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Holloway D, James S, Ekinci E, Craft J. Systematic review of the effectiveness of nurse-led care in reducing glycated haemoglobin in adults with Type 1 or 2 diabetes. Int J Nurs Pract 2023; 29:e13135. [PMID: 36733216 DOI: 10.1111/ijn.13135] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Type 1 and 2 diabetes care, especially within primary health-care settings, has traditionally involved doctor-led clinics. However, with increasing chronic disease burden, there is scope for nurses to expand their role in assisting diabetes self-management. AIMS This study aimed to determine the effectiveness of nurse-led care in reducing glycated haemoglobin in adults with Type 1 or 2 diabetes. METHODS Methodology from the Joanna Briggs Institute Method for Systematic Review Research and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, including identifying publications, assessing study quality, summarizing evidence and interpreting findings. The search strategy involved using the Medical Subject Headings and keyword variations when searching MEDLINE (Ovid), Scopus, PubMed and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Inclusion criteria were samples with Type 1 or 2 diabetes, mean age of ≥18 years, English language studies and publication date of January 2011-December 2021. RESULTS Overall, 34 articles from 16 countries met inclusion criteria. Though not always clinically significant, results indicated that nurse-led care had beneficial impacts on glycated haemoglobin values, with reductions from 0.03% to 2.0%. This was evident when nurses received formal training, used treatment algorithms, had limited medical support, utilized technology and offered defined culturally sensitive and appropriate diabetes care. CONCLUSIONS Findings support nurse-led Type 1 and 2 diabetes care. Although further research is required, changes may necessitate increased recognition of nurse-led care and funding. Nurse-led care models should differ according to health-care settings.
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Affiliation(s)
- Danielle Holloway
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Caboolture, Queensland, Australia
| | - Steven James
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Petrie, Queensland, Australia
| | - Elif Ekinci
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Judy Craft
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Caboolture, Queensland, Australia
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Kor PPK, Kwan RYC, Cheung DSK, Lai C. The utilization of a nurse-led clinic by older people with cognitive complaints: Do they follow our advice? Int J Nurs Pract 2022; 28:e13096. [PMID: 36003029 DOI: 10.1111/ijn.13096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 06/08/2022] [Accepted: 07/23/2022] [Indexed: 12/01/2022]
Abstract
AIM Cognitive assessment services were found to be beneficial to older people with cognitive complaints but information is limited on adherence to the recommendations provided. This study aimed to identify predictors of clients' adherence to nursing recommendations after attending a community-based nurse-led cognitive assessment service in Hong Kong. METHODS A cross-sectional design was adopted. We analysed a dataset routinely collected from clients attending the services between January 2012 and January 2018. Multiple regression analyses were conducted to identify predictors (demographics, functional health status and cognitive performance) of the clients' adherence. Their satisfaction with the services was also examined. RESULTS Two hundred and twenty-three clients attended the clinic. Of the 133 who completed the telephone follow-up at the 6 months postconsultation, 44.1% did not adhere to the recommendations. Clients with a higher Clinical Dementia Rating (OR = 4.17), lower Clock Drawing Test score (OR = 1.13) and lower education level (OR = 0.91) were found to be less likely to adhere to the nursing recommendations. Ninety-six percent (190/198) were satisfied with the overall services. CONCLUSION Cognitive assessment services in nurse-led clinics could provide a self-referred service for older people with cognitive complaints. However, low adherence to nursing recommendations was found among clients with poorer cognitive functions and lower education levels.
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Affiliation(s)
- Patrick Pui-Kin Kor
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, SAR, China
| | | | | | - Claudia Lai
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, SAR, China
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Luck KE, Doucet S. A rapid review exploring nurse-led memory clinics. Nurs Open 2021; 8:1538-1549. [PMID: 34102023 PMCID: PMC8186716 DOI: 10.1002/nop2.688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/18/2020] [Accepted: 10/27/2020] [Indexed: 01/23/2023] Open
Abstract
AIMS To systematically explore the structures, functions, outcomes, roles and nursing credentials of memory clinics where nurses autonomously lead diagnosis and postdiagnostic care. DESIGN A systematic rapid review was conducted. DATA SOURCES MEDLINE (Ovid), CINAHL Full-Text (EBSCO) and EMBASE were systematically searched in December 2019 with no timeframe limitations imposed. REVIEW METHODS The modified PRISMA checklist was used as a guide to facilitate the review. Articles identified were screened and assessed for inclusion criteria, and screening of reference lists of included studies was also completed. RESULTS Six articles, published between 2011-2019, including two case studies, two descriptive reports, one qualitative study and one programme evaluation were included in the review. Nurse-led memory clinics were situated in community centres, on university campuses, hospitals and in general practitioners' offices. The services offered included assessment, diagnosis and treatment/postdiagnostic care. Nurse credentials included advanced practice nurses and a community psychiatric nurse who was a non-medical prescriber. Overall, there was low quantity and quality of evidence to evaluate outcomes.
