Clinical Nurse Specialist Research Articles

Elements Supporting Translation of Evidence Into Practice: A Model for Clinical Nurse Specialist and Nurse Scientist Collaboration.

To present evidence-based elements supporting the synergistic relationship between nurse scientists and clinical nurse specialists to improve the translation of evidence into practice. Using best-practice elements to support the improvement of evidence-based translation, we define the roles and synergies between nurse scientists and clinical nurse specialists within clinical environments. Five themes were identified in the literature review:● Although clinical nurse specialists and nurse scientists differ in focus and competencies, they are in key positions to collaborate to meet healthcare demands.● Clinical nurse specialists are well-equipped to implement the science developed by nurse scientists.● To meet the increased demands and complexity of the healthcare system and patient needs, organizational leadership must lend support to clinical nurse specialists and nurse scientist collaboration.● Clinical nurse specialists are well-positioned to foster interprofessional partnerships and generate opportunities for evidence-based project initiatives across healthcare disciplines.● Clinical nurse specialists should utilize professional models to inform practice to improve the review, translation, and implementation of research into practice. Projects conducted using a collaborative structure had a system-level impact and long-term sustainability capabilities. Additionally, projects were more likely to be disseminated by clinical nurse specialists within a formal structure.

Addressing US Military Transgender Care Inequalities: Clinical Nurse Specialist Bridging Healthcare Gaps.

There are more than 130 000 US veterans and more than 12 500 active-duty service members who identify as transgender. Lack of training in transgender and gender-affirming care among healthcare providers in the military is still reported. The article aims to explore and advocate for the unique role of advanced practice registered nurses, especially clinical nurse specialists, in providing culturally sensitive and evidence-based care to the transgender population within the US military. The clinical nurse specialists' pivotal role in policy advocacy and translation of evidence to improve the quality of care and patient outcomes for transgender service members is highlighted. The article also explores the historical journey of transgender care in the US military, addressing discriminatory policies and the implications of the ever-evolving regulations in military transgender healthcare. The article aims to create awareness of clinical nurse specialist utilization in US military healthcare services to improve the care of transgender individuals in the military. The uncertain future for transgender service members highlights the ongoing commitment needed to navigate complex military healthcare policies and foster inclusive, evidence-based practices. Therefore, the clinical nurse specialist plays a pivotal role in shaping the future of transgender healthcare within the US military.

Describing Clinical Nurse Specialist Practice: A Mixed-Methods Study.

To describe clinical nurse specialist practice in Québec, Canada, and propose a dashboard to track role dimensions and outcomes. Sequential mixed-methods study across 6 sites in Québec (June 2021 to May 2022). Phase 1: Focus groups (n = 8) and individual interviews (n = 3) were conducted to adapt a time and motion tool. Phase 2: Time and motion studies (n = 25; 203 hours 5 minutes) described clinical nurse specialist practice. Phase 3: A rapid literature review and study participants' feedback informed the dashboard's development. Analysis: Descriptive statistics, with content analysis for qualitative data. The proportion of time clinical nurse specialists spent in role dimensions included clinical (22.8%), education (11.2%), administrative/leadership (48.6%), research (9.6%), and personal (7.7%). On average, they spent 17% of work time with patients, but this varied across specialties and locations. Key dashboard characteristics and uses were identified. Important differences were noted in clinical nurse specialist time spent in activities across specialties and regions in Québec. Approximately one-fifth of work time was spent in direct patient care. Additional research is needed to examine the link between clinical nurse specialist practice and outcomes in other jurisdictions and test the implementation of a dashboard to make their practice more visible.

Piloting an Innovative Collaboration Between a Clinical Nurse Specialist Program and a Professional Organization.

Piloting an Innovative Collaboration Between a Clinical Nurse Specialist Program and a Professional Organization.

Artificial intelligence versus human touch: can artificial intelligence accurately generate a literature review on laser technologies?

