What do community palliative care nurse specialists do? An activity analysis

A self-assessed activity analysis of a team of community palliative care nurse specialists was undertaken as part of a wider review of their service. Although it was not a research project, it proved to be a pragmatic and worthwhile means of analysing the work of individual nurse specialists and measuring what they actually do.The results and outcomes are presented in order to share the experience and to break down some of the isolation of community palliative nursing practice.The study found quite wide variations in practice between the individual nurse specialists but that most spent a high proportion of their time on clinical work at the expense of other aspects of the nurse specialist role, such as education, research and audit. It also found that most of the nurse specialists worked many more than their contracted hours and took very few breaks during the working day. The study promoted discussion within the team, changes have been introduced and the study will be repeated in two years' time.     

A demystification of the clinical nurse specialist role: perceptions of clinical nurse specialists and nurse administrators

Differences of nurse administrators and clinical nurse specialists regarding components of the clinical specialist role were investigated. To be effective in facilitating the maximum use of the abilities of the clinical specialist, it is essential that nurse educators establish a data base about the clinical nurse specialist role from the perspective of employers and the clinical nurse specialists themselves. Subjects were 54 nurse administrators and 35 clinical specialists from a large metropolitan area. The results indicated that, generally, both groups were in agreement except for the research component. Administrators placed a higher value on research than did the clinical specialists. Both groups valued the clinical practice component with the clinical specialists tending to see themselves more heavily committed to direct specialized patient care than did the administrators. The educational component was also valued with the consultant function receiving the highest rating of all the functions surveyed. The administration component was valued least highly of all the components. It is recommended that nurse educators evaluate their educational endeavors in preparation of clinical specialists especially for research functions, and, also, consultation and those functions supportive of nursing staff.     

Intravascular therapy process improvement in a multihospital system: don't get stuck with substandard care

Using the process of FOCUS PDSA (a quality improvement format), two clinical nurse specialists reviewed the delivery of intravenous care at a multihospital (4-hospital) system. The clinical nurse specialists formed a multi-facility nursing team to lead the assessment, develop a plan, implement changes, and evaluate the process. This process reflects the use of clinical nurse specialists as experts in using research-based data, national recommendations, and benchmark data to ultimately improve practice and reduce risks and overall costs. This process allows the clinical nurse specialist to be viewed as an innovator, a project manager, and a program developer in a major system. The clinical nurse specialists were selected to lead this process improvement based on their knowledge and competencies in the specific area of intravenous therapy.     

An audit of patient satisfaction with uro-oncology nurse specialists – a questionnaire study

Specialist nurses have an established role in the management of urological cancer in helping patients to understand their disease and treatment options and in offering counselling and emotional support. There is evidence to suggest that patients who see the nurse specialist express more satisfaction and have less anxiety than those who see junior doctors. Other studies have found that the specialist nurses’ clinical expertise compared favourably with that of other clinicians. This audit aimed to assess the patient satisfaction with uro‐oncology nurse specialists and their nurse‐led clinics. One hundred, 15‐point patient satisfaction questionnaires were sent to new and existing patients with urological cancer who had been randomly identified by the uro‐oncology nurse specialist. The questions were concerned with the provision of information to patients and with the satisfaction of the nurse specialist service. The results showed that patients found contact with the uro‐oncology nurse specialist supportive, informative and beneficial to their treatment. The authors felt that raising the profile of the uro‐oncology nurse specialist would be beneficial to patient treatment and care.     

Working with the team: strategies employed by hospital cancer nurse specialists to implement their role

