Clinical Nurse Specialist Research Articles

Voices from the frontline: Perspectives from certified nurse practitioners, clinical nurse specialists and physician assistants at an Academic Medical Center.

The COVID-19 pandemic has exacerbated already existing stressors within health care. In August 2020, a campus-wide COVID-19 well-being survey indicated high levels of burnout, stress, and mental health concerns among certified nurse practitioners (CNPs), clinical nurse specialists (CNSs), and physician assistants (PAs) within our Department of Medicine. In response to this survey, an interdisciplinary task force was formed by CNPs, CNSs, and PAs across departmental specialty divisions to conduct focus groups to gain a deeper understanding of workplace experience both prepandemic and during the COVID-19 pandemic. As part of a quality-improvement project, 14 focus groups involving 34 CNPs, CNSs, and PAs within our department were conducted to better understand their experiences before and during the COVID-19 pandemic. A rapid qualitative analysis was used to identify themes and subthemes. In this article, we explore these themes and review potential solutions solicited from the focus groups. The following themes were identified: (1) the importance of being valued; (2) the need for career development opportunities; and (3) the significance of professional fulfillment. Each of these themes existed before, but was exacerbated by, the ongoing COVID-19 pandemic. The manifestation of these stressors is unique to the CNPs, CNSs, and PAs experience, although the larger themes may overlap with physician colleagues. To improve the professional experience and well-being of CNPs, CNSs, and PAs at our institution, it will be critical for leadership to acknowledge these differences and develop specific initiatives to address these concerns.

N21 Clinical Nurse Specialist in Inflammatory Bowel Disease (CNS-IBD). Care challenges and economic sustainability. A Scoping review

Abstract Background Inflammatory Bowel Diseases (IBD), as part of an immune-mediated chronic illness with a tendency for symptom exacerbation that can be difficult to predict, have a significant impact on the patient's quality of life, greatly diminishing their overall well-being. The healthcare demand of patients and the need to continue improving health-related quality of life (HRQoL) while reducing healthcare expenditure create the necessity for the role of the Clinical Nurse Specialist in Inflammatory Bowel Disease (CNS-IBD) to achieve therapeutic success. Therefore, the main objectives of our research are to assess the relationship between consultations with the Clinical Nurse Specialist in Inflammatory Bowel Disease and the patient's health-related quality of life, and, secondarily, to evaluate the economic sustainability of this consultation within healthcare systems. Methods Searches were conducted in the following databases: PubMed, UpToDate, Cochrane Library, Scopus, and CINAHL, as well as in relevant scientific journals: BMJ Open and The New England Journal of Medicine (NEJM). There were no time or language restrictions. A total of n = 6,620 articles were retrieved. After applying eligibility criteria, n = 257 articles were deemed potentially relevant for abstract review. N = 117 articles were reviewed in full. Finally, n = 5 studies published between 2012 and 2022 were included. Results The results show an improvement in health-related quality of life, as measured by the IBDQ-32 and the PRO measures questionnaire, thanks to greater patient empowerment and better disease management. The reduction in hospital admissions and the prompt response to flare-ups indicate a decrease in healthcare costs and the burden on healthcare facilities. Conclusion This scoping review summarises the current scientific evidence regarding the effectiveness of the Clinical Nurse Specialist in Inflammatory Bowel Disease and its impact on improving the health-related quality of life of patients, as well as the efficiency and sustainability it can offer to healthcare institutions. The evidence in this scoping review suggests that CNS-IBDs play a key role in patient care and the improvement of HRQoL. However, medical follow-up and treatment remain essential for better control of clinical symptoms. Studies addressing the economic efficiency of this intervention within our research yielded significantly positive results. Nevertheless, the scientific evidence is limited, with a clear shortage of studies specifically focusing on nursing practice to improve the life conditions of patients.