To compare the accuracy of open-source Artificial Intelligence (AI) Large Language Models (LLM) against human authors to generate a systematic review (SR) on the new pulsed-Thulium:YAG (p-Tm:YAG) laser. Five manuscripts were compared. The Human-SR on p-Tm:YAG (considered to be the "ground truth") was written by independent certified endourologists with expertise in lasers, accepted in a peer-review pubmed-indexed journal (but not yet available online, and therefore not accessible to the LLMs). The query to the AI LLMs was: "write a systematic review on pulsed-Thulium:YAG laser for lithotripsy" which was submitted to four LLMs (ChatGPT3.5/Vercel/Claude/Mistral-7b). The LLM-SR were uniformed and Human-SR reformatted to fit the general output appearance, to ensure blindness. Nine participants with various levels of endourological expertise (three Clinical Nurse Specialist nurses, Urology Trainees and Consultants) objectively assessed the accuracy of the five SRs using a bespoke 10 "checkpoint" proforma. A subjective assessment was recorded using a composite score including quality (0-10), clarity (0-10) and overall manuscript rank (1-5). The Human-SR was objectively and subjectively more accurate than LLM-SRs (96 ± 7% and 86.8 ± 8.2% respectively; p < 0.001). The LLM-SRs did not significantly differ but ChatGPT3.5 presented greater subjective and objective accuracy scores (62.4 ± 15% and 29 ± 28% respectively; p > 0.05). Quality and clarity assessments were significantly impacted by SR type but not the expertise level (p < 0.001 and > 0.05, respectively). LLM generated data on highly technical topics present a lower accuracy than Key Opinion Leaders. LLMs, especially ChatGPT3.5, with human supervision could improve our practice.

IMPROVING THE EffiCIENCY OF THE NEURO-ONCOLOGY NEW PATIENT CLINIC AT THE ROYAL MARSDEN HOSPITAL

Abstract AIMS Patients seen for the first time in the neuro oncology outpatient unit are typically reviewed by a registrar, then a consultant and a clinical nurse specialist (CNS). This can lead to repetition in history taking and prolonged appointment times. We aimed to improve this by introducing a clerking proforma. METHOD Prospective audit of all new patients seen in clinic over a four month period. The total clinic appointment time was recorded for each patient. A proforma was designed to cover the main domains of presenting symptoms, especially focussing on tumour related symptoms, medications including dexamethasone and antiepileptic use, and ensured the appropriate information was given to the patient about the treatment proposed and driving restrictions. The proforma was introduced in to the clinic after 2 months and results analysed to see if a difference was made in terms of overall patient time in the clinic. Qualitative feedback gathered from the team members involved. RESULTS 10 patients were included prior to the use of the proforma and 9 patients afterwards. Patients presented with a mixture of high and low grade gliomas. Treatment options discussed included chemotherapy, radiotherapy, surveillance and best supportive care. The average time of patient stay in the department prior to the proforma was 107 minutes (range 65 to 165) and after the introduction of the proforma was 91 (range 40 to 110). The proforma was well received by the clinical team, it was felt useful to have a template to structure the new patient consultation, especially for more junior registrars, and the consultants were more confident that the appropriate information had been given. CONCLUSION Within the confines of a small sample size, the introduction of a proforma reduced the average new patient consultation time and standardised the clinical information collected.

The emerging role of a Stroke Clinical Nurse Specialist (CNS) in Early Supported Discharged: Developing a pathway for stroke nursing for secondary prevention in the community. A scoping review protocol.

Background Stroke represents a major source of mortality and morbidity globally. The role of a stroke Clinical Nurse Specialist (CNS) as an expert team member in early supported discharge (ESD) for stroke, is not well defined or described although it is well established in other models of after-hospital and out-reach specialist care in the community. A greater focus has been on patients receiving rehabilitation post-stroke, however there is a need for a more holistic approach to care which clinical nurse specialists can offer to patients as part of ESD. Nurses are often the cohesive point of contact for other after-hospital services, managing many aspects of secondary prevention. Objective The aim of this scoping review is to explore the evidence in relation to the role of the stroke nurse providing secondary prevention interventions to stroke patients in a community setting. Methods We will conduct a scoping review in accordance with the Arksey and O’Malley, 2005 1 scoping review framework and the PRISMA-ScR guidelines to map available literature on the role of the stroke nurse in post-stroke care of patients in the community. The Cochrane Central Register of Controlled Trials and Systematic literature searches including databases MEDLINE, EMBASE, CINAHL, google scholar and grey literature will be searched using keyword searches. Data will be charted and synthesised and a narrative synthesis will be conducted. Conclusions This scoping review will be used to identify gaps in the current literature and identify areas for future research in the role of the stroke nurse in ESD in relation to secondary prevention for stroke patients and inform the development of a pathway for stroke nursing in ESD.

