Prostate cancer is prevalent worldwide. In England, men living with this malignancy often report unmet psychological, informational, urological and sexual needs. Their experience of care is ...correspondingly lower than that of other patient groups with cancer. To address this, prostate cancer clinical nurse specialist posts were established across England and Scotland. Their intent was to support men with this form of cancer, enhance symptom management and improve quality of service provision.
The research sought to investigate prostate cancer clinical nurse specialists’ roles, determine whom they targeted services at, and determine their work practices and perceived contribution.
A mixed method multi-site exploratory-descriptive design was employed.
Data were collected across four acute NHS Trusts—one in the South of England, one in the Midlands, one in Northern England and one in Scotland, respectively.
Participants included 4 prostate cancer clinical nurse specialists, 19 of their clinical colleagues and 40 men they provided care to.
Data were collected through nurse specialists’ completion of a Diary and Contact Sheets. Interviews were conducted concurrently with the nurses, stakeholders they worked alongside and patients on their caseload. Data were collected between November 2004 and January 2006.
There was great variation in the qualifications and experience of nurse specialists and in the services they provided. Services ranged from generic support and information provided across the disease trajectory to provision of services to meet specific care needs, e.g. providing nurse-led clinics for erectile dysfunction. Patients and members of the multidisciplinary team welcomed the introduction of nurse specialists but were aware they could become over burdened through their rapidly growing caseloads.
Variability in services provided by the prostate cancer nurse specialists arose from differences in local demand for nursing services and the skills and experiences of those appointed. Such variability – whilst understandable – has implications for access and equity across patient groups. Further, it can compromise efforts to define clinical nurse specialists’ contribution to care, can impede others’ expectation of their role, and render their outcomes difficult to evaluate.
The Veterans Health Administration (VHA) Office of Nursing Services (ONS) was an early adopter of Clinical Nurse Leader (CNL) practice, generating some of the earliest pilot data of CNL practice ...effectiveness. In 2011 the VHA ONS CNL Implementation & Evaluation Service (CNL I&E) piloted a curriculum to facilitate CNL transition to effective practice at local VHA settings. In 2015, the CNL I&E and local VHA setting stakeholders collaborated to refine the program, based on lessons learned at the national and local level. The workgroup reviewed the literature to identify theoretical frameworks for CNL practice and practice development. The workgroup selected Benner et al.'s Novice-to-Expert model as the defining framework for CNL practice development, and Bender et al.'s CNL Practice Model as the defining framework for CNL practice integration. The selected frameworks were cross-walked against existing curriculum elements to identify and clarify additional practice development needs. The work generated key insights into: core stages of transition to effective practice; CNL progress and expectations for each stage; and organizational support structures necessary for CNL success at each stage. The refined CNL development model is a robust tool that can be applied to support consistent and effective integration of CNL practice into care delivery.
This paper presents our experience of managing children with a tracheostomy in a multidisciplinary team clinic consisting of an ENT consultant, paediatric respiratory consultant, a nurse specialist, ...and speech and language therapist.
A retrospective case note review was conducted of all children seen in the multidisciplinary team tracheostomy clinic (at a tertiary paediatric hospital) between February 2009 and September 2014.
Ninety-seven patients were examined. The most common indications for tracheostomy were: lower airway and respiratory problems (66 per cent), upper airway obstruction (64 per cent), and neurodevelopmental problems (60.8 per cent).
Children with a tracheostomy are a diverse group of patients. The most common indications for paediatric tracheostomy have changed from infective causes to airway obstruction and anomalies, long-term ventilation requirement, and underlying neuromuscular or respiratory problems. Our unified approach empowers the carers and patient, as a home management plan, long-term plan and goals are generated at the end of each appointment.