P1038 Establishing a Tertiary-Level Inflammatory Bowel Disease Service in the UAE: A Response to Rising Incidence and Service Gaps

Abstract Background Inflammatory bowel disease (IBD) is a growing public health concern in the Middle East, with the UAE experiencing a rapid rise in its incidence. Due to the predominance of private healthcare facilities, dedicated IBD services are exceedingly rare, and care is often fragmented. We outline the key initiatives undertaken to establish one of the few structured and comprehensive IBD services in the region. Methods Post-2023, our hospital initiated targeted changes to establish a tertiary care IBD service in the UAE. Through an analysis of service modifications and organizational strategies, we detail efforts to improve care delivery towards providing excellence in IBD care. Results The introduction of a structured care model has significantly improved IBD outcomes through a dedicated team of IBD-trained physicians, IBD clinical nurse specialist (CNS), and an administrator. Multidisciplinary meetings have standardized care, enabling early diagnosis, initiation and optimisation of advanced therapies (AT). The service has notably reduced corticosteroid use, indicating effective disease control. A growing comprehensive IBD registry now prospectively tracks over 320 patients on AT, providing valuable data for clinical and research needs. High-risk patient lists and virtual flare clinics have decreased hospital admissions by nearly 90%, facilitating proactive management. The service has early adoption of novel ATs and is supported by an active clinical trials program. Early initiation of AT, particularly for moderate to severe Crohn’s disease, has reduced the median time to treatment from diagnosis to 1.54 months (IQR 2.23) in 2024. Holistic IBD clinics, with access to a specialist dietitian and psychologist, have improved patient satisfaction and outcomes. CNS-led initiatives, including educational sessions on medication use, disease management, preconception and pregnancy care have significantly boosted patient engagement and health outcomes. Patient support and advocacy groups have been established, providing a platform for education and shared experiences. Additionally, Arabic versions of disease and AT patient information leaflets have been developed to enhance accessibility and understanding. Advanced IBD endoscopy, including chromoendoscopy, is now offered as standard care. Conclusion The establishment of a structured, multidisciplinary IBD service has transformed care delivery, addressing critical gaps in the regional healthcare landscape. Key initiatives have led to improved clinical outcomes, reduced hospital admissions, and enhanced patient satisfaction. This model serves as a benchmark for comprehensive IBD care in the region, demonstrating the impact of specialized, patient-centred services.

Advanced practice nursing, critical care, and Spain: A point of view.

Advanced Practice Nursing (APN) continues to gain recognition. Despite the guidelines published by the International Council of Nurses in 2020, there is still some confusion about this concept. In general, APN is used in three different and not necessarily compatible ways: as an umbrella term that regulates four different roles, as a level of practice, or as a role itself. Specialization in nursing does not always imply advanced practice, although both concepts are not mutually exclusive. The "Acute Care Nurse Practitioners" in the United States can conduct physical examinations and medical histories, diagnose, prescribe medications, or request and interpret complementary tests. They pose no risk to patients and have shown positive clinical outcomes in Critical Care Units. They also add "value" by improving communication, interprofessional coordination, or adherence to protocols. The "Clinical Nurse Specialists" in Critical Care help improve quality, staff education, and provide care to complex patients. They have a beneficial impact on reducing nosocomial infections, adverse events, hospital stay, or costs. The implementation of APN roles in Spain faces challenges due to its circumstances, such as the high number of physicians or the lack of systematic and transparent measurement of outcomes. Historically, the nursing corporation has promoted a disproportionately positive view of the Spanish healthcare system and nursing. The corporation has followed the model of medical specialization without supporting studies and a framework that hinders its integration into APN. The orthodox vision of Spanish nursing still holds significant weight, where experience is valued more than education, complicating the expansion of competencies. Numerous regional projects have been developed without a unified voice or approach. APN should not be a distraction from continuing to advocate for improvements in nurses' working conditions.

The Role of Oncology Clinical Nurse Specialists in Enhancing Cancer Survivorship Care: A Comprehensive Review of Global Implementation Challenges and Opportunities

Background: The role of oncology clinical nurse specialists (CNS) has become increasingly vital in the landscape of cancer care, especially as healthcare systems adapt to the growing demands of cancer survivorship. These advanced practice nurses provide critical support throughout the cancer journey, emphasizing symptom management, patient education, and coordination of care. Methods: This literature review employed a Rapid Evidence Assessment methodology, focusing on peer-reviewed articles published between 2022 and 2023. The review analyzed the global implementation of the oncology CNS role, examining various healthcare systems and the unique challenges associated with this position. Results: The findings indicate that oncology CNSs significantly enhance patient outcomes, including reduced hospitalizations and improved quality of life for cancer patients. In the UK, for instance, data revealed a substantial decrease in non-acute hospitalizations among lung cancer patients under CNS care. Qualitative research highlighted the emotional support provided by CNSs, which is crucial for patients navigating complex treatment regimens. Challenges identified include role ambiguity, insufficient training, and systemic barriers that hinder effective practice. Conclusion: The oncology CNS role is essential for improving cancer care delivery, yet it faces significant challenges that limit its potential. To optimize the impact of CNSs, healthcare systems must clearly define their responsibilities, enhance training programs, and foster collaboration among multidisciplinary teams. This review underscores the need for further research to fully understand the contributions of oncology CNSs in diverse healthcare settings, as well as to identify strategies for overcoming existing barriers.