Audit Of Clinical Frailty Scale (CFS) Screening In Medical Assessment Unit (MAU) Admitted Patients In A Model-2 Hospital

Abstract Background This model-2 hospital serves a demographic where 1-in-3 MAU attendees are over 75-year-old. It has been shown that in those where frailty is identified and managed early, outcomes are better. This study audits the newly established frailty screening pathway to capture frailty data on patients from point of admission, commencing January 2024. Methods The Hospital Frailty Committee established a frailty screening pathway for all patients presenting to the MAU. Using the CFS and a bespoke sticker incorporated into the MAU booklets, patients ≥75 years old were routinely screened. In admitted patients, a CFS score of ≥ 6 triggers a referral to the Clinical Nurse Specialist (CNS) of the Older Adult. For discharged patients, a CFS score of ≥ 6 triggers referral to the public health nurse. We compared the completion of the bespoke sticker to number of onward received referrals to the CNS via electronic referral system. We measured i.) proportion of completed bespoke stickers; ii.) quality of sticker completion and iii.) proportion of appropriate triggered referrals (inpatients). Results We identified 34% (n=94) of 247 MAU attendees as meeting the criteria for frailty screening (age≥75) for which the MAU booklet was reviewed manually. A total of 81% (n=77) had a bespoke sticker in their documentation, 71% of which were completed (n=55). Of these 55, 72% (n=40) were admitted with a median CFS of 6 (Average 5.5). Of the 40, 57.5% (n=23) were referred and seen by the CNS, 35% (n=14) were not referred (appropriately), 2.5% (n=1) not referred who should have been and 5% (n=2) were referred but not seen. Conclusion Establishment of this pathway and subsequent audit highlights the high level of frailty in our patient cohort. In addition, 5% of admissions would have benefitted from CNS input, but didn’t get it, highlighting need to further expand and develop service.

Establishing The Role Of The Clinical Nurse Specialist For The Older Adult In A Model 2 Hospital

Abstract Background On average 87.5% of inpatients in our Model-2 Hospital are aged sixty-five years or above. Equally 57.5% of inpatients have medium to maximum dependency care needs. In order to meet the needs of this cohort of patients a new post “Clinical Nurse Specialist (CNS) For The Older Adult” was established in September 2023. Methods Using an online referral system, criteria for referral included i) new onset confusion or delirium, ii) clinical frailty score (CFS) of six or greater, iii) known Parkinson’s disease and iv) nursing or medical team clinical judgement. All reviewed patients received a comprehensive geriatric assessment using the Geriatric 5M framework (Mobility, Medications, Multi-Complexities, Mind and Matters Most) ensuring all aspects of patient care were assessed and promoting timely input from our multi-disciplinary team (Physiotherapy, Dietitian, Speech and Language Therapy, Occupational Therapy and Pharmacy). Results Over a period of 207 days the newly established CNS service received a total of 317 referrals. Two thirds (n=206, 65%) received CNS review, one third (n=111, 35%) did not; 45 (14%) were under the care of a consultant Geriatrician and not reviewed to avoid duplication and 66 (21%) were discharged before review could occur. Conclusion Referral numbers received since the established of the CNS post emphasises the need for the service in our hospital inpatient population. Development of the post has ensured that two-in-three referred patients receive a CNS lead CGA. Results from this pilot highlights the need to further develop and expand the service to target the one-in-five who missed review and further extension of the referral criteria.

