Nurse-led Model Research Articles

Externalised nurse-led model for hepatitis C virus microelimination and impact of drug use profile.

Direct-acting antivirals have greatly simplified the treatment of hepatitis C virus (HCV), yet circuits that bring diagnosis and treatment closer to people who inject drugs (PWID) are needed to achieve the elimination targets of the WHO. With this purpose we have established an externalised nurse-driven circuit among former and active PWID in an addiction centre (AC) and a harm reduction centre (HRC). The nursing staff offered HCV screening, diagnosis and treatment to the AC and HRC users, administered medication after the hepatologist's remote prescription to those with an active infection who accepted being treated, and implemented educational and harm reduction interventions. Participants and results: Between October 2018 and March 2021, 566 users accepted screening. 134 (24%) had an active infection, with a higher prevalence among HRC users (42% vs 17%; p<0.001), who were more frequently foreigners, homeless and reported active drug use and syringe sharing. Treatment initiation was similar between groups. Overall sustained viral response (SVR) for intention-to-treat (ITT) and per protocol (PP) was 70% and 88% respectively. Overall adherence was good in both groups; however, SVR was higher in AC users compared to HRC users (ITT-SVR 81% vs 55%). All reinfections (6% by ITT) occurred in the HRC group. Overall loss to follow-up rate was 21%. This patient-centred nurse-driven circuit demonstrates that HCV treatment can be successfully delivered to PWID even with active drug use and socio-economic complexity. User-specific characteristics need to be considered when setting up these interventions to maximise success.

Abstract 4117856: Effects of a Nurse-led Common-sense Model of Self-regulation-Based Heart Failure Self-care Program on Patient Outcomes: A Randomized Controlled Trial

Introduction: Guidelines have recognized the critical role of self-care in heart failure (HF), but people with HF do not adequately practice self-care. The Common-Sense Model (CSM) of Self-Regulation is a widely used theoretical framework for promoting behavior change and improving disease prognosis among patients. However, studies on the effects of the application of this model among people with HF are limited and present mixed results. Aims: To examine the effects of a nurse-led CSM of Self-Regulation-based self-care intervention on illness perceptions, self-care behaviors, self-care self-efficacy, self-care behaviors, health-related quality of life, depression, anxiety, symptom burden, sleep quality, healthcare service utilization, and mortality among people with HF. Methods: A randomized controlled trial was conducted. Participants were recruited from a university-affiliated hospital and randomized at a 1:1 ratio into the intervention or the control groups. Participants in the intervention group received a 6-week nurse-led CSM of Self-Regulation-based self-care program and usual care. Control group participants only received the usual care. Outcomes of interest were measured at baseline, 6 weeks (T1), and 3 months (T2) after enrollment. The generalized estimating equations model and Mann-Whitney U test were used to examine the intervention effects on the study outcomes. Results: 138 subjects were enrolled in the study between March and May 2023. Participants in the intervention showed statistically greater improvements in illness perceptions, self-care self-efficacy, self-care behaviors, health-related quality of life, depression, symptom burden, and sleep quality compared with the controls at T1 and T2. We also observed a statistically significant reduction in the number of HF-related unscheduled outpatient department visits in the intervention group compared to the control group at T2. However, no significant differences were found in anxiety, number of HF-related hospital readmissions, length of HF-related hospital stays, number of HF-related emergency department visits, or HF-related mortality between the study groups at T1 and T2. Conclusion: Our program generates favorable effects on promoting behavior change and improving health outcomes among people with HF. It also fills the knowledge gaps around the application of CSM of Self-Regulation in people with HF and provides more empirical evidence supporting the effectiveness of nurse-led interventions.

Nurse led models of care for outpatient substance use disorder treatment: A scoping review.

