Nurse-led Clinic For Patients Research Articles

A Nurse-Led Clinic Model for the Treatment of Cervical Dystonia Using Botulinum Toxin

Dystonia is a neurological movement disorder characterised by sustained or intermittent muscle contractions, producing abnormal and often repetitive movements, abnormal posture or both. It is often accompanied by chronic pain, depression and anxiety. The treatment of dystonia is primarily symptomatic, designed to improve posture and function and to relieve associated pain. This can include oral medications, botulinum toxin (BoNT) injection, and deep brain stimulation (DBS). This article will focus on BoNT treatment, which is just one facet in the treatment of cervical dystonia. The involvement of clinical nurse specialists and the use of a nurse-led clinic can increase efficiency and effectiveness (namely, increased clinic efficiency and capacity, reduced appointment waiting times, and improved continuity of care for the patients), as well as patient access, education, psychosocial support, monitoring and, ultimately, empowerment. This article will discuss the key elements, considerations and benefits of setting up a nurse-led clinic for patients with dystonia.

An advanced nurse-led clinic for patients following percutaneous coronary intervention

Percutaneous coronary intervention (PCI) is internationally recognised as the preferred initial treatment for acute coronary syndrome and as a treatment option for chronic coronary heart disease. The use of PCI has led to shorter inpatient stays. However, reduced length of stay can mean less opportunity for patient education. Once discharged from hospital, timely outpatient review encompassing symptom reassessment, advanced physical assessment, medication and cardiovascular risk management is a key component of patient care. In an Irish acute hospital setting, cardiology clinical nurse specialists and advanced nurse practitioners have established an advanced nurse-led post-PCI clinic. This article describes the post-PCI clinic and provides an overview of the patient profile and outcomes over a 2-year period, with an emphasis on advanced nursing roles and patient symptoms.

Nurse-led clinic for patients with liver cirrhosis—effects on health-related quality of life: study protocol of a pragmatic multicentre randomised controlled trial

IntroductionLiver cirrhosis affects health-related quality of life (HRQoL) even in its early stages. Morbidity is especially high when the disease decompensates and self-care actions become essential. Nurse involvement in secondary...

OC-056 Evaluation of a novel nurse-led one-stop clinic for patients referred for investigation of suspected non-alcoholic fatty liver disease

Introduction Non-alcoholic fatty liver disease (NAFLD) affects approximately 1 in 4 adults in the UK.1In our hospital catchment area there are an estimated 150000 individuals with NAFLD, approximately 12000 of who are likely to have advanced liver fibrosis. Our aim was to evaluate the utility of a weekly nurse-led NAFLD clinic including transient elastography (Fibroscan; TE) to screen for advanced fibrosis in the management of rising numbers of referrals to our secondary care Hepatology clinics. Method A designated referral pathway was devised in conjunction with local primary care commissioners where patients with suspected NAFLD and with a NAFLD-fibrosis score2in the indeterminate or high risk range (>–1.455) were assessed in a one-stop clinic by a clinical nurse specialist using a specific clerking template. TE was performed on all patients with NAFLD and discharge to primary care with lifestyle advice considered in those with TE values below the threshold for advanced liver fibrosis/cirrhosis (7.9 kPa).3Prospective demographic and clinical data were collected on all patients seen in the clinic from May 1st–Dec 31st2014. Results A total of 112 patients were seen during the evaluation period; Male:Female 3:2, median age 59 years (range 20–91). Thirteen (12%) consumed alcohol at levels above those consistent with a diagnosis of NAFLD (females >14 units/week; males >21 units/week), 2 (1.8%) had autoimmune hepatitis and 2 (1.8%) had chronic hepatitis C. The remaining 95 (85%) were diagnosed with NAFLD. Amongst this NAFLD population, TE values <7.9 kPa were present in 56 patients (59%), 43 of whom were discharged to primary care. This represented 45% of the NAFLD patients and 38% of all referrals made. Thirteen NAFLD patients had TE readings <7.9 kPa but were followed up in consultant clinics for other clinical reasons. Thirty-three patients (35%) had TE readings ≥7.9 kPa, all of whom were followed-up in consultant clinics, as well as 6 patients (6%) in whom TE was unreliable. Conclusion A one-stop nurse-led clinic for patients with suspected NAFLD and an indeterminate or high NAFLD fibrosis score allowed early discharge of approximately 40% of the patients referred. Such clinics may be a useful way of stratifying patient risk and utilising resources effectively in the face of increasing demand on secondary care Hepatology services. Disclosure of interest None Declared.

What is the value of a nurseled clinic for patients with replacement heart valves?

Background: Long-term regular specialist surveillance is recommended to reduce the risks of complications arising after heart valve surgery. This could be delivered by a nurse-led valve clinic. Aims: To determine how often clinical events are detected within a nurse-led valve clinic and how often a cardiologist or sonographer is required. Methods: Nurse-led valve clinic outcomes and events were analysed over 48 months from 2010 to 2013. An endpoint was any new symptom or event or the need for an unscheduled echocardiogram. Results: There were 544 visits in 206 patients. Endpoints were found in 178 visits (33%). A cardiologist was required in 100 visits (18%) to see the patient in 27 and give advice in 73. Another clinician was needed in 8 visits. Unscheduled echocardiography was required in 70 (13%) visits. Conclusion: A nurse-led valve clinic is feasible. Clinical endpoints are detected frequently and enhanced long-term care can be safely provided. Review or discussion with a cardiologist or unscheduled echocardiography is sometimes required which supports the model of a multidisciplinary clinic.

Introducing a nurse-led clinic for patients who self-harm.

A fortnightly self-harm clinic was set up for patients from a secure psychiatric unit. This prize-winning paper describes how it both reduced admissions to A&E and won the support of patients, who became involved in their wound care.

A nurse-led clinic for patients with peripheral vascular disease.

Patients with peripheral vascular disease have complex and challenging health needs. This article describes an innovative nurse practitioner role in the provision of care for patients with intermittent claudication in an acute hospital setting. A small-scale evaluative study of patient satisfaction with the nurse consultation revealed high levels of satisfaction with the care received. It is suggested that experienced nurses can make substantial contributions to improving care for patients with chronic disease.