Specialist Nurses Research Articles

Development of a Clinical Nurse Specialist Internship to Promote Evidence-Based Practice and Improve Outcomes

Development of a Clinical Nurse Specialist Internship to Promote Evidence-Based Practice and Improve Outcomes

N15 Developing a Tool for educating newly diagnosed Patients with Inflammatory Bowel Disease based on a Quality Database Indicator

Abstract Background There is evidence that education improves quality of life and empowers patients with chronic diseases including inflammatory bowel disease(IBD). Education also indicates a better use of ressources enabling relevant treatment to be started earlier. Education meets an increasing wish from patients to be involved. ECCO recommend patient education and state that this is well handled by specialist nurses. When establishing Danish Quality Database for Inflammatory Bowel Disease(DANIBD) the steering committee agreed that education for the newly diagnosed patients with IBD should be an indicator of quality. This was a new task and a big challenge for many clinics and also it was unusual for nursing to stand out so clearly in a database. The tool aims at 1.- supporting the clinics in implementing the new task into clinical practice 2.- securing uniformity in the education in relation to fulfilling the indicator and 3.- improving quality of patient education and nurse consultations to patients with IBD. Methods In the IBD group of the Danish Nursing Association(DSR) it was decided to develop a tool that would serve as an inspiration or could be used directly by the clinics. The tool should ensure that the demands in the indicator was met but should also contain inspiration for other subjects regarding patient education and nurse consultations. Based on literature and the experience of the group members a list of subjects were made and distributed among the group members for developing slides and notes. At plenary meetings all this was put together, structured and edited. In order to get a professional product a collaboration with an art director was established. Financing was secured by donations from the pharmaceutical industry. Results There now are two powerpoint presentations - one for Crohn's disease and one for ulcerative colitis. each presentation is split in two parts. Part one meets the database and part two is an inspiration for covering other subjects relevant for patient education and nurse consultations. The presentations encourages the dialogue with the patient and can be customized by the individual clinics or the individual nurses. The presentations contain additional notes and links to further information. In order to help implement the tool two nurses from each clinic in Denmark were invited to one day of training in using the tool and in communication. The presentations were put on the webpage of the IBD group from where it can be downloaded and used by everyone interested. Conclusion Developing a quality indicator within the database has started an engaging process focusing on the patient and on improving nursong for patients with IBD. It is expected that the tool will help support and empower patients in their lives with IBD.

N20 Sexual health in IBD can be brought up with help from tools

Abstract Background Sexual topics can be tabooed; both for patients with IBD and for the health care professionals (HCPs). Patients with IBD have more sexual problems than the background population. A considerable number of patients with IBD have other autoimmune diseases (Ads), which may exacerbate sexual problems. Based on patient reported data, we aimed to develop communication tools and models for talks about patients' sexual health. Furthermore, we aimed to generate informative patient leaflets for different ADs including one specific for patients with IBD. Methods A cross-sectional e-survey on sexual health among patients with IBD, dermatological- and/or rheumatologically diseases (both solely and in combination). Patients were invited consecutively as they tuned up in the out-patient clinics at our university hospital. Participation were anonymous and access were possible by using a QR-code. The questions were ad hoc designed and focused on 1) disease-related sexual problems, 2) partner-related sexual problems, and 3) the need (and current practise) for talks with HCPs about sexual health. In addition, the participants could add qualitative descriptions. Quantitative data were analysed using descriptive statistics. NVivo™ were used to code the qualitative data. Based on the survey results we developed and implemented communication tools in daily practise. Results 170 patients scanned the QR-code. 142 responded (61% females, 44% had IBD, 49% had a dermatologically disease, 40% had a rheumatologically disease, 33% had ≥ 2 AD). 51% of participants with only 1 AD reported disease-related sexual problems vs 71% for participants with ≥ 2 ADs. In IBD, the main reasons for impaired sexual health were: pain, fatigue, fistulas, incontinence and mental reasons. 86% responded that they didn't talk to HCPs about sexual issues (38% wish the HCPs to bring up the topic, 34% felt the topic to be a taboo, and 25% found it difficult to address problems). Based on the findings, specialist nurses with knowledge of all 3 ADs developed communication tools. The tools were tested and evaluated by both patients and reviewed by Clinic for Sexual Health and include: i) communication aid for nurses; ii) action card for nurses; iii) leaflets to patients with IBD. Conclusion Disease-related sexual problems are common for patients with IBD and ADs. Even more prevalent for patients with more than one AD. Sexual health is seldom a topic between patients and HCPs. Based on patient reported data, simple tools are developed and implemented. Figure 1: Typical levels of topics for the HCPs talks with patients about sexual health. HCPs will most often be able to help patients by focusing on the 2 lower levels.

