Nephrostomy Care and Boundary Spanning

Nephrostomy care is an essential part of healthcare organizations (HCO), whose goal revolves around diagnosing and treating patients with kidney or renal dysfunctions. HCOs require a unique set of management skills and approaches, which enable to optimize the workflow among these institutions. Operational leadership in HCO is a crucial concept, which aims to sustain and improve the current set of services provided. Since 1950, numerous leadership behavior theories were proposed in order to categorize and analyze the leader’s behavioral patterns for effective management.

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Nephrostomy care historically was based on renal dysfunction treatment methodologies, which focused on creating an artificial link between kidney and urinary diversion tool. More primitive approaches were used, such as urostomy, which is performed more distally on urinary pathway (Patel & Nakada, 2017). Nephrostomy surgery was first conducted by Rupel and Brown, who used cystoscope and nephrostomy tube. However, nephrostomy care mainly concentrates on proximal nephrostomy procedures, which are more precise, cleaner, and safer (Patel & Nakada, 2017).

Operational managers are responsible for observing and improving how every detail and element of an organization build a vast infrastructure of the HCO. All healthcare organizations possess an array of medical and treatment serviced, which should be efficiently designed, aligned with each other, implemented, and continuously improved.

HCO functionality involves boundary spanning, which is necessary for constant adaptation for environmental changes and shifts. Its primary purpose is to make practical and flexible plans for the future, therefore, allowing the healthcare organizations to properly adjust for upcoming economic and social changes (Thakur, 2018). Among these preparations is surveillance, which is a critical instrument to identify opportunities for improvement (OFI). OFI emerges from environmental changes; thus, their timely detection and analysis are necessary for adaptable strategy (Sebesta, Thompson, Mobley, & Shah, 2018).

There are several key functions, which enable the management to properly sustain the operational infrastructure of nephrostomy care and HCO: knowledge management, corporate design, constant improvement, and maintenance of operational foundations. Knowledge improvement aims to deliver reliable and complete information of analysis to associates and teams (Pabon-Ramos et al., 2016). Corporate or accountability design in nephrostomy aid establish precise expectations from each group and assists in implementing the array of services to meet the demand form the public. For example, a medical officer makes a chart of patients undergoing nephrostomy tube changes or insertions (Lange & Gutierrez-Aceves, 2018).

Furthermore, the constant flow of improvement is critical for reaching timely and coordinated decisions in a systematic manner, which might involve annual goal setting and budgeting. In nephrostomy care, the urea, electrolytes, and creatinine (UEC’s) need to be ordered and monitored year by year (Kaler et al., 2016). It is also important to continuously update and improve operational and strategic foundations in order to provide patients with useful services and identify possible opportunities for further development.

These practical strategies are conducted by the process improvement team (PIT), who are responsible for creating a smooth workflow in acute nephrostomy care settings (Hsu et al., 2016). The process execution of the PIT is monitored and evaluated by the performance improvement team (PIC). The PIC aims to arrange a governing board and senior management meetings devoted to reviewing the efficiency of the programs (Gohen, Arslan, Donmez, Halad, & Sezgin, 2019).

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There are four major requirements in order to properly conduct effective boundary spanning: establishing a network, creating a trust, training of associates, and knowledge assembly. Healthcare organizations need to integrate the network of listening activities, which enable nephrostomy care units (NCU) to be recognized by and communicate with stakeholders (Garg, Bansal, Singh, & Sankhwar, 2019).

The HCOs should represent and elaborate on their common values of trust and responsibility for stakeholders. The given approach allows discussing complex topics in a highly comfortable and candid fashion (Brandt et al., 2018). In addition, it is essential to deliver vigorous and advanced training for associates of the nephrostomy care unit. This will enable them to understand the stakeholder’s views of management accurately and to adequately represent HCO’s perspective (Abdeljaleel et al., 2018).

Lastly, NCUs with the assistance of the process improvement team should systematically and collectively assemble, analyze, and intergrade the gained knowledge from individual feedbacks and responses. For example, the informational base from patients with renal dysfunctions can allow medical officers and registered nurses to effectively adjust the pre- and post-procedure management during the insertion process of nephrostomy tube (Vargas-Cruz et al., 2017).

