Specialist community nurses: a critical analysis of their role in the management of long-term conditions

A Survey of Community Nurses' Knowledge and Strategies Used to Relieve Breathlessness in People with Chronic Obstructive Pulmonary Disease

BACKGROUND

Little is known about community nurses' knowledge of breathlessness and its management in chronic obstructive pulmonary disease (COPD).

AIM

To explore the community registered nurses' knowledge of COPD and the strategies that they use to manage breathlessness in people with COPD.

METHODS

A cross-sectional survey study of community registered nurses was conducted using the 65-item Bristol COPD Knowledge Questionnaire and an open-ended item to outline breathlessness strategies.

FINDINGS

A total of 59 nurses participated. The total mean Bristol COPD Knowledge Questionnaire Score was 43. The breathlessness category was the lowest scoring category. There were three themes that synthesised: the community nurse's role in monitoring self-management of medications to relieve breathlessness; the use of non-pharmacological strategies to relieve breathlessness; the nursing skills used to monitor breathlessness in people with COPD.

Nurses and Physicians' Perceptions Regarding the Role of Oncology Clinical Nurse Specialists in an Exploratory Qualitative Study

The purpose of the study was to examine the attitudes of nursing and medical teams about the role of oncology clinical nurse specialists in the healthcare system in Israel, where, unlike many countries in the world, such a role has not yet been developed or professionally defined. We conducted 24 interviews with physicians and nurses between August and October 2021. The interviews were transcribed and analyzed using a thematic analysis method. The Consolidated Criteria for Reporting Qualitative Research checklist was used to report the study. Five main themes emerged from the interviews: (1) contribution to the healthcare system, (2) contribution to the patient, (3) drawing professional boundaries, (4) additional responsibilities and authority for oncology clinical nurse specialists, and (5) the field's readiness for a new position of oncology clinical nurse specialists. The findings provide evidence about the need to develop the role of clinical nurse specialists in the oncology field due to its potential benefits for nurses, physicians, patients, family members, and the healthcare system. At the same time, an in-depth exploration of the boundaries of the role and its implementation, in full cooperation with the oncologists and relevant professional unions, is needed to prevent unnecessary conflicts in the oncology field. Professional development training programs in nursing must create a platform for open dialogue between key stakeholders, nurses, and physicians, in order to help all involved parties, place the benefits to the patients above any personal or status considerations.

Exploration of knowledge, attitudes, and perceived benefits towards nurse managers' participation in the health policy-making process: a qualitative thematic analysis study

Background

Participation of nurse managers in policy-making could help policy-makers to propose relevant and effective policies and support other policy actors involved with these processes.

Objective

This study aimed at exploring the attitudes and perceived benefits of nurse managers' participation in the health policy-making process.

Methods

In this descriptive qualitative research, semi-structured interviews were conducted with 16 nurse managers, government officials, and faculty members. Recruitment was based on purposive sampling from different regions across Iran. A thematic analysis was performed in MAXQDA (version 2012).

Results

After analysis of the qualitative data, four themes and 13 sub-themes emerged. The themes were feelings about nurse managers' participation, advantages of nurse managers' participation, problems due to the non-participation of nurse managers, and recommendations for improvement of the policy-making process.

Conclusion

The outcomes provided new insights into the perceived benefits of and attitudes towards nurse managers' participation in health policy making in the Iranian setting. It is crucial to strengthen the capacity for nurse managers' participation in health policy making to develop effective healthcare policies.

Holistic care of patients with diabetic foot ulcers during the COVID-19 era: integration of Henderson's Need Theory

The COVID-19 pandemic has inhibited the practice of diabetic foot ulcer care, particularly in the community. Comprehensive theory-based nursing care is needed to prevent further complications. Unfortunately, a study combining theory with nursing care in diabetic foot ulcer care has not been explored. When caring for patients with diabetic foot ulcers, who are also at increased risk of severe complications from COVID-19, it is important to take a holistic view of the patient and consider all of their needs and the factors affecting them. Henderson's Need Theory and the 14 basic needs contained within it was chosen to be integrated in the care of patients with diabetic foot ulcers during the pandemic, with the hope that the findings will help nurses to optimise care in both hospital-based and community practice.

