An exploration of the Role of the Prostate Cancer Specialist Nurse from Two International Perspectives.

OBJECTIVE: A diagnosis of prostate cancer is a major life-changing event that brings social, psychological, physical, financial, and spiritual challenges. In both the United Kingdom (UK) and Australia, prostate cancer specialist nurses (PCSNs) have a unique role in the care of men and their families. Prostate cancer specialist nursing roles are described from the UK and Australian perspective. DATA SOURCES: Government regulations, peer-reviewed journal articles, nursing society and government websites. CONCLUSION: Specialist nursing roles have developed within different frameworks and in response to very different political drivers in the UK and in Australia. An evidence base has developed demonstrating that PCSNs offer positive outcomes for men and their families. Despite some differences in the scope of international roles, there are common aspects. Both health care settings have challenges in terms of education, role definition, and capacity. Yet both PCSN roles have delivered innovative models of specialist care in terms of service delivery and patient support and education. IMPLICATIONS FOR NURSING PRACTICE: PCSNs have the potential to significantly decrease the burden on the public health system and influence change. For men with prostate cancer and their families, PCSNs can improve care through holistic nursing models focussing on what is important to individuals: support, education, management of side effects, rehabilitation, and by delivering and improving access to high-quality care.

Clinical Nurse Leader Knowledge Production to Quality Improvement in a Seamless Trajectory: A Participatory Research Approach.

BACKGROUND: Health systems are actively implementing Clinical Nurse Leader (CNL)-integrated care delivery across the United States. PROBLEM: However, the CNL model is a complex health care intervention, making it difficult to generate evidence of effectiveness using traditional research frameworks. APPROACH: Participatory research is a growing alternative to traditional research frameworks, emphasizing partnership with target community members in all phases of research activities. This article describes a system-based participatory study that leveraged academic and practice knowledge to conduct research that was feasible and relevant, and which produced findings that were easily translated into systematic action by the health system. OUTCOMES: Study data were used to produce improvements in the health system's CNL onboarding process, role differentiation, performance, recruitment, and growth plus development. CONCLUSIONS: A participatory approach can be used in future CNL studies, providing a framework for research efforts and potentially speeding up CNL evidence generation and utilization in practice.

Using patient-reported outcome measures to deliver enhanced supportive care to people with lung cancer: feasibility and acceptability of a nurse-led consultation model.

PURPOSE: Developing new supportive/palliative care services for lung cancer should encompass effective ways to promptly identify and address patients' healthcare needs. We examined whether an in-clinic, nurse-led consultation model, which was driven by use of a patient-reported outcomes (PRO) measure, was feasible and acceptable in the identification of unmet needs in patients with lung cancer. METHODS: A two-part, repeated-measures, mixed-methods study was conducted. Part 1 employed literature reviews and stakeholder focus group interviews to inform selection of a population-appropriate needs assessment PRO measure. In Part 2, lung cancer nurse specialists (CNS) conducted three consecutive monthly consultations with patients. Recruitment/retention data, PRO data, and exit interview data were analysed. RESULTS: The Sheffield Profile for Assessment and Referral to Care was the PRO measure selected based on Part 1 data. Twenty patients (response rate: 26%) participated in Part 2; 13 (65%) participated in all three consultations/assessments. The PRO measure helped patients to structure their thinking and prompted them to discuss previously underreported and/or sensitive issues, including such topics as family concerns, or death and dying. Lung CNS highlighted how PRO-measures-driven consultations differed from previous ones, in that their scope was broadened to allow nurses to offer personalised care. Small-to-moderate reductions in all domains of need were noted over time. CONCLUSIONS: Nurse-led PRO-measures-driven consultations are acceptable and conditionally feasible to holistically identify and effectively manage patient needs in modern lung cancer care. PRO data should be systematically collected and audited to assist in the provision of supportive care to people with lung cancer.

Promoting a Strategic Approach to Clinical Nurse Leader Practice Integration.

The Office of Nursing Services of the Department of Veterans Affairs (VA) piloted implementation of the clinical nurse leader (CNL) into the care delivery model and established a strategic goal in 2011 to implement the CNL role across the VA health care system. The VA Office of Nursing Services CNL Implementation and Evaluation (CNL I&E) Service was created as one mechanism to facilitate that goal in response to a need identified by facility nurse executives for consultative support for CNL practice integration. This article discusses strategies employed by the CNL I&E consultative team to help facility-level nursing leadership integrate CNLs into practice. Measures of success include steady growth in CNL practice capacity as well as positive feedback from nurse executives about the value of consultative engagement. Future steps to better integrate CNL practice into the VA include consolidation of lessons learned, collaboration to strengthen the evidence base for CNL practice, and further exploration of the transformational potential of CNL practice across the care continuum.