N21 Shared Decision Making: A Qualitative Exploration of Clinical Nurse Specialists in Gastroenterology

Abstract Background Clinical Nurse Specialists (CNS) participation in the Shared Decision Making (SDM) process and understanding basic concepts and principles related to the decision-making process are critical. (Storms et al. 2015). The core concept role of CNS includes a clinical focus on direct and indirect care of the patients in the specialist area, health educator and trainer, patient advocate, audit and research and consultation (NCNM, 2008). They have many opportunities to participate in the SDM process with patients arising from clinic visits, telephone helpline services and multidisciplinary team meetings. Nurses are progressively deemed influential in shared decision-making; however, studies on the SDM role of the CNS are limited; our study investigates the experiences of CNS in SDM, in the speciality of gastroenterology (GI) in both medical and surgical. Methods This study adopted a qualitative descriptive style. The survey was distributed to medical and surgical GI CNS at a tertiary referral hospital. This study aimed to look at three aspects of CNS's SDM experience: the CNS's knowledge about SDM, generating discussion and coordination, and respect for sociocultural factors. Semi-depth interviews were conducted for data collection. There were 11CNS participants from surgical and medical GI specialities, including IBD, hepatology, endoscopy, upper GI, and colorectal nursing. All interviews were recorded and transcribed verbatim and coded. Results Six themes emerged from the data collected: perceptions, attitudes, positive change, influential factors, reflection and obstacles. SDM is an unknown concept for the majority of the CNS.CNS self-identified as integral to the speciality and the patient's primary contact. Conclusion CNS has little understanding of the SDM concept. SDM is perceived as MDT (Multi-Disciplinary Team) making decisions without patient involvement. Formal education and increased awareness of the SDM process are essential for CNS active participation in individual patients. The procured knowledge of SDM enhances the CNS's confidence in active participation in MDT team meetings and the SDM process. It consequently improves patient experience, knowledge and participation in the SDM process.

N03 Flexibility & Accessibility, e-Literacy, Resourcing and The Human Factor: Early Lessons from EIBD, a UK Qualitative Interview Study

