The similarities and differences between advanced nurse practitioners and clinical nurse specialists.

A lack of awareness exists within healthcare services on the differences between the roles of advanced nurse practitioner (ANP) and clinical nurse specialist (CNS). This may lead to ambiguity in relation to the development, scope of practice and impact of these roles. The aim of this review was to compare the similarities and differences between the ANP and CNS within the research literature. Databases (CINAHL, Medline and Embase) were searched using selected search terms. This resulted in 120 articles of potential interest being identified. Following a rigorous review process for content and relevance, this was reduced to 12. Both roles are valuable and effective, predominately being clinically based with education, leadership and research components. CNS roles are specialist, ANP are more likely to be generalist. Where there is regulation and governance the role of the ANP is clearly defined and structured; however, a lack of governance and regulation is evident in many countries.

Community diabetes nurse specialists: service evaluation to describe their professional role.

This paper presents a service evaluation on the role of Community Diabetes Nurse Specialists (CDNS), which was undertaken as a response to various changes. Quantitative and qualitative data were captured over 6 months. It was found that GPs refer patients to CDNSs four times more frequently than other health professionals. The clinical care of CDNSs mainly relates to diabetes education, insulin, assessment and self-management. Telehealth is used twice as frequently as face-to-face communications. The CDNSs do not refer patients onto other health professionals, but have multiple communications with other health professionals and agencies. They manage very complex clinical and social situations, using high-level clinical decision making and balancing person-centred care and patient safety. Structured patient education is being delivered. CDNSs mentor other staff and students, although their own formal professional development is very limited. To conclude, CDNSs are the end point for patient care in the community, managing complex patient situations, while adopting a person-centred approach.

Minimising central line-associated bloodstream infection rate in inserting central venous catheters in the adult intensive care units.

AIMS AND OBJECTIVES: To investigate the procedural aspects in inserting central venous catheters that minimise central line-associated bloodstream infection rates in adult intensive care units through a structured literature review. BACKGROUND: In adult intensive care units, central line-associated bloodstream infections are a major cause of high mortality rates and increased in costs due to the consequences of complications. METHODS: Eligible articles were identified by combining indexed keywords using Boolean operator of "AND" under databases of Ovid and CINAHL. Titles and abstract of retrieved papers were screened and duplicates removed. Inclusion and exclusion criteria were applied to derive the final papers, which contained seminal studies. The quality of papers was assessed using a special data extraction form. RESULTS: The number of papers retrieved from all databases was 337, reduced to 302 after removing duplicates. Papers were scanned for titles and abstract to locate those relevant to the review question. After this, 250 papers were excluded for different reasons and a total of 52 papers were fully accessed to assess for eligibility. The final number of papers included was 10 articles. CONCLUSION: Many interventions can be implemented in the adult intensive care unit during the insertion of a central venous catheter to minimise central line-associated bloodstream infections rates. These include choosing the subclavian site to insert the catheters as the least infectious and decolonising patients' skin with alcoholic chlorhexidine gluconate preparation due to its broad antimicrobial effect and durability. RELEVANCE TO CLINICAL PRACTICE: Choosing optimal sites for central venous catheter insertion is a complex process that relies on many factors. Furthermore, the introduction of chlorhexidine gluconate preparations should be accompanied with multifaceted interventions including quality improvement initiatives to improve healthcare workers' compliance. As a quality marker in adult intensive care units, healthcare sectors should work on establishing benchmarks with other sectors around the world.

Nurses' needs in delivering palliative care for long-term conditions.

This study addressed the question 'What are the needs of community nurses in delivering palliative care to people with long-term conditions?' A qualitative exploratory descriptive design was employed. Ten community nurses (Band 5-7) were recruited from a purposive sample following a process of randomised stratified sampling, according to geographical area and Band for matched numbers. Semi-structured interviews were undertaken and audio recorded with written informed consent. The interviews were transcribed verbatim and analysed using an adapted Burnard's framework. The study found that establishing therapeutic relationships, having access to resources, co-ordination and provision of clinical care and collaborative working were all highlighted by the community nurses as needs in delivering palliative care. If these four needs were met, the community nurses believed they could deliver palliative care to their patients. Issues around a lack of resources, community nurses' educational needs and the late referral of patients with non-malignant long-term conditions to community nursing were also identified.

Communicating news of a patient's death to relatives.

