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Journal articles on the topic 'Clinical nurse consultant'

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Published: 10 December 2022
Last updated: 28 January 2023

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1

Mackinson, Lynn G., Juliann Corey, Veronica Kelly, Kristin P. O’Reilly, Jennifer P. Stevens, Susan Desanto-Madeya, Donna Williams, Sharon C. O’Donoghue, and Jane Foley. "Nurse Project Consultant: Critical Care Nurses Move Beyond the Bedside to Affect Quality and Safety." Critical Care Nurse 38, no. 3 (June 1, 2018): 54–66. http://dx.doi.org/10.4037/ccn2018838.

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A nurse project consultant role empowered 3 critical care nurses to expand their scope of practice beyond the bedside and engage within complex health care delivery systems to reduce harms in the intensive care unit. As members of an interdisciplinary team, the nurse project consultants contributed their clinical expertise and systems knowledge to develop innovations that optimize care provided in the intensive care unit. This article discusses the formal development of and institutional support for the nurse project consultant role. The nurse project consultants’ responsibilities within a group of quality improvement initiatives are described and their challenges and lessons learned discussed. The nurse project consultant role is a new model of engaging critical care nurses as leaders in health care redesign.
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2

Fowler, John. "Clinical supervision: from staff nurse to nurse consultant." British Journal of Nursing 22, no. 22 (December 12, 2013): 1322. http://dx.doi.org/10.12968/bjon.2013.22.22.1322.

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3

Fowler, John. "Clinical supervision: from staff nurse to nurse consultant." British Journal of Nursing 23, no. 2 (February 12, 2014): 114. http://dx.doi.org/10.12968/bjon.2014.23.2.114.

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4

Nitkunan, Arani, Creselda Bagtas, Ajay Boodhoo, Charmaine Grant, Glenda Lastrilla, Bridget MacDonald, Francesca Mastrolilli, Waqar Rashid, Medina Southam, and Fred Schon. "025 Croydon neurology: 5 years of novel service developments." Journal of Neurology, Neurosurgery & Psychiatry 93, no. 9 (August 12, 2022): e2.218. http://dx.doi.org/10.1136/jnnp-2022-abn2.69.

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5 years ago we embarked on a series of novel developments to improve our DGH neurology services. The key was ever closer integrated working between consultant neurologists and specialist nurses with support from our Trust and commissioners.We highlight 6 very diverse ongoing projects:1. Acute neurology ward referrals have increased by 49% between 2016-2021 with nurses triaging referrals prior to consultant review.2. Post discharge nurse telephone review for selected patients since 2020 to try and reduce readmission rates.3. Consultant delivered helpline for all local GPs Monday to Friday since 2020 to discuss urgent cases of concern.4. Nurse delivered lumbar puncture service, since 2019 138 procedures carried out.5. Diagnostic coding for all neurology outpatients started in 2021. Within 8 months all 5 consultants were coding over 70% of attendances.6. Patient initiated follow up (PIFU) – 2020 NHS England initiative. Specialist nurse Helpline for patients with epilepsy, multiple sclerosis and Parkinson’s running successfully since 2018.Service improvements need not be expensive or onerous but require imagination and team cohesion. We strongly recommend others to try what seems most appropriate to their service.
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5

Castledine, George. "The role of the clinical nurse consultant." British Journal of Nursing 7, no. 17 (September 24, 1998): 1054. http://dx.doi.org/10.12968/bjon.1998.7.17.5603.

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6

Richmond, Jacqui. "Clinical nurse consultant (HBV) and research fellow." Gastrointestinal Nursing 13, no. 7 (September 2, 2015): 64. http://dx.doi.org/10.12968/gasn.2015.13.7.64.

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7

Walker, Marcus L. "The Clinical Nurse Specialist as a Consultant." Nursing Management (Springhouse) 17, no. 5 (May 1986): 61. http://dx.doi.org/10.1097/00006247-198605000-00026.

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8

Maylor, Miles E. "Differentiating between a consultant nurse and a clinical nurse specialist." British Journal of Nursing 14, no. 8 (April 2005): 463–68. http://dx.doi.org/10.12968/bjon.2005.14.8.17932.

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9

Fowler, John. "From staff nurse to nurse consultant: Survival Guide part 4: Surviving as a senior clinical nurse." British Journal of Nursing 28, no. 16 (September 12, 2019): 1096. http://dx.doi.org/10.12968/bjon.2019.28.16.1096.