Understanding the Scale and Nature of Parent/Guardian Telephone Calls to a Tertiary Children’s Cardiac Centre: A Service Evaluation

ABSTRACT Heart defects are the second most common congenital anomaly in babies born in the UK and standards state families should have access to a children’s cardiac nurse specialist telephone advice service. However, there is little published information to describe the nature of calls and the workload associated with telephone support. We conducted a prospective service evaluation of telephone calls received at one UK specialist children’s cardiac surgical center from parents/carers (April–June 2019). All inpatient cardiac teams (cardiology secretaries, inpatient cardiac wards, outpatient department and Clinical Nurse Specialist team) were asked to record calls on a purpose-designed template. This included recording of call duration and reason (from pre-defined categories), with the aim to identify the volume and nature of phone calls. Actions and time taken to resolve issues were not recorded. Data was entered into Excel and analyzed using descriptive statistics. In a seven-week period, 204 telephone calls were received; 41% (n = 83) to the clinical nurse specialist team, 25% (n = 51) to medical secretaries, 20% (n = 42) to cardiac ward staff and 14% (n = 28) to the cardiac outpatient department. The mean length of calls was 6.08 mins (SD 5.07 mins). Across all groups phone call duration totaled 20.8 hours. Sixty-two calls (31% of all calls) reflected 70 concerns/queries about a current health issue. The most common reasons included respiratory (n = 13), heart rate or rhythm (n = 12) and chest pain/pallor (n = 11). Sixty-five calls (32% of all calls) related to issues surrounding medications, with 23% (n = 15) related to dose queries and 49% (n = 32) related to repeat prescription requests or challenges obtaining prescriptions. The results demonstrated a high telephone support need for current health issues or medication queries which required timely assessment and support from health care professionals working across cardiac services. Further research is required to identify the time implications of dealing with phone calls and interventions to support parent/guardian assessment and communication about their concerns and medication management.

Clinical Nurse Specialist Coaching Improves Transition Preparedness in Older Adults.

Person-centered coaching provided by clinical nurse specialists (CNSs) is an effective, acceptable, and feasible evidence-based intervention. Psychosocial distress experienced by older adults and their families during transitions of care can contribute to adverse events. CNS coaching demonstrated increased self-reported preparedness for healthcare transitions and knowledge-of-care options. CNS coaching promoted engagement and self-efficacy. Nurse administrators can incorporate this intervention in a variety of care settings to improve outcomes related to transitions of care.

The Role of a Cardio-Oncology Clinical Nurse Specialist in the United Kingdom

The Role of a Cardio-Oncology Clinical Nurse Specialist in the United Kingdom

BS SO10 - Predictive Factors in the Development of Dumping Syndrome After Bariatric Surgery

Abstract Background Dumping syndrome (DS) is a recognised complication of Roux En-Y Gastric Bypass (RYGB) and rarely Sleeve Gastrectomy (SG). The prevalence of DS is unclear, with current literature ranging from 10-50%. The condition is characterised by gastrointestinal and vasomotor symptoms resulting in a significant impact on quality of life. This study aimed to prospectively utilise Sigstad scoring to evaluate post-operative patients, investigating the timing of symptom onset and its correlation with pre-existing diabetes, revision surgery, and percentage of Total Body Weight Loss (TBWL). Method We used the Sigstad scoring questionnaire, administered by our bariatric Clinical Nurse Specialists (CNS) at outpatient clinics to assess patients for DS between January to May 2024. Data collected included patient demographics, surgery type and date, TBWL, Body Mass Index (BMI), and whether the patient had a diagnosis of Diabetes Mellitus type II (DMII). A diagnosis of DS was confirmed if a patients score ³7 points on the Sigstad questionnaire. We explored factors influencing the development of DS. Results In total, 64 patients were evaluated for DS of whom 86% were female and the median age was 44 years (IQR: 35-45). Most patients (67%) had undergone primary RYGB, 19% SG, 11% conversion from SG to RYGB and 70% were assessed within one year of surgery. DS symptoms emerged in 25% of patients, predominantly within the first-year post-operation (60%). The median TBWL was 12% (IQR: 9-22%), showing no correlation to DS onset. Patients with DMII exhibited a higher propensity for DS (66% vs 20%, p=0.029). Patients undergoing revisional surgery also had a higher incidence of DS (33% vs 6%, p=0.117). Conclusion A quarter of patients undergoing bariatric surgery will develop DS, most of whom within the first-year post-surgery. Revisional surgery and pre-existing DMII are the primary predictors in developing DS. There was no observed association between TBWL and DS onset. Further extensive studies are needed to confirm these observations.