To map key characteristics and describe nurse led models of care for the treatment of persons with substance use disorders (SUDs) in the outpatient setting. A scoping review. Conducted in accordance with the JBI methodology. The PRISMA-ScR checklist was used. Pubmed, CINAHL Complete (EBSCOhost), Cochrane Library, APA PsycNet and Scopus were searched from 1999 to May 2022 and updated on 28 November 2023. A handsearch and a grey literature search was conducted. Title and abstract screening was performed on 774 articles resulting in 88 articles for full text screening. Full text screening yielded 13 articles that met inclusion criteria. Existing nurse-led models of care for SUDS are scarce and limited in scope, with the majority focused on treating opioid use disorder. Additional research is needed to develop, test, and implement efficacious nurse-led models of care for the treatment and management of SUDs. Nurse led models of care have demonstrated their efficacy and quality in the management of other chronic diseases. As we move forward with innovative solutions for individuals with addiction, nurse led models of care can be a mechanism to deliver high quality, evidence-based care for SUDs. SUDs are chronic diseases that impact individuals, families, and communities. SUDs require a biopsychosocial approach to treatment. Globally, nurses are well positioned to provide high quality care to mitigate the impact of SUDs. This scoping review mapped the extant literature on nurse led models of care for substance use disorder treatment in the outpatient setting finding that additional research is needed to develop, test and implement evidence-based interventions to care for individuals, families, and communities experiencing SUDs. PRISMA checklist for scoping reviews. No patient or public contribution were part of this study. Open Science Framework accessible at: https://doi.org/10.17605/OSF.IO/NSW7V.

Patient engagement in pulmonary embolism research: Insights form the Attend-PE study

Abstract Background There is growing recognition of the significance of a close collaboration between patients, clinicians, and researchers to ensure that research and health service delivery effectively meets the needs of end users [1-3]. However, there is limited understanding of best practices for patient engagement in research among patients with venous thromboembolism, and there is sparse knowledge about challenges to and facilitators of this process [4, 5]. Purpose To describe and explore the process and evaluate the impact of patient engagement in the development of a structured nurse-led post pulmonary embolism care model (the Attend-PE model). Method This prospective embedded case study of patient engagement was conducted within the research project - A structured Integrated post Pulmonary Embolism care model (Attend-PE). The study was based on documents from patient journey mapping (PJM), documents and field notes from workshops, and semi-structured interviews with two patients with pulmonary embolism, two clinicians working with pulmonary embolism patients and the Attend-PE researchers. Data were analyzed based on research questions guided by the United Kingdom six Standards for Public Involvement; Inclusive opportunities, Working together, Support &amp; learning, Governance, Communications and Impact [6]. Result Patients played a crucial role throughout the entire Attend-PE study, contributing to research questions, design, execution, and dissemination, as illustrated in Figure 1. The patients were involved at a higher engagement level in the co-creation of the Attend-PE model and co-creation of patient education and information material. Comparatively the engagement level was lower in decisions regarding outcomes, feasibility testing and implementation of the Attend-PE model, as shown in Figure 2. Notably, despite lower engagement level, the continuous involvement in the research process was invaluable to the patients. This ensured that they maintained insight in the research process, even though their contributions varied in the different phases. Important facilitators of patient engagement within the Attend-PE were related to "Inclusive opportunities" and "Support and learning". Patients highlighted the importance of being a part of the process, working together as a team, and being prepared for the work. Important challenges to patient involvement related to "Communication" and "Governance", including lack of expectation alignment and communication regarding clinical elements where clinicians often dominated the discussions. Conclusion Patient involvement has been invaluable in the development of a structured nurse-led post pulmonary embolism care model. Further, patients will be involved in evaluation of the national implementation process and dissemination of study results.Figure 1Figure 2

Management of Glucocorticoid-Induced Hyperglycemia in Cancer Patients: A Feasibility Study.

Glucocorticoids are commonly used in the management of patients with hematological and solid malignancies. However, their use may be associated with impaired glycemic metabolism and increased treatment-related morbidity and mortality. This study aimed to examine the feasibility and acceptability of a nurse-led model of care (MOC) for screening and managing glucocorticoid-induced hyperglycemia (GIH) in non-diabetic patients requiring high-dose glucocorticoid (HDG) therapies, as well as patients' and health professionals' experiences with the MOC. This study was a single-site feasibility study. Patients with hematological or oncological malignancies who were >18 years of age, receiving a chemotherapy regimen including HDGs, had no prior diagnosis of diabetes or prediabetes, and were not at the end of life were considered eligible for this study. Participants were recruited from a district hospital's Cancer Centre in Australia. All consenting participants were screened for diabetes and were provided with a blood glucose meter to monitor their blood glucose levels (BGLs) four times a day on the days of glucocorticoid therapy (GT) plus one extra day following GT, for the first four cycles of their treatment, to screen for the presence of GIH. Feasibility and acceptability were assessed using rates of consent, study completion, and staff and patient surveys. Forty-eight percent (35/74) of patients approached consented to participate in the study and had screening tests for preexisting diabetes. None were diagnosed with diabetes. Six out of 35 patients withdrew, and 10/29 patients did not complete the recommended BGL monitoring. Thirteen percent (4/29) of patients developed GIH. The most common reasons for non-participation and study withdrawal were related to the self-monitoring of BGLs. While clinical stakeholders found the MOC feasible and acceptable, the results of this study suggest that alternative methods for encouraging self-monitoring of BGL and monitoring the presence of GIH during high-dose chemotherapy need to be explored to address issues associated with adherence and sustainability.

