Specialist Nurses Research Articles

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.

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.

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.

ISCO-08 Classification and scope of practice of nurses: Survey among WHO-Europe member states

Abstract Background The expansion of nurse’s roles in the delivery of care needs transparent defining of roles, extra education/training opportunities, and complementary legislative regulations. Methods This cross-sectional study was planned to explore status of nursing and midwifery workforce in WHO Europe member states. Data were collected from December 2020 until September 2023. Results ISCO-08 2221 is used to classify for only bachelor prepared-nurses in 2 of countries (Bulgaria and Spain). Besides, it is used only for vocational prepared-nurses in 2 of countries (Kyrgyzstan and Tajikistan). Those countries only have vocational or bachelor education. ISCO-08 2221 is used in 1 of countries which have two entry levels with vocational and bachelor prepared-nurses (Georgia). ISCO-08 3221 is referred to vocational training in 5 (20%) countries (Armenia, Finland, the UK, Croatia, Hungary). ISCO-08 2221 is main classification for all levels prepared nurses in 18 countries including Switzerland, Cyprus, Czechia, Germany, Denmark, Ireland, Israel, Iceland, Kazakhstan, Lithuania Latvia, Malta, Poland, Portugal, Romania, Sweden, Slovakia, Türkiye. Scope of practice of vocational and bachelor prepared nurses is defined by law/legislation in 25 of member states. Scope of practice vocational versus bachelor depends on conduct scientific tasks (Switzerland), being broader (Kazakhstan), competency level (Hungary, Croatia, Portugal) exceptionally there is no difference in Malta. Scope of Registered Nurse, Specialist Nurse and Advanced Nurse Practitioner differ in 22 of countries of those which on activities/practice/roles, expanded authority, working with determined care group. As a result, while scope of practice of professional nurses varies in line with their education level, ISCO-08 2221 is used for nurses’ classification from all education levels in member states. Key messages • There is no classification for postgraduate trained nurses (as is the case for physicians), even though scope of practice is different across education levels. • When revising the ISCO-08 classification, it should be recommended that a common terminology is needed to define postgraduate nurses in region.

The impact and value of the Parkinson’s nurse specialist to people with Parkinson’s and their care partners: a grounded theory qualitative study

BackgroundWhere available, Parkinson’s Nurse Specialists (PNS) provide a range of care, support, guidance, and advocacy for people with Parkinson’s (PwP), and, where appropriate, their care partners (CP). Parkinson’s is a complex and progressive condition. Consequently, evaluating health outcomes is not a reliable method to understand the value and impact of PNS. Previous research has identified PNS can improve the subjective well-being of PwP in the community, also that barriers to care include heavy caseloads and a lack of time. Yet little is known about the value of the role of the PNS, particularly about the impact of pharmacological management and review. This research aims to close this research gap by providing explanatory theories of the impact and value of PNS to PwP, their CP, and other professionals.MethodsA social constructivist grounded theory approach was used. Semi-structured interviews were conducted with three groups, PNS, PwP, and CP. Interviews were analysed using NVivo for coding and categorising and Word for memo-writing. Data was analysed inductively and iteratively to identify contexts, social processes, actions, and behaviours, before final emergent theories were identified.Results46 semi-structured interviews (PNS 18, PwP 19, CP 9) led to four data categories and 13 sub-categories that delineated PNS value. (1) Expert Counsel; provision of emotional support, education, and lifestyle guidance; CP inclusion; provision from diagnosis; and across all stages of Parkinson’s. (2) Conduit of Care; signposting, referral, and connection to PwP, CP, others; PNS barriers and facilitators; (3) Team/Partnership; continuity and partnership, ‘working together’; (4) Pharmacological Support, PNS prescribing; concordance; speed of treatment. Where PNS were accessible they could offer personalised support and partnership, so providing person-centred care that improves health and well-being.ConclusionWhere a PNS is accessible due to service availability and manageable caseloads, to provide person-centred care, they deliver several benefits to PwP and CP which improve health and perceived well-being. Where PNS are not available, PwP and CP often struggle to manage their Parkinson’s with negative impacts on health and well-being.

Artificial intelligence versus human touch: can artificial intelligence accurately generate a literature review on laser technologies?

