Nurse-led Practice Research Articles

Experiences of nurses working in nurse-led clinics in Traditional Chinese Medicine hospitals: A focused ethnographic study.

Traditional Chinese Medicine (TCM) nurse-led clinics (NLC) is an innovative working model in China, representing the specialization and extension of nurses' role. However, as a pioneer in TCM nursing, this new model of working is facing both opportunities and challenges because it is known little about the operational status of NLCs. To explore the experiences of nurses who work in NLC in TCM hospitals. A focused ethnographic study was conducted in three TCM hospitals affiliated with Guangzhou University of Chinese Medicine. We interviewed eleven nurses in those hospitals and observed seven of them working with patients. We used snowball sampling for data collection including interview, non-participant observation and documents from medical records. All the data were processed as following steps: (a) coding for descriptive labels; (b) sorting for patterns; (c) identifying outliers or negative cases; (d) generalizing with construction and theories and (e) noting reflective remarks. Nurse-led clinics help nurses develop their skills and knowledge that are highly recognized by public since they meet the growing needs of patients and also relieve the workload of physicians in the hospitals. However, lack of specialization is still a major challenge in NLCs due to insufficiency of full-time staff with specialized education, nurse-led practice without standardized guidelines, restrictions on prescription right of nurses, and also inadequate support from hospitals. As a revolutionary innovation of working model for nurses in TCM hospitals, NLCs could improve quality of care and lead to a comprehensive promotion of nursing career. However, there are several challenges on providing high quality care for patients whilst improving educational development of nurses. This study suggests that nurses, hospital administration and the government should cooperate with each other to develop standard nursing programs for NLCs. It is imperative to identify nursing roles, collect available resources, and develop supportive policies and training programs to enhance the quality of NLCs.

Distinctive nursing practices in working with mothers to care for hospitalised children at a district hospital in KwaZulu-Natal, South Africa: a descriptive observational study

BackgroundThe presence of family members and their active involvement in caring for hospitalised children is an established practice in many African paediatric settings, with family members often regarded as a resource. This aspect of African paediatric nursing practice lacks formal expression or a clear conceptual basis, and difficulties arise when applying concepts of family involvement originating from the culturally distinct practice environments of higher resourced settings including Europe and America. The aim of this study was to articulate a nurse-led practice innovation intended to facilitate family involvement in the care of hospitalised children, observed in a paediatric inpatient ward in a district hospital in rural KwaZulu-Natal, South Africa.MethodsA qualitative case study design was used. Data collection included visual research methods (graphic facilitation, sociograms and photo-elicitation) as well as a focus group, interviews and practice observation. Activities associated with 20 nurses and 22 mother-child dyads were observed. Data were subjected to content analysis, with Standards for Reporting Qualitative Research (SRQR) applied.ResultsFindings relate to six aspects of practice, categorised thematically as: preserving the mother-child pair; enabling continuous presence; psychological support and empathy; sharing knowledge; mothers as a resource; and belief and trust.ConclusionThe nursing practices and organisational policies observed in this setting relating to the facilitation of continuous maternal presence represent a distinctive nursing practice innovation. This deliberate practice contrasts with models of care provision which originate in higher resourced settings including Europe and America, such as Family Centred Care, and contrasts with informal practices in local African settings which tolerate the presence of mothers in other settings, as well as local institutional policies which limit mothers’ presence to varying extents.

Building interprofessional team effectiveness in a nurse-led rural health center

Abstract Background Interprofessional team care is a model that demonstrates positive effects on the triple aim of improving quality of care, improving health and reducing costs. Nurse-led practices are well suited for these models. Archer Family Health Care (AFHC) is a nurse-led practice that utilizes interprofessional team care. Purpose To describe interprofessional team training at AFHC and evaluate effects of training on perceived team functioning. Methods The AFHC team participated in TeamSTEPPS® guided trainings throughout the three year grant period. All staff and providers were included in the team trainings. Training consisted of participation in team retreats, training modules and focus group discussions on team functionality, goal setting and workflow analysis and revision. Standardized assessment of the team competencies was completed five times over three years using the TeamSTEPPS® Team Perceptions Questionnaire (T-TPQ), the Collaborative Practice Assessment Tool (CPAT), and the Team Competencies (TC) questionnaire. Results identified perceived strengths and weaknesses of interprofessional team and served to guide team training activities. Discussion Improvements occurred over time for several measures, including teamwork, team performance, communication, and decision-making. Conclusion Standardized evaluation of team competencies is a useful tool to enhance perceived functioning of a nurse-led interprofessional team. Results support the need for ongoing interprofessional team evaluation and training.

Developing, implementing and evaluating a model for an outpatient self-harm service.

