COVID-19 and adult congenital heart disease services: impact on support and advice from nurse specialists.

Although the focus on service provision in response to the COVID-19 pandemic has mainly been on acute and particularly intensive care, it is important to consider other services that are still needed. This is especially the case for vulnerable patients with long-term conditions, such as those under the care of an adult congenital heart disease (ACHD) service. The authors conducted a survey of ACHD nurse specialists in centres across the UK to acertain what they were planning in terms of the redeployment of nurse specialists. The results showed a range of plans with an average of half of nurses per centre being moved, but with 65% of the workforce planned to be redeployed to deal with the pandemic. The telephone advice service at the authors' own level 1 centre showed a significant increase in patients seeking advice when compared with the previous year, with large peaks following major Government announcements. Access to specialist advice for patients with complex conditions is of vital interest, for those in a wide range of specialities.

Managing capability in specialist nursing practice.

Raising concerns over another nurse's clinical practice and capability presents significant challenges, particularly in specialist clinical nursing roles. However, the support provided to nurses who raise such concerns is not always optimal. While compassionate leadership in healthcare has been stated as a priority to develop safer workplaces for staff, it must be balanced against the need to manage staff undergoing capability management processes. This article discusses how enhanced training and support for both line managers and staff can improve the capability management processes.

Nurse-led care for the management of rheumatoid arthritis: a review of the global literature and proposed strategies for implementation in Africa and the Middle East.

Globally, increasing demand for rheumatology services has led to a greater reliance on non-physician healthcare professionals (HCPs), such as rheumatology nurse specialists, to deliver care as part of a multidisciplinary team. Across Africa and the Middle East (AfME), there remains a shortage of rheumatology HCPs, including rheumatology nurses, which presents a major challenge to the delivery of rheumatology services, and subsequently the treatment and management of conditions such as rheumatoid arthritis (RA). To further explore the importance of nurse-led care (NLC) for patients with RA and create a set of proposed strategies for the implementation of NLC in the AfME region, we used a modified Delphi technique. A review of the global literature was conducted using the PubMed search engine, with the most relevant publications selected. The findings were summarized and presented to the author group, which was composed of representatives from different countries and HCP disciplines. The authors also drew on their knowledge of the wider literature to provide context. Overall, results suggest that NLC is associated with improved patient perceptions of RA care, and equivalent or superior clinical and cost outcomes versus physician-led care in RA disease management. Expert commentary provided by the authors gives insights into the challenges of implementing nurse-led RA care. We further report practical proposed strategies for the development and implementation of NLC for patients with RA, specifically in the AfME region. These proposed strategies aim to act as a foundation for the introduction and development of NLC programs across the AfME region.

Efforts to reduce the length of stay in a low-intensity ICU: Changes in the ICU brought about by collaboration between Certified Nurse Specialists as head nurses and intensivists.

Certified Nurse Specialists (CNS) are advanced practice nurses that often play a role in management. This study aims to investigate whether cooperation between CNSs in the position of Intensive Care Unit (ICU) head nurse and intensivists change the length of stay for ICU patients. A single centered retrospective cohort study design was followed. A multivariable regression analysis was performed to determine whether there is a difference in patients' length of ICU stay for two years before and after CNS as ICU head nurse and an intensivist started collaborating. The patients' diagnosis, age, gender, scheduled/emergency admission, surgical history, length of ICU stay, usage of ventilator, and details of ICU treatment were collected from the institution's electronic medical records. During the study period (April 2015 to March 2019), 3,135 patients were admitted to ICU, with 1,471 in the before collaboration group and 1,664 in the after-collaboration group. Collaboration between the CNS as head nurse and intensivists was significantly associated with shorter length of ICU stay (coefficient -0.03 [95% CI, -0.05-0.01], p < 0.001, t-statistic -3.29). Our main finding illustrates that in low-intensity ICUs, collaboration between CNSs as head nurses and intensivists may reduce patients' length of ICU stay.

Specialist nurse initiated interventions in breast cancer care: A systematic review of randomised controlled trials.

