The development of telephone triage: historical, professional and personal perspectives

The authors examine the concept of nurse led services: professional, theoretical, developmental, and ethical implications for the nursing profession, patients, and their families. In the UK, the Scope of Professional Practice (1992) cleared the way for registered nurses to expand their role, ultimately to provide a better service and to develop the profession. The nursing profession has a strong tradition of adapting to change and responding positively to new health care needs ( DOH 1999). This nursing strategy for England makes particular reference to nurse led initiatives and direct reference to National Health Service (NHS) Direct; the 24-h nurse led telephone help and advice service available across England and Wales. Particular attention will be focused on a nurse led telephone triage which was developed in the authors’ own area of elective orthopaedics.     

NHS cadet schemes: do they widen access to professional healthcare education?

AIM: The aim of this paper is to report a study investigating the extent to which National Health Service cadet schemes widen access to professional health care education. BACKGROUND: Cadet schemes have been reintroduced in the United Kingdom to increase recruitment of nurses and other health care staff to the National Health Service and also to widen access and increase participation in professional health care education by groups poorly represented in such education, including minority ethnic groups. METHODS: A questionnaire survey of all cadet schemes (n = 62) in England at the time of the study was carried out, and the respondents were cadet scheme leaders (n = 62) and cadet students (n = 411). The questionnaires to scheme leaders enquired about when the schemes were established, what the schemes were preparing cadets for, modes of delivery and entry qualifications. The questionnaires to cadets enquired about age, gender, family circumstances, prior experience and ethnic background. FINDINGS: The majority of schemes had been established since the health service reforms of 1999 and most were preparing cadets to enter professional nurse education programmes. Very few provided opportunities for part-time study and some asked for entry qualifications. Cadets were younger on entry than a comparator group of student nurses, fewer were married, fewer had previous employment or health-related employment and a lower percentage of cadets were white. CONCLUSION: Cadet schemes have the potential to widen access to professional health care study, but there is only limited evidence that they are doing so. In particular there was a lack of mature entrants to health care professional education via the schemes. However, the majority of schemes offered a route into professional education for students who did not hold sufficient educational qualifications for direct entry to professional health care education. It is encouraging that cadet schemes appear to be attracting a significantly greater proportion of students from Black and minority ethnic groups than preregistration nursing programmes overall.     

Future directions for the Prostate Cancer Specialist Nurse in Australia

Prostate cancer is the most commonly diagnosed cancer in Australian men. A cancer diagnosis causes physical, social and psychological morbidity. The role of the specialist nurse in chronic illness care is well recognized both nationally and internationally; however, the role of the Prostate Cancer Specialist Nurse is not as developed or formalized in Australian health care delivery. Prostate Cancer Foundation of Australia (PCFA) aims to bridge this gap and has developed a model to pilot a number of Prostate Cancer Specialist Nurses in various locations throughout both metropolitan and regional Australia. This paper reports on the findings of a project commissioned by PCFA to define a model for a national Prostate Cancer Specialist Nursing service. The service model was developed following an extensive consultation process at a national level. A framework for practice and professional development for the Prostate Cancer Specialist Nurse has been developed which utilizes both the Australian Nursing and Midwifery Council Registered Nurse Competency Frameworks and the National Cancer Nursing Education Project Professional Development Framework. The pilot program will involve PCFA working in partnership with host health regions by providing funding for the recruitment of the nurses on a 3‐year trial basis. The nurses will be employed directly by the host health regions and will be professionally supported by PCFA. The program will also be formally evaluated.     

Working with volunteers: key issues for gerontological nursing - Future challenges

To ensure that older people have access to all the advice, information and support they need nurses are increasingly expected to work with volunteers and the wider Voluntary and Community Sector. This article charts some of the current issues facing the sector so that nurses can collaborate more effectively, respect the contribution that volunteers can make and ultimately deliver well being, independence and choice. The focus is on recent policy in England which has sought to modernize and equip the Voluntary and Community Sector to meet National Health Service priorities. However, the underpinning themes and issues are likely to have broader resonance for volunteering in an international context. Trends in commissioning (service procurement) are identified which are likely to influence the future role and numbers of volunteers working in health and social care. Throughout this article key issues for nurse practitioners are discussed: What is the changing role of the volunteer? Can volunteers deliver significant extra capacity? What are the workforce implications? What are the risks and outcomes for older people?     