Abstract Background Since the COVID-19 pandemic, the use of health tools (video/phone consultations, patient portals, and digital applications) has increased in the clinical management of patients with Inflammatory Bowel Disease (PIBD). We aimed to evidence the acceptability of eHealth tools by investigating the shared experience of PIBD and healthcare professionals (HCPs) in using eHealth to carry out follow-up appointments and support self-management. Methods An exploratory qualitative method was used. Participants were recruited via professional networks, social media platforms, Crohn's and Colitis UK website and newsletters. Semi-structured interviews were conducted remotely in April/May 2023 using MS Teams or Zoom. Transcripts were analysed using a thematic analysis. Results Fifteen HCPs (13 female) participated: IBD specialist nurses (n=9); gastroenterologists (n=2), pharmacists (n=2) and Dieticians (n=2). The 16 PIBD (10 female) participants were living with Crohn’s Disease (n=9), Ulcerative Colitis (n=6), and Inflammatory Bowel Disease Unclassified (n=1); age was reported in ranges 18 -24 (n=3), 24-34 (n=1), 35-54 (n=8), and 55-65 (n=2) and 75-85 (n=1). Time since IBD diagnosis ranged from < 6 months - 43 years (mean time 18.7 years). Some participants had pre-diagnosis symptoms for at least one year (81%) to over five years (25%). Four themes emerged: • Flexibility and Accessibility: PIBD appreciated the ease of virtual appointments and access to test results and information but wanted flexibility and a personal approach to their care; eHealth connected them to their IBD team more easily. • Resource: HCPs wanted better digital training since remote assessment skills differ from in-person assessment skills. They also identified the need for admin support when planning to implement eHealth tools. HCPs and PIBD wondered whether eHealth was primarily a cost-savings exercise, whilst the need for resource efficiencies across the health service was recognised. • e-Literacy: HCPs were concerned that some older PIBD might be excluded from accessing eHealth due to e-literacy and capability issues, perceiving that eHealth is for the younger generation. • The Human Factor: PIBD and HCPs wanted to have already met in person anyone they engaged with later virtually. For PIBD, in-person consultations meant they felt seen or understood, and they described the importance of hands-on abdominal examinations in reassuring them about their health status. Conclusion There is an acceptability of eHealth to support the care of PIBD, but HCPs and PIBD still value the Human factor. Concerns over Resourcing, Flexibility and Accessibility and e-Literacy may need addressing to avoid these becoming barriers to the benefits of virtual healthcare in supporting PIBD.

N35 Inflammatory Bowel Disease (IBD) nurses' knowledge practice and attitudes related to Microscopic Colitis (MC)

Abstract Background Microscopic Colitis (MC) is affiliated with and increasingly recognized as an Inflammatory Bowel Disease (IBD). Crohn's Disease and Ulcerative Colitis (IBD) were first described over a century ago. Microscopic Colitis was first described in 1976 and the last decade has seen increasing awareness and European guidelines developed. There is no education on microscopic colitis for IBD nurses and it is not known of the practice of MC by IBD nurses in Ireland. Furthermore it is not incorporated in the Nurse European Crohn's and Colitis Organisation (N-ECCO) guidelines. The aim was to assess knowledge, practice and attitudes of IBD nurses in relation to MC. Methods A quantitative cross sectional survey research methodology was conducted using a 17 point questionnaire. 29 (n=29) IBD nurses from the IBD national association of Ireland (IBDNAI) responded from a total of 52 (55.7%). The inclusion criteria was 1) registered practicing nurse 2) on IBDNAI register 3) willing to participate. Data was recorded and analysed using SPSS software. Descriptive statistics were implemented. Cronbach's Alpha for instrument reliability was 0.789. Results The majority were female (90%) between ages 36-55 years (86%). The greater number (41%) had over 11 years of experience, followed by 38% with 1-5 years experience. The highest work location was Clinical Nurse Specialist 65.5% (n=19) and the majority qualified at Post Grad level (27.6%, n=8) or Masters level (34.5%, n=10). Mean and standard deviation scores for knowledge indicated no significant variation but variation was most significant with treatments for MC. Knowledge and years of experience revealed no significant variation. Less than one year experience (Mean 1.50 SD.707) and greater than 11 years (Mean 1.42 SD.669) Knowledge scores for symptoms are high (65.5%-90%) but investigations and treatments are average (31%, 38% and 48.3%). In relation to practice the majority of IBD nurses 71% do not receive referrals and 78.5% do not review patients diagnosed with MC at the out-patient department. Attitudes from IBD nurses regarding MC as part of the IBD nurse caseload, 42.8% said no and 57.10% said yes. 67% agreed that MC should be incorporated into the N-ECCO guidelines. Conclusion Education on Microscopic Colitis for IBD nurses is required nationally in Ireland which will improve the integration into practice. IBD nurses are best placed to care for patients diagnosed with MC. Recognition for MC to be incorporated into the Nurse European Crohn's and Colitis (N-ECCO) guidelines needs to be considered.