Aim To reduce the incidence of self-harming behaviour and improve well-being and experience of care for individuals who present regularly to the emergency department in one hospital following self-harm, by providing outpatient care. Method This was a 12-month nurse-led practice development project to develop, implement and evaluate a brief-intervention outpatient service for individuals who presented to the emergency department following self-harm and who were identified as being at risk of further self-harm. The service improvement was informed by an action research process and the principles of appreciative inquiry. Findings The project provided a short-term outpatient follow-up service, known as Brief Interventions in Repeat Self Harm (BIRSH), to patients who presented to the emergency department following self-harm, and who were considered at risk of further self-harm. The intervention enabled the clinician to validate the patient's distress and offer them short-term outpatient follow-up care. The BIRSH sessions were offered to 38 patients. A total of 26 patients attended one or more BIRSH session, and all of these individuals showed a reduction in the number of presentations to the emergency department following self-harm in the six months following the intervention, compared to the six months before the intervention. Conclusion The BIRSH outpatient service appears to have been a contributory factor in reducing self-harm for patients who engaged with the service. The service improvement was informed by an action research process and the principles of appreciative inquiry, which provided a positive, focused approach to the practice development project.

How nurse-led practices perceive implementation of the patient-centered medical home

PurposeThe Affordable Care Act (ACA) promotes the Patient-Centered Medical Home (PCMH) model as a way to improve healthcare quality, the patient experience, and has identified nurse-led primary care as a mechanism meeting the increasing demand for quality primary care. The purpose of this study was to investigate the implementation of a PCMH model in nurse-led primary care practices and to identify facilitators and barriers to the implementation of this model. MethodsData were collected through in-depth interviews with providers and staff in nurse-led practices. ResultsThese data suggest two categories of processes that facilitate the integration of PCMH in the nurse-led practice setting: patient-oriented facilitators and organizational facilitators. In addition, a number of barriers were identified to implementing the PCMH model. Overall, these practices creatively engaged in the transformation process by structuring themselves as a complex adaptive system and building upon the core principles of nurse-led care. ConclusionSince the core principles of nurse-led care map onto many of the same principles of the PCMH model, this study discusses the possibility that nurse-led practices may experience fewer barriers when transitioning into PCMHs.

Social Justice, Social Determinants of Health, Interprofessional Practice and Community Engagement as Formative Elements of a Nurse Practitioner Managed Health Center

Aim: This paper presents four key elements for developing infrastructure to address health disparities which are social justice, social determinants of health, interprofessional practice, and community engagement. Method: These elements are then illustrated within a nurse-led interprofessional practice exemplar. Conclusion: Using these key elements, there is great potential for developing and carrying out a community-based participatory research agenda to address health inequity within a nurse-led interprofessional practice setting.

The Effectiveness of Nurse-Led Preoperative Assessment Clinics for Patients Receiving Elective Orthopaedic Surgery: A Systematic Review

Nurse-led preoperative assessment clinics (POAC) have been introduced in different specialty areas to assess and prepare patients preoperatively in order to avoid last-minute surgery cancellations. Not all patients are referred to POACs before surgery, and the benefits of nurse-led POACs are not well documented in Hong Kong. The purpose of this systemic review was to identify the best available research evidence to inform current clinical practice, guide health care decision making and promote better care. The Joanna Briggs Institute (JBI) approach for conducting systematicreview of quantitative research was used. Data bases searched included all published and unpublished studies in Chinese and English. All studies with adult patients who required elective orthopaedic surgery e.g. total knee replacement, total hip replacement, reduction of fracture or reconstruction surgery etc. in a hospital or day surgery center and attended a nurse-led POAC before surgery were included. Ten studies were critically appraised. Results showed that nurse-led POACs can reduce surgery cancellation rates. These studies suggested a reduction in the rate of postoperative mortality and length of hospital stay. In addition, the level of satisfaction towards services provided was significantly high. Although POACs are being increasingly implemented worldwide, the development of clinical guidelines, pathways and protocols was advocated. The best available evidence asserted that nurses in the POAC could serve as effective coordinators, assessors and educators. The nurse-led practice optimized patients' condition before surgery and hence minimized elective surgery cancellations.

Voices - Nurse-led general practice is an exciting model of care, says Crystal Oldman

Voices - Nurse-led general practice is an exciting model of care, says Crystal Oldman

Inspectors heap praise on nurse-led GP practice

Inspectors heap praise on nurse-led GP practice

Nurse-led practice rated outstanding by CQC

Vulnerable patients and people with mental health problems receive outstanding care at a nurse-led general practice in Exeter. Liam Benison reports

Assessment of psychosocial problems in primary care COPD patients

The emphasis placed on assessing psychosocial needs in nurse-led practice based consultations for chronic obstructive pulmonary disease (COPD) has not been reported. We investigated the frequency with which nurses performed a range of tasks, and explored if the types of tasks performed were related to levels of training or the setting of clinical consultations. Participants were lead COPD nurses based at 500 randomly selected UK general practices. Respondents completed a questionnaire between February and June 2006. The frequency with which key task were performed - never, sometimes, often or always - was recorded. Follow-up consultations were conducted by 349 of the 368 nurses who responded (74% response rate). Of these, 51% (95% confidence interval (CI):45-56%) reported often or always assessing psychosocial needs, in comparison to 98% (97-99%) who reported often or always checking inhaler technique and 86% (82-89%) who often or always recorded spirometry values. Frequent assessment of psychosocial needs was associated with postregistration COPD education and consultations taking place in designated respiratory clinics. Nurses focus on objective tasks, possibly to the detriment of assessing psychosocial needs. To raise the profile of these aspects of care: updates of the COPD section of the GMS contract should encompass the assessment of patient's psychosocial status and potential impact of this on quality of life; and appropriate education should be provided.

