Liaison Nurses Research Articles

Geriatric emergency department innovations: preliminary data for the geriatric nurse liaison model.

Older adults account for a large and growing segment of the emergency department (ED) population. They are often admitted to the hospital for nonurgent conditions such as dementia, impaired functional status, and gait instability. The aims of this geriatric ED innovations (GEDI) project were to develop GEDI nurse liaisons by training ED nurses in geriatric assessment and care coordination skills, describe characteristics of patients that these GEDI nurse liaisons see, and measure the admission rate of these patients. Four ED nurses participated in the GEDI training program, which consisted of 82hours of clinical rotations in geriatrics and palliative medicine, 82hours of didactics, and a pilot phase for refinement of the GEDI consultation process. Individuals were eligible for GEDI consultation if they had an Identification of Seniors At Risk (ISAR) score greater than 2 or at ED clinician request. GEDI consultation was available Monday through Friday from 9:00 a.m. to 8:00 p.m. An extensive database was set up to collect clinical outcomes data for all older adults in the ED before and after GEDI implementation. The liaisons underwent training from January through March 2013. From April through August 2013, 408 GEDI consultations were performed in 7,213 total older adults in the ED (5.7%, 95% confidence interval (CI)=5.2-6.2%), 2,124 of whom were eligible for GEDI consultation (19.2%, 95% CI=17.6-20.9%); 34.6% (95% CI=30.1-39.3%) received social work consultation, 43.9% (95% CI=39.1-48.7) received pharmacy consultation, and more than 90% received telephone follow-up. The admission rate for GEDI patients was 44.9% (95% CI=40.1-49.7), compared with 60.0% (95% CI=58.8-61.2) non-GEDI. ED nurses undergoing a 3-month training program can develop geriatric-specific assessment skills. Implementation of these skills in the ED may be associated with fewer admissions of older adults.

Intensive multidisciplinary care programme for frail patients

Rationale and Objectives: Patients with chronic diseases re-admitted for acute events are associated with a high use of hospital resources and represent a challenge for healthcare systems. In such cases, follow-up interventions at discharge can be effective. The widespread adoption of follow-up procedures not involving telemonitoring may greatly decrease re-admissions rates without the costs associated with telemedicine. To assess the impact of a structured follow-up programme on patient-perceived healthcare quality, treatment adherence, re-admissions and Emergency Department attendances.Methods: This was a before and after study of 242 patients at risk of re-admission for chronic obstructive pulmonary disease (COPD) or heart failure (HF), recruited between 1st July 2009 and 30th June 2010 at Donostia Tertiary University Hospital (Gipuzkoa, Spain). The follow-up ended on 30th December 2010. The intervention involved identifying independent re-admitted patients, providing personalised information and a direct number to call in the event of clinical worsening, assigning specialists and liaison nurses, structured follow-up by telephone and appointments and contact with general practitioners. Patient perceived quality of care estimated was analyzed using a focus group technique. To assess the number of re-admissions and the Emergency Department attendances we estimated the relative risk reduction as a percentage and corresponding 95% confidence intervals.Results: In terms of perceived quality of care, the most valued elements were related to having an assigned doctor/nurse and easy access in the event of worsening. Overall, 97.9% of patients reported full adherence to treatment (95% CI: 95.4-98.83).Hospital bed days and Emergency Department attendances decreased by 60.7% (95% CI: 58.7-62.7) and 77% (95% CI: 73.2-80.3), respectively.Conclusions: The intensive multidisciplinary care programme can reduce Emergency Department attendances and improve perceived quality of care in patients with HF and COPD.

PTH-029 Lifestyle Screening And Brief Interventions In A Gastroenterology Clinic

IntroductionWorcestershire Acute Hospitals NHS Trust currently have an Alcohol Liaison Nurse (ALN) Service. In response to NICE and Making Every Contact Count we wanted to implement a lifestyle screening tool...

OC-058 Ambulatory Care Alcohol Detoxification (acad) At Whittington Health: A New Approach !