Development of a Hospital Wide Inpatient Frailty Screening Pathway in a Model-2 Hospital

Abstract Background Our model-2 hospital is experiencing a higher proportion of frail older adults presenting to our medical assessment unit (MAU) and via direct ward admissions. Frailty increases the risk of co-morbidity, falls and mortality during hospital admission. Screening for frailty a point of admission allows early identification of these patients who are at higher risk of adverse outcomes. Early frailty screening also assists healthcare professionals with multidisciplinary team (MDT) management and treatment plans. Our hospital frailty committee established a frailty screening pathway for all inpatients aged 75 years and older to screen for frailty and minimise the risk of adverse outcomes secondary to frailty. Methods A hospital wide consultant chaired frailty committee was established with stakeholders from the MDT. Two separate screening pathways were developed, one for MAU admissions and one for direct ward admissions. A standardised frailty policy and standardised operating procedure (SOP) with algorithm illustration were compiled. Hospital wide education emphasised the development of a bespoke Clinical Frailty Score (CFS) sticker in conjunction with referral pathways to the newly established Clinical Nurse Specialist (CNS) For The Older Adult. In each pathway CFS-screening is completed for adults ≥75years at first-point of contact using the CFS, a score ≥6 triggers onward referral, CNS for inpatient and public health nurse for MAU discharged patients. Results Both pathways are established and used effectively and routinely on a daily basis. Associated educational sessions have emphasised the importance of frailty in our inpatient cohort. Conclusion The developed algorithms have been useful for identifying frailty and improving patient care with onward CNS referral. Future audits will assess effectiveness of screening and support advancement of frailty committee objectives via supporting business cases for resourcing.

Supporting Complex Severely Frail Patients at Home with Community Specialist Team Intervention

Abstract Background The Community Specialist Team for Older Persons (CST-OP) was created to support older people to live well at home. The team primarily aims to reduce ED presentations and admissions into acute facilities for over 65s. The team became the first fully staffed CST-OP in Q3 2022. Referrals are responded to within 24-48 hours and each referral has a comprehensive geriatric assessment completed. Interdisciplinary assessment is used to identify interventional needs which the team then addresses. This abstract specifically examines the success of supporting people with a Clinical Frailty Score (CFS) of 7 and above to remain at home. Methods The team consists of a senior 1 WTE Social Worker, Physiotherapist, Therapy Assistant, Consultant Geriatrician, Advanced Nurse Practitioner and Clinical Nurse Specialist. The team also has 0.5 WTE Senior Speech and Language Therapist and Dietician. Referrals are accepted from the FIT team, GPs and Older Persons OPD clinic. The team operates on a 100% domiciliary based assessment. A comprehensive geriatric assessment is completed with each referral. A care plan is generated, and interdisciplinary intervention carried out. Results From September 2022 to December 2023 69 patients with a CFS of 7 or above were reviewed by the CST-OP. 60 remained at home, 7 transitioned to LTC and 2 RIP. These figures represent an 86% success rate. Conclusion Evidence suggests older people living with severe frailty can be supported to live well at home by Community Specialist Teams via timely interdisciplinary assessment and intervention and appropriate utilisation of community supports.

Advance Healthcare Directives: the Irish Implementation Reality from an Interdisciplinary Group Concept Mapping Study

Abstract Background Advance Healthcare Directives became legal in Ireland on 26th April 2023. While Advance Healthcare Directives are primarily rooted in patients’ legally binding refusal of treatments or interventions, they also encourage patients to set out their care preferences for the future (Government of Ireland 2015). Despite care of the older adult broadly transitioning from acute hospital to community, and a greater than ever focus on keeping older adults living at home for longer, low awareness of, and professional uncertainty around, Advance Healthcare Directives and how to integrate them into the care of the older adult has been widely expressed by Irish hospital physicians (Crowley and Doran 2022). Methods In this implementation study, Group Concept Mapping, using the relatively novel ‘GroupWisdom™’ software, is used to collect and analyse data from multiple healthcare professions to identify contextual issues that affect the implementation of Advance Healthcare Directives. 44 frontline healthcare professionals including Hospital Consultants (n=6), General Practitioners (n=5), Paramedics (n=7), Advance Nurse Practitioners (n=4), Clinical Nurse Specialists (n=4), Public Health Nurses (n=5), Critical Care Nurses (n=3), Nurse Managers (n=2), Healthcare Managers (n=2), Occupational Therapists (n=2) and Social Workers (n=4) participate in this mixed method study. Policymakers and other stakeholders are also involved throughout. Results The main implementation issues for Advance Healthcare Directives in order of importance as outlined by Healthcare Professionals are: 1) Public Education; 2) Homecare Services; 3) Timing and Location; 4) Family Members; 5) Lack of Education for the Healthcare Professional; 6) Complications for the Healthcare Professional; 7) Individual and Cultural Beliefs. Conclusion This study contributes a valuable understanding of where the implementation issues reside for healthcare professionals and policymakers, and how these can be addressed to ensure successful implementation. This implementation study focuses on practical considerations, offering multiple workable solutions to help to resolve these implementation issues on the ground.