Aim. This paper describes the strategies used by cancer nurse specialists in the UK to implement their role within the multiprofessional team. Background. The prevalence of cancer increasingly preoccupies the developed world causing concern about the effective use of healthcare resources. The demand to contain healthcare costs and meet the complex needs of patients has led to the development of new and different types of nurse specialist roles. In the UK, these initiatives have been supplemented by reorganizing cancer services to ensure care is delivered by collaborative multiprofessional teams: nurse specialists are considered core team members. While role ambiguity and conflict are acknowledged as barriers to the successful introduction of new roles, little is known about the strategies used by individuals to facilitate role implementation. Design. A grounded theory design using purposive and theoretical sampling. Methods. Twenty‐nine cancer nurse specialists from five hospitals participated in observation and semistructured interviews. The data were analysed concurrently using the constant comparative method. Results. Acceptance, especially by doctors, was the main problem facing cancer nurse specialists. In addition, they experienced insufficient organizational support for their role. Difficulties with acceptance impaired nurses’ ability to provide supportive care to cancer patients. Nurse specialists responded by employing several strategies including building relationships and establishing role boundaries. Conclusions. Some strategies used by nurse specialists are more successful than others in facilitating role implementation. While recommendations exist to assist the introduction of new roles in practice, their implementation by healthcare organizations may be limited. Future approaches should focus on helping nurses develop awareness of the problems they face, why they arise and effective mechanisms for their resolution. Relevance to clinical practice. The findings highlight the mismatch between cancer policy aspirations and reality and the actions taken by nurse specialists to overcome the problems they encounter.     

A phenomenological investigation into the role the clinical nurse specialist

This research study adopts a phenomenological approach to investigate how a group of clinical nurse specialists think and experience their role. It reviews the literature on the clinical nurse specialist from 1943, when Frances Reiter first coined the phrase 'nurse clinician', to the present time, when individuals are committed to a range of initiatives aimed at improving the quality of the British National Health Service and patient care. The study investigates and analyses their views and conveys the personal meaning of clinical nurse specialists 'lived experience' in the role. Findings of the study suggest that clinical nurse specialists are experienced practitioners who strive to be in positions in which they influence patient care and utilize advanced knowledge, expertise and leadership skills in a multidisciplinary environment. The literature proposes that for the role to be recognized and accepted individuals need to be educated at an advanced level, demonstrate practice based in research and have a firm base as a specialist in nursing. The findings clearly suggest that while the role of the clinical nurse specialist can be influenced in a positive manner by the organization and guided by the individual, it is important to acknowledge that the role is in a transitional phase. Finally, the research suggest the importance of establishing a clear role definition in a creative and supportive environment allowing for a autonomy, professional growth and the development of individuals as clinically competent nurse specialists.     

Focus group interviews to examine the role and development of the clinical nurse specialist

This paper reports on the use of focus groups to investigate the development of clinical nurse specialist roles. The need for this project was identified during initial research, undertaken in two London Hospital Trusts, to assess the variety and nature of advanced clinical nursing roles already in evidence. From analysis of these data, this second stage of the research developed, in which the future of the clinical nurse specialist role within these two trust settings was explored. The initial steps of grounded theory, analytical techniques and procedures, using a constant comparative method, were used to analyse the findings from five focus groups (composed of a total of 25 nurses from two trusts). From the data, six categories were identified; role components; experience versus education; supportive strategies; personal qualities; future role development and development strategies. These categories provide the framework for discussing the findings of the research, within the context of the available literature. This examination of the clinical nurse specialist role highlights issues for career progression and education strategies. Both will need careful planning, in order for the clinical nurse specialist role to be considered and evolve as part of a potential strategy for the development of nursing roles within the two trusts and on a national level.     

Do hospital-based palliative care clinical nurse specialists de-skill general staff?

A large number of clinical nurse specialists work within the area of palliative care, particularly in the acute hospital setting. This article presents the qualitative findings of an evaluation study that looked at the impact of the clinical nurse specialist within a palliative care team in a large acute hospital in the North-West of England. A total of 31 interviews were conducted with stakeholders from across the hospital setting. The data were analysed for emerging themes using a case and cross-case analysis. The results indicated that the senior stakeholders and the palliative care team felt that the clinical nurse specialists might be de-skilling the general nursing and medical staff, while junior staff did not perceive that they were being de-skilled. This article discusses potential explanations for this, including the possibility that junior staff may not be fully aware of the role of palliative care clinical nurse specialist. The impact that clinical nurse specialists are having on empowering the junior staff is also discussed and recommendations for further research are suggested.     