1879 On a knife's edge: role of a Clinical Nurse Specialist on balancing complex treatment decisions in acute surgery

Abstract Introduction 1 in 4 older individuals having emergency general surgery live with frailty, are more likely to have a longer hospital stay, readmission rate, morbidity and mortality. This underscores the importance of individualised approaches to care through Shared Decision Making (SDM). We introduced SDM into our surgical liaison service aiming to measure effectiveness and patient outcomes. Methods Between October 2021 and September 2022, patients aged >70 years living with frailty admitted to the surgical unit were identified by an Older Persons Clinical Nurse Specialist (CNS). Involvement in treatment decisions was measured by using the patient and clinician SDM-Q9 questionnaire. Pre-admission as well as follow-up quality of life scores at 6 months using the EQ-5D-5L (0-100) as well as Decision Regret were obtained on subsets of patients. Results Of a total of 76 patients seen by the CNS, follow-up data were available for 61 patients, clinician and patient SM-Q9 were completed in 54 patients. Clinicians were 10% more likely to strongly or completely agree that they explained choice available, 16% more likely to feel they explained treatment options compared with patients. Patients were less likely to feel completely involved in decision making. However, they were more likely to agree they understood clinical information presented them. Low levels of decision regret were ascertained at follow up where 18 patients agreed and 32 patients strongly agreed that a right decision was made of their care. Of 15 patients who underwent emergency laparotomy, mean EQ-5D scores across all domains from improved from baseline (69 vs 78). Conclusions CNS led implementation of SDM is feasible, acceptable. Patients felt involved in their care and had lower levels of decisional regret. Encouraging and investing in an environment where health professionals take time to determine what is important to their patient can be associated with better outcomes.

A qualitative study on the willingness and influencing factors of master of geriatric nursing specialist postgraduates to volunteer for home respite care for disabled elderly families

BackgroundAs China’s population ages, the demand for care for the disabled elderly is increasing, and family caregivers find it challenging to meet the comprehensive care needs of the disabled elderly. Through home respite services, families of the disabled elderly can receive help and support from specialized nursing professionals to ease the burden on family caregivers and provide high-quality services. This study explores the willingness and influencing factors of Master of Geriatric Nursing Specialist postgraduates in China to volunteer to provide home respite services for disabled elderly individuals.MethodsA qualitative study based on Grounded Theory used Strauss and Corbin’s programmatic version. A purposive sampling method was employed to conduct semi-structured interviews with 12 Master of Geriatric Nursing Specialist postgraduates from a tertiary hospital in Changsha, Hunan Province, China.ResultsThe willingness of Master of Geriatric Nursing Specialist postgraduates to volunteer to provide home respite services for the disabled elderly was established as a core category, which was influenced by three main categories: personal factors, service object factors, and social factors, and nine categories formed from 39 initial concepts were included under the main category.ConclusionsInfluenced by China’s traditional cultural background, Master of Geriatric Nursing Specialist postgraduates in China have shown high motivation in volunteering to provide home respite services for the families of the disabled elderly but have been challenged by several challenges from China’s healthcare environment and education system. Relevant departments need to adopt a series of policies and measures to increase volunteers’ willingness to participate in respite care and promote its development.

Improving care for head-and-neck and thyroid cancer patients.

Catherine English and the Head-and-Neck Clinical Nurse Specialist Team at the Southern Health and Social Care Trust (catherine.english@southerntrust.hscni.net) were winners of the Bronze Award in the Oncology Nurse of the Year category at the BJN Awards 2023.

Modules From the End-of-Life Nursing Education Consortium: Japan Core Curriculum Necessary for Second- to Fourth-Year Nurses as Assessed by Advanced Practice Registered Nurses.

