Ambulatory Nurses Research Articles

Nurses experience and perceptions towards video consultations and how affects the relation to the patients

Abstract Background The integration of telehealth services, particularly video consultations, has rapidly expanded in healthcare settings, presenting a paradigm shift in patient care. The study aimed to contribute to a deeper understanding of how ambulatory nurses experience using video consultations. Further, we aimed to explore how video consultations are established and how video consultations affect ambulatory nursing care from the nurse’s perspective. Method A hermenutic qualitative focus group approach was employed with nurses from two Danish cardiological outpatient clinics. Findings Two focus group interviews provided qualitative insights into the nuanced perspectives of nurses. Findings are presented by three themes 1) ‘Nursing care is a relational practice and must remain so’, 2) ‘Video consultations have both pros and cons and must be used at the right time’ and 3) ‘Missing initiatives that will enable the nurses to use video consultation’. The findings provided an in-depth understanding of factors that can affect the motivation, opportunities, and enablers, which, in their absence, can be used to explain the limited scope of vide Conclusion The study highlights the importance of organizational support and infrastructure in shaping nurses' attitudes towards video consultations. Strategies for successful implementation include targeted training programs, user-friendly technology, and clear implementation strategy. Additionally, understanding the contextual factors influencing nurses' attitudes is crucial for tailoring interventions and optimizing the integration of video consultations into routine clinical practice.

Ambulatory Nursing Care for Young Children Suffering from Febrile Convulsions

Background: Specialist ambulatory care Nursing is a complicated, diverse profession that includes solitary and group practice. Young children who experience febrile seizures, often known as fits or convulsions, are affected by fever. Aim: It aimed to assess ambulatory nursing care for young children suffering from febrile convulsions. Design: Descriptive research design is used. Sample: A convenient sample for all ambulatory nurses they were 100 nurses. Setting: Study conducted at all outpatient clinics at Central Children's Hospital, Al-zahrawi ( Ibn Al-Baladi.) Teaching hospital and Welfare children teaching hospital Two tools: 1st Structural interviewing questionnaire composed of two parts (demographic characteristics, ambulatory nurse knowledge about febrile convulsions), second tool: observation checklist of ambulatory nurse practice. Results: Regarding ambulatory nurses' knowledge about Febrile Convulsions, 65% of nurses have satisfactory knowledge, 35% of them have unsatisfactory knowledge regarding febrile convulsions, Also, 70% of nurses done practice, and 25.0% of them not done practice and 5% of them do not know regarding measurement young children body temperature under axillary, While, 65% of nurses done practice, and 20.0% of them not done practice and 15% of them do not know regarding the right way to make tap compresses and 70.0% of nurses done practice, and 20.0% of them not done practice and 10% of them do not know regarding the right way to give oxygen therapy. Conclusion: there was a positive relation between nurses' total knowledge and total practice regarding the right way to measure body temperature, the measurement of young children's temperature under axillary, and the right way to give oxygen therapy with statistical significance difference between nurses' knowledge and practice regarding febrile convulsions (p< 0.001). Recommendations: Continuous health education and training programs for the nurses about febrile convulsions.

Impacts of Shared Governance on Ambulatory Nursing Engagement

An ambulatory shared governance program was initiated in an outlying location of a large academic hospital to evaluate the impact on engagement, process improvement, and safety event reporting. Shared governance led to improvements in engagement, empowerment, and autonomy. Although the impact of shared governance has been evaluated in inpatient settings, there is a paucity of evidence evaluating the impact in ambulatory settings, specifically clinical care centers in outlying locations. Clinically significant findings were noted, including increase in staff involvement in shared governance initiatives, involvement in institutional changes and quality improvement related to submissions, and leadership growth.

Nurses, doctors, and mortality: the effectiveness of early health professionals in rural Finland, 1880–1938

Abstract This article estimates the mortality effects of introducing modern health professionals in rural Finnish municipalities in the years 1880 to 1938 using panel data with approximately 25,000 observations over 423 population clusters. Our results show that ambulatory nurses had a more significant impact on mortality than municipal doctors. The effect of doctors depended on their proximity to the population. Qualitative evidence suggests that a superior capacity to influence behavior in communities mattered more than treatment or medical knowledge in the pre-biomedical context. Doctors consequently advocated for the hiring of more nurses. Their estimated contribution to mortality decline still remained modest.

The Ambulatory Dedicated Education Unit (DEU): An important example of academic practice partnership in ambulatory care.

