Parental needs assessment: a design for clinical nurse specialist practice

Parents of children with orthopedic illness or disability were asked to identify their needs and their children's needs for education and support. Their responses were used to shape the clinical nurse specialist's practice. Information about the child's diagnosis and its effect on growth, development, and sexuality were the areas of greatest needs identified by parents in this study. Incorporation of these perceived needs into practice is described.     

The meaning of a consultation with the diabetes nurse specialist

Scand J Caring Sci; 2010; 24; 341–348
The meaning of a consultation with the diabetes nurse specialist Objective: The aim of this study was to elucidate the essential meaning of a consultation between diabetes nurse specialists and patients to gain a deeper understanding of the patients’ experiences. Methods: Twenty patients with type 2 diabetes were interviewed about their experience of a consultation at an annual check‐up with the diabetes nurse specialist. A phenomenological hermeneutic method was used in the analysis and interpretation of the text. Results: The patient’s experience of a consultation was interpreted as manifestation of hold on the disease control. This means a safeguard to continue daily life shown in the four themes being controlled, feeling exposed, feeling comfortable, and feeling prepared. Conclusion: The patients’ experiences of a consultation with the diabetes nurse specialist became the basis for a health maintenance process in dealing with critical health–disease aspects. Implications to practice: In a consultation, professionals have to take into account the potential emotional turbulence that disease progression can mean to a patient. Diabetes care implies patient dependence on support to avoid a potential self‐management insufficiency and call attention to professionals’ time for listening to patients’ perceptions.     

Caring for uninsured patients with diabetes: designing and evaluating a novel chronic care model for diabetes care

Background Safety net urban hospitals are being overwhelmed by an increasing number of patients with diabetes, who frequently only access the health system through visits to emergency departments and urgent care clinics. It is uncertain whether the chronic care model advocated for diabetes care would be feasible and effective for managing diabetes in an acute care setting. Objective Determine if redesigning the system of care for treating diabetic patients who do not have primary care doctors is feasible, acceptable to patients and effectively lowers patients' haemoglobin A1c, blood pressure and cholesterol levels. Design Prospective single cohort study. Patients A total of 1098 consecutive diabetic patients presenting to an urgent care clinic at an urban safety net public hospital in Chicago between October 2004 and April 2006 who had a haemoglobin A1c measured at baseline. Intervention Adapt the chronic care model for managing diabetes to the acute care setting of an urgent care clinic to manage uninsured patients with diabetes who do not have primary care. Results Among the 1098 patients, 833 (76%) had a repeat A1c during the 2‐ to 12‐month follow‐up period. On average, A1c values decreased by 1.5 percentage points; systolic blood pressure decreased by 9 mmHg; low‐density lipoprotein cholesterol decreased 11 points; and weight decreased 2.3 pounds (all: P < 0.001). The percentage using angiotensin‐converting enzyme inhibitor drugs increased from 45% to 83%; aspirin use increased from 38% to 83%; and statin use increased from 34% to 76%. Conclusions This novel chronic care model for diabetes care of uninsured patients without primary care doctors was feasible, acceptable and effective in increasing the quality of diabetes care and decreasing haemoglobin A1c, blood pressure, cholesterol and weight.     

Caring for a child with Down's syndrome in the acute care setting

This article discusses Down's syndrome and its effect on the child. Some common medical conditions that may necessitate a child with Down's syndrome attending hospital either as an inpatient or an outpatient are identified. These include cardiac disease, atlantoaxial instability, growth, thyroid function and eye, ear, nose and throat issues. The nurse's role in minimising the stress involved for the child and the family is discussed. Practical suggestions are offered for ways of enhancing practice and improving outcomes, specifically in the area of communicating with the child and family.     

The nurse specialist as main care-provider for patients with type 2 diabetes in a primary care setting: effects on patient outcomes

A solution to safeguard high quality diabetes care may be to allocate care to the nurse specialist. By using a one group pretest-posttest design with additional comparisons, this study evaluated effects on patient outcomes of a shared care model with the diabetes nurse as main care-provider for patients with type 2 diabetes in a primary care setting. The shared care model resulted in an improved glycaemic control, additional consultations and other outcomes being equivalent to diabetes care before introduction, with the general practitioner as main care-provider. Assignment of care for patients with type 2 diabetes to nurse specialists seems to be justified.     

Supporting care homes: the older people's specialist nurse

This article outlines the health needs of older nursing home residents and identifies the case for the role of an older people's specialist nurse within a multidisciplinary care homes support team (CHST). This model has been successfully introduced in the London boroughs of Lambeth, Southwark and Lewisham as a response to the profile of local health need among care home residents and changes in national policy such as the introduction of NHS-funding nursing care. The structure of the CHST is described, and the older people's specialist nurse is discussed in detail. The emergent role of the older people's specialist nurse as key to managing the interface between the nursing homes and primary care is highlighted as a key benefit of this unique role.     

The breast care nurse: the care specialist in breast centres

VOIGT B., GRIMM A., LOßACK M., KLOSE P., SCHNEIDER A. & RICHTER‐EHRENSTEIN C. (2011) The breast care nurse: the care specialist in breast centres. International Nursing Review 58 , 450–453 Background: In Europe, breast cancer is the most common form of cancer in women; 26.5 per cent of all new malignant diseases and 17.5 per cent of all cancer deaths are due to this type of cancer. In Germany, approximately every tenth woman is diagnosed with breast cancer during her lifetime. Objective: In order to increase the quality of life of breast cancer patients, the European Society of Mastology (EUSOMA) requires the availability of, and an integration of qualified and specialized care into the interdisciplinary team. Thus, in Germany, a new type of job profile for ‘breast nurse’ as a qualified care specialist has to be established and has to be oriented towards the international standards of a breast care nurse (BCN). Methods: The Charité's Academy of Health – in cooperation with the Interdisciplinary Breast Centre of the Charité– has offered a career advisory service curriculum for the BCN since 2006 in accordance with the EUSOMA guidelines. Results: In three courses, 45 BCNs have been trained. In the first refresher seminar in May 2009, the BCNs were given an opportunity to exchange with fellow BCNs their experiences. Conclusion: We were able to set up a new curriculum to train nurses as BCNs as to improve the quality of care for breast cancer patients and to orientate the training towards the international standards of a BCN qualification.