Long term care-acute system integration and transformation: Innovations in models of care.

The article discusses innovations in integrating Long-Term Care (LTC) and acute systems, focusing on Humber River Health's (HRH) model. Older adults in LTC homes are vulnerable to avoidable Emergency Department (ED) visits due to frailty and medical complexity. HRH developed an integrated care model centred on LTC Remote Monitoring (RM) with LTC partners, leveraging nurse-led care models, digital tools, and virtual care hub to reduce avoidable ED transfers. Key components include the PREVIEW-ED© tool for early detection of clinical deterioration, LTC+ Hub and LTC++ Diagnostic Imaging and Transportation, supporting improved access to healthcare services. The program aligns with the Quintuple Aim, emphasizing patient and provider experiences, population health, cost reduction, and health equity. Results show significant reductions in ED visits, hospital lengths of stay, and associated costs, while enhancing resident and provider experiences. The LTC RM model is positioned as a scalable solution for system transformation in integrated care.

Achievements and Challenges in the Development of a Nurse-Led Respectful Delivery Care Model Provided by Partners in Health in Rural Mexico.

The model of obstetric care predominant in Mexico in most public and private healthcare institutions is particularly focused on a physiological perspective of the female body that does not respond to women's need for emotional comfort and satisfaction. In the last decade, however, various initiatives that provide obstetric care centered on women's rights have emerged. To analyze the implementation of a model of humanized/respectful delivery care supervised by nursing and midwifery undergraduate interns in a birthing center in the state of Chiapas, in order to identify achievements and future challenges. We used information from secondary sources and carried out a descriptive analysis. Births attended at the birthing center increased in relation to all the births registered in the Angel Albino Corzo municipality between 2017 and 2022. Positive indicators of respectful care increased with the implemented model, while negative indicators decreased. Between 2016 and 2022, obstetric nurses attended more than 1500 births without maternal deaths and managed some emergency cases referred to specialized care. This case illustrates the potential of alternative models of obstetric care. Evidence-based, midwife- and nurse-led models of clinical obstetric care should be expanded in the Mexican healthcare system.

A controlled study: Evaluating the clinical impact of a nurse-centred multidisciplinary hospice care model on anxiety, depression, and quality of life in patients with advanced malignant tumours.

To explore the clinical effect of a nurse-centred multidisciplinary collaborative hospice care model in patients with advanced malignant tumours. A total of 30 patients with advanced malignant tumours were hospitalised and randomly divided into a study group and a control group, each consisting of 15 cases. The study group received nurse-led multidisciplinary collaborative hospice care, whereas the control group underwent high-quality nursing intervention. Variables such as the self-rating anxiety scale (SAS) score, self-rating depression scale (SDS) score, quality of life scale (EORTC QLQ-C30) score, patient happiness, and nursing satisfaction were compared between the two groups. Post-intervention, the SAS and SDS scores in the study group were lower than those in the control group (p < 0.01). The overall quality of life score of the study group was higher than that of the control group (p < 0.01). The Memorial University of Newfoundland Scale of Happiness scores in the study group also surpassed those of the control group (p < 0.01). Additionally, nursing satisfaction in the study group exceeded that of the control group (p = 0.027). The nurse-led multidisciplinary collaborative hospice care model substantially alleviated negative emotions among patients, effectively improved their quality of life and happiness, and garnered positive evaluations of nursing satisfaction.