IntroductionAlcohol-related harm costs NHS £3.5 billion a year. It has become a “top priority” for the NHS. Alcohol Concern reported 1.2 million alcohol-related admissions in 2011/12, an increase of 135%...

Fitness to Stand Trial in New Zealand: Different Factors Associated with Fitness to Stand Trial Between Mentally Disordered and Intellectually Disabled Defendants in the New Zealand Criminal Justice System

Individuals on trial for an offence are expected to contribute to their own defence via liaison with their defence team and be able to participate meaningfully in the court process. Defendants who are unable to do so are deemed unfit to stand trial. The factors associated with fitness to stand trial within the New Zealand criminal justice system have not been closely examined. This study compared sociodemographic, offence-related, clinical and court-related factors associated with fitness to stand trial for 200 mentally disordered and intellectually disabled (ID) defendants assessed for the New Zealand Courts. The study found generic sociodemographic, offence-related and clinical factors were not significantly associated with fitness to stand trial. By contrast, court-related factors such as previous assessment of fitness to stand trial and previous finding of unfitness, and clinical factors such as previous diagnosis of ID and low cognitive functioning were significantly associated with unfitness to stand trial. Court liaison nurses' concerns about the defendant's ability to communicate and comprehend appeared to be reliable indicators of unfitness, suggesting that this may be a useful initial screen of eligibility before more formal assessment of competency and intelligence.

Factors associated with post-intensive care unit adverse events: a clinical validation study.

Many patients discharged from intensive care units (ICU) have complex care needs, placing them at risk of an adverse event in a ward environment. Currently, there is limited understanding of factors associated with these events in the post-intensive care population. A recent study explored intensive care liaison nurses' opinions on factors associated with these events; 25 factors were identified, highlighting the multifaceted nature of post-intensive care adverse events. This study aimed to clinically validate 25 factors intensive care liaison nurses believe are associated with post-intensive care adverse events, to determine the factors' relevance and importance to clinical practice. Prospective, clinical validation study. Data were prospectively collected on a convenience sample of 52 patients at 4 tertiary referral hospitals in an Australian capital city. All patients had experienced an adverse event after intensive care discharge. Each of the 25 factors contributed to adverse events in at least 6 patients. The factors associated with the most adverse events were those that related to the patient such as illness severity and co-morbidities. Clinical care and research should focus on modifiable factors in care processes to reduce the risk of future adverse events in post-intensive care patients. Many patients are at risk of post-ICU adverse events due to the contribution of non-modifiable factors. However, by focusing on modifiable factors in care processes, the risk of post-ICU adverse events may be reduced.

Quality and equality.

The Purple Star quality kite mark was developed by Hertfordshire County Council's Health Liaison Nursing Team for services committed to providing equal care for people with a learning disability.

Establishing the Surgical Nurse Liaison Role to Improve Patient and Family Member Communication

Having clear personal communication with a surgical patient's family members decreases the anxiety and increases patient and family member satisfaction. Perioperative team members at one East Coast community hospital implemented a new approach to communication in the perioperative area to address patient satisfaction after patient survey scores declined in the areas of communication and calming fears. An additional consideration was the facility's plan to move to a new facility in which the surgical department would be split across two floors. A literature review revealed that adding a surgical nurse liaison can increase patient, family member, and staff member satisfaction. The administration approved creation of the position, with duties that included managing the waiting area, facilitating interaction between physicians and patients' family members, and assisting with family visits to the perianesthesia unit. After implementation of this position, results of surveys showed increases in patient satisfaction. One year after the position was established, staff members reported they were happy with the position as well.

A cure for crime.