To compare the accuracy of open-source Artificial Intelligence (AI) Large Language Models (LLM) against human authors to generate a systematic review (SR) on the new pulsed-Thulium:YAG (p-Tm:YAG) laser. Five manuscripts were compared. The Human-SR on p-Tm:YAG (considered to be the "ground truth") was written by independent certified endourologists with expertise in lasers, accepted in a peer-review pubmed-indexed journal (but not yet available online, and therefore not accessible to the LLMs). The query to the AI LLMs was: "write a systematic review on pulsed-Thulium:YAG laser for lithotripsy" which was submitted to four LLMs (ChatGPT3.5/Vercel/Claude/Mistral-7b). The LLM-SR were uniformed and Human-SR reformatted to fit the general output appearance, to ensure blindness. Nine participants with various levels of endourological expertise (three Clinical Nurse Specialist nurses, Urology Trainees and Consultants) objectively assessed the accuracy of the five SRs using a bespoke 10 "checkpoint" proforma. A subjective assessment was recorded using a composite score including quality (0-10), clarity (0-10) and overall manuscript rank (1-5). The Human-SR was objectively and subjectively more accurate than LLM-SRs (96 ± 7% and 86.8 ± 8.2% respectively; p < 0.001). The LLM-SRs did not significantly differ but ChatGPT3.5 presented greater subjective and objective accuracy scores (62.4 ± 15% and 29 ± 28% respectively; p > 0.05). Quality and clarity assessments were significantly impacted by SR type but not the expertise level (p < 0.001 and > 0.05, respectively). LLM generated data on highly technical topics present a lower accuracy than Key Opinion Leaders. LLMs, especially ChatGPT3.5, with human supervision could improve our practice.

Knowledge, attitudes, and practice of primary care professionals regarding community activities: a descriptive study.

Promoting health via a community approach is one of the most effective strategies for reducing the current incidence of chronic diseases. Primary care (PC), through the implementation of community activities (CA), has the potential to achieve this goal. Yet the implementation of CA at health centers is not standardized and is often thanks only to the voluntariness of health professionals. To ascertain the knowledge, attitudes, and practices of PC professionals regarding the implementation of CA. We carried out a cross-sectional study by circulating a self-administered online questionnaire on CA, across the period December 2022 through June 2023 in Galicia (Spain). All health professionals working in the Galician Health Service PC setting were invited to participate. A total of 521 health professionals participated in the study. They included all types of PC health professionals (physicians, general and specialist nurses -midwives, pediatrics, family and community, mental health- and social workers), including residents in training. Only 14.8% and 12.5% of professionals correctly identified CAs and social prescription (SPr) interventions, respectively. Furthermore, 93.9% recognized that the development of CA in health centers was deficient. Despite this, 76.5% showed a good attitude toward participation in CA. PC professionals find it difficult to identify CA and SPr interventions. Therefore, it is necessary to improve the training of these professionals in the implementation of CA with a view to enhancing population health, reducing the incidence of chronic diseases, and helping lessen the healthcare burden of the health system.

Using nominal group technique to compare patients’ and clinicians’ perspectives on symptoms in multiple myeloma to inform the development of a self management tool for patients with relapsed myeloma

Background The nominal group technique (NGT) allows stakeholders to directly generate items for needs assessment. The objective was to demonstrate the use of NGT to inform the development of a healthcare app in patients with relapsed myeloma. Healthcare professionals with experience in the care of patients with relapsed/refractory myeloma were invited to participate. Methods One NGT group was conducted. In the group, health care professionals working in haematology were asked to vote anonymously in order of highest priority, on symptoms previously highlighted by relapsed/refractory myeloma patients in four focus groups. Results A total of 18 healthcare professionals working in the area of haematology participated in the NGT discussion; consultants (n=6), haematology registrars (n=2), specialist nurses [Advanced Nurse Practitioner/Clinical Nurse Specialist] (haematology) (n=3), staff nurse (n=1), and “other” health care professionals (n=6). Participants ranged in experience of working with myeloma patients from 2 years to over 27 years. The symptoms voted in highest priority were: Pain, Fatigue, Peripheral Neuropathy, Infection Risk and Steroid Induced Side Effects. Conclusions The NGT was an efficient method for obtaining information to inform a healthcare app.

