Nurse-led clinic

From Wikipedia, the free encyclopedia
Jump to: navigation, search

A nurse-led clinic is any outpatient clinic that is run or managed by registered nurses, usually nurse practitioners. Nurse-led clinics have assumed distinct roles over the years, and examples exist within hospital outpatient departments,[1] public health clinics[2] and independent practice environments.[3]

Definition[edit]

A broad definition of a nurse-led clinic defines these clinics based on what nursing activities are performed at the site.[4] Nurses within a nurse-led clinic assume their own patient case-loads, provide an educative role to patients to promote health, provide psychological support, monitor the patient's condition and perform nursing interventions.[4] Advanced practice registered nurses, usually nurse practitioners, may have expanded roles within these clinics, depending on the scope of practice defined by their state, provincial or territorial government.

Overview[edit]

The recent growth of nurse-led clinics is considered an emerging area of nursing practice; they were originally discussed in nursing journals in the 1980s, and developed over the 1990s into practice areas that have generated financial, legal and professional challenges over the years.[4] There has been recent growth of nurse-led clinics both within hospitals and in the community.[4] However, that growth has been unequal across different legislative regions. As an example, Canada's only known nurse-led clinics exist in Ontario.[5] Unlike many clinics which exist in the United States, Ontario's clinics have been met with some criticism from the Ontario Medical Association and some family physicians who view nurse-led clinics to be unproven innovations in primary care.[5]

In the UK, advanced nursing practice developed in the 1980s in response to increased health needs and cost, and in keeping with health policy.(11) A later impetus came from the “New deal for junior doctors” which was a government response to the European Community directive to reduce junior doctors' hours of work.(12, 13)

Nurse-led clinics typically focus on chronic disease management: conditions where regular follow-up and expertise is required, but also where a patient may not necessarily need to see a physician at every visit.[4] Most nurse-led clinics use nursing theory and knowledge to educate patients and form care plans to manage their conditions.[4]

Review of evidence[edit]

Nurse-led clinics have a brief history of evaluation in scientific literature.[4] Not only is there a large amount of heterogeneity between nurse-led clinics, but there are also different educational backgrounds for nurses who wish to enter these roles.

In a partially blind randomized controlled trial, adult patients with Type II Diabetes were found to have better control of hypertension and hyperlipidemia in a nurse-led clinic when compared to conventional follow-up care.[6] A related study also found that nurse-led clinics were more effective than conventional care in controlling hypertension for adult patients with Type II Diabetes and uncontrolled hypertension.[7] Generally, it was found that most patients experienced improved outcomes following nurse-led clinic consultation, with the best improvement rates found for wound care and continence clinics.[8]

Many nurse-led clinics have also been associated with enhanced patient satisfaction with care.[8] A nurse-led clinic for intractable constipation in pediatric populations was compared to a pediatric gastroenterology clinic, illustrating that parent satisfaction was significantly higher for those who attended the nurse-led clinic.[9]

In areas where nursing practice may require additional support to maintain patient safety, some nurse-led clinics have implemented decision support tools, computerized systems and evidence-based algorithms to support their practice. Nurse-led clinics which utilize computerized decision support tools to manage oral anticoagulation dosages were found be to as effective as hospital-based clinics for INR control and stability.[10]

References[edit]

  1. ^ Rudra, N. (2009, May). Heat on nurse-led clinic to succeed, in Canberra Times [1]
  2. ^ Sussex County, New Jersey (2002). Public Health Nursing Page
  3. ^ Ontario Ministry of Health and Long-Term Care (2009, June). Introduction to nurse practitioner-led clinics. [2]
  4. ^ a b c d e f g Hatchett, R. (2003). Nurse-Led Clinics: Practice Issues. New York, NY: Routledge.
  5. ^ a b Hodges, D. (2009, July). Ontario docs concerned by nurse-led clinics. Retrieved from --~~~~www.everbetter.ca, originally published in The Medical Post. [3]
  6. ^ New, J.P.; Mason, J.M.; Freemantle, N.; Teasdale, S; Wong, LM; Bruce, NJ; Burns, JA; Gibson, JM (2003). "Specialist nurse-led intervention to treat and control hypertension and hyperlipidemia in diabetes (SPLINT): a randomized controlled trial". Diabetes Care 26 (8): 2250–2255. doi:10.2337/diacare.26.8.2250. PMID 12882844. 
  7. ^ Denver, E.A.; Barnard, M.; Woolfson, R.G.; Earle, K.A. (2003). "Management of uncontrolled hypertension in a nurse-led clinic compared with conventional care for patients with type 2 diabetes". Diabetes Care 26 (8): 2256–2260. doi:10.2337/diacare.26.8.2256. PMID 12882845. 
  8. ^ a b Wong, F.K.; Chung, L.C. (2006). "Establishing a definition for a nurse-led clinic: structure, process, and outcome". Journal of Advanced Nursing 3 (3): 358–369. doi:10.1111/j.1365-2648.2006.03730.x. PMID 16441541. 
  9. ^ Sullivan, P.B.; Burnett, C.A.; Juszczak, E. (2006). "Parent satisfaction in a nurse led clinic compared with a paediatric gastroenterology clinic for the management of intractable, functional constipation". Archives of Disease in Childhood 6 (6): 499–501. doi:10.1136/adc.2005.087486. PMC 2082804. PMID 16531455. 
  10. ^ Fitzmaurice, D.A.; Hobbs, F.D.; Murray, E.T.; Holder, RL; Allan, TF; Rose, PE (2000). "Oral anticoagulation management in primary care with the use of computerized decision support and near-patient testing: a randomized, controlled trial". Archives of Internal Medicine 60 (15): 2343–2348. doi:10.1001/archinte.160.15.2343. PMID 10927732. 
  1. Department of Health Nursing Division. A Strategy for Nursing: a report of the steering committee. London: HMSO; 1989.
  2. NHS Management Executive. Junior Doctors: The New Deal. London: HMSO; 1991.
  3. Department of Health. A Compendium of Solutions to Implementing the Working Time Directive for Doctors in Training from August 2004. London: Department of Health; 2004.