AIMS AND OBJECTIVES: To evaluate the effectiveness of specialist nurse interventions in the care of women with breast cancer. BACKGROUND: Nurses perform a crucial role in physical and psychosocial support of women with breast cancer. However, only few reviews have explored and discussed the roles and interventions carried out by specialised nurses in breast cancer care. DESIGN: Systematic review based on PRISMA guidelines. METHODS: A comprehensive literature search was conducted in PubMed, CINAHL, Scopus, Web of Science, Science Direct, Cochrane Library, IndMed and Shodhganga databases for articles published in English language from 1980 to 2018. Only RCTs were included. Quality assessment, data extraction and analysis were completed on all included studies. RESULTS: Sixteen papers were assessed for methodological quality. Due to methodological heterogeneity of the papers, a meta-analysis was not performed. The reviewers categorised the main outcomes under different domains like physical problems, psychological problems, patient satisfaction, patient needs, quality of life and cost data. DISCUSSION: This review provides evidence on specialist nurses' role in breast cancer care. The methodological aspects of studies in this review vary in different aspects. More studies with rigorous scientific methods are needed to provide robust evidence on effectiveness of specialist nurses' role. CONCLUSION: Even though specialist nursing interventions can contribute to health outcomes of women with breast cancer, there is limited number of studies reported from developing countries. This warrants the need for specialist nurse interventions in breast cancer care from developing countries. RELEVANCE TO CLINICAL PRACTICE: Offering a specialist nurse service helps the patients to meet their informational and educational needs, supportive care and coordination of care. Specialist breast nurse services can be integrated into hospital setting to improve patient care and treatment adherence.

Factors influencing the implementation of Epilepsy Specialist Nurse role: Using the Consolidation Framework for Implementation Research.

BACKGROUND: Research to support the added value of including Epilepsy Specialist Nurses as members of the multidisciplinary team is developing, yet little information exists on factors influencing the translation of these roles into practice. AIM: To describe the enabling and inhibiting factors to the implementation of the Epilepsy Specialist Nurse role in the Republic of Ireland. METHODS: A qualitative design involving semi-structure interviews, observation and analysis of documents, such as portfolios was used. The sample included 12 Epilepsy Specialist Nurses, 24 multidisciplinary team members, and 35 individuals with epilepsy and family members. Data were analysed using the Consolidation Framework for Implementation Research. Reporting rigour is demonstrated using the COREQ checklist (See Appendix S1). RESULTS: While there was overwhelming support for the role, barriers and enablers were identified across all domains of the Consolidation Framework for Implementation Research. Enablers included national policies and guidelines, leadership from senior nursing and medical colleagues, climate of learning and mentorship, networking opportunities, infrastructural supports and competence of Epilepsy Specialist Nurses. Barriers included the limited consideration of service expansion and the increasingly complex nature of clinical cases on workload capacity. Deficits in infrastructural supports, challenges in relation to role preparation, role implementation and role responsibility, including concerns around lone practitioner models and concerns that the role was a cost-saving measure, also emerged as potential barriers to future sustainability. CONCLUSION: The Consolidation Framework for Implementation Research offers researchers a pragmatic typology for analysing interrelationships between enabling and inhibiting factors that impact implementation of advanced practice roles, across different evidence sources, disciplines and boundaries. RELEVANCE TO CLINICAL PRACTICE: In order to secure role sustainability, managers need to address the rate of service expansion, models of role development, deficits in supports and perceived motivations for role development on the quality, acceptability and sustainability of services provided.

Divisional review of the nurse specialist role.

Nurse specialists have been described as providing an optimal return on investment for income generation, patient safety, cost savings, and improvements in patient care and experience. However, there is often a lack of understanding of the nurse specialist role and how such nurses support improved patient outcomes. To assess the effect of the nurse specialist in a division of one large NHS trust, a review of the nurse specialist role was undertaken within eight specialties. This review profiled nurse specialists' roles in terms of their activity, income generation and quality, with the aim of producing specialist job plans to accurately reflect their roles. Nurse specialists were provided with a job-planning template and face-to-face sessions on how to complete it. The returned job plans were reviewed by a panel consisting of nursing management, lead clinical nurse specialists and representatives from finance. The results were used to generate three generic nurse specialist job plans that recognised the core elements of the role. The division intends to undertake a further review of nurse specialists, which aims to explore the role in further detail, including identifying their development needs. Having examined the effects of the nurse specialist role, the division needs to ensure that nurse specialists are resourced to reach their full potential.