Academic Practice Partnerships (APPs) work synergistically to support mutual goals and educate the nursing workforce of the future. Enhanced recognition of the need for undergraduate nursing educational experiences in ambulatory care has increased the importance of Ambulatory APPs specifically. One mechanism for building Ambulatory APPs and shifting clinical education into multiple spheres of care is the Ambulatory Dedicated Education Unit (DEU). Partners at the University of Minnesota and Mayo Clinic in Rochester, Minnesota developed an Ambulatory DEU in early 2019. Barriers to educating nursing students in the ambulatory setting were effectively mitigated through the design of the DEU and mutual efforts to sustain the Ambulatory APP through flexibility and adaptation. The Ambulatory DEU clinical learning model is a strong example of an effective Ambulatory APP. The DEU was effective in overcoming eight common barriers to clinical learning in ambulatory settings and engaged 28 expert ambulatory registered nurses in the clinical teaching of between 25 and 32 senior Bachelor of Science in Nursing (BSN) students each year. Each student participating in the DEU experienced 90h of ambulatory clinical learning. The Ambulatory DEU is in its fourth year and remains an effective mechanism for engaging nursing students in the competencies and complex care of ambulatory nursing. Increasingly complex nursing care is being provided in ambulatory care settings. The DEU is an effective mechanism to prepare students in the ambulatory sphere of care and is a unique opportunity for ambulatory practice partners to learn and grow from participating in a partnered teaching environment.

Ambulatory Nurse Leadership: Necessary to Drive Innovation and Inspire Transformative Change.

This article discusses the role of and need for nursing leadership in ambulatory care spaces. Challenges within health care and increasing complexity of patients exist, regardless of whether a nurse leader works in a traditional hospital setting or outside of that setting. Regardless of setting, nurse leaders want the same things for their patients and staff. The required skill set and characteristics for nurse leaders are the same, just used in a different venue. Traditional hospital nurse leaders must collaborate with nurse leaders in ambulatory to ensure each patient navigates through the continuum with as little disruption as possible. Nurse leaders in ambulatory can offer hospital leaders a fresh perspective on leadership, highlighting the value they bring to the table and how transferrable their skill set is to this setting, given the same support for success that is fundamental in the hospital setting. Strong nurse leadership is critical for driving innovation and inspiring transformative change in ambulatory settings.

Equine ambulatory nursing: maximising our teamwork potential and accelerating patient care

The equine ambulatory nursing role seeks to support and improve the multidiscplinary team skill set to improve patient welfare, client satisfaction, work–life balance and job retention. This exciting new opportunity gives equine nurses a chance to provide a more complete service to the client and patient. For this role to work, it is crucial that guidelines are adhered to and nurses stay within their limitations, and that correct training is given. Overall, it is a promising step forward in whole team patient care, vet–nurse referrals and quality of care.

Supporting Ambulatory Nurses Transitioning From Direct Care to Leadership: A Pilot Project.

Frontline nurse leadership is foundational to career progression and succession planning, but preparation is often limited. COVID-19 has further complicated this process by limiting access to professional development resources typically available to new leaders. This article discusses the implementation of an innovative onboarding program that combined a web-based toolkit, mentor network, and precepted shadow shifts to navigate challenges associated with the pandemic and overcome barriers to frontline nurse leader preparation in the ambulatory care setting.

Associations of job demands and patient safety event involvement on burnout among a multidisciplinary group of pediatric hematology/oncology clinicians.

Workplace burnout can result in negative consequences for clinicians and patients. We assessed burnout prevalence and sources among pediatric hematology/oncology inpatient nurses, ambulatory nurses, physicians (MDs), and advanced practice providers (APPs) by evaluating effects of job demands and involvement in patient safety events (PSEs). A cross-sectional survey (Maslach Burnout Inventory) measured emotional exhaustion, depersonalization, and reduced personal accomplishment. The National Aeronautics and Space Administration Task Load Index measured mental demand, physical demand, temporal demand, effort, and frustration. Relative weights analyses estimated the unique contributions of tasks and PSEs on burnout. Post hoc analyses evaluated open-response comments for burnout factors. Burnout prevalence was 33%, 20%, 34%, and 33% in inpatient nurses, ambulatory nurses, and MD, and APPs, respectively (N=481, response rate 69%). Reduced personal accomplishment was significantly higher in inpatient nurses than MDs and APPs. Job frustration was the most significant predictor of burnout across all four cohorts. Other significant predictors of burnout included temporal demand (nursing groups and MDs), effort (inpatient nurses and MDs), and PSE involvement (ambulatory nurses). Open-response comments identified time constraints, lack of administrator support, insufficient institutional support for self-care, and inadequate staffing and/or turnover as sources of frustration. All four clinician groups reported substantial levels of burnout, and job demands predicted burnout. The body of knowledge on job stress and workplace burnout supports targeting organizational-level sources versus individual-level factors as the most effective prevention and reduction strategy. This study elaborates on this evidence by identifying structural drivers of burnout within a multidisciplinary context of pediatric hematology/oncology clinicians.