Negotiating the role of the practice nurse in general practice

The debate about the role of the practice nurse is not only about practice nursing per se, but raises broader issues about the organization of primary health care Two related issues emerge as significant the role of the practice nurse in providing primary health care, and the effective use of the practice nurse resource in the 'new' National Health Service This paper, by drawing on material from a qualitative study, specifically examines the type of work performed by practice nurses and the factors that influence this The responses of practice nurses, general practitioners, Family Health Service Authority (FHSA) advisers, community nurse purchasers and managers of community nursing provider units suggest that a consensus on the future development of practice nursing is unlikely The different stakeholders emphasized different issues, reflecting their own priorities and backgrounds Practice nurses' accounts of the future, for example, focused on professional issues General practitioners stressed the importance of role development which met then-General Medical Service responsibilities Purchasing agencies, provider units and FHSAs adopted a wider perspective and were more concerned to develop an effective and integrated primary health care service The tensions generated by their different interests and perspectives, and the subsequent organizational and policy initiatives that emerge, will provide the context in which the role of practice nurses will be negotiated     

Developing the role of the ophthalmic nurse in England

The role of the ophthalmic nurse in England has developed during the last 5 years with more nurses working as practitioners who run their own clinics. With the introduction of Working for Patients, the whole ethos of the National Health Service in England has changed. This study uses structured interviews to identify how three Trusts have developed the role of the ophthalmic nurse to meet the changing needs of the National Health Service. Analysis of the data identified that despite numerous problems encountered, ophthalmic nurses are responsible for driving same-day surgery ensuring that patients' needs are met.     

The specialist nurse: a classification system

This paper focuses on the important developments of specialty nursing practice within Australia and reports the results of a recent survey of specialist nurses in Victoria. Debate among the worldwide nursing community reflects confusion and ambiguity about specialist practice. Similarly, variation, duplication and inconsistency characterise the status of specialist nurse education in Australia. This situation contributes to role problems for specialist nurses and may arise from their lack of contribution to the decision making process. Seventy-five nurses undertaking a range of specialist nursing courses offered by three educational providers (a university, major teaching hospital and professional organisation) completed a survey questionnaire to establish the extent to which they agreed with the major recommendations proposed in the National Review of Specialist Nurse Education (Specialist Review) (Russell et al 1997). Despite contention within the profession, specialist nurses in Victoria show support for a unified approach toward definition, title and credentials. The discussion specifically addresses the implications for the future classification of specialist nurses in Australia.     

Role development of the clinical nurse specialist within the Indian Health Service

The clinical nurse specialist is employed in many health care facilities to improve patient care. One service unit of the Indian Health Service has expressed interest in the development of this role. At the present time, there are no advanced practitioners within this facility. Development, as well as implementation of the role, must be based on the cultural and health care needs of the Indian people. This paper discusses development of the role of perioperative clinical nurse specialist, based on personal experience, at a service unit providing health care to a large tribe of American Indians in the Southwestern United States. Examples of care incorporating cultural practices, are used to illustrate the practice of the perioperative specialist within the Indian Health Service. The nursing process is used to organize the development of the role.     

The functions of the nurse in an integrated national health service.

The British National Health Service was reorganized in 1974 when the hospital services and the community health services, previously administered separately, were brought together into one organization: the Area Health Authority. The reorganization was a culmination of developments triggered off as long ago as 1589 when the first Poor Law Act was passed, but more particularly, the reorganization was the natural outcome of a number of important government and professional nursing reports published during the past 30 years. From 1974 the community and hospital nursing services have, therefore, been amalgamated under the direction of one head of the nursing services: a district (or area) nursing officer, who, together with medical, administrative and financial colleagues, manages the health services on a day-to-day basis in a team managing by consensus. The nurse's role in the management teams is both executive and professional: the nurse's unique contribution is that he/she brings a nursing perspective to management. The new nursing service organization has provided new opportunities for reorientating middle nurse managers to a clinical role. It has also provided opportunities for innovating integrated teams of community and hospital nurses and for developing specialist nursing roles. Nurses are also now able to make other additional contributions to health care by their involvement in health care planning team activities and by their membership of the statutory area and regional nursing and midwifery advisory committees. But, on the whole, changes and influence on health care have been brought about chiefly by changes in the managerial structure of British nursing, which is a perspective of the British nursing profession that seems to have been all pervasive since Florence Nightingale's reforms and which is perpetuated by the powerfully socializing agent of British nurse training. As health care and nursing service organizations should be means towards the end of good patient care, it may be timely to focus on the suggestion of autonomous nurse practitioners supported by a separately organized administrative structure.     