This study aimed to identify the modules of the End-of-Life Nursing Education Consortium-Japan Core Curriculum (ELNEC-J), which are particularly necessary for second- to fourth-year nurses. This cross-sectional study recruited certified nurse specialists in cancer nursing (CNSCNs) endorsed by the Japanese Nursing Association enrolled in Advanced Practice Registered Nurses (APRNs) in Japan. We asked individuals who were active members of the volunteer association of CNSCNs in the Tokai region to participate via email, and we collected data using Google Forms. The participants were asked about their background, including APRN experience and current position. Furthermore, we asked them to select three necessary modules for second- to fourth-year nurses' education from the 10 modules of the ELNEC-J. The study recruited a total of 19 (89%) APRNs (response rate: 100%). Out of them, 14 (73.6%) had more than six years of clinical experience in APRNs, and 12 (63.1%) held managerial positions. Regarding the 10 modules of the ELNEC-J, the responses for the necessary modules were as follows: nursing care at end-of-life 13 (68.4%), pain management 12 (63.2%), symptom management 10 (52.6%), communication 10 (52.6%), and ethical issues in palliative care nursing five (31.6%). According to the perspective of APRNs responsible for palliative care education for incumbent nurses, nursing care at the end of life, pain management, symptom management, and communication are required for second- to fourth-year nurse education.

Supporting self-management for patients with Interstitial Lung Diseases: Utility and acceptability of digital devices.

Patients diagnosed with Interstitial Lung Diseases (ILD) use devices to self-monitor their health and well-being. Little is known about the range of devices, selection, frequency and terms of use and overall utility. We sought to quantify patients' usage and experiences with home digital devices, and further evaluate their perceived utility and barriers to adaptation. A team of expert clinicians and patient partners interested in self-management approaches designed a 48-question cross-sectional electronic survey; specifically targeted at individuals diagnosed with ILD. The survey was critically appraised by the interdisciplinary self-management group at Royal Devon University Hospitals NHS Foundation Trust during a 6-month validation process. The survey was open for participation between September 2021 and December 2022, and responses were collected anonymously. Data were analysed descriptively for quantitative aspects and through thematic analysis for qualitative input. 104 patients accessed the survey and 89/104 (86%) reported a diagnosis of lung fibrosis, including 46/89 (52%) idiopathic pulmonary fibrosis (IPF) with 57/89 (64%) of participants diagnosed >3 years and 59/89 (66%) female. 52/65(80%) were in the UK; 33/65 (51%) reported severe breathlessness medical research council MRC grade 3-4 and 32/65 (49%) disclosed co-morbid arthritis or joint problems. Of these, 18/83 (22%) used a hand- held spirometer, with only 6/17 (35%) advised on how to interpret the readings. Pulse oximetry devices were the most frequently used device by 35/71 (49%) and 20/64 (31%) measured their saturations more than once daily. 29/63 (46%) of respondents reported home-monitoring brought reassurance; of these, for 25/63 (40%) a feeling of control. 10/57 (18%) felt it had a negative effect, citing fluctuating readings as causing stress and 'paranoia'. The most likely help-seeking triggers were worsening breathlessness 53/65 (82%) and low oxygen saturation 43/65 (66%). Nurse specialists were the most frequent source of help 24/63 (38%). Conclusion: Patients can learn appropriate technical skills, yet perceptions of home-monitoring are variable; targeted assessment and tailored support is likely to be beneficial.

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.

Formulation and application of the "hospital-to-home + online-to-offline" treatment scheme in caring for and supporting vulnerable patients with chronic heart failure.

Chronic heart failure (CHF) is the terminal stage of cardiovascular disease. In this study, the "hospital-to-home + online-to-offline" (H2H + O2O) care scheme was implemented for patients with CHF during vulnerable periods, and its effect was evaluated. Patients with CHF in the cardiovascular department of a Class III/Grade A hospital in Jiangxi Province from January to December 2020 were selected using a convenience sampling method and randomly divided into a control and intervention group (n= 100 each). The patients in the control group received routine in-hospital treatment and out-of-hospital follow-up, while in the intervention group, a multi-disciplinary cooperation team with CHF specialist nurses evaluated and stratified the patients before discharge and formulated individualized prescriptions and care plans. Based on the "Health & Happiness" chronic disease follow-up application designed for this study, the specialist nurses provided patients with one-to-one guidance. After three months, the cardiac function, heart failure knowledge, self-care behavior, and re-hospitalization rate of the patients were compared between the two groups. Cardiac function was evaluated by the serum B-type natriuretic peptide (BNP), the left ventricular ejection fraction (LVEF), and a six-minute walking test (6MWT). Heart failure knowledge and self-care behavior was assessed using specific questionaries. The level of cardiac function in the intervention group was significantly higher than that in the control group, and the difference was statistically significant (P< 0.001). The mastery of heart failure knowledge and self-care behavior in the intervention group were significantly higher than those in the control group, and the differences were statistically significant (P< 0.05). The re-hospitalization rate due to CHF in the intervention group was 21.0%, which was lower than that in the control group (35.0%), and the difference was statistically significant (P< 0.05). The H2H + O2O care scheme can be used for the transition of vulnerable patients with CHF from the hospital to family care to improve the patients' level of cardiac function, elevate their knowledge level and self-care abilities, and improve their overall health outcomes.