The use of digital devices by district nurses in their assessment of service users

District nursing services are relentless in adapting to change and continuously seek different methods to improve the care they offer to service users. One of the relatively new changes where adaptation has been necessary is the use of digital devices to record assessments and work in real time. As documented in The NHS Long Term Plan (NHS) (2019), the NHS is being required to grow into the new digital age and, subsequently, district nurses (DNs) have needed to embrace the use of a paper-lite system. Although beneficial overall, the use of technology is a threat to the person-centred nursing approach used in assessment, which is the highest fundamental value in nursing. This article will seek to conceptualise the importance of a person-centred initial assessment with a service user who has either a long-term and/or a lifelong condition whilst considering the use of digital devices, benefits, and drawbacks of their use. It will emphasise the role of the DN, encompassing the multidisciplinary services throughout, whilst also considering any recommendations for further development.

Proposal for a general framework for the administration of anticancer immunotherapy in a hospital-at-home care

INTRODUCTION

Immunotherapy has transformed the treatment paradigm of several cancers. Hospital-at-home (HAH) care is an innovative healthcare model in which treatments are delivered at home under the supervision of a hospital, which likely applies to cancer immunotherapy. For this home-care option, official treatment guidelines are still lacking. We therefore sought to create guidance and recommendations on how to administer immune response checkpoint inhibitor therapies and other monoclonal antibodies used in cancer treatment in the context of HAH setting.

METHODS

A multidisciplinary group of healthcare professionals with expertise in managing cancer patients and prescribing immunotherapy in HAH settings was set up.

RESULTS

Based on the survey results and working group discussions, six major components were identified: (1) existing HAH organization in France; (2) underlying framework; (3) flowchart; (4) patient pathway before, the day of, and after immunotherapy; (5) healthcare personnel training; (6) patient therapeutic education. The detailed specifications for each component are provided herein, along with an illustrative flowchart. The prerequisites for home administration of cancer immunotherapies are summarized in Table 1.

DISCUSSION

This paper seeks to facilitate the implementation of cancer immunotherapy within HAH settings for the healthcare professionals concerned.

Competency Model for the Middle Nurse Manager (MCGE-Logistic Level)

Healthcare systems are immersed in transformative processes, influenced by economic changes, together with social and health instability. The middle nurse manager plays a fundamental role, since he or she is responsible for translating the strategic vision, values and objectives of the organization. The objective of this study was to propose the model of competencies to be developed by the middle nurse manager in the Spanish healthcare system. Our methodology consisted in the application of the Delphi method in order to reach an agreement on the necessary competencies, and principal component analysis (PCA) was used to determine the construct validity, reducing the dimensionality of the set of data. Fifty-one competencies were identified for the definition of the model, highlighting decision-making, leadership and communication. The PCA pointed out the structural validity of the proposed model through the saturation of the main components (α Cronbach > 0.631). The results show the model of competencies which the middle nurse manager in the Spanish healthcare system must develop. Middle nurse managers may use these as criteria to plan their professional strategies in the context of management. This model of competencies can be applied to establishing selection processes or training programs for the role of middle nurse manager.

Nurse Manager Core Competencies: A Proposal in the Spanish Health System

Nurses who are capable of developing their competencies appropriately in the field of management are considered fundamental to the sustainability and improvement of health outcomes. These core competencies are the critical competencies to be developed in specific areas. There are different core competencies for nurse managers, but none in the Spanish health system. The objective of this research is to identify the core competencies needed for nurse managers in the Spanish health system. The research was carried out using the Delphi method to reach a consensus on the core competencies and a Principal Component Analysis (PCA) to determine construct validity, reducing the dimensionality of a dataset by finding the causes of variability in the set and organizing them by importance. A panel of 50 experts in management and healthcare engaged in a four-round Delphi study with Likert scored surveys. We identified eight core competencies from an initial list of 51: decision making, relationship management, communication skills, listening, Leadership, conflict management, ethical principles, collaboration and team management skills. PCA indicated the structural validity of the core competencies by saturation into three components (α Cronbach >0.613): communication, leadership and decision making. The research shows that eight competencies must be developed by the nursing managers in the Spanish health system. Nurse managers can use these core competencies as criteria to develop and plan their professional career. These core competencies can serve as a guideline for the design of nurse managers’ development programs in Spain.

What affects length of hospital stay? A case study from Malta

PURPOSE

Hospital length of stay (LOS) is not only a function of patient- and disease-related factors, but is also determined by other health system-wide variables. Managers and clinicians strive to achieve the best possible trade-off between patients' needs and efficient utilisation of hospital resources, while also embracing ethical decision making. The purpose of this paper is to explore the perceptions of the hospital's major stakeholders as to what affects the duration of LOS of inpatients.

DESIGN/METHODOLOGY/APPROACH

Using a data-triangulated case study approach, 50 semi-structured interviews were performed with management, doctors, nurses and patients. Additionally, the hospitals' standard operating procedures, which are pertinent to the subject, were also included in the thematic analysis.