The opportunities for improvement arise at times of slightest environmental changes; therefore, excellent nephrostomy care units of HCOs are involved in epidemiologic planning model. It is a powerful tool that enables healthcare organizations and their subunits to gradually make forecasts for possible patient amounts (Szvalb et al., 2018). This is especially relevant in areas, where the number of patients does not support local HCO. The nephrostomy care units are forced to adjust their operational processes according to the demand of the local community (Sarkar & Parr, 2018). For instance, percutaneous nephrostomy is a procedure for placing the catheter into the renal collecting system.

The entire process is guided and observed through imaging equipment due to the enclosed nature of the process (Niwa et al., 2018). Renal collecting system includes two types of nephrostomy drainage tubes: pigtail and wide bore. These tubes are an essential part of NCUs’ array of operational services for patients with renal problems (Krohmer, Pillai, Guevara, Bones, & Dickey, 2018).

The epidemiological planning model is necessary in order to forecast the need for instrumentation and staffing. The model is highly useful to predict future arrangements; thus, it assesses and factors in five major sources of data: population, disease risk, market share, staff requirements, and facility requirements (Hu et al., 2018). The given model uses nationwide governmental and statistical data to translate it for their corresponding small local areas and minor civil divisions for the purpose of specifically categorizing the information.

The statistical records and historical backgrounds of patients with risk of kidney failure and renal abnormalities allow nephrostomy care units to assess the characteristics of the small areas (Gibbons et al., 2018). The disease risk is evaluated and analyzed by measuring the incidence rate of new cases in the population, prevalence of cases at a point in time, and demand for services provided by HCO. Consecutively, process improvement team calculates and classifies the market share (Georgescu, Jecu, Geavlete, & Geavlete, 2016).

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Lastly, it is important to make a plausible estimate of the skills required for the given period, which is highly dependent on the demand. The measurements of skill capacity are conducted through overviewing the necessity for physicians, nephrologist, registered nurses, other staff members and overall personnel forecast for every array of services (Chang, Chen, Jou, Li, & Chen, 2019).

Moreover, nephrostomy care units are required to make estimates of expendable equipment needs for the given period, which is done by predicting the numbers of expected patients and time length of the services provided. For example, the simplest nephrostomy tube removal process in NCU needs the following equipment: personal protection equipment, dressing pack, stitch cutter, sterile normal saline, gloves, apply a pressure dressing, syringe, ostomy (Batura, & Gopal Rao, 2019).

References

Abdeljaleel, O. A., Alnadhari, I., Mahmoud, S., Khachatryan, G., Salah, M., Ali, O., & Shamsodini, A. (2018). Treatment of renal fungal ball with fluconazole instillation through a nephrostomy tube: Case report and literature review. The American Journal of Case Reports, 19(1), 1179-1183.

Batura, D., & Gopal Rao, G. (2019). A systematic review of the clinical significance of nephrostomy urine cultures. World Journal of Urology, 37(8), 1-11.

Brandt, M. P., Lehnert, T., Czilwik, T., Borgmann, H., Gruber-Rouh, T., Thalhammer, A., … Tsaur, I. (2018). CT-guided nephrostomy–An expedient tool for complex clinical scenarios. European Journal of Radiology, 110(12), 142-147.

Chang, S. K., Chen, B. J., Jou, Y. C., Li, M. C., & Chen, P. Y. (2019). Ureteroscope-aided reinsertion of dislodged pigtail nephrostomy tube through collapsed tract. Urology Journal, 9(3), 124-179.

Garg, G., Bansal, N., Singh, M., & Sankhwar, S. N. (2019). Role of percutaneous nephrostomy in bladder carcinoma with obstructive uropathy: A story revisited. Indian Journal of Palliative Care, 25(1), 53-56.

Georgescu, D., Jecu, M., Geavlete, P. A., & Geavlete, B. (2016). Percutaneous surgery of the upper urinary tract. ScienceDirect, 2(4), 165-178.

