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1
Farrell, Carole Denise. "An exploration of oncology specialist nurses' roles in nurse-led chemotherapy clinics." Thesis, University of Manchester, 2014. https://www.research.manchester.ac.uk/portal/en/theses/an-exploration-of-oncology-specialist-nurses-roles-in-nurseled-chemotherapy-clinics(9e4907a5-92ac-4719-90f9-12dba4942b0e).html.
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The purpose of this study was to investigate nurses’ roles within nurse-led chemotherapy clinics. There has been a rapid expansion and development of nursing roles and responsibilities in oncology, but little understanding of how roles are enacted and their impact on patient experiences and outcomes. This was a two stage approach comprising a survey of UK oncology specialist nurses followed by an ethnographic study of nurses’ roles in nurse led chemotherapy clinics. Ethics approval was obtained prior to each study; research and development approval was obtained from each hospital site prior to Study 2. Study 1 used a questionnaire survey to explore the scope of nurses’ roles. A purposive sample of oncology specialist nurses perceived to be undertaking nurse-led clinics was obtained using snowball methods. Data analysis included descriptive and inferential statistics. Study 2 used ethnographic methods to explore nurses’ roles in nurse-led chemotherapy clinics, which included clinical observations, interviews with nurse participants and studying documentation (protocols) for nurse-led chemotherapy clinics. Findings were coded and thematic analysis undertaken. In study 1, 103 completed questionnaires were received with a response rate of 64%, however analysis identified 79 (76.7%) nurses undertaking nurse-led clinics, therefore statistical analysis was limited to this sample of 79 nurses. An additional 12 (11.7%) nurses wanted to undertake nurse-led clinics, therefore findings from this group were analysed separately. There was little congruence between nurses’ titles and clinical roles, with significant differences in practice between different groups of nurses, in relation to history-taking (p=.036), assessing response to treatment (p=.033). Although there was no difference in the number of nurses undertaking clinical examinations (p=.065), there were differences in the nature of examinations undertaken, including respiratory (p= .002). There were also significant differences between groups of nurses in relation to nurse prescribing (p<.0001). Study 2 included observations (61 consultations by 13 nurses) and interviews (n=11). There was variability in patient numbers within nurse-led clinics, identifying implications for service delivery and sustainability. Disparities in nurses’ roles and responsibilities revealed four different levels of nurse-led chemotherapy clinics, from chemotherapy administration to totally nurse-led clinics. The identification of four levels of nurse-led chemotherapy is a new finding, and suggests a framework for nurse-led chemotherapy clinics that could link with nurse competencies and training. Five main themes were identified in study 2; a central theme of autonomy linked with themes of knowledge, skills, power and beliefs. A key finding was the reduced emphasis on compassionate care with greater medical (clinical) responsibilities within nurses’ roles, and poor communication skills by some nurses. Despite a great diversity in oncology specialist nurses’ roles, the lack of clarity in roles and responsibilities is creating confusion. Similarly the rapid increase in nurse-led chemotherapy clinics has been ad hoc with no formal evaluations. Although nurses in study 2 perceived they were providing holistic care there was no evidence of this in observations, and nurses appear to use a medical model care based on doctor-nurse substitution, which may have led to reduced emphasis on nursing skills and compassionate care.
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林家寶 and Ka-po Lam. "Nurse-led telephone-based smoking cessation intervention." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B43251286.
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Gabe, Marie Ellenor. "Nurse-led medication monitoring and adverse events." Thesis, Swansea University, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.678307.
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Lam, Ka-po. "Nurse-led telephone-based smoking cessation intervention." Click to view the E-thesis via HKUTO, 2009. http://sunzi.lib.hku.hk/hkuto/record/B43251286.
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Vanhook, Patricia M., Trish Aniol, Rachel Clifton, and John Orzechowski. "Changing State Policy through Nurse-Led Medical-Legal Partnership." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/7424.
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Yeung, Man Mandy, and 楊敏. "Nurse-led evidence based (hepatitis B) vaccination programme for nurses in the out-patient department." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B46583518.
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Novotny, Jacqueline. "A General Design Methodology for Postpartum Nurse Practitioner-Led Clinics." Thesis, Université d'Ottawa / University of Ottawa, 2021. http://hdl.handle.net/10393/41857.
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Having a newborn can be a big change for families, especially for first-time parents. At hospital discharge, parents are often provided with a lot of information, which can be difficult to retain. Due to shortened postnatal lengths of stay, nurses typically have less time to educate parents, which often results in families feeling overwhelmed. After hospital discharge, it is recommended for families to see a health care provider (i.e., physician, nurse practitioner, or registered midwife) within 72 hours for a follow-up appointment. This follow-up appointment is meant to assess both the mother and newborn to ensure they are both in good health and to provide any needed support. Unfortunately, completing the appointment within this timeframe may not be possible for every family or they may not be aware of its importance. Depending on the family’s model of care, completing the follow-up appointment within 72 hours after hospital discharge can be challenging. Families that have a physician as their health care provider may experience delays in scheduling the follow-up appointment. This can be due to the physician’s lack of availability, as there is a physician shortage in most communities. Furthermore, some families do not have access to a health care provider and, therefore, do not see a care provider after hospital discharge. Completing the follow-up appointment later than when it is recommended, or not at all, can result in negative health consequences for the mother and newborn and can also increase re-admission hospital rates and related costs (Cargill et al., 2007). At the moment, postnatal lengths of stay are shortening but the service delivery has not changed to accommodate this trend (Lemyre et al., 2018). This means that the services typically provided to families in the hospital now need to be provided in the community. The follow-up appointment after hospital discharge is an opportunity to provide these services; however, timely access to a health care provider, specifically a physician, can be challenging. Thus, this thesis explores the development of a general design methodology for a postpartum nurse practitioner-led clinic. The aim of the clinic is to provide timely access to any family that needs to complete the necessary postpartum services after hospital discharge within a community. An analytical model was developed to explore the characteristics of a postpartum nurse practitioner-led clinic and how it would operate (i.e., what services would be offered, the amount of time needed for these services, what is needed to offer these services, etc.). The model conducts a simulation of the appointment scheduling process based on the input values entered into it and evaluates a number of performance metrics (e.g., number of diversions, patient wait times, resource idle time, clinic overtime, number of appointments provided within 72 hours and number of appointments provided beyond 72 hours). The findings from the model can support the potential implementation of a postpartum nurse practitioner-led clinic in any community. Implementing such clinics could increase awareness, further educate parents and increase access to postpartum services.
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Willems, Danielle Catharina Mathias. "Nurse-led telemonitoring in asthma process, outcomes and cost-effectiveness /." Maastricht : Maastricht : Universiteit Maastricht ; University Library, Universiteit Maastricht [host], 2008. http://arno.unimaas.nl/show.cgi?fid=9552.
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Salcedo, Maria Victoria Trinidad. "Needs Assessment for a Nurse Practitioner-Led Transitional Care Program." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1450.
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The rising cost of health care and changes in healthcare delivery have prompted a need to improve continuity from the hospital to home. This scholarly project was initiated to assess the impact on patient outcomes related to initiation of a nurse practitioner-led transitional care program (TCP). Using the Diffusion of Innovations and Health Belief Models, the purpose of this study was to identify the impact of a TCP on improving the health of patients with congestive heart failure (CHF), diabetes mellitus Type II (DM II), and chronic obstructive pulmonary disorder (COPD). The impact of the TCP was evaluated by a review of patient satisfaction results, reduction in patient readmission rate, and emergency room consults. Two years of data from a community-based health care program were collated from a sample of 819 individuals with chronic disease between 65- and 85-years-old who had a 30-day hospital readmission after a nurse practitioner home visit and a 30- day readmission for an exacerbation of their CHF, DM II, or COPD. The secondary data were analyzed, using SPSS, to determine changes in rates of readmission. Descriptive statistics were used to represent and compare changes in rates. After implementation of the nurse practitioner home visit program, the 30-day readmission demonstrated an 81.07% reduction and the 30-day readmission for exacerbation of COPD, CHF, and DM II was reduced by 36.77%. The project findings contribute to social change by identifying how a reduction in the frequency of hospitalizations could contribute to decreased health care expenses and improved health outcomes. Home care and chronic health care organizations, as well as advanced-practice nurses working in home care settings, may use the results of the study to establish effective community interventions that reduce health care costs.