Breaking the news of the death of a patient to their relatives is one of the most difficult and dreaded aspects of nursing. While it is not an aspect of the job that nurses relish, it is key that nursing staff have full understanding of their role during this time to allow them to communicate this difficult news in a sensitive manner. This article will examine the role of the nurse in communicating the news of a patient's death to their next of kin and relatives. Staff education and training to deal with the bereaved will be assessed, as will the nurse's perceptions of their role. The impact of the nurse's presence on the bereaved will be looked at, and finally the role of the nurse in bereavement follow up will conclude this article.

Breaking news of death to relatives.

Breaking news of death can have a significant impact on bereaved relatives if it is not carried out appropriately. This article explores best practice on breaking news of death, and discusses why it is so important for nurses to get it right.

Residential PTSD treatment outcomes during cognitive processing therapy for veterans with and without recent histories of cannabis use.

Prior evidence has suggested that cannabis use is associated with greater posttraumatic stress disorder (PTSD) symptom severity and worse outcomes following trauma-focused treatment. However, lack of high-quality randomized studies necessitates the use of clinical data to clarify the relationship between cannabis use and PTSD treatment to help inform clinical practice. A total of 114 veterans completed cognitive processing therapy in a residential PTSD treatment program. Differences in treatment response between cannabis users and nonusers were evaluated for measures of PTSD, depression, and posttraumatic growth using analysis of covariance to control for pretreatment scores and other drug use. At baseline, cannabis users reported higher levels of PTSD symptom severity relative to nonusers but reported similar levels of depression and posttraumatic growth. Significant differences between groups in the amount of change were not observed on any of the measures from before to after treatment; however, the total sample reported significant improvements in all measures of interest. These results suggest that PTSD treatment outcomes for cannabis users may be similar to nonusers when use is stopped during treatment. Additional data are needed regarding whether outcomes remain similar at follow-up, whether cannabis users maintain abstinence after treatment, and the impact of resumed cannabis use on PTSD symptoms. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Perceptions of a service redesign by adults living with type 2 diabetes.

AIM: This article is a report of a study conducted to explore the perceptions of adults with type 2 diabetes towards the service redesign. BACKGROUND: Diabetes is reaching epidemic proportions and the management of this chronic illness is changing in response to this challenge. In the United Kingdom, there is ongoing restructuring of healthcare services for people with chronic illnesses to ensure that their general health and clinical needs are met predominantly in primary care. METHOD: An explorative qualitative approach was used. Eight focus groups were conducted with 35 people with type 2 diabetes in one urban location between 2003 and 2004. Five focus groups were conducted with people who had recently experienced the restructured service and three groups with people who had up to 2 years' experience of the new service. Concurrent data collection and thematic analysis were conducted by three researchers and credibility and verification sought by feedback to participants. FINDINGS: Five main themes were identified: impact of living with diabetes; understanding diabetes; drivers for organizational change; care in context and individual concerns. Participants identified issues for ongoing development of the service. CONCLUSION: People with type 2 diabetes appreciate their care management within the primary care setting where there has been investment in staff to deliver this care. Healthcare resources are required to support the development of staff and the necessary infrastructure to undertake management in primary care. Policy makers need to address the balance of resources between primary and secondary care.

Decision-making: initiating insulin therapy for adults with diabetes.

AIM: This paper is a report of a study to describe nurses' perceptions of decision-making and the evidence base for the initiation of insulin therapy. BACKGROUND: Several theoretical perspectives and professional's attributes underpin decision-making to commence insulin therapy. The management of type 2 diabetes is moving from secondary to primary care and this affects how clinical decisions are made, by whom and the evidence base for these decisions. METHOD: A postal survey was conducted with a stratified sample of 3478 Diabetes Specialist Nurses and Practice Nurses with a special interest in diabetes across the four countries of the United Kingdom. A total of 1310 valid responses were returned, giving a response rate of 37.7%. The questionnaire was designed for the study and pilot-tested before use. Responses were given using Likert-type scales. Data were collected during 2005 and 2006, and one reminder was sent. RESULTS: People with diabetes are seen as having little influence in decision-making. Consultant physicians appear to be influential in most decisions, and the nursing groups held varying perceptions of who made clinical decisions. Nurses' identified different responsibilities for those working solely in secondary care from those working in both community and secondary care. Practice nurses were not as involved as anticipated. CONCLUSION: Nurses working with people with diabetes need to encourage them to become more active partners in care. Clinical guidelines can assist in decision-making where nurses are least experienced in initiating insulin therapy.

Identifying the needs of critical and acute cardiac care nurses within the first two years of practice in Egypt using a nominal group technique.

