SEMINAR

ON
AMBULATORY
CARE

Submitted to: Submitted by:

Mrs. Shobana, Ms. A. Nithya,
HOD of MSN dept. 1st yr.M.sc nsg.

Submitted on: 20.11.2019

 AMBULATORY CARE
INTRODUCTION:

In any given year, most Americans are not hospitalization, but the
average person makes 3.6 visits to ambulatory care per year. This makes
ambulatory settings the major site for health care delivery in the United States.
Ambulatory care visits have increased for several reasons.

MEANING FOR AMBULATION:

Ambulation means, those who can move around.

WHAT IS AMBULATORY CARE NURSING?

Professional ambulatory care nursing includes those clinical,

management, educational and research activities provided by registered nurse or
seek assistance with health maintenance or health promotion. These individuals
engage predominantly in self-care and self-managed health activities or receive
care from family and significant others outside an institutional setting.

DEFINITION:

Ambulatory care nursing services are episodic, less than 24 hours in

duration, and occur as a single encounter over

OTHER NAME FOR AMBULATORY PATIENT CARE SERVICE:

 Doctors office
 Clinic
 Ambulatory surgery center
 Emergency room
 Outpatient hospital department

CHARACTERISTICS:

The following themes arose consistently in discussion about the unique

characteristics of ambulatory care nursing:
 Nursing Autonomy
 Client advocacy
  Skillful rapid assessment
 Holistic nursing care
 Client teaching
 Wellness and health promotion
 Coordination and continuity of care
 Long -term relationship with client and families
 Telephone triage,instruction,and advice
 Client and family control as major caregivers, users of health care system
and decision makers regarding compliance with care regimen
 Collaboration with other health care providers
 Case management

BENEFITS:

 The number of hours or days people stay in hospital for illness, surgery,
or complex treatment has decreased.
 More clients are seen in ambulatory settings for post hospital visits and
follow-up care.
 New technology has made ambulatory settings the site for people to
undergo many surgical and complex procedures that previously required
hospitalization.
 Advances in the treatment of chronic health problems have made it
possible to treat and monitor client’s progress in the ambulatory care
setting.
 As a result, both the numbers and acuity of people cared for in
ambulatory setting have increased.
 Clients often feel less stress because they not separated from their family
significant others and community.
 Care in the community decrease s exposure to nosocomial infection and
other hazards of hospitalization.
 Ambulatory care is often less costly than hospitalization, saving money
for clients, insurance companies, employers, and the government.
 Socioeconomic factors have also encouraged the growth of ambulatory
care.
 The growth of managed care organization has increased the demand for
primary care services and ambulatory facilities.
 Clients who are insured often must see a primary care provider before
obtaining referrals to specality or hospital care.
 The opportunities for professional nurse to work in ambulatory care
settings are expected to increase in the years to come.

TYPES:
 Home or clinic
  Ambulatory surgery
 Wireless mobile cardiac monitoring system
 Ambulatory electrocardiography
 Telemedicine
 Trans telephonic monitoring
 Adult day health care
HOME OR CLINIC:

1. Provides follow -up care during office or clinic visit or by telephone

contact.
2. Reinforces previous teaching and answers patients and family’s
question about surgery and follow-up care.
3. Assess patient’s response to surgery and anesthesia and their effects
on body image and function.
4. Determine family’s perception of surgery and its outcomes.
AMBULATORY SURGERY:
 Ambulatory surgery includes outpatient, same day or short stay surgery
that does not require an overnight hospital stay.
 Centers providing these services may be hospital based or free standing
surgi centers.
 Over half of all surgical procedures are conducted on an outpatient basis.
These include ophthalmic, gastroenterological, gynecological, ENT,
orthopedic, cosmetic or restorative.
 One-day surgery in which the client is admitted the day of surgery and
observed overnight has also increased in popularity.
 Ambulatory surgery also offers cost saving by eliminating the need for
hospital stay.
 This reduces the possibility of nosocomial infections.
AMBULATORY ELECTROCARDIOGRAPHY:
 Is a form of continuous ECG monitoring used for diagnostic purpose
in the outpatient setting?
 Electrode are connected with lead wires to a cable that is inserted into
a portable recorder (Holter monitor) that records ECG into a digital
memory device.
 The patient wears the holter monitor for 24hrs to detect dysrhythmias
or myocardial ischemia that occur during waking hours or sleep.
 The keeps a diary, nothing the time of any symptoms or performance
of unusual activities.
  Data from the digital memory device are uploaded into a computer for
further evaluation.
 It is used to identify the etiology of symptoms.( eg.syncope,
palpitation )
 To detect episodes of myocardial ischemia and to evaluate
effectiveness of cardiac medication ( eg. antiarrhythmic ,nitrates) or
pace maker function.
ADULT DAY HEALTH CARE:

 It provides social, recreational and health related services to

individuals in a safe, community-based environment.
 This includes daily supervision, social activities,
opportunities for social interaction, activity daily living
assistance for two major groups of adults.
 Those who are cognitively impaired and those who have
problems independently performing activity daily livings.
 Adult day health care similar to adult day care but are
designed to meet of older adults and with disabilities who
need a higher level of care.
AMBULATORY SETTING:

 Ambulatory health care is provided for patients in community or

hospital-based setting.
 The types of agencies that provide such care are medical clinics,
ambulatory care units, urgent care centre, cardiac rehabilitation
programmer, mental health centers, student health centers, community
outreach programme, and nursing centers.
 Some ambulatory centers provide care for specific population such as
migrant worker, or Native Americans.
 The centers may operate in freestanding buildings, storefronts, or
mobile unit.
 Agencies may provide ambulatory health care in addition to other
services, such as an adult day care or health programmed.