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10

Fowler, John. "Clinical supervision: from staff nurse to nurse consultant. Part 11: evaluation." British Journal of Nursing 23, no. 1 (January 9, 2014): 55. http://dx.doi.org/10.12968/bjon.2014.23.1.55.

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11

York, L. N., and P. Freed. "Psychiatric Clinical Nurse Specialist as Chemical Dependence Consultant." Journal of Addictions Nursing 12, no. 1 (2000): 43–50. http://dx.doi.org/10.3109/10884600009040637.

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12

POTEET, GAYE W. "The Consultant Role of the Clinical Nurse Specialist." Clinical Nurse Specialist 1, no. 1 (1987): 45. http://dx.doi.org/10.1097/00002800-198700110-00012.

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13

POTEET, GAYE W. "The Consultant Role of the Clinical Nurse Specialist." Clinical Nurse Specialist 1, no. 1 (1987): 45. http://dx.doi.org/10.1097/00002800-198721000-00012.

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14

Fowler, John. "Clinical supervision: from staff nurse to nurse consultant Part 1: What is clinical supervision?" British Journal of Nursing 22, no. 13 (July 2013): 786. http://dx.doi.org/10.12968/bjon.2013.22.13.786.

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15

Fowler, John. "From staff nurse to nurse consultant - Clinical leadership part 12: series summary." British Journal of Nursing 26, no. 6 (March 23, 2017): 368. http://dx.doi.org/10.12968/bjon.2017.26.6.368.

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16

Fowler, John. "Advancing Practice: from staff nurse to nurse consultant. Part 4: clinical supervision." British Journal of Nursing 22, no. 4 (February 28, 2013): 240. http://dx.doi.org/10.12968/bjon.2013.22.4.240.

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17

Walters, Allan John. "Being a clinical nurse consultant: A hermeneutic phenomenological reflection." International Journal of Nursing Practice 2, no. 1 (March 1996): 2–10. http://dx.doi.org/10.1111/j.1440-172x.1996.tb00015.x.

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18

Rosser, Elizabeth, Rachael Grey, Deborah Neal, Julie Reeve, Caroline Smith, and Janine Valentine. "Supporting clinical leadership through action: The nurse consultant role." Journal of Clinical Nursing 26, no. 23-24 (July 13, 2017): 4768–76. http://dx.doi.org/10.1111/jocn.13830.

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19

O’Connor, Margaret, and Ysanne Chapman. "The palliative care clinical nurse consultant: An essential link." Collegian 15, no. 4 (October 2008): 151–57. http://dx.doi.org/10.1016/j.colegn.2008.06.002.

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20

Connolly, Lauren, Alison Pottle, and Robert Smith. "Developing an innovative role for a clinical nurse specialist in structural heart disease services." British Journal of Cardiac Nursing 16, no. 5 (May 2, 2021): 1–9. http://dx.doi.org/10.12968/bjca.2021.0001.

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This article explores a new advanced nursing role within interventional cardiology. The role was jointly developed by the lead consultant and clinical nurse specialist, and has received the first official centre of excellence award in the world. As a result, the service will now deliver expert training programmes taught by the consultant team and specialist nurse. This service was created for patients with mitral valve disease. It has a dedicated and structured pathway, with the patient always at the centre of care. This article introduces the role of nurse second operator in complex valvular intervention, which allows the clinical nurse specialist to be fully involved in the entire patient journey from referral to discharge. The author describes how the role was established and the developments that have been made in the first 3 years of the post. The role encompasses both inpatient and outpatient care in a bespoke, nurse-led service, as well as responsibility for maintaining accurate data collection and adherence to the patient pathway throughout the service. This has facilitated a streamlined and tailored service that strives to deliver high-quality, equitable care to patients across the UK. It is hoped that this will encourage other centres to develop such roles for specialist nurses.
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21

Fowler, John. "From staff nurse to nurse consultant: Clinical leadership part 11: leadership and training." British Journal of Nursing 26, no. 4 (February 23, 2017): 248. http://dx.doi.org/10.12968/bjon.2017.26.4.248.

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22

Fowler, John. "Teaching and Learning: from staff nurse to nurse consultant. Part 4: Clinical teaching." British Journal of Nursing 21, no. 14 (July 26, 2012): 880. http://dx.doi.org/10.12968/bjon.2012.21.14.880.

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23

Fowler, John. "Clinical supervision: from staff nurse to nurse consultant. Part 2: clarity of terms." British Journal of Nursing 22, no. 14 (August 2013): 848. http://dx.doi.org/10.12968/bjon.2013.22.14.848.

