinue it. Several factors have been identified that pose as risk factors to CAUTI which include but not limited to drainage bag not being below the level of the bladder, healthcare personnel not practicing standard precautions and utilizing aseptic techniques during insertion of catheters, unsterile equipment, and unnecessary placement of urinary
Ignatavicius, D. D., & Workman, M. L. (2013). Medical-surgical nursing: patient-centered collaborative care (7th ed.). St. Louis: Elsevier Saunders.
Central lines (CL) are used frequently in hospitals throughout the world. They are placed by trained health care providers, many times nurses, using sterile technique but nosocomial central line catheter associated blood stream infections (CLABSI) have been a dangerous issue. This is a problem that nurses need to pay particular attention to, and is a quality assurance issue, because CLABSI’s “are associated with increased morbidity, mortality, and health care costs” (The Joint Commission, 2012). There have been numerous studies conducted, with the objective to determine steps to take to decrease CLABSI infection rate, and research continues to be ongoing today. The problem is prevalent on many nursing units, with some patients at great risk than others, but some studies have shown if health care providers follow the current literature, or evidence based guidelines, CLABSIs can be prevented (The Joint Commission, 2012). The purpose of this paper is to summarize current findings related to this topic, and establish a quality assurance (QA) change plan nurses can implement for CL placement and maintenance, leading to decreased risk of nosocomial CLABSIs.
Weaver , K., & Mitcham, C. (2008). Nursing Concept Analysis in North America State of the
According to the Registered Nurse (RN) Scope of Practice Position Statement, “the RN is responsible for providing safe, compassionate, and comprehensive nursing care to patients and their families with complex healthcare needs” (Texas Board of Nursing, 2011). Nurses often care for five to six patients at one time; therefore, in order to provide the best quality care, patients are often connected to monitoring devices such as, physiological monitors, venti...
Medical-surgical nursing: patient-centered collaborative care (7th ed.). St. Louis: Elsevier University. Taylor, C. (2011). The 'Standard'. Introduction to Nursing -.
Ignatavicius, D.D. & Workman, M.L.(2010). Medical-Surgical Nursing: Patient-Centered Collaborative Care. (6th ed.). St. Philadelphia PA: Saunders Elsevier
Selecting to publish my manuscript with the American Journal of Nursing best fit my project on rotating peripheral IV’s when only clinically indicated. The American Journal of Nursing target multidisciplinary in healthcare. It is the most used journal for healthcare professionals and covers clinical evidence-based practices. My project proposal would be of interest to healthcare professionals of all nursing specialties because it will improve patient quality care and nursing workflow.
Safety is focused on reducing the chance of harm to staff and patients. The 2016 National Patient Safety Goals for Hospitals includes criteria such as using two forms of identification when caring for a patient to ensure the right patient is being treated, proper hand washing techniques to prevent nosocomial infections and reporting critical information promptly (Joint Commission, 2015). It is important that nurses follow standards and protocols intending to patients to decrease adverse
Circulating nurses must check the expiry date and the integrity of the packaging and wear the correct PPE prior to opening the articles. Each article must maintain its sterility; therefore the setup must be continuously monitored. Instrument nurses must create the sterile field using sterile drapes as they minimise the transference of microorganisms. They must also keep their hands at chest level, as areas below table height can be easily contaminated (Australian College of Operating Room Nurses, 2010).
6). Good intention is the main moral principle considered and consequences are irrelevant (Joel, 2013, p. 526). Seemingly, the deontological ideology focuses on the actions of the agent and would disregard patient focus and individuality. It is difficult to apply contemporary ethical theories to the nurse because of the values of the nursing profession. “Contemporary ethical theories do not lend themselves to the health-care professions or to ethically defensible decisions in health-care practice. None of the dominant ethical theories could be discovered in, or derived from, the profession of nursing” (Joel, 2013, p. 526). Casuistry, while not an ethical theory, is a case-based approach to practical decision-making. Cases that have set precedence are identified and comparisons are made using similarities, differences, and previous experiences. This concept is used to complement ethical theories in patient decision making by clinical ethics committees (Slowther, Johnston, Goodall, & Hope, 2004, § C4). Personally and professionally balancing ethical perspectives to be able to consider all details on a case by case basis seems like a more appropriate
Nurses play a critical role on patient’s health; the relationship that a nurse and patient develop can in some cases be life altering. Applying these characteristics and being a servant leader to patients establishes life long impressions and makes critical difference in treatment allowing for optimal care to be received. Always listen to patients concerns, be empathetic in their concerns, and help while committing to their personal growth, one never knows whom they are actually a leader for. Some individuals look up to nurses and count
I went to the operating room on March 23, 2016 for the Wilkes Community College Nursing Class of 2017 for observation. Another student and I were assigned to this unit from 7:30am-2:00pm. When we got their we changed into the operating room scrubs, placed a bonnet on our heads and placed booties over our shoes. I got to observe three different surgeries, two laparoscopic shoulder surgeries and one ankle surgery. While cleaning the surgical room for the next surgery, I got to communicate with the nurses and surgical team they explained the flow and equipment that was used in the operating room.