Clinical and cost effectiveness of nurse-led self-management interventions for patients with copd in primary care: A systematic review

Background and objectiveChronic obstructive pulmonary disease is increasing in prevalence and constitutes a major cause of morbidity and mortality globally. As well as contributing to a significant decline in health status in many patients, this condition creates a considerable burden on healthcare providers. Self-management interventions are frequently implemented in community settings to limit the impact of chronic obstructive pulmonary disease on everyday life of individuals and to manage pressure on health systems. Nurses are the most likely professional group to provide self-management support. This systematic review aims to evaluate the clinical and cost effectiveness of nurse-led self-management for patients with chronic obstructive pulmonary disease in primary care.DesignA systematic review was conducted to identify randomized controlled studies comparing nurse-led self-management interventions to usual careData sourcesSeven electronic databases, including British Nursing Index, MEDLINE, CINAHL, AMED, EMBASE, Cochrane Library and NHS Economic Evaluation Database, were searched for relevant studies.Review methodsThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used to guide the structure of the review. The relevance of citations was assessed based on inclusion criteria, with full texts retrieved as required to reach a decision. Data extraction was performed independently by two reviewers. The Cochrane risk of bias tool was used to undertake a quality review. A narrative summary method was used to describe review findings.ResultsTwenty-six articles describing 20 randomised controlled trials were included in the analysis. Self-management interventions were heterogeneous, with a variable number of components, level of support, mode of delivery and length of follow up. The review demonstrated that nurse-led self-management programmes may be associated with reductions in anxiety and unscheduled physician visits and increases in self-efficacy, but definitive conclusions could not be reached. Few studies addressed economic outcomes and the diverse perspectives, time frames and settings made comparisons difficult. Evidence on cost-effectiveness was inconclusive.ConclusionsSome nurse-led self-management programmes in this systematic review produced beneficial effects in terms of reducing unscheduled physician visits, lowering patients’ anxiety and increasing self-efficacy, but there is insufficient evidence to reach firm conclusions on the clinical or cost-effectiveness of the interventions. Further research should aim to identify the optimal components of these programmes and to identify those patients most likely to benefit. The inclusion of economic analyses in future studies would facilitate decisions by policy makers on the implementation of self-management interventions.     

Nurse-led services in Queensland: A scoping study

Background

Nurse-led services are expanding in Australia, yet current information about the scope and nature of these services is lacking. The need for more coordinated service planning and systematic evaluation prompted a scoping study to inform future development.

A nurse-led intervention to reduce the incidence and duration of delirium among adults admitted to intensive care: A stepped-wedge cluster randomised trial

BackgroundDelirium is an acute change in behaviour, characterised by a fluctuating course, inattention, and disorganised thinking. For critically ill adults in the intensive care, the incidence of delirium has been reported to be at least 30% and is associated with both short-term and long-term complications, longer hospital stay, increased risk of mortality, and long-term cognitive problems.AimThe objective of this study was to determine the effectiveness of a nurse-led delirium-prevention protocol in reducing the incidence and duration of delirium among adults admitted to intensive care.MethodsA hybrid stepped-wedge cluster randomised controlled trial was conducted to assess the effectiveness of the implementation and dissemination of the nurse-led intervention to reduce the incidence and duration of delirium among adults admitted to the four adults intensive care units in the southwest of Sydney, Australia.ResultsBetween May 2019 and February 2020, over a 10-month period, 2618 admissions, among 2566 patients, were included in the study. After an initial 3-month baseline period, each month there was a random crossover to the nurse-led intervention in one of the four intensive care units, and by the 7th month of the trial, all units were exposed to the intervention for at least 3 months. The incidence of acute delirium was observed to be 10.7% (95% confidence interval [CI] = 9.1–12.4%), compared to 14.1% (95% CI = 12.2–16.2%) during the preintervention (baseline) period (adjusted rate ratio [adjRR] = 0.78, 95% CI = 0.57–1.08, p = 0.134). The average delirium-free-days for these preintervention and postintervention periods were 4.1 days (95% CI = 3.9–4.3) and 4.4 days (95% CI = 4.2–4.5), respectively (adjusted difference = 0.24 days [95% CI = −0.12 to 0.60], p = 0.199).ConclusionFollowing the introduction of a nurse-led, nonpharmacological intervention to reduce the burden of delirium, among adults admitted to intensive care, we observed no statistically significant decrease in the incidence of delirium or the duration of delirium.     

