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Specialist stoma care nurses (SSCNs) are highly educated professionals who play a critical role in the care of people living with a stoma. However, they experience some unique challenges. Currently in the UK, stoma care has no national standards, targets or best practice pathway, resulting in significant variation and an undervalued service. As members of an evidence-based profession, SSCNs need to demonstrate their value. Specialist nurses in cancer care and inflammatory bowel disease are supported by nationally, with pathways, targets and standards of care, as well as career and education frameworks. This system could be used for SSCNs. A national approach is needed to develop an evidence-based best-practice pathway, commissioned and implemented across the UK for all stoma patients and with SSCNs at its heart. SSCNs need to demonstrate their value through data and evidence. Working with Getting it Right First Time, a taskforce aims to review the evidence and establish minimum standards of care for all stoma patients. SSCNs should be co-ordinators and drivers of change at the highest level of national innovation, policy and decision-making. The work of SSCNs should be is recognised and valued because what they do matters. [ABSTRACT FROM AUTHOR]

Design: A multi‐methods, single‐centre pilot comprising a quasi‐experimental pre‐/post‐test design and an exploratory qualitative study. Setting: A rural Australian hospital and health service. Participants: Men newly diagnosed with localised prostate cancer who were scheduled to undergo, or had undergone, radical or robotic prostatectomy surgery within the previous 3 months. Intervention: The intervention comprised a 12‐week virtual care program delivered via teleconference by a specialist nurse, using a pre‐existing connected care platform. The program was tailored to the post‐operative recovery journey targeting post‐operative care, psychoeducation, problem‐solving and goal setting. Main Outcome Measures: Primary outcome: program acceptability. Secondary outcomes: quality of life; prostate cancer‐related distress; insomnia severity; fatigue severity; measured at baseline (T1); immediately post‐intervention (T2); and 12 weeks post‐intervention (T3). Results: Seventeen participants completed the program. The program intervention showed very high levels (≥4/5) of acceptability, appropriateness and feasibility. At T1, 47% (n = 8) of men reported clinically significant psychological distress, which had significantly decreased by T3 (p = 0.020). There was a significant improvement in urinary irritative/obstructive symptoms (p = 0.030) and a corresponding decrease in urinary function burden (p = 0.005) from T1 to T3. Conclusions: This pilot has shown that a tailored nurse‐led virtual care program, incorporating post‐surgical follow‐up and integrated low‐intensity psychosocial care, is both acceptable to rural participants and feasible in terms of implementation and impact on patient outcomes. [ABSTRACT FROM AUTHOR]

Aims: To explore Registered Nurses' motives to undergo specialist training and to choose a particular speciality. Design: A descriptive qualitative interview study. Methods: Semi‐structured interviews were conducted during 2021 with 20 Swedish specialist nurse students from different specialisation areas. Qualitative content analysis was used. The COREQ checklist was used to report the study. Results: Specialist nurse students' motivations for further training were divided into three main categories with two sub‐categories each. The main categories were 'toward new challenges and conditions in work life', 'contributions to the development and higher competencies in health care' and 'personal work and life experiences as ground for choice'. Conclusion: Our study demonstrates the importance of motivating factors in the career choices of Specialist nurse students, such as personal challenges, desirable working conditions, career growth opportunities and personal experiences in the career choices. Creating a supportive work environment that helps to prioritise work‐life balance and offers the development of new skills might help retain nurses. No Patient or Public Contribution: No patient or public contribution was used. However, if more nurses would choose to undergo specialist training, especially in areas facing significant shortages, it would most likely lead to improved health‐related outcomes for patients or populations. [ABSTRACT FROM AUTHOR]