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24

Fowler, John. "Advancing practice: from staff nurse to nurse consultant Part 4: using clinical supervision." British Journal of Nursing 22, no. 16 (September 2013): 941. http://dx.doi.org/10.12968/bjon.2013.22.16.941.

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25

Fowler, John. "Clinical supervision: from staff nurse to nurse consultant: Part 7: the manager's role." British Journal of Nursing 22, no. 19 (October 2013): 1135. http://dx.doi.org/10.12968/bjon.2013.22.19.1135.

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26

Fowler, John. "Clinical supervision: from staff nurse to nurse consultant. Part 9: models of implementation." British Journal of Nursing 22, no. 21 (December 11, 2013): 1261. http://dx.doi.org/10.12968/bjon.2013.22.21.1261.

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27

Dulhanty, Louise. "BANN shines a light on innovative practice." British Journal of Neuroscience Nursing 18, no. 6 (December 2, 2022): 284. http://dx.doi.org/10.12968/bjnn.2022.18.6.284.

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The British Association of Neuroscience Nurses (BANN) is driven in supporting the development of roles within Neuroscience Nursing. The second article in this series highlights the fantastic career of Louise Dulhanty, a Neurovascular Consultant Nurse at the Manchester Centre for Clinical Neurosciences.
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28

Begum, J., J. Fourmy, and M. K. Nisar. "SAT0648-HPR CAN A SPECIALIST NURSE REPLACE A CONSULTANT - AN INNOVATIVE MODEL FOR OSTEOPOROSIS CARE." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1283.1–1283. http://dx.doi.org/10.1136/annrheumdis-2020-eular.1986.

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Background:Specialist services are heavily reliant on a consultant reviewing a patient and discussing management options. However this can significantly delay treatment pathway owing to lack of sufficient consultant appointments. Clinical nurse specialists (CNSs) are an integral part of a multidisciplinary team employed to provide effective care for the diverse needs of patients with chronic conditions such as osteoporosis.Objectives:We designed an innovative proof-of-concept osteoporosis service with patients only consulting a metabolic bone CNS and a consultant providing remote oversight. The aim of the project was to improve the efficiency of the service by eliminating consultant appointments and reducing unnecessary hospital visits whilst continuing to deliver a high-quality and safe service.Methods:A new pathway was implemented where a consultant rheumatologist and a CNS virtually triaged post menopausal women over the age of 65 into the service. A dedicated proforma provided the template for the CNS to undertake new patient telephone consultation. Relevant investigations were requested during the telephone clinic and treatment related information was despatched to help with shared decision making. All patients were then reviewed in a consultant-CNS virtual MDT. Appropriate parenteral treatment option was agreed and confirmed to each individual. The CNS worked through a safety checklist and provided further advice and support to the patient as necessary. Using the database, we compared the timelines for patient journey to conventional pathway, obtained the number of consultant follow-up appointments saved by implementing this service and calculated total savings.Results:In the proof-of-concept phase, 60 patients were triaged into the new service. It was a combination of 25 new referrals and 35 patients pulled from the consultants’ waiting list. Mean age of participants was 77.2 years (65-92). Referral to virtual triage took median 20 days (0-62). Median time for triage to new patient CNS telephone consultation was 18 days (6-87). Time to virtual MDT for treatment authorisation was median zero days (0-76 days). 19 patients had anabolic therapy commenced via home care. Remaining had anti resorptive therapy. No patient requested face-to-face review. Only one patient fed back that they would’ve preferred to see the consultant once. Sixty new patient consultant appointments were saved and median delay in treatment commencement was reduced from 84 to 38 days.Conclusion:To our knowledge, this is the first successful example of an innovative service wholly provided by CNSs for commencing parenteral anti-osteoporotic therapy with only remote consultant supervision. Our service redesign has significantly improved the efficiency of the parenteral osteoporosis pathway with reduction in treatment delay and a more streamlined patient journey. A nurse-delivered osteoporosis treatment pathway is highly effective, safe and provides an innovative solution to thinly stretched health care needs of people with chronic conditions.Disclosure of Interests:Julie Begum: None declared, Joanne Fourmy: None declared, Muhammad Khurram Nisar Grant/research support from: Muhammad Nisar undertakes clinical trials and received support (including attendance at conferences, speaker fees and honoraria) from Roche, Chugai, MSD, Abbvie, Pfizer, BMS, Celgene, Novartis and UCB, Consultant of: Muhammad Nisar undertakes clinical trials and received support (including attendance at conferences, speaker fees and honoraria) from Roche, Chugai, MSD, Abbvie, Pfizer, BMS, Celgene, Novartis and UCB, Speakers bureau: Muhammad Nisar undertakes clinical trials and received support (including attendance at conferences, speaker fees and honoraria) from Roche, Chugai, MSD, Abbvie, Pfizer, BMS, Celgene, Novartis and UCB
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29