An Evidence-Based Nurse-Led Intervention to Reduce Diabetes Distress Among Adults With Type 1 Diabetes and Diabetes Distress (REDUCE): Development of a Complex Intervention Using Qualitative Methods Informed by the Medical Research Council Framework.

Diabetes distress refers to the negative emotional reaction to living with the demands of diabetes; it occurs in >40% of adults with type 1 diabetes (T1D). However, no interventions to reduce diabetes distress are specifically designed to be an integral part of diabetes care. This study aims to modify and adapt existing evidence-based methods into a nurse-led group intervention to reduce diabetes distress among adults with T1D and moderate to severe diabetes distress. The overall framework of this study was informed by the initial phase of the Medical Research Council's complex intervention framework that focused on undertaking intervention identification and development to guide the adaptation of the intervention. This study took place at 2 specialized diabetes centers in Denmark from November 2019 to June 2021. A total of 36 adults with T1D participated in 10 parallel workshops. A total of 12 diabetes-specialized nurses were interviewed and participated in 1 cocreation workshop; 12 multidisciplinary specialists, including psychologists, educational specialists, and researchers, participated in 4 cocreation workshops and 14 feedback meetings. Data were analyzed by applying a deductive analytic approach. The intervention included 5 biweekly 2.5-hour small group sessions involving adults with T1D and diabetes distress. Guided by a detailed step-by-step manual, the intervention was delivered by 2 trained diabetes specialist nurses. The intervention material included visual conversation tools covering seven diabetes-specific sources derived from the 28-item Type 1 Diabetes Distress Scale for measuring diabetes distress: (1) powerlessness, (2) self-management, (3) fear of hypoglycemia, (4) food and eating, (5) friends and family, (6) negative social perception, and (7) physician distress. The tools are designed to kick-start awareness and sharing of diabetes-specific challenges and strengths, individual reflections, as well as plenary and peer-to-peer discussions about strategies to manage diabetes distress, providing new perspectives on diabetes worries and strategies to overcome negative emotions. Diabetes specialist nurses expressed a need for a manual with descriptions of methods and detailed guidelines for using the tools. To deliver the intervention, nurses need increased knowledge about diabetes distress, how to support diabetes distress reduction, and training and supervision to improve skills. This co-design study describes the adaptation of a complex intervention with a strong evidence base, including detailed reporting of the theoretical underpinnings and core mechanisms.

Developing a consensus guide to toilet training all children.

June Rogers, Independent Practitioner and Consultant, Down Syndrome UK (junerogersmbe@hotmail.com), and Davina Richardson, Children's Nurse Specialist, Bladder and Bowel UK, The Toilet Training Team, were winners of the Gold Award in the Continence Nurse of the Year category of the BJN Awards 2024.

Trauma nursing practitioners’ preferences for training for trauma specialist nurses based on job competencies

IntroductionOptimizing trauma nurse training is of great significance in enhancing nurses’ professional skills, strengthening their emergency response capabilities, facilitating career development, and improving patient rescue success rates. This study aims to investigate the preferences of trauma nursing practitioners for trauma specialist nurse training based on job competency. Methods631 Trauma nursing practitioners from 20 hospitals in Guizhou Province, China, participated in this cross-sectional study. The instruments used were the General Information Questionnaire and the Self-designed training preference questionnaire for trauma specialist nurses based on job competency theory. Questionnaires are distributed and collected through online questionnaires. Results93.03% of trauma nursing practitioners expressed their willingness to participate in trauma nurse specialist training, of which 80.35% had high-level training needs. 78.92% of trauma nursing practitioners expressed their hope to receive trauma nurse specialist training through operational demonstration training, online live broadcasts, and scenario simulation drills. Among the various dimensions of job competency, the highest demand was for professional knowledge, skills, and ability. ConclusionTrauma nursing practitioners highly value and recognize the professional training of trauma nurse specialists and prefer training methods that are highly practical and can directly improve clinical skills. The research results provide an important basis for further optimizing the training program for trauma nurse specialists.

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.

Background 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. Objective 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. Methods 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. Conclusions 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.

