Urology ward attenders: auditing a nurse-led service

This audit describes a urology walk‐in service where patients are treated on the acute urology ward. Any patient previously known to the urology department or undergoing urology treatment can contact the ward 24 h a day for management of urology‐related issues. The service is nurse led and has evolved to become known as a ‘ward attender’ service. The audit is designed to observe how many patients present over a 12‐month period and the type of conditions seen. The aim is to see what effect this service has on the ward, its resources and primary care. The notes of ward attenders presenting to the urology ward over a 12‐month period were retrospectively analysed. Data collected included source of referral, types of urology conditions seen and treatment provided. Patients were divided in to two groups based on either planned (elective) or unplanned (emergency) attendance. Attenders were given questionnaires to obtain patient opinion on various aspects of service provision. Four hundred and four patients presented to the urology ward for review and treatment in one calendar year. These patients were seen by nursing staff and 21 other patients were reviewed by doctors. Ten patients required admission following review. Emergency attendances included patients with blocked nephrostomy tubes; haematuria, urinary retention or sepsis following endoscopy and catheter‐related issues. Elective attendances included patients requiring bladder washouts, change of catheter and instructions for intermittent self‐catheterization. This service helps forge a close working relationship with general practitioners, community nurses and nursing homes, by accepting direct referrals from them. Patients presenting as ward attenders comment that the service is rapid and that by being seen by more familiar staff, trust and confidence is built. By introducing this service, we feel we are contributing to the changes in the way urology patients are managed in the National Health Service.     

Implementing a nurse-led fracture intervention service

Osteoporosis affects three million people in the UK. The condition puts people at high risk of sustaining potentially debilitating fractures. The key to effective management is early intervention and disease management to reduce patients' fracture risk. This article reports on the introduction of a nurse-led fracture intervention service that aims to selectively case-find those at highest risk of osteoporosis. An audit was undertaken to evaluate the service.     

Evaluating a nurse-led DXA scanning service

AIM: To examine the feasibility of using a peripheral dual energy X-ray absorptiometry (DXA) scanning service in a nurse-led clinic and whether or not it would influence treatment and clinician satisfaction with the service. METHOD: A nurse-led clinic, using peripheral DXA scans to identify patients at risk of osteoporosis, was established in the rheumatology department of the hospital. Patients were referred from several sources. A questionnaire was sent to referring health professionals with each scan result. Returned questionnaires were statistically analysed. Of the sample size of 2000, 1024 questionnaires were returned, giving a response rate of 51 per cent. RESULTS: The results confirmed the hypothesis that a nurse-led peripheral DXA scanning service is feasible and beneficial to referring clinicians. Eighty nine per cent (n=912) of respondents stated that the scan results influenced treatment of patients. CONCLUSION: Further investigation of the extent that the DXA scanning service may have reduced unnecessary treatment is required.     

Running a nurse-led Chlamydia testing service

Healthy Respect is a Scottish Executive funded National Health Demonstration Project, which addresses young people's sexual health. One of the 19 projects in phase 1 (2001 to 2004) was to introduce Chlamydia trachomatis testing in non-medical settings. This involved the development, implementation and evaluation of an initiative in a sexual health service which aimed to encourage young people under the age of 25 years in Lothian to be tested for Chlamydia. This article discusses why it is important to test for Chlamydia and details an initiative that was set up to provide this service.     

Developing a nurse-led child sedation service

This article explores nurse-led sedation of children in preparation for investigations such as magnetic resonance imaging or minor surgical procedures. The importance of the multidisciplinary team in setting up, implementing and evaluating this new nurse-led initiative is described. Effective planning, involvement, agreement and training are key to a successful change in practice, with responsibility being delegated to competent nursing staff. Evaluation has shown all-round benefits. Trained nurse-led sedation is safe, effective and efficient and nurses are motivated to undertake this extended role.     

Providing patient choice: a nurse-led haematology outpatient service

An autologous peripheral blood stem cell transplant service is now available on an outpatient basis for haematology patients in one trust. The nurse-led service provides patients with the benefits of being at home with their families, which improves their quality of life during treatment that often has unpleasant side-effects. The service also brings benefits for the trust.     