Hughes, J. "The role of the nurse consultant in infection control." British Journal of Infection Control 3, no. 5 (October 2002): 26–29. http://dx.doi.org/10.1177/175717740200300505.

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W ith the advent of the Controls Assurance Standards (NHS Executive, 1999), Clinical Governance (1999), The Management and Control of Hospital Acquired Infections in Acute NHS Trusts in England (Department of Health, 2000) and other circulars and directives, the role of the infection control nurse has never been so challenging, putting infection control firmly on the government and public agenda. In line with this and the Health Service Circular 1999/217 Nurse Midwife and Health Visitor Consultants (Department of Health, 1999), it enabled the appointment of a nurse consultant in infection control at University Hospital Aintree, Liverpool. This paper will review the background to the development of the role to date, how it applies to the discipline of infection control and suggest how to take the role forward in the future.
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30

Rogers, Martha, and Jean Trimnell. "Maximizing the use of the clinical nurse specialist as consultant." Nursing Administration Quarterly 12, no. 1 (1987): 53–58. http://dx.doi.org/10.1097/00006216-198701210-00011.

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31

Schlict, K. "The role of the clinical nurse consultant in intensive care." Australian Critical Care 10, no. 1 (March 1997): 24. http://dx.doi.org/10.1016/s1036-7314(97)70386-2.

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32

Cashin, Andrew, Helen Stasa, Janice Gullick, Rae Conway, Michelle Cunich, and Thomas Buckley. "Clarifying Clinical Nurse Consultant work in Australia: A phenomenological study." Collegian 22, no. 4 (December 2015): 405–12. http://dx.doi.org/10.1016/j.colegn.2014.09.002.

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33

Jannings, Wendy, and Sue Armitage. "Informal Education: A Hidden Element of Clinical Nurse Consultant Practice." Journal of Continuing Education in Nursing 32, no. 2 (March 1, 2001): 54–59. http://dx.doi.org/10.3928/0022-0124-20010301-04.

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34

Fowler, John. "Supporting self and others: from staff nurse to nurse consultant. Part 5: Clinical supervision." British Journal of Nursing 20, no. 13 (July 12, 2011): 830. http://dx.doi.org/10.12968/bjon.2011.20.13.830.

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35

Liu, Pingyang, Audrey Lyndon, Jane L. Holl, Julie Johnson, Karl Y. Bilimoria, and Anne M. Stey. "Barriers and facilitators to interdisciplinary communication during consultations: a qualitative study." BMJ Open 11, no. 9 (September 2021): e046111. http://dx.doi.org/10.1136/bmjopen-2020-046111.

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ObjectiveCommunication failures between clinicians lead to poor patient outcomes. Critically injured patients have multiple injured organ systems and require complex multidisciplinary care from a wide range of healthcare professionals and communication failures are abundantly common. This study sought to determine barriers and facilitators to interdisciplinary communication between the consulting trauma, intensive care unit (ICU) team and specialty consultants for critically injured patients at an urban, safety-net, level 1 trauma centre.DesignAn observational qualitative study of barriers and facilitators to interdisciplinary communication.SettingWe conducted observations of daily rounds in two trauma surgical ICUs and recorded the most frequently consulted teams.ParticipantsKey informant interviews after presenting clinical vignettes as discussion prompts were conducted with a broad range of clinicians from the ICUs and physicians and nurse practitioners from the consultant teams who were identified during the observations. Interviews were recorded and transcribed verbatim. Data of these 10 interviews were combined with primary transcript data from prior study (25 interviews) and analysed together because of the same setting with same themes. Independent coding of the transcripts, with iterative reconciliation, was performed by two coders.Outcomes measuresFacilitators and barriers of interdisciplinary communication were identified.ResultsA total of 35 interview transcripts were analysed. Cardiology and interventional radiology were the most frequently consulted teams. Consulting and consultant clinicians reported that perceived accessibility from the team seeking a consultation and the consultant team impacted interdisciplinary communication. Accessibility had a physical dimension as well as a psychological dimension. Accessibility was demonstrated by responsiveness between clinicians of different disciplines and in turn facilitated interdisciplinary communication. Social norms, cognitive biases, hierarchy and relationships were reported as both facilitators and barriers to accessibility, and therefore, interdisciplinary communication.ConclusionAccessibility impacted interdisciplinary communication between the consulting and the consultant team.Article summaryElucidates barriers and facilitators to interdisciplinary communication between consulting and consultant teams.
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36