Background: As the number of nursing home residents with multiple healthcare needs grows, the demand for nursing expertise increases. The implementation of new care models involving nurses with expanded roles is crucial for ensuring quality care in nursing homes. Objectives: To investigate the characteristics and activities of nurses employed in nursing homes in expanded roles and the factors associated with variation in the activities performed. Methods: This multicentre cross‐sectional survey in Switzerland collected data from a convenience sample of 118 nursing homes between September 2018 and October 2019. From a subsample of 62 nursing homes, we analysed the characteristics and activities of 104 nurses in expanded roles. Associations between the activities performed and the educational background of the nurses in expanded roles, their direct supervisors' positions and the presence of physicians in the nursing homes were examined. Results: Most Registered Nurses in expanded roles were diploma educated (48%), with fewer having a bachelor's (35%) or master's degree (17%). Overall, direct clinical practice and guidance and coaching activities were conducted monthly to weekly; consultation, evidence‐based practice, collaboration and ethical decision‐making activities were conducted monthly. We saw variations where a higher educational background was associated with more frequent evidence‐based practice activities (z = 3.47, p < 0.001), and if direct supervisors were ward managers, nurses in expanded roles worked more frequently below their scope of practice (z = 4.10, p < 0.001). Conclusion: This is the first study to use Hamric's integrative Advanced Practice Nursing model to examine the activities of nurses in expanded roles in nursing homes. We found considerable variation in their activities, where nursing homes seem to adapt their roles to their educational background and the local context. Implications for Practice: Our findings show the importance of clarifying role expectations for Registered Nurses in expanded roles, allowing them to practice at the top of the licence to meet residents' complex healthcare needs. [ABSTRACT FROM AUTHOR]

Background Child mental health services are under major pressure worldwide. In the Netherlands, Youth Mental Health Practice Nurses (YMHPNs) have been introduced in general practice to improve access to care. In this study, we evaluated care delivered by YMHPNs. Methods We used medical records of a population-based cohort (21 717 children, 0–17 years). Characteristics of children consulting a YMHPN, type of problem, care delivered by YMHPNs and referrals were assessed using quantitative content analysis. Results Records of 375 children (mean age 12.9 years, 59.2% girl) were analysed. These children were often in their adolescence (57.3% was between 13 and 17 years), and more often female than male (59.2% vs 40.8%). YMHPNs had a median of four consultations (IQR 2–7) with the child. YMHPNs managed a variety of psychosocial problems. YMHPNs managed 22.4% of children without need of referral, 52.0% were eventually referred for additional care. 13.3% of children dropped out during the treatment trajectory. In the remaining 12.3% of children, the treatment trajectory was stopped because the child was already attending specialized services, the treatment trajectory was still ongoing or the medical record was inconclusive. Conclusions YMHPNs successfully managed one in four children with psychosocial problems without need for referral. Nevertheless, most children were eventually referred for additional care. [ABSTRACT FROM AUTHOR]

Nurses have become integral members of multidisciplinary teams in managing rheumatic diseases, departing from their traditional patient care roles. This article provides a comprehensive review of nurses' roles, interventions, and impacts in several rheumatic diseases, including rheumatoid arthritis, osteoarthritis, spondyloarthritis, gout, systemic lupus erythematosus, and polymyalgia rheumatica. It has been demonstrated that care under nursing supervision is effective and safe, with benefits including disease management, quality of life, and treatment adherence. In addition, nurses play a crucial role in promoting health, educating patients, and administering biological disease-modifying anti-rheumatic drugs. The COVID-19 pandemic has highlighted the significance of telehealth services and nurses' role in delivering remote care. However, nursing education and training challenges persist, particularly in standardization and access to postgraduate education. Efforts to enhance the role of nurses in rheumatology care are necessary to optimize patient outcomes and meet the evolving needs of individuals with rheumatic diseases. Collaboration across healthcare institutions, professional groups, and educational facilities is necessary for promoting the continual growth and advancement of rheumatology nurse practice. By equipping nurses with the requisite knowledge, expertise, and resources to deliver top-notch care, we can enhance the well-being of individuals with rheumatic diseases and foster improved overall health outcomes. [ABSTRACT FROM AUTHOR]

Background: Nurses improve themselves with various trainings according to the developing era and patient needs. Determining the effects of postgraduate education in the clinical field opens new horizons for improving the quality of patient care. Aim: To determine the opinions of the participants about the effects of postgraduate education in nursing and the reflection of these effects on the clinic field and patient care by the nurse specialist. Methods: This is a phenomenological descriptive qualitative study which was data gathered through in-depth interviews with nurses, physicians, and patients. For content analysis, the data were subjected to thematic analysis. Results: The data obtained from the views of the participants about the effects of postgraduate education in nursing and its reflections on the clinic were combined under 4 main themes and 20 sub-codes. Conclusions: It was concluded that postgraduate education has effects on nursing roles, individual development, other professional development, increasing its professional value and scientific power, and these effects are reflected positively in clinical field. [ABSTRACT FROM AUTHOR]