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Verschuur, Elisabeth Maria Lutgardis. "Nurse-led Follow-up and Palliative Care of Esophageal Cancer Patients." [S.l.] : Rotterdam : [The Author] ; Erasmus University [Host], 2007. http://hdl.handle.net/1765/10551.
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Assefa, Metasebia. "Evaluating the Effectiveness of Registered Nurse-led Chronic Pain Self-Management Program within a Primary Care Facility." Thesis, Université d'Ottawa / University of Ottawa, 2019. http://hdl.handle.net/10393/39074.
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Self-management support (SMS) is considered an effective approach to chronic pain (CP) management. However, the provision of SMS for chronic pain patients faces challenges within primary care facilities in Ontario. An innovative SMS program led by a Registered Nurse (RN) at the Bruyère Family Health Team in Ottawa has been created for chronic pain patients. The goal of this program is to improve the current chronic pain management using SMS in an outpatient facility by harnessing the skills of primary health care team members. The hope would be that this program could be spread and scaled across other programs in the region.
This thesis exists in two parts:
1. Evaluate the RN-led chronic pain self-management program to determine its effectiveness in terms of self-reported pain scales and Morphine Equivalence Quotient (MEQ)
2. Understand the perspectives of health care practitioners, administrators and patients within the RN-led chronic pain self-management program
Patients meet with the RN for initial face-to-face visit for an hour, for SMS and then for at least one follow up visit. The primary outcome variables of interest were their self-reported pain evaluated using validated pain scales. Opioid use was also assessed before and after the porgram based on the MEQ. Results were analyzed using SPSSversion20. An online questionnair was distributed to team members. All responses were conceptually arranged into a SWOT analysis, which will be directed toward the ongoing management needs of the clinic.
Between January 2016 and August 2018, 125 patients were seen of these 58 patients (12 males and 46 females) had at least one follow up appointment with the RN. In 46.2% of the population there was a decrease in their total opioid dose from their first to their last appointment and of these 4 patients (15.4%) had a daily MEQ of 0 by their last appointment. There was a significant average difference between patient’s daily MEQs at their first and last appointment (t20= 2.245, p<0.05). On average patients came into their first appointment with a daily MEQ of 23.88 higher than at their last visit (95% CI [1.69, 46.07]).
Staff and patients who participated in the online survey identified the following strengths: multidisciplinary approach, increased accessibility for patients, cost effectiveness, better patient engagement, and no refills of opioids
Canada needs a better strategy to manage the CP epidemic. This chronic pain self-management program led by an RN focuses on a multidisciplinary approach that is readily accessible to patients and integrated within primary care to best meet and prioritize the needs of chronic pain patients.
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Muller, Catherina Elizabeth. "Nurse led change to influence HIV and AIDS workplace policy / C.E. Muller." Thesis, North-West University, 2010. http://hdl.handle.net/10394/4641.
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Globally, nurses' contribution to informed health policy decisions is limited, as there are many
barriers to Nurse led change to successfully influence the HIV and AIDS policy process. In
South Africa nurses at all levels of health care are not involved or consulted during the
formulation of the HIV and AIDS workplace policy. This has led to concern about the
absence of nurses at the policy table. This study forms part of a larger international study
programme entitled: “Strengthening Nurses’ Capacity in HIV and AIDS Policy Development
in Sub–Saharan Africa and the Caribbean”. This programme of international research aims
to empower nurses to become involved in the policy process (formulation, implementation
and evaluation) in order to strengthen health systems in the areas of HIV and AIDS care.
Nurses' absence at the policy table prompted the researcher to explore and describe barriers
to Nurse led change to influence HIV and AIDS workplace policy. Phase 1 of the research
consisted of a literature review to identify barriers to Nurse led change to influence the HIV
and AIDS workplace policy. Management's opinion about the human resource management
capacity and problems experienced working in an HIV and AIDS environment was obtained
through a quantitative and qualitative empirical method of data collection and analysis.
Frontline nurses' perspective was obtained through qualitative interviewing to identify
problems experienced with policy in an HIV and AIDS workplace environment. A mixedmethod
triangulation research design was used to achieve the objectives of phase 1 of the
study, and strategies applied included exploratory, descriptive and contextual designs.
The analysis of the data contributed to the identification and classification of problems
experienced by nurses to influence HIV and AIDS workplace policy at macro, meso and
microlevel, resulting in the formulation of fifty–nine (59) concluding problem statements.
These concluding statements formed the basis for the strategy development for Nurse led
change to influence HIV and AIDS workplace policy, which was the only objective of the
second phase of the research. The strategy for Nurse led change to influence HIV and AIDS workplace policy was
developed by using a strategic process to determine the vision, mission, values, principles,
assumptions, strategic objectives and functional tactics based on the concluding problem
statements. Finally, the research was evaluated, limitations were identified and
recommendations were formulated for practice, education, research and policy.Thesis (Ph.D. (Nursing))--North-West University, Potchefstroom Campus, 2011.
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Cyr, Julia Anne, and Julia Anne Cyr. "Evaluation of a Nurse Practitioner Led Program on Decreasing Emergency Room Visits." Diss., The University of Arizona, 2017. http://hdl.handle.net/10150/626651.
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Background: The overuse of the emergency department (ED) for non- critical patients has been associated with overcrowding and a rise in healthcare cost. Green Valley Fire Department (GVFD) has created a program, Fire-Based Urgent Medicals Service (FBUMS) with a nurse practitioner (NP). Patients can call 9-1-1 or the ""NP hotline"" and request to be seen by the NP instead of being immediately transported to the hospital via ambulance.
Purpose: The purpose of this project is to evaluate the impact of the nurse practitioner led FBUMS, on ED visits and ambulance transports.
Methods: A survey was mailed to all persons, age 18 and older, who were seen by the NP with FBUMS between February 2017 and March 2017. The survey asked about the reasons for contacting GVFD, the type of treatment received, and whether they went to ED after treatment.
Data analysis: Descriptive statistics including frequencies, percentages, means and standard deviations were used to analyze each of the answered survey questions in Microsoft Excel©.
Results: Surveys completed (n=42). The majority, 39 (92.9%) stated they did not receive care at the ED within 72 hours following their appointment with the NP, three (7.1%) stated they did. By dramatically decreasing transport to the hospital and associated ED treatment, it is estimated to have saved approximately $53,425 in ambulance costs and $54,210 in ED treatment for a total savings of $99,632.52.
Conclusion: A Fire-Based Urgent Medical Service led by a nurse practitioner decreased emergency room visits and ambulance transports.
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李雯靜 and Man-ching Anney Lee. "Effects of the disease management programme with nurse-led heart failure clinic." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B40721036.
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Lam, Hiu-wa, and 林曉樺. "The use of a nurse-led education program in reducing pediatric eczema." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B48335599.
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Atopic eczema is a chronic relapsing inflammatory skin disease commonly associated with atopy. The disease is common in early childhood and is characterized by dryness of skin, itchiness and skin flexures. There has been no cure for the disease. Treatments of atopic eczema focus on relieving symptoms, maintaining skin integrity and preventing secondary infection. With good compliance to the treatment, most patients may obtain optimal control. Education is essential for good compliance to the treatment. In local public acute hospitals, the current service provided restricts the time for comprehensive patient education during follow-up by physicians. Some studies indicated that nurse-led programs are effective in managing chronic illness because patients have longer consultation time and more information. The effect of nurse-led program in managing common chronic disease like atopic eczema may be promising. However, there was no systematic review on the use of nurse-led education program in reducing pediatric eczema in the local setting.
Against the above background, this dissertation aims to systematically evaluate the current evidences on the effectiveness of nurse-led education program for pediatric eczematous patients in reducing the severity of eczema, to develop an evidence-based guideline of the program, to assess the implementation potential and to develop implementation strategies and evaluation plan.
A systemic review of the literature from Medline (Ovid SP), PubMed and CINAHL (EBSCOhost) was conducted. A total of 298 citations were retrieved after the database search. Finally, 5 studies were identified and included in the systemic review. Data were extracted and the quality of each included studies was assessed with the help of the appraisal instruments. In which, one study was methodologically strong, two studies were of moderate methodological qualities and two studies were of poor methodological qualities. Among the four studies with severity of eczema as outcome measures, three studies showed significant in reducing severity of eczema. Therefore, we considered sufficient evidence that supported the use of nurse-led education program in reducing pediatric eczema.