Articulating the role of the clinical nurse specialist in new brunswick

The clinical nurse specialist (CNS) role is often misunderstood and underutilized. Through partnership with the CNS Advisory Committee in the Horizon Health Network and the Masters of Nursing Program at the University of New Brunswick, the authors developed a clear articulation and visual representation of the CNS role in New Brunswick. This paper synthesizes information gleaned from interviews with the clinical nurse specialists working within Horizon Health Network and integrates this information with the published literature and the position statement of the Canadian Nurses Association (CNA). Vision, voice and value emerged as key considerations, as did barriers to, and successes of, the CNS role. This paper contributes to the acquisition of knowledge regarding the role of the CNS according to the CNA and current published literature. It further promotes an understanding of the important role of the CNS in the healthcare system in New Brunswick, and introduces strategies that can be utilized by clinical nurse specialists to demonstrate value and support the continuation of the role.     

Development of an alcohol withdrawal protocol: CNS collaborative exemplar

PURPOSE: The purpose of this process improvement project was to develop an Alcohol Withdrawal Syndrome (AWS) management protocol for acute care. SIGNIFICANCE: The prevalence of alcohol abuse in our society presents challenges for health professionals, and few nurses have received formal education on the identification and treatment of AWS, which has frequently resulted in ineffective, nonstandardized care. However, nurses practicing in medical-surgical, emergency, trauma, and critical care settings must be astute in the assessment and management of AWS. DESIGN/BACKGROUND/RATIONALE: Following an analysis of existing management protocols, a behavioral health clinical nurse specialist was asked to lead a work team composed of physicians, pharmacists, and nurses to develop a new evidence-based alcohol withdrawal protocol for acute care. METHODS/DESCRIPTION: By implementing a standardized assessment tool and treatment protocol, clinical nurse specialists empowered nursing staff with strategies to prevent the serious medical complications associated with AWS. FINDINGS/OUTCOMES: The development and integration of a safe and effective treatment protocol to manage AWS was facilitated by collaborative, evidence-based decision making. CONCLUSION: Clinical experience and specialty expertise were integrated by clinical nurse specialists skilled in group dynamics, problem-solving, and the implementation of change. Improving care of patients in AWS is an exemplar for clinical nurse specialist roles as change agent and patient advocate.     

安徽省急诊急救专科护士工作现状调查与思考

目的:了解安徽省急诊急救专科护士的工作现状,为完善专科护士培养制度,加强专科护士使用与管理提供参考依据。方法:采用自行设计的调查问卷,对经安徽省急诊急救专科护士培训基地培训并取得资格的92名急诊急救专科护士的工作现状进行调查。结果:①92名急诊急救专科护士中有6名已离开急救护理岗位,离岗率为5.71%。②22名(34.78%)专科护士担任护士长职务,其中有20名是培训后升为护士长职务的,角色改变率为21.74%。③专科护士在教学方面发挥了较多的作用,但在急救技能、抢救流程、转运模式、各种规范的修订与完善、院外急救知识培训等高级临床实践方面作用发挥得不明显。④护士缺编、护士未分层次使用、职责不明确是影响专科护士核心能力发挥的主要因素。⑤经培训后,专科护士查阅文献和科研能力提高。⑥100%专科护士认为需要得到管理层支持和经常参加学术会议以促进其核心能力持续养成。结论:发挥专科护士高级临床护理实践作用,科学地使用专科护士,加强专科护士岗位管理,进行资格再认证,真正使专科护士学有所用,是目前面临的亟待解决的问题。     

Nurse specialist assessment and management of palliative care patients who are depressed--a study of perceptions and attitudes

Depression is a frequent symptom in palliative care patients but is often not diagnosed. In the U.K., the majority of patients with advanced cancer are referred to a clinical nurse specialist (CNS) whose remit includes the assessment of psychological symptoms and depression. Clinical nurse specialists have a key role in the diagnosis and management of patients with depression and it is important that they have the skills to do so. A postal questionnaire of all U.K. hospital, hospice, and community palliative care clinical nurse specialist teams was carried out to determine how they assessed depression in their patients. The response rate was 40%. Seventy-nine percent of all clinical nurse specialists believed their skills were poor in this area, and 92% felt they required further training. These beliefs were substantiated by the difficulties nurses encountered in assessing depression and by their beliefs regarding antidepressant medication. Clinical nurse specialists have a pivotal role in improving the detection and management of depression in palliative care patients, and require further training in this area.     