FINDINGS

This study shows that LOS is a multi-dimensional construct, which results from a complex interplay of various inputs, processes and outcomes.

RESEARCH LIMITATIONS/IMPLICATIONS

The findings emerging from a single case study approach cannot be generalised across settings and contexts, albeit being in line with the current literature.

PRACTICAL IMPLICATIONS

The study concludes that a robust hospital strategy, which addresses deficient organisational processes that may unnecessarily prolong LOS, is needed. Moreover, the hospital's strategy must be sustained by providing good primary care facilities within the community set-up, as well as by providing more long-term care and rehabilitation beds to support the hospital turnover.

ORIGINALITY/VALUE

The subject of LOS in hospitals has so far been tackled in a fragmented manner. This paper provides a comprehensive and triangulated account of the complexities surrounding the duration in which patients are kept in hospital by key stakeholders, most of whom were hands-on in the day-to-day running of the hospital under study.

The oncology nurse coordinator: role perceptions of staff members and nurse coordinators

BACKGROUND

There is extensive evidence that the role of nurse coordinators is beneficial for patients. Nurse coordinators are more available to patients compared to general registered nurses, know better to control symptoms and work as team players with multiple care providers. Despite its significance, there is a dearth of literature on the subject in Israel and a lack of clarity regarding the definitions of the role in terms of responsibilities and authorities. The aim of the study is to: To examine how the role of nurse oncology coordinator is implemented in various fields of oncology and to describe the actual performance of different kinds of oncology nurse coordinators and staff perceptions regarding this role in one tertiary hospital in Jerusalem.

METHODS

A phenomenological approach was used to explore the participants' experiences and views of nurse coordinators' performance. We conducted a qualitative study using in-depth semi-structured interviews. Interviewees included 30 employees from different levels of the hospitals, and leading figures associated with oncology medicine outside of the hospital: Nurses and physicians of the Sharett Oncology Institute of Hadassah Ein Kerem Hospital in Jerusalem, the administrative staff of Hadassah Ein Kerem Hospital, head nurses of the Israel Cancer Association, the chairperson of the Non-Profit Organization of Oncology Nurses, nurse directors at the Ministry of Health Nursing Division, and seven nurse coordinators at Hadassah Ein Kerem Hospital in diverse fields of oncology.

RESULTS

The nurse coordinator is perceived as an important staff member providing care to cancer patients. Several key elements were found to be common features in the work of all nurse coordinators: emotional support, guidance to patients, and coordination of patients' care.

CONCLUSIONS

The nurse coordinator plays a noteworthy role in the health care system. In view of the variety of roles that the nurse coordinator assumes in different units, performance standards must be adapted to the performance areas for each unit, as well as nurses' professional development requirements. Changes in a service organization and careful attention to the continuum of care highlight the need to develop and to strengthen the role of a nurse who coordinates treatment over the entire continuum of care, both in the hospital and in the community.

Programmed home visits by nursing professionals to older adults: prevention or treatment?

OBJETIVOS:

conocer la repercusión de la visita domiciliaria de los profesionales en enfermería a personas de 65 años o más, pluripatológicas, en morbimortalidad.

MÉTODO:

estudio retrospectivo caso-control por auditoria de historias clínicas. Muestreo aleatorio. Variables principales morbilidad, mortalidad; descriptivas: visitas de la enfermera, filiación, datos clínicos y socio sanitarios. Análisis por medidas de tendencia central, dispersión, posición, tabulación, frecuencias relativas, absolutas; no paramétricas, contrastes χ2; Wilcoxon-Mann-Whitney.

RESULTADOS:

se estudiaron a 1743 pacientes, de ellos 199 recibieron visita domiciliaria; la edad media de quien recibe visita es de 81,99 años; estos presentan mayor número de patologías de media 3,76; habitan en domicilio particular, si bien en conjunto presentan más institucionalización que los controles; el 50% no tiene identificado el Cuidador Principal; es mayor el número de visitas de las enfermeras a los pacientes que viven en residencias (p < 0,001). El 50% de casos no tiene plan de cuidados, con relación significativa (p < 0,001). No existen diferencias significativas en tiempo de vida entre los casos y los controles.

CONCLUSIÓN:

la visita domiciliaria del profesional en enfermería no repercute en la morbimortalidad; visita a los pacientes cuando ya ha aparecido el problema de salud, no hay datos de prevención.