Aim: To identify attitudes and barriers to evidence-based practice from the perspective of Portuguese nurses specialized in medical-surgical nursing. Design: Descriptive cross-sectional study. Methods: Data collection in 2022, via a digital form comprising a questionnaire on socio-professional characterization and the Portuguese version of the “Barriers to Evidence-Based Practice in Primary Care”. Non-probability convenience sampling. Data analysis performed using the Statistical Package for the Social Sciences, version 24. The checklist used was “Strengthening the Reporting of Observational Studies in Epidemiology”. Results: The final sample consisted of 218 specialist medical-surgical nurses working in clinical practice settings in Portugal, who showed a generally positive attitude towards evidence-based practice. The barriers to evidence-based practice highlighted were lack of incentives, support from expert colleagues, training, financing, and time. Conclusion: Specialist medical-surgical nurses value evidence-based practice and recognized its benefits, but also identified barriers that make its practical implementation a challenge. The identification of the attitudes and barriers allows for the identification of shortcomings and the making of tailored training plans, thereby increasing the integration of evidence into the practice of these renowned professionals. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to explore the work conditions that influence the opportunities for professional development of specialist nurses in surgical care. Design: A qualitative descriptive design was used. Methods: With a purposeful sampling procedure, 14 specialist nurses in surgical care were included. Four focus‐group interviews were conducted during November to December 2021 and deductively analysed using the Job Demand‐Resource theory as a guiding framework. Reporting adheres to COREQ guidelines. Findings: Work conditions that were identified as job demands and that inhibited nurses' opportunities for professional development were mainly found at an organizational and leadership level. Primarily, those conditions included role ambiguity and time constraints caused by uncompensated nursing shortages that restricted the nurses from exercising their role. Such conditions could also discourage other nurses from further education. Job demands were seen as largely compensated for by work conditions identified as job resources and located mainly at an individual level, for example finding the work interesting and multifaceted. Most prominent was the participants' inner motivation to work with surgical patients and to continue to develop themselves and other nurses professionally. Conclusions: A prerequisite for professional development is that the specialist role is clearly defined in collaboration with representatives from the nursing profession and universities. Hence, hospital organizations need to reflect on how to utilize the competence. Also, it is important that nurse leaders promote the specialist nurses' motivation by supporting them in the exercise of their role. Impact: Findings from this study revealed work conditions that need to be acknowledged during hospital organizations' endeavours to maintain and enhance nursing competence. Patient or Public Contribution: Patient or public contribution was not applicable since the study focused on specialist nurses' working conditions. [ABSTRACT FROM AUTHOR]

Background: The context of end-of-life care for older heart failure patients with a complex clinical course provided by certified nurse specialists in gerontology (GCNSs) and Certified nurses in chronic heart failure (CNCHFs) is unclear; therefore, this study aims to describe comprehensive nursing practice for older patients with heart failure at their end of life. Methods: This study adopts a qualitative descriptive design using content analysis. Five GCNSs, and five CNCHFs were interviewed using a web app from January to March 2022. Results: Thirteen categories of nursing practices for older patients with heart failure were generated: (1) Provide thorough acute care by a multidisciplinary team to alleviate dyspnea, (2) Assess psychiatric symptoms and use a suitable environment to perform treatment, (3) Explain the progression of heart failure with the doctor, (4) Build a trusting relationship with the patient and family and implement advance care planning (ACP) early during the patient's recovery, (5) Involve multiple professions to help patients to achieve their desired life, (6) Perform ACP always in collaboration with multiple professionals, (7) Provide lifestyle guidance according to patients' feelings so that they can continue living at home after discharge from the hospital, (8) Provide palliative and acute care in parallel with multiple professions, (9) Achieve end-of-life care at home through multidisciplinary cooperation, (10) Provide basic nursing care to the patient and family until the moment of death, (11) Provide concurrent acute and palliative care as well as psychological support to alleviate physical and mental symptoms, (12) Share the patient's prognosis and future wishes with multiple professionals, and (13) Engage in ACP from early stages, through several conversations with patients and their families. Conclusions: Specialized nurses provide acute care, palliative care, and psychological support to alleviate physical and mental symptoms throughout the different stages of chronic heart failure. In addition to nursing care by specialized nurses at each stage shown in this study, it is important to initiate ACP early in the end-of-life stage and to provide care for patients with multiple professionals. [ABSTRACT FROM AUTHOR]