Specializing Nurses as An Indirect Education Program for Stoma Patients.

Education programs are beneficial for patients with different chronic conditions. Prior studies have examined direct education, where information is transferred directly to patients. In contrast, in this program, information is transferred directly to nurses who become specialists and transfer education individually to patients. Hence, this paper evaluates the impact of having specialist nurses for stoma patients at hospitals, as those nurses provide healthcare to patients but also inform and educate patients about their condition and needs. The analysis uses an observational study with ostomized patients in Spain at hospitals with and without specialist nurses, and measures health service utilization and health-related quality of life (HRQL), besides performing a cost analysis and a cost-effectiveness analysis at both types of hospitals. The results show that patients with access to specialist nurses self-manage better, present lower adverse events and a better evolution of HRQL, and significantly demand more consultations with specialist nurses and less to A&E, primary care or specialists, resulting in important savings for the health system. Consequently, specializing or hiring nurses to provide indirect education to stoma patients is cost-effective and highly beneficial for patients. This type of indirect education strategy might be considered for specific conditions with low incidence or difficulties in identifying target patients or delivering information directly to them.

The role of specialist nurses for organ donation: A solution for maximising organ donation rates?

AIMS AND OBJECTIVES: To explore the role that Donor Transplant Co-ordinators have played and the future potential of Specialist Nurses for Organ Donation (SN-ODs), within organ donation strategies in the UK and other countries. BACKGROUND: Organ donation and transplantation rates vary extensively around the world. However, there is a universal shortage of deceased donors, prompting different approaches to increase transplantation rates. Within the UK, the Clinical Lead for Organ Donation and Specialist Nurse in Organ Donation undertake a key role in the implementation of the Organ Donation Strategy. The Human Transplantation (Wales) Act 2015 is a recent development which facilities a deemed (presumed) consent approach to organ donation, the Specialist Nurse in Organ Donation undertakes a major role identifying the potential donor in this situation by confirming the deemed consent status of the donor and supporting bereaved relatives. UK governments in England and Scotland are currently seeking legislative changes to an opt-out system of organ donation, in line with the Wales change. DESIGN: This discursive paper explores the role from Donor Transplant Co-ordinator to Specialist Nurse in Organ Donation (SN-OD) within organ donation policy in different settings, but with a specific focus on the UK. The paper clarifies the current and future potential of nurses working with bereaved families when requesting authorisation for donation. IMPLICATIONS FOR NURSING: The current scope and future potential of Donor Transplant Co-ordinator and Specialist Nurse in Organ Donation roles need better recognition. Little empirical data exist about the key role that these nurses play in the organ donation process, especially in relation to gaining authorisation to proceed to donation. CONCLUSION: There is a need to clarify the role of the Specialist Nurse in Organ Donation and their impact on improving rates of organ donation.

Trends in the primary health care nursing workforce providing diabetes care in Auckland, New Zealand: A cross-sectional survey.

AIMS: To describe trends from 2006-8 to 2016 in demographic, education and work settings of the primary health care nursing workforce who provide diabetes care in the Auckland region. METHODS: A total of 1416 practice, Accident and Medical, district and diabetes specialist nurses were identified who provide community-based care. Of those, 459 were randomly selected and 336 were interviewed in 2016, and were compared with 287 nurses interviewed in 2006-8. RESULTS: A 73% response rate was attained in 2016. Compared with nurses in 2006-8, primary health care nurses in 2016 were younger, less experienced, more likely to be Asian, undertook more post-graduate education, worked more in Accident and Medical Clinics and worked in larger practices with ≥4 doctors. However, less worked with a dietitian or received visits from specialist nurses compared with nurses in 2006-8. Significantly more nurses in 2016 had their own room for administrative work and the ability to email patients suggesting greater autonomy. CONCLUSIONS: Major demographic, educational and workplace changes have occurred in the Auckland primary health care nursing workforce from 2006-8 to 2016. A significant increase in practice nurses and a large decrease in the number of diabetes specialist nurses were evident, in the Auckland region.

Core components of the rural nurse specialist role in New Zealand.