Abstract Objective This review aimed to examine the effectiveness of clinical nurse specialist (CNS) interventions in patients with chronic obstructive pulmonary disease (COPD). COPD significantly ...affects people’s health worldwide. With the development in nursing, CNSs are playing increasingly important roles in different departments. However, the studies on the effectiveness of CNSs in COPD are not as well organized as the studies on the effectiveness of CNSs in bronchiectasis and asthma. Therefore, this review aims to find some updated evidence on the CNS interventions for patients with COPD and on whether these interventions are effective. Methods A narrative analysis of the data was performed for the eligible studies. Four databases were chosen: CINAHL, MEDLINE, British Nursing Index, and Cochrane Library. Other websites such as the National Institute for Health and Clinical Excellence, National Health Service Evidence, Association of Respiratory Nurse Specialists, and National Association of Clinical Nurse Specialist were searched as well. Two reviewers performed study identification independently, and all the retrieved articles were stored using the EndNote X7 software. The risk of bias in the included studies was assessed using the Cochrane Collaboration’s risk of bias tool. Results A total of nine studies were included in this review. There were five current interventions by CNSs for patients with COPD. These interventions were home nursing support, CNS’s supported discharge, multidisciplinary cooperation programs, nurse-led care programs, and self-care management education. The effectiveness of these five interventions was evaluated individually. There is low- to moderate-quality evidence indicating that home nursing support interventions may have a positive effect on mortality and quality of life. No significant difference in quality of life has been found between the CNS-supported discharge intervention and the usual service. The multidisciplinary cooperation program probably had a positive effect on quality of life in patients with COPD. Both nurse-led care and self-care management education intervention had a positive effect on mortality of patients with COPD. Conclusions The findings of this review provide updated evidence on the effectiveness of CNS interventions for patients with COPD. Although nine trials were included and five types of interventions were identified, there is still lack of high-quality evidence.
This process paper describes the evolution and growth of Dedicated Education Units through an academic-practice partnership at a college of nursing and urban medical center. This collaboration marked ...a period of rapid expansion from a single unit pilot dedicated education unit to five within a six-year timeframe. During the expansion from the pilot phase to creation of the dedicated units, it was determined that success in one unit did not translate to success in others. Using Tuckman's Group Development Theory as a lens for analysis of barriers and facilitators, suggested oversight and monitoring parameters were identified and include: (1) a dedicated clinical faculty coordinator is a necessity; (2) clearly defined dedicated education unit vision and goals need to be articulated to all; (3) a unit must commit to providing dedicated education unit clinical experiences only; (4) designated resources are needed for attending to staff and student scheduling requirements; (6) established and barrier-free clinical instructor educational support for nurse educator transition; (7) an objective evaluation plan with established benchmarks, (8) a need to evaluate the coordinator role as partnerships expand to multiple units, and (9) awareness of potential storming among new and experienced dedicated education units.
•Group Development Theory provides a novel framework for guiding dedicated education unit (DEU) growth and success.•Identification of the need for a Clinical Faculty Coordinator as DEU champion to facilitate DEU creation and expansion.•Suggested evaluation of academic roles as DEU partnerships expand.•Strategies to ensure DEUs success, since adequate planning and resourcing are critical.•Approaches provided to monitor for unintentional changes to the DEU model/philosophy during program expansion.
The purpose of this research study was to describe and interpret the experience of nurses without any educational theory as they transition from the role of the clinical nurse expert to the novice ...nurse educator. A qualitative design with a phenomenology method was conducted of 8 clinical nurse experts who have transitioned into the role of the novice nurse educator within the past 2 years. Analysis of the data yielded 3 themes: (a) clinical nurse experts have expert knowledge to share and have a desire to educate the next generation; (b) the transition process elicits feelings of stress related to not having educational theory; (c) consistent mentoring contributes to an easier transition to the role. As a result of this study, nursing program administrators can assist the clinical nurse expert by providing additional support in areas of educational theory, examination writing, and analysis.
The purpose of this study was to pilot a “hybrid” style journal club and determine whether measurable effects could be detected over 8-weeks' time on evidence-based practice ability, desire, ...behaviors, use, and barriers.
