The clinical nurse specialist in New Zealand: how is the role defined?

New Zealand, like many countries, is developing new advanced nursing practice roles to meet emerging needs. While much has been written about the Nurse Practitioner (NP), the role of Clinical Nurse Specialist (CNS) remains relatively unexplored and lacks national definition. This paper reports the findings from research designed to investigate the role of the CNS and how it is defined by New Zealand District Health Boards (DHBs). The study sought to identify the current requirements and expectations for the CNS role and how it is defined in practice. In 2008, 15 CNS job descriptions were collected from eight DHBs throughout the country generating data that were treated both quantitatively and qualitatively. Overall, few areas of consensus were found regarding the essential requirements for the CNS role and there were inconsistencies in how the roles were defined, most notably concerning requirements for postgraduate qualifications and Professional Development Recognition Programmes. Thematic analysis of the documents generated four key areas relevant to the CNS role. These described the CNS as a leader, a clinical expert, a co-ordinator and an educator. The findings indicate that the CNS role is inconsistently defined in New Zealand, particularly with respect to the postgraduate qualifications required and what is meant by 'expertise'.

Exploring New Zealand orthopaedic nurses' knowledge of osteoporosis.

BACKGROUND: Osteoporosis is a highly prevalent yet preventable disease. Nurses can play a major role in the prevention of osteoporosis and preventive treatment of patients who have had an osteoporotic fracture. PURPOSE: This study explored whether New Zealand orthopaedic nurses have the knowledge to provide osteoporosis prevention education, and also examined these nurses' perceptions of their role in the diagnosis and prevention of osteoporosis. METHODS: A questionnaire assessing osteoporosis knowledge was sent to a convenience sample of orthopaedic nurses. Data were analyzed quantitatively for the knowledge component, and qualitatively for the nurses' perception of their role, perceived barriers, and educational preferences. RESULTS AND CONCLUSION: Findings reveal that New Zealand orthopaedic nurses have inadequate osteoporosis knowledge and this is a barrier to educating patients regarding osteoporosis. Adherence to published recommendations for the management of osteoporosis has been inconsistent. Confusion about who should lead osteoporosis prevention is evident and it seems that nurses play a passive role.

Mental health nurses' beliefs about smoking by mental health facility inpatients.

This study examined beliefs of mental health nurses about smoking by clients, nurses, and visitors in inpatient facilities and identified the influence of years of experience, smoke-free status, and workplace on these beliefs. Data were collected by a survey, distributed via a nursing newsletter with approximately 600 members. Descriptive statistics and cross-tabulations explored the data. A total of 104 responses were received. Smoke-free status made significant differences to nurses' beliefs relating to prohibition of smoking for clients, staff, and visitors; concern about the effects of passive smoking; the role of smoking in the development of therapeutic relationships; smoking as a source of patient pleasure; and the role of smoking in symptom management. That half of the nurses who responded believe that smoking is helpful in the creation of therapeutic relationships is of concern. The nurse plays an important role model in promoting smoke-free lifestyles amongst clients, and the effects of positive role modelling could be lost if nurses continue to smoke with clients. The negative impacts of smoking on the physical health of mental health inpatients is considerable and well documented, and the creation of smoke-free inpatient mental health services can help to address these.

Clinical outcomes and patients' perceptions of nurse-led healthy lifestyle clinics.

BACKGROUND AND CONTEXT: The Nurse-Led Healthy Lifestyle Clinics focussed on lifestyle issues for patients with known health inequalities. Much of the nursing was educative and preventative care. This evaluation assessed patient experiences and opinions, as well as clinical outcomes. ASSESSMENT OF PROBLEM: Information came from clinical outcome data for 2850 individuals and 424 patient satisfaction surveys. RESULTS: Patients were aged 0-95 years (45% between 40 and 59 years); 60% Pakeha/European, 31.4% Maori, 4.2% Pacific and 4.4% other ethnicities. Only 19% of claimants (approximately 40% were Maori or Pacific) came from quintile 5 addresses, suggesting the target population was not reached effectively. Ninety-four percent of patients had a better understanding of their diagnosis, medication and treatment plan, and were more motivated to self-manage their health needs. This increase in patient empowerment is a significant outcome of the project. Clinical outcome data showed no significant differences between first and last clinic visits for average weight, blood pressure, smoking, glycosylated haemoglobin levels, waist circumference or cardiovascular risk. Significant improvements were shown in the Dartmouth Primary Care Cooperative Information results for social activity, change in health, and overall health (n=89). STRATEGIES FOR IMPROVEMENT: More effective techniques to access the target population have been implemented, as has an extended period for review of clinical outcomes. LESSONS: More focussed evaluation of clinical outcomes is necessary to provide quantitative data on the clinics. The large percentage of patients who felt more empowered to self-manage their health needs suggests the clinics were effective in this area.

Nurses' perceptions of nurse-led healthy lifestyle clinics.

INTRODUCTION: Nineteen Nurse-Led Healthy Lifestyle Clinics (NLHLCs) were implemented and targeted Maori, Pacific and people living in high deprivation areas. The general focus of the clinics was on lifestyle issues and much of the nursing was educative and preventative care. The aim of this project was to assess nurses' experiences and opinions of their participation in the clinics. METHODS: Nurses participating in the clinics were asked to complete a monthly narrative report over five reporting periods, and these were collated and evaluated for emergent themes. Sixteen nurses were subsequently interviewed and the transcripts analysed to identify major themes and sub-themes. FINDINGS: In total, 167 narrative reports were collected from 53 of the 115 participating nurses. Almost all the nurses either strongly agreed or agreed that they enjoyed working in an NLHLC. This enjoyment was the result of: increased time for in-depth consultations, being able to provide enhanced holistic patient care, developing knowledge, gaining experience, receiving positive patient feedback and the satisfaction of seeing patient improvements. Nurses reported that the opportunity and responsibility of providing holistic nursing care, and the skills and knowledge gained from participating in the project, were extremely valuable. CONCLUSION: NLHLCs provide benefits for both patient and nurse. For the nurse, job satisfaction is increased through positive patient feedback, opportunities for professional development and a greater feeling of empowerment.