Ambulatory care in nursing

ambulatory care

1. PRESENTER: Ms. Anshu M.Sc. Nursing KGMU College Of Nursing

2. INTRODUCTION  An ambulatory care patient as “an individual presenting for personal health services who is neither bedridden nor currently admitted to any health care institution”  By- National Ambulatory Medical Care Survey (NAMCS)

3. INTRODUCTION Ambulatory care nursing  is the   nursing  care of patients who receive treatment on an outpatient basis, ie they do not require admission to a  hospital  for an overnight stay. The setting can vary widely, from hospital-based clinics to patient homes

4. Ambulatory Care Nurses take care of patients in environments outside of hospitals. Their primary focus lies in pain management and general health education for patients with chronic injuries or illness. They provide the medical screenings, triage, and case management that help restore a patient’s ability to live independently.

5. DEFINITON Ambulatory care nursing includes those clinical, management, and research activities provided by registered nurses for and with individuals who seek care and assistance with health maintenance, health promotion and/or health related problems.

6. CHARACTERISTICS Nursing autonomy Client advocacy Skilful, rapid assessment Holistic nursing care Client teaching Wellness and health promotion Coordination and continuity of care Long term relationships with clients and families

7. Telephone triage, consultation, follow-up, and surveillance Collaboration with other health care providers Case management

8. CONCEPTUAL MODELS IN AMBULATORY CARE NURSING PRACTICE Clinical model Levels of prevention model Primary health care, primary care, and managed care models

9. 1.CLINICAL MODEL In this model, health is conceptualized as the absence of the clinical manifestations of the disease. It is assumed that the body is a machine and the modern medical technology can use physical and chemical interventions to “fix the machine” whenever it is broken

10. This has led to great emphasis on expensive, acute care with high technology treatments and relatively little attention to prevention, public health, environmental measures, or personal responsibility for health.

11. 2. LEVELS OF PREVENTION MODEL The levels of prevention model, advocated by Leavell and Clark in 1965, has influenced both public health and ambulatory care delivery worldwide. This model suggests that the natural history of any disease exists on a continuum, with health at one end and advanced disease at other.

12. HEALTH CONTINUUM

13. 3. PRIMARY HEALTH CARE, PRIMARY CARE, AND MANAGED CARE MODELS Primary health care focuses on the universal right to basic health care. Primary care focuses on integrated care coordinated by one primary provider. Managed care approaches the use of health care services from a cost containment perspectives.

14. AMBULATORY CARE PRACTICE SETTINGS Physicians’ offices Community hospital outpatient departments Teaching hospital outpatient departments Health maintenance organizations as Ambulatory Care Delivery Sites Emergency Departments Other Ambulatory Care settings

15. SERVICES PROVIDED IN AMBULATORY CENTERS Ambulatory surgery centers (ASCs) Catheterization labs Dental practices Dialysis centers Urgent care centers Imaging centers In vitro fertilization clinics Telemedicine providers.

16. ROLE OF NURSE RNs enhance patient safety and the quality and effectiveness of care delivery and are thus essential and irreplaceable in the provision of patient care services in the ambulatory setting . RNs are responsible for the design, administration, and evaluation of professional nursing services within an organization in accordance with the framework established by state nurse practice acts, nursing scope of practice, and organizational standards of care.

17. RNs provide the leadership necessary for collaboration and coordination of services, which includes defining the appropriate skill mix and delegation of tasks among licensed and unlicensed health care workers. RNs are fully accountable in all ambulatory care settings for all nursing services and associated patient outcomes provided under their direction.

18. ROLE OF NURSE Telehealth - Nurses in telehealth   utilize a variety of technologies to triage, conduct consultations, and deliver necessary follow-up on patient’s outcomes and status. Physician's office  - In the physician’s clinic nurses are needed to assist the doctors with patient consultations and procedures. Different specialties include family medicine, cardiology, gastroenterology, endocrinology, obstetrics, ophthalmology, dermatology, etc. Urgent care -  The Urgent Care Association of America projects more than 15,000 immediate care centers assess and treat ailments requiring treatment beyond that of a doctor’s office but not severe enough for the hospital.

19. Community centres  - In the community nurses act as patient educators, coordinators, and advocates. In this role the ambulatory nurse may be responsible for research to incorporate into community programs. Schools  - Nurses in school facilities respond to medical emergencies within the school area. In addition to this, they are responsible in assessing the health of the students, faculty, and other school staff. Health Insurance companies -  Health insurance companies have an interest in hiring nurses to collaborate with health care providers to ensure coverage guidelines are followed appropriately. Nurses can also have a role as a nurse on the 24-hour helpline. 

20. TRENDS IN AMBULATORY NURSING CARE Health care is changing:- From an illness oriented to a wellness orientation From an acute care emphasis to primary care From inpatient to outpatient services From individual health to community well being From fragmented care to managed care From independent institutions to integrated system From service duplication to a continuum of services

21. CONCLUSIONS Ambulatory care nursing is one of the fastest growing areas of nursing speciality practice. Ambulatory care nurses are not only expert clinicians but also expert communications. They play key roles in facilitating the client’s successful progress through the integrated delivery systems. Ambulatory nurses make quality health care accesible .

22. REFRENCES https://www.aaacn.org http://nursejournal.org/trauma-nursing/ambulatory-care-nursing http://nursingworld.org/MainMenuCategories/Policy-Advocacy/Positions-and-Resolutions/ANAPositionStatements http://www.nursingexplorer.com