Popejoy, Lori L., Marilyn J. Rantz, Vicki Conn, Deidre Wipke-Tevis, Victoria T. Grando, and Rose Porter. "Improving Quality of Care in Nursing Facilities: Gerontological Clinical Nurse Specialist as Research Nurse Consultant." Journal of Gerontological Nursing 26, no. 4 (April 1, 2000): 6–9. http://dx.doi.org/10.3928/0098-9134-20000401-04.

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37

Fowler, John. "Clinical supervision: from staff nurse to nurse consultant. Part 6: Implementation at a strategic level." British Journal of Nursing 22, no. 18 (October 2013): 1079. http://dx.doi.org/10.12968/bjon.2013.22.18.1079.

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38

Weaver, Rhys, Moira O'Connor, Irene Ngune, Richard Carey Smith, Jane Phillips, and Georgia Halkett. "Perspectives of the sarcoma clinical nurse consultant role: A qualitative study." Collegian 28, no. 4 (August 2021): 422–30. http://dx.doi.org/10.1016/j.colegn.2020.12.006.

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39

McDougall, Graham J. "The Role of the Clinical Nurse Specialist Consultant in Organizational Development." Clinical Nurse Specialist 1, no. 3 (1987): 133–39. http://dx.doi.org/10.1097/00002800-198700130-00013.

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40

McDougall, Graham J. "The Role of the Clinical Nurse Specialist Consultant in Organizational Development." Clinical Nurse Specialist 1, no. 3 (1987): 133–39. http://dx.doi.org/10.1097/00002800-198723000-00013.

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41

O'Rourke, Ciara. "Acquired brain injury nurse-led clinic: roll out, review and referral." British Journal of Neuroscience Nursing 18, no. 1 (February 2, 2022): 5–9. http://dx.doi.org/10.12968/bjnn.2022.18.1.5.

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Aim: This paper documents the introduction of a nurse-led outpatient clinic for patients post acquired brain injury (ABI). Nurse-led clinics in primary care settings have been widely acclaimed as a positive step towards improving access to investigations and specialist services, and offering a solution towards limited clinician resources. Method: A retrospective analysis was undertaken to review the ABI nurse-led clinic service over a 12-month period. This analysis reviewed how the clinic has impacted the hospital in terms of hours saved by the neurosurgical consultant clinic by the patient attending the nurse-led clinic. This paper also looks at how the clinic benefits the patient by timely access to the ABI clinical nurse specialist along with referrals and review by community-based rehab services, Headway Ireland and ABI Ireland. Findings: Through the review of the ABI clinic over a 12-month period, 47 hours were saved from the consultant led clinics. It was also found that 30% of patients reviewed in the ABI clinic were now in an appropriate ABI community support service. Conclusion: The audit shows that the ABI nurse-led clinic benefits the patient is terms of timely review and follow-up after traumatic brain injury (TBI). The patient also has early access to specialist TBI follow-on services, which enhances recovery and overall quality of care. The nurse-led clinic also benefits the organisation by reviewing and following up on patients who would have previously have been reviewed at the consultant-led clinics, therefore, reducing waiting times.
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42

Masieh, D., J. Begum, J. Fourmy, and M. K. Nisar. "POS1488-HPR CAN A SPECIALIST NURSE LEAD A COMPREHENSIVE OSTEOPOROSIS SERVICE WITH REMOTE SUPERVISION – AN INNOVATIVE CONCEPT." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 1028.2–1029. http://dx.doi.org/10.1136/annrheumdis-2021-eular.1069.