Specialized nursing practice for chronic disease management in the primary care setting: an evidence-based analysis

BACKGROUND

In response to the increasing demand for better chronic disease management and improved health care efficiency in Ontario, nursing roles have expanded in the primary health care setting.

OBJECTIVES

To determine the effectiveness of specialized nurses who have a clinical role in patient care in optimizing chronic disease management among adults in the primary health care setting.

DATA SOURCES AND REVIEW METHODS

A literature search was performed using OVID MEDLINE, OVID MEDLINE In-Process and Other Non-Indexed Citations, OVID EMBASE, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), the Wiley Cochrane Library, and the Centre for Reviews and Dissemination database. Results were limited to randomized controlled trials and systematic reviews and were divided into 2 models: Model 1 (nurse alone versus physician alone) and Model 2 (nurse and physician versus physician alone). Effectiveness was determined by comparable outcomes between groups in Model 1, or improved outcomes or efficiency in Model 2.

RESULTS

Six studies were included. In Model 1, there were no significant differences in health resource use, disease-specific measures, quality of life, or patient satisfaction. In Model 2, there was a reduction in hospitalizations and improved management of blood pressure and lipids among patients with coronary artery disease. Among patients with diabetes, there was a reduction in hemoglobin A1c but no difference in other disease-specific measures. There was a trend toward improved process measures, including medication prescribing and clinical assessments. Results related to quality of life were inconsistent, but patient satisfaction with the nurse-physician team was improved. Overall, there were more and longer visits to the nurse, and physician workload did not change.

LIMITATIONS

There was heterogeneity across patient populations, and in the titles, roles, and scope of practice of the specialized nurses.

CONCLUSIONS

Specialized nurses with an autonomous role in patient care had comparable outcomes to physicians alone (Model 1) based on moderate quality evidence, with consistent results among a subgroup analysis of patients with diabetes based on low quality evidence. Model 2 showed an overall improvement in appropriate process measures, disease-specific measures, and patient satisfaction based on low to moderate quality evidence. There was low quality evidence that nurses working under Model 2 may reduce hospitalizations for patients with coronary artery disease. The specific role of the nurse in supplementing or substituting physician care was unclear, making it difficult to determine the impact on efficiency.

PLAIN LANGUAGE SUMMARY

Nurses with additional skills, training, or scope of practice may help improve the primary care of patients with chronic diseases. This review found that specialized nurses working on their own could achieve health outcomes that were similar to those of doctors. It also found that specialized nurses who worked with doctors could reduce hospital visits and improve certain patient outcomes related to diabetes, coronary artery disease, or heart failure. Patients who had nurse-led care were more satisfied and tended to receive more tests and medications. It is unclear whether specialized nurses improve quality of life or doctor workload.

Success and failure in integrated models of nursing for long term conditions: multiple case studies of whole systems

BACKGROUND

Current projections indicate that the UK faces a 252% increase in people aged over 65 with one or more long term conditions (LTC) by 2050. Nurses, managing their own caseloads and clinics, working across sectors and organisational boundaries and as part of a wider multi-disciplinary team, are frequently seen as key to managing this growing demand. However, the evidence base informing the nursing role in managing LTC, the most effective configuration of the multi-disciplinary team and the policy evidence relating to the infrastructure required to support cross organisational working, remains weak.

OBJECTIVES

To explore, identify and characterise the origins, processes and outcomes of effective chronic disease management models and the nursing contributions to such models.

DESIGN

Case study whole systems analysis using qualitative interview methods.

SETTINGS

Two community matron services, two primary care (GP) practice nursing services, two hospital based specialist nursing services were purposefully sampled from across England and Wales.

PARTICIPANTS

Selection criteria were derived using a consensus conference. The nurses in the service, all patients and carers on the caseload, members of the multi-disciplinary team and stakeholders were invited to participate.

METHODS

Semi-structured interviews with all participants, thematic analysis within a whole system framework.

RESULTS

The study found high levels of clinical nursing expertise which in the case of the community matrons was meeting the aim of reducing hospital admissions. Both the primary care and hospital nurse specialist indicate similar levels of clinical expertise which was highly valued by medical colleagues and patients. Patients continued to experience fragmented care determined by diagnostic categories rather than patient need and by the specific remit of the clinic or service the patient was using. Patient data systems are still organised around the impact on services and prevalence of disease at an individual level and not around the patient experience of disease.

CONCLUSION

Nurses are making a major contribution to meeting the policy objectives for long term conditions. Primary care nurses and hospital nurse specialists do broadly similar roles. The scope of the nursing roles and services studied were idiosyncratic, opportunistic and reactive, rather than planned and commissioned on an analysis of local population need.