An evidence-based guideline of the program was developed. The characteristics of the patients in the local setting are similar to those of the identified studies. The availability of the resources and the readiness of the staff towards the proposed innovation are supportive in the local setting. Thus the findings of the reviewed studies were transferable and the proposed innovation was feasible. Cost-benefit analysis showed that the proposed program could be able to generate a potential saving of about $ 550,000 in the local setting annually.
In the implementation plan, a three-month pilot study on ten patients will be conducted before the implementation of the program. Evaluation will be made after the end of the pilot study and the end of the implementation program. Refining of final protocol will be done according to the evaluation and comments from the pilot study. The severity of eczema and the patient’s satisfaction are considered as primary and secondary patient outcomes respectively. The healthcare provider outcomes are the staff morale and the workload. Systematic outcomes are the admission rate of pediatric ward and the attendance rate of pediatric outpatient clinic, and the cost of innovation. Finally, patient outcomes, healthcare provider outcomes and systemic outcomes would be evaluated in order to identify the effectiveness of the program.published_or_final_version
Nursing Studies
Master
Master of Nursing
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Miles, Kevin Vincent. "Evaluating a model of nurse-led care in a genitourinary medicine clinic." Thesis, University College London (University of London), 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.271125.
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Lee, Man-ching Anney. "Effects of the disease management programme with nurse-led heart failure clinic." Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B40721036.
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King, Elizabeth Louise. "A Nurse Practitioner-Led TIA/Stroke Program To Serve Rural Northwest Montana." Diss., The University of Arizona, 2014. http://hdl.handle.net/10150/347071.
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Cerebrovascular accidents (CVAs) are identified as the principal cause of long-term severe disability in the United States (American Heart Association, 2012). Cerebrovascular accidents (CVAs) are the fourth leading cause of mortality in the United States (Minino, Murphy, Xu & Kochanek, 2011). Small towns and rural areas are currently in a health care crisis. With most subspecialty services located in metropolitan areas, distance and lack of accessibility creates disparity in evidence-based practice implementation. The growing gap between the health of rural and urban Americans is evident and will widen without proper interjection (Alkadry, Wilson, & Nicholas, 2006; Brown, Lisabeth, Roychoudhury, Ye, & Morgenstern, 2005; Sacco et. al, 2006). While there have been significant recent advances to support patients during the acute phase of a stroke in Montana, guidance for primary care providers and patients is currently limited for secondary stroke prevention services in the state, including Northwest Montana. Current morbidity and mortality data due to stroke in rural northwestern Montana may reflect a gap between existing guidelines for secondary risk reduction and the current practice of instituting those prevention guidelines. Effective secondary stroke prevention strategies are those that are based on a model of care that is evidenced based, feasible, and meets the unique needs of the population. A qualitative descriptive design was used to achieve the AIMS of this study. A critical analysis of the literature was used (AIM 1) to identify previously published information related to TIA/stroke clinics and programs. Focus groups were used (AIM 2) to elicit information from health care professionals in northwestern Montana about the need for and preferences for an advanced practice nurse-run stroke/TIA clinic. We found that like other reports from rural sectors, Primary Care Providers and Neurology providers in Northwest rural Montana identified challenges in access to care and cultural influences on patient adherence. It was evident that Primary Care Providers and Neurology providers were in favor of instituting a Nurse Practitioner-led secondary prevention program for stroke and TIA. We propose a stroke/TIA program to serve Northwest rural Montana that includes Nurse Practitioner-led transitional care services, care coordination, and education and program evaluation services.
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Ciocson, Ana Flor Rasonabe. "A Nurse-Led Evidence-Based Quality Improvement Program on Childhood Obesity Prevention." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4721.
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The increased prevalence rate of childhood obesity in Saudi Arabia is a nationwide health issue. The doctoral project was instituted in the pediatric out-patient clinic (POPC) of a tertiary university hospital in Riyadh, Saudi Arabia. Child obesity clinic and clinical practice guideline (CPG) for primary prevention were not available in the pediatric outpatient clinic with a high incidence of newly diagnose obese children. The focus of this doctoral project was to improve the clinical nursing practice of POPC nurses through the adoption of CPG on primary prevention of childhood obesity. The knowledge translation into action framework provided a summary of descriptive series of ideal CPG implementation steps in POPC. The search for published CPGs was taken from DynaMed, National Guideline Clearinghouse, Guideline International Network, Pubmed, and Google Scholar. There were 2 tools applied for analysis and synthesis. First, the appraisal of guidelines for research and evaluation II instrument was used to assess the quality of the guidelines. Second, the BARRIERS' scale was used to assess the extent of nurses' perception of barriers in CPG utilization. The 1st findings from this study revealed that RNAO CPG was the best and high-quality CPG over the Endocrine Society and the Institute for Clinical Systems Improvement CPGs. The 2nd findings showed that most of the nurses perceived BARRIERS to utilization towards on the unclear implications of the CPG in their daily nursing practice. Hence, one of the vital recommendations was to have CPG awareness and education before the implementation. Overall, the doctoral project contributed to positive social change through guidelines, policies, and protocol provision for childhood obesity prevention in similar settings.
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Mullins, Christine, Katherine Hall, Sandy Diffenderfer, Jo-Ann Marrs, and April Stidham. "Development and Implementation of Advanced Practice Registered Nurse Competency Validation Tools in Four Nurse-Led Clinics in Rural East Tennessee." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/7092.
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Background: Graduate nursing academic faculty rely heavily on clinical preceptors for mentorship and clinical practicum experiences for BSN-DNP degree-seeking family nurse practitioner (FNP) students. Thus, it is important that preceptors have documented clinical competencies to assure the delivery of quality, evidence-based practice that meets regulatory requirements prior to precepting students.Objectives: The objectives of this quality improvement project were to develop and implement APRN competency validation tools (CVTs) in nurse-led clinic settings.Methods: Rapid Cycle Quality Improvement (RCQI) strategies were used to develop and implement APRN CVTs.Results: Three APRN CVTs were successfully developed, tested, refined, and implemented in four nurse-led clinics in rural east Tennessee. With one exception, the APRN preceptors had documentation of clinical competency prior to approval as a SPADES preceptor. Graduate academic faculty, preceptors, and students reported satisfaction with the SPADES project.Conclusion: CVTs are feasible tools for documentation of validated clinical APRN preceptors’ competency in nurse-led clinics. The CVTs and the medical record review checklist are available upon request from the primary author.Implications for Nursing: Use of APRN CVTs provides documentation that the preceptor uses evidence-based practice in the clinic setting prior to precepting students.
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Alison, P., K. Gonnella, B. Marsali, and Patricia M. Vanhook. "Statewide and Sector Strategies for Growing Medical-Legal Partnership." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/7428.
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Lau, Wai-kwan, and 劉慧君. "An evidence-based nurse-led fluid and dietary control program for haemodialysis patient." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193072.
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End stage renal failure refers to an irreversible kidney dysfunction in which the kidneys fail to remove toxins from the blood stream. Haemodialysis is an effective treatment modality to sustain the lives of patients with end stage renal failure by removing waste products like urea, creatinine, and excess fluid. It involves a challenging regimen including dietary restrictions to ensure long-term survival. Failure to adhere with the regimen can result in fatal consequences.
Renal patient discomfort related to non-adherence is commonly seen in clinical settings; however, there is currently no evidence-based fluid or dietary education program available to haemodialysis patients. This dissertation aims to identify and evaluate current evidence for the effectiveness of dietary and fluid control programs in the treatment of haemodialysis patients, to assess the transferability and feasibility of implementing a nurse-led education program regarding dietary and fluid control in haemodialysis patients, and to develop an evidence-based, nurse-led fluid and dietary control program for haemodialysis patients.