Lung cancer treatment rates and the role of the lung cancer nurse specialist: a qualitative study.

OBJECTIVES: This qualitative study examines how the Lung Cancer Nurse Specialist (LCNS) role operates and why they may be able to increase access to treatment. SETTING: 4 Hospital NHS Foundation Trusts in England. DESIGN: A multiple case study design using semistructured interviews, observation and Framework Analysis techniques. PARTICIPANTS: Four LCNSs, comprised the 'cases'. Twenty four clinicians who worked with the LCNS participated in individual interviews. Six LCNSs took part in a group interview and 60 lung cancer multidisciplinary team (MDT) members and coordinators were observed in the MDT meeting. RESULTS: The LCNS is crucial within the MDT and can act as a catalyst to patient access to treatment. The study identified the clinical activity (assessment, managing symptoms, psychological support and information provision) and role characteristics that can facilitate treatment access. These characteristics are the LCNS's presence across the patient pathway, acting as the 'hub' of the MDT, maintaining a holistic patient focus and working to an advanced level of practice. The findings indicate how factors may have a cumulative impact on treatment access. CONCLUSIONS: If UK patient with lung cancer survival rates are to improve in line with comparable countries, we need to employ every advantage. This study demonstrates how the LCNS role may open doors to positive patient outcomes, including treatment. Further research is required to explore patients' experiences, decision-making and attitudes to treatment.

Outcomes of Clinical Nurse Specialist Role Transformation to Population-Focused Model.

PURPOSE/OBJECTIVES: In 2010, our comprehensive cancer center developed a professional practice model where the clinical nurse specialist role was transformed to proactively plan and facilitate evidence-based best practices in collaboration with a transdisciplinary, population-focused team that manages the patient across the cancer care continuum. BACKGROUND: Prior to this transition, practice was unit based, focused on nursing staff education, skills, and competencies, and practice varied widely based on the needs of the unit. This lack of role consistency resulted in decreased autonomy and collaboration and frustration with not consistently impacting positive outcomes. DESCRIPTION: Nursing leadership worked with the clinical nurse specialists to develop and transition to a population-focused model. Some responsibilities in the unit-based model were retained, whereas others were transitioned to different roles. The reporting structure was centralized, and the role was realigned to focus on a specific patient population encompassing care from diagnosis throughout survivorship. OUTCOME: Baseline job satisfaction data were collected prior to the transition and repeated at 6 and 12 months, then 2, 3, and 4 years after implementation. Over time, there was significant improvement in participation in decision making, support of leadership, and positive contributions to patients and staff, resulting in improved nursing-sensitive patient outcomes, an increase in evidence-based practice initiatives and nursing research projects, and substantial professional growth of clinical staff. CONCLUSION: With this practice model, clinical nurse specialists consistently and proactively plan and facilitate evidence-based best practice in collaboration with a transdisciplinary team that manages the patient from diagnosis through the cancer trajectory. Results of outcome measurement report job satisfaction at an all-time high. Significant impact is demonstrated for patients and families, the nursing staff, and the organization. IMPLICATIONS: Healthcare organizations should evaluate current roles and practice models for opportunities to incorporate innovations that will result in improved patient care and satisfaction.

Enhancing the clinical leadership of band 6 staff.

This is the third article in a series of seven articles on an initiative in NHS Lanarkshire. Visible clinical leaders can have a significant effect on patient care and standards of practice. Over the past decade the development of clinical leadership has focused on senior charge nurses or midwives and team leaders, that is, band 7 practitioners or above. Band 6 staff 'act up' in these roles and therefore need to develop the associated knowledge, skills and attributes for their current practice and future progression into such roles. This article reports on the establishment, implementation and evaluation of a clinical leadership programme developed specifically for band 6 nurses, midwives and allied health professionals at one Scottish NHS board.

The evolution and development of an instrument to measure essential professional nursing practices.

Nursing continues to evolve from a task-oriented occupation to a holistic professional practice. Increased professionalism requires accurate measurement of care processes and practice. Nursing studies often omit measurement of the relationship between structures in the work environment and processes of care or between processes of care and patient outcomes. Process measurement is integral to understanding and improving nursing practice. This article describes the development of an updated Essentials of Magnetism process measurement instrument for clinical nurses (CNs) practicing on inpatient units in hospitals. It has been renamed Essential Professional Nursing Practices: CN.

Policy-makers' views on impact of specialist and advanced practitioner roles in Ireland: the SCAPE study.