Alcohol and other drug (AOD) nurse practitioners have an advanced scope of practice that allows them to diagnose, prescribe pharmacological treatments for alcohol and other substance use disorders, and monitor physical and mental health. The Behaviour Change Wheel (BCW) is used to understand barriers and facilitators to implementation by applying three conditions of behaviour change (capability, opportunity, and motivation—the COM‐B framework). The aim of this paper is to describe the current AOD nurse practitioner workforce, and to explore barriers and facilitators to AOD nurse practitioner uptake in Australia. A mixed method approach was used in this study: a survey to determine the current state of the AOD nurse practitioner workforce (n = 41) and qualitative interviews with 14 participants to determine barriers to endorsement and ongoing work as a nurse practitioner. Interview transcripts were analysed using thematic analysis and mapped to the COM‐B framework. The AOD nurse practitioner is a highly specialized provider of holistic care to people who use alcohol and other drugs, with AOD nurse practitioners performing advanced roles such as prescribing and medication management. However, there are several barriers to the further uptake of AOD nurse practitioners in Australia, including varied organizational support, a lack of support for the higher study required to become a nurse practitioner and a lack of available positions. Arguably, nurse practitioners are key to addressing prescriber shortages inherent in AOD treatment settings. In addition, they are equipped to provide true holistic care. We recommend that barriers are addressed to expand the AOD nurse practitioner workforce in Australia. [ABSTRACT FROM AUTHOR]

In 2005, the Korea Disease Control and Prevention Agency (KDCA) launched “Health Care Facility Counseling Project on People Living with human immunodeficiency virus (HIV)” funded by the private-subsidy project for the prevention of acquired immune deficiency syndrome (AIDS) and sexually transmitted diseases to provide people living with HIV (PLWH) psychological support and counsel them about the disease and antiretroviral therapy (ART). Currently, 38 counseling nurse specialists work at 28 healthcare facilities for patient care. Of all PLWH in Korea, 71.9% received benefits from the Counseling Project. Adherence to ART medication (>95.0%), level of depression or anxiety, counseling coverage, and viral load status were monitored as common project indicators. Various specialized programs have been implemented in diverse facilities. This project has played a pivotal role in HIV care continuum and viral suppression policies, resulting in 95.9% of PLWH maintaining undetectable status (<40 copies/ml) in 2021. In this review, we present the chronology and fulfillment of this project, which will be an essential step for future planning in the context of aging and the chronic comorbid nature of HIV/AIDS. [ABSTRACT FROM AUTHOR]

Objective: To assess the acceptability of a nurse‐led prostate cancer survivorship intervention adapted for virtual delivery and tailored to post‐surgical care, in a regional Australian hospital and health service. Methods: A qualitative exploratory study using the Theoretical Framework of Acceptability (TFA). Results: Twenty‐two participants took part in a semistructured interview comprising men who had completed the program (n = 16) and health professionals/service stakeholders involved in program delivery (n = 6). Acceptability of this virtual prostate cancer survivorship care program was very high across all constructs of the TFA, from the perspectives of both program recipients and those delivering the program. The quality of care received was seen as superior to what men had experienced previously (burden, opportunity costs). The time afforded by the regularly scheduled video‐consultations allowed men to come to terms with the recovery process in their own time (self‐efficacy), and provided an ongoing sense of support and access to care outside the consultation (ethicality). Clinically, the program improved care co‐ordination, expedited identification of survivorship care needs, and met service priorities of providing quality care close to home (burden, perceived effectiveness). Conclusions: Findings from this study suggest virtual post‐surgical care delivered via videoconferencing is highly acceptable to prostate cancer survivors in a regional setting. Future research exploring virtual program implementation at scale and long‐term patient and service outcomes is warranted. [ABSTRACT FROM AUTHOR]

Aims: The aims of the study were to identify factors affecting nurses' decision to undergo specialist education and choose a specialty and to describe differences between specialization areas with different types of care. Design: A descriptive cross‐sectional design. Methods: A survey was conducted among specialist nurse students in three nursing colleges in Sweden (n = 227). Instruments such as Big Five Inventory and RAND‐36 and items earlier used by Bexelius and Olsson were included. Survey data were analysed by using descriptive and analytical statistics, and for open‐ended question qualitative content analysis was used. Results: Wage benefit during the education was regarded by 47% as an incentive to start studies. Most of the specialist nurse students considered an opportunity for new tasks (75%), new areas of responsibility (75%), intellectual challenges (72%) and higher wages (71%) to be of high importance when choosing a specialty. However, the students in specialization areas with transitory care‐rated challenges regarding the practical skills (84%) and the occurrence of acute events (82%) higher. Conclusion: Although higher wages were important to make nurses feel that they will get value from the education, there were also other important aspects, such as opportunity for new tasks, new areas of responsibility and intellectual challenges that influenced nurses' willingness to undergo a specialist education. Our findings provide employers with the useful information to guide and influence nurses' decisions to enter specialist education and their choice of specialist area. [ABSTRACT FROM AUTHOR]