Challenges and Benefits of Developing Case Management in an ICPOP Hub

Abstract Background Case management is a collaborative procedure involving assessment, planning, facilitation, care coordination, evaluation, and advocacy. Its aim is to address the comprehensive health needs of individuals and families by utilising communication and existing resources to achieve high-quality and cost-effective results. The Integrated Care Program for Older Persons (ICPOP) aims to improve life for older people by providing access to tailored interventions supporting them to live well in their own homes. (ICPOP, 2017). The goal of nurse-led case management interventions within the ICPOP Hub, is to provide continuous, patient-centred, comprehensive care for older adults with complex care needs. Methods The Nursing team, comprising Clinical Nurse Specialists, Candidate Advanced Nurse Practitioner, undertook case management of 40 patients with complex care needs, over a six-month period. Diagnoses included Delirium, Dementia, Parkinson’s disease, frailty syndromes. Particular attention was given to patients who, through case management, were able to be discharged earlier from the acute hospital, aligning with the goals of the Integrated Care Model. Quality Improvement methodologies were used aiming to improve service delivery, efficiency, patient outcomes. Results (Required) Benefits Challenges Conclusion Case management enables older adults to continue living independently at home but requires integration into a broader system prioritising seamless delivery utilising a collaborative, multidisciplinary approach to health and social care.

Implementation Of A Specialist Geriatric Ward; Outcomes One Year After Inception

Abstract Background Older adults being admitted to an acute hospital setting have care needs that would benefit from coordinated care on a Specialist Geriatric Ward (SGW). Prior to May 2023, older patients admitted to our institution received input from geriatric medicine through a variety of avenues. There was a clear need for dedicated and formal access to specialist geriatric services. It was hypothesised that care delivered on a SGW would improve patient access to the Right Care, in the Right Place at the Right Time. It has long been recognised in the literature that a dedicated SGW with appropriate access to Health and Social Care Professionals is the gold standard of care for older adults admitted to the acute setting. Methods An evidence based SGW was designed and implemented in May 2023. This consisted of a 32-bed dementia and delirium friendly ward, staffed with a consultant geriatrician, medical team, frailty and dementia Clinical Nurse Specialists, a multidisciplinary team and a dedicated patient flow lead for older persons. Ingress pathways to the ward included emergency department medical admissions, Frailty at the Front door referrals and patients selected from geriatric medicine consults. Egress pathways availed of included offsite rehabilitation, rehabilitation at home services and integrated care team input. All patients received early discharge planning and a comprehensive geriatric assessment was initiated on admission to the ward. Key performance indicators included length of stay (LoS), reduction in “Safari Rounds” which improves Clinician/Patient contact, daily whiteboard rounds, improved predicted discharge date (PDD) compliance. Data and outcomes were reviewed weekly. Results After one year, the SGW demonstrated improvements across all metrics with percentage cohorted patients improving by 24% and both average and median LoS reduce by 19 days. Total number of bed days saved was 1,513. Conclusion Multidisciplinary care delivered on a SGW improves patient and service outcomes.

Filling Gaps in Practice Leadership: Succession Planning for Clinical Nurse Specialist Positions.

To create a succession plan for clinical nurse specialist positions across multiple clinical settings. Mayo Clinic (Rochester, Minnesota) had multiple clinical nurse specialist position vacancies. However, standard recruitment methods and a collaboration between human resources and nursing managers to expand the applicant pool yielded few applicants. A work group was subsequently commissioned to identify innovative ways to fill the vacant clinical nurse specialist positions. Guiding principles for hiring and implementing the role were developed. During the 4-year project period (2016 through 2019), the time to fill positions decreased from 174 days to 83 days. Nurse managers and clinical nurse specialists reported an increased number of registered nurses seeking information about the profession. Twenty-eight clinical nurse specialist interns, titled clinical resource nurses, were hired, and 14 completed their graduate degree, obtained state licensure, and transitioned to clinical nurse specialist roles. Twelve clinical resource nurses were on schedule to transition to clinical nurse specialist positions, and 2 left their positions. A succession plan that used clinical nurse specialists to mentor clinical resource nurses to fill gaps in practice priorities while completing graduate education was a successful strategy to fill vacant clinical nurse specialist positions.