Development and implementation of a noise reduction intervention programme: a pre‐ and postaudit of three hospital wards

By developing, implementing and delivering a noise reduction intervention programme, we aimed to attempt to reduce the high noise levels on inpatient wards. Sleep is essential for human survival and sleep deprivation is detrimental to health and well being. Exposure to noise has been found to disrupt sleep in hospitalised patients which is to be expected as noise levels have been measured and reported as high. A primarily nursing focused, multi-method approach, involving development of clinical guidelines, ward environment review and a staff noise awareness and education programme, was used to target mainly nursing staff plus other healthcare staff on three wards within one hospital. This practice development initiative was carried out in three key phases (1) Preaudit of ward noise levels, (2) The development, implementation and delivery of a noise reduction intervention programme, (3) Postaudit of ward noise levels. Preintervention average peak decibel levels over 24 hours were found to be 96.48 dB(A) and postintervention average peak decibel levels were measured at 77.52 dB(A), representing an overall significant reduction in noise levels (p < 0.001). This study describes one way to reduce peak noise levels on inpatient hospital wards. Sleep deprivation is detrimental to patients with acute illness, so any developments to improve patients' sleep are important. Nurses have a key role in leading, developing and implementing changes to reduce peak noise levels on inpatient wards in hospitals. This nurse-led practice development programme has demonstrated how improvements can be achieved by significantly reducing peak noise levels using simple multi-method change strategies.

Developing a framework for admission and discharge: a nurse‐led initiative within a mental health setting

Admission to a mental health inpatient setting is one important aspect of care which requires collaborative working between Community Mental Health Teams (CMHTs) and ward staff. However, links are not always formalized. The failure of effective gatekeeping coupled with inconsistent admission and discharge practices further complicates the situation for all those involved. A number of local changes, for example, adoption of a centralized bed bureau, together with policy changes, initiated a nurse-led practice development project. It was predicted that by creating a framework for more formalized communication between the different disciplines admission and discharge processes would be improved, thus enhancing service users' satisfaction and empowering all staff participating in the process. During the project, 132 service users were notified as potentially requiring admission. Admissions were avoided and diverted for 22 of them. The quality of the communication and information shared between the CMHTs and ward staff was significantly improved. Accessing inpatient beds, at times still remained problematic, as beds could only remain ring-fenced on 65% of occasions. This initiative, conducted within a 'real world setting', showed that it is possible to improve admission and discharge practices by creating a framework for a formalized communication process between disciplines.

Running a general practice under APMS

A nurse-led practice in west London was one of the first to be taken on under an APMS contract.

Rachel Harrison: Gaining acceptance

Rachel Harrison heads a nurse-led PMS practice in West Speke, South Liverpool. She spoke to Liam Benison

How to set up and run your own practice

Establishing a nurse-led practice may seem like a daunting task at first but, as Catherine Baraniak explains, the benefits can outweigh the challenges.

Nurse-led practice clinics have an important role in multidisciplinary diabetes care

Nurse-led practice clinics have an important role in multidisciplinary diabetes care

An evaluation of the quality of a chemotherapy administration service established by nurses in an oncology day care centre

Traditionally, chemotherapy administration has been a medical role in Hong Kong. In 1998, two chemotherapy nurses took over part of this role within a major oncology day care centre after completing a course in chemotherapy administration and patient care. The aim of this study was to measure and evaluate the quality of care by using a self-developed audit form and the Worthing Chemotherapy Satisfaction Questionnaire (WSCQ). All records of patients who had had IV cannulas inserted by nurses over a period of one year were audited for the accuracy of the IV cannulation (n=2217). Also, patient satisfaction was assessed in 50 patients. The results showed that the accuracy of IV cannulation was kept constantly above 80% from the eighth month of auditing onwards. It was also found that patients preferred the use of a butterfly needle for the administration of chemotherapy. The study revealed that the level of information received regarding treatment (r=0.36, P=0.011) and satisfaction of practical advice on caring for side effects (r=0.35, P=0.012) were determinants of patients' overall satisfaction. Furthermore, anxiety when patients received chemotherapy could also be associated with overall satisfaction (r=−0.27), although the P value was of borderline significance only (P=0.58). In conclusion, the study reflected a high level of quality of care in relation to this element of nurse-led practice.