Reflections on Ambulatory Care Nursing and the Impact of the Clinical Nurse Specialist.

The aims of this study were to identify and discuss reflections of ambulatory care nursing and the integral role of the clinical nurse specialist (CNS) in defining nursing practice in the ambulatory care setting. Three CNSs and a CNS student, all assigned to the ambulatory care setting, discussed their experiences supporting nursing practice in the ambulatory care setting. Major reflections were identified, organized, and then expounded from personal experiences and published studies to highlight the impacts of the CNS in ambulatory care nursing. Four major reflections were identified: ambulatory nursing is complex, ambulatory care nursing is in its infancy, ambulatory care nursing adds value, and opportunities exist for measuring the impact of ambulatory care nursing. Progress is being made in determining the role of the nurse in the ambulatory care setting, but more work is required. The CNS is prepared to define nursing practice in the ambulatory care setting and develop nursing-specific resources that support nurses in practicing to the full extent of their licensure. The ambulatory care setting is expected to support the majority of the healthcare needs of the future. Ambulatory care nurses are well suited to meaningfully contribute to patient care. Evidence-based nursing practice in this setting is vital to ensure safe, quality patient care.

Ambulatory Nurse Education Improves Metabolic Profile and Physical Activity in Patients with Cardiovascular Disease

Introduction: Although interventions combining patient education and post discharge management havedemonstrated benefits in patients with cardiovascular disease the benefit attributable to ambulatory nurseeducation (ANE) alone is uncertain.Material and Method: A quasi experimental study was conducted in Specialist Cardiology Ambulance D& D in Pristinaamong 98 patients. Ambulatory nurse education was implemented to assess the effectivenesson awareness on life style where pretest and posttest design without control group was used. A completeclinical and laboratory measurements before and after ANE (at 30, 60 and 90 days) were performed. Theclinical outcome were physical activity, body mass index, blood pressure, lipid and diabetic profile. Thepre-post tested (validity, reliability and pilot testing) structured questionnaire was used for data collection.Results: At follow up to 90 days, in patients that underwent ANE program, the following indices weredecreased: BMI (p<0.001), glycemic level (p<0.001), HbCA1 (p=0.02), lipid profile (cholesterol, triglyceridesand LDL-C, p<0.001 for all). HDL-C was increased (p=0.01) In addition, physical activity was significantlyimproved: total activity and daily activity were increased ((p<0.001) and p=0.002, respectively).Conclusion: The ambulatory nurse education improves glycemic and lipidic control, BMI and physicalactivity in patients with cardiovascular disease.

Medical Emergencies in the Primary Care Setting: An Evidence Based Practice Approach Using Simulation to Improve Readiness

BackgroundSimulation is an evidenced based strategy which has been shown to impact office-based readiness to respond in a medical emergency. Medical emergencies occur in the primary care setting on a less frequent basis than in the inpatient setting. Clinicians working in primary care may benefit from an opportunity to refresh their skills. MethodsThis descriptive pre and post survey design evidenced based project examined staff reported levels of competence and confidence when responding to an emergency in a pediatric primary care office. Simulation educators partnered with ambulatory nursing and medical leaders to create a mock code program for staff in a care network. During a 14-month period, simulations were conducted in 30 primary care sites. Staff completed pre- and post-simulation surveys to assess levels of confidence in decision-making skills and competence when managing medical emergencies. FindingsA statistically significant increase in the mean scores for both confidence and competence was demonstrated when comparing pre- and post-simulation survey results. Discussion and application to practiceSimulation as an educational technique resulted in an increased level of competence and confidence of primary care office staff to respond to an emergency. Additionally, staff developed an overall heightened awareness of emergency processes and recognized of the value of simulation as an educational tool.

