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The pandemic highlighted a need to ensure appropriate care for patients with COVID who resided on a medical-surgical unit while also experiencing an acute mental health crisis. Interprofessional members established a clinical pathway that provided clinicians with guidance for appropriate care. Keywords: COVID, psychiatric condition, psychiatric care, interprofessional care, clinical pathway, Literature Summary * Patients with psychiatric conditions who have COVID can be managed safely with appropriate precautions (Zhang et al., 2020). * A need exists for trained experts in psychosomatic [...]

Multiple studies document there are patients for whom hemodialysis can be predicted not to offer a survival advantage. The medical evidence also includes reports of strong, active medical management without dialysis programs in Australia, Canada, and the United Kingdom, yet the nephrology community in the United States has yet to provide to patients with end stage kidney disease an active medical management without dialysis option available throughout the country. This article reviews barriers and facilitators to starting such a program and offers recommendations for the components that have enabled international programs to be successful. Key Words: Active medical management without dialysis, conservative kidney management, conservative care, kidney supportive care, kidney palliative care, dialysis, chronic kidney disease, advance care planning, end of life, quality of life, shared decision-making., [NC PD] 1.2 contact hours Introduction to Medical Management The 1990 Institute of Medicine (IOM) review of patients with kidney failure, Kidney Failure and the Federal Government, revealed an increasing [...]

Background Enhanced Recovery After Surgery (ERAS) is a perioperative evidence-based fast-track, multimodal program shown to decrease surgical site infection (SSI) and hospital length of stay (LOS). However, organizations face difficulty with patient protocol adherence. Studies show the addition of a nurse navigator to coordinate care results in reduced Emergency Department visits and readmissions. Aim Determine if patient adherence to the ERAS pathway increased with the dedication of a nurse navigator and influenced LOS, SSI rates, and hospital readmission rates for patients undergoing elective colorectal surgery. Method A retrospective chart review compared 100 patients on the ERAS pathway from two facilities within the health system (admissions September 2015-April 2018). The study was divided into Phase I (without navigator) and Phase II (with navigator). Results Statistical differences presented in 6 of 22 data points for Phase II, including patients who received ERAS protocol education, were referred to Pre-Surgery Center, consumed Gatorade, had head of bed elevated 30 degrees, and had measures to prevent postoperative nausea and vomiting. Fewer patients were discharged with analgesia. No statistical differences were found in LOS, readmission rates, and occurrence of SSI. Limitations and Implications A small convenience sample was used. ERAS was a new protocol for the facilities and had a small number of participating surgeons. Conclusion Use of nurse navigators may impact patient adherence to protocols, improve patient outcomes, and may decrease the need for analgesia at discharge, thus promoting high-quality, cost-effective health care., Colorectal surgery can be used to treat diverticulitis and colorectal cancer. An estimated 4.2% of adults will be diagnosed with colorectal cancer (National Cancer Institute, 2018). Diverticulitis occurs when small [...]

Studies indicate 40% of indwelling urinary catheters are unnecessary in hospitalized patients (Gardam, Amihod, Orenstein, Consolacion, & Miller, 1998; Gokula, Hickner, & Smith, 2004). The results of a protocol developed to limit catheter use are described., For many years, long-term care has been attuned to the problems associated with indwelling urinary catheters (Gammack, 2003; Newman, 2006). Use of catheters has been limited to residents with very [...]

Two nurse researchers at the Royal Columbian Hospital (RCH) in New Westminster, British Columbia, Canada have identified the cause and designed a protocol to prevent a previously unrecognized post-anesthesia pain [...]