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"People need to ask appropriate questions and
make an informed decision," Hill said.
"Advertising misleads people," said Kate
Wilson, RN, a staff nurse at the ophthalmology clinic
at Kaiser Permanente Redwood City in California, and
selecting a surgeon on the basis of price is a bad idea.
Patients should have extensive prescreening to determine
if they are good candidates for the procedure-and surgery
should not be performed on those who aren't.
Sharon Sjulstad, RN, CRNO, CNOR, director of operations
at Barnet Dulaney Perkins Eye Center in Arizona, is
comfortable with advertising, as long as patients know
what they are getting. "But the patient has to
dig deep to make sure they know."
Concerned about the lack of standards in the field,
a group of nurses helped develop a recommended-practices
manual under the aegis of the American Society of Ophthalmic
Registered Nurses. Katzen, Navarro and Sjulstad were
members of the work group that wrote the standards.
"Lasik is not totally sterile like the OR,"
Hill said. "It is a combination of clean and sterile.
We felt the situation needed to be researched to find
the best practice of how to manage that, to ensure patients
would not have adverse results from the surgery."
The group expects the guidelines to be somewhat controversial,
as well as to evolve in time.
"The idea was to have unified practices,"
Katzen said. "We made the first statement that
anything that touches the eye must be sterile."
As data are compiled on the effectiveness of the guidelines,
evidence-based practices can ultimately be developed.
Part of the problem, though, is finding trained nurses
or even nurses who are interested in the field, Sjulstad
said. "Typically, technicians work up the patients
in the clinic without nurses to help them through it."
By providing guidance for those technicians, the standards,
the authors hope, will improve patient care.
To Katzen, the ideal situation would be for nurses
in ophthalmologic centers to be cross-trained, able
to handle the technical aspects as well as the patient
care. "Nurses have been trained in sterile procedures,
where for the most part technicians have not,"
she said. For that to happen, the medical community
must be educated about the value of a nurse in this
setting.
"There's no question that it is a cost-containment
issue," Navarro said. "But I think we will
transcend it. Because there is a nursing shortage, we
need to make sure nurses are taking care of patients
and not doing routine tasks that someone else can do."
"If you have a crisis in the center-and we've
had full cardiac and respiratory arrests-you need a
nurse," Katzen said. "Nurses have been fully
trained in CPR skills."
She encourages nurses to look into the field. "Not
only is it exciting and fulfilling, but from a lifestyle
standpoint, you are able to have fairly regular hours.
It is mostly 9 to 5, five days a week."
Besides, as baby boomers age, the population needing
eye care will grow tremendously. That means even more
nurses will be needed.
Contact Melissa Gaskill at gaskill@dbcity.com
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