NURSING N515PE – Clinical Problem Neurosurgery Essay
Clinical Problem Neurosurgery
American Sentinel University
Table of Contents
Practice Problem……………………………………………………………………………………………………………… 3
Impact on Nursing Care or Patient Outcomes……………………………………………………………………… 3
Problem Solution…………………………………………………………………………………………………………….. 4
Conclusion……………………………………………………………………………………………………………………… 4
References……………………………………………………………………………………………………………………… 6
Clinical Problem Neurosurgery
In this paper the author will describe a clinical problem she experiences within the neurosurgery population, the problem experienced is poor outcomes and re-admissions due to non compliance of post-operative orders. A review of the literature will be completed and followed by further discussion surrounding the problem, the implications for the patient, and what impact the problem has on nursing care NURSING N515PE – Clinical Problem Neurosurgery Essay. Potential solutions will be offered and discussed making reference to how these solutions fit into evidence-based practice guidelines.
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The problem to be discussed is that of non-compliance of post operative orders which leads to poor outcomes and on occasion re-admissions. One particular order that is not well complied with is the use of incentive spirometers (IS) and breathing exercises. Following surgery patients are painful and fail to see the benefits of using the IS and completing deep breathing and coughing hourly while awake. One possible outcome of non-compliance of IS and breathing exercises is pneumonia NURSING N515PE – Clinical Problem Neurosurgery Essay.
Impact on Nursing Care or Patient Outcomes
The incidence of post spinal fusion pneumonia is 2.58 – 3.41% (Murgai et al., 2018, table 2) and this is noted by the author as a problem that often leads to re-admission or delayed discharge. From a nursing perspective, teaching the use of the IS or breathing exercises happens on every shift as the chart audits verify in the patient education section of the electronic medical record (EMR). Despite frequent teaching and reminders; many patients fail to comply. The author has found that the reasons for non-compliance can be varied: pain levels, poor technique, lack of interest, poor memory or belligerence to name a few. The hospital as a whole, has a vested interest in wanting to reduce the incidence of pneumonia. The Hospital Re-admissions Reduction Program (HRRP), which is a value-based purchasing program administered by Centers for Medicare and Medicaid Services (CMS), penalizes hospitals financially with higher levels of re-admissions (“HRRP,” 2019) NURSING N515PE – Clinical Problem Neurosurgery Essay.
A potential solution is that of education prior to surgery, it is said that knowledge is power and also that if patients have a perceived benefit they are more likely to comply with a prescribed regime (Panesar, 2012). Most fusion surgery is elective and therefore, there is the opportunity to have some sort of class to aid in the education of patients to help them understand what to expect and how to make the optimal recovery. There is a proven model of preoperative education classes in cardiac and orthopedics, a similar model might prove helpful for neurosurgery/spinal fusion patients. Some of these education classes have been using the term ‘pre’habilitation to describe the work completed to prepare for surgery. NURSING N515PE – Clinical Problem Neurosurgery Essay.
Pre-operative education programs have proved useful in patient outcomes in several studies reviewed (Shananhan & Leissner, 2017), (Kruzik, 2009), (Lotzke et al., 2016), (Ries, 2016) & (Allison & George, 2014). There is also the opportunity to cover not just the use of IS and breathing exercises in this class but a myriad of other subjects that could ease the preparation for, the understanding of the post-operative recovery period of the spinal fusion patient.
Pneumonia in the post-operative spinal fusion patient increases re-admissions, delays healing and complicates the recovery of this patient population. The use of an education class to teach the use of IS and breathing exercises along with other relevant topics has the opportunity to increase the success of surgery, prevent the hospital being penalized financially for re-admissions and will improve the outcomes for the patient population NURSING N515PE – Clinical Problem Neurosurgery Essay.
Allison, J., & George, M. (2014, March). Using Preoperative Assessment and Patient Instruction to Improve Patient Safety. AORN Journal, 99, 364-375. http://dx.doi.org/10.1016/j.aorn.2013.10.021
Hospital Readmissions Reduction Program (HRRP). (2019). Retrieved from https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/readmissions-reduction-program.html NURSING N515PE – Clinical Problem Neurosurgery Essay
Kruzik, N. (2009, September). Benefits of preoperative education for adult elective surgery patients. AORN Journal , 90, 381-387. http://dx.doi.org/10.1016/j.aorn.2009.06.022
Lotzke, H., Jakobsson, M., Brisby, H., Gutke, A., Hagg, O., Smeets, R., … Lundberg, M. (2016). Use of the PREPARE (PREhabilitation, Physical Activity and exeRcisE) program to improve outcomes after lumbar fusion surgery for severe low back pain: a study protocol of a person-centered randomised controlled trial. BMC Musculoskeletal Disorders, 17, 1-13. http://dx.doi.org/10/.1186/s12891-016-1203-8
Murgai, R., D’Oro, A., Heindel, P., Schoell, K., Barkoh, K., Buser, Z., & Wang, J. (2018, December). Incidence of Respiratory Complications Following Lumbar Spine Surgery. International Journal of Spine Surgery, 12, 718-724. http://dx.doi.org/10.14444/5090 NURSING N515PE – Clinical Problem Neurosurgery Essay
Panesar, K. (2012). Patient Compliance and Health Behavior Models. Retrieved from https://www.uspharmacist.com/article/patient-compliance-and-health-behavior-models
Ries, E. (2016, February). Better Sooner and Later REHABILITATION. PT In Motion, 8(1), 20-31.
Shananhan, J. L., & Leissner, K. B. (2017). Prehabilitation for the Enhanced Recovery After Surgery Patient. Journal of Laparoendoscopic & Advanced Surgical Techniques, 27, 880-882. http://dx.doi.org/10.1089/lap.2017.0238 NURSING N515PE – Clinical Problem Neurosurgery Essay