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Background:Specialist services traditionally rely on a consultant to lead a multidisciplinary team and provide patient facing activities. However, demand outstrips the limited expertise available and therefore significant delays occur in treatment pathways. There is an urgent need to expand the skill set of the employed workforce and think ‘outside the box’. A service run by clinical nurse specialists (CNS) can be an effective solution. CNS are already an integral part of multidisciplinary teams caring for a diverse range of patients including those with chronic conditions such as osteoporosis.Objectives:We designed an innovative osteoporosis service with patients consulting only a metabolic bone CNS with a consultant rheumatologist providing remote oversight. The aim of the project was to improve the efficiency of the service by eliminating consultant appointments and reducing unnecessary hospital visits while continuing to deliver a high-quality and safe service.Methods:A new pathway was implemented where a consultant rheumatologist and a CNS virtually triaged post menopausal women over the age of 65 into the service. A dedicated proforma provided the template for the CNS to undertake new patient telephone consultation. Relevant investigations were requested during the telephone clinic and treatment related information was despatched to help with shared decision making. All patients were then reviewed in a Rheumatologist-CNS virtual MDT. An appropriate parenteral treatment option was agreed and confirmed to each individual. The CNS worked through a safety checklist and provided further advice and support to the patient as necessary. Using the database, we compared the timelines for the patient journey to the conventional pathway, obtained the number of consultant follow-up appointments saved by implementing this service, and calculated total savings.Results:In the pilot phase, 116 patients were triaged into the new service. The patient cohort was a combination of new referrals and patients taken from the consultants’ waiting lists. The mean age of the participants was 78 years (65-93). The median time: from referral to virtual triage was 20 days (0-308); from triage to new patient CNS telephone consultation was 20 days (0-137); and from virtual MDT to treatment authorisation was zero days (0-331 days). 45 patients had anabolic therapy commenced via home care. The remainder had anti resorptive therapy. No patient requested face-to-face review. Only one patient fed back that they would’ve preferred to see the consultant once. 116 new patient consultant appointments were saved and the median delay in treatment commencement was reduced from 84 to 38 days.Conclusion:To our knowledge, this is the first successful example of an innovative service wholly provided by CNS for commencing parenteral anti-osteoporotic therapy with only remote consultant supervision. Our service redesign has significantly improved the efficiency of the parenteral osteoporosis pathway with reduction in treatment delay and a more streamlined patient journey. A nurse-delivered osteoporosis treatment pathway is highly effective, safe and provides an innovative solution to address thinly stretched health care resources for people with chronic conditions.Disclosure of Interests:None declared
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43

So, Hang Mui. "Multiple Levels of Impact of Nurse Consultant-Led Continuous Quality Improvement: The Experience of a Critical Care Nurse Consultant in Hong Kong." Connect: The World of Critical Care Nursing 13, no. 4 (December 1, 2019): 185–95. http://dx.doi.org/10.1891/wfccn-d-19-00013.

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Nurse consultants (NCs; intensive care) are actively involved in continuous quality improvement (CQI) projects, evidenced-based practice (EBP), and research to bring positive impact on patients, the nursing profession, and the healthcare institution. The clinical, professional, and leadership competencies of NC are essential elements for the successful initiation, implementation, and evaluation of CQI projects, EBP initiatives, and research. Dissemination and sharing of the evaluation results, via publications and presentations at conferences are of paramount importance to document the contribution of NC on improving the quality of patient care. This article reports on the experience of a NC with quality improvement projects spanning more than 10 years since introduction of the NC role. Quality improvement projects that are discussed include: prevention of ventilator-associated pneumonia, in-hospital follow-up of post-ICU discharge patients and prevention of venous thromboembolism with nonpharmacological measures.
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44

Gleason, Joan M., and Kathleen T. Flynn. "The Surgical Clinical Nurse Specialist As Consultant in a Tertiary Care Setting." Clinical Nurse Specialist 1, no. 3 (1987): 129–32. http://dx.doi.org/10.1097/00002800-198700130-00012.

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45

Gleason, Joan M., and Kathleen T. Flynn. "The Surgical Clinical Nurse Specialist As Consultant in a Tertiary Care Setting." Clinical Nurse Specialist 1, no. 3 (1987): 129–32. http://dx.doi.org/10.1097/00002800-198723000-00012.

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46

Brunk, Quincealea A. "The Clinical Nurse Specialist as an External Consultant: A Framework for Practice." Clinical Nurse Specialist 6, no. 1 (1992): 2–4. http://dx.doi.org/10.1097/00002800-199200610-00002.

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47

Duane, Fleur M., Dianne P. Goeman, Chris J. Beanland, and Susan H. Koch. "The role of a clinical nurse consultant dementia specialist: A qualitative evaluation." Dementia 14, no. 4 (August 27, 2013): 436–49. http://dx.doi.org/10.1177/1471301213498759.

