2. INTRODUCTION
• An ambulatory care patient as “an individual
presenting for personal health services who is
neither bedridden nor currently admitted to
any health care institution”
By- National Ambulatory Medical Care Survey
(NAMCS)
3. INTRODUCTION
• Ambulatory care nursing is the nursing care
of patients who receive treatment on an
outpatient basis, ie they do not require
admission to a hospital for an overnight stay.
The setting can vary widely, from hospital-
based clinics to patient homes
4. • Ambulatory Care Nurses take care of patients
in environments outside of hospitals. Their
primary focus lies in pain management and
general health education for patients with
chronic injuries or illness. They provide the
medical screenings, triage, and case
management that help restore a patient’s
ability to live independently.
5. DEFINITON
• Ambulatory care nursing includes those
clinical, management, and research activities
provided by registered nurses for and with
individuals who seek care and assistance with
health maintenance, health promotion and/or
health related problems.
6. CHARACTERISTICS
• Nursing autonomy
• Client advocacy
• Skilful, rapid assessment
• Holistic nursing care
• Client teaching
• Wellness and health promotion
• Coordination and continuity of care
• Long term relationships with clients and
families
7. • Telephone triage, consultation, follow-up, and
surveillance
• Collaboration with other health care providers
• Case management
8. CONCEPTUAL MODELS IN
AMBULATORY CARE NURSING
PRACTICE
• Clinical model
• Levels of prevention model
• Primary health care, primary care, and
managed care models
9. 1.CLINICAL MODEL
• In this model, health is conceptualized as the
absence of the clinical manifestations of the
disease.
• It is assumed that the body is a machine and
the modern medical technology can use
physical and chemical interventions to “fix the
machine” whenever it is broken
10. • This has led to great emphasis on expensive,
acute care with high technology treatments
and relatively little attention to prevention,
public health, environmental measures, or
personal responsibility for health.
11. 2. LEVELS OF PREVENTION MODEL
• The levels of prevention model, advocated by
Leavell and Clark in 1965, has influenced both
public health and ambulatory care delivery
worldwide.
• This model suggests that the natural history of
any disease exists on a continuum, with health
at one end and advanced disease at other.
13. 3. PRIMARY HEALTH CARE, PRIMARY
CARE, AND MANAGED CARE MODELS
• Primary health care focuses on the universal
right to basic health care.
• Primary care focuses on integrated care
coordinated by one primary provider.
• Managed care approaches the use of health
care services from a cost containment
perspectives.
14. AMBULATORY CARE PRACTICE
SETTINGS
• Physicians’ offices
• Community hospital outpatient departments
• Teaching hospital outpatient departments
• Health maintenance organizations as
Ambulatory Care Delivery Sites
• Emergency Departments
• Other Ambulatory Care settings
15. SERVICES PROVIDED IN AMBULATORY
CENTERS
• Ambulatory surgery centers (ASCs)
• Catheterization labs
• Dental practices
• Dialysis centers
• Urgent care centers
• Imaging centers
• In vitro fertilization clinics
• Telemedicine providers.
16. ROLE OF NURSE
• RNs enhance patient safety and the quality and
effectiveness of care delivery and are thus
essential and irreplaceable in the provision of
patient care services in the ambulatory setting.
• RNs are responsible for the design,
administration, and evaluation of professional
nursing services within an organization in
accordance with the framework established by
state nurse practice acts, nursing scope of
practice, and organizational standards of care.
17. • RNs provide the leadership necessary for
collaboration and coordination of services,
which includes defining the appropriate skill
mix and delegation of tasks among licensed
and unlicensed health care workers.
• RNs are fully accountable in all ambulatory
care settings for all nursing services and
associated patient outcomes provided under
their direction.
18. ROLE OF NURSE
• Telehealth - Nurses in telehealth utilize a variety of
technologies to triage, conduct consultations, and
deliver necessary follow-up on patient’s outcomes and
status.
• Physician's office - In the physician’s clinic nurses are
needed to assist the doctors with patient consultations
and procedures. Different specialties include family
medicine, cardiology, gastroenterology, endocrinology,
obstetrics, ophthalmology, dermatology, etc.
• Urgent care - The Urgent Care Association of America
projects more than 15,000 immediate care centers
assess and treat ailments requiring treatment beyond
that of a doctor’s office but not severe enough for the
hospital.
19. • Community centres - In the community nurses act as
patient educators, coordinators, and advocates. In this role
the ambulatory nurse may be responsible for research to
incorporate into community programs.
• Schools - Nurses in school facilities respond to medical
emergencies within the school area. In addition to this,
they are responsible in assessing the health of the students,
faculty, and other school staff.
• Health Insurance companies - Health insurance companies
have an interest in hiring nurses to collaborate with health
care providers to ensure coverage guidelines are followed
appropriately. Nurses can also have a role as a nurse on the
24-hour helpline.
20. TRENDS IN AMBULATORY NURSING
CARE
Health care is changing:-
• From an illness oriented to a wellness orientation
• From an acute care emphasis to primary care
• From inpatient to outpatient services
• From individual health to community well being
• From fragmented care to managed care
• From independent institutions to integrated
system
• From service duplication to a continuum of
services
21. CONCLUSIONS
• Ambulatory care nursing is one of the fastest
growing areas of nursing speciality practice.
• Ambulatory care nurses are not only expert
clinicians but also expert communications.
• They play key roles in facilitating the client’s
successful progress through the integrated
delivery systems.
• Ambulatory nurses make quality health care
accesible.