Purpose: As the Australian population grows and ages, the demand for eye care services, and nurses to provide the services, is expected to increase. This will impact nurses, who are Australia's largest health-care provider group. Understanding and mapping the current role and use of nurses in eye care is an essential first step for future health workforce planning and development. To map their engagement, we undertook a scoping review to gain an understanding of the current Australian nurse eye care workforce landscape, to help guide and support future workforce development activities. Secondly, we evaluated if publications in this field incorporated or mentioned the Australian Ophthalmic Nursing Association's National Standards (Practice standards) in their publication. This review also offers other nations and eye care providers the opportunity to evaluate their own health workforce plan and nurse utility. Study Design and Methods: We conducted a review of academic and grey literature, via various search engines, and an inclusion and exclusion criteria. Results: We uncovered 11 publications. Of those, five were academic papers examining extended and advanced nursing practice, one was a letter to the editor, two were industry feature reviews, two were industry reports and the final was the Practice Standards. Key themes throughout indicated the benefit of nurse training and nurse involvement in eye care. Overall, there was insufficient information or data to describe nurse deployment, practice and utility. Finally, the Practice Standards were not referenced in any publication. Conclusion: There is insufficient published information to calculate the level and involvement of nurses, or describe their existing role, advancement or future deployment in eye care in Australia. Without clear information, Australia is unable to develop effective health workforce strategies to attract, train, retain, and appropriately deploy nurses to meet future eye care needs. [ABSTRACT FROM AUTHOR]

Aims: To investigate the knowledge sharing behaviour of critical care nurse specialists and identify potential influencing factors. Background: The specialist knowledge of critical care nurses is an important resource for the nursing team. It is necessary to investigate influencing factors of knowledge sharing behaviour of them. Methods: Convenience sampling was used to conduct an investigation involving critical care nurse specialists from three provinces in China between October 2018 and June 2019. Practice Environment Scale, Competency Inventory for Registered Nurses, Knowledge Self‐efficacy Scale, and knowledge sharing behaviour scale were utilized. Results: The knowledge sharing behaviour score of critical care nurse specialists was 64.84 ± 11.53. The results of the regression analysis showed that the level of education, position, involvement of nurses in hospital affairs, knowledge, self‐efficacy, sex, average number of night shifts per month, years engaged in nursing work, type of employment, leadership skills, critical thinking ability and manpower and material resources accounted for 45.9% of the variance. Conclusions: Critical care nurse specialists exhibited limited knowledge sharing behaviour. Therefore, interventions based on the dependent variables are necessary. Implications for Nursing Management: Knowledge sharing behaviour of critical care nurse specialists remains at a low level. Hence, it is necessary to encourage their greater participation according to associated factors. [ABSTRACT FROM AUTHOR]

Copyright of QhaliKay: Revista de Ciencias de la Salud is the property of QhaliKay Revista de Ciencias de la Salud and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives RA should be treated to target in a process of shared decision-making with patients. Person-centred care is essential to meeting specific patient needs. Nurse-led clinics, where a nurse is responsible for care, have demonstrated added value in some countries but are still not implemented widely. This study aimed to explore stakeholders' perceptions of advantages, disadvantages and conditions for the implementation of nurse-led clinics for RA in Belgium. Methods We performed a cross-sectional qualitative study consisting of five semi-structured focus group interviews. Rheumatology nurses, patients with RA and rheumatologists were interviewed as stakeholders. The analysis was carried out by three researchers according to the Qualitative Analysis Guide of Leuven (QUAGOL), formulating a conceptual framework of overarching themes and deconstructing this into perceived advantages, disadvantages and conditions. Results Two focus groups with nurses (total n  = 16), two with patients (n  = 17) and one with rheumatologists (n  = 9) were conducted. The interview synthesis resulted in five overarching themes across stakeholders: efficiency of care, disease management, legal and organizational requirements, the conventional role of the nurse and the extended role of the nurse. All stakeholders perceived additional education for nurses as essential, but rheumatologists debated nurses' abilities to lead a rheumatology clinic. Furthermore, patients preferred care protocols to guide nurses, and care providers approached this reluctantly. Generally, patients with a well-controlled disease were perceived as the ideal candidates for nurse-led care. Conclusion Nurse-led clinics could provide many benefits but require additional nurse education and a legal and organizational framework before being implemented widely and successfully. [ABSTRACT FROM AUTHOR]