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48

Wu, Chenwei, Chatty O'Keeffe, Jesse Sanford, Jean Hagel, Shelia Childs, Gary Evers, Julie Melbourne, Collyn West, Michael Koch, and Paul B. Cornia. "Simple signature/countersignature shared-accountability quality improvement initiative to improve reliability of blood sample collection: an essential clinical task." BMJ Open Quality 11, no. 3 (September 2022): e001765. http://dx.doi.org/10.1136/bmjoq-2021-001765.

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BackgroundTimely lab results are important to clinical decision-making and hospital flow. However, at our institution, unreliable blood sample collection for patients with central venous access jeopardised this outcome and created staff dissatisfaction.MethodsA multidisciplinary team of nurses including a specialist clinical nurse leader (CNL), the hospital intravenous team and quality improvement (QI) consultants aimed to achieve >80% blood sample collection reliability among patients with central venous access by employing a simple signature/countersignature form coupled with audit-feedback and behavioural economics strategies. The form was piloted on one 25-bed unit. Data were collected for 60 weeks and interpreted per standard run chart rules.ResultsBlood sample collection reliability exceeded the 80% goal by week 22. The practice was sustained on the pilot unit and spread successfully to other wards despite significant operational threats including the COVID-19 pandemic.ConclusionsAt our institution, a simple signature/countersignature form supplemented by audit-feedback and behavioural economics strategies led to sustained practice change among staff. The pairing of CNL to QI consultant enhanced change potency and durability.
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Begum, J., J. Fourmy, and M. K. Nisar. "POS1478-HPR NURSE LED REMOTE MANAGEMENT OF OSTEOPOROSIS – DO PATIENTS APPROVE?" Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 1024.1–1024. http://dx.doi.org/10.1136/annrheumdis-2021-eular.1072.

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Background:Specialist services are heavily reliant on consultant delivered models however lack of sufficient consultant appointments pose a significant operational challenge. Clinical nurse specialists (CNSs) are highly trained and can fill this gap whilst maintaining a high standard of care.Objectives:We designed an innovative proof-of-concept osteoporosis service with patients only consulting a metabolic bone CNS and a consultant providing remote oversight. The aim of the project was to improve the efficiency of the service by eliminating consultant appointments and reducing unnecessary hospital visits whilst continuing to deliver high-quality care.Methods:A new pathway was implemented where a consultant rheumatologist and a CNS virtually triaged women over the age of 65 into the service. A dedicated proforma provided the template for the CNS to undertake new patient telephone consultation. Relevant investigations were requested during the telephone clinic and treatment related information was despatched to help with shared decision making. All patients were then reviewed in a consultant-CNS virtual MDT. Appropriate parenteral treatment option was agreed and confirmed to each individual. The CNS worked through a safety checklist and provided further advice and support to the patient as necessary. We surveyed 100 consecutive patients to gain their feedback regarding the service using a ten-item questionnaire employing binary and Likert scale options.Results:The questionnaire was posted to 100 patients. Mean age of participants was 77.2 years (65-92). 75 returned the survey. 67 (89%) were happy with the waiting time and seventy (93%) found thirty-minute appointment acceptable. 66 (88%) were happy with the phone consultation and agreed that the care plan was adequately explained. 73 (97%) were happy for the CNS review in future and would recommend the service. 67 (89%) were satisfied with the overall service. Though most (95%) were able to take the call maintaining privacy, eleven (15%) participants would’ve found physical appointment more convenient. When asked which medium they would prefer for future reviews, only fifty (66%) patients would keep telephone as their choice. Sixteen (21%) would prefer face to face consultation, seven (9%) a combination of the two and only two would choose online option.Conclusion:To our knowledge, this is the first successful example of an innovative service wholly provided by CNSs. Most patients were satisfied with this model of care and would highly recommend it. They were happy to be reviewed by CNS in the future. However a significant minority did not like the remote element and a higher proportion would choose physical review in future if offered. Interestingly, telephone consultation still scored substantially higher than online platform despite being physically visible in the latter. This is intriguing as most remote services strive for online consultations assuming its preference to phone. Our study suggests against this notion certainly in older patient group. Overall, a nurse-delivered osteoporosis treatment pathway is highly effective, safe and provides an innovative solution though remote consultations may not be the optimal delivery model.Disclosure of Interests:None declared
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Ta, V., O. Schieir, M. F. Valois, G. Hazlewood, C. Hitchon, L. Bessette, D. Tin, et al. "FRI0030 MORE THAN HALF OF NEWLY DIAGNOSED RA PATIENTS ARE NOT CONVINCED OF THE NECESSITY OF RA MEDICINES: ASSOCIATIONS WITH RA CHARACTERISTICS, SYMPTOMS, AND FUNCTION IN THE CANADIAN EARLY ARTHRITIS COHORT (CATCH)." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 588.1–588. http://dx.doi.org/10.1136/annrheumdis-2020-eular.4328.