AIM: To ascertain and explore the views held by key healthcare policy-makers on the impact of clinical specialist and advanced practice nursing and midwifery roles. BACKGROUND: Specialist and advanced practice roles are common world-wide and were introduced in Ireland in 2000. After experiencing these roles for a decade, the views of healthcare policy-makers were sought as part of a national evaluation. METHODS: A qualitative, descriptive design was used. Following ethical approval, 12 policy-makers were interviewed in 2010, using a six-part interview schedule. RESULTS: Policy-makers believed that specialist and advanced practice roles resulted in better continuity of care, improved patient/client outcomes and a more holistic approach. These clinicians were also said to be leading guideline development, new initiatives in care, education of staff, audit and policy development. They lacked administrative support and research time. Budget cuts and a government-applied recruitment moratorium were said to hamper the development of specialist/advanced practice roles. CONCLUSION: Healthcare policy-makers believe that specialists and advanced practitioners contribute to higher quality patient/client care, particularly at a strategic level. IMPLICATIONS FOR NURSING MANAGEMENT: These roles could make an important contribution to future health service developments, particularly in relation to chronic-disease management and community care, where more advanced practitioner posts are required.

The work left undone. Understanding the challenge of providing holistic lung cancer nursing care in the UK.

In England best practice guidance in cancer recommends that all patients have access to a specialist nurse such as the tumour specific clinical nurse specialist. The role has become pivotal providing aspects of care e.g. meeting information needs, holistic nurse led follow up including symptom control, managing care and providing psychological and social interventions including referral to others in the role of keyworker. There are approximately 295 lung cancer nurse specialists in England and recent study to model optimum caseload used an on line survey to look at workload of lung cancer specialist nurses. A survey of 100 lung cancer nurses from across the UK (RR78%) examined the perception of the work left undone against best practice guidance, caseload size, workload and other factors. 67 of 78 respondents perceived they left work such as proactive management (52) undertaking holistic needs assessments (46) providing appropriate psychological care (26) and meeting information needs (16). The majority (70) worked unpaid overtime (mean 3.8 h range 1-10 h) per week. Although proactive management is thought to result in better outcomes for lung cancer patients in terms of survival, quality of life and decisions of end of life a substantial number of the specialist nurses felt that factors such as caseload and organisational factors inhibited this.

Barriers and facilitators to implementation of the institute of medicine recommendations on preventing mental, emotional, and behavioral disorders among young people.

PROBLEM: The purpose of this study was to gain an understanding of the barriers and facilitators to implementation of the five overarching recommendations of the Institute of Medicine report and to consider the implications for nursing. METHODS: Data were collected through use of a semi-structured interview of purposive sample of 22 key informants regarding the barriers and facilitators to implementation of the report's five major recommendations. FINDINGS: The major barriers were competing priorities, lack of infrastructure for implementation, lack of public education regarding mental health and the effectiveness of prevention, stigma, and a paucity of facilitating factors. The facilitators were leadership, flexible resources, linkage to healthcare reform or other legislation, coordination across agencies and governmental levels, and additional research. CONCLUSIONS: The discussion focuses on ways of promoting facilitating factors and consideration of nursing's potential contributions in the areas of education, practice, and research.

Biological nurse specialist: goodwill to good practice.

The extensive use of biological agents in recent years for the treatment of rheumatological diseases has required a steep learning curve for the specialist nurses who manage and work in this specialty. Safe prescribing of biological therapies requires good infrastructure and specialist nursing personnel. With additional training, the specialist nurse may take responsibility for a number of tasks in the patient pathway including screening, treatment administration, patient education, prescription coordination for home drug delivery, patient support, monitoring and data collection. Biological treatment is becoming more widely used in several specialities, in particular gastroenterology, dermatology and ophthalmology. Since 2002, rheumatology specialist nurses have taken the lead in assessment and providing biologic therapy, not only for patients suffering from rheumatic diseases but also for those with immune-mediated inflammatory disorders. The unique nature and variable safety profiles of these agents led to the development of immune-mediated inflammatory disease infusion (IMID) centres and highlighted the importance of having biological specialist nurses. This article will discuss the evolution of the IMID/biologic specialist nurse role and how IMID services started with goodwill from the rheumatology nurse specialists to develop into a main component of the holistic approach to care.

Knowledge, attitudes, and use of complementary and alternative therapies among clinical nurse specialists in an academic medical center.

