Navarro V B, Blackman J H, Greenbaum M D
Insight. 1993 Dec;18(4):12-5.
To be competitive as a tertiary facility in today's healthcare environment, our institute implemented two nursing programs using the Continuous Quality Improvement (CQI) framework: a) creation of the Nursing and Trauma Center, a nursing unit with the flexibility to adjust to continuing changes in patient mix comprising three nursing units (eye emergency room, same day surgery unit, and inpatient unit) designed to consolidate and standardize care to ophthalmic patients and develop a multi-skilled nursing staff to provide nursing care to all ophthalmic patient populations; and b) creation of the Controlled Medical Intensity (CMI) program, in which certain ophthalmic surgeries are performed in the most cost effective and efficient manner (while maintaining quality care). Conceived to compete with surgi-centers, CMI surgery is performed under local retrobulbar anesthesia with minimal, one-time intravenous (IV) conscious sedation (administered by operating room/recovery room nurses according to a standard protocol). Surgical supplies are standardized. These expanded roles have given nurses the opportunity to practice professional autonomy using nursing judgment.
为了在当今的医疗环境中作为三级医疗机构具有竞争力，我们的机构使用持续质量改进（CQI）框架实施了两个护理项目：a）创建护理与创伤中心，这是一个护理单元，能够灵活适应患者组合的持续变化，该中心由三个护理单元（眼科急诊室、同日手术单元和住院单元）组成，旨在整合并规范对眼科患者的护理，并培养多技能护理人员，为所有眼科患者群体提供护理；b）创建可控医疗强度（CMI）项目，其中某些眼科手术以最具成本效益和效率的方式进行（同时保持优质护理）。为了与外科中心竞争，CMI手术在局部球后麻醉下进行，仅给予极少的一次性静脉（IV）清醒镇静（由手术室/恢复室护士根据标准方案给药）。手术用品实现了标准化。这些扩展的角色使护士有机会运用护理判断力来实践专业自主性。