Four electronic bibliographical databases including PubMed, Cochrane library, PsycInfo and CINAHL and two searching engines including Google scholar and ProQuest were used to identify studies that examined the effectiveness of educational programs or interventions on fluid or dietary control for patients on haemodialysis. Forty-five unique studies were identified as potentially relevant. Eleven of those studies met the selection criteria and were evaluated in this dissertation. Appraisal instrument was used to evaluate the quality of the selected studies. Six studies and three studies showed statistically significant in reduction of serum phosphate level and interdialytic weight gain respectively after educational intervention. Critical evaluation of the available studies led to an evidence-based, nurse-led, fluid and dietary control program for haemodialysis patients that followed the guideline development process of the Scottish Intercollegiate Guideline Network.
Comparison on the similarity of patient characteristics, staff competence, and organizational settings of the evaluated studies were similar to those of the target unit. Therefore, the proposed program may be transferable and feasible. Furthermore, a cost-benefit analysis showed that the benefit of the fluid and dietary control program to patients outweighs the cost needed to implement the program.
This dissertation outlines a proposed twenty-week program including marketing of the program, training of staff in the targeted renal unit, pilot testing, and application of the proposed program. Evaluation of the program will focus on three categories: patient outcome, health care provider outcome, and organization outcome. Clinical effectiveness of the program is defined by an overall reduction in patients’ mean interdialytic weight gain and mean serum phosphate level, improvement in knowledge test scores by patients, satisfactory nurses’ attendance rate in the renal training sessions, high nurse satisfaction with the educational program, and reduction of admission rate related to non-adherence.published_or_final_version
Nursing Studies
Master
Master of Nursing
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Campbell, Kami S. "Enhancing Interest and Knowledge of How to Start a Nurse Practitioner-Led Clinic." Otterbein University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=otbn1461151661.
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Willcox, Adrienne. "Nurse-led pre-travel health consultations : evaluating current practice and developing a new model." Thesis, University of Warwick, 2010. http://wrap.warwick.ac.uk/38542/.
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This study explores the pre-travel consultation between nurses and people who plan to travel abroad from the UK. Travel health services have developed ad hoc in response to rising public demand, and are mainly nurse-led in UK general practice. There is little research evidence to describe or evaluate pre-travel healthcare provision. Using a mainly qualitative bricolage design of six methods, the research traces the ‘journey’ of health recommendations made to travellers. Starting with guidance documents produced by experts, it then tracks the fulfilment of these recommendations through consultations conducted by nurses and captures the ways in which travellers use or discard the recommendations while travelling. It explores the clinical reasoning behind activities in pre-travel consultations, and generates ideas for practice development. The key findings are that pre-travel healthcare is medicine-centric and issues of time, organisation, and the model adopted by nurses affects the quality of consultations. Two styles of consultation were identified: the Kitchen Sink style was comprehensive and verbose; the Medical and Minimal style focused on vaccinations. Travellers recalled or used very little of what was imparted during their consultations, but far from being ‘blank slates’, travellers usually managed their health appropriately and had far more knowledge than nurses recognised. The thesis offers conceptual insights to the pre-travel consultation which relate to patient safety, quality and the legal integrity of practitioners. It offers a prototype model of the pre-travel consultation that takes account of the challenges associated with current practice. The implications for practice relate to education for nurses in consultation management, patient-centredness, proactive versus reactive service provision, and patient education. PRE-TRAVEL - the new model for consultations - contributes a framework for engaging with these issues, subject to post-doctoral testing.
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Pooler, Alison. "Exacerbations of severe asthma : psychosocial predictors and the impact of a nurse-led clinic." Thesis, Keele University, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.496334.
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There is considerable evidence to support the notion that people's medical conditions do not exist in a vacuum, but are influenced by psychological and social factors (Partridge & Johnstone, 1989). These factors are related to both the cause and progress of the disease. There are a limited number of drugs that patients with severe asthma can take, and the resultant side effects are both physiological and psychological due to the high dosages required. Alternate management approaches need to be identified for this group of people with severe asthma and it is hoped that this research project helps to highlight these and encourage further research into the social and psychological aspects of asthma management.
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Mathew, Ronnie. "The role of nurse LED colonoscopy and its impact on the National Health Service." Thesis, University of Hull, 2008. http://hydra.hull.ac.uk/resources/hull:5799.
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鄧潔心 and Kit-sum Tang. "A clinical guideline for management of lymphoedema using nurse-led manual lymphatic drainage therapy." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193080.
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Breast cancer is the number one cancer in female in Hong Kong. Breast cancer-related lymphoedema causes both physical and psychological sufferings in breast cancer survivors and significantly degrades their quality of life. Medical costs for these women are substantially higher than women without lymphoedema. Effective and standardized intervention for these patients will be beneficial to both patients and healthcare institutes.
The dissertation aims to evaluate the current evidence on the effectiveness of manual lymphatic drainage in managing breast cancer-related lymphoedema, to develop an evidence-based guideline for nurse-led manual lymphatic drainage in managing breast cancer-related lymphoedema as well as to assess its implementation potential and to design implementation strategies and an evaluation plan for its adoption in a local public hospital in Hong Kong.
A systematic search of the literature revealed seven studies on manual lymphatic drainage for breast cancer related lymphoedema that met the selection criteria of the dissertation. Methodological quality of the selected studies was evaluated according to the method developed by the Scottish Intercollegiate Guidelines Network and data were extracted and synthesized. Five of the trials were of moderate to good methodological quality and they demonstrated that manual lymphatic drainage was safe and had additional benefits over exercise and compression alone especially in patients with early lymphoedema.
A protocol on manual lymphatic drainage for breast cancer related lymphoedema was subsequently developed. The implementation potential of the protocol in the local setting was established by examining its feasibility, evaluation potential and cost-benefit. Adoption of the program was found to be able to produce a potential annual saving of HK$ 444,200 for the hospital on top of benefits to patients and staff.
A three-phase implementation plan was designed in which an implementation team would initiate and guide the proposed change through a careful communication plan and a pilot study would be conducted to confirm feasibility of the protocol. An evaluation plan including patient, healthcare provider and system outcomes would then help ensure the effectiveness and sustainability of the manual lymphatic drainage protocol and guide its future refinement.published_or_final_version
Nursing Studies
Master
Master of Nursing
28
Ikoona, Eric. "Factors influencing the development and implementation of nurse-led antiretroviral treatment clinics in Uganda." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2017. http://researchonline.lshtm.ac.uk/4189857/.
Full textAbstract:
A major barrier to universal access to antiretroviral treatment (ART) in Uganda is the critical shortage of trained healthcare workers, particularly doctors. Although there are plans to legalise nurses to provide ART, little is known about the potential barriers and facilitators to the development and implementation of effective nurse-led ART clinics in Uganda. Thus, this study sought to understand the factors influencing the introduction of nurse-led ART clinics in Uganda as well as to determine nurses’ and doctors’ competencies in delivering HIV care to inform the design of strategies that would enhance their success. To this end, descriptive cross-sectional studies through a questionnaire survey, semi-structured interviews, and focus group discussions (FGDs) were conducted with numerous stakeholders including patients. HIV clinical vignette tests were used to assess doctors’ and nurses’ competencies in delivering ART. The results revealed that nurse-led ART clinics were already widespread in Uganda, albeit the lack of a policy allowing them to operate. Moreover, their successful development and implementation is critically dependent on nurses’ competence, self-confidence, motivation, authority, and autonomy, as well as on the availability of systems and human resource support and on the acceptability of nurses as providers of ART by patients and other stakeholders. Major challenges identified include the lack of patients’ and cmmunity support, the absence of legal and regulatory frameworks, and a weak general health system including inadequate equipment, supervision support and mentoring, among others. In conclusion, this study found that nurse-led ART clinics are already operating on a wide scale in Uganda, although on an ad hoc basis, and are viewed by stakeholders as a key strategy for scaling up human immune deficiency virus HIV services including ART. Now may be the appropriate time to plan adequately for the legalised and regulated development and implementation of these clinics while addressing the numerous factors that influence nurses’ ability and capacity to deliver HIV services efficiently and effectively.
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Alexandrou, Evan. "Towards best practice : procedural characteristics and outcomes of nurse-led central venous catheter insertion." Thesis, Curtin University, 2013. http://hdl.handle.net/20.500.11937/138.
Full textAbstract:
This thesis presents a series of six, discrete yet interrelated studies describing the role of specialist nurses in inserting central venous catheters. These studies suggest that appropriate training, credentialing and procedural volume are critical in determining procedural and patient outcomes and potentially more important than professional qualifications. These data are useful in articulating the role of advance practice nursing in promoting the quality and safety of patient care.
