Critical care without walls: The role of the nurse consultant in critical care

Critical Care Resource Nurse Team: A Patient Safety and Quality Outcomes Model

The Critical Care Resource Nurse Team (CCRNT) evolved from our traditional Rapid Response Team (RRT). The CCRNT is a unique paradigm created using the conceptual framework of the American Association of Critical Care Nursing Synergy Model for Patient Care. The goal of the CCRNT is to help align nurse competencies with patient needs. This team was seen as a much-needed strong clinical support by nursing leadership as large numbers of inexperienced new graduate registered nurses were hired and senior experienced nurses were leaving the workforce. The CCRNT supports 24/7 RRT, Code Blue, Code Stroke, Emergency Airway Response Team, Early Warning System, Medical Emergency Team, simulation team training, and bedside nurse support and mentoring. Coverage expanded from inpatient medical/surgical areas to all areas of the medical center and included hospital-wide initiatives. The focus for the CCRNT changed to a system-wide nursing and patient safety model to improve practice and intervene in near-miss events. This model improved communication between disciplines, provided critical surveillance of at-risk patients, supported patient safety with a significant decrease in patient mortality, and offered a 24/7 expert critical care nurse resource team for staff.

Training needs detected by nurses in an intensive care unit: a phenomenological study

INTRODUCTION

The competences of intensive care (ICU) nurses in their healthcare environment, have increased with the acquisition of new responsibilities associated with new care and devices for critical patients. Many studies suggest the need for specific training of nurses that work in these units. Based on this evidence, the European Federation of Critical Care Nurses Associations, recommends unifying the training of intensive care nurses. Therefore we set ourselves the following objective: to assess the training needs detected by ICU nurses through their experience and practical knowledge.

METHOD

Descriptive qualitative study, with a phenomenological approach, through semi-structured interview where the four areas (clinical practice, professional, management and educational) covered by the European Federation of Critical Care Nurses Associations were studied. Fifteen nurses from an adult polyvalent ICU were interviewed.

RESULTS

The interviewees acknowledged that the previous training was deficient for the care and support measures that they had to face. They considered that subsequent training and experience were decisive in order to carry out their work effectively. They also stated that support measures and care are topics to be developed continuously through targeted training.

CONCLUSION

The nurses in this research study acknowledged that training is needed to achieve the competences required in ICU, and these are affected by the type of unit and patients.

Staffing and workforce issues in the pediatric intensive care unit

The health care industry is in the midst of incredible change, and unfortunately, change is not easy. The intensive care unit (ICU) plays a critical role in the overall delivery of care to patients in the hospital. Care in the ICU is expensive. One of the best ways of improving the value of care delivered in the ICU is to focus greater attention on the needs of the critical care workforce. Herein, we highlight three major areas of concern-the changing model of care delivery outside of the traditional four walls of the ICU, the need for greater diversity in the pediatric critical care workforce, and the widespread problem of professional burnout and its impact on patient care.

Advanced nursing roles: a systematic review

In this systematic literature review, we analyzed and synthesized the literature on one specialized advance practice nursing role in three countries for the purpose of describing and comparing these roles, as well as discussing whether an international consensus of the advance practice nursing definition is possible. A systematic search on CINAHL and PubMed Medline was conducted in 2011 to search the literature on the nurse consultant in the UK, the clinical nurse specialist in the USA, and the clinical nurse consultant in Australia. The studies (n = 42) were analyzed and combined using qualitative content analysis method. The roles of the nurse consultant, clinical nurse specialist, and clinical nurse consultant were similar. The variation in the roles appears to derive from organizational or individual choices, not the country in question. The study process comprised a synthesized representation of one specialized advance practice nursing role. More work is needed to further define the concept of the advance practice nursing, as well as its implementation on other cultures beyond this review. Based on this review, an international consensus regarding the definition of advance practice nursing and its subroles is possible.

Supporting trail-blazing: A systematic review of the factors that facilitate or inhibit the implementation of new nursing roles: the experiences of UK consultant nurses

BACKGROUND

If emerging 'trail-blazers', such as the consultant nurse, are to be successful in developing and sustaining new ways of working then factors that support or inhibit new role developments need identification. There is a growing body of evaluative and anecdotal evidence about the experience of consultant nurses since the introduction of the role in the UK thirteen years ago.