OA07.04 Optimising Care of Older Patients with Lung Cancer - An Innovative Nurse-led Model of Care

OA07.04 Optimising Care of Older Patients with Lung Cancer - An Innovative Nurse-led Model of Care

Feasibility of a nurse-led, mHealth-assisted, and team-based collaborative care model for heart failure care in India: Findings from a multi-stakeholder qualitative study

Background Heart failure (HF) management is often challenging due to poor adherence to GDMT and self-care. Continuous monitoring of patients by a dedicated care manager may enhance adherence to self-care and treatment and prevent hospitalisations. For the adoption and acceptance of a collaborative care model (CCM) for HF management in Indian settings, understanding the perspectives of all stakeholders regarding its various components and feasibility is needed. Therefore, we aimed to obtain perceptions of potential challenges to care and suggestions on multiple components of the proposed CCM in managing HF and its feasibility. Methods In-depth interviews were done among HF patients, caregivers, nurses, and cardiologists from private, co-operative, and public sector tertiary care hospital settings that cater to HF patients in Kerala, India. An in-depth interview guide was used to elicit the data. Data were analysed using Python QualCoder version 2.2. We used a framework method for the analysis of data. Results A total of 22 in-depth interviews were conducted. We found that the existing care for HF in many settings was inadequate for continuous engagement with the patients. Non-adherence to treatment and other self-care measures, was noted as a major challenge to HF care. Healthcare providers and patients felt nurses were better at leading collaborative care. However, various barriers, including technical and technological, and the apprehensions of nurses in leading the CCM were identified. The stakeholders also identified the mHealth-assisted CCM as a potential tool to save money. The stakeholders also appreciated the role of nurses in creating confidence in patients. Conclusions A nurse-led, mHealth-assisted, and team-based collaborative care was recognised as an excellent step to improve patient adherence. Effective implementation of it could reduce hospitalisations and improve patients' ability to manage their HF symptoms.

The Ambulatory Diabetes Outreach Program (ADOP): Rigorous Evaluation of a Pharmacist and Nurse-Led Care Model.

Although several systematic reviews found that ambulatory diabetes mellitus (DM) interventions involving pharmacists generally yielded better outcomes than the ones that did not, existing studies have limitations in rigor and study design. To examine the intention-to-treat effects of the Ambulatory Diabetes Outreach Program (ADOP) on participants' A1c values and healthcare utilization over a 52-month follow-up period. Difference-in-differences with staggered adoption. Specifically, we employed the Callaway and Sant'Anna's "group-time average treatment effect" estimator using not-yet treated as controls adjusting for patient's age, BMI, sex, race, comorbidity, payor, and socio-economic status. All patients with at least one ADOP treatment encounter from July 2017 to October 2021, regardless of program completion or length of exposure to the program. ADOP, a collaborative population health program led by pharmacists and nurse specialists to provide individualized type 2 DM management and education within a large and diverse health system. Patients' A1c values and healthcare utilization, including inpatient admission, inpatient days, and numbers of visits to the emergency department, urgent care, and primary care in recent 6months. ADOP participation was associated with an overall average reduction of 1.04 percentage points (95%CI - 1.12, - 0.95) in A1c level. Similar A1c reductions were also observed in the subgroups by sex and race/ethnicity. An average of 2months were required to reach the overall average effect, which persisted over 4years. Compared to the respective utilization levels pre-intervention, participants also had average reductions in inpatient admissions by 32.4%, inpatient days by 81.6%, visits to the emergency department by 21.6%, and primary care by 17.9%. The results suggest that a collaborative model of pharmacist and nurse-led type 2 DM intervention was effective in improving A1c outcomes and reducing healthcare utilization in the long term.

A Quality Improvement Project On The Introduction Of A Nurse-Led, Patient Self-Monitored Blood Pressure Telehealth Platform

Abstract Background Telehealth is a strategy for health and wellbeing promotion. Hypertension is a modifiable risk factor in vascular health. Timely, reliable and accessible identification of this risk is important. Working within an interdisciplinary ambulatory neurovascular hub, a nurse-led model of service provided the opportunity to effectively identify and modify this risk through the secondary prevention measure of hypertension management. Methods An interdisciplinary neurovascular service quality improvement group, the “Stroke Big Room”, evaluated service models and telehealth platforms for patient-self monitoring of hypertension. The telehealth “Florence” platform was introduced. An accompanying Patient Information Leaflet was developed with the Communications Team within the Trust. Patients with a blood pressure of 130/80mmHg and a confirmed diagnosis of minor stroke or transient ischaemic attack were offered the “Flo” platform. Results A 20-patient sample found: 50% required no treatment change, 30% were commenced on antihypertensive treatment and 20% required antihypertensive dose increase. In the 2023/24 financial year, 285 patients participated in the Flo platform. Conclusion Timely identification and modification of hypertension is a reversible risk factor for neurovascular disease. A nurse-led service for the provision of, education on and support in use of a telehealth monitoring platform is an effective approach. This service model allows for effective secondary prevention treatment in a rapid and accessible way. The telehealth platform “Flo” was accessible to patients on the basis of patient reported outcome measures. As a result of the use of the platform, pharmacotherapeutic interventions occurred in 50% of participants in this telehealth programme.

