Exploring the perceived role and impact of the nurse consultant

Background: Nurse consultant roles were introduced in 1999 with defined role criteria including expert practice, research, education and leadership. The primary objective of the role is to develop nurses and nursing to provide effective patient outcomes. In 2000 the first nurse consultant in rheumatology was appointed to establish a co‐ordinated service for the management of patients with chronic musculoskeletal pain. There are now ten nurse consultants within rheumatology yet little is known of their role or impact. Aim: The aim of the study was to identify the perceived role and impact of one nurse consultant (NC) in rheumatology within the context of being a practitioner‐researcher. Method: Seven peers of the NC and five patients cared for by the NC participated in a semi‐structured interview to identify their perceptions regarding the role of the NC within the rheumatology service. Results: The following themes were identified from the interviews: (1) development of a new model of care for patients with chronic musculoskeletal pain; (2) holistic person‐centred care experienced and valued by the patient; (3) leadership and education; and (4) feeling cared for. Conclusion: The NC role had impacted on service development and culture in the instigation of a chronic musculoskeletal pain service and leadership and education activities. Patients experienced the holistic nature of the role. Copyright © 2006 John Wiley & Sons, Ltd.     

Potential for development of haemophilia link nurse role within UK hospitals

Link nurses are practising nurses with an expressed interest in a given specialty, with formal links to clinical nurse specialists and other specialist staff. The role involves attending meetings to discuss ideas and new developments, and relaying findings to other ward nurses to improve their practice. Such nurses are common in many specialties such as diabetes and tissue viability. In haemophilia, the role has the potential to enhance the care of haemophilia patients on general hospital wards. In April 2012, a focus group of five haemophilia nurses was convened to discuss their experiences of ‘link nurse’ programmes within district general hospitals and the potential value of developing the haemophilia link nurse role, and to consider the materials needed to support such role development. It was agreed to test whether other haemophilia nurses perceived such a need by means of a short five‐item questionnaire devised by the group and made available to all members of the UK's Haemophilia Nurse's Association via Survey‐Monkey. Final responses from 59 haemophilia nurses across the UK have been analysed. Most nurses agreed that there was value in the development of a haemophilia link nurse role within UK hospitals and thought their trusts would support it. While barriers and potential downsides were acknowledged, this was seen as a useful way of sharing information and knowledge with colleagues from different specialties and of raising awareness of bleeding disorders among the general nursing community. Haemophilia nurses should coordinate the development of a Haemophilia Link Nurse training and education pack.     

The future history of gerontological nursing

Having established an academic and clinical infrastructure, geriatric nursing is well positioned to play a central role in improving the health of the nation's older adults now and in the future. Currently, whether working independently, in collaborative practice with physicians, or as members of geriatric teams, geriatric nurse practitioners and clinical specialists have been shown to improve care to older adults in the community, in hospitals, and in skilled nursing facilities. Sixty-three master's programs now prepare advanced practice geriatric nurses. Geriatric nurse researchers have contributed to our understanding of the most pressing problems that impact profoundly on the health and quality of life of older adults. Despite these advances, the number of geriatric nurse specialists remains small, with only 4200 certified specialists and a serious shortage of geriatric nursing faculty. Geriatric nursing is moving to ensure geriatric competency in all nurses who work with older adults in the future. The future should see the benefits of current efforts to infuse geriatric content into baccalaureate programs that prepare registered nurses, into master's programs that prepare adult and family nurse practitioners, and into the day-to-day practice of the nation's 2.2 million practicing registered nurses.     

Rheumatology nursing: Evolution of the role and functions of a subspecialty

This article traces the evolution and historical background of rheumatology nursing through the contribution of those who were a part of the process. The role and functions of the rheumatology nurse are revealed in the literature and the activities in which rheumatology nurses have been involved. Rheumatology nursing as aspecialty in itself or as a subspecialty of rehabilitation, orthopedic, or medical/surgical nursing is described.     

How do clinical nurse specialists influence primary care management of asthma? A qualitative study.

