Nurse-led Practices Research Articles

Nurse-led evidence-based nursing practice of reducing pulmonary complications among patients after thoracic surgery

Objective To carry out nurse-led evidence-based practices to reduce the incidence of pulmonary complications of patients after thoracic surgery. Methods A multidisciplinary team was set up. The best evidence-based interventions were obtained by adopting evidence-based nursing procedures and were implemented in the clinical practice after localization. Based on the evidence, examination standards were established, and obstacles and promoting factors in the implementation process were evaluated. Then action strategies were formulated to regulate medical staff′s clinical practice. The patients′ incidence of pulmonary complications, pulmonary function indicators, patient satisfaction and pulmonary rehabilitation knowledge and medical staff′s compliance with examination standards were compared before and after the application of the best evidence. Results After the application of the best evidence, the incidence of pulmonary complications decreased from 18.2%(6/33) to 0 (χ2 value was 4.264, P < 0.05). The pulmonary indicators of FEV1/FVC, breath holding test and six minute walking test were (76.1±3.3)%, (27.2±1.5) s and (522.6±13.0) m before the application of best evidence, respectively, and (82.7±2.8)%, (31.0±5.3) s and (561.5±16.4) m after the application of best evidence, respectively. The differences were all statistically significant (t value was -8.600, -3.007, 10.542, P < 0.01). Meanwhile the medical staff′s compliance with the 10 examination standards were all increased to over 85% after the implementation of the best evidence (χ2 value was 16.834-64.000, P<0.01). Patients′ pulmonary rehabilitation knowledge was 24.2%(8/33) and 83.9% (26/31) respectively before and after the application of the best evidence, the difference was statistically significant (χ2 value was 22.823, P<0.01). Patients′ satisfaction improved. Conclusions By applying the best evidence, nurse-led multidisciplinary team can reduce the incidence of pulmonary complications and improve the care quality for patients after thoracic surgery. Key words: Nurse-led; Multidisciplinary team; Evidence-based nursing; Pulmonary complications

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.

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.

Entrepreneurship: Assessing the Readiness of the New Jersey APN Workforce.

There is an unprecedented opportunity to move advanced practice nurses (APNs) into primary care settings at a steady rate over the next 5 to 8 years. In addition, the opportunity for nurse-owned or nurse-led practices has never been greater. However, many APNs currently work in a structured environment where the employer focuses on the business aspects of the practice and the APN focuses primarily on clinical care. Often APNs are unaware of the entrepreneurial contribution they make to the practice. A Needs Assessment Survey was developed to better understand business and practice management knowledge and skills of APNs in New Jersey. The survey included 14 categories for competency development. Twelve of the 14 categories showed that APNs were at a novice or an advanced beginner level. APNs need to demonstrate their value and take a lead to help solve primary care access issues. This can only be accomplished if APNs are willing to seize the opportunity and overcome barriers and knowledge gaps through both formal and informal education to step out of their traditional positions into more independent roles.

A model for nurse-led care

Cuckoo Lane is one of the only nurse-led practices in the country. Seeta Bhardwa looks at how it all started and what the future holds

Nurse‐led education and counselling to enhance adherence to phosphate binders

To investigate whether nurse-led education and counselling enhance phosphate binder adherence in chronic dialysis patients. One in two chronic dialysis patients experiences difficulties in adhering to phosphate binders. The reasons for non-adherence are multifactorial and accordingly require a multifaceted strategy. To date, investigations have been confined primarily to single interventions to promote adherence. This study examines the effect of a multifaceted approach. The design was interventional. Adherence to phosphate binders was blindly and electronically monitored for 17 consecutive weeks with the Medication Event Monitoring System (MEMS). After four weeks baseline monitoring, the effects of the intervention were studied for an additional 13 weeks. In week 5, the study nurse gave all 41 participating patients education on phosphate binders. Thereafter, the study nurse gave bi-weekly personalised counselling to enhance adherence to phosphate binders. The evolution of adherence over time was assessed and compared with historical control data. Secondary outcome variables included serum values of phosphate, calcium and parathyroid hormone and phosphate binder knowledge. In week 1, mean adherence was 83% in this study (intervention group), compared with 86% in the historical control group. In the intervention group, mean adherence increased from 83-94% after 13 weeks. By contrast, in the historical control group, mean adherence declined from 86-76%. In the intervention group, serum phosphate values decreased from 4·9-4·3 mg/dl and phosphate binder knowledge increased from a mean score of 53-75%. Combining education and continuous counselling holds promise in enhancing phosphate binder adherence. Large-scaled and long-term field studies are indicated to determine which nurse-led practices lead to an integral and sustained medication adherence management. Nursing strategies to scale up adherence should at least include educating patients and regularly reinforcing adherence behaviour.