The Clinical Nurse Specialist: A Valuable Asset to a High-Reliability Healthcare Organization.

High-reliability organizations aim to achieve zero harm. The clinical nurse specialist (CNS) is an advanced practice RN who adds value to the leadership team. The CNS is proficient in influencing care delivery across the continuum and the master of developing collaborative relationships that aid in the discovery of deficiencies in care and generation of innovative ideas to minimize deficiencies. This column provides some examples of the impact and role of the CNS.

Lessons Learned From a Clinical Nurse Specialist "Elder".

Lessons Learned From a Clinical Nurse Specialist "Elder".

Learning Management System: Innovation in Providing Clinical Nurse Specialist Student Resources.

Learning Management System: Innovation in Providing Clinical Nurse Specialist Student Resources.

The Clinical Nurse Specialist: Maximizing Return on Investment.

The United States health care system is facing an unprecedented nursing shortage, increasing complexity of care, and fewer experienced nurse mentors. These factors contribute to a cycle of burnout, turnover, decreased quality and safety, and a worsening financial bottom line. Improving these contributing factors depends on our ability to mitigate the structural causes of burnout and turnover. The clinical nurse specialist role is essential to improving the work environment, advancing evidence-based nursing practice, reducing turnover, and stabilizing the bottom line.

Evaluating the integration of CTCA as part of an accelerated diagnostic pathway for patients presenting to the Emergency Department with acute chest pain: a two-year review

Abstract Introduction Chest pain accounts for 8.8% of all presentations to an Hospital Emergency Department. In line with ESC guidelines (2019), an adapted HEART pathway, utilising CT Coronary Angiogram (CTCA) is delivered by our Emergency Cardiology Advanced Nurse Practitioners (ANP) and Clinical Nurse Specialists (CNS) as part of an ambulatory chest pain pathway. It is our first line diagnostic test for patients with a non-ischaemic 12-lead ECG and normal cardiac biomarkers, with a low-to-intermediate HEART score. Responsibility for the referral of patients onto the pathway is shared with the Cardiology Registrars. This is a collaborative interdisciplinary pathway between Emergency Medicine, Cardiology, and Radiology. Purpose To evaluate the effectiveness and safety of CTCA as part of an Accelerated Diagnostic Pathway (ADP), for evaluation of chest pain of possible cardiac origin in low-to-intermediate risk chest pain patients. Methods We examined the CTCA and safety outcomes of patients presenting between Jan 1st 2022 – Dec 31st 2023 who were risk stratified as low-to-intermediate risk for coronary artery disease, based on Heart score, 12-lead ECG and biomarker testing, using the electronic patient records. Institutional ethics was in place. Results Between January 1st and December 31st 2022, 290 patients were referred for CTCA, with a total of 268 CTCAs completed. The number of patients referred on the ADP increased by 53.4% in 2023 with 445 being referred for CTCA, 416 of which have been completed, with 12 pending completion. 38% of patients were found to have evidence of coronary artery disease (CAD). Coronary artery disease causing at least 50% stenosis was identified in 11% of patients. 4.5% of these patients required revascularisation, 17 of whom underwent Percutaneous Coronary Intervention (PCI) with a further 13 being referred for Coronary Artery Bypass Grafting. A positive family history was the most dominant risk factor associated with significant CAD. An equivalent number of males to females were referred for CTCA, however, men were more than 7 times more likely to have severe disease. (12% vs 88%). All patients referred for CTCA via the chest pain pathway were followed up by the Emergency Cardiology ANP/CNS in a virtual clinic, delivering risk factor modification advice and preventative therapies, when indicated. There was no evidence of any major adverse cardiovascular events within a 30-day period for this patient cohort. Conclusion The integration of CTCA into an adapted HEART pathway has resulted a safe and timely discharge for patients presenting to ED with acute chest pain, of possible cardiac origin. CTCA offers excellent early detection of coronary artery disease in this patient cohort with normal ECGs and cardiac biomarkers, but with a history of chest pain suggestive of CAD.