Development of a nurse-led skin camouflage clinic

This article outlines the development of an outpatient skin camouflage service and summarises findings from an audit of the service after one year, which resulted in the clinic expanding to a monthly all-day session.     

Recommended follow-up for ileo-anal pouch patient

One of the greatest advances in colorectal surgery over the past 30-years has been the development of restorative proctocolectomy with ileal pouch-anal anastomosis for patients suffering with ulcerative colitis and selected patients with familial adenomatous polyposis. This has coincided with a proliferation of new and exciting advanced clinical roles for nurses in the United Kingdom and subsequently has led to an increase in the responsibilities and professional status of nurses. Staff development is necessary to maintain the unique contribution that nurses make to health care in the terms of practice, education and research. Nurse specialists in gastroenterology are taking their place alongside medical specialists, and more importantly establishing themselves as the principle carer in many diverse roles. However, as these nursing roles expand, a recognized framework needs to be designed, which takes into account the educational, ethical and legal issues related to accountability of running nurse-led clinics, offering support, advice and follow-up for patients. This article provides nursing staff with research-based recommendations and practical guidance on running a successful nurse-led pouch clinic and follow-up service in collaboration with the consultant surgeon, gastroenterology teams and nursing staff involved specifically with the ileo-anal pouch patient.     

Development of a nurse-led chronic pain clinic in UK primary care

We describe the development of an innovative, nurse-led chronic pain clinic in primary care. Benefit of the structured intervention was seen in terms of overall patient pain (as measured by the short form McGill-Melzack pain scale) with no overall impact on drug costs. A significant proportion (54%) of patients taking non-steroidal anti-inflammatory drugs were deemed to be at risk of gastropathy and in need of gastroprotection as defined by the clinic protocol. Areas worthy of further study are discussed.     

Piloting a nurse-led gynaecology preoperative-assessment clinic

This article outlines a pilot project to develop and evaluate a nurse-led gynaecology preoperative-assessment clinic at an acute hospital trust. The main aim of the clinic was to offer an effective preoperative-assessment service that provided high quality individualised and sensitive patient care. Further aims were that the clinic could be a template for other preoperative-assessment clinics, an educational resource for staff, a tool for clinical nursing career progression and a service to help ease junior doctors' workloads.     

Effectiveness of a nurse-led pregnancy termination clinic

A new nurse-led service was developed for women requesting pregnancy termination. Compared with the previous service, the nurse-led clinic reduced waiting times and cost almost 40 per cent less.     

Patient satisfaction in a nurse-led rheumatology clinic

Patient satisfaction with a nurse-led rheumatology clinic was tested using the Leeds Satisfaction Questionnaire (LSQ), which was specially developed and shown to be both reliable (Cronbach's alpha, 0.96) and stable (test-re-test r = 0·83). A total of 70 patients with rheumatoid arthrists, aged 22–75 years were randomly allocated to either a nurse's or a rheumatologist's clinic and seen on six occasions over a year. They completed the LSQ on entry and there were no significant differences between them. By week 48 the medical cohort showed significantly increased satisfaction with access and continuity ( P < 0.05) but no change in overall satisfaction. The patients in the nurse-led clinic recorded significant increases in overall satisfaction and in all subscales ( P < 0.0001). Between-group comparison at week 48 showed the nurse's patients to be significantly more satisfied than those of the rheumatologist.     

The development of a nurse-led outpatient orthopaedic clinic

In the past 18 months nurses at the orthopaedic outpatients department at Harrogate District Hospital have radically transformed their roles by developing a nurse-led joint replacement follow-up clinic. This clinic, initiated in response to both local and national developments, has led to increased nurse autonomy as well as a demonstrable improvement in patient services.     