"I'm quite proud of how we've handled it": health professionals' experiences of returning additional findings from the 100,000 genomes project.

Participants in the 100,000 Genomes Project (100kGP) could consent to receive additional finding (AF) results, individual variants relating to genes associated with susceptibility to cancer and familial hypercholesterolemia (FH). In the study reported here, qualitative interviews were used to explore the experiences of National Health Service (NHS) professionals from across England who were tasked with returning over 80,000 "no AF" results and 700 positive AF results to 100kGP participants. Interviews were conducted with 45 professionals from a range of backgrounds, including Genetic Counsellors, Clinical Geneticists, FH Clinical Nurse Specialists and Clinical Scientists. Interviews were analysed using a codebook thematic analysis approach. Returning AF results has been a significant endeavour, with challenges for pathways, administrative processes and clinical and laboratory time when the capacity of NHS services is already stretched. Professionals discussed going "above and beyond" to prioritise patient care through pathway design, additional clinics, overtime, longer appointments and provision of follow-up appointments. Professionals also described facing practical and emotional challenges when returning AFs. Benefits for patients from receiving AFs in the 100kGP were highlighted and professionals were generally positive about offering clinically actionable AFs within routine NHS clinical care. Professionals were, however, cautious around the implementation of AFs into routine care and felt more research and discussion was needed to determine which AFs to offer, approaches to consent and communication of results, costs and the potential strain on NHS capacity and resources. Further consultation is required with careful review of pathways and resources before offering AFs in clinical practice.

A systematic review of the follow-up priorities of colorectal cancer survivors

Background: Colorectal cancer (CRC) is the third most common cancer worldwide. Survival has improved over recent years and CRC survivors are a growing group of patients living with and beyond a diagnosis of cancer. Aims: This study aims to explore the follow-up priorities of CRC survivors and to determine if all those affected by CRC have been given a voice through current literature. Method: A systematic integrative literature review was performed across three databases— CINAHL, Medline and PsycINFO—from 2014 to 2024. This yielded 12 papers for inclusion. Thematic analysis was undertaken with themes from each paper identified and coded. Common themes were grouped and renamed. Results: Six themes emerged: understanding and managing long-term effects of treatment; the importance of good information; delivery of follow-up care; ease of access to care and investigations; fear of recurrence; and the changing impact of cancer treatment. Ethnic minority groups and non-native language speakers appeared underrepresented in the included studies; only 50% of included studies made ethnicity data available. It was not possible to determine whether other groups had been included, such as members of the LGBTQ+ community, those with learning disabilities or those with mental health conditions. Conclusions: Survivors of CRC require access to information and support to manage the effects of treatment in the short, medium and long term to optimise their quality of life post treatment. The approach to this should be shaped to the preference and need of the individual. Colorectal cancer Clinical Nurse Specialists need to tailor practice and use their expertise to meet the needs of CRC survivors during follow-up care processes. More evidence is needed on the follow-up priorities of CRC survivors from underrepresented groups to ensure that their voices are heard and their needs addressed.

Elements Supporting Translation of Evidence Into Practice: A Model for Clinical Nurse Specialist and Nurse Scientist Collaboration.

To present evidence-based elements supporting the synergistic relationship between nurse scientists and clinical nurse specialists to improve the translation of evidence into practice. Using best-practice elements to support the improvement of evidence-based translation, we define the roles and synergies between nurse scientists and clinical nurse specialists within clinical environments. Five themes were identified in the literature review:● Although clinical nurse specialists and nurse scientists differ in focus and competencies, they are in key positions to collaborate to meet healthcare demands.● Clinical nurse specialists are well-equipped to implement the science developed by nurse scientists.● To meet the increased demands and complexity of the healthcare system and patient needs, organizational leadership must lend support to clinical nurse specialists and nurse scientist collaboration.● Clinical nurse specialists are well-positioned to foster interprofessional partnerships and generate opportunities for evidence-based project initiatives across healthcare disciplines.● Clinical nurse specialists should utilize professional models to inform practice to improve the review, translation, and implementation of research into practice. Projects conducted using a collaborative structure had a system-level impact and long-term sustainability capabilities. Additionally, projects were more likely to be disseminated by clinical nurse specialists within a formal structure.

