GUJARAT INSTITUTE OF NURSING EDUCATION AND RESEARCH

SUBJECT :- Medical Surgical Nursing TOPIC :- Presentation On Ambulatory Care, Acute and Chronic Care

SUBMITTED TO, Mrs. Minaxi D Patel, Lecturer, sr.scale,cl-1, H.O.D.Of F.Y.MSc Nursing, GINERA

SUBMITTED BY, Oza Ankita B, F.Y.Msc Nsg Student, Roll No-

Ambulatory Care
Whats it all about?

Objectives
Describe ambulatory care Identify major impacts on ambulatory care practice Identify and describe current ambulatory practice settings Compare practice in ambulatory and inpatient settings

Definition

Ambulatory care is a personal health care consultation, treatment or intervention using advanced medical technology or procedures delivered on an outpatient basis .

Ambulatory Care

A specialty practice area which is community based May take place in different sites hospitals, schools, workplaces or homes Encounter may be face-to-face or by phone Requires rapid response to high volumes of patients in a short span of time while dealing with issues that are not always predictable

Ambulatory care nursing is a unique specialty within the profession of nursing. It involves promoting health and prevention of disease, illness, and disability in the individual by rapid, focused assessments. The emphasis of ambulatory care nursing is on aiding both the patient and family in maximizing wellness and minimizing the symptoms of the condition, chronic or acute, in a cost-effective way. Practice standards are provided by the American Academy of Ambulatory Care Nursing as well as the American Nurses Association.

Ambulatory care nurses work in outpatient settings, responding to high volumes of patients in short term spans while dealing with issues that are not always predictable. The specialty spans all populations of patients, and care ranges from wellness/prevention to illness and support of the dying. The American Academy of Ambulatory Care Nursing (AAACN) is the specialty nursing association of professional nurses who identify ambulatory care practice as an essential to the continuum of high-quality, cost-effective health care.

Its mission is to advance the art and science of ambulatory care nursing. AAACN (formerly the American Academy of Ambulatory Nursing Administration) was founded in 1978 as a non-profit education forum. In 1993, the organization's name was changed to the American Academy of Ambulatory Care Nursing.

Background:

Ambulatory care nursing, previously defined by the setting and the length of the healthcare encounter, has evolved into a specialty whose practice setting emphasizes health promotion and disease prevention and nursing care with extensive patient and family involvement.

Ambulatory care nurses are facing issues such as the use of the increasingly desirable and less invasive technologies; an aging population; the need for education, clinical expertise and competence in disaster preparedness; and such workplace issues as the nursing shortage and the necessity of adapting to doing more with fewer resources. The healthcare delivery system will continue to change, and nurses will be challenged to provide alternative care delivery methods such as telehealth and on-line clinics.

The American Academy of Ambulatory Care Nursing and the American Nurses Association have defined professional ambulatory care nursing as those clinical, management, educational, and research activities provided by registered nurses for and with individuals who seek care for health-related problems or concerns or seek assistance with health maintenance and/or health promotion.

Ambulatory Care is Changing

As the costs of acute care services increase, as new technologies are adopted & as reimbursement shrinks, patient care is being shifted to the outpatient setting resulting in increased patient volume and sicker patients.

Current Trends Impacting Ambulatory Care

Increasing life expectancy Environmental threats Increased legislation & regulation Technological Advances (clinical & nonclinical) Consumer awareness

Conceptual Models That Influence Ambulatory Care Nursing Practice:The Clinical Model Level of Prevention Model 1) Primary Prevention 2) Secondary Prevention 3) Tertiary Prevention Primary Health Care, Primary Care, and Managed Care Models

Conceptual framework of Ambulatory Care Nursing

Conceptual framework shown three role for ambulatory care nurses:1) The Clinical Nursing Role 2) The Organizational/ Systems Role 3) The professional Role

Characteristics Of Ambulatory Care

Visit Encounters are short. Control of care and treatment modalities are in the hands of the client and his family. Many members of health care work together. Contact through communication Devices. Constant Pressure to increase efficiency and effectiveness of care.

Ambulatory Patient Characteristics

Acutely ill requiring triage & possible emergency care Acutely ill requiring support, diagnosis & treatment Chronically ill requiring ongoing monitoring & assistance with education/self-management Chronically ill with acute exacerbation In need of a defined treatment & procedure In need of education, reassurance & support In need of preventive services May not walk in &/or may not walk out

Continue
Ambulatory nursing care requires critical reasoning and astute clinical judgment. Ambulatory care registered nurses provide care across the life span to individuals, families, caregivers, groups, populations, and communities. Ambulatory care nursing occurs across the continuum of care in a variety of settings.