Aims: To investigate the attitudes and beliefs towards the implementation of nurse prescribing among general nurses and nurse specialists. Design: A cross‐sectional survey among general nurses and nurse specialists was conducted in seven provinces and one autonomous region in mainland China using convenience sampling method. Methods: The attitudes and beliefs towards nurse prescribing were assessed using the Nurse Attitudes and Beliefs towards Nurse prescribing scale, of which Cronbach's coefficient was 0.902, retest reliability was 0.808. Respondents from eight hospitals across the country were employed to complete an online questionnaire. Results: Nurse specialists (n = 399) had statistically significantly more favourable intentions towards nurse prescribing than general nurses (n = 415; 105.64 ± 12.83 vs. 96.39 ± 13.16; p <.001). The years of clinical work experience, professional title, education degree were positively correlated with general nurses' and nurse specialists' attitudes and beliefs towards nurse prescribing (p <.05). Among nurse specialists, the variety of specialties and whether they work in nurse‐led clinics on an outpatient basis have positively influence on their intentions towards nurse prescribing (p <.05). [ABSTRACT FROM AUTHOR]

Aim: To identify and evaluate the impact of Intellectual Disability Nurse Specialists person‐centred care for people with intellectual disability. Design: An Integrative review of the literature was performed between January 2007–December 2017. Methods: Searching the PubMed Library of Medicine, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline Ovid, PsychINFO, Health Source: Nursing/Academic edition. A total of eight articles were selected for the final study example, including four mixed methods studies and four qualitative studies. Results: Three Intellectual Disability Nurse Specialist models were evaluated, and three main themes emerged: person‐centred care, organizational and practice development. Conclusion: The Intellectual Disability Nurse Specialist expert knowledge and skills contribute to the development of effective systems and processes. The results highlighted the complex nature of the Intellectual Disability Nurse Specialist role and the importance of ongoing development, promotion and evaluation and their contribution to care in the healthcare setting. [ABSTRACT FROM AUTHOR]

Background: Wound care nurses are recognised as a key element for improving health outcomes. However, there is still fragmented knowledge of the outcomes associated with their practice in individuals with pressure ulcers. Aims and objectives: To identify, summarise and map all available evidence related to the outcomes of wound care nurses' practice in individuals with pressure ulcers. Design: Integrative literature review. Review method: To report the review, we followed the modified version of Cooper's five‐step methodology, and the PRISMA guidelines. Methods: The search was carried out on CINAHL, PubMed, the Cochrane Library and Scopus, with a time frame ranging from each database inception to December 21, 2019. We included observational or experimental studies of adult individuals affected by (or at risk of) developing pressure ulcers who were also cared for by wound care nurses. Results: Of the 439 peer‐reviewed publications, 13 studies met the inclusion criteria. The most frequent outcomes were pressure ulcer incidence, healing rate and time taken for complete healing. Less frequent outcomes were changes in pressure ulcers' stage, number of completely healed wounds, treatment costs and physical discomfort. No patient‐reported outcomes were assessed. Conclusion: This review indicates that clinical‐related outcomes were by far the most reported. Future studies should broaden the spectrum of outcomes to include more subjective parameters (e.g. pain, quality of life, stress, etc.), in order to gain a better understanding of the global impact of wound care practice on patients with pressure ulcers. Relevance to clinical practice: There is promising evidence of a positive impact of wound care nurses' practice on health and economic outcomes. Nonetheless, more robust and rigorous research is needed to provide stronger evidence in the field and support investment in these practitioners. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to identify the work activities of nurse-led rapid response teams (RRT). Methods: For this study a methodological approach was used to identify work activities for nurse-led RRT. The study was conducted in two stages. The first step was to analyze the work activities of domestic nurse-led RRTs using the interview method, and then develop a questionnaire based on the results of the interviews. As a second step, field surveys were conducted by nurse-led RRT nurses to investigate importance and performance based on the developed questionnaire. Results: Fifty-eight work activities were identified for nurse-led RRTs in the following nine core areas: advanced nursing practice, education, counseling, consultation, collaboration, ethical decision-making, research, evidence-based practice, and leadership. Conclusion: The identified work activities for nurse-led RRTs will be used as basic data in nurse-led RRTs job description, developing job standards and can also serve as basic data for developing a nurse-led RRT educational curriculum. The results of this study suggest that follow-up research is needed to develop job standards based on the identified nurse-led RRT's work activities. [ABSTRACT FROM AUTHOR]