护士主导的老年综合评估干预在老年慢性阻塞性肺疾病患者中的应用

目的探讨护士主导的老年综合评估(CGA)干预在老年慢性阻塞性肺疾病(COPD)患者中的应用效果。方法选取我院2018年1月至2019年1月收治的104例老年COPD患者作为研究对象,按照随机数字表法等分为对照组与观察组,对照组给予科室常规评估和护理,观察组实施护士主导的CGA模式干预。干预后比较两组患者肺功能各指标、医学应对方式以及满意度情况。结果观察组FEV 1、FEV 1/FVC指标优于对照组(P<0.05);观察组面对、屈服及回避应对方式与对照组比较差异具有统计学意义(P<0.05);观察组患者满意度明显高于对照组(P<0.05)。结论针对老年COPD患者应当及时应用护士主导的CGA干预模式,改善肺功能各项指标,减轻患者负面情绪,增强信心,提高护理服务满意度。     

Nurses versus clinicians—who''s best at pre-operative assessment?

Previous studies have emphasised the lack of relevant medical history information available for patients attending for surgery. The records of 57, consecutive patients attending the nurse-led Pre-Admission Clinic (PAC) at the Oral Surgery Day Case Unit at Newcastle Dental Hospital were reviewed to determine whether nurses or clinicians were best at identifying potential medical problems. For 22 patients, nurse-led PAC interview revealed additional information not recorded by clinicians, most frequently cardiovascular disorders (9), arthritis (5) and drug allergies (2). Pancreatitis, epilepsy, recurrent epistaxis and a history of a fractured mandible were other conditions only identified following nurse consultation. Medical history taking by nurses at PAC thus provides an important screening function prior to successful ambulatory surgery.     

Telephone first post-intervention follow-up for men who have had radical radiotherapy to the prostate: evaluation of a novel service delivery approach

The increasing prevalence of prostate cancer places pressure on services, leading to questions about how best to configure services, so as to maintain quality and best utilise the skills of the multi-disciplinary team. There have been positive evaluations of specialist nursing roles, nurse-led service provision and telephone consultations, leading us to consider whether telephone follow-up led by a specialist nurse might be an acceptable alternative to traditional follow-up in hospital-based out-patient clinics for patients receiving radical radiotherapy for prostate cancer. Thirty-six men were included in a pilot introduction of telephone follow-up, evaluated via a questionnaire survey. The evaluation explored patients' satisfaction with practical arrangements; satisfaction with the nurse; acceptability of telephone follow-up and acceptability of this being nurse-led. Patients reported high levels of satisfaction with practical arrangements. Thirty-five patients considered the nurse to be knowledgeable and found nurse-led care acceptable. Only one patient was unhappy with telephone follow-up, whilst 27 were "very happy". Only one patient felt that telephone follow-up was poorer than traditional follow-up, whilst 27 found it "as good" and three "better". Particular advantages were reported in terms of convenience and time savings. Telephone follow-up appears to have potential for this patient group and merits wider, research-based consideration.     