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Background:Although DMARDs are essential for early aggressive control of RA to reduce symptoms and disability, medication adherence is variable. Beliefs about the necessity of medications and safety concerns predict adherence and are modifiable.Objectives:To examine associations among RA medication necessity beliefs and concerns, sociodemographics, RA characteristics, symptom level and function in newly diagnosed RA patients.Methods:Baseline data were analyzed from participants in the Canadian Early Arthritis Cohort (CATCH) who enrolled between 2017-2020 and completed the Beliefs about Medicine Questionnaire (BMQ) and PROMIS-29. All met ACR1987 or 2010 ACR/EULAR criteria and had active RA at enrollment. BMQ Necessity (N) and Concerns (C) scores were classified ashigh(≥20) orlow(<20) and categorized into: Accepting (↑N ↓C); Ambivalent (↑N↑C); Sceptical (↓N↑C); and 4) Indifferent (↓N↓C). Groups were compared using ANOVA and chi-square tests.Results:The 362 patients were mostly white (83%) women (66%) with a mean (SD) age of 56 (15), symptom duration of 6 (3) months, and 32% were obese (BMI≥30). More than half (56%) were DMARD-naive or minimally exposed. Mean N and C scores were similar between men and women; 54% were classified asIndifferent, 31%Accepting, 9%Ambivalent,and 6%Sceptical.As compared to those classified asAccepting, moreIndifferent participantssmoked, had a healthy weight, lower TJCs, and trend for lower CDAI (Table). Groups were similar by sociodemographics, symptom duration, and DMARD/steroid use, except fewerIndifferentpatients received MTX.Indifferentpatients had statistically and meaningfully lower patient global, depression, anxiety, fatigue and pain interference, and higher function and participation scores (Table).Conclusion:Many new RA patients had low medication necessity beliefs and concerns, and only 31% had high necessity beliefs and low concerns around diagnosis. Lifestyle and lower CDAI, TJCs, symptoms and functional impacts were associated with RA medication indifference. Identifying medication indifference can prompt discussions about medication beliefs/concerns to facilitate shared decision-making and adherence.Disclosure of Interests:Viviane Ta: None declared, Orit Schieir: None declared, Marie-France Valois: None declared, Glen Hazlewood: None declared, Carol Hitchon Grant/research support from: UCB Canada; Pfizer Canada, Louis Bessette Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Sanofi, Diane Tin: None declared, Carter Thorne Consultant of: Abbvie, Centocor, Janssen, Lilly, Medexus/Medac, Pfizer, Speakers bureau: Medexus/Medac, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB, Gilles Boire Grant/research support from: Merck Canada (Registry of biologices, Improvement of comorbidity surveillance)Amgen Canada (CATCH, clinical nurse)Abbvie (CATCH, clinical nurse)Pfizer (CATCH, Registry of biologics, Clinical nurse)Hoffman-LaRoche (CATCH)UCB Canada (CATCH, Clinical nurse)BMS (CATCH, Clinical nurse, Observational Study Protocol IM101664. SEROPOSITIVITY IN A LARGE CANADIAN OBSERVATIONAL COHORT)Janssen (CATCH)Celgene (Clinical nurse)Eli Lilly (Registry of biologics, Clinical nurse), Consultant of: Eli Lilly, Janssen, Novartis, Pfizer, Speakers bureau: Merck, BMS, Pfizer, Edward Keystone Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, F. Hoffmann-La Roche Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Pfizer Pharmaceuticals, Sanofi-Aventis, Consultant of: AbbVie, Amgen, AstraZeneca Pharma, Biotest, Bristol-Myers Squibb Company, Celltrion, Crescendo Bioscience, F. Hoffmann-La Roche Inc, Genentech Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, UCB., Speakers bureau: Amgen, AbbVie, Bristol-Myers Squibb Canada, F. Hoffmann-La Roche Inc., Janssen Inc., Merck, Pfizer Pharmaceuticals, Sanofi Genzyme, UCB, Vivian Bykerk: None declared, Susan J. Bartlett Consultant of: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Speakers bureau: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie
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