Symptom familiarity reinforces patterns about symptom management. SIM enriches understanding of symptom experiences. Comprehensive assessment, including the intraindividual perspective, is essential to successful symptom management.
Rapid shifts in the demographics and techniques of weight loss surgery (WLS) have led to new issues, new data, new concerns, and new challenges. In 2004, this journal published comprehensive evidence-based guidelines on WLS. In this issue, we've updated those guidelines to assure patient safety in this fast-changing field. WLS involves a uniquely vulnerable population in need of specialized resources and ongoing multidisciplinary care. Timely best-practice updates are required to identify new risks, develop strategies to address them, and optimize treatment. Findings in these reports are based on a comprehensive review of the most current literature on WLS; they directly link patient safety to methods for setting evidence-based guidelines developed from peer-reviewed scientific publications. Among other outcomes, these reports show that WLS reduces chronic disease risk factors, improves health, and confers a survival benefit on those who undergo it. The literature also shows that laparoscopy has displaced open surgery as the predominant approach; that government agencies and insurers only reimburse procedures performed at accredited WLS centers; that best practice care requires close collaboration between members of a multidisciplinary team; and that new and existing facilities require wide-ranging changes to accommodate growing numbers of severely obese patients. More than 100 specialists from across the state of Massachusetts and across the many disciplines involved in WLS came together to develop these new standards. We expect them to have far-reaching effects of the development of health care policy and the practice of WLS.
IntroductIonEvidence-based best practice guidelines for nursing in weight loss surgery (WLS) have been previously described (1). Earlier guidelines focused on staff education; preoperative, perioperative, and postoperative care; postanesthesia care; discharge and follow-up (2). This report covers key updates relating to WLS nursing.WLS patients are a high-risk population for morbidity and mortality, with a hazard ratio that increases with BMI. Surgical and anesthetic advances, combined with changes in the demographics and obesity levels of patients, have increased the need for effective and vigilant nursing care. The latest studies show an increase in the number of procedures performed, with more WLS in adolescents; decreases in length of stay; advances in the use of clinical pathways; and development of ergonomic technology. This report updates best practice guidelines with a focus on long-term outcomes and patient safety. Methods And ProceduresWe searched PubMed, MEDLINE, and the Cochrane Library for articles published on WLS and perioperative nursing, preoperative, perioperative, postoperative, anesthesia, and discharge follow-up published between April 2004 and May 2007. The system used to grade the quality of the evidence has already been described (2). We identified >54 papers; the 46 most relevant were reviewed in detail. These included a randomized controlled trial, prospective and retrospective cohort studies, meta-analyses, case reports, prior systematic reviews, and expert opinion. The focus of the recommendations and the process used to develop them are reported elsewhere (2). results Planning and communicationThe WLS nurse is responsible for assessment, documentation, and communication with all members of the heath care team. The nurse assesses all data, formulates a care plan, and determines nursing diagnoses and interventions for each patient. Planning is initiated at the first patient contact with the WLS program. Communication with the patient during each phase of care allows for adjustments in the plan. The nurse promotes multidisciplinary team collaboration by developing and implementing education programs related to the care of the WLS patient. This collaboration promotes awareness of evidencebased practices and sensitivity to the needs of extremely obese patients (3).Effective communication between all members of the health care team is essential for quality care. Certain practices may lead to decreased adverse advents, prompt diagnosis and treatment, and better outcomes. These include: allowing sufficient time to listen to, and collect information from patients; use of time out; site verification in the operating room; concise and timely reporting of symptoms; and the repeating back of information (hear back method) between team members. The objective of this study is to update evidence-based best practice guidelines for nursing in weight loss surgery (WLS). We performed a systematic search of English-language literature on WLS and perioperative nursing, postoperative, anesthesia, and disch...
The new world order demands nursing faculty members be as competent in teaching and coaching students as they are about the art and science of nursing. The complexity associated with classroom management requires mastery of innovative learning modalities to assist students to think critically using research-based evidence in making patient care decisions. Grand Canyon University has made faculty competence a priority to ensure quality student outcomes. The College of Nursing has embraced a systematic process for creating faculty excellence through a comprehensive faculty development initiative. Developing faculty requires university support through policy and resources that is essential to prepare nurses for the new world order and therefore closing the education practice gap.
The relationship between nursing education and nursing practice has been the topic of discussion throughout the history of the profession. The rate of change at the turn of this new century is unfolding more rapidly than ever. In this article the London underground is used as a metaphor to examine transition issues related to nursing education and care delivery. Commuters entering the underground are met with signs and announcements warning travelers to "mind the gap" (the gap is the opening between the train and the platform). The purpose of the underground is to safely transport people from one destination to another. One wrong step and travelers can find themselves in a potentially fatal situation.
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