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Gohen, M., Arslan, O. E., Donmez, M. I., Halad, A. O., & Sezgin, T. (2019). Ureteral catheter vs. nephrostomy tube for patients undergoing PNL under spinal anesthesia: A prospectively randomized trial. Journal of Endourology, 33(18), 132-144.

Gibbons, R., Leonard, N., Magee, M., Zanaboni, A., Patterson, J., & Constantino, T. (2018). Xanthogranulomatous pyelonephritis: A complicated febrile urinary tract infection detected by point-of-care ultrasound in the emergency department. The Journal of Emergency Medicine, 55(1), 1-4.

Hsu, L., Li, H., Pucheril, D., Hansen, M., Littleton, R., Peabody, J., & Sammon, J. (2016). Use of percutaneous nephrostomy and ureteral stenting in management of ureteral obstruction. World Journal of Urology, 5(2), 172-181.

Hu, T., Zhang, N., Mcdevitt, J. L., Odu, A., Xi, Y., Lamus, D., … Pillai, A. K. (2018). Comparative evaluation of nonprocedural nephrostomy-related complications in patients with ureteric obstruction due to cancer versus other causes: Is the protocol of routine 3-month nephrostomy exchange optimal for both disease processes? Journal of Clinical Interventional Radiology, 2(1), 23-26.

Kaler, K. S., Parkhomenko, E., Okunohov, Z., Patel, R. M., Landman, J., Clayman, R. V., & Uribe, C. A. (2016). Ureteroscopic holmium laser-assisted retrograde nephrostomy access: a novel approach to percutaneous stone removal. World Journal of Urology, 36(6), 963-969.

Krohmer, S. J., Pillai, A. K., Guevara, C. J., Bones, B. L., & Dickey, K. W. (2018). Image-guided nephrostomy interventions: How to recognize, avoid, or get out of trouble. ScienceDirect, 21(4), 261-266.

Lange, J. N., & Gutierrez-Aceves, J. (2018). Comparative outcomes of conventional and miniaturized percutaneous nephrostolithotomy for the treatment of kidney stones—Does a miniaturized tract improve quality of care? Urology Practice, 5(3), 205-209.

Niwa, N., Matsumoto, K., Kikuchi, E., Yazawa, S., Takeda, T., Morita, S., … Oya, M. (2018). Incidence and timing of inadvertent nephrostomy catheter displacement in patients with ureteral obstruction. Clinical Nephrology, 90(2), 112-116.

Pabon-Ramos, W. M., Dariushnia, S. R., Walker, T. G., Janne d’Othee, B., Ganguli, S., Midia, M., … Nikolic, B. (2016). Quality improvement guidelines for percutaneous nephrostomy. Journal of Vascular and Interventional Radiology, 27(3), 410-414.

Patel, S. R., & Nakada, S. Y. (2017). The history and development of percutaneous nephrolithotomy. The History of Technologic Advancements in Urology, 15(7), 123-132.

Sarkar, D., & Parr, N. J. (2018). Dislodged nephrostomy: a top tip. BMJ Innovations, 4(1), 113-114.

Sebesta, E. M., Thompson, S., Mobley, D., & Shah, O. (2018). MP89-07 percutaneous nephrostomy versus retrograde ureteral stenting in patients with obstructive pyelonephritis and sepsis: Implementation of a hospital-wide protocol. The Journal of Urology, 199(4), 1208-1210.

Szvalb, A. D., Haddad, H. E., Rolston, K. V., Sabir, S. H., Jiang, Y., Raad, I. I., & Viola, G. M. (2018). Risk factors for recurrent percutaneous nephrostomy catheter-related infections. Infection, 47(339), 1-7.

Thakur, D. (2018). Comparison of standard and tubeless percutaneous nephrolithotomy in a tertiary care hospital in eastern Nepal. Birat Journal of Health Sciences, 3(1), 366-369.

Vargas-Cruz, N., Reitzel, R. A., Rosenblatt, J., Jamal, M., Szvlab, A. D., Chaftari, A. M., … Raad, I. (2017). In vitro study of antimicrobial percutaneous nephrostomy catheters for prevention of renal infections. American Society for Microbiology. 10(3), 32-37.

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