Long-term outcomes of a decentralized, nurse-led, statewide model of care for hepatitis C among people in prison in Victoria, Australia.

Prisons provide a key strategic opportunity to upscale hepatitis C testing and treatment in a high prevalence setting and are crucial for elimination efforts. A decentralized, statewide nurse-led model of care offering hepatitis C treatment for people in prison was implemented in Victoria, Australia in 2015. The program provides hepatitis C care to all 14 adult prison sites in the jurisdiction. We prospectively evaluated treatment uptake between 1 November 2015 and 31 December 2021. Data on all people in prison treated were recorded in a clinical database. The primary outcomes were i) total number of people in prison with hepatitis C treated; ii) total number of DAA treatment courses. 3,133 DAA treatment courses were prescribed to 2,768 people in prison. The proportion of total Victoria DAA prescriptions the program was responsible for increased from 6% in 2016 to a peak of 23% in 2020. Of those treated, median age was 39 years, 91% were male and 9% had cirrhosis. Few (20%) had previously engaged in hepatitis C care in the community and at first treatment course in prison, only 6% had previously accessed hepatitis C treatment. Complete follow up data were available for 1,757/2,768 (63%) treated, with 1,627/1,757 (93%) achieving SVR12. A decentralized, nurse-led, statewide model of care was highly effective in treating large numbers of people in prison with hepatitis C and achieved high rates of SVR12. Nurse-led prison programs are playing a crucial role in eliminating hepatitis C as a public health threat in Australia.

Effectiveness of a nurse-led peripherally inserted central catheter service: A retrospective cohort study.

A multitude of challenges arises from the growing utilisation of peripherally inserted central catheters (PICCs), including the ability to provide timely, effective and safe insertion, which must be ensured and prioritised in patient care. A nurse-led model of care has become more prevalent as PICCs become extensively needed due to their applications. However, despite their widespread use, such intervention is yet in its inception in Saudi Arabia, and thereby, evaluating the outcomes of this service is of utmost importance to support patient safety initiatives and quality of care. This research aims to assess the effectiveness of a nurse-led PICC placement service. A quantitative retrospective cohort design was used. The sample of this study was 333 random subsets of records on PICC insertion for adult patients between 1st April 2019 and 31st March 2023 in a tertiary medical facility in Riyadh, Saudi Arabia. A nurse-led PICC service demonstrated an overall successful placement of 330 cases (99.1%), out of which 323 PICCs (97%) were successfully inserted under intra-cavitary electrocardiogram (IC-ECG) guidance, while 7 PICCs (2.1%) were successfully inserted with fluoroscopy. The overall complication rate was 2.35 occurrences per 1000 CL days, whereas the complication rate within the first 10 days after PICC insertion was 0.42 per 1000 CL days. A nurse-led model for PICC insertion has remarkably high success rates and low rates of complication, highlighting the pivotal role of a specialised PICC team. This service boasted a commendable track record of achieving a high rate of success in its implementation, implying that a nurse-led PICC service operates effectively to improve the patient experience by delivering timely and high-quality healthcare service.

Hospital in the Home: Nurse-Led Models of Care and Pathways.

Hospital in the Home (HITH) model of care was developed to support the COVID-19 response and the need to deliver care in new ways to ensure secondary care services were free to deliver care to the sickest patients and not be overwhelmed by the COVID-19 patients needing hospital-level care. Intermediate Care Services, led by nursing and allied health stepped up to the challenge and collaborated on the development of the HITH model of care with defined pathways. This provided hospital-level acute health services in the home that was a clinically safe alternative option to inpatient care. The establishment of HITH released bed capacity and resources and therefore prevented the need for expanding hospital inpatient capacity at a time where resources and staff were constrained. Care delivery was achieved by utilising both in-person visits and telehealth. Technology supported the care delivery which allowed patients, whanau (family) and clinicians to be connected.