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Affiliation(s)
| | - Shelley Doucet
- University of New BrunswickSaint JohnNBCanada
- Dalhousie Medicine New BrunswickSaint JohnNBCanada
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Greenbank K, Hemingway S, Thiyagesh S, Stephenson J. Service user and carer experiences of the advanced nurse practitioner role in a memory assessment team. ACTA ACUST UNITED AC 2020; 29:960-967. [PMID: 32901537 DOI: 10.12968/bjon.2020.29.16.960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Advanced nurse practitioners (ANPs) within memory services can support prompt diagnoses of dementia. Further understanding of the role is necessary as evidence on its effectiveness is limited. AIM To assess service user and carer satisfaction with the ANP role within Kirklees memory assessment team. METHODS A cross-sectional survey was undertaken to evaluate carer and patient perceptions of the ANP role in a local memory assessment team. The survey was developed using the Royal College of Nursing's four pillars as a structure: clinical/direct care practice, leadership and collaborative practice, improving quality and developing practice, and developing self and others. RESULTS One hundred and fifteen surveys were sent out, and 85 were completed, a response rate of 73.9%. Patients expressed significant satisfaction with the ANP, in particular in the areas of direct clinical practice (84%) and quality of care received (87%). CONCLUSION Patients and families are highly satisfied with the service provided by the ANP. High-quality research is needed on the cost effectiveness and outcomes of ANP interventions.
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Affiliation(s)
- Karen Greenbank
- Advanced Nurse Practitioner, Kirklees Memory Assessment Team, South West Yorkshire Partnership NHS Foundation Trust
| | - Steve Hemingway
- Senior Lecturer in Mental Health, University of Huddersfield
| | - Subha Thiyagesh
- Consultant in Psychiatry for Older People, Medical Director, South West Yorkshire Partnership NHS Foundation Trust
| | - John Stephenson
- Senior Lecturer in Biomedical Statistics, University of Huddersfield
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Aldridge E, Verburg PE, Sierp S, Andraweera P, Dekker GA, Roberts CT, Arstall MA. A Protocol for Nurse-Practitioner Led Cardiovascular Follow-Up After Pregnancy Complications in a Socioeconomically Disadvantaged Population. Front Cardiovasc Med 2020; 6:184. [PMID: 31970161 PMCID: PMC6960097 DOI: 10.3389/fcvm.2019.00184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/05/2019] [Indexed: 11/17/2022] Open
Abstract
Background: Women who experience pregnancy complications have an increased risk of future cardiovascular disease when compared to their healthy counterparts. Despite recommendations, there is no standardized cardiovascular follow-up in the postpartum period for these women, and the Australian follow-up protocols that have been previously described are research-based. This study proposes a new model of care for a nurse practitioner-led postpartum intervention clinic for women who experience severe hypertensive disorders of pregnancy, gestational diabetes mellitus requiring medication, severe intrauterine growth restriction, idiopathic preterm delivery, or placental abruption, in a socioeconomically disadvantaged population. Methods: All women receiving antenatal care or who deliver at the Lyell McEwin Hospital, a tertiary acute care facility located in the northern Adelaide metropolitan area, following a severe complication of pregnancy are referred to the intervention clinic for review at 6 months postpartum. A comprehensive assessment is conducted from demographics, medical history, diet and exercise habits, psychosocial information, health literacy, pathology results, and physical measurements. Subsequently, patient-specific education and clinical counseling are provided by a specialized nurse practitioner. Clinic appointments are repeated at 18 months and 5 years postpartum. All data is also collated into a registry, which aims to assess the efficacy of the intervention at improving modifiable cardiovascular risk factors and reducing cardiovascular risk. Discussion: There is limited information on the efficacy of postpartum intervention clinics in reducing cardiovascular risk in women who have experienced pregnancy complications. Analyses of the data collected in the registry will provide essential information about how best to reduce cardiovascular risk in women in socioeconomically disadvantaged and disease-burdened populations.
