Care Clinical Nurse Specialist Research Articles

Telemedicine vs Face-to-Face for Nursing Home Residents With Acute Presentations: A Noninferiority Study.

Telemedicine and face-to-face outreach services to nursing homes (NHs) have been used to reduce hospital utilization rates for acute presentations. However, how these modalities compare against each other is unclear. This article examines if the management of acute presentations in NHs with care involving telemedicine is noninferior to care delivered face-to-face. A noninferiority study was conducted on a prospective cohort. Face-to-face intervention involved on-site assessment by a geriatrician and aged care clinical nurse specialist (CNS). Telemedicine intervention involved on-site assessment by an aged care CNS with telemedicine input by a geriatrician. A total of 438 NH residents with acute presentations from 17 NHs between November 2021 and June2022. Between-group differences in proportion of residents successfully managed on-site and mean number of encounters were evaluated using bootstrapped multiple linear regression; 95% CIs were compared against predefined noninferiority margins with noninferiority P values calculated. In the adjusted models, care involving telemedicine demonstrated noninferiority in the difference in proportion of residents successfully managed on-site (95% CI lower limit-6.2% to-1.4% vs-10% noninferiority margin; P < .001 for noninferiority) but not in the difference in mean number of encounters (95% CI upper limit 1.42 to 1.50 encounters vs 1 encounter noninferiority margin; P= .7 for noninferiority). In our model of care, care that involved telemedicine was noninferior to care delivered face-to-face in managing NH residents with acute presentations on-site. However, additional encounters may be required. Application of telemedicine ought to be tailored to fit the needs and preferences of stakeholders.

The practice of palliative care clinical nurse specialists in the care of cancer patients in the State of Qatar

Background and objective: There is an annual increase in the number of metastatic advanced cancer patients who require palliative care; this is paralleled by the necessary increase in the workload of palliative care Clinical Nurse Specialist (CNS). Palliative care CNSs are crucial members in the palliative care multidisciplinary team. The aim of this paper is to describe the role of clinical nurse specialists by clarifying the ambiguity of their responsibilities in advanced cancer patients' care in the state of Qatar.Methods: Data used in this descriptive study were extracted from a shared Excel data registry system that has been created by palliative care CNSs. Data were retrieved from the 1st of January 2021 till the 31st of December 2021 and translated into numbers and percentages. Results: A total of 3,571 patients' encounters were captured starting from the 1st of January 2021 till the 31st of December 2021. National Center for Cancer Care and Research (NCCCR) inpatient's encounters (33%), followed by telephone consultations (32%) were the highest two approaches to palliative care services delivered by CNSs. Pain and non-pain symptoms management, early introduction to palliative care, patient and family education and support, end-of-life care, and coordination of care with other health care professionals are few examples of the other services offered by palliative care CNSs for cancer patients at Hamad Medical Corporation (HMC).Conclusions: Palliative care CNSs’ roles are multidimensional and highly needed. Some of their clinical activities are unnoticed, especially due to the high number of patients’ encounters and the different geographic locations at HMC that CNSs cover. Future research is highly needed to describe the role of palliative care CNSs in areas, such as research, education, and leadership.

Evaluating the specialist palliative care clinical nurse specialist role in an acute hospital setting: a mixed methods sequential explanatory study

BackgroundSpecial palliative care is provided in a range of settings including a patient’s home (their primary place of dwelling), a hospice in-patient unit, or an acute hospital. The aim of the study was to evaluate the role of the specialist in palliative care clinical nurse specialist (SPC CNS) role in an acute hospital setting.MethodsThis study was conducted using a mixed methods sequential explanatory approach in two phases; phase 1 involved completion of a study questionnaire (n = 121) and phase 2 involved part-taking in a focus group (n = 6) or individual interview (n = 4).ResultsPhase 1 results indicated that respondents held positive attitudes towards the Specialist Palliative Care Clinical Nurses Specialist (SPC CNS) in relation to clinical care, education and patient advocacy. Phase 2 qualitative findings identified the importance of the role in terms of symptom management, education and support.ConclusionsThis study provides an evaluation of a SPC CNS role since it was established in an acute hospital setting. The evidence indicates that there is a varied understanding of the role of the SPC CNS. The role was seen as an important one particularly in terms of referrals to and support provided by the SPC CNS, as well as recognition of the importance of the role is providing ongoing education to staff.

Critical Care Clinical Nurse Specialist Role in Developmental Care for Infants With Heart Disease.

Critical Care Clinical Nurse Specialist Role in Developmental Care for Infants With Heart Disease.

Managing delirium in terminally ill patients: perspective of palliative care nurse specialists.