METHODS: We carried out a qualitative interview study alongside a randomised controlled trial which tested the effectiveness of asthma nurse specialists in east London. We carried out face-to-face interviews with five asthma nurse specialists, eight general practitioners (GPs) and six practice nurses, and also held a focus group session with six people who had attended hospital with acute asthma. RESULTS: Four factors were associated with effective specialist nurse liaison: (1) primary care practices which prioritised asthma care; (2) GPs who trusted practice nurses to manage chronic disease autonomously; (3) GPs who recognised specialist nurse expertise and acted on their advice; and (4) practices which had simple systems in place to deal with recommendations. Patients found nurse specialists approachable and informative. CONCLUSIONS: Asthma specialist nurse influence was greatest in practices that prioritised asthma care and where practice nurses had clinical autonomy. Patients valued specialist nurses but found advice from a multiplicity of clinicians confusing. Ensuring that practices prioritise chronic disease care, and improving the credibility of nurse specialists amongst GPs, may improve the effectiveness of asthma nurse specialists.     

Why don't haemophilia nurses do research?

Clinical research should form a core component of the role of haemophilia nurse specialists. The UK Haemophilia Nurses Association sought to determine the barriers that prevent nurse specialists from engaging in research and to seek ways to promote clinical research by haemophilia nurses in the UK. Web-based survey with subsequent workshop discussion was conducted. Responses were received from 32 nurses (a 50% response rate), all of whom agreed that haemophilia nurses should be actively involved in nursing research although only 21 had actually participated in research specifically related to haemophilia practice. Of these, most research had been related to educational programmes or (less commonly) was limited to data collection as part of multidisciplinary studies. Involvement in research rarely resulted in publication. Some barriers to involvement in nursing research and subsequent publication were suggested by survey respondents. They also identified key practice areas that warranted nurse-based research including carriership and antenatal decision-making, along with the role and impact on care of the specialist haemophilia nurse, education and empowerment. To overcome the barriers to engaging in research and publishing, nurses require dedicated research time, mentorship and collaboration with more experienced haemophilia nurse researchers.     

Assessing Quality of Life in routine clinical practice: A pilot study

To assess the feasibility and usefulness of administering a quality of life (QoL) questionnaire in routine clinical practice, we performed a 5‐centre UK study with nurses administering a disease‐specific questionnaire, the Renal Quality of Life Profile (RQLP), to 140 patients. The completed questionnaires were reviewed by the nurse who felt that there were issues requiring discussion in 46% of patients. These issues were either discussed with the nurse immediately in person (65%), or the patient was contacted by telephone (28%) or post (7%) and appropriate referrals and interventions were actioned. We conclude that measurement of QoL is feasible and useful in routine clinical nursing practice.     

Influences that drive clinical decision-making among rheumatology nurses. Part 1: literature review

Decisions nurses make while providing patient care to their client group will impact on the patient's immediate and long-term outcomes and will also impact on service provision. Although many studies have focused on the clinical decision-making process itself within general nursing areas, little has been published as to what factors influence decisions in rheumatology nursing at the clinical level. Initial review of the literature suggested the following themes could influence decision-making: clinical decision-making, intuition, evidence-based practice, experiential learning, knowing the patient, skilled knowledge and rheumatology nursing. This article examines the literature surrounding clinical decision-making which may influence decision-making within rheumatology nursing practice.     

Critical care nurse perceptions of family needs

Family needs research has for the most part focused on the families' perceptions when a significant other is admitted to the intensive care unit. We examined critical care nurse perceptions of family needs. The questionnaire "Needs of Families of Critically Ill Patients" was given to 126 intensive care unit nurses. The tool was an adaptation of Molter's questionnaire "Needs of Relatives of Critically Ill Patients." The revised tool examined nurse perception of family needs, perception of time available to meet the needs in daily practice, and the best professional to meet the family need if the need was identified as best met by someone other than the nurse. The majority of the nurses perceived family needs as important or very important, and 85% of the nurses indicated that they were able to meet family needs and had the time to do so. Cognitive family were ranked higher than psychologic or personal and physical needs. Nurses from the four intensive care units ranked family needs significantly differently, a result that may be influenced by differing patient acuity and patient length of stay on individual units. Nurses' perceptions of family needs were influenced by units worked, length of time practicing in critical care, educational preparation, and length of time in nursing.     