As an emergency department sister in an inner-city hospital Alice Kershberg knows only too well the consequences of violent crime. In her new role as violence reduction nurse at the Royal London Hospital, part of Barts Health NHS Trust, she will be supporting local councils and the police to reduce violence in the community. Ultimately, it is hoped the initiative will result in fewer victims of crime attending the trust’s emergency department for treatment. ‘Many victims of violent crime we see here are as young as 15 to 17,’ says Ms Kershberg. ‘And sadly, when we are treating them for one life-threatening wound, sometimes we can see scars from previous attacks. It’s a waste of lives. They see no alternative but to join gangs who carry knives or guns.’ Each month, between 150 and 200 patients are treated at the emergency department following a crime such as gang violence or domestic abuse. A key part of Ms Kershberg’s new job is to organise the collection of anonymous information from patients. The data-collection form is based on one designed by an A&E department in Cardiff that had a problem with violent crime, with added input from the College of Emergency Medicine. Questions cover the location of the assault, the type of weapon used and whether the patient knew the assailant. Representatives of local councils and the police, who Ms Kershberg meets with once a month, analyse the data for patterns that might reveal common causes or areas of high crime. Health and social services then use the information to put in place services designed to offer local residents, and young people in particular, alternatives to drinking in excess and joining gangs. Ms Kershberg says 75 per cent of assaults are not reported to the police, but victims will talk to nurses – and they are most receptive when they are being treated in the emergency department. ‘It is the best “teachable moment”,’ she says. ‘And we won’t be talking to just the victim – they usually turn up with ten to 12 friends, so we have an ideal opportunity to educate them all.’ Data collection in the emergency department has revealed that a quarter of violent crimes over the weekend are linked to alcohol consumption. ‘We are working closely with Barts’ alcohol liaison nurses and community services to offer support to people to help them cut down on their drinking,’ says Ms Kershberg.

An overview of nursing in Europe: a SWOT analysis.

This article sets out a global analysis of the weaknesses, threats, strengths and opportunities that define the current situation of nursing in Europe. The nursing profession in Europe is suffering from a crisis of self-efficacy with the syndrome of burnout being one of its consequences. Other weaknesses include shortage of staff, job insecurity, devalued nursing image in society and the lack of recognition of emotional and psychological dimensions of care. The threats to this profession are linked to the lack of prestige and social recognition and to the current economic crisis in Europe. The European economic crisis favours staff shortages and increased European migration flow. The strength of the group lies in the art of caring, which is its defining feature. Primary Care Nursing and Hospital Liaison Nursing demonstrate the great professional adaptability in meeting the needs of the ever-changing society. The European Higher Education Area and the strengthening of the specialties provide opportunities for the nursing profession. Both represent an important progress towards solid professionalism that will give nursing greater visibility. Moreover, nursing must implement strategies to disseminate its activity and emerge from anonymity. Nursing must show society the image it wants to project.

The barriers to and enablers of providing reasonably adjusted health services to people with intellectual disabilities in acute hospitals: evidence from a mixed-methods study

ObjectiveTo identify the factors that promote and compromise the implementation of reasonably adjusted healthcare services for patients with intellectual disabilities in acute National Health Service (NHS) hospitals.DesignA mixed-methods study involving...

Uniform care for patients undergoing peritoneal dialysis in non-nephrology departments

Objective To establish a nursing model of uniform care and homogeneous and safe care for patients unergoing peritoneal dialysis(PD) in non-nephrology departments.Methods A nursing team professional in PD was established in the hospital to train the liaison nurses in non-nephrology departments according to the criterion for nurses professional in PD and in term of the conception of uniform care.Essential knowledge and skills related to PD were included in the training courses.Comparisons were performed to evaluate the knowledge and skills related to PD in liaison nurses and service quality for patients undergoing PD admitted in non-nephrology departments before and after the new nursing model.Results After adapting uniform care,the nurses' PD knowledge and skills was significantly improved (P＜0.05),while service qualities for patients undergoing PD were significantly enhanced (P＜0.05) in the 24 non-nephrology departments.Conclusions Uniform care is a guarantee for the quality of patient care for patients undergoning PD in non-nephrology departments.It benefits both the patients and nurses by improving patient satisfaction,as well as enhancing the professional self-identity of the nurses. Key words: Uniform care; Peritoneal dialysis; Liaison nurses; Nursing model