BACKGROUND: There has been an increase in the use and awareness of complementary and integrative therapies in the United States over the last 10 years. Clinical nurse specialists (CNSs) are in an ideal place to influence this paradigm shift in medicine to provide holistic care. PURPOSE: This study was designed to describe the knowledge, attitudes, and use of complementary and alternative medicine (CAM) by CNSs in a large Midwest medical center. DESIGN: This study used a descriptive exploratory correlational design. SAMPLE/SETTING: Seventy-six CNSs who work in various inpatient and outpatient units within this medical facility were surveyed electronically, in the fall of 2008, using a 26-item questionnaire developed by the research team. METHOD: Data were analyzed using descriptive statistics. FINDINGS: The results demonstrate that CNSs at this academic medical center use several CAM therapies for their personal use and for professional practice with patients. The top therapies that CNSs personally used were humor, massage, spirituality/prayer, music therapy, and relaxed breathing. The top therapies requested most by patients were massage, spirituality/prayer, healing touch, acupuncture, and music therapy. The results indicated that most CNSs thought CAM therapies were beneficial and that there was some evidence for use of these therapies for use by patients or by CNSs. IMPLICATIONS: The results of this study will help to determine educational needs and clinical practice of CAM therapies with CNSs at this academic medical center. The survey used and the research results from this study can be a template for other CNSs to use to begin to address this topic of CAM use in other hospitals and clinical settings. This survey could be used to explore CAM use by patients in specialty areas for practice enhancement.

Practical strategies for treating postsurgical bowel dysfunction.

Postsurgical bowel dysfunction is a potential complication for patients undergoing ileoanal anastomosis, restorative proctocolectomy, and low anterior anastomosis. In our setting, these patients are referred to the Anorectal Physiology Clinic at the Townsville Hospital, Queensland, for comprehensive behavioral therapy. The goals of the therapy are as follows: improve stool consistency, improve control over stool elimination, decrease fecal frequency and rectal urgency, fecal continence without excessive restrictions on food and fluid intake, and increase quality of life. This article outlines our holistic approach and specific treatment strategies, including assessment, education, support and assistance with coping, individualized dietary and fluid modifications, medications, and exercise. Biofeedback is used to help patients improve anal sphincter and pelvic floor muscle function and bowel elimination habits. Information on the biofeedback component of the treatment program will be described in a subsequent article.

Infusing evidence-based practice into interdisciplinary perinatal morbidity and mortality conferences.

Incorporating evidence-based practice into the hospital setting has been a challenge but is needed to deliver quality healthcare. Interdisciplinary morbidity and mortality conferences are used to discuss perinatal and neonatal care issues with high-risk and low-frequency cases, such as fetal demise, maternal death, or identified areas for improvement. By involving an interdisciplinary team to review the patient's case, a more holistic perspective of the patient's care will be achieved. The purpose of this article is to demonstrate how nurses can be an essential part of the interdisciplinary morbidity and mortality conferences and how to infuse evidence-based practice into the conference. A perinatal morbidity and mortality conference will be described to illustrate how one maternal-neonatal department brought medicine and nursing together to review care.

The times they are a changin.

AIM: A discussion paper outlining the potential for a multi-qualified health practitioner who has undertaken a programme of study incorporating the strengths of the specialist nurse with other professional routes. BACKGROUND AND RATIONALE: The concept and the context of 'nursing' is wide and generalized across the healthcare spectrum with a huge number of practitioners in separate branches, specialities and sub-specialities. As a profession, nursing consists of different groups in alliance with each other. How different is the work of the mental health forensic expert from an acute interventionalist, or a nurse therapist, from a clinical expert in neurological deterioration? The alliance holds because of the way nurses are educated and culturalized into the profession, and the influence of the statutory bodies and the context of a historical nationalized health system. This paper discusses the potential for a new type of healthcare professional, one which pushes the intra- and inter-professional agenda towards multi-qualified staff who would be able to work across current care boundaries and be more flexible regarding future care delivery. In September 2003, the Nursing and Midwifery Council stated that there were 'more than 656 000 practitioners' on its register and proposed that from April 2004, there were new entry descriptors. Identifying such large numbers of practitioners across a wide range of specialities brings several areas of the profession into question. Above all else, it highlights how nursing has fought and gained recognition for specialisms and that through this, it may be argued client groups receive the best possible 'fit' for their needs, wants and demands. However, it also highlights deficits in certain disciplines of care, for example, in mental health and learning disabilities. We argue that a practitioner holding different professional qualifications would be in a position to provide a more holistic service to the client. Is there then a gap for a 'new breed' of practitioner; 'a hybrid' that can achieve a balanced care provision to reduce the stress of multiple visits and multiple explanations? METHODS: Review of the literature but essentially informed by the authors personal vision relating to the future of health practitioner education. IMPLICATIONS FOR NURSING MANAGEMENT: This article is of significance for nurse managers as the future workforce and skill mix of both acute and community settings will be strongly influenced by the initial preregistration nurse education.