INTRODUCTION: New Zealand has a rural population with unique healthcare needs. Traditionally, rural health care has been provided by medical general practitioners (GPs); however, as the number of GPs declines, the rural nurse specialist (RNS) role has emerged. The RNS is a registered nurse with advanced nursing skills that enable independent, autonomous practice within rural areas. The health needs of each rural community are specific to that area and the RNS role has been developed according to local healthcare needs. The purpose of this research was to provide a description of the RNS role in New Zealand. METHODS: A descriptive exploratory approach was used in this qualitative study. The study was conducted in two parts. Phase 1 consisted of document content analysis of RNS position descriptions and phase 2 comprised four semi-structured interviews with RNSs. Data were analysed using thematic analysis. The Modified Strong Model of Advanced Practice was utilised as a framework for thematic analysis during both phases. RESULTS: Rural nurse specialists demonstrated a wide variance in the understanding of the term 'RNS'. The RNS role was found to include provision of care across a wide range of settings according to local needs. Advanced assessment skills were expected by employers and considered a major component of the role by RNSs. Advanced assessments skills were utilised to enhance communication and thus increase collaboration with other health professionals. The ability to effectively communicate and collaborate with other health professionals was found to be a high priority. However, RNSs perceived that collaboration and thus patient care was affected by a lack of role clarity. The nurse practitioner (NP) role in New Zealand was considered more effective, with greater role recognition for the NP. Education was considered essential to maintain advanced assessment skills. RNSs identified providing education in the form of health promotion relevant to local needs as important. There was a lack of information regarding publication and professional leadership, highlighting this as an area for development. Another issue was the importance of stress management in an isolated area. CONCLUSION: The RNS role requires advanced knowledge to provide independent patient care. Advanced skills utilised include assessment, diagnosis and treatment of patients. RNSs must have postgraduate education to develop the advanced skills required in this role. RNSs perceive the NP role as having better role clarity; therefore, all participants were considering becoming an NP. There are barriers to becoming an NP, thus an expansion of the current RNS role is recommended. Further recommendations from this study include increased professional leadership to improve RNS visibility and further continued interprofessional education to enhance collaboration.

[Development of a program theory as a basis for the evaluation of a dementia special care unit]. / Entwicklung einer Programmtheorie als Grundlage für die Evaluation einer Demenzstation.

Background: An existing dementia special care unit should be evaluated. In order to build a sound foundation of the evaluation a deep theoretical understanding of the implemented intervention is needed, which has not been explicated yet. One possibility to achieve this is the development of a program theory. Aim: The aim is to present a method to develop a program theory for the existing living and care concept of the dementia special care unit, which is used in a larger project to evaluate the concept theory-drivenly. Method: The evaluation is embedded in the framework of van Belle et al. (2010) and an action model and a change model (Chen, 2015) is created. For the specification of the change model the contribution analysis (Mayne, 2011) is applied. Data were collected in workshops with the developers and the nurses of the dementia special care unit and a literature research concerning interventions and outcomes was carried out. The results were synthesized in a consens workshop. Results: The action model describes the interventions of the dementia special care unit, the implementers, the organization and the context. The change model compromises the mechanisms through which interventions achieve outcomes. Conclusions: The results of the program theory can be employed to choose data collection methods and instruments for the evaluation. On the basis of the results of the evaluation the program theory can be refined and adapted.

Variation in job titles within the nursing workforce.

AIMS AND OBJECTIVES/BACKGROUND: The work of specialist nursing has been under scrutiny for many years in the UK due to a perception that it is not cost-effective. A common issue is the lack of consistency of job titles, which causes confusion to the public, employing organisations, colleagues and commissioners of services. Lack of consistency has implications for the wider perception of advanced specialist practice in the worldwide community and the workforce more generally. This study aims to understand the variation in job titles in the UK population. METHODS: A pre-existing data set of accrued studies into the work of nurses working in specialisms was mined for insight (N = 17,960). This study used knowledge discovery through data and descriptive statistics to perform secondary analysis. RESULTS: Mining these data revealed 595 job titles in use in 17,960 specialist posts once the specialism had been removed. The most commonly used titles were Clinical Nurse Specialist, Nurse Specialist/Specialist Nurse, Advanced Nurse Practitioner and Nurse Practitioner. There were three other primary groupings. These were variants with a specialist or technical prefix of suffix, for example Nurse Endoscopist, variants of seniority such as trainee, senior nurse for [specialism] or variants of function such as Nurse Prescriber. The clustering was driven primarily by pay band. A total of 323 posts were recorded as holding titles such as Advanced Nurse Practitioner or Specialist Nurse who were not registered with the Nursing & Midwifery Council. RELEVANCE TO CLINICAL PRACTICE: In this data set, there is a large array of titles, which appear to have little relationship with other factors like education. This is confusing to the public, employers and those commissioning services. It also demonstrates that the previous assumptions by Council for Healthcare Regulatory Excellence that advanced practice labels are associated with career progression are unsound and should be addressed by the regulator.