Reasons for Returning to the Emergency Department: Perspectives of Patients and the Liaison Nurse Clinician

Objectives: The authors wanted to understand the reasons why patients discharged from internal medicine units return to the emergency department within a short term period. The purpose of the study was to explore patients’ perspective of their reasons for returning to the emergency department within fourteen days post-discharge from an internal medicine unit, and to examine how these reasons relate to those determined by the liaison nurse clinician prior to discharge.Methods: A qualitative descriptive design was selected to develop the study and individual face-to-face semi-structured interviews were conducted with participants. A convenience sample of eight participants was recruited from a major teaching hospital in Montreal, Canada. The study triangulated three different data sources, which were the patient’s perspective through the interview and the liaison nurse clinician’s perspective through the use of two evaluation tools, which were the Bounceback Probability Legend and the LACE Index Scoring Tool.Results: The participants attributed their return to the emergency department due to 1) being discharged too soon, 2) feeling weak at discharge, 3) having limited discharge instructions prior to discharge, and 4) having limited resources available to rely on for help once home. It was also noticed that participants went through a decision-making process for choosing to return to the emergency department. Additionally, the liaison nurse clinician’s evaluation tools identified different reasons from those the participants had attributed to their return to the emergency department.Conclusions: The findings suggest that health care professionals must evaluate and assess patients on several components upon their discharge, such as the understanding of their illness, primary concerns, and readiness prior to discharge. The study provides further data in supporting the need of patient’s involvement in the process of discharge planning.

Cronicidad y complejidad: nuevos roles en Enfermería. Enfermeras de Práctica Avanzada y paciente crónico

El aumento de las enfermedades crónicas y el envejecimiento progresivo de la población es una fuente de preocupación y de ocupación para los diferentes organismos que tienen bajo su responsabilidad el cuidado de la salud. Ello ha motivado que se generen multitud de documentos enfocados al análisis de la situación y de la atención de las enfermedades crónicas, así como recomendaciones de la OMS para que los países y los servicios de salud diseñen e implementen estrategias que permitan abordar la demanda existente, controlar y prevenir las enfermedades crónicas. Paralelamente a esta amenaza, surge la necesidad de dar respuesta a la demanda que genera la cronicidad en toda su dimensión, y desde los diferentes sistemas se va, cada vez con más fuerza, manifestando la necesidad de contar para ello con equipos multidisciplinares, en los que la enfermera cobra cada vez más valor. A la vez que la cronicidad supone una amenaza por los costes que genera, es también una oportunidad para la Enfermería estar allí donde se precisa de cuidados avanzados, realizados por profesionales con competencias clínicas avanzadas y reconocidas, para llevar a cabo la gestión de casos y el seguimiento y control de pacientes crónicos complejos. Los diferentes servicios del Sistema Nacional de Salud, están incorporando, aunque no con el desarrollo que sería deseable, enfermeras que desempeñan diversos roles (gestoras de casos, enfermeras de enlace, enfermeras de práctica avanzada, etc, etc). Es, pues, el momento de que las autoridades sanitarias determinen en la relación de puestos funcionales la figura de la Enfermera de Práctica Avanzada, y con ello se podrá avanzar en el desarrollo de unas competencias unificadas en todo el Sistema Nacional de Salud. De las experiencias realizadas, hemos aprendido que las Enfermeras de Práctica Avanzada son un recurso que facilita la sostenibilidad de los servicios, por la eficiencia demostrada en los resultados obtenidos en la atención a pacientes crónicos y crónicos complejos. The increase in chronic diseases and the progressive ageing of the population is a source of concern for the different agencies with responsibility for health care. This has led to the creation of many documents focused on the analysis of the current situation and care of chronic diseases, including the WHO recommendations intended to assist countries and health services design and implement strategies that will address the existing demand, control and prevention of chronic diseases. In addition, there is a need to respond to the demand generated by chronic diseases in every sense, and from the different systems it is becoming more difficult to get enough support from multidisciplinary teams where the nurse has a central importance. While chronic diseases are becoming a threat due to the costs they generate, it is also an opportunity for nursing to be at the forefront for advanced care requirements, performed by professionals with recognized advanced clinical skills and ability for case management while monitoring and controlling complex chronic patients. The different services of the National Health System have introduced nurses that play different roles (cases managers, liaison nurses, advanced practice nurses and so on). However, it could be argued that they are not being trained to a desirable development level. It is therefore time for health care authorities to determine the role of the advanced practice nurse in relation to functional positions, and allow them to make an advance in the development of unified skills for the whole National Health System. From our experience we have learned that the advanced practice nurse is a resource that helps in the sustainability of services, thanks to the efficiency shown in the results obtained from the care given to both chronic and complex chronic patients.