Background: Many Dutch nurse practitioners (NPs) work together with physicians and specialized nurses (SNs) in outpatient clinics, although the latter have questioned the added value of NPs in the outpatient clinic. Clarification of the distinction between and the added value of both nursing professions in relation to each other could lead to optimal use of the unique competencies of each type of nurse. Purpose: To explore NPs' perspectives on their added value in relation to SNs in the outpatient clinic. Methodological orientation: Data were analyzed by Braun and Clarke's thematic analysis. The CanMEDS competences were used to identify the NPs' comments about their practice. Sample: Twelve semi-structured interviews were conducted with NPs from two hospital settings. Conclusions: The added value of NPs was most evident in: nursing leadership, integrating care and cure and performing an expert level of nursing expertise, and competencies in science. To optimize their roles, NPs and SNs need to make all team members aware of their unique competences and promote role clarification. Implications for practice: This study provides barriers in barriers that influence optimal positioning of NPs within the interdisciplinary team, stresses the importance of discussion on the optimal skill mix within the interdisciplinary team, and describes the NPs' leadership role because this is the encompassing link between the main competencies of their practice. Addressing and overcoming these findings could improve the NPs' positioning and effective collaboration within (the outpatient clinic's) interprofessional teams. [ABSTRACT FROM AUTHOR]

Objective To develop an demand-oriented evaluation index system for core competence of clinical nurse specialists, in order to provide reference for cultivation, qualification approval and assessment of clinical nurse specialists. Methods Based on the literature review, theoretical study and expert interviews, an evaluation index system for core competence of clinical nurse specialists was constructed by using a two-round Delphi methods with 30 experts. Results The response rate was 100.00% in the first round and 100.00% in the second round. The authoritative coefficient (Cr) was 0.827, the familiarity with the indicators (Cs) was 0.767 and the judgment basis of the indicators (Ca) was 0.887. The Kendall coefficient of concordance of first-level indicators, second-level indicators and third-level indicators was 0.233, 0.102 and 0.118, respectively. Totally 5 first-level indicators, 20 second-level indicators and 15 third-level indicators were identified. Conclusion The evaluation index system for core competence could provided a valuable evidence for the training, assessment and appointment of clinical nurse specialists. [ABSTRACT FROM AUTHOR]

Copyright of Enfermería en Cardiologia is the property of Asociacion Espanola de Enfermeria en Cardiologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Enfermería en Cardiologia is the property of Asociacion Espanola de Enfermeria en Cardiologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: This study investigated the relationship of the partnership between nurses and parents of hospitalized children with the quality of pediatric nursing care as perceived by pediatric nurses. Methods: A cross-sectional descriptive study was conducted among 90 nurses. The data collected were analyzed using the independent t-test and the Pearson correlation coefficient. Results: The level of partnership between nurses and parents showed significant differences by nurses' age (t=2.22, p=.029) and marital status (t=2.54, p=.013). The quality of pediatric nursing care was found to significantly differ by the nurses' age (t=2.62, p=.013), marital status (t=4.17, p<.001), whether nurses had children (t=2.53, p=.020), pediatric ward work experience (t=2.43, p=.020), and total work experience (t=2.51, p=.016). The level of partnership between nurses and parents was positively correlated with the quality of pediatric nursing care (r=.48, p<.001). Conclusion: To improve the quality of nursing care for hospitalized children and their parents, it is important to consider the specific characteristics of pediatric nurses, whose clinical skills should be improved. [ABSTRACT FROM AUTHOR]

Antimicrobial stewardship (AMS) has developed over the past decade as a critical tool to promote the appropriate use of antimicrobials in order to contain antimicrobial resistance (AMR) and conserve antimicrobial medicines. Current literature supports the role of the nurse in AMR, with a strong focus on the responsibilities of the nurse in infection prevention and control (IPC), both in the formal role of the IPC nurse specialist, and the more general IPC role of the bedside nurse. There is also growing support for the collaborative role of the nurse in the multidisciplinary AMS team. There is, however, very little literature examining the clinical practice role of the nurse in AMS. In this discussion, we contend that nursing practice may unknowingly contribute to AMR owing to varying methods of administration of intermittent intravenous infusions, resulting in under-dosing of antimicrobial medicines. [ABSTRACT FROM AUTHOR]