Feasibility of a respiratory nurse specialist-led sleep disorder service in a district general hospital.

Aim The burden of referrals to investigate sleep disorders has escalated considerably. In order to address this, the feasibility of a nurse-led sleep disorder clinic was investigated. Methods Sleep referrals were stratified on the basis of information contained within the primary care referral, and appropriate home-based sleep studies arranged if obstructive sleep apnoea was considered the most likely working diagnosis. Selected patients were started on continuous positive airway pressure treatment if deemed appropriate. Education was almost exclusively provided by specialist nursing staff or by means of validated information by the British Lung Foundation. Results Eighty patients were included in the respiratory nurse-led sleep service. Feedback from the patient questionnaire was positive and 59 patients were managed without requirement to attend consultant-led outpatient services. Non-sleep breathing disorders as the reason for daytime somnolence, and patients requiring referral to tertiary services, were identified. Conclusion Developing a respiratory nurse-led sleep service is adequate to identify non-sleep breathing disorders, is fit for purpose, functions broadly in accordance with American Sleep Society guidelines, and is well received by patients.

Use of a screening tool and primary health care gerontology nurse specialist for high-needs older people.

OBJECTIVES: To describe implementation of an innovative gerontology nurse specialist role within one primary health organisation in Auckland, New Zealand. Quantitative outcomes of the screening tool as well as the nurse specialist assessment will be presented. METHOD: The intervention involved use of the Brief Risk Identification for Geriatric Health Tool (BRIGHT) to identify high-needs older people with subsequent comprehensive geriatric assessment (CGA) performed by the gerontology nurse specialist. RESULTS: A total 384 of the 416 BRIGHTs were completed (92% response rate) and 15% of these were identified as high risk (n = 57). The BRIGHTs for high-risk older people revealed the highest scoring question was 'needing help with housework' (26%). The most frequent intervention by the gerontology nurse specialist was education (30%). CONCLUSIONS: The primary health care gerontology nurse specialist model delivers a proactive case finding and specialist gerontology intervention for older people at high risk of functional or health decline.

Conflict management style, supportive work environments and the experience of work stress in emergency nurses.

AIMS: To examine the conflict management style that emergency department (ED) nurses use to resolve conflict and to determine whether their style of managing conflict and a supportive work environment affects their experience of work stress. BACKGROUND: Conflict is a common stressor that is encountered as nurses strive to achieve patient satisfaction goals while delivering quality care. How a nurse perceives support may impact work stress levels and how they deal with conflict. METHODS: A correlational design examined the relationship between supportive work environment, and conflict management style and work stress in a sample of 222 ED nurses using the expanded nurse work stress scale; the survey of perceived organisational support; and the Rahim organisational conflict inventory-II. RESULTS: Twenty seven percent of nurses reported elevated levels of work stress. A supportive work environment and avoidant conflict management style were significant predictors of work stress. CONCLUSIONS: Findings suggest that ED nurses' perception of a supportive work environment and their approach to resolving conflict may be related to their experience of work stress. IMPLICATIONS FOR NURSING MANAGEMENT: Providing opportunities for ED nurses in skills training in constructive conflict resolution may help to reduce work stress and to improve the quality of patient care.

The role and impact of the specialist trauma nurse: an integrative review.

To identify the scope, context, and impact on patient and health service outcomes of the specialist trauma nurse. Integrative review with data sourced from CINAHL, OvidSP, Scopus, and hand searching of references. Abstracts were screened for inclusion/exclusion criteria with 56 articles appraised for quality, analyzed, and synthesized into 3 main categories. This international review shows a widely varied scope and context of practice with positive impacts on patient and health service outcomes. Further research and exploration are recommended to develop a consistent model of care and further ascertain the benefits of the specialist trauma nurse role.