Continue
Ambulatory care registered nurses interact with patients during face to face encounters or through a variety of telecommunication strategies. Nurse patient encounters can occur once or as a series of occurrences. Ambulatory care registered nurses, acting as partners and advisors, assist and support patients and families to optimally manage their health care.

Continue
Ambulatory care registered nurses facilitate continuity of care using the nursing process, multidisciplinary collaboration Ambulatory care registered nurses are knowledgeable about and provide leadership in the clinical and managerial operations

Where Ambulatory Care is Practiced/Provide

University hospital outpatient Community hospital outpatient Solo & group medical practices HMO Government health systems

Occupational health centers School health clinics Shelters for the homeless Community clinics Surgical procedure centers Urgent care centers

Inpatient Practice vs. Ambulatory Practice

Aspect of Role
Treatment episode Observation mode

Inpatient
Inpatient Direct & continuous

Ambulatory
Visit/phone/email Episodic

Management of treatment plan

Primary Intervention Mode

Nurse - Input from patient &/or family

Direct

Patient &/or familyInput from nurse

Consultative May or may not be formal nursing structure Scheduling system,

Nurse managed dept. Organizational presence of nursing Bed capacity, staffing Workload variability/intensity ratios

Nursing Responsibilities:Provide Direct Patient Care Conducting Patient intake Screening Treating Patient With all conditions Refering Patient to other agencies for additional services Teaching patient self care activities Offering health education

Extraordinary Nursing Care. Every Patient. Every Time.

Acute & Chronic Care

Whats it all about?

Acute Care:Introduction: Pattern of health care in which a patient is treated for a brief but severe episode of illness, for the sequelae of an accident or other trauma, or during recovery from surgery. Acute care is usually given in a hospital by specialized personnel using complex and sophisticated technical equipment and materials, and it may involve intensive or emergency care. This pattern of care is often necessary for only a short time, unlike chronic care.

Definition of Acute care

Acute care is a branch of secondary health care where a patient receives active but short-term treatment for a severe injury or episode of illness, an urgent medical condition, or during recovery from surgery.

Types of Hospital Which Provide Acute Care

Govt. Sponsored Hospital Voluntary Health Agency For Profit Hospital Magnet Hospital

Role of Nurses in Acute Care

Provide of direct care Educator Researcher Manager

Delivering Acute Nursing Care

Total care nursing Functional nursing Team nursing Primary nursing Case management

Chronic Care
Introduction: Chronic care encompasses the oversights activities conducted by health care professionals to help patients with chronic diseases and health conditions such as diabetes, high blood pressure, lupus, multiple sclerosis and sleep apnea learn to understand their condition and live successfully with it. This term is equivalent to disease management (health) for chronic conditions.

Definition:

Providing or concerned with long-term medical care lasting usually more than 90 days especially for individuals with chronic physical or mental impairment.

Important of chronic care

Chronic care needed for better life expectancy. They need to be motivated to comply because treatment usually produces an improved state, rather than the results that most patients desirea cure. Chronic care management helps patients systematically monitor their progress and coordinate with experts to identify and solve any problems they encounter in their treatment.

Whats responsible for the quality chasm for the chronically ill?

Practice systems oriented to acute disease that arent working for patients or professionals Inadequate use of information technology Poorly aligned payment structure
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We have models to improve care; The Chronic Care Model

Medical Care Home

The Chronic Care Model (CCM)

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Medical Home and Chronic Care Model are complementary

Both emphasize and support patient role

in decision-making

MH redefines primary care responsibility

CCM redesigns care delivery for planned care

Elements of both are

integrated into the Patient-Centered Medical Home

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Is chronic care improvement possible across the entire population?

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FOR THE IMPROVEMENT OF THE CHRONIC CARE NEED TO DO:

Training and education Employment areas Subspecialities References External links

Differences Between Acute and Chronic Conditions

Beginning Cause Duration Diagnosis
Diagnostic tests Treatment

ACUTE Rapid Usually one Short Commonly accurate Often decisive Cure common

CHRONIC Gradual Many Indefinite Often uncertain

Often limited value Cure rare

Differences Between Acute and Chronic Care

Role of Professional

ACUTE CHRONIC Select and Teacher/coach conduct therapy and partner

Role of Patient
Lorig 2000

Follow orders

Partner/ Daily manager

THANK YOU