Addressing US Military Transgender Care Inequalities: Clinical Nurse Specialist Bridging Healthcare Gaps.

There are more than 130 000 US veterans and more than 12 500 active-duty service members who identify as transgender. Lack of training in transgender and gender-affirming care among healthcare providers in the military is still reported. The article aims to explore and advocate for the unique role of advanced practice registered nurses, especially clinical nurse specialists, in providing culturally sensitive and evidence-based care to the transgender population within the US military. The clinical nurse specialists' pivotal role in policy advocacy and translation of evidence to improve the quality of care and patient outcomes for transgender service members is highlighted. The article also explores the historical journey of transgender care in the US military, addressing discriminatory policies and the implications of the ever-evolving regulations in military transgender healthcare. The article aims to create awareness of clinical nurse specialist utilization in US military healthcare services to improve the care of transgender individuals in the military. The uncertain future for transgender service members highlights the ongoing commitment needed to navigate complex military healthcare policies and foster inclusive, evidence-based practices. Therefore, the clinical nurse specialist plays a pivotal role in shaping the future of transgender healthcare within the US military.

Out of the Hospital, Out of the Box: Utilizing the CNS Role in Home Healthcare Settings.

The United States has poorer population health outcomes compared to similar developed nations despite higher healthcare spending. Multiple factors contribute to this problem, including high healthcare costs, insurance coverage limitations, and a lack of focus on preventive care and wellness. Clinical Nurse Specialists (CNSs), primarily known for their impact in acute care settings, increasingly demonstrate their value in outpatient settings like home healthcare. CNSs possess graduate-level training, equipping them with the skills and expertise to develop and implement strategies that improve population health outcomes in home health settings. CNSs provide clinical leadership and support to staff while remaining at the forefront of ensuring the organization delivers high-quality patient care. Understanding the specific skills and competencies of the CNS to support the patient, family, staff, and organization is necessary to improve outcomes for patients in outpatient settings. The CNS delivers care through direct patient care, supporting nurses and nursing practice, and improving organizational systems. This unique skill set allows CNSs to influence home healthcare outcomes across various levels of care positively. This article sheds light on how CNSs enhance patient outcomes in outpatient settings like home healthcare.

The Value of Renal Clinical Nurse Specialists: Future Potential and Current Challenges in the United Kingdom

The renal clinical nurse specialist (CNS) should be the main source of support and information for people affected by kidney cancer. The CNS is best placed to offer holistic care and often gets to know the patient, especially well as they progress on second- or third-line therapies. We discuss future potential and current challenges in the United Kingdom based on our health professional experiences. This is a discussion paper based on clinical expertise and informed by current literature. The CNS role for uro-oncology in many centers covers a large patient population and all 5 tumor sites: prostate, bladder, renal, testis, and penile. Urology has a decreasing workforce and increasing difficulty in recruiting to the role in these services. A number of renal CNSs are new to post due to the recruitment crisis without dedicated CNS competencies. Renal CNSs can be proven to reduce costs through managing patients' side-effect profile, ensuring people affected by cancer continue their maintenance therapies. Therapies for kidney cancer have revolutionized treatment for patients and improved their overall survival in recent years. With longer prognoses and specialist therapies that include targeted and immunotherapy drugs, people affected by kidney cancer need dedicated renal CNSs to support them throughout the cancer pathway. Educational projects and resources, such as the aspirant cancer career and education (ACCEND) project and RCC4Nurses, will be key to support both new and longer serving CNSs to pursue successful roles in uro-oncology while providing excellent patient care.

Describing Clinical Nurse Specialist Practice: A Mixed-Methods Study.