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Schoenwald, Anthony V. "Nurse practitioner led pain management the day after Caesarean section : a randomised controlled trial." Thesis, Queensland University of Technology, 2017. https://eprints.qut.edu.au/103760/1/Anthony_Schoenwald_Thesis.pdf.
Full textAbstract:
Caesarean pain is a major problem for women in the days after childbirth and is often not well controlled with the routine practice of twice daily controlled-release oxycodone. This randomised controlled trial demonstrated that a nurse practitioner intervention designed to support maternal participation using immediate-release oxycodone and supportive educational strategies was a safe and effective approach for pain management after caesarean section. At three months follow-up, a small subset of women had persistent pain which was strongly correlated with postnatal depression. Nurse practitioners have the potential to transform acute pain management by meeting individual patient needs over their healthcare journey.
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Barraclough, Frances Lee. "Nurse Practitioner Led Services in Primary Health Care in Rural NSW– Two Case Studies." Thesis, The University of Sydney, 2014. http://hdl.handle.net/2123/12491.
Full textAbstract:
Background Nurse Practitioners (NPs) are a relatively new advanced nursing role. It was hoped that NPs would reduce some of the challenges facing health care, address workforce shortages and improve access to services for rural populations. The most recent census of Australian NPs showed that just twelve of 208 working NPs were located in primary health care settings. It also showed the majority of NPs were employed in metropolitan areas. Few previous studies describe NP roles in detail, or in rural primary health care settings. Aims This study aims to describe, in detail, the roles of two NPs in rural New South Wales in primary health care settings. One case study focuses on the delivery of an integrated mental health service and the other on leadership in aged care. Methods A case study methodology was employed, using multiple data sources. Data were gathered using semi-structured interviews with 31 key stakeholders, the examination of key documentation, and observation of the NPs within these settings. In the first case study, quantitative data were also analysed. Interview data were analysed thematically. Results The case studies offer an in-depth description of why and how these roles were established, what the NPs do and their impact within the context of small rural towns. They illustrate how NPs established intersectoral partnerships, new service delivery models and advocacy regarding the way health care was provided. The case studies also provide valuable information on how to best incorporate NPs into rural primary health care. Conclusion This study details the complexity of two NP roles within rural primary health care settings. The two case studies show that in these settings, NPs are providing leadership, supporting other services, helping to address workforce shortages, improving access to services for rural populations, and therefore demonstrating the positive impact of NPs working in these settings.
32
McLaren, Elisha Janet. "Improving Health Outcomes for Endometrial Cancer Survivors: Addressing Co-morbidities through a Nurse- Led Lifestyle Intervention." Thesis, The University of Sydney, 2016. http://hdl.handle.net/2123/17831.
Full textAbstract:
Background: Endometrial Cancer is now the most common gynaecological cancer in Australia and continues to rise in incidence1 This increase is largely attributed to risk factors such as obesity, diabetes and hypertension, common comorbidities in these women2. While Cancer Cure is frequently achieved, many remain at high risk of premature death3. Oncology nurses may help ameliorate the effects of comorbidities through the delivery of lifestyle interventions. Aim: The aim of this research was to investigate the feasibility of a nurse-led lifestyle intervention for endometrial cancer survivors. Method: Pre and post evaluation with the RE-AIM framework4 was used to determine feasibility, through evaluation of, Reach; Efficacy; Adoption; Implementation and Maintenance. The Active Australia Survey5 and the Dietary Behaviour Questionnaire6 measured physical activity and dietary behaviour at baseline, one month and six months. Intervention: The nurse-led intervention included Motivational Interviewing7, the 5A’s approach8, tailored print material9, and referral to the “NSW” Get Healthy Coaching Service10. Results: Twenty participants were recruited with one drop out at six months. Compared to baseline, improvements were continuous walking doubled at six months (p=.026) but no statistically significant findings were found for vigorous (p=.176) or more moderate activity (p=.138). The improvements in dietary behaviour and exercise from baseline to six months suggest some maintenance of lifestyle modification by participants. Improvements were found in total dietary behaviour at one month (p=.002) and six months (p=.036). Significant improvements were found in fat intake at one month (p=.004) and at six months (p=.032). No significant findings for fibre intake was found. Conclusion: Results from this study are promising, suggesting that the nurse-led intervention is feasible. However, many of the participants were already exercising prior to the intervention, limiting reach. Adoption and implementation was supported in this single study site but more research with greater sample sizes, in a variety of settings is needed to ensure generalizability to the wider population.
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Göransson, Katarina. "Registered nurse-led emergency department triage : organisation, allocation of acuity ratings and triage decision making." Doctoral thesis, Örebro University, Department of Health Sciences, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-732.
Full textAbstract:
Successful triage is the basis for sound emergency department (ED) care, whereas unsuccessful triage could result in adverse outcomes. ED triage is a rather unexplored area in the Swedish health care system. This thesis contributes to our understanding of this complex nursing task. The main focus of this study has been on the organisation, performance, and decision making in Swedish ED triage. Specific aims were to describe the Swedish ED triage context, describe and compare registered nurses’ (RNs) allocation of acuity ratings, use of thinking strategies and the way they structure the ED triage process.
In this descriptive, comparative, and correlative research project quantitative and qualitative data were collected using telephone interviews, patient scenarios and think aloud method. Both convenience and purposeful sampling were used when identifying the participating 69 nurse managers and 423 RNs from various types of hospital-based EDs throughout the country.
The results showed national variation, both in the way triage was organised and in the way it was conducted. From an organisational perspective, the variation emerged in several areas: the use of various triageurs, designated triage nurses, and triage scales. Variation was also noted in the accuracy and concordance of allocated acuity ratings. Statistical methods provided limited explanations for these variations, suggesting that RNs’ clinical experience might have some affect on the RNs’ triage accuracy. The project identified several thinking strategies used by the RNs, indicating that the RNs, amongst other things, searched for additional information, generated hypotheses about the fictitious patients and provided explanations for the interventions chosen. The RNs formed relationships between their interventions and the fictitious patients’ symptoms. The RNs structured the triage process in several ways, beginning the process by searching for information, generating hypotheses, or allocating acuity ratings. Comparison of RNs’ use of thinking strategies and the structure of the triage process based on triage accuracy revealed only slight differences.
The findings in this dissertation indicate that the way a patient is triaged, and by whom, depends upon the particular organisation of the ED. Moreover, the large variation in RNs triage accuracy and the inter-rater agreement and concordance of the allocated acuity ratings suggest that the acuity rating allocated to a patient may vary considerably, depending on who does the allocation. That neither clinical experience nor the RNs’ decision-making processes alone can explain the variations in the RNs triage accuracy indicates that accuracy might be influenced by individual and contextual factors. Future studies investigating triage accuracy are recommended to be carried out in natural settings.
In conclusion, Swedish ED triage is permeated by diversity, both in its organisation and in its performance. The reasons for these variations are not well understood.
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Faag, Carina. "A comprehensive nurse-led intervention for patients with peripheral vestibular disorders : the feasibility and benefits." Licentiate thesis, Örebro universitet, Institutionen för hälsovetenskap och medicin, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-49627.
Full textAbstract:
Dizziness and balance problems are common symptoms at all ages, the symptoms are more common in women than in men and increases with age. Several studies clearly demonstrate that peripheral vestibular disorders symptoms may lead to the patients reporting functional consequences of a physical, mental and social character. The overall aim of this thesis was to investigate the efficacy and feasibility of an intervention for patients with peripheral vestibular disorders that contains patient education in groups in combination with individual support. The study is a randomized controlled trial (RCT). Thirty-six patients participated in the study: the intervention group (n = 18), who received the intervention and standard care, and patients in a control group (n = 18), who received standard care. The intervention includes a patient education program and individualized nursing support during a six-month period. Outcomes were collected by self-assessment questionnaires about dizziness-related symptoms, well-being, sense of coherence, and self-care measured at baseline before randomization and at six and nine months later. All patients were also instructed to complete a diary where they recorded symptoms that arose during an episode of dizziness. The main results show that the patients who received the intervention rated statistically significant fewer vertigo-related symptoms and a higher sense of coherence than the control group at the ninemonth follow-up. The intervention was feasible and seems to support the patients to manage symptoms. The effects were small and must be considered in relation to the efforts of the intervention. Confirmative studies are warranted.