Nursing in Egypt faces many challenges and working conditions in health care settings are generally poor. Little is known about the needs of new nurses transitioning in Egypt. The literature focuses on the first year of practice and only a small body of research has explored the transition needs within acute care speciality settings. This paper reports on the important professional needs of new graduate nurses working in an acute cardiac setting in Egypt during the first two years of practice and differences between their perceived most important needs. The total population participated and two group interviews were conducted (n = 5; n = 6) using the nominal group technique. Needs were identified and prioritised using both rankings and ratings to attain consensus. Content analysis was conducted to produce themes and enable cross-group comparison. Rating scores were standardised for comparison within and between groups. Both groups ranked and rated items as important: 1) education, training and continued professional development; 2) professional standards; 3) supportive clinical practice environment; 4) manageable work patterns, and 5) organisational structure. It is important that health care organisations are responsive to these needs to ensure support strategies reflect the priorities of new nurses transitioning in acute care hospitals within Egypt.

Corporate solutions to caseload management -- an evaluation.

This paper describes an evaluation of a change in health visiting service delivery from GP caseload management to corporate caseload working, in one inner city health centre located in a deprived area of Glasgow. The aim of the study was to identify if moving to corporate caseload working provides the reported benefits cited in the limited literature available. A purposive sample consisting of ten health visitors, one GP, one manager and three clients volunteered to participate in this mixed methods evaluation study. Data were collected by means of a stress questionnaire, public health nursing diary, focus groups and semi-structured interviews. Findings show that immediate improvements were seen in team working, staff communication, sharing practice, enhanced clinical reflection and standards of documentation. However, corporate caseload working did not appear to reduce staff stress levels, increase public health nursing activity or improve quality of client service. Further research conducted over a longer time period with a full staffing complement is needed to validate these findings.

Comparative study on the effect of enteral feeding on blood glucose.

Stress hyperglycaemia is common in intensive care patients. There is recent evidence to suggest that maintaining the blood glucose of a patient in intensive care between 4 mmol/litre and 6.1 mmol/litre reduces morbidity and mortality. The aim of this comparative study was to determine if blood glucose control improves with abolishing feeding breaks and introducing continuous enteral feeding. Twenty ventilated patients admitted to a combined medical and surgical intensive care unit were sampled. Ten patients received standard care (enteral feeding for 18 hours with an 8-hour break). The interventional group received continuous enteral feeding over the 24 hours. Analysis of the data revealed that continuous enteral feeding reduced blood glucose levels significantly, improved blood glucose control and reduced insulin requirements. Research should continue to determine if the results of this study could be replicated within a larger group of intensive care patients.

Nurses' rationale for blood glucose monitoring in critical care.

Morbidity and mortality in a critical care environment is improved when there is tight control of blood glucose. This study aimed to explore nurses' rationale for blood glucose monitoring in a critical care setting. An exploratory qualitative design was utilized in one acute division of a large NHS Trust in Scotland. Volunteers were sought by letter and through posters in the clinical area. Five staff nurses from two critical care areas volunteered to take part in one-to-one interviews that were tape-recorded. All transcripts were analysed using content analysis. Nurses described differing perspectives on blood glucose monitoring. Nurses did not know the blood glucose level that defines hyperglycaemia, a knowledge gap which impacts on care intervention. Three sisters from the wards were interviewed to determine their perceptions of the reasons for the poor response rate. They identified several issues thought to impact on staff volunteering for research.

Identifying the palliative care role of the nurse working in community hospitals: an exploratory study.

AIM: to ascertain registered nurses' and GPs' perceptions of and influences on the nurse's role in providing palliative care in community hospitals. DESIGN: qualitative exploratory/descriptive study. SETTING: two community hospital sites within Perth and Kinross, Scotland. METHOD: taped semi-structured interviews with four registered nurses and two GPs. Participants' perceptions were sought on the roles of nursing and medical professionals and of factors facilitating and hindering the provision of palliative care within the community hospital setting. FINDINGS: six key themes were identified through thematic analysis of the information: communication, teamwork and relationships, holistic care, resources, culture, professional role. CONCLUSION: the themes were inter-related and gave valuable insight into the multidimensional nature and significance of the nurse's role in palliative care in the community hospital setting.

The distress experienced by people with type 2 diabetes.