The benefits of a nurse-led preoperative assessment clinic

OPAC has proved itself a valuable service, not only to patients but also in ensuring the efficient management of these patients' care throughout their contact with the hospital. It has been shown that a registered nurse is able to use this service as a means of identifying a variety of problems that can affect patient admission and use this foresight to alleviate patient concerns, plan to enable early discharge and minimise lost and disrupted theatre times. This post has since become a regular provision within the orthopaedic service, funded by the trust, and is a routine service provided to all orthopaedic patients due to undergo elective orthopaedic surgery. In addition, the clinic monitors waiting lists and removes those patients who no longer require or wish to have surgery. Quality care is provided promptly and efficiently on a one-to-one basis and patients experience minimum disruption due to the centralisation of clinic services. Nurse-led clinics appear more cost-effective as they employ a senior nurse instead of a consultant or anaesthetist and this is achieved without losing the quality of patient care. In the new, modern and dependable NHS, nurse-led clinics are the way forward.     

The development of a nurse-led complex wound clinic

This article describes the development of a nurse-led complex wound clinic in Lincolnshire in April 2003, and describes one patient's experience of the service. It also explores the benefits of collaborative initiatives that have the potential to improve patient outcomes.     

How a nurse-led clinic cut outpatient waiting times

Joe Annandale describes how changing the respiratory nurse specialist role can improve outpatient waiting times and meet patients' needs.     

A patient satisfaction survey of a nurse-led colorectal clinic

A new service was set up to achieve government targets to see patients with signs or symptoms of a possible colorectal cancer within two weeks of referral from their GP. The new clinics were nurse-led. A patient satisfaction survey was used to assess patients' opinions about the clinic. The results showed patients had a positive view of the clinic.     

A regional nurse-led osteoporosis clinic.

This article describes the work of a nurse-led osteoporosis clinic and its perceived benefits to both patients and staff.     

Diagnosis of early arthritis: outcomes of a nurse-led clinic

Recent data suggest that early treatment of inflammatory arthritis can improve patient outcomes. While rheumatologists recognized this need for early evaluation and treatment, the current load on the rheumatology service nationwide may limit the capacity for timely evaluation. The authors developed a protocol to be applied through a specialized early arthritis clinic that is able to discriminate between different categories of early arthritis, to shortening the time taken to reach the correct diagnosis and provide the appropriate management. A total of 108 patients have been reviewed in the early arthritis clinic over 12 months. It took 3 weeks for the patients to be fully assessed in the rheumatology clinic instead of 16 weeks. Completing the clinic proforma helped the assessor to cover all causes of arthritis/arthralgia. Disease-modifying antirheumatic drug (DMARD) therapy was initiated within a few weeks (2 to 5 weeks) once diagnosis was confirmed, instead of 8 to 10 months previously. This early arthritis clinic model helped to shorten the referral lag time (duration between symptoms onset and first rheumatologist assessment) as well as lag time to DMARD therapy (duration between symptom onset and the institution of DMARD therapy).     

Running a nurse-led nebulizer clinic in a district general hospital

The widespread home use of nebulizers for delivering bronchodilating medication in patients with a variety of respiratory conditions is well documented, as is the lack of appropriate assessment before this form of treatment is prescribed (Cochrane et al, 1985). When it is considered that the use of nebulizers at home is increasing (Drug Information Bulletin, 1994), it is essential that appropriate assessment is undertaken in line with British Thoracic Society recommendations in order to ensure that the degree of benefit is sufficient to justify the inconvenience, potential dangers and high cost of nebulizer therapy in the home. This article examines a nurse-led nebulizer assessment clinic that was set up as part of a service for providing home nebulization for long-term use in patients with chronic obstructive pulmonary disease or chronic severe asthma.     

Setting up a community nurse-led healed leg ulcer clinic

The success of compression therapy and emphasis on healing rates of venous ulcers in studies has shifted the emphasis from prevention to cure. Venous insufficiency is, in the majority of cases, a chronic condition. From a patient's perspective, unless they are suitable for corrective surgery, he/she will never be rewarded with a cure. Patients often need to make permanent life-style changes to reduce the risk of ulceration or re-ulceration and may require differing levels of support to achieve this. The implementation of a designated clinic for patients with healed leg ulcers in a primary care trust in the east end of London is the first step in promoting a collaborative approach to prevention of leg ulcer recurrence.