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Göransson, Katarina. "Registered nurse-led emergency department triage : organisation, allocation of acuity ratings and triage decision making /." Örebro : Hälsovetenskapliga institutionen, Örebro universitet, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-732.
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林進其 and Chun-ki Lam. "A modified nurse-led rehabilitation program to accelerate overall recovery of patients after colorectal surgery." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193021.
Full textAbstract:
The number of patients with colorectal cancer had increased dramatically in recent years (Hong Kong cancer registry, 2012), and surgical resection is the first line treatment of colorectal. To enhance patients’recovery process, there is a need to develop a comprehensive and user-friendly, with most important, an evidence-based guideline for promoting patients’ recovery process. Traditional post-operative management is associated with different postoperative complications, delayed recovery, and lengthened hospital stay. Recent research documented that using a specific rehabilitation programme focused on education; early mobilization and early diet regime could enhance patients’ recovery. Therefore, this transitional research aims to evaluate the current evidence on the effect of adopting a specific rehabilitation programme, to formulate an evidence-based guideline, assess its implementation potential, and to develop an implementation and evaluation plan.
Ten related literature were retrieved from four electronic bibliographical databases. Critical appraisal had been done to ensure the quality and validity of the selected evidences. A clinical guideline is developed based upon the information from the identified high level of literature. The implementation potential is assessed based on the similarity and the readiness of the target setting to the proposed environment. It was found that the transferability of the protocol was high and it was feasible to be implemented into the target site. Little expenditure and input was expected, as the protocol was a systematic reformation of practice, rather that developing a set of totally new practice to current clinical setting.
An implementation plan was then planned, which included the communication plan with all the stakeholders. After reaching a consensus among the stakeholders, a two-month pilot study will be carried out for examining the readiness before the full-scale implementation of the program.
The evaluation plan of the effectiveness of the proposed program is developed. Result will be used to provide recommendation for further adjustment on the protocol to yield a better outcome. The implementation of this nurse-led rehabilitation program is suggested to be worthy of adoption in the clinical setting for bringing benefits to patients, the hospital and staffs.published_or_final_version
Nursing Studies
Master
Master of Nursing
37
Chuayna, Nonglak. "Implementing clinical guidelines in nurse-led primary health care in Thailand : a randomised controlled trial." Thesis, University of Liverpool, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.274428.
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Walsh, B. M. "A randomized controlled trial comparing nurse-led with standard care for post-acute medical patients." Thesis, University of Southampton, 2000. https://eprints.soton.ac.uk/57952/.
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Walsh, Bronagh Mary. "Comparing nurse-led with standard care for post-acute medical patients : a randomised controlled trial." Thesis, University of Southampton, 2000. https://eprints.soton.ac.uk/50634/.
Full textAbstract:
This study was carried out in the context of increased pressure on acute medical beds, increasing demand for alternatives to acute medical care and the need to reduce junior doctors' working hours. Nurse-led in-patient care has been advocated as a response to these pressures that also has the potential to improve patient outcomes. However, evidence to support the safety and effectiveness of this model of care was limited and came from Nursing Development Units, making it difficult to predict how well the model of care would perform in routine NHS practice. The nurse-led in-patient service was compared with standard care on the acute wards via a randomised controlled trial. Recruitment for the trial took 17.5 months. Key outcomes were length of stay following randomisation, discharge destination and change in physical functioning. Secondary outcomes were mortality, re-admissions within thirty days of discharge, falls, complications of hospitalisation. The process of care was explored by comparing medical reviews, therapy reviews, changes to medication and numbers of tests and investigations during the trial period. The nurse-led service did not demonstrate any improvement in outcomes, but substantially increased the length of stay in the treatment arm of the trial. The apparently higher rate of therapy reviews and rates of some complications were diminished when these outcomes were controlled for length of stay. Daily rates of medical reviews, medical investigations and changes to medications were lower for the treatment arm of the trial. The findings of this study do not support the limited benefit reported in previous studies. The widespread introduction of this model of care cannot, therefore, be advocated on the basis of improved outcomes for post-acute patients. However, the nurse-led intervention was not shown to be worse than standard care and may result in organisational benefits, such as reduced medical input. From the poor outcomes observed in this study, it would appear that neither nurse-led nor standard care is meeting the needs of this patient group. Further research is needed to identify and evaluate appropriate nursing interventions for post-acute medical patients.
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Mahomed, Rosemary. "A grounded theory of patient satisfaction with nurse-led chronic disease management in general practice." Thesis, Griffith University, 2010. http://hdl.handle.net/10072/367915.
Full textAbstract:
This study was an investigation into the process of patient satisfaction
with nurse-led management of chronic conditions in general practice. It
adds to the theoretical understanding of patient satisfaction by
providing an explanation of the processes patients go through to
determine their level of satisfaction with chronic disease management
provided by a practice nurse (PN) in collaboration with a general
medical practitioner (GP). This study was nested within the Practice
Nurse Project funded by the Australian Research Council (ARC), which
trialled a new model of nurse-led care in three general practices, one in
Western Victoria and two in South East Queensland. Three chronic
conditions were managed by the PNs in the project; diabetes type 2,
Ischaemic heart disease (IHD) and hypertension.
A grounded theory approach, underpinned by constructivist ontology
and an interpretive epistemology, was used for this study. Participants
for the study were drawn from those patients who had consented to be
part of the PN Project and who had been randomised to the PN arm of
the project. Initially purposive sampling was employed to access men
and women with a range of ages and chronic conditions at each of the
study locations. As data were analysed, theoretical sampling was used
to develop and integrate emerging categories. In-depth interviews were
held with 38 participants, some of whom were interviewed more than
once. The interview guides were continually revised to reflect
developing concepts. Data collection continued until theoretical
saturation occurred, that is, all categories were fully developed and
integrated into a theory. Constant comparative analysis of the data was
undertaken concurrently with sampling and data collection consistent
with grounded theory methods.
The basic social process to emerge from the data was Navigating Care,
which is comprised of three separate but interrelated processes;
Determining Care Needs, Forming a Relationship and Having
Confidence. Navigating care is an on-going and cyclical process and
issues with any part of the process can reduce patients’ satisfaction or
may lead to them opting out of PN-led management. Patients
determine their care needs through a process of monitoring and selfassessment.
If they consider that the PN is the appropriate person to
provide for their care needs, they then proceed to Forming a
Relationship with and Having Confidence in the PN. These two
processes are concurrent and interdependent. The patient’s experience
during these processes also provides a feedback loop to further
determination of their care needs. The two stages involved in Forming
a Relationship are Building Rapport and Working Together. Time,
Communication and Continuity are important properties of Forming a
Relationship. The confidence that patients have in PN-led chronic
disease management is built on Trusting the Model of Care, Trusting
the Role of Nurse, Trusting their Doctor and Evaluating the PN. The
extent to which each of these processes influence the level of
confidence depends on the individual patient. Communication is also
an important property of Having Confidence, especially in Evaluating
the PN.
The theory of Navigating Care provides an explanation of the processes
undertaken by patients in determining their satisfaction with PN-led
management of chronic conditions, which adds to the existing
theoretical understanding of patient satisfaction. This understanding
can be used to facilitate acceptance of new models of nurse-led care in
general practice and assist in identifying patients for whom nurse-led
care would be suitable. The findings can also be used to inform nursing
practice and inform the development of more sensitive instruments
measuring patient satisfaction. Finally, if patients feel more
comfortable with PNs than doctors, they may be more willing to engage
with nurses in systematic management of their chronic conditions.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Nursing and Midwifery
Griffith Health
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Backlund, Kristina, and Jessica Höök. "Erfarenheter av sjuksköterskeledd mottagning hos patienter med reumatoid artrit : En litteraturstudie." Thesis, Högskolan i Gävle, Medicin- och vårdvetenskap, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-24492.
