Orientation enrichment for the new vascular nurse

Joan M. Beauchamp, BSN, RN, CNA, BCNurse Manager Vascular Surgery Unit, Rochester GeneralHospital, Rochester, New York

Co-Presenter: Kristina Richenberg, BSN, RN

Transitioning from nursing student to graduate nurse is oftenoverwhelming. Most new nursing graduates spend time in ahospital-based orientation and then they are mentored to theirposition in the hospital setting. This acute care vascular surgeryunit put together a plan to enrich the orientation of the newgraduates. The orientation includes a vascular class presented bya vascular clinical nurse specialist, observation of vascular sur-gery with the surgeon, and education in the vascular lab observ-ing vascular studies. The nurse is more confident in his/herknowledge and better able to assist the patient at achievinghis/her desired outcomes.

Save that stump: A multidisciplinary approach tochanging stump dressing care on a vascular unit

Heather Bevan, Mappm,Nurse Unit Manager—Cardiothoracic/Vascular Unit JohnHunter Hospital, NSW, Australia

A review of stump care following lower extremity amputa-tion surgery highlighted that our current dressing protocols anddecisions were based on local practice, skill, and intuition.Added to this was the input from the Limb Centre’s seniorphysiotherapist that patients experienced a delay in applyingprosthetic limbs in the rehabiliation setting mainly due in part tooedematous, traumatised and poorly healing stumps. This gen-erated the desire to improve clinical practice and standardisestump care where possible within our unit. Postoperative man-agement of the amputated limb is an important determinant ofrecovery from amputation (Smith, McFarland, Sangeorzan,Reiber, and Czeriecki, 2004).

A multidisciplinary approach was used to implement theRemovable Rigid Cast dressing into the unit for Below KneeAmputations. Early results with this change in practice areencouraging.

Providing amputee peer support: Visits and videos

Marie Neaton, APRN, BCVascular Clinical Nurse Specialist, St. Joseph Mercy Hospital,Ann Arbor, Michigan

The St. Joseph Mercy Hospital Amputee Support Group hasbeen active since 1990 and has been through several “lifecycles.” Currently, the group is thriving and focused on provid-ing peer support not only through the support group format butalso by providing 1:1 peer visits and has produced a video. Thevideo There is Life after Amputation features the support groupand the stories of several members. It is available for viewing bypatients through the hospital closed circuit TV system. Theposter describes the principles of peer support, the currentsupport group format, the peer visitation process, and the video.

Building a vascular nursing team

Liz Brown-Milan, BSN, RN, CVN, CCRNPeripheral Vascular Nurse Clinician, William BeaumontHospital, Royal Oak, Michigan

Co-Presenters: Denise Ray, BSN, RN; Pat Lott, BSN, RN, CVN;Linda Addy, MSN, RN, APRN, BC

In September 2005, a new program was started to enhancethe role of the professional nursing staff. It is designed as aneducational offering, as a retention strategy, and as a method toimprove nurse-physician communication. The goal of this pro-gram is to increase the knowledge and enhance the criticalthinking ability of the RN in relation to vascular surgery patients.The nurses spend time in the OR, the physician’s office, grandrounds, conferences, vascular lab, hyperbaric oxygen therapycenter, wound clinic, and clinical rounds throughout the hospital.Objectives and curriculum are based on Standards of VascularNursing Practice (2003) and Vascular Nursing (3rd ed). Inaddition, the RNs identified the “Top 5” vascular nursing skillsto improve/enhance with the new program. Each nurse com-pleted a pre/post test and general survey regarding the experi-ence. Results of pre/post tests demonstrate improvement inknowledge of vascular assessment and interventions for vascularsurgery patients. Evaluations were very positive for courseobjectives and individual objectives. Comments:

“It was a great learning experience.”“The physicians took time to explain things in the OR.”“The Hyperbaric Oxygen Center staff was very informative

and helpful.”Acknowledgment: Vascular Knowledge Assessment Test de-

veloped by Karen Groller, MSN, RN

The choice of excellence, quality improvement, andteamwork at its best

Melanie Lee, RN, CNurse Manager Vascular Thoracic Unit, Baptist Hospital East,Louisville, Kentucky

Increasing healthcare costs, scarcity of critical care beds,and managed care capitation posed a challenge for maintain-ing cost-effective quality care for patients having electivemajor vascular procedures. These issues served as the impetusto look at practice changes that would allow for the care of thestable vascular patient on one unit from admission throughdischarge. A multidisciplinary team investigates how tosafely change practice. An extensive literature search wascompleted to identify national trends. Practice changes wereinitiated in 1997 after educating the nursing staff, and pur-chasing equipment needed for monitoring the surgical vascu-lar patient. Initially the stable carotid endarterectomy andlower extremity bypass vascular surgical patients were sentdirectly to this unit, bypassing the ICU, and allowing for carefrom immediate post op to discharge. This change increasedsatisfaction for patients and families and facilitated earlierdischarge. The program was expanded to other vascular cases,including non-coronary stent procedures, AAA stent proce-dures, and open AAA repair. Outcome pathways were devel-

Vol. XXIV No. 3 PAGE 95JOURNAL OF VASCULAR NURSINGwww.jvascnurs.net