Design and Implementation of a Face-to-Face Peer Feedback Program for Ambulatory Nursing.

Ongoing dissatisfaction with anonymous peer feedback led to problem solving to equip nurses to provide and receive respectful and meaningful feedback during face-to-face peer review. Giving and receiving feedback about other's performance and collaboration are a vital aspect of teambuilding; yet, no programmatic training existed to prepare and equip nurses to feel confident and comfortable in providing or receiving face-to-face peer feedback. A search of the literature demonstrated a dearth of evidence related to developing these teambuilding relationships. The facilitator role appeared in some literature outside nursing but was poorly articulated and yet appeared important to the process. This was a quality improvement project that utilized online surveys with both multiple-choice and open-ended questions for data collection across 3 time points for 2 different cohorts over a 2-year implementation period. Strategies included education related to providing feedback with positive intent regardless of feedback type. A facilitator role was used to ensure effective communication and provide support to the peers during the process. Nurse participants described increased comfort and knowledge related to providing/receiving face-to-face feedback. Training and use of a facilitator provided the necessary support; 75% of participants reported comfort with giving face-to-face feedback. However, the greater majority, 80% to 92%, of participants reported increased comfort with receiving face-to-face feedback. Using active peer-to-peer support has become an accepted standard for face-to-face peer feedback as an aspect of the annual review process.

Integrating Immunotherapy and Bone Marrow Transplant Clinic Operations Policies for FACT Accreditation

Topic Significance & Study Purpose/Background/Rationale Our Blood and Marrow Transplant (BMT) center is part of an NCI-designated cancer center that performs nearly 500 transplants a year. Historically, it was a free-standing hospital/clinic and in 2001 became part of a larger clinical alliance. BMT Physicians manage clinical care and research. Standard Practice guidelines were established with physicians based on the need for standardized care and to educate rotating medical personnel. In the last 25 years BMT care has transferred from hospital to the Ambulatory Clinic. BMT Ambulatory Nurse Management recognized standardization of Operational Policy was essential. This work became the basis for creating the policies required for Foundation for the Accreditation of Cellular Therapy (FACT). Methods, Intervention, & Analysis The BMT clinic managed patient care and staff orientation when chimeric antigen receptor (CAR) T-cell therapy first began at our institution. The Immunotherapy (IMTX) Clinic is now separate from the BMT Clinic but many clinical care guidelines remain similar. It was determined that the IMTX clinic would fall under the BMT FACT accreditation standards, as our needs for accreditation are intertwined. BMT maintains Operations Standards for adult/pediatric inpatient/ambulatory care across three geographic sites of practice. IMTX operations guide adult inpatient/ambulatory care across two institutions in our alliance. Findings & Interpretation BMT and IMTX maintain Operations Standards by review through the Transplant & Immunotherapy Clinic Operations Team (TICOT). TICOT membership includes all departments providing services to BMT and/or IMTX patients and in each institution with patient care involvement. Policies each have designated owners and are distributed a month prior to the meeting when due for revision. At monthly cross-institutional meetings, policies are collaboratively reviewed and approved for the central policy data base. Discussion & Implications Changes in 2015 transferred policy management to the BMT Nursing Supervisor with BMT Medical Director oversight. The IMTX clinical staff is responsible for reviewing policy and addressing the differences to cover IMTX FACT requirements. BMT/IMTX designated CNS reviews policies to assure alignment with FACT standards. Nurse leaders most familiar with clinic operations are critical to the process of policy creation, implementation, revision and maintenance for the best standards of care and practice in BMT/IMTX cellular therapy care delivery.

Searching for "transformative moments": A qualitative study of nurses' work during home visits to COPD patients and their caregivers in Norway.

AimThe integration of families into healthcare services is being emphasized increasingly in healthcare polices. The aim of this study was to investigate how professionals during home visits support both patients and caregivers in accepting and accommodating to illness.DesignAn explorative qualitative design.MethodsParticipant observations from home visits (N = 20) of pulmonary ambulatory nurses to COPD patients in Norway, followed by interviews with these nurses.ResultsOur findings demonstrate the delicate nature of nurses’ work during home visits to COPD patients and their caregivers. They support both patients and caregivers in reconciling themselves with the negative consequences of illness, as well as giving legitimation to and potential room for, sustainable arrangements within the scope of the relationship. The nurses address significant issues, having transformative potential concerning attitudes and practices related to the management of illness and adjusting to a complex illness trajectory.