A nurse-led model of care to improve access to contraception and abortion in rural general practice: Co-design with consumers and providers.

To describe key features of a co-designed nurse-led model of care intended to improve access to early medication abortion and long-acting reversible contraception in rural Australian general practice. Co-design methodology informed by the Experience-Based Co-Design Framework. Consumers, nurses, physicians and key women's health stakeholders participated in a co-design workshop focused on the patient journey in seeking contraception or abortion care. Data generated at the workshop were analysed using Braun and Clarkes' six-step process for thematic analysis. Fifty-two participants took part in the co-design workshop. Key recommendations regarding setting up the model included: raising awareness of the early medication abortion and contraceptive implant services, providing flexible booking options, ensuring appointment availability, providing training for reception staff and fostering good relationships with relevant local services. Recommendations for implementing the model were also identified, including the provision of accessible information, patient-approved communication processes that ensure privacy and safety, establishing roles and responsibilities, supporting consumer autonomy and having clear pathways for referrals and complications. Our approach to experience-based co-design ensured that consumer experiences, values and priorities, together with practitioner insights, were central to the development of a nurse-led model of care. The co-designed nurse-led model of care for contraception and medication abortion is one strategy to increase access to these essential reproductive health services, particularly in rural areas, while providing an opportunity for nurses to work to their full scope of practice. Nurse-led care has gained global recognition as an effective strategy to promote equitable access to sexual and reproductive healthcare. Still, nurse-led contraception and abortion have yet to be implemented andevaluated in Australian general practice. This study will inform the model of care to be implemented and evaluated as part of the ORIENT trial to be completed in 2025. Reported in line with the Standards for Reporting Qualitative Research (SRQR) checklist. Two consumer representatives contributed to the development of the co-design methodology as members of the ORIENT Intervention Advisory Group Governance Committee.

Impact of a Nurse-Led Chronic Disease Management Intervention Model on Quality of Care and Satisfaction of Maintenance Hemodialysis Patients

Objective: To explore the impact of a nurse-led chronic disease management model on the quality of care and satisfaction of maintenance hemodialysis patients. Methods: 72 patients who received maintenance hemodialysis (MHD) from June 2021 to March 2022 were selected to undergo the nurse-led chronic disease management model. The hemodialysis indexes, nutritional status, and the occurrence of adverse events were assessed after 24 weeks of the intervention, and patients’ satisfaction was investigated and analyzed. Results: Comparing pre-intervention and after 24 weeks of intervention, urea reduction rate and urea clearance were improved but not statistically different (P &gt; 0.05), but β2-microglobulin was significantly reduced compared with pre-intervention (P &lt; 0.05); after 24 weeks of intervention, the effect of decreasing blood calcium, parathyroid hormone, and potassium levels was not obvious (P &gt; 0.05), and the level of blood phosphorus decreased significantly compared with pre-intervention (P &lt; 0.01), albumin and hemoglobin levels were increased and better than before intervention (P &lt; 0.05); after 24 weeks of intervention, the incidence of intradialytic hypotension and hypertension was lower than before intervention (P &lt; 0.05), and the total incidence of complications was significantly lower than before intervention (P &lt; 0.01); there was no significant difference in the Self-Depression Scale scores after 24 weeks of intervention (P &gt; 0.05), and Self-Anxiety Scale scores were significantly lower and better than before intervention (P &lt; 0.01). Patient satisfaction was greatly improved, with a statistically significant difference (P &lt; 0.05). Conclusion: The chronic disease management intervention model led by specialized nurses is conducive to improving the psychological state and nutritional status of dialysis patients, enhancing the adequacy of dialysis for patients, reducing the incidence of related complications, and ultimately achieving the purpose of improving the quality of life of patients, which has significant clinical value.