Delirium occurs frequently at end of life. Palliative care clinical nurse specialists (CNSs) are involved in community palliative care provision. Many patients prefer being cared for at home, yet managing delirium in this setting presents unique challenges, potentially resulting in emergency hospital or hospice admission. We examined the experiences and practice of palliative care CNSs managing delirium in the community; 10 interviews were undertaken. Data were analysed using the framework approach. Challenges to delirium management in the community included limited time with patients, reliance on families and access to medications. Assessment tools were not used routinely; time limited visits and inconsistent retesting were perceived barriers. Management approaches differed depending on CNSs' previous delirium education. Strategies to prevent delirium were not used. Community delirium management presents challenges; support surrounding these could be beneficial. Routine assessment tool use and delirium prevention strategies should be included in further education and research.

Practice Analysis: Adult-Gerontology Acute Care Nurse Practitioner and Clinical Nurse Specialist.

Standards for advanced practice registered nurse (APRN) licensure in the United States require certification programs to analyze practice in order to document the knowledge and skills necessary for entry-level adult-gerontology acute care nurse practitioners (AGACNPs) and wellness-through-acute-care clinical nurse specialists (AGCNSs). The practice analysis done every 5 years by the AACN Certification Corporation provides research data for use in establishing test plans for certification of APRNs. To describe the development of a survey to collect information on the current practice of AGACNPs and AGCNSs, and to compare the results from practitioners in the 2 roles. In 2016, a task force of subject matter experts created a survey of the practice activities and competencies of AGACNPs and AGCNSs. Respondents rated activities and competencies according to their applicability and significance to APRN practice. The subject matter experts analyzed the ratings to determine which patient care problems, skills and procedures, and competencies would be included in the updated certification test plans. After analyzing the survey responses, subject matter experts retained 135 patient care problems, 45 skills and procedures, and all national competencies for AGACNPs and 123 patient care problems, 56 skills and procedures, and all national competencies for AGCNSs. Both roles involve several of the same patient care problems, skills and procedures, and competencies. Data from practice analysis surveys formed the basis for developing reliable and valid certification examinations for entry-level APRNs. The information from such studies of practice should inform practicing nurses and students, as well as educators, accreditors, legislators, and regulators, about the work of AGACNPs and AGCNSs.

Managing Do Not Attempt Cardiopulmonary Resuscitation conversations in the community.

Clear, sensitive and timely communication with palliative and end-of-life (EoL) patients and their families is important. Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) conversations can help patients accept their impending death and achieve a more dignified death. This research explored the experiences and communication strategies of clinical nurse specialists (CNSs) in palliative care when managing DNACPR conversations in the community. Six semi-structured interviews were conducted with community palliative care CNSs, and the results were summarised using autoethnography. Delays in EoL discussions mean that some community palliative care CNSs are having DNACPR conversations at their first meeting with patients. Balancing being clear and sensitive is challenging, especially when patients and families have previously been informed inappropriately or insensitively about DNACPR decisions. DNACPR discussions should be initiated by exploring patient understanding and preferences while emphasising care continuation and a more dignified death.

Education in stoma care: a survey and interviews with stoma care nurses

Guidance for stoma care clinical nurse specialists (CNSs) provided by the Association of Stoma Care Nurses (ASCN) UK and Royal College of Nursing (RCN) states that senior nurses are expected to have at least a degree-level specialist qualification in conjunction with clinical experience. To determine how to better meet the educational needs of stoma care CNSs, data were collected from this group of professionals. One-in-five stoma care CNS in the UK replied to an online survey, plus telephone interviews. The findings showed that, when attending a course, accreditation was important, as well as that education was predominantly used for professional development and underpinning clinical knowledge. There were three themes that emerged from the surveys and interviews: development of education, delivery style and future developments. These were felt to be important to the nurses when attending educational courses.

Integrated care in practise - across regions (Scotland and Denmark)