Journal clubs have been suggested as a method to increase nurses' confidence with using research evidence to guide practice. However, it is yet unknown how nurse educators can best implement effective programs for clinicians with varying schedules, education levels, and research skills.
Thirty-six participants from one large urban United States hospital (72% registered nurses) were invited to access bi-weekly interdisciplinary journal club activities. Nurse educators created curriculum focused on clinical problem solving that was offered via in-person sessions or a social media site.
A pretest–posttest no control group design was used to measure impacts of those engaged in journal club activities. Data were collected using a combination of validated evidence-based practice instruments and program participation records.
A two-tailed paired t test showed significant increases over 8weeks' time in evidence-based practice use (p=.002) and behaviors (p=.007). Slight preference for in-person sessions was reported, although greater participation was reflected in online activities. Mean satisfaction ratings were high; however, attrition rates suggest that more is needed to maximize clinician engagement.
A hybrid method using online and in-person sessions was feasible and adaptive for varying learning styles and work schedules. Positive changes in measurements were detected among journal club participants. Instruments were identified that may be useful for trialing similar programs intended to increase evidence-based practice self-efficacy, use, behaviors, and ability.
Purpose
To identify and examine the expert panelists’ visions on the future implementation of the clinical nurse specialist (CNS) role in Finland.
Design and Methods
A policy Delphi design was ...conducted in 2013. A purposive sampling method was used to recognize expert panelists in the areas of advanced practice nursing (APN), healthcare management, and advanced practice nurse education. Three iterative Web‐based survey rounds were conducted (n = 25, n = 22, n = 19). Both qualitative and quantitative methods were used to analyze the data.
Findings
The expert panelists envisioned the future of the CNS role in Finland. This study portrayed the CNS role in Finland as generally consistent with the international role. CNS have comprehensive skills and knowledge that they use to guide and develop nursing practice; however, several threats may affect their role achievement. The existing national consensus, contradiction, and ambivalence related to CNS roles were revealed through the examination of the results, thus pointing out the areas for consideration when further developing these roles and role policies.
Conclusions
This is the first national study to examine the implementation of the CNS role in Finland. Expert panelists’ views regarding the CNS role will be valuable in the forthcoming national policy formulation process. Although the policy Delphi design is not often utilized, this study reveals that it is very well suited to guide and inform national and international APN policy development.
Clinical Relevance
This study contributes to CNS role development and describes the methods facilitating the essential policy formulation process.
Despite emerging evidence for the clinical and financial efficacy of the clinical nurse specialist (CNS), the provision of this role is patchy across the country. There is also a risk that incumbent ...CNS' may be redirected to less specialist work in trusts that do not appreciate the full value of the service that these nurses provide. Optimal and equitable patient access to CNS care will require the development of a strong evidence base showing that specialist nurses not only deliver patient-focused care, but that they can also help to meet healthcare managers' objectives of streamlined, cost-effective clinical services.
Aims To explore the feasibility and acceptability of a clinical nurse leader (CNL) role to improve interdisciplinary collaboration (IC) within a fragmented acute‐care microsystem.
Background ...Fragmented patient care is associated with preventable adverse healthcare outcomes. IC decreases fragmentation and improves patient care quality. The CNL role is theorized to provide the necessary leadership and competency skill base to impact IC at the optimal organizational level, the point of care where most healthcare decisions are made.
Methods This study used a descriptive non‐experimental design. CNL daily workflow was developed to target empirical determinants of IC. Descriptive data were collected from multiple stakeholders using an investigator‐developed survey.
Results Findings indicate the integration of the role is feasible and acceptable to the microsystem healthcare team.
Conclusions Preliminary evidence suggests the CNL role may be an effective intervention to facilitate IC. More research is needed to support the CNL role’s association with microsystem IC.
Implications for nursing management The CNL role presents an innovative opportunity for clinical and administrative leadership to partner together to redesign a healthcare delivery system and improve patient care quality.
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