The Nurse Liaison Role in the Cooperative Group Setting

To review the history of nurse involvement within the cooperative group environment, define the role of the nurse liaison, identify challenges for the nurse in interdisciplinary research, and explore future trends of nurse involvement in cooperative group studies. Published articles, government reports, and Web sites. Nurse liaisons provide a nursing perspective to the design of cooperative group trials and ensure that nursing and patient feasibility issues about the trial are addressed, and provide guidance to nurses at participating institutions, as well as their home institution. The nurse liaison must be committed to their cooperative group role. Because of their proximity in time and space to the patient, nurse liaisons have a unique vantage point that can provide meaningful feedback for all stages of protocol development, implementation, and evaluation.

A Study of the Effectiveness of Psychiatric Clinical Liaison Nurses and Determinants of Psychiatric Admission in an Accident and Emergency Department of Hong Kong

Background This study examines how psychiatric clinical liaison nurses (CLN) services in the accident and emergency department (ED) meet the demand for those people with mental health problems. In addition, we aim to identify determinants for psychiatric admission. Methods All psychiatric patients attended the ED within the periods of May to July of 2007, May to July of 2008 and January to March 2012 were recruited. Data was recorded on patients' demographics, past mental history, time of arrival to the ED, time of discharge from the ED, length of stay in the ED, time to urgent psychiatric services (CLN services in 2008 and 2012, and urgent psychiatrist consultation in 2007), and on clinical symptoms and outcome. Results Totally 484, 519 and 587 attendances were analysed in 2007, 2008 and 2012 respectively. Results showed that the introduction of CLN to the ED significantly shortens the waiting time for patients from registration in the ED to urgent psychiatric services, from 33.5 hours to 21.4 hours then to nine hours. However, the mean length of stay in the ED was prolonged from three hours to five hours. Overall admission rate was similar. Re-attendance rate was decreased. Five significant determinants of psychiatric admission in an attendance to the ED were identified: patients presented with psychotic symptoms, violent behavior, suicidality, known to mental health services and depressive symptoms. Conclusions The CLN service as described in this study appears to be a useful resource in the ED for patients with mental health problems. Five determinants of psychiatric admission are identified. (Hong Kong j.emerg.med. 2013;20:364-370)

Experiences of the implementation of a learning disability nursing liaison service within an acute hospital setting: a service evaluation