Background: SCOTCAP is a programme for an innovative point-of-care investigation of the lower gastrointestinal (GI) tract using minimally invasive colon capsule endoscopy (CCE). This project was established by working closely with partners in Region of Southern Denmark (RSD), where the model originated in population screening programmes. Working in partnership we have progressed the development, deployment and methodology in both regions. By using CCE, GI investigation can potentially become a primary care service, overseen by a remote GI consultant, allowing transformation into the community, a new integrated care model. The use of CCE has great potential to remove pressure that GI investigations impose on health care systems. Digital health and care innovation centre (DHI), Scotland’s national centre to accelerate digital health and care adoption, has brought together multi-stakeholders to demonstrate this service and digital innovation. The collaboration with RSD has demonstrated acceleration of the knowledge and lessons learned at transferring this to a scalable model. The projects have adopted a quadruple helix model by involving Industry, Academia, urban and rural health boards/regions, along with citizens to co-produce this integrated health and care innovation pathway. Objectives: The main objective is to reduce the bottleneck in diagnostic demand for GI disease assessment. This shall be achieved by creating an innovative integrated service based on CCE which can be delivered at point-of-care in the community, a GP practice or even the home of the person. Secondary care clinical nurse specialists (CNS) who are trained in CCE will deliver training to primary care practice nurses to support the patients that will receive CCE. Furthermore, it should reduce the total cost of GI diagnostics by eliminating unnecessary travel, minimize impact on daily life of patients, avoid complications, reduce specialist participation, optimise resource utilization and enable modern digital health technology in an integrated care setting. Secondly, it should improve innovation capabilities in health and life sciences and create local jobs in service delivery. Local regions have pioneered this work with feasibility studies conducted at primary care sites with a range of lessons learned. CCE is an innovative technology where a capsule containing a digital camera is swallowed, passes through the gastrointestinal tract and downloads 400,000 images which are then viewed and remotely analysed. It is highly accurate, cost effective and increases choice for patients. Patient participation has taken place, early feedback; “I think the pillcam procedure would be very helpful to patients in the future, enabling them to be diagnosed near home and not have to travel the long distance to Hospital” “Not having a round trip of 120 miles for the procedure” “Only took 2.5 hrs to complete so quicker recovery as no anaesthetic required”. Conclusion: By May 2018, DHI would present in partnership with RSD, early insight from functional framework for CCE delivery, we would welcome the opportunity to share this service, digital and business innovation, along with lessons learned and early indicators with delegates at the integrated care conference (ICIC) in the Netherlands – demonstrating how regions can work effectively together (Scotland/South Denmark).

Please hold the line: setting up a telecare service for stoma patients using Skype

Telehealth is an efficient and cost-effective way to follow up patients discharged after the enhanced recovery after surgery (ERAS) pathway. Colorectal and stoma care clinical nurse specialist (CNS) teams explored giving patients the option to have their follow-up appointment via the online videotelephony application Skype, instead of by telephone. A literature review returned no applicable results. A pilot study of patients going through colorectal preoperative assessment showed that there was interest in the idea, but that not all patients were able to access Skype. Seven participants returned questionnaires reporting unanimous satisfaction with the service. To improve patient access, tablets were procured and given to those stoma patients undergoing planned surgery who did not have their own device. Video calls allow for visual assessment of the patient, as well as personalised face-to-face interaction. The CNS teams aim to roll this service out further by increasing access for patients.

The Power of Mentoring.

The Power of Mentoring.

Coping: teenagers undergoing stoma formation.

Stoma-forming surgery can raise a number of challenges for patients of any age, including psychosocial impact, altered body image and altered body function. Adolescents may experience additional challenges as they are already adapting to changes in body image and personal identity while striving for independence. Healthcare professionals supporting adolescents with stomas need to have awareness of specific issues that may be encountered and the support required to aid and promote coping and adjustment. This case study considers adolescents coping and adjusting to living with a stoma and the role of the Stoma Care Clinical Nurse Specialist.

Breast cancer survivors concerned about preserving fertility

The palliative care clinical nurse specialist (CNS) role is a dynamic but difficult one, associated with significant and ever-changing challenges and stress, for which practitioners might not have the requisite power to effect change, according to this descriptive exploratory study. Using a purposive sample of community palliative care CNSs from a hospice in Northern Ireland, 33 staff were invited to participate and 17 ultimately contributed to semi-structured interviews. The interviews explored the learning, development and support needs of staff that would enable them to realise the main constituents of their role: clinical practice, education, research, and leadership and management. The interviews were recorded, transcribed and thematically analysed. The researchers identified and categorised three themes: the influence of organisational culture, the influence of the individual and solutions to developmental needs. In the organisational culture, stable working relationships and informal peer support were reportedly the most conspicuous forms of professional support mechanism, with more formal means such as mentoring and clinical supervision also appreciated. Nonetheless, stressful, often isolated, lone-working practices meant that the emotional effect of caring and individual self-care measures were not addressed satisfactorily. Most personal knowledge was described as obtained by practice-based ‘experiential’ learning; however, the nurses recognised the need for formal educational opportunities and qualifications. Whittaker E, Kernohan W, McLaughlin D (2014) Learning, development, and support needs of community palliative care clinical nurse specialists. International Journal of Palliative Nursing. 20, 9, 425-433.