Colorectal cancer. Part 4: Specialist nurse roles

The key nurse specialists involved in the management of colorectal cancer include the colorectal nurse specialist, the stoma therapist and the chemotherapy nurse specialist. The specialist nurse must integrate management, consultation, research and education functions alongside the clinical role. The specialist nurse provides expert advice and information and support and helps the person to live with their diagnosis of cancer.     

The role of the pediatric clinical nurse specialist in gastroenterology.

Clinical nurse specialists have been employed by hospitals for many years. However, very little published information exists specifically describing the role of the pediatric clinical nurse specialist in the field of gastroenterology. The pediatric GI staff nurse and/or GI assistant may be uncertain as how to best utilize this important nursing resource. The author discusses her own role implementation as a pediatric gastroenterology/nutrition clinical nurse specialist and highlights in particular her role as a resource to the GI nurses.     

The work of clinical nurse specialists (HIV/AIDS) in areas with a low prevalence of HIV infection

The role of the clinical nurse specialists (HIV/AIDS) who work in areas with a low known prevalence of HIV is considered and their contribution to patient care, either directly or indirectly through the education and support of other health care workers, is discussed. Attention is given to the implications for nursing practice and the role of the clinical nurse specialist associated with the relative infrequency of contact with patients who have HIV disease; and some of the issues for people living with HIV/AIDS in rural areas are alluded to. Finally, some of the limitations of the clinical nurse specialist role are delineated and some consideration is given to the future role of clinical nurse specialists for HIV and AIDS.     

Clinical nurse specialists as entrepreneurs: constrained or liberated

Aims. This qualitative study explored the experiences of two groups of clinical nurse specialists – continence advisors and tissue viability nurses – working in primary care in the UK. In particular, the study focused on how clinical nurse specialists’ relationships with other health‐care professionals had an impact on their role. Background. Clinical nurse specialists are recognized worldwide as having expertise in a given field, which they use to develop the practice of others. Additionally, clinical nurse specialists share many of the characteristics of entrepreneurs, which they use to develop services related to their speciality. However, little research has been conducted in relation to clinical nurse specialists’ experiences as they attempt to diversify nursing practice. Design/methods. An ethnographic approach was adopted comprising many elements of Glaserian grounded theory. Data were collected via participant observation and face‐to‐face interviews with 22 clinical nurse specialists. Findings. Services provided by clinical nurse specialists were not static, clinical nurse specialists being the main drivers for service developments. However, clinical nurse specialists encountered difficulties when introducing new ideas. Given their role as advisors, clinical nurse specialists lacked authority to bring about change and were dependent on a number of mechanisms to bring about change, including ‘cultivating relationships’ with more powerful others, most notably the speciality consultant. Conclusions. The UK government has pledged to ‘liberate the talents of nurses’ so that their skills can be used to progress patient services. This study highlights the fact that a lack of collaborative working practices between health‐care professionals led to clinical nurse specialists being constrained. Relevance to clinical practice. Health‐care organizations need to provide an environment in which the entrepreneurial skills of clinical nurse specialists may be capitalized on. In the absence of an outlet for their ideas regarding service developments, clinical nurse specialists may remain dependent on the mechanisms witnessed in this study for some time.     

从专科护士制度谈护理专业的发展

护理工作是医疗卫生事业的重要组成部分。近年来，随着社会与科技的发展，人们对卫生保健的需求不断提高，护理工作的职责与功能也远远超出了传统领域。在国外有相对发展成熟的专科护士制度，可为培养我国高级护理人才提供借鉴。同时，对国外专科护士制度的学习与研究，可促进我国护理专业的纵深发展。     

The clinical nurse specialist: a way forward?

The words clinical nurse specialist have been part of the nursing vocabulary for some time, but are these nurses specialized practitioners like many of us, or is there a larger role for them to play? This paper is a piece of reflective writing and is intended to further the debate concerning clinical nurse specialists The paper examines clinical nurse specialists from an intensive care unit perspective It looks at the intensive care unit and the wealth of under-utilized experience these environments contain The paper examines the existing and envisaged roles of clinical nurse specialists, their education and utilization, and also the difficulties that they are likely to face in their evolution, both from within the nursing profession and from outside it