Accessible Summary This article is about learning disability liaison nurses, and whether they help people with learning disabilities to have a better experience when they are in hospital. We talked to people with learning disabilities, their carers and hospital staff to find out what they thought about learning disability liaison nurses in acute hospitals. Everybody thought that these nurses were very important, and that they helped patients and hospital staff to talk to each other and understand each other better. This work shows that learning disability liaison nurses working in an acute hospital can help people with learning disabilities to receive a better service. SummaryIt has been well documented that people with learning disabilities receive poor care in acute settings. Over the last few years, a number of learning disability liaison nurse services have developed in the United Kingdom as a response to this, but there has been a failure to systematically gather evidence as to their effectiveness. This article reports on a service evaluation that sought to establish whether implementing a learning disability liaison nurse service improved hospital experiences for patients with learning disabilities, and their carers, whilst in an acute hospital setting. Quantitative data were collected on all patients with learning disabilities referred to this service over a six‐month period, and this included numbers referred (elective and emergency), length of time for referral, presenting conditions and age profile, as well as activities of the liaison nurses. These data suggest an incremental rise in referral of patients with learning disabilities to this service over time, relatively few inappropriate referrals, referrals from hospital staff and community services were similar, and these nurses found that some patients with learning disabilities were not referred to the service. Concerning activities of these nurses, these were dominated by discharge planning, assisting in making reasonable adjustments, liaison work and assisting with mental capacity issues. In addition, patients with learning disabilities, their carers and hospital staff who had experience of this learning disability nursing liaison service were interviewed. It was found from these interviews that all participants understood the role of the liaison nurse and articulated that they improved communication as well as promoting holistic care. Those interviewed highlighted the importance of such a role and the need for it to continue. This service evaluation makes an important contribution to an ongoing gap in learning disability literature concerning the importance of such a service.

A description of the ICU liaison nurse role in Argentina

Recognising and responding to clinical deterioration in hospital patients has been promoted by many western countries to improve patient safety. In non-western and developing countries it is likely to be even more important to focus on strategies of patient safety. This paper reflects the services provided by Intensive Care Unit Liaison Nurses (ICULN) in the first year of their work, July 2010-June 2011, in an Argentinean hospital. This practice audit aimed to describe the ICULN patient care activities performed for patients discharged from the ICU and ward patients with complex care needs, and to identify education activities carried with ward nursing staff caring for these patients. Experienced critical care nurses, with strong communication and education skills were appointed as ICULNs. They were asked to assess ward patients transferred from ICU once per shift and ward patients as requested by staff. They had to provide patient complex care if necessary and education to ward nurses caring for these patients. A total of 387 patients were followed by ICULNs. The median age of patients was 49 (IQR 26) years (range 15-89). A total of 369 (95.3%) of the patients were discharged from ICU and 18 (4.7%) were ward patients who required complex care. The most frequent conditions patients had were surgery, neurologic conditions, trauma and sepsis. Thirty four (9.2%) of 369 patients who were initially in ICU, were readmitted during the same hospitalisation. During the study period ICULNs performed 5973 patient care and 1709 staff education activities. ICULNs provide advanced assessment and surveillance of ICU discharged and complex ward patients, and facilitate ICU-ward transition assisting and educating ward staff. Further evaluation is necessary to better describe the role in Argentina and the effect of ICULN service on patient outcomes and on staff.

Interprofessional meetings in geriatric assessment units: a matter of care organization

Inpatient geriatric assessment units (GAUs) exist in Quebec, Canada, to deliver comprehensive, integrated care to older vulnerable patients. Most cases should be discussed at interprofessional meetings (IMs), but research has shown this not to be so for 39% of GAU patients. Consequently, a study was undertaken to (1) describe GAU team composition and (2) identify GAU and patient characteristics associated with case discussion at IMs at least once during a patient’s stay. To this end, 877 hospitalization records from 44 GAUs were reviewed. Results showed most teams were composed of attending physicians, nurses, physical and occupational therapists, dietitians and social workers; 66% included clinical pharmacists and 43% liaison nurses. Multilevel modeling showed longer length of stay to be the strongest predictor of case discussion at an IM. Case discussion was also more likely for patients admitted via in- or inter-hospital transfer rather than via the emergency department, if the GAU included a liaison nurse, and if the GAU was not located in an urban area. In summary, case discussion at an IM depended more on how and where a patient was admitted than on the patient characteristics per se, suggesting that this is a matter of care organization.

The Perianesthesia Liaison Nurse: Bridging Communications… Patients, Family Members and Health Care Providers

Surgery can provoke anxiety not only for patients but also for the family members. Both real and perceived fears are felt during these times. Among them are fear of the unknown, utter confusion, money woes, job loss, disruption of routines and the unfamiliar hospital environment.