Study finds only those who believe in energy healing receive benefits

The palliative care clinical nurse specialist (CNS) role is a dynamic but difficult one, associated with significant and ever-changing challenges and stress, for which practitioners might not have the requisite power to effect change, according to this descriptive exploratory study. Using a purposive sample of community palliative care CNSs from a hospice in Northern Ireland, 33 staff were invited to participate and 17 ultimately contributed to semi-structured interviews. The interviews explored the learning, development and support needs of staff that would enable them to realise the main constituents of their role: clinical practice, education, research, and leadership and management. The interviews were recorded, transcribed and thematically analysed. The researchers identified and categorised three themes: the influence of organisational culture, the influence of the individual and solutions to developmental needs. In the organisational culture, stable working relationships and informal peer support were reportedly the most conspicuous forms of professional support mechanism, with more formal means such as mentoring and clinical supervision also appreciated. Nonetheless, stressful, often isolated, lone-working practices meant that the emotional effect of caring and individual self-care measures were not addressed satisfactorily. Most personal knowledge was described as obtained by practice-based ‘experiential’ learning; however, the nurses recognised the need for formal educational opportunities and qualifications. Whittaker E, Kernohan W, McLaughlin D (2014) Learning, development, and support needs of community palliative care clinical nurse specialists. International Journal of Palliative Nursing. 20, 9, 425-433.

Palliative care staff report stress from lone working practices

The palliative care clinical nurse specialist (CNS) role is a dynamic but difficult one, associated with significant and ever-changing challenges and stress, for which practitioners might not have the requisite power to effect change, according to this descriptive exploratory study. Using a purposive sample of community palliative care CNSs from a hospice in Northern Ireland, 33 staff were invited to participate and 17 ultimately contributed to semi-structured interviews. The interviews explored the learning, development and support needs of staff that would enable them to realise the main constituents of their role: clinical practice, education, research, and leadership and management. The interviews were recorded, transcribed and thematically analysed. The researchers identified and categorised three themes: the influence of organisational culture, the influence of the individual and solutions to developmental needs. In the organisational culture, stable working relationships and informal peer support were reportedly the most conspicuous forms of professional support mechanism, with more formal means such as mentoring and clinical supervision also appreciated. Nonetheless, stressful, often isolated, lone-working practices meant that the emotional effect of caring and individual self-care measures were not addressed satisfactorily. Most personal knowledge was described as obtained by practice-based ‘experiential’ learning; however, the nurses recognised the need for formal educational opportunities and qualifications. Whittaker E, Kernohan W, McLaughlin D (2014) Learning, development, and support needs of community palliative care clinical nurse specialists. International Journal of Palliative Nursing. 20, 9, 425-433.

THE DEVELOPMENT AND INITIAL VALIDATION OF A QUESTIONNAIRE TO MEASURE THE KEY ATTRIBUTES OF THE CLINICAL NURSE SPECIALIST IN PALLIATIVE CARE

BackgroundThe Scottish Government recognises the importance of quality, person-centred healthcare, and current worldwide events have forced an examination of the nursing contribution to this agenda. This increasing requirement to demonstrate...

A COMMUNITY PALLIATIVE CARE NURSE SPECIALIST LED INTERVENTION TO IMPROVE PALLIATIVE CARE IN CARE HOMES: PRELIMINARY RESULTS

BackgroundApproximately 20% of people die in long term care settings. National and international policies call for care homes to provide reliably good end-of-life care. Specialist palliative care providers are well...

Clinical nurse specialists’ perspectives on advance care planning conversations: a qualitative study

The aim of the study was to identify the challenges experienced by clinical nurse specialists (CNSs) when facilitating advance care planning (ACP) conversations with terminally ill patients. This paper focuses on the factors that influence CNSs when they are deciding whether to open an ACP discussion. Semi-structured interviews were used to collect data from eight purposively selected palliative care CNSs working in two different community teams. The interviews were recorded, transcribed, and analysed to identify themes. ACP required the CNSs to 'walk a tightrope', balancing potential harm with purported benefit. The nurses identified that their decision to introduce an ACP discussion was influenced by three key factors: an assessment of the patient's readiness to discuss the topic, their physical condition, and the nurse's relationship with the patient and family. ACP involves risk-taking on the part of those initiating it, owing to the potential for unforeseen or negative consequences. Further research is required to identify the factors that facilitate nurses involving patients in ACP.

P5 The South Edinburgh care homes project: A community nurse specialist-led intervention to improve palliative care

ContextApproximately 20% of people die in long term care settings. (1) National and international policies call for care homes to provide reliably good end-of-life care. Hospices are well placed to...

Evaluation of nurse prescribing in a community palliative care team

Nurse independent prescribing (NIP) within adult community palliative care has been implemented in many areas ito improve the quality of care for these patients by providing a more flexible and streamlined service. In order to evaluate whether NIP does benefit community palliative patients, a small case study was carried out comparing how long it took for patients to receive their medication following assessment or review by the palliative care clinical nurse specialist (CNS), both before and after implementation of NIP. The results suggest that NIP resulted in more timely access to medication for these patients.