Promoting physical activity in patients with rheumatoid arthritis: rheumatologists’ and health professionals’ practice and educational needs

Despite the proven health benefits, patients with rheumatoid arthritis (RA) are found to be less physically active than their healthy peers. The aim of this study was to examine to what extent and how physical activity, defined as any bodily movement resulting in energy expenditure, is currently promoted by health care providers in patients with RA and how they perceive their competencies and educational needs. For this cross-sectional study, Dutch rheumatologists, rheumatology clinical nurse specialists, and expert physical therapists were sent a postal survey including four domains: attitudes towards physical activity in RA, advices given to patients with RA, and perceived competencies and educational needs. A total of 126 rheumatologists (50%), 132 clinical nurse specialists (56%), and 112 physical therapists (53%) returned the questionnaire. More than 90% agreed that physical activity is an important health goal for RA patients and regularly advised their patients to engage in physical activity. Public health recommendations for moderate-intensity physical activity were found attainable in RA patients by 66%, 74%, and 65% and were by used by 19%, 41%, and 49% of them, respectively. On average, respondents rated their competency to promote physical activity as low to medium, and 54%, 85%, and 72% of the respondents expressed a need for additional education regarding this topic. Rheumatologists, nurses, and physical therapists considered regular physical activity to be an important health goal for RA patients. The majority of them commonly gave advice on physical activity but felt not sufficiently competent and indicated a need for additional education.     

Rheumatology nurse practitioners' perceptions of their role

Objectives: To identify the current practices of rheumatology nurse practitioners and ascertain their perceptions of how their role could be enhanced. Method: A cross‐sectional questionnaire study of currently employed nurse practitioners in rheumatology in the United Kingdom (UK) was undertaken. Results: 200 questionnaires were distributed and 118 nurses responded. Ninety‐five respondents met the inclusion criteria for undertaking an advanced nursing role. Typical conditions dealt with included: rheumatoid arthritis (96.8%); psoriatic arthritis (95.8%); osteoarthritis (63.2%); ankylosing spondylitis (62.8%); systemic lupus erythematosus (51.6%); and scleroderma (34.7%). Drug monitoring, education, counselling of patients and arranging basic investigations were routinely performed by more than 80% of respondents. A smaller proportion performed an extended role that included dealing with referrals, research and audit, the administration of intra‐articular injections, and admission of patients. Specific attributes identified as being necessary for competence were: knowledge and understanding of rheumatic diseases (48.4%); drug therapy (33.7%); good communication skills (35.8%); understanding of the roles of the team (27.4%); working effectively (23.2%) as part of a multidisciplinary team; assessment of patients by physical examination (28.4%); teaching (26.3%), research (17.9%); organizational skills (14.7%); and the interpretation of investigations (9.5%). Factors that could enhance their role included: attendance at postgraduate courses (30.5%); obtaining further qualifications (13.7%); active participation in the delivery of medical education (41.1%); training in practical procedures (31.6%); protected time and resources for audit and research (11.6%); formal training in counselling (11.6%); and implementation of nurse prescribing (10.5%). Conclusion: Nurse practitioners already have a wide remit and play an invaluable part in the delivery of modern rheumatology services. An extended role could improve patient care and enhance nursing career pathways in rheumatology. Copyright © 2006 John Wiley & Sons, Ltd.     

Rheumatology nurses' work-related empowerment

Objective: The purpose of the study was to investigate rheumatology nurse specialists' work related empowerment. Method: Nine nurses undertaking graduate studies were asked to write an essay on ‘What work related skills does the rheumatology nurse need to master?’ In addition, one interview was conducted. The material was analysed using the method of inductive content analysis. Results: The following key areas of work related empowerment were identified as important: knowledge about rheumatic diseases; treatments and follow up monitoring care; knowledge about patient education and counselling; collaboration and the ability to co operate; mastery of manual skills and development of the quality of nursing care for patients with rheumatic disease. Conclusion: The study contributes to a better understanding of work related empowerment among rheumatology nurses. The results of the study can be used to develop the role components of healthcare professionals who attend patients with rheumatic disease. Copyright © 2007 John Wiley & Sons, Ltd.     