OBJECTIVE

To synthesise the evidence on the experiences of UK consultant nurses in implementing a new role in order to identify inhibitors and facilitators of role development.

INCLUSION CRITERIA

This review sought qualitative and mixed methodology studies that yielded qualitative data about the phenomenon of interest, together with narrative opinion papers i.e. consultant nurses' experiences of role development.

SEARCH STRATEGY

The search in 14 databases considered studies and opinion papers published between January 1999 and April 2010 in English.

METHODOLOGICAL QUALITY

All retrieved studies and opinion papers were assessed by two independent reviewers using the standardised Joanna Briggs Institute critical appraisal tools.

DATA COLLECTION

Data were extracted from included papers using the standardised Joanna Briggs Institute data extraction tool.

DATA SYNTHESIS

Data synthesis used the Joanna Briggs Institute approach for meta-synthesis by meta-aggregation. Findings were synthesised into categories and categories were aggregated into synthesised findings.

RESULTS

On the basis of critical appraisal, no opinion papers were included in the review. A total of 11 qualitative studies were included, yielding a total of 313 findings. These were synthesised into 64 categories which were further synthesised into 11 synthesised findings about factors that facilitate and inhibit the role's implementation and development.

CONCLUSION

Drawing directly on consultant nurses' experiences, these findings add evidence to what is already known about what does and does not work in developing a consultant role. They indicate that an understanding about the role's core functions is needed, as is a supportive environment in which the consultant can fully operate.

IMPLICATIONS FOR PRACTICE

The implications for practice are derived from the results of the synthesised findings. An organisation, through its policies, practices, procedures and individuals, must support the consultant's leadership and collaborative goal directed approach to care delivery and service development. This can be achieved by allowing the consultant both autonomy and authority. The synthesised findings reinforce the need to optimise the facilitators and minimise the inhibitors of role development. They can also make a contribution to the conceptual understanding of the consultant role.

IMPLICATIONS FOR RESEARCH

Further research into the experiences of consultant nurses is necessary - in particular, how nurse consultants interpret their relationships with others, negotiate resources and demonstrate the impact of their role in each of the core functions, notably the leadership function.

Investigating the role and impact of expert nurses

This literature review was conducted to identify the attributes of an expert nurse and the direct and indirect impact they have on patient care, health-care organisations and nursing. Given the loss of expert nursing posts as a result of NHS deficits, there is an urgent need to differentiate between a range of expert nursing roles and how these contribute to positive patient and health outcomes and organisational efficiency. The focus of the literature search was on developments in the UK and the results indicated that ambiguity and confusion exist around the terminology and definitions associated with expert nurses. Research shows that expert nurses have a positive impact on patient care and organisational efficiency. However, a lack of clarity leads to a dilution of expert nursing roles and nurse expertise. There is a need for national guidance on the skills required of expert nurses and the necessity of considering the formal protection of nursing titles.

'One patient amongst many': a qualitative analysis of intensive care unit patients' experiences of transferring to the general ward

Introduction

Many patients experience 'relocation stress' when they are transferred from an intensive care unit (ICU) to step-down (high dependency) or general ward care, and much has been written about the psychological causes. This qualitative analysis of in-depth, narrative interviews with former ICU patients explores and examines patients' accounts in order to identify additional causes of relocation stress.

Methods

Forty former ICU patients were recruited throughout the UK, using maximum variation sampling, to achieve a broad range of experiences of intensive care. Interviews in people's homes were recorded on video and audio equipment as part of a study for the Database of Personal Experiences of Health and Illness (DIPEx) web resource. All interviews were transcribed, checked and returned to respondents. For this report, a qualitative thematic analysis was used to explore experiences of transfer.

Results

We found that most people experienced relocation distress not only because of physical and emotional difficulties relating to their illness and treatment and the inevitable anxiety resulting from leaving a protected environment, but also from concrete, practical causes. These included specific concerns about communication, feeding, nursing care and support, as well as ward organization and environment. Written excerpts from the interviews and two video excerpts taken from the DIPEx website illustrate our findings.