Full textAbstract:
Sammanfattning Bakgrund: Kronisk ledgångsreumatism eller Reumatoid Artrit (RA) är en kronisk inflammatorisk ledsjukdom och är den vanligaste artritsjukdomen vars huvudsymtom är ledvärk. RA finns i alla folkgrupper, dock med varierande prevalens. I Skandinavien ligger prevalensen på ca 0,7 %. Etnologin till RA är en blandning av genetiska och omgivningsrelaterade faktorer. Att leva med RA påverkar patienten fysiskt, känslomässigt, psykologiskt och även socialt vilket leder till att hela livssituationen påverkas. Syfte: Syftet med litteraturstudien var att beskriva erfarenheter av sjuksköterskeledd mottagning hos patienter med reumatoid artrit samt beskriva undersökningsgruppen i de inkluderade artiklarna. Metod: En litteraturstudie med beskrivande design. Huvudresultat: Patienternas erfarenhet av sjuksköterskeledd mottagning var möten i en varm, vänlig och familjär atmosfär. Vården beskrevs som personcentrerad och kompetent och var baserad utifrån varje individs speciella behov. Sjuksköterskans specialistkunskaper värderades högt och uppgavs skapa en känsla av trygghet hos patienten. Den sjuksköterskeledda mottagningen upplevdes som lättillgänglig, flexibel och skapade kontinuitet i vården. Tillgängligheten medförde också att patienten visste när och hur de skulle kontakta sjuksköterskan. Patientens erfarenhet var att en god kommunikation med vårdpersonalen, gav en ömsesidig respekt och ingav patienten ökat förtroende. Slutsats: Slutsatsen av denna studie är att sjuksköterskeledd mottagning kan skapa ett mervärde för patientens omvårdnad. Den erbjudna vården representerade för deltagarna trygghet, hopp och förtroende. För att ett mervärde ska skapas är det av största vikt med god kommunikation och relationskapande, vilket i sin tur ger trygghet och skapar en grundläggande möjlighet för hälsofrämjande omvårdnad.Abstract Background: Chronic arthritis rheumatism or rheumatoid arthritis (RA) is a chronic inflammatory joint disease and is the most common arthritis disease, in which headache is joint pain. RA is present in all populations, with varying prevalence. In Scandinavia, the prevalence is approximately 0.7%. The ethnology of RA is a combination of genetic and environmental factors. Living with RA affect the patient physically, emotionally, psychologically and socially, meaning that the whole life situation is affected. Aim: The purpose of the literature study was to describe the experiences of nurse-led clinics for patients with rheumatoid arthritis and to present the study groups described in the articles included. Methods: A descriptive literature study Main results: Patients' experiences of nurse-led clinics were encounters in a warm, friendly and familiar atmosphere. The care was described as person-centered and competent provided and based on each individual's special needs. The nursing specialist skills were highly valued and described to create a sense of security for the patient. The nurse-led clinic was reported readily available, flexible and to create stability in the care. The accessibility also meant that the patients were aware of when and how to contact the nurse. The patient's experience was that good communication with the healthcare staff provided a mutual respect and instilled an increased patient confidence. Conclusion: The conclusion of this study was that nurse-led clinics could add value for the patient nursing care. This offered care represented familiarity, hope and confidence for the patients. To achieve added value, good communication and relationship are of the utmost importance, which in turn provide security and create a fundamental possibility in health-promoting care.
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Li, Miaozhen. "Using an APN-Led Transitional Care Program to Reduce 30-Day Hospital Readmissions." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4005.
Full textAbstract:
Heart failure (HF) is a serious public health problem associated with high mortality rates, hospital readmissions, and health care costs. Transitional care has emerged as a disease management model used to reduce readmissions for hospital-discharged patients with HF. However, the efficacy of an advanced practice nurse (APN)-led transitional care program (TCP) in readmission reduction is under debate. The practice question for this project examined the extent to which an APN-led TCP was effective in reducing 30-day all-cause readmissions for hospital-discharged HF patients. The logic model was the framework guiding this program evaluation. An analysis of quality improvement HF data from September 2015 to August 2016 was reviewed for one hospital in southern California. The APN-led TCP included 47 patients and had 7 patients with 30-day readmissions. The physicians' group included 298 patients and had 53 patients with 30-day readmissions. The results of chi-square analysis revealed a nonsignificant association between 30-day readmissions and post-discharge care providers [Ï? 2 (1, N = 345) = 0.236, p = 0.627], and the HF 30-day readmission rates were the same between two groups. The APN-led TCP served a large proportion of Medi-Cal patients (48.94%) who had less primary care access, while the majority of patients in the physicians' group were Medicare (51%) who had primary care providers. This project highlights the positive social changes that advanced practice nurses affect via their critical leadership and clinical roles in increasing care access for the low-income population. Further studies on payer sources and readmissions are recommended on the efficacy of APN-led TCP in readmission reduction.
43
Campbell, N. C. "Secondary prevention in coronary heart disease : a randomised trial of nurse-led clinics in primary care." Thesis, University of Cambridge, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.597263.
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Hui, Chi-hoi, and 許志海. "Nurse-led non-invasive mechanical ventilation guideline for acute pulmonary oedema patients in acute medical wards." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B4658190X.
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O'Rourke, Tammy. "Stakeholder Participation in Primary Care System Change: A Case Study Examination of the Introduction of the First Nurse Practitioner-Led Clinic in Ontario." Thèse, Université d'Ottawa / University of Ottawa, 2013. http://hdl.handle.net/10393/24277.
Full textAbstract:
Purpose: To examine stakeholder participation in the primary care system change process that led to the introduction of the first Nurse Practitioner-Led Clinic in Ontario.
Design: Qualitative case study guided by the principles of stakeholder and system change theory.
Setting: Northern Community in Ontario, Canada.
Participants: Purposeful sample of healthcare providers, healthcare managers and health policy stakeholders.
Procedures: This case study was bound by place (Sudbury), time (January 2006–January 2008), activity (stakeholder participation), and process (introduction of an innovation, the first Nurse Practitioner-Led Clinic in Ontario, during a primary care system change). Semi-structured individual interviews were conducted with participants who represented the clinic, the local community, and the province. Public documents, such as newspaper articles published during the 2 year time boundary for this case and professional healthcare organization publications, were also examined. Interviews were analyzed using qualitative content analysis and public documents were reviewed for key messages to complement the interview findings. Field notes written during data collection and analysis were used to provide additional depth, contribute insights to the data, and ascribe meaning to the results.
Main Findings: Sixteen interviews were conducted with key stakeholders. Twenty public documents which yielded the most specific information relevant to the case study time boundaries and activities were selected and reviewed. Six main themes are reported: felt need, two visions for change (one for a Nurse Practitioner-Led Clinic and one for Family Health Teams [FHTs]), vision processes related to ensuring the visions became or continued to be a reality in Ontario’s healthcare system (shaping, sharing, and protecting the vision), stakeholder activities, and sustaining and spreading the vision.
Conclusions: In this case, stakeholder participation influenced policy decisions and was a key contributor to the primary care system change process to introduce the first Nurse Practitioner-Led Clinic in Ontario. Stakeholders are motivated by various needs to engage in activities to introduce an innovation in primary care. One of the most common needs felt by both those who supported the introduction of the first Nurse Practitioner-Led Clinic and those who were opposed to it was the need for improved patient access to primary care.
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Birch, Michele Renee, and Michele Renee Birch. "Reducing Hospital Readmissions Using a Nurse Practitioner Led Interprofessional Collaborative Management Model of Caring: A Feasibility Study." Diss., The University of Arizona, 2017. http://hdl.handle.net/10150/626637.
Full textAbstract:
The purpose of this DNP project was to determine the feasibility of implementing a nurse practitioner led interprofessional collaborative management model of caring for patients with complex medical conditions who are at high risk for ED and hospital readmission. The target of the feasibility study was an accountable care organization (ACO) in Idaho. The ACO assumes greater financial risk for providing care to a population that includes Medicare Advantage patients - dual insured Medicare/Medicaid patients. The care management teams are currently led by physicians.
The members of the population that suffer most from multiple chronic conditions often encounter barriers to accessing high quality primary care, in particular when transitioning between different levels of care. Interprofessional collaborative team based care coordination can address medical and social issues that can affect a patient’s ability to achieve/maintain wellness. The literature suggests that nurse practitioners are ideally suited to lead those teams
Approval was given by leadership in the ACO to accomplish a study to determine the feasibility of successfully implementing an innovative NP led interprofessional collaborative care management model: the AEIØOU Bundle of Care Practices. Principles of qualitative descriptive methodology, using content analysis, were applied to explore the responses provided at individual interviews by thirteen key stakeholders. The data collected were not intended to be generalized, but rather to evaluate the potential for implementation of a new model of interprofessional collaborative care within the ACO.