Effect of empathy nursing combined with SBAR communication system on the negative emotions and nursing quality of children with tracheotomy.

Situation, Background, Assessment, and Recommendation (SBAR) is a structured method for communicating critical information that requires immediate attention and action. To study the effects of empathy nursing combined with the SBAR communication system on the negative emotions and nursing quality of children undergoing tracheotomy. This is a clinical observational study. A total of 100 tracheotomy patients who were cared for in the pediatric intensive care unit (subsequent treatment in the tracheotomy clinic or otolaryngology ward) of our hospital from September 2021 to June 2022 were recruited and assigned at a ratio of 1:1 either into a control group (empathic care) or an observation group (empathic care combined with SBAR) using a randomized method. Further, the postoperative anxiety self-rating scale scores, negative emotions, hope index, and nursing quality were compared between the two groups. After nursing, the psychological resilience scale score of the observation group was higher than that of the control group, whereas the anxiety self-rating scale score was significantly lower than that of the control group (all P< 0.05). Basic and special nursing, knowledge awareness, and safety management of the two groups of patients improved significantly, with higher results in the observation group than in the control group (P< 0.05). Empathy nursing combined with the SBAR communication system considerably improves postoperative negative emotions and enhances the quality of nursing care for patients undergoing tracheotomy.

Early Recognition and Management of Side Effects Related to Systemic Anticancer Therapy for Advanced Breast Cancer

ObjectivesAdvances in science and technology have meant there are numerous treatment options available for people with advanced breast cancer (ABC). However, each therapeutic approach can cause side effects or adverse events, which can significantly affect the person's quality of life, overall well-being, and, in some instances, safety. This report presents an overview of the common side effects of systemic anticancer therapy and ways to manage them. Data SourcesData sources include peer-reviewed articles sourced in electronic databases and national and international best practice guidelines (ESMO, ASCO, and MASCC guidelines). ConclusionSystemic anticancer therapies have side effects that healthcare professionals need to know about to monitor and manage them in early stages. Nurses play an important role in patient education, early identification, monitoring, and management of treatment side effects. Implications for Nursing PracticePeople with ABC face many challenges during their treatment journey. Oncology nurses, specialist nurses, and nurse practitioners can be of support by providing preventive measures and side effects management at an early stage. Nurses need to have a good understanding of toxicity management but also advanced tumor-specific cancer knowledge of the different subtypes of ABC and holistic assessment skills. They are also key to providing support and enhancing self-management and early recognition of side effects.

Specialized nurses' role in ensuring patient safety within the context of telehealth in home care: A scoping review.

Specialized nurses are uniquely positioned to implement innovative telehealth solutions to improve the quality and safety of home care, and this has become a focal point of contemporary healthcare research. This review aimed to identify the nature and scope of specialized nurses' roles in ensuring patient safety within the context of telehealth in home care. A scoping review of the international literature was carried out from January 1, 2013, to August 29, 2024. The review employed Levac et al.'s framework to delineate the research phenomenon and consolidate existing empirical research findings. Through a comparative analysis, the review integrated findings from selected studies, highlighting both similarities and differences related to this phenomenon, which led to the development of distinct categories. The search yielded 1127 articles, from which 23 studies met the inclusion criteria for research synthesis and subsequent reporting of results. These studies spanned specialized nurses' roles in telehealth and various fields in which specialized nurses utilized telehealth to deliver high-quality and safe home care. The findings highlighted key outcomes linked to the improvement of patient safety in home care encompassing continuity of care, confidence in care, monitoring and early intervention, medication safety, engagement and adherence, and healthcare costs. The review revealed the crucial role played by specialized nurses in harnessing telehealth in healthcare to meet the highest care standards, creating an environment that prioritizes the well-being and patient safety in home care.

Reasons Patients With Primary Progressive Multiple Sclerosis Contact Their Specialist Nurses.

Questions asked by patients with primary progressive multiple sclerosis (PPMS) during patient-initiated MS nurse consultations may contain salient information that can help health care providers understand their needs, which, in turn, can help tailor counseling and treatment. Records of all patients with PPMS visiting the MS center of a large teaching hospital in the Netherlands between January 2007 and January 2021 were studied retrospectively. Number and type (scheduled or patient initiated) of MS nurse consultations, reasons for consultations (in prespecified categories), and frequency of subsequent referrals were registered. Association between factors (living with partner, Expanded Disability Status Scale score, comorbidities, age, sex) and number of patient-initiated consultations was studied using negative binomial regression analysis. In total, 98 patients with PPMS were included, with 720 MS nurse consultations during follow-up (median duration, 8.1 years), of which 274 (38%) were patient initiated. Patients had a broad spectrum of reasons to contact MS nurses. The most common categories were treatment (36%) and micturition and defecation (31%). Patients living without a partner (incidence rate ratio, 2.340; 95% CI, 1.057-5.178) and male patients (incidence rate ratio, 1.890; 95% CI, 0.925-3.861) consulted MS nurses more frequently. The MS nurses made 146 referrals (20% of all contacts); 59 were after patient-initiated consultation (22%). The most frequent referrals were to neurologists, urologists, and rehabilitation specialists. Multiple sclerosis nurses have a pivotal role in PPMS care, especially for patients living without a partner and male patients. Recurring questions about (new) treatment options illustrate the pressing need for highly effective treatment. Micturition and defecation problems are also a considerable concern and warrant close monitoring.

Application and Promotion of Whole-Process Capacity Management Model for CHF Patients Led by Specialist Nurses in &amp;amp;#8220;Heart Failure Center Alliance Unit&amp;amp;#8221;

Application and Promotion of Whole-Process Capacity Management Model for CHF Patients Led by Specialist Nurses in &amp;amp;#8220;Heart Failure Center Alliance Unit&amp;amp;#8221;

Clinical Nurse Specialists Using Evidence-Based Practice to Prevent Falls

Abstract Purpose/Objectives The purpose of this quality improvement project was to reduce inpatient falls and falls with injury by implementing the Hester Davis Fall Program, a comprehensive, evidence-based prevention program, with the leadership of clinical nurse specialists. Description of the Project/Program The Plan-Do-Study-Act model was utilized to implement the program at 2 adult acute care facilities. Clinical nurse specialists collaborated with nurse managers to guide planning, implementation, and evaluation of patient outcomes. Routine meetings with Hester Davis sustainability coaches and access to data analytic dashboards provided visibility of audit data, allowing for the intentional selection of targeted strategies to improve risk assessment scoring and implementation of appropriate interventions. Outcome Although both facilities demonstrated overall favorable trends in fall rates, one facility demonstrated rates less than the National Database of Nursing Quality Indicators mean. In the 9 months following implementation, total falls for both facilities decreased from 744 to 692 for the same period in the previous year, resulting in estimated cost-savings of $202 176 to $491 400. Conclusion Clinical nurse specialists play a key role in the successful implementation of evidence-based programs. As organizations look to improve quality measures, it is vital that senior nurse leaders ensure the availability of appropriate resources including the identification of individuals with the appropriate skill set to lead quality improvement.

Research progress of core competence of specialist nurses in extracorporeal membrane oxygenation

Research progress of core competence of specialist nurses in extracorporeal membrane oxygenation