Copyright of Enfermería en Cardiologia is the property of Asociacion Espanola de Enfermeria en Cardiologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Clinical governance processes are important for improving patient care. Patients with adrenal insufficiency are at significant risk if they have an adrenal crisis and require steroid therapy. Families should receive education on managing illness or stress, that is, steroid sick day rules. Most of this education is delivered by children's nurses. Two local cases of mortality related to adrenal insufficiency were reviewed and a questionnaire audit was undertaken to compare the steroid sick day rules education provided to patients and their families with published standards. Most training (75%) was delivered by nurses. Most families/patients (94%) had received written information on oral dosing for steroid sick day rules, and were confident about when/how to double up oral steroid doses (78%). Fewer families recalled being given written information about the emergency hydrocortisone injection (53%), and fewer were confident about how to give the injection (46%). Several important changes and modifications to clinical practice have been implemented in response to the clinical governance findings. These include setting up notification 'red flags' on patients' electronic records and holding specialist family teaching sessions on steroid sick day rules. [ABSTRACT FROM AUTHOR]

Purpose: This study was intended to investigate the frequency of job performance of the Korean professional medical support staffs (PMSS). Method : The data of 1,666 PMSS from 36 hospitals and over 500 beds were analyzed. The participants were divided into 5 groups: advanced practice nurses (APN), clinical nurse experts, physician assistants (PA), coordinators, and others. Results : Among the 5 main domains of job performance, advanced clinical practice has the highest frequency (111.36 d/y), followed by consultation/collaboration (75.66 d/y), education/counseling (53.54 d/y), leadership (23.90 d/y), and research (19.14 d/y). There was a significant difference in the frequency of job performance between the 5 groups of participants. The invasive activities were more frequent in the PA group. In the education and counseling domain, APNs had a higher level of job frequency than others (p<.001). In the research and leadership domains, APNs and coordinators had more prominent performance frequency than other groups (p<.01). However, there are some ambiguities in the job performance of the 5 groups depending on institutional characteristics. Conclusion : To establish the scope of work of PMSS, organizational and individual efforts are needed to promote and expand the leadership and research domains. To resolve the ambiguities of PMSS' roles, it is necessary to reorganize their titles. [ABSTRACT FROM AUTHOR]

Specialist nurses have a crucial role within the allergy and immunology specialty that reflects their competence in an increasingly complex area of work and ability to use advanced diagnostic testing and therapeutic modalities. A specialist nurse in Qatar follows the local Hamad Medical Cooperation (HMC) guidelines and the competency published by the British Society for Allergy and Clinical Immunology (BSACI). Specialist Allergy Nurses Learning domain: Learn and review the written standard operating procedure (SOP) and protocols for all diagnostic and therapeutic allergy procedures, including skin prick testing (inhaled, food, and others), intradermal testing, skin patch testing, penicillin testing, food and drug challenges, different desensitization protocols, and biologics and other medication administration. In addition, learn the protocol for immunotherapy administration and maintain an updated knowledge of trends and developments in the field by reading relevant articles, journals, and related material and attending seminars and conferences, as needed. Maintain a safe work environment: Perform all the above procedures and medication administration with a high grade of competency under physician supervision. Apply quality measures to ensure safety. Furthermore, perform stocktaking by regularly checking procedure requirements, availability of items and consumables, date of expiry of items, and medications. Monitor the patients closely during drug and food allergy challenge procedures and record and report patients' vitals and reactions to treating physicians. Ensure that a patient stays the required observation time after injection(s). General care: Assess patient needs and suggest solutions to patient care problems. Provide education and resources for the patient and family support as needed. React appropriately and on time during patient reaction situations to mitigate early adverse reactions. Maintain patient, employee, and clinic confidentiality. Specialist Immunology Nurses • Develop specialist knowledge and experience in immunology. •Develop nurse-led clinics for administering immunoglobulin replacement therapy safely and effectively based on patients' preferences (IV vs. SC and in-hospital vs. home programs). •Coordinate communication between members of the multidisciplinary team to facilitate the appropriate delivery of care. •Provide education and resources for the patient and family support (insurance issues, resources for vaccination recommendations, concerns regarding traveling and