Benefits of nurse prescribing for patients in pain: nurses' views

Title. Benefits of nurse prescribing for patients in pain: nurses’ views. Aim This paper is a report of a study to explore nurses’ views on the benefits of adopting the role of prescribing for patients with acute and chronic pain. Background. It was envisioned that the advent of nurse prescribing would be beneficial to the efficiency and effectiveness of the United Kingdom National Health Service. Research to date does indeed indicate that nurse prescribing can be beneficial to patients, nurses and the health service in general. Despite the expansion of nurse prescribing, there is little evidence of its impact according to nurses working in specialist areas, such as with patients in acute and chronic pain. Method. Interviews were conducted during 2006 and 2007 with 26 nurses qualified to prescribe medicines for patients in acute and chronic pain. This was a qualitative study and a thematic analysis was conducted. Findings. Nurses reported a number of benefits, including faster access to treatment, improved quality of care, more appropriate prescribing of medication, improved safety, improved relations and communication with patients, greater efficiency and cost effectiveness. Nurses benefited from increased job satisfaction, credibility with patients and healthcare professionals and also gained knowledge through prescribing. Conclusion. There is potential for the benefits of nurse prescribing to be expanded beyond the United Kingdom in settings where nurses hold similar roles in the treatment of pain, although further research using a wider range of research methods is recommended to substantiate these findings.     

La implantación de la especialidad de Enfermería de Salud Mental en Andalucía desde un enfoque comunitario

Health systems have a responsibility to respond to the new health needs of the population, which are characterized by factors such as aging, chronicity and/or dependency situations and which requires quality and specialized care adapted to different areas where care is provided, care offered by trained and increasingly qualified professionals to improve the health outcomes of the caregivers.In 2016, in Andalusia the regulatory framework by which is created the statutory professional category of nurse/specialists is published, including the specialty of Mental Health Nursing in the Andalusian Health Service.In the field of Mental Health, the development of this normative framework and the definition and occupation of positions, will allow the health system to combine the role of nurse specialist nurses with that of nurses who provide general care, registered nurses, in order to advance in the best response to the health needs of citizens in this area of care. The development of the specialty will be an added value both to improve the health outcomes of people with mental health problems, and to improve the quality of care, efficiency and sustainability of health systems.     

Specialist or generic community nursing care for HIV/AIDS patients?

Improved management of HIV-related illness means that patients spend over 80% of their time in non-institutional settings Most community-based health care in the United Kingdom is provided by primary health care teams general practitioners and community nurses, with support from social workers However, in many areas specialist HIV services have assumed responsibility for the care of HIV/AIDS patients, and primary health care teams have only played a marginal role Our study examined patterns of community nursing for HIV/AIDS patients in one regional health authority, North-East Thames (NETRHA) Interviews with 77 people in seven health districts included community nurse managers, clinical nurse specialists (CNS) HIV/AIDS and palliative care nurses The appropriateness of different nursing models was assessed, taking into account the changing epidemiological and demographic profile of the disease, the influence of dedicated HIV funding, and the effect of recent British National Health Service reforms Three models of care have developed in NETRHA specialist HIV teams, individual CNS HIV/AIDS acting as a resource to generic staff, and care given by generic community nurses Our work suggests that both generic community nurses and patients benefit from specialist input, and that this should be provided using CNSs HIV/AIDS in an advisory and facilitative capacity     

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.     