Conclusion

We conclude that there are several aspects of care that deserve further examination by researchers and service providers, and that not all of the factors associated with relocation stress should be seen as an inevitable consequence of the psychological adjustment involved in transfer from an ICU.

Oncology-critical care nursing collaboration: recommendations for optimizing continuity of care of critically ill patients with cancer

Highly specialized care is required for critically ill patients with cancer, but continuity of care equally is important to their survival when they are admitted to the critical care setting. The use of oncology nurses as liaisons to critical care nurses may help ensure the continuity of care and reduce rates of morbidity and mortality. This article provides a framework for collaborative consultation between oncology and critical care nurses.

The current role of the consultant nurse in critical care: consolidation or consternation?

BACKGROUND

The consultant nurse role emerged into the National Health Service in 1999, presented against a backdrop of practice and service modernisation. As with any innovative development, the role was originally subject to much scrutiny with regards to impact and outcome. However, six years after its initial introduction, continued focus and support on this role is less visible. This paper presents a follow-up review of the role and function of consultant nurses in critical care, using an original survey tool that underpinned Dawson and McEwen's work in 2003. From the results of the current study, key changes in role are identified and areas for further development are highlighted.

AIMS

To provide a contemporary profile of the consultant nurse in critical care. To identify changes in the consultant nurse role from 2003 to 2006.

METHOD

A national email survey of all known critical care nurse consultants in post in the United Kingdom was undertaken in October 2006. Using a validated survey tool originally used in 2003, a return rate of 73% (n = 47) was yielded.

RESULTS

Biographics of this survey reveal a static consultant nurse population with increasing length of tenure in post (mean = 60.2 months). There is no substantial increase in the size of the cohort since 2003. Postholders demonstrate advanced academic skills through higher degrees (94%) and carry a national and international profile through presentation and publication portfolios (92% national and 53% international presentation, 62% multi-authored publication, 47% single authored publication). The core role that consultant nurses in critical care engaged in is practice and service development (mean involvement score = 3.65), with expert practice holding least mean involvement scores (mean involvement score = 2.67). There is evidence of increasing use by these posts for strategic input at organisational/trust level.

CONCLUSIONS

This paper has identified ongoing strengths and limited developments of the consultant nurse in critical care role. Whilst it is clear that core role functions have not dramatically changed, there are demonstrable shifts towards more strategic engagement within Acute Care Trusts. This has brought about concerns regarding overall management of the role, and sustainability of postholders to balance this ever-increasing portfolio. It is also clear that there has been little new investment in this key leadership role, and this raises concerns as to the perceived contribution that experienced clinical nurses bring to a currently financially and operationally driven health service agenda.

The influence of outreach in the development of the nurse consultant role in critical care: cause or effect?

BACKGROUND

Critical care nurse consultant roles have evolved against a background of service innovation that has resulted in the development of critical care outreach services. Despite compelling evidence that there was a serious problem with the management of critically ill patients in the ward environment, there is little evidence to support outreach as a concept or as a role for nurse consultants.

AIMS

The aims for this part of the study were to:

METHODS

A national postal survey of all 72 critical care nurse consultants in post in England by August 2003; response rate 72% (n = 52). All data was entered on to a computer anonymously and analysed using SPSS version 11.5. A factor analysis revealed a sub-set of nurse consultants who had a significantly greater involvement in outreach activity.

RESULTS

Critical care nurse consultants have a high involvement in the development of care for critically ill patients outside the traditional boundaries of critical care. A sub-set emerged that has a significantly greater involvement in outreach activity. This includes roles such as working with an individual or team to develop their practice (whole group mean involvement score M = 4.45, outreach M = 4.88, p < 0.001); developing education outside the ICU/HDU (whole group M = 4.13, outreach M = 4.88, p < 0.001) and receiving nurse led referrals from the wards (whole group M = 3.92, outreach M = 4.81, p < 0.001).

CONCLUSIONS

Given the lack of evidence for outreach, organisations should consider the high level of involvement of the nurse consultant outside the traditional boundaries of the ICU/HDU.