To describe clinical nurse specialist practice in Québec, Canada, and propose a dashboard to track role dimensions and outcomes. Sequential mixed-methods study across 6 sites in Québec (June 2021 to May 2022). Phase 1: Focus groups (n = 8) and individual interviews (n = 3) were conducted to adapt a time and motion tool. Phase 2: Time and motion studies (n = 25; 203 hours 5 minutes) described clinical nurse specialist practice. Phase 3: A rapid literature review and study participants' feedback informed the dashboard's development. Analysis: Descriptive statistics, with content analysis for qualitative data. The proportion of time clinical nurse specialists spent in role dimensions included clinical (22.8%), education (11.2%), administrative/leadership (48.6%), research (9.6%), and personal (7.7%). On average, they spent 17% of work time with patients, but this varied across specialties and locations. Key dashboard characteristics and uses were identified. Important differences were noted in clinical nurse specialist time spent in activities across specialties and regions in Québec. Approximately one-fifth of work time was spent in direct patient care. Additional research is needed to examine the link between clinical nurse specialist practice and outcomes in other jurisdictions and test the implementation of a dashboard to make their practice more visible.

Piloting an Innovative Collaboration Between a Clinical Nurse Specialist Program and a Professional Organization.

Piloting an Innovative Collaboration Between a Clinical Nurse Specialist Program and a Professional Organization.

IMPROVING THE EffiCIENCY OF THE NEURO-ONCOLOGY NEW PATIENT CLINIC AT THE ROYAL MARSDEN HOSPITAL

Abstract AIMS Patients seen for the first time in the neuro oncology outpatient unit are typically reviewed by a registrar, then a consultant and a clinical nurse specialist (CNS). This can lead to repetition in history taking and prolonged appointment times. We aimed to improve this by introducing a clerking proforma. METHOD Prospective audit of all new patients seen in clinic over a four month period. The total clinic appointment time was recorded for each patient. A proforma was designed to cover the main domains of presenting symptoms, especially focussing on tumour related symptoms, medications including dexamethasone and antiepileptic use, and ensured the appropriate information was given to the patient about the treatment proposed and driving restrictions. The proforma was introduced in to the clinic after 2 months and results analysed to see if a difference was made in terms of overall patient time in the clinic. Qualitative feedback gathered from the team members involved. RESULTS 10 patients were included prior to the use of the proforma and 9 patients afterwards. Patients presented with a mixture of high and low grade gliomas. Treatment options discussed included chemotherapy, radiotherapy, surveillance and best supportive care. The average time of patient stay in the department prior to the proforma was 107 minutes (range 65 to 165) and after the introduction of the proforma was 91 (range 40 to 110). The proforma was well received by the clinical team, it was felt useful to have a template to structure the new patient consultation, especially for more junior registrars, and the consultants were more confident that the appropriate information had been given. CONCLUSION Within the confines of a small sample size, the introduction of a proforma reduced the average new patient consultation time and standardised the clinical information collected.

The emerging role of a Stroke Clinical Nurse Specialist (CNS) in Early Supported Discharged: Developing a pathway for stroke nursing for secondary prevention in the community. A scoping review protocol.

Stroke represents a major source of mortality and morbidity globally. The role of a stroke Clinical Nurse Specialist (CNS) as an expert team member in early supported discharge (ESD) for stroke, is not well defined or described although it is well established in other models of after-hospital and out-reach specialist care in the community. A greater focus has been on patients receiving rehabilitation post-stroke, however there is a need for a more holistic approach to care which clinical nurse specialists can offer to patients as part of ESD. Nurses are often the cohesive point of contact for other after-hospital services, managing many aspects of secondary prevention. The aim of this scoping review is to explore the evidence in relation to the role of the stroke nurse providing secondary prevention interventions to stroke patients in a community setting. We will conduct a scoping review in accordance with the Arksey and O'Malley, 2005 1 scoping review framework and the PRISMA-ScR guidelines to map available literature on the role of the stroke nurse in post-stroke care of patients in the community. The Cochrane Central Register of Controlled Trials and Systematic literature searches including databases MEDLINE, EMBASE, CINAHL, google scholar and grey literature will be searched using keyword searches. Data will be charted and synthesised and a narrative synthesis will be conducted. This scoping review will be used to identify gaps in the current literature and identify areas for future research in the role of the stroke nurse in ESD in relation to secondary prevention for stroke patients and inform the development of a pathway for stroke nursing in ESD.

The History of Clinical Nurse Specialists in Emergency Care.

The Clinical Nurse Specialist (CNS) role has been instrumental in advancing nursing practice, healthcare delivery, and patient outcomes across various specialties, particularly in emergency care. This manuscript provides an extensive review of the history of CNSs in emergency settings, exploring the development of the practice model, the challenges encountered, and their impact on patient and organizational outcomes.