Obstructive sleep apnoea syndrome: a nurse-led domiciliary service

AIM: This paper reports a successful transformation of clinical practice from inpatient diagnosis and initiation of treatment for obstructive sleep apnoea syndrome to a nurse-led domiciliary model increasing patient access and choice. BACKGROUND: Obstructive sleep apnoea syndrome is common, affecting globally 2-4% of the adult population. It is characterized by periodic complete or partial collapse of the upper airway, leading to hypoxaemia and sleep fragmentation, resulting in daytime sleepiness and impaired quality of life. It can be treated successfully with nocturnal continuous positive airway pressure. Strategies for diagnosis and initiation of treatment have traditionally been inpatient-based, but limited facilities and increasing demand in many countries have necessitated alternative strategies. METHODS: As an extension to our current inpatient provision, we have established nurse-led domiciliary investigation and treatment. Patients meeting predefined criteria undergo a limited sleep study followed by therapy initiation at home. Confirmation of investigation findings, evaluation of treatment, education and long-term review are carried out in nurse-led clinics. RESULTS: We evaluated outcome in the first 150 patients managed in this way between August 2002 and December 2003. In our highly selected patient group, 79% of those who undertook a trial of treatment continued at 3 months, with average compliance >5 hours per night, a figure which compares favourably with our overall patient population. Statistically significant sustained improvement in sleepiness was seen. Independent predictors of long-term acceptability of continuous positive airway pressure were disease severity and magnitude of improvement in sleepiness. CONCLUSION: A nurse-led service for domiciliary diagnosis, treatment initiation and on-going management of selected patients with obstructive sleep apnoea syndrome is feasible and cost-effective, with outcomes comparable with conventional inpatient services. This approach is applicable in most countries where increasing demand for investigations greatly exceeds the availability of traditional facilities.     

Reducing re-admission for asthma: impact of a nurse-led service

High rates of re-admission of children with acute asthma led to the establishment of a nurse-led service in one hospital in England. Improved approaches to care, discharge planning and subsequent management were introduced based on the BTS/SIGN guideline for asthma management. These approaches included a reducing regime for salbutamol inhaler treatment, consistent assessment of need for regular preventer treatment and of 'step up' asthma control measures at home. Review of inhaler technique is particularly important to ensure that the appropriate drug delivery device is used depending on the age of the child. Telephone follow-up is used to re-enforce information provided prior to discharge. Subsequent follow up in the nurse-led clinic provides an opportunity to review the child's home management and effectiveness of any treatment changes. Audit data indicate a reduction in re-admission rates for children with asthma from 22 per cent to around six per cent.     

Patients' satisfaction with a nurse-led oncology service

This study reports the findings of a quantitative study determining the satisfaction levels of patients attending a nurse-led oncology day ward. A random sample of 100 patients was surveyed using an adapted version of the Leeds Satisfaction Questionnaire (Hill, 1997) to ascertain the satisfaction levels of patients attending the unit. Satisfaction levels were found to be favorable in general. However, the study did highlight that some aspects of patient information required attention. Moreover, issues with the use of the questionnaire emerged as the inclusion of both positive and negative statements in the Likert-style questionnaire presented contradictory findings.     

Developing a nurse-led service for COPD patients

A rise in the rate of hospital admissions for patients with COPD has led to the development of nurse-led home care. A study in which a nurse-led team provided domiciliary treatment with ongoing follow-up, was found to be cost-effective and reduced the need for hospital care.     

An evaluation of a nurse-led cystoscopy surveillance service

The findings of a regional audit found that Salford had a high incidence of superficial bladder cancer. It was felt that the needs of the patient population could best be served by introducing a nurse-led cystoscopy service. This paper reports on the findings of a postal survey to evaluate the appropriateness and quality of care offered by the new service.     

Exploring nursing values in the development of a nurse-led service

This article considers the development of nurse-led services as a part of a pilot study and explores the therapeutic nature of the role of the nurse. In particular it suggests a need for reconsideration of the fundamental values of nurse-led care in the context of changing organizational culture. Within the UK there has been pressure from policy makers to extend the role of the specialist nurse and create new nursing roles, shifting the boundaries between professional health groups. The philosophy of nurse-led initiatives has therefore been driven mainly from a service redesign and clinical need standpoint rather than necessarily focusing on enhancing patients' experience and the changes in organizational culture required to achieve this. While several studies have focused on the safety, comparative cost and comparative patient outcomes in nurse-led care in relation to traditional or doctor-led care, little attention has been given to the changing organizational values underlying the nursing role. Exploring this context is essential if new nursing roles are to provide more than relief for bottlenecks in the system and also meet their potential for providing patient centred and innovative models of care.