With diabetes an ever-increasing problem across the developed world, a great deal of research has been carried out into the effects of the disease on the patient. Yet despite the fact that type 1 diabetes accounts for only a relatively small proportion of worldwide cases, it has been the focus of research attention. This study aimed to investigate the distress associated with type 2 diabetes, whether gender differences existed in the impact of type 2 diabetes and how men and women viewed dietary management. A multi-method, two-stage research approach was taken. Quantitative data were obtained using the Problem Areas in Diabetes (PAID) questionnaire, and no statistically significant gender difference was identified. Worrying about the future, the possibility of complications and feelings of guilt or anxiety when 'off-track' with diabetes management were sources of significant distress. Treatment mode, length of time diagnosed with diabetes and age were significant factors which impacted on the emotional distress experienced by the individual. A subsample of respondents took part in the survey. Behavioural impact, emotional impact and fear of complications were major themes identified in the interviews. Views of the dietary management of diabetes were also explored within the focus groups and three broad categories identified: dietary restrictions, value judgements and the influence of others. Awareness by health-care professionals of factors influencing adaptation to diabetes is recommended.

Educating a patient with diabetes about foot care.

Care study Mrs Rasul is a 55-year-old Asian woman who has had maturity onset diabetes for 17 years. At a hospital clinic appointment she was identified as being at risk of developing a neuropathic foot ulcer. She was referred to the diabetic nurse specialist for education and supervision. She lives at home with her husband, son and daughter. Religious factors dictate that she prays on her knees five times a day, which places pressure on her feet.

Sudden bereavement in acute care settings.

AIM: This literature review examines best practice in caring for those who have been bereaved suddenly in acute care settings. Theories of bereavement are outlined in relation to sudden death. The evidence base for best practice is presented and the role of the nurse in this situation is examined. CONCLUSION: There are common psychological, physical and behavioural manifestations of grief, but people experiencing the sudden death of a loved one are at risk of more pronounced and prolonged grief reactions than those who had been expecting death. Nurses have an important role in facilitating bereavement in acute care settings. Preparation for bereavement care begins before an individual has died and continues through to identifying the appropriate person to provide follow-up care. Those who are unexpectedly and suddenly bereaved should receive practical and considerate evidence-based care.

Implementing an Assessment Clinic in a Residential PTSD Program.

Creating useful treatment plans can help improve services to consumers of mental health services. As more evidence-based practices are implemented, deciding what treatment, at what time, for whom becomes an important factor in facilitating positive outcomes. Readiness for trauma-focused treatments for Posttraumatic Stress Disorder (PTSD) such as Cognitive Processing Therapy or Prolonged Exposure Therapy may influence whether an individual can successfully complete either protocol. In addition, components of adjunctive therapies such as Acceptance and Commitment Therapy or Dialectical Behavior Therapy may be useful in moving a particular patient toward readiness and successful completion of treatment. Psychological assessment adds valuable data to inform these types of treatment decisions. This paper describes the implementation of a psychological assessment clinic in a residential PTSD treatment setting. Barriers to implementation, use of the data, and Veterans' reactions to the feedback provided to them are included.

Quality of life in people with type 2 diabetes in relation to deprivation, gender, and age in a new community-based model of care.

Objectives. To evaluate changes in health related quality of life (HRQL) for individuals with Type 2 diabetes following the introduction of a new community-based model of care. Methods. A survey method was used in which HRQL, Problems Areas In Diabetes (PAID) and demographics were assessed before and 18 months after introducing the new service. Results. Overall HRQL and PAID scores were lower than published levels in individuals with diabetes but remained stable during the transition to the new model of care except for the bodily pain domain and deteriorating PAID scores for older patients. Four domains of SF36 health showed deterioration in the highest socio-economic groups. Deterioration was also observed in males, most notably mental health, in patients aged 54 years or less, 75 years or more and patients from socio-economic groups 1 and 2. HRQL was lowest at baseline and follow-up in socio-economic groups 6 & 7. Low levels of distress in patients across all deprivation categories was observed but remained stable over the transition. Conclusions. HRQL and distress associated with diabetes remained stable following the introduction of the new community-based model of care except for deterioration in the bodily pain domain and deteriorating PAID scores for older patients. Relevance for Practice. (i) Health related quality of life assessment is practical and acceptable to patients. (ii) In clinical governance terms it is good practice to monitor the impact of change in service delivery on the health of the patients in your care. (iii) Screening with health related quality of life tools such as generic and disease specific tools could help identify health problems otherwise undetected within current clinical care. Systematic identification of the most vulnerable groups with Type 2 diabetes should allow care to be better targeted.