Findings suggest that implementation of this model is feasible within the ACO. Common themes uncovered include: (a) change is challenging, (b) coordinated patient care aligns with organizational goals, (c) success requires cost analysis, a comprehensive business plan, buy-in from primary care physicians, and a pilot program, and (d) strong support among all participants for NP and RN home visits was notable.
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Ndosi, Mwidimi Emmanuel. "Outcomes of nurse-led care for people with rheumatoid arthritis : a nation-wide multicentre randomised controlled study." Thesis, University of Leeds, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.574516.
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Objective To establish whether nurse-led care (NLC) was clinically effective in managing rheumatoid arthritis (RA). Methods This was a multicentre RCT with a non-inferiority design. The hypothesis was that the outcomes from NLC would not be inferior to those obtained from the rheumatologist-led care (RLC). Patients with RA were recruited from 10 rheumatology centres across the UK and were allocated randomly to either NLC or RLC. The primary outcome (disease activity - measured by DAS28) and secondary outcomes (ESR, CRP, pain, fatigue, stiffness, quality of life, self-efficacy, disability, psychological well-being and satisfaction) were compared between the two groups at each follow-up time point and using data pooled over time (52 weeks). The primary analysis followed a "per-protocol" approach and one-sided 95%CI was used to test the null hypothesis using a priori-defined threshold of 0.6 DAS28 score change. Results Patients under NLC (n=91) were comparable to those under RLC (n=90) in their demographic and baseline characteristics. NLC made fewer medication changes, ordered fewer X-Rays but made more conferrals, gave more patient education and psychosocial support than RLC. DAS28 change scores demonstrated that NLC was not inferior to RLC at any follow-up time point. The pooled average difference in DAS28 score was 0.17 (95%CI = -0.12, 0.46); therefore, the null hypothesis was rejected. NLC did not have higher risk than RLC for failing to achieve a low disease activity state or for having non-responders. The intention-to-treat analysis provided similar results. At week 26, patients under NLC had more general satisfaction than those under RLC. There were no significant differences in any other secondary outcomes during the follow-up period (weeks 26 to week 52). Conclusions The main results demonstrated that NLC is not inferior to RLC in managing RA. This will contribute to the evidence for NLC in rheumatology and may influence future policy. Further research is needed to determine the pathway that leads to NLC impact.
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Chan, Ching-han Helen, and 陳靜嫻. "Physician and nurse-led brief intervention for alcohol drinking in the primary care setting : a systematic review." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193834.
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Background: With the increasing public health concern over the alcohol related health burden and mortality globally, the World Health Organization (WHO) has listed alcohol use as the top three risk factors in Non-Communicable Disease (NCD) and the alcohol related mortality and morbidity could be avoided through early intervention and prevention. The Department of Health (DH) of Hong Kong Special Administration Region (HKSAR) has declared the alcohol epidemic was alarming with the increasing in prevalence of alcohol use and binge drinking especially among young people with the westernization of Hong Kong society.
In combating local alcohol use epidemic, DH has put priority to reform health care sector system and to ensure that the local health care system is responsive to the local alcohol use problem. Brief intervention (BI) was found to be effective in dealing with at-risk alcohol use especially in primary health care settings in the various past systematic reviews. However, most reviews mainly focus on physician-led BI while the role of nurse in BI delivery in alcohol drinking had not been under great attention. The effectiveness of nurse-led BI to at-risk drinking has not been fully examined as compared with physician-led interventions in the past reviews. Evaluation of treatment components in terms of intensity, treatment components and service settings may also shed light to public health policy makers in development of local model of BI in dealing with drinking problem in the Chinese population.
Objective: To investigate the effectiveness of physician-led or nurse-led BI on quantity of alcohol consumption, number of drinking days, number of binge drinking episode and health care utilization. The potentially effective treatment intensity, treatments components and setting of intervention were also investigated.
Methods: All the studies published from 1990 to 2012 in MEDLINE, would be evaluated on the effectiveness of BI delivered by physicians and/or nurses to adult at-risk drinkers in primary health care settings, were searched and identified using a combination of keywords.
Results: A total of 13 randomized controlled trials out of 134 articles from MEDLINE were included in this systematic review. The included studies used different outcome measurements to compare the effectiveness of BI by physicians and/or nurses in treating at-risk drinking. Similar demographics and clinical characteristics of the subjects between the intervention and control groups were reported. The studies were from 5 countries. The age range of subjects was from 14 to 75 years old. Majority of subjects drank beyond the recommended limits defined by Alcohol Abuse and Alcoholism (NIAA), United State (US). Through there were discrepancies among the results generated in the included studies on the effectiveness of physician-led and/ or nurse-led BI, the benefits of nurse-led BI in treatment of at-risk drinking cannot be dispelled and could be considered as an alternative or supplement to the physician-led BI in busy primary health care setting today. BI with at least two 5-15 minute sessions was found to be more effective than very BI with one 5-minute session only. High quality BI with all five essential treatment components (information giving, advice, goal setting, assistance and follow up) were found to be more effective than partially included treatment. BI were found effective in dealing at risk alcohol use in all General Out Patient Clinic (GOPC) while the effectiveness of BI on alcohol drinking in Special Out Patient Clinic (SOPC) needs further research to warrant the result.
Conclusion: Based on this systematic review, the potential effects of nurse-led BI remain unclear in comparison with physician-led BI for at-risk drinkers. More researches on the effectiveness of BI by nurse and its cost-effectiveness as well as BI delivered by different primary health care personnel in treating at-risk alcohol drinking with long study period, especially in the Chinese population, is needed to provide further evidence on the development of local BI in local primary health care settings.published_or_final_version
Medicine
Master
Master of Public Health
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Edwards, Margaret. "A study to determine the appropriate case mix for a district nurse-led hospital at home team." Thesis, King's College London (University of London), 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.407252.
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Evdokimoff, Merrily Nan. "Testing the Efficacy of a Nurse-Led, Patient Self-Management Intervention to Decrease Rehospitalization in Older Adults." Thesis, Boston College, 2012. http://hdl.handle.net/2345/2911.
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Thesis advisor: Rosanna DeMarcoAbstract Testing the Efficacy of A Nurse-Led, Patient Self-Management Intervention to Decrease Rehospitalization in Older Adults Merrily Evdokimoff, Ph.D. Rosanna DeMarco, Ph.D., Committee Chair Rehospitalization rates of 20% within 30 days of hospital discharge and 27% within 60 days are one of the highest strains on the federal Medicare budget. The Center for Medicare and Medicaid Services (CMS) has responded by imposing financial disincentives in reimbursement regulations directed to those providers deemed responsible for preventable rehospitalizations. Identifying cost-effective interventions that are appropriate for individuals with chronic illnesses that may be provided within the current home health care system of reimbursement is critical. The purpose of this quasi-scientific intervention study was to test the efficacy of a cost-effective, nurse-led intervention to decrease rehospitalizations of community dwelling older adult Medicare beneficiaries receiving certified home health services following an acute care hospital admission. The intervention was based on Eric Coleman's Care Transition Intervention SM utilizing a personal health record, patient goal setting, and knowledge of "red flags" or changes in condition. Coaching by the home care nurses was added to Coleman's intervention to facilitate support of patient self-management. Three home care agencies, 60 clinicians and 87 patients participated in the study. Findings demonstrated a lower rate of readmission to the hospital in patients receiving the intervention. However, it was not statistically significant. Significant differences were noted between the intervention and the comparison groups including more married or partnered members and higher Case Mix Weight (CMW) or acuity score within the intervention group. Among the rehospitalized participants, provision of a greater number of skilled nursing visits was found. Future replication of the study should include a larger sample and greater time for education of the clinical staff. Inclusion of therapists and productivity adjustments for participating staff during initiation of study is also needed. Further examination of the role of depression in rehospitalization with a larger sample would provide greater understanding of the role depression plays in self-management and rehospitalization
Thesis (PhD) — Boston College, 2012
Submitted to: Boston College. Connell School of Nursing
Discipline: Nursing