Nurse led telephone follow up in ovarian cancer: A psychosocial perspective

Survivorship is a relatively new concept in ovarian cancer due to improvements in diagnosis, surgery and chemotherapy. As more women require long term follow up for ovarian cancer the pressure on these services is increased and the question of how best to care for these women needs to be addressed. This paper considers the results of a pilot study of nurse led telephone follow up in ovarian cancer from a psychosocial perspective. Fifty-two women received telephone follow up over a 10-month period; one aspect of this intervention was the opportunity for women to discuss psychosocial concerns with the clinical nurse specialist. A nurse database held records of patient discussions, and patient feedback regarding the service was collected using FACT Ovarian quality of life questionnaire, plus the satisfaction and experience with follow up questionnaire. Thirty-three women were recorded as discussing psychological concerns with the nurse, 42% discussed feelings of anxiety or depression and 33% discussed fear of disease recurrence. Thirty-nine women were recorded as having discussed social concerns with the nurse, 56% discussed their family (husband, children, etc.), 51% discussed work and/or finances, and 41% discussed sexual intimacy. The majority of women (73%) expressed a preference for nurse led telephone follow up, the main advantages were reported as the relationship and discussions between the patient and the nurse, and the convenience of having follow up appointments over the phone instead of attending clinic. This pilot study suggests that nurse led telephone follow up offers an acceptable opportunity for psychosocial support for women with ovarian cancer.     

以护士为主导的个案管理对中晚期胃癌患者的影响观察

目的探究以护士为主导的个案管理对中晚期胃癌患者的影响。方法将靖江市人民医院2018年3月至2018年8月收治的行常规干预的中晚期胃癌患者54例作为对照组,2018年9月至2019年2月收治的行以护士为主导的个案管理干预的中晚期胃癌患者54例作为观察组。于两组患者入院时、出院前进行疼痛数值评定量表(NRS)、健康促进生活方式量表(HPLP-Ⅱ)及满意度调查表测评,比较两组患者各量表的评分情况。结果观察组出院前中度及重度疼痛率低于对照组(P<0.05);观察组出院前HPLP-Ⅱ量表中的健康责任、自我实现、营养、运动、应对压力、人际关系6项评分均高于对照组(P<0.05);观察组出院前护理满意度为92.59%,高于对照组的70.37%,差异有统计学意义(P<0.05)。结论对中晚期胃癌患者行以护士为主导的个案管理干预可有效降低患者疼痛程度,改善其生活质量,提高满意度。     

Nurse‐led prostate assessment clinics – are they fit for purpose?

Nurse‐led prostate assessment clinics (PACs) have been shown to be both cost‐effective and reduce the workload of urologists. We set out to determine how closely guidelines were adhered to in our PAC and whether the outcomes of these clinics, as determined by set protocols, were producing effective management strategies. The notes of 100 consecutive patients who attended the PAC at a single institution were retrospectively analysed. The presenting symptoms, examination findings, investigations performed and their results were documented, and the consultation outcome was recorded. In particular, we assessed whether the guidelines for investigations and management were followed and whether there were any changes in these following consultant review. Of the 100 patients (mean age 67 years), 79 were referred from primary care. The most common presenting symptoms were frequency and nocturia. Ninety‐two per cent of patients were appropriately assigned to the PAC. Eighty‐two per cent had a complete assessment according to the clinic guidelines. Patient management was appropriate and based on clinic guidelines in 81%. Following consultant review, 78% had no change in their management, while 26% were discharged. Nurse‐led PACs are fit for purpose. Guidelines for assessment and management are closely followed with minimal changes to treatment at consultant review.     

Nurse-led inpatient care: opening the 'black box'

With recent evaluations contradicting early reports of improved outcomes from nurse-led inpatient care, the 'black box' of nurse-led care must be opened in order to examine the model of treatment. We present findings on the processes of care in one nurse-led unit (NLU), compared with an acute ward. Patterns and quality of nursing care were quantified using bar-code technology to measure type, frequency and duration of nursing activities and Quality Patient Care Scale to measure the quality of care. NLU quality matched, but did not exceed, quality on the acute ward. Patterns of care differed between wards, but activities associated with therapeutic nursing were no more frequent on the NLU. These findings support the hypothesis that disappointing outcomes in recent evaluations may be linked to failure to implement a therapeutic model of nursing.