Rehabilitation Specialty Hospital Conversion to Support a COVID-19 Pandemic Surge: Nurses' Perceptions.

The purpose of this study was to understand the novel experience of a rehabilitation specialty hospital conversion to acute medical/COVID-19 patient care from the perspective of rehabilitation nurses. A descriptive qualitative study was conducted. Thirty-six nurses employed by the rehabilitation specialty hospital were invited to participate. Narrative data were collected via an online survey and were analyzed using a conventional content analysis approach. Fifteen (42%) of those eligible participated. The overarching descriptor of the rehabilitation nurses' experiences was "we did what we had to do." Three primary descriptors emerged: challenged, conflicted, and compromised. Communication from leadership prominently informed the conversion experience. Expecting rehabilitation specialty nurses to care for a different patient population is an important consideration and requires leadership to understand the distinctive characteristics of the specialty and its approach to care. Addressing the impact on nursing staff in any disaster requires listening and communicating to provide needed support. Recognizing the characteristics of nursing specialties, the need for self-care among nursing staff and the salience of effective communication are essential during specialty hospital conversions.

Patient-centred stoma care support: colostomy patients.

Colostomy patients have distinct needs that require specialised pathways for optimal care. Recognising that these needs vary, based on the type and configuration of the stoma, is crucial. Specialist nurses play a vital role in providing long-term support and expertise. While many stoma nursing services in the UK offer patient pathways, these often lack specificity for different stoma types. Tailoring pathways to colostomy patients can prevent complications, reduce hospital readmissions and enhance quality of life. Community nurses and other healthcare professionals are essential in supporting colostomy patients through individualised care. Their involvement ensures that patients receive appropriate preparation for life with a stoma and are adequately educated about their specific needs. This multidisciplinary approach fosters a comprehensive care environment, addressing both the physical and emotional aspects of living with a colostomy. By focusing on personalised care and life-long support, healthcare professionals can significantly improve patient outcomes and overall well-being.

The application value of the multidisciplinary team model led by specialist nurses in pressure ulcer management.

The application value of the multidisciplinary team model led by specialist nurses in pressure ulcer management.

EP.15A.04 A Tripartite Care Model for Home Care of Lung Cancer Patients Based on the Theory of Tripartite Care Led by Specialist Nurses

EP.15A.04 A Tripartite Care Model for Home Care of Lung Cancer Patients Based on the Theory of Tripartite Care Led by Specialist Nurses

Time to Make Early Pregnancy Care a Priority in Canada

Early pregnancy is a critical period often accompanied by complications like early pregnancy loss. Early Pregnancy Assessment Clinics (EPACs) provide specialized and compassionate care to those experiencing these complications. First introduced in the UK, EPACs have been found to improve quality of care, reduce wait times, and cut costs. In Canada, EPACs are primarily limited to large urban centers at hospital sites. Access in other parts of the country, especially in rural areas, remains limited. Low-volume units managed by specialist nurses and family doctors, with support from specialists, are the best way to bring EPACs to more Canadians in need.

Research Trends of Specialty Nurse Training from 2003 to 2023: A Bibliometric Analysis via CiteSpace.

To analyze research trends, frontiers, and hot topics in specialty nurse training over the past 20 years, and provide a reference for researchers to understand the current research landscape in this field. Studies from the core collection of Web of Science were used. Furthermore, CiteSpace 6.3 R3 was utilized to analyze information on country, institution, authors, keywords and burst words. A total of 296 articles were included in the analysis. The United States had the highest number of articles, and there was limited cooperation between authors and institutions. The research hotspots in this field included "clinical education models for specialist nurses", "APN role training", and "interprofessional education". The future research trend is to explore the effective integration of training models suitable for different regions and cultural backgrounds and cross-professional education models. It is suggested that researchers pay attention to the innovation and development of specialized nursing clinical practice under different cultural backgrounds, and strengthen international exchanges and cooperation.

Extensivist: improving the delivery of enhanced health in older people’s care homes

BackgroundOlder people living in care homes are often frail and clinically complex. The Enhanced Health in Care Homes (EHCH) framework supports organisational and clinical strategies to deliver good care, promoting...