Priorities in healthcare provision in Parkinson's disease from the perspective of Parkinson Nurses: A focus group study

BackgroundThrough their expertise and diverse skills, Parkinson Nurses are key care providers for people with Parkinson's disease. They are seen as an important profession for person-centered and multidisciplinary care, considered priorities in Parkinson's care delivery. Currently, however, little is known about the priorities that this profession itself defines for the care of Parkinson's patients and how they perceive their own role in the care process. ObjectiveTo explore the perspective of Parkinson Nurses on care priorities in people with Parkinson's disease. DesignQualitative study. Setting(s)The iCare-PD study served as the object of study by establishing an interdisciplinary, person-centered and nurse-led care model in several European countries and Canada. The nurses who participated in this model were part of the study. ParticipantsSix Parkinson Nurses participated in the study. MethodsWe conducted a thematic focus group, adopting the paradigm of pragmatism to draft an interview guide. The focus group was based on the inspiration card method and followed recommendations for co-creation processes. ResultsParkinson Nurses define care priorities for Parkinson's in areas of education, multi-professionalism, and need-orientation. They see themselves as mediators and coordinators of care delivery processes. ConclusionsIn line with international recommendations, Parkinson Nurses prioritize key aspects of multidisciplinary and person-centered care. At the same time, however, the nurses also name care priorities that go beyond the international recommendations. It is therefore crucial to integrate the perspective of this important profession into recommendations for the delivery of healthcare for people with Parkinson's.Tweetable abstract How do specialized nurses define priorities for person-centered Parkinson's care? Answers are sought in this qualitative study by @MarlenaMunster.

Micro-elimination of chronic hepatitis C virus in mental health settings: A prospective multicentre pragmatic trial.

Hepatitis C virus (HCV) prevalence is high in the mental health population. We sought to evaluate testing and treatment uptake for HCV following the implementation of a universal nurse led study in inpatient and outpatient mental health populations. From January 2018 to December 2020, we screened mental health inpatients (n = 322) and community mental health patients (n = 615) for HCV with either specialist hepatology nurses or mental health nurses (mental health nurse). 75.5% (464/615) of community patients and 100% (322/322) of inpatients consented to screening, with an HCV antibody-positive prevalence of 12.7% (59/464) in community patients and 19.6% (63/322) in inpatients. RNA detectable prevalence was 4.0% (22/464) and 7.5% (24/322), respectively. Community patients who were screened by specialist hepatology nurses were more likely to consent to screening (94.4% vs. 45.7%, p < 0.001) but had lower proportion of HCV antibody (10.5% vs. 20.3%, p < 0.001) and RNA detectable (4.0% vs. 7.5%, p = 0.018) when compared to mental health nurse screening. Engagement with treatment was 27.0% of community mental health patients and 45.8% of mental health inpatients undergoing treatment. All patients undergoing treatment and underwent sustained viral response (SVR) testing achieved SVR. Universal screening of HCV using a nurse-led model has high rates of success in mental health patients with high proportions undergoing screening, with no reduction in the rates of SVR achieved with DAA therapy compared to the general population. Further work is needed to bridge the gap between identification of HCV and treatment among mental health patients.

Intensive Primary Care Nursing: Exploring the Impact of a Nurse-Led Model for Medically and Social Complex Patients.

Lack of access to primary care contributes to health inequities. Treatment settings that utilize the full experience and training of nurses, both registered nurses (RNs) and advanced practice registered nurses (APRNs), can expand in primary care and successfully address health inequities. This small study describes the implementation of a model of primary care called intensive primary care (IPC), which has eight elements that support the full utilization of a nurse's experience and training. This is a mixed method qualitative study, which reports the observations of the implementation and pre- and post-intervention measures. The IPC model was implemented at a free clinic, which targeted underserved population between 2020 and 2023. Participants were selected as a convenience sample. Participants were to have two or more chronic health problems The participants received primary care using the IPC model, which included setting self-management goals, and meeting with RN or APRN on a monthly basis (face to face, via phone or zoom) to monitor progress toward goals. Twenty-two people were approached, and 19 completed the intervention. Pre- and Post-intervention measures (Patient Assessment of Chronic Illness Care [PACIC]-20); Functional, Communicative, Critical Thinking Health Literacy; Perceived Stress; Patient Activation; Perceived Self Efficacy for Chronic Disease; EuroQo- 5 Dimension (EQ-5D); Trust in Provider; Emotional Support-Patient Reported Outcome Measure Information System (PROMIS); and Patient Health Questionnaire-9) were obtained and analyzed with paired T test (α < .05). Nurses involved meet weekly to share observations recorded in free form notes. These observations were summarized by two of the authors (MD and KF) at the end of the study. All patients had improved physical health outcomes, but more importantly, there were significant improvements in measures known to impact health and health outcomes, specifically, patient activation, self-efficacy for chronic illness, PACIC, and trust in provider. Time spent with patients, both duration and frequency of contact, was observed to have significant impacts.