The Fife hormone service for prostate cancer patients: a cost‐effective and patient‐centric model

Injectable hormone therapy is a key element of treatment for many patients with prostate cancer. In the UK, it is typically administered in primary care. In 2003, National Health Service (NHS) Fife rolled out an innovative service for these patients, in which responsibility was moved from primary care to a specialist nurse‐led service in secondary care. The initial rationale was based on cost savings, but a significant number of other advantages have subsequently been demonstrated. These include a simpler patient journey, improved continuity of care and reduced use of consultant time. Standards of care have also improved, with fewer missed appointments, better provision of patient support and rapid access to specialist physician care when needed. An audit of 377 of 542 patients currently treated within the service has provided supportive evidence for many of these advantages. The Fife service offers a cost‐effective model for locally provided nurse‐led care that could be applied to hormone therapy services for prostate cancer elsewhere in the UK, and to services for other cancers with large numbers of patients requiring long‐term management.     

Demand for post-qualifying professional education in the health care sector in England

The British National Health Service is proposing to establish local consortia for educational contracting, with the wider involvement and responsibility being devolved to service providers This paper addresses the economic considerations of purchasing post-qualifying professional education in the English hospital sector, for hospital nurses, doctors and physiotherapists in England     

Practice nurses and clinical guidelines in a changing primary care context: an empirical study

BACKGROUND: Practice Nurses form an increasingly large proportion of the English National Health Service primary care workforce and the delegation to them of clinical work from General Practitioners has attracted some academic attention. Central to this process are clinical guidelines, which provide the interface between the movement towards 'evidence-based practice' and a range of government-driven policy developments in primary care. AIMS: To identify the attitudes of practice nurses to clinical guidelines; to investigate the impact of guidelines on nurse/physician relationships; and to describe the impact of the changing primary care context on nurses. METHODS: We interviewed a sample of 29 Practice Nurses three times during a 16-month period to clarify their attitudes towards guidelines, their use of guidelines in practice and their assessment of guidelines' importance. We gathered further data on organizational culture and perceptions of national reforms of primary care structures. RESULTS: We found that practice nurses are generally supportive of clinical guidelines. Moreover, nurses' role and influence within primary care is in a process of transition to one in which they may undertake responsibility for influencing General Practitioners' clinical behaviour so as to adhere to guidelines. Practice nurses themselves recognize and welcome this, though with some reservations. CONCLUSIONS: Our findings support the proposal that explicit codification of the scientific basis of the work of lower paid groups may enhance their relative professional status.     

Caring for a child with diabetes: the effect of specialist nurse care on parents'' needs and concerns

One hundred and sixty parents of 10- to 18-year-old children with diabetes were interviewed using Hymovich's Chronicity Impact and Coping Instrument (CICI: PQ). Eighty-two parents had access to a specialist nurse service; 72 parents did not. Regardless of the age of the child or the duration of diabetes, parents expressed a need for advice and support with child care. Parents with a specialist nurse needed information on more topics tending to focus on activities of daily living and child development rather than physical care and illness. They were also more likely to seek and receive help from nurses. Their level of concern was greater and, it is argued, may be the price parents pay for greater awareness. The findings of this study suggest that a systematic assessment of parent coping is necessary if specialist nurses are to help parents in their role as primary health carers.     

The work left undone. Understanding the challenge of providing holistic lung cancer nursing care in the UK

In England best practice guidance in cancer recommends that all patients have access to a specialist nurse such as the tumour specific clinical nurse specialist. The role has become pivotal providing aspects of care e.g. meeting information needs, holistic nurse led follow up including symptom control, managing care and providing psychological and social interventions including referral to others in the role of keyworker. There are approximately 295 lung cancer nurse specialists in England and recent study to model optimum caseload used an on line survey to look at workload of lung cancer specialist nurses. A survey of 100 lung cancer nurses from across the UK (RR78%) examined the perception of the work left undone against best practice guidance, caseload size, workload and other factors. 67 of 78 respondents perceived they left work such as proactive management (52) undertaking holistic needs assessments (46) providing appropriate psychological care (26) and meeting information needs (16). The majority (70) worked unpaid overtime (mean 3.8 h range 1–10 h) per week. Although proactive management is thought to result in better outcomes for lung cancer patients in terms of survival, quality of life and decisions of end of life a substantial number of the specialist nurses felt that factors such as caseload and organisational factors inhibited this.