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Affiliation(s)
- Emily Aldridge
- Adelaide Medical School, Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia.,Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,Department of Cardiology, Lyell McEwin Hospital, Adelaide, SA, Australia
| | - Petra E Verburg
- Adelaide Medical School, Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia.,Department of Obstetrics and Gynaecology, Rijnstate Hospital, Arnhem, Netherlands
| | - Susan Sierp
- Department of Cardiology, Lyell McEwin Hospital, Adelaide, SA, Australia
| | - Prabha Andraweera
- Adelaide Medical School, Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia.,Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Gustaaf A Dekker
- Adelaide Medical School, Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia.,Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,Department of Obstetrics and Gynaecology, Lyell McEwin Hospital, Adelaide, SA, Australia
| | - Claire T Roberts
- Adelaide Medical School, Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia.,Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Margaret A Arstall
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,Department of Cardiology, Lyell McEwin Hospital, Adelaide, SA, Australia
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Jager M, de Zeeuw J, Tullius J, Papa R, Giammarchi C, Whittal A, de Winter AF. Patient Perspectives to Inform a Health Literacy Educational Program: A Systematic Review and Thematic Synthesis of Qualitative Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4300. [PMID: 31694299 PMCID: PMC6862529 DOI: 10.3390/ijerph16214300] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 01/22/2023]
Abstract
Patient-centred care is tailored to the needs of patients and is necessary for better health outcomes, especially for individuals with limited health literacy (LHL). However, its implementation remains challenging. The key to effectively address patient-centred care is to include perspectives of patients with LHL within the curricula of (future) healthcare providers (HCP). This systematic review aimed to explore and synthesize evidence on the needs, experiences and preferences of patients with LHL and to inform an existing educational framework. We searched three databases: PsychInfo, Medline and Cinahl, and extracted 798 articles. One-hundred and three articles met the inclusion criteria. After data extraction and thematic synthesis, key themes were identified. Patients with LHL and chronic diseases encounter multiple problems in the care process, which are often related to a lack of person-centeredness. Patient perspectives were categorized into four key themes: (1) Support system; (2) Patient self-management; (3) Capacities of HCPs; (4) Barriers in healthcare systems. "Cultural sensitivity" and "eHealth" were identified as recurring themes. A set of learning outcomes for (future) HCPs was developed based on our findings. The perspectives of patients with LHL provided valuable input for a comprehensive and person-centred educational framework that can enhance the relevance and quality of education for (future) HCPs, and contribute to better person-centred care for patients with LHL.
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Affiliation(s)
- Margot Jager
- Department of Health Sciences, University Medical Center Groningen and University of Groningen, 9700 AD Groningen, The Netherlands; (J.T.); (A.F.d.W.)
| | - Janine de Zeeuw
- Department of Health Sciences, University Medical Center Groningen and University of Groningen, 9700 AD Groningen, The Netherlands; (J.T.); (A.F.d.W.)
- Department of Medical Sciences, Educational Institute, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Janne Tullius
- Department of Health Sciences, University Medical Center Groningen and University of Groningen, 9700 AD Groningen, The Netherlands; (J.T.); (A.F.d.W.)
| | - Roberta Papa
- Regional Health Agency Marche Region, 60125 Ancona, Italy; (R.P.); (C.G.)
- IRCCS INRCA, 60124 Ancona, Italy
| | - Cinzia Giammarchi
- Regional Health Agency Marche Region, 60125 Ancona, Italy; (R.P.); (C.G.)
- IRCCS INRCA, 60124 Ancona, Italy
| | - Amanda Whittal
- Department of Psychology & Methods, Jacobs University, 28759 Bremen, Germany;
| | - Andrea F. de Winter
- Department of Health Sciences, University Medical Center Groningen and University of Groningen, 9700 AD Groningen, The Netherlands; (J.T.); (A.F.d.W.)
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Open referral policy within a nurse-led memory clinic: patient demographics, assessment scores, and diagnostic profiles. Int Psychogeriatr 2015; 27:967-79. [PMID: 25483359 DOI: 10.1017/s1041610214002361] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Memory clinics, typically led by multidisciplinary teams and requiring health professional referral, are one means of providing diagnosis and care coordination for dementia. Nurse-led clinics may provide an effective and alternative means to dementia diagnosis, and open referral policies may minimize existing barriers to accessing a diagnosis, but evidence is needed. METHODS Patients attending a one-day per week nurse-led memory clinic over a 25-month period during 2011-2013 (n = 106) completed comprehensive cognitive assessments and were diagnosed by an aged care nurse practitioner. Descriptive statistics detail the demographics, assessment scores, and diagnostic profiles of patients. Comparable data from published literature was identified, and the differences were analyzed qualitatively. RESULTS One hundred and six patients were assessed with the key differences from other data sets being history of falls more common, higher mean Mini-Mental State Examination scores, and fewer dementia diagnoses. Sixty-four patients (60%) were self-referred to the nurse-led memory clinic, of which 19 (30%) were diagnosed with mild cognitive impairment (MCI) or dementia. Overall, forty-eight patients (45%) received diagnoses of MCI or dementia. CONCLUSIONS An open referral policy led to a high proportion of patients being self-referred, and nearly a third of these were diagnosed with cognitive impairment or dementia. Open referral policies and nurse-led services may overcome some of the barriers to early diagnosis that are currently experienced. Considering an aging population worldwide and the associated increases in cognitive impairment, which benefits from early identification and intervention, this paper provides an alternative model of nurse-led assessment.
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