Types of endoscopic instruments.

1. Rigid endoscopes provide excellent optics and are durable, but are not as versatile as flexible scopes. Flexible endoscopes provide accessibility to otherwise inaccessible areas, but have poorer optics. 2. There are several issues to consider when making the decision to use disposable or reusable items. This decision must be made jointly by the OR manager and the surgeon. The most important issue is patient outcome. 3. It is certain that the trend towards noninvasive procedures will continue as surgeons from additional surgical specialties adopt endoscopic techniques. The perioperative nurse must be ready to expand practice to facilitate the growing technology of endoscopic procedures.

Managing the trauma patient: focusing on perioperative education.

The key to planning and implementing safe, effective care to the trauma patient lies in initial and ongoing education, both hospital- and unit-based. Evaluation provides valuable feedback to assess the comprehensiveness of existing tools and the need for change. The perioperative nurse needs to know the pathophysiology of trauma, mechanisms of injury, continuity of care through the healthcare system, and trauma protocols of the facility, as well as the instrumentation and equipment used during trauma surgery. The goal of trauma orientation and continuing education is for the perioperative nurse to be able to use the nursing process to rapidly assess, diagnose, plan, implement, and evaluate nursing care for the trauma patient.

Role development of the clinical nurse specialist within the Indian Health Service.

The clinical nurse specialist is employed in many health care facilities to improve patient care. One service unit of the Indian Health Service has expressed interest in the development of this role. At the present time, there are no advanced practitioners within this facility. Development, as well as implementation of the role, must be based on the cultural and health care needs of the Indian people. This paper discusses development of the role of perioperative clinical nurse specialist, based on personal experience, at a service unit providing health care to a large tribe of American Indians in the Southwestern United States. Examples of care incorporating cultural practices, are used to illustrate the practice of the perioperative specialist within the Indian Health Service. The nursing process is used to organize the development of the role.