Das Curriculum ?Rheumatologische Fachassistenz DGRh-BDRh�� als Weg der Professionalisierung medizinischer Assistenzberufe

Rheumatological care in Germany is influenced by limited resources and education and qualification of health professionals is a way to optimize utilization of these resources.The curriculum for rheumatology health professionals of the Academy of the German Association of Rheumatologists (DGRh) was developed to qualify clinical nursing specialists of rheumatology clinics as well as specialized rheumatology hospitals on a systematic basis.Since 2006 499 participants have each been trained over 4 weekends and certification was achieved by examinations. The topics cover the principles of anatomy and the pathology of diseases up to modern diagnostic methods and treatment, including practical skills. Additional specialized courses for nurses of rheumatology hospitals and refresher courses give the participants the opportunity to increase their depth of knowledge.After 8 of the basic courses questionnaires were sent to all participants for evaluation and 143 (51%) out of 277 participants responded. Of the responders 95% found that their knowledge of understanding rheumatic diseases improved considerably or very considerably, 90% found that their ability to determine urgent cases and 86% to correctly judge emergency situations had improved and 50% agreed with the statement that their field of work and their tasks had changed after the training courses. Increased responsibilities, documentations of patient history, involvement in clinical trials and infusions and information of the patients about their disease or the treatment were listed as new tasks of the participants. In conclusion the evaluation shows that the curriculum for rheumatology health professionals is an effective step towards qualification for clinical nursing specialists. We believe that this will support the work of medical doctors in rheumatology and will improve the quality of care for patients with rheumatic diseases.     

护理人员参与MDT的身份与角色的研究进展

多学科团队（multidisciplinary team,MDT）已成为国内外恶性肿瘤的常见诊疗模式。护理人员越来越多以护理专家、专科护士、个案管理护士等身份的参与MDT,参与作出临床决策的过程,承担了沟通者、协调者等角色,还在姑息治疗多学科团队中发挥了重要作用。虽然目前护理人员参与MDT还需面对挑战,但通过指南与规范的完善、良好的团队文化的构建、专科护士的培养、MDT的培训和管理者的支持措施,有可能显著提高临床护理人员参与MDT的质量。     

Clinical nurse specialists and nurse practitioners: complementary roles for infectious disease and infection control

BACKGROUND: The escalation of infectious diseases worldwide heralds an unprecedented need for nurses with advanced practice graduate preparation. OBJECTIVE: To describe how a graduate program prepares clinical nurse specialists and nurse practitioners in infectious diseases or infection control to provide distinct yet complementary care for patients with contagious disease and potentially antimicrobial-resistant infections. RESULTS: The University of Washington School of Nursing launched a new master of nursing program for infectious disease and infection control to reduce the threat of infectious diseases and multiple-resistant organisms.     

Perceived age of facial features is a significant diagnosis criterion for age‐related carotid atherosclerosis in Japanese subjects: J‐SHIPP study

Aim: Vascular aging is known to be a major determinant of life expectancy. Recently, perceived age was reported to be a better predictor for mortality than chronological age. Based on these findings, we investigated whether or not perceived age was related to atherosclerosis in a general population. Methods: The participants were 273 individuals aged ≥50 years who participated in the Skin‐doc in Anti‐Aging Doc program. Facial photos were taken under a shadowless lamp from three directions (antero‐posterior, and 60° right and left oblique projection) using a high‐resolution digital camera. Perceived age was assessed either by 19 professional nurses in the geriatric ward or using facial identification program software. Carotid intima‐media thickness (IMT), radial augmentation index (AI) and brachial‐ankle pulse wave velocity (baPWV) were measured as indices for atherosclerosis. Results: The perceived age difference (expressed as the difference between perceived age and chronological age), when estimated either by nurses or software, was significantly and negatively associated with chronological age. Subjects who were evaluated by nurses to be younger than their chronological age had significantly lower carotid IMT after adjustment for chronological age. Conversely, carotid IMT was an independent and negative determinant of looking young, as perceived by nurses. Similar observations were also made between perceived age using facial identification software and carotid IMT. Radial AI and baPWV were not associated with perceived age. Conclusion: These findings show that carotid atherosclerosis is related to perceived age. This association might underlie previous findings showing that perceived age predicts life expectancy. Geriatr Gerontol Int 2012; ??: ??–??.