Measuring Care Coordination in the Pediatric Cardiology Ambulatory Setting

The role of ambulatory nursing is diverse, and the impact on patient outcomes is difficult to measure. The concept of care coordination is an important focus for the ambulatory nurse. We describe the efforts to implement the Cardiac Care Coordination Measurement Tool to document and quantify care coordination activities in a pediatric cardiac ambulatory setting.

Compassion Practices, Nurse Well-Being, and Ambulatory Patient Experience Ratings

Compassion practices both recognize and reward compassion in the workplace as well as provide compassionate support to health care employees. However, these practices represent an underexplored organizational tool that may aid clinician well-being and positively impact patient ambulatory care experiences. To examine the relationship between compassion practices and nursing staff well-being and clinic-level patients' experience ratings in the ambulatory clinic setting. Surveys were collected from ambulatory nurses in January and February of 2015 in 30 ambulatory clinics affiliated with an academic medical center. Patient experience ratings were collected April to June of 2015. One hundred seventy-seven ambulatory nurses (Registered Nurses, LPNs, medical assistants), as well as 3525 adult patients from the ambulatory clinics. Ambulatory nurses assessed compassion practices, emotional exhaustion, and psychological vitality. Patient experience ratings were patient perceptions of courtesy and caring shown by nurses and patients' ratings of the outpatient services. Compassion practices are significantly and negatively associated with nurse emotional exhaustion and positively associated with nurse psychological vitality. At the clinic-level, compassion practices are significantly and positively associated with patient perceptions of caring shown by nurses and overall patient ratings of the outpatient clinic. Supplemental analyses provide preliminary evidence that nurse well-being mediates the relationship between compassion practices and patient ratings of their care experience. Our findings illustrate that compassion practices are positively associated with nurse well-being and patient perceptions of the care experience in outpatient clinics.

Developing of a Tool for Ambulatory Care Nurse Competencies

Developing of a Tool for Ambulatory Care Nurse Competencies

Transitions in care and reduction in discharge errors.

77 Background: Patients are often overwhelmed at the time of hospital discharge and focus on home rather than the discharge process. Fragmented communication and lack of planning between the hospital team, patient, family and primary oncologist can lead to frustration and delays in implementation of palliative or curative therapies and potential hospital readmission when the plan of care is not followed in a timely manner. Our goal is to avoid medication errors, delays in implementation of a care plan and reemergence of symptoms or new symptoms as a result of a suboptimal discharge transition. Methods: A multidisciplinary care transition team including phone nurses, social workers, pharmacists, physicians, nursing leadership and a palliative care practitioner meet monthly to review and refine discharge transitions. Our intervention is a proactive phone call, by specially trained ambulatory oncology nurses, to patients within 1-2 business days after discharge from the inpatient Hematology Oncology service. The nurse asks consistent questions to address common issues in the discharge transition including review of symptoms, understanding of discharge medications, confirmation of new medication initiation, side effects, coping, and next appointment with the oncologist. The nurse reinforces the ambulatory nurse phone line and availability of same day sick visits. Results: Preliminary discharge phone call results from the nurses’ interventions include clarification of discharge medications, interventions when a patient had not obtained the ordered medication including antibiotics, referrals for same day sick visits, referrals to social work for emotional and financial distress, education on medications or side effect management, and follow-up appointments. The average time for the post discharge call is 13 minutes. Conclusions: Our follow up discharge intervention by the oncology nurse has shown many patients are uncertain of medications and follow-up even when provided with detailed discharge paperwork and medication reconciliation. A proactive discharge phone call may help resolve these issues and prevent future readmissions. A six month summary of our intervention will be presented.

Moral Distress: Recognition, Diagnosis, and Treatment.

Infusion nursing is a unique hybrid of inpatient and ambulatory nursing. The subspecialty of nurses cares for patients requiring treatment over long periods, including cancer patients receiving chemotherapy and patients who require short bursts of treatment, such as those with multiple sclerosis, Crohn's disease, and rheumatoid arthritis. Infusion nurses are exposed to many of the common root causes of moral distress in their practice, similar to nurses caring for terminally ill or critically ill patients. The specific aims of this article are to (1) define moral distress, moral residue, and the crescendo effect; (2) describe ethical stressors that can be confused with moral distress; (3) review the effects of moral distress on different health care providers; and (4) provide strategies to manage moral distress in the workplace using a case example.