Telemedicine:
Telemedicine refers to the practice of caring for patients remotely when
the provider and patient are not physically present with each other. Modern
technology has enabled doctors to consult patients by using HIPAA compliant
video-conferencing tools. Most robust and easy to use telemedicine software.
Telemedicine Definition: What is the Meaning of Telemedicine.
Telemedicine is the exchange of medical information from one location to
another using electronic communication, which improves patient health status.
Definition of telehealth

Telehealth is the distribution of health-related services and information via

electronic information and telecommunication technologies. It allows long-
distance patient and clinician contact, care, advice, reminders, education,
intervention, monitoring, and remote admissions.
What are examples of telemedicine?

Patient consultations via video conferencing, transmission of still images,

e-health (including patient portals), remote monitoring of vital signs, continuing
medical education, consumer-focused wireless applications, and nursing call
centers, among other applications, are all considered part of telemedicine.
Goals and Needs of Telemedicine:
 Accompanied by data and image transfer ( live)
 Video conferencing
 Common software usage at both ends, thus globalization of a songle
database software.
 Role of trained technical personnel is equally important and necessary
at the patient end.
 Successful remuneration system to attract private practitioners.

Types:
Tele nutrition
Telenursing
Tele pharmacy
 Tele dentistry
Tele audiology
Tele neurology
Tele neuropsychology
Tele ophthalmology
Tele surgery
Tele cardiac care
Tele rehabilitation
Tele trauma care
Tele dermatology

TeleNutrition:
Telenutrition refers to the use of video conferencing/ telephony to provide
online consultation by a nutritionist or dietician. Patient or clients upload their
vital statistics, diet logs, food pictures etc. on TeleNutrition portal which are
then used by nutritionist or dietician to analyze their current health condition.
Nutritionist or dietician can then set goals for their respective client/ patients
and monitor their progress regularly by follow-up consultations.
Telenursing:

Telenursing refers to the use of tele communications and information

technology in order to provide nursing services in health care whenever a large
physical distance exists between patient and nurse, or between any number of
nurses. As a field it is part of telehealth, and has many points of contacts with
other medical and non-medical applications, such as tele diagnosis,
teleconsultation, telemonitoring, etc.

Telepharmacy:

Telepharmacy is the delivery of pharmaceutical care via telecommunications to

patients in locations where they may not have direct contact with a pharmacist.
It is an instance of the wider phenomenon of telemedicine, as implemented in
the field of pharmacy. Telepharmacy services include drug therapy monitoring,
patient counseling, prior authorization and refill authorization for prescription
drugs, and monitoring of formulary compliance with the aid
of teleconferencing or videoconferencing.
The term can also refer to the use of videoconferencing in pharmacy for other
purposes, such as providing education, training, and management services to
pharmacists and pharmacy staff remotely.[26
Telecardiology[edit]

Teleradiology is the ability to send radiographic images (x-rays, CT, MR,

PET/CT, SPECT/CT, MG, US...) from one location to another.[62] For this
process to be implemented, three essential components are required, an image
sending station, a transmission network, and a receiving-image review station.
The most typical implementation are two computers connected via the Internet.

Teleradiology is the most popular use for telemedicine and accounts for at least
50% of all telemedicine usage.
Advantages of telemedicine for patients:
 No transportation time or costs
 No need to take time off of work
 Eliminate child or elder care issues
 No demand options
 Access to specialists
 Less chance of catching a new illness
 Less time in the waiting room.
 Better health advantage of telemedicine
Advantages of telemedicine:
Telemedicine increases access to care
Telemedicine improves of quality of care delivery.
Telemedicine reduces healthcare costs.
Telemedicine enhances traditional face- face medicine
Telemedicine improves patient patient engagement and satisfaction
Tele medicine improves provider satisfaction.
Dis- Advantage of Telemedicine:
 The overall cost of telecommunication system, especially data
management apparatus and practical training of medical professional is
great.
 Virtual clinical treatment decreases human interaction among the health
care professionals and patients that increase the risk of error in clinical
services.
 Confidential medical information can be leaked through faults electronic
system.
 Telemedicine might take longer time for the difficulties in connecting
virtual communication due to low internet speed or server problem.
 This system cannot provide immediate treatment, such as antibiotics.
 Low quality of health information records like x ray or other images,
clinical progress reports etc.
 Telemedicine system requires tough legal regulation to prevent
unauthorized and illegal service provider in this sector.

ROLE OF NURSE:
 It include providing direct patient care, conducting patient intake
screening, treating patients with acute or chronic illness or emergency
conditions, referring [patients to other agencies for additional services,
teaching patient selfcare activities and offering health education
programme that promote health maintenance.
 Nurse practitioner, educated in primary care, often practice in ambulatory
care setting that focuses on gerontology, pediatric, family and adult health
or women.
 CONCLUSION:
For the conclusion of this topic, ambulatory care is very necessary for this
growing population .so as a nurse practitioner we should have adequate
knowledge regarding this developing patient care.
BIBLIOGRAPHY:
 Joyce m. black, jane hokanson hawks, anna belle m. Keene .“ medical
surgical nursing . 6th edition. Volume 1. elsevier publication.page no.83.
 Brunner and suddarths. Text book of medical surgical nursing .
12thedition.volume1.lippincott publication. Page no.19.
 Lewis 2014 . medical surgical nursing.2ndedition. volume1. elsevier
publication.page no.64.
 Potter.perry. fundamentals of nursing .6th edition .elservier publication.
Page no.1595-1600.