An integrative review of peer support for patients undergoing major limb amputation.

Medical literature is replete with evidence regarding physical rehabilitation of the amputee; however, scant attention has been paid to psychological rehabilitation. The objective was to perform an integrative review of the published medical evidence regarding amputee peer support in the civilian population and provide an evidence-based clinical practice recommendation. This study was based on an exhaustive examination of the civilian amputee peer support medical evidence, bibliographic search, and on the experience of the authors when performing this integrative review. Our search uncovered 10 published peer-reviewed pieces of medical evidence including one level III retrospective case controlled trial, two level IV case series, and seven level V expert opinions. Given the totality of the published evidence, albeit limited, in favor of amputee peer support, an abundance of unpublished anecdotal evidence, virtually no potential risk of harm, and low cost, it seems reasonable to recommend incorporating a preoperative and/or postoperative peer visit in clinical protocols for all patients incurring a major limb amputation.

Improving glycemic control in the acute care setting through nurse education.

Patients with a primary or secondary diagnosis of diabetes present unique challenges during an inpatient hospital stay to treat an acute or chronic illness. Upon review of current hospital practice, an interprofessional team embarked on a performance improvement project to improve outcomes for the complex medical-surgical diabetic patient. The methods detailed herein--a comprehensive education plan, preceptorship and peer accountability, active engagement and support by the unit nursing leadership team, and interprofessional collaboration--offer strategies any organization can implement to positively impact diabetes care.

Testing the effectiveness of the Amputee Mobility Protocol: a pilot study.

We studied prolonged length of stay (LOS) in the acute care setting on a medical-surgical vascular unit, related to loss of functional mobility status after lower extremity amputation, and implementation of the Amputee Mobility Protocol (AMP) as a standard of care for all patients pre- and post-lower extremity amputation who were admitted to the medical-surgical vascular unit. A comparative pre-post observational study evaluated the effect of AMP on level of functional mobility and LOS after lower extremity amputation in the patient population on the medical-surgical vascular unit. Data was collected retrospectively from patient chart reviews from November of 2004 to March of 2005 for the pre-AMP group and through concurrent patient chart reviews from November of 2005 to March of 2006 for the post-AMP group. Dependent variables included functional mobility and LOS, which were evaluated by a modified Functional Independence Measure (FIM) score and the hospital LOS. Forty-four eligible patients were enrolled in the AMP pilot study during a 5-month period. The sample population consisted of 30 patients pre-AMP and 14 patients post-AMP. LOS for transmetatarsal amputations decreased by 0.7 days, whereas functional mobility increased by a minimum of one level in the modified FIM score. Functional mobility increased for transtibial amputations by one level and transfemoral amputations by 2 levels using the modified FIM score. LOS increased for patients undergoing transtibial (7.1 days) and transfemoral (2.7 days) amputations. This quality improvement project heightened staff awareness regarding ambulation and its impact on functional mobility and early discharge. Vascular nurses were able to affect patients' functional mobility and LOS by implementing a standardized AMP. Data showed that using the standardized AMP increased patients' functional mobility but did not significantly decrease acute care setting LOS. The AMP continues to be used for this patient population because of its impact on functional mobility and independence. This pilot study relates to 3 of the top 20 vascular research priorities: 1) an interdisciplinary strategy to improve the patient's level of functional independence and thereby decrease LOS and cost; 2) the nursing intervention of early, predetermined ambulation schedules will increase the nursing knowledge of strategies that facilitate recovery after vascular surgery in this population; and 3) factors that affect patient outcomes after these three major vascular procedures will be addressed in pilot outcomes. Limitations of the AMP pilot study included the small sample size, staff turnover, and lack of a concurrent control group. The next phase of this project will create and implement a similar activity protocol for patients after abdominal aortic aneurysm repair and various types of lower extremity bypass procedures.

Building a successful support group for post-amputation patients.

The purpose of this article is to identify five steps to attain a successful amputee support group and share the process for establishing and maintaining a peer visitation program for in-patient amputees. Whatever the cause, losing a limb is a life-changing event that one should not go through alone. Support groups can assist patients and their families through this transition in a positive and healthy way.