To describe the role of the clinical nurse specialist, an advanced practice registered nurse in the intensive care setting. The value and impact of the clinical nurse specialist role as a member of ...the ICU is presented along with a review of clinical nurse specialist education, licensure, and certification requirements as well as a description of the clinical nurse specialist role, scope of practice, and competencies. In addition, a selected review of clinical nurse specialist-led quality improvement and research that resulted in improved patient outcomes is provided.
Review of published medical and nursing literature and expert opinion guidance from a collaborative effort between the Society of Critical Care Medicine, American Association of Critical Care Nurses, and National Association of Clinical Nurse Specialists.
Not applicable.
Not applicable.
Not applicable.
The utilization of a clinical nurse specialist, an advanced practice role, in the ICU is a unique and valuable approach for organizations who strive to move evidence into sustainable practice and drive quality through an interprofessional approach. The valuable contributions made by the clinical nurse specialist efficiently and effectively meet the needs of patients, clinicians, and organizations while improving patient outcomes and optimizing cost avoidance strategies, which further lower economic demands on the healthcare system.
, Divisional Chief Nurse, Ashford and St Peter's Hospitals NHS Foundation Trust, formerly Cardiology Nurse Consultant, Buckinghamshire Healthcare NHS Trust (ghazala.yasin@nhs.net) was the winner of ...the Gold Award in the Cardiovascular Nurse of the Year Category in the BJN Awards 2023.
Rationale, aims and objectives
Clinical nurse specialists (CNSs) are major providers of transitional care. This paper describes a systematic review of randomized controlled trials (RCTs) evaluating ...the clinical effectiveness and cost‐effectiveness of CNS transitional care.
Methods
We searched 10 electronic databases, 1980 to July 2013, and hand‐searched reference lists and key journals for RCTs that evaluated health system outcomes of CNS transitional care. Study quality was assessed using the Cochrane Risk of Bias and Quality of Health Economic Studies tools. The quality of evidence for individual outcomes was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. We pooled data for similar outcomes.
Results
Thirteen RCTs of CNS transitional care were identified (n = 2463 participants). The studies had low (n = 3), moderate (n = 8) and high (n = 2) risk of bias and weak economic analyses. Post‐cancer surgery, CNS care was superior in reducing patient mortality. For patients with heart failure, CNS care delayed time to and reduced death or re‐hospitalization, improved treatment adherence and patient satisfaction, and reduced costs and length of re‐hospitalization stay. For elderly patients and caregivers, CNS care improved caregiver depression and reduced re‐hospitalization, re‐hospitalization length of stay and costs. For high‐risk pregnant women and very low birthweight infants, CNS care improved infant immunization rates and maternal satisfaction with care and reduced maternal and infant length of hospital stay and costs.
Conclusions
There is low‐quality evidence that CNS transitional care improves patient health outcomes, delays re‐hospitalization and reduces hospital length of stay, re‐hospitalization rates and costs. Further research incorporating robust economic evaluation is needed.
Full text
Available for:
DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
To provide a critical reflection of COVID-19 in the context of oncology nursing and provide recommendations for caring for people affected by cancer during this pandemic.
Electronic databases, ...including CINAHL, MEDLINE, PsychINFO, Scopus, professional web sites, and grey literature were searched using Google Scholar.
Nurses are key stakeholders in developing and implementing policies regarding standards of care during the COVID-19 pandemic. This pandemic poses several challenges for oncology services. Oncology nurses are providing a pivotal role in the care and management of the novel COVID-19 in the year landmarked as the International Year of the Nurse.
It is too early to tell what shape this pandemic will take and its impact on oncology care. However, several important clinical considerations have been discussed to inform oncology nursing care and practice.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
This study aimed to identify clinical nurses' evidence-based practice (EBP) knowledge, beliefs, organizational readiness, and EBP implementation levels, and to determine the factors that affect EBP ...implementation in order to successfully establish EBP. This study was conducted at a university-affiliated tertiary hospital located in a provincial area in Korea. The research design was based on Melnyk and Fineout-Overholt's Advancing Research & Clinical Practice through Close Collaboration model as the first step.
A descriptive and cross-sectional design was conducted and a convenience sample of 521 full-time registered nurses from an 849-bed tertiary hospital were included. Structured questionnaires were used to assess EBP knowledge, EBP beliefs, organizational culture & readiness and EBP implementation. Data were analyzed using SPSS V 25.0 by using descriptive and inferential statistics and hierarchical multiple regression was performed to determine the factors affecting the implementation of EBP.
Our findings showed that the clinical nurses had a positive level of EBP beliefs, but the level of EBP knowledge, organizational readiness and EBP implementation were insufficient. EBP knowledge, beliefs, and organizational readiness were significantly positively correlated with EBP implementation. In the final model, EBP knowledge and organizational readiness were significant predictors of EBP implementation; the model predicted 22.2% of the variance in implementation.
Based on these results, the main focus of the study was the importance of individual nurses' efforts in carrying out EBP, but above all efforts to create an organizational culture to prepare and support EBP at the nursing organization level. In the initial process of introducing and establishing EBP, nurse administrators will need to minimize expected barriers, enhance facilitators, and strive to build an infrastructure based on vision, policy-making, budgeting, excellent personnel and facilities within the organization.
Full text
Available for:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background:
This article is part two of a series presenting the findings of stakeholder surveys with ostomates and stoma care nurses (SCNs) for stoma services in England. Part one explored the ...experiences of ostomates. This article focuses on the views and experiences of 108 SCNs in England.
Aim:
To understand the experience of SCNs in England in relation to current services provided. This includes the scope of the SCN role, the service they provide, and SCN experience and views on areas for improvement.
Method:
SCNs were invited to share their experiences and views in a national online survey. Questions considered the experience of the nurse, where the care they provide is delivered, how their post is funded and their views on current issues such as responsibility for managing waste of stoma product. Two free-text questions asked what areas of stoma care services worked well and what areas could be improved, results of which were coded and thematically analysed.
Findings:
Themes included patient care, industry involvement and prescribing process.
Conclusion:
Overall, survey respondents felt that they provided a good standard of care. Nurses reported complex industry relationships. Awareness of the Nursing and Midwifery Council Code, Bribery Act 2010 and NHS England guidance on managing conflicts of interest is advocated, as is promoting transparency in funding arrangements. It was noted that there appears to be variation in the care provided to ostomates.
To determine the clinical effectiveness and cost-effectiveness of nurse-led care (NLC) for people with rheumatoid arthritis (RA).
In a multicentre pragmatic randomised controlled trial, the ...assessment of clinical effects followed a non-inferiority design, while patient satisfaction and cost assessments followed a superiority design. Participants were 181 adults with RA randomly assigned to either NLC or rheumatologist-led care (RLC), both arms carrying out their normal practice. The primary outcome was the disease activity score (DAS28) assessed at baseline, weeks 13, 26, 39 and 52; the non-inferiority margin being DAS28 change of 0.6. Mean differences between the groups were estimated controlling for covariates following per-protocol (PP) and intention-to-treat (ITT) strategies. The economic evaluation (NHS and healthcare perspectives) estimated cost relative to change in DAS28 and quality-adjusted life-years (QALY) derived from EQ5D.
Demographics and baseline characteristics of patients under NLC (n=91) were comparable to those under RLC (n=90). Overall baseline-adjusted difference in DAS28 mean change (95% CI) for RLC minus NLC was -0.31 (-0.63 to 0.02) for PP and -0.15 (-0.45 to 0.14) for ITT analyses. Mean difference in healthcare cost (RLC minus NLC) was £710 (-£352, £1773) and -£128 (-£1263, £1006) for PP and ITT analyses, respectively. NLC was more cost-effective with respect to cost and DAS28, but not in relation to QALY utility scores. In all secondary outcomes, significance was met for non-inferiority of NLC. NLC had higher 'general satisfaction' scores than RLC in week 26.
The results provide robust evidence to support non-inferiority of NLC in the management of RA.
ISRCTN29803766.
Purpose: To examine the development of advanced nursing practice globally.
Methods: Data were collected from documentary resources available in the International Nurse Practitioners/Advanced Practice ...Nurse Network (INP/APNN) of the International Council of Nurses. The areas examined were guided by the “key informant survey on advanced nursing practice self‐administered questionnaire.” Two core members of the INP/APNN who have rich experience in global advanced nursing development analyzed the data.
A total of 14 countries and three regions from five continents were included in the analyses. The development of advanced nursing practice in these areas is facilitated by a need for better access to care in a cost‐containment era and the enhancement of nursing education to postgraduate level. The mechanism for regulation of practice is in place in some countries.
Conclusions: Confirms the development of advanced practice in nursing is a global trend.
Clinical Relevance: APNs can improve global health with points to enhanced education in nursing and regulation of advanced practice.
Full text
Available for:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK, VSZLJ
PDF
