Neurosurgery

Patient Care

Goals and Objectives

  1. Interpret the results of initial focused clinical evaluations (history, physical examination, laboratory data) performed on patients admitted to the neurosurgical service to
    1. Identify patients who are at risk for CNS failure
    2. Identify the patients who neurosurgical procedures
    3. Identify the patients who require advanced neurosurgical evaluation
  2. Interpret the results of daily focused clinical evaluations (history, physical examination, laboratory data) performed on patients admitted to the neurosurgical service toDescribe how to evaluate an adult with known or suspected CNS disease
    1. Implement known strategies to minimize patient harm during neurosurgical service admission
    2. Assess the efficacy of treatments and therapies
    3. Treat ongoing or new CNS failure
  3. Describe how to evaluate an adult with known or suspected CNS disease
  4. Become familiar with the different radiological studies available for CNS evaluation including computed tomography, magnetic resonance imaging, and positron-emitted tomography.

Responsibilities and Expectations 

  1. Write admission and inpatient orders with the guidance of the neurosurgical NP, residents, fellows, and attending physician
  2. Compose H&Ps, daily progress notes, and procedure notes.
  3. Attend daily morning rounds and be prepared to present patients in an organized and succinct manner
  4. Update the neurosurgery patient list to facilitate the transfer of care from shift to shift
  5. Implement the clinical decisions made by the team during rounds.Notify the service NP if unable to implement the clinical plan
    1. Communicate with the primary NP, resident, and attending
    2. Arrange consultations
    3. Communicate with the bedside RN
    4. Review ongoing diagnostic studies
  6. Notify the service NP if unable to implement the clinical plan
  7. Communicate the results of consultations, diagnostic tests, and therapeutic procedures to the service NP in a timely manner

Medical knowledge

Goals and objectives

  1. Understand the clinical importance of intracranial pressure in the setting of
  2. Understand the clinical management of extraventricular drainage systems
    1. Stroke
    2. Intracranial tumors
  3. Describe the importance of cerebral blood flow autoregulation
  4. Understand the pathology and treatment of subarachnoid hemorrhage and arteriovenous malformations including
    1. Neurointerventional radiology procedures
    2. Neurosurgical procedures
  5. Understand the pathology and management of intracranial tumors including
    1. Gliomas
    2. Astrocytomas
    3. Meningiomas
  6. Describe the management of new onset seizures and seizure prophylaxis in the neurosurgical population
  7. Understand the concept of brain death and the management of the organ donor patient

Practice-Based Learning and Improvement

Goals and Objectives

  1. Apply knowledge of study designs and statistical methods to critique the literature on diagnostic and therapeutic effectiveness of in interventions performed in the neurosurgical population.
  2. Analyze common complications related to neurosurgery

Responsibilities and Expectations

  1. Attend morning educational conference
  2. Attend monthly neurosurgery M&M conference to review and analyze treatment outcomes and complications
  3. Meet with the NP fellowship director at least once during the rotation to review goals and objectives

Interpersonal and Communication Skills

Goals and Objectives

  1. Communicate effectively as a member of the multidisciplinary team which rounds together
  2. Communicate effectively with patients and families
  3. Work effectively as a member of a professional group
  4. Consistently demonstrate sensitivity to patients from different cultures

Responsibilities and Expectations

  1. Establish appropriate role in the multidisciplinary care team
  2. Maintain appropritate lines of communication within the care team and across disciplines

Professionalism

Goals and Objectives

  1. Enhance the body of knowledge in advanced practice nursing through exchange of ideas and knowledge in professional organizations, conferences, research activities, and written publications.
  2. Functions as a licensed independent practitioner

Responsibilities and Expectations

  1. Demonstrate respect, compassion, and integrity
  2. Demonstrate a commitment to excellence and on-going professional development
  3. Provides patient centered care recognizing cultural diversity and the patient or designee as a full partner in decision making

Systems-Based Practice 

Goals and Objectives 

  1. Understand the allocation of neurosurgical services at UCSF
  2. Analyze the impact of neurosurgery on individuals and populations 

Responsibilities and Expectations 

  1. Practice cost effective, evidence based health care and resource allocation that does not compromise quality of care
  2. Know how to partner with health care managers and health care providers to assess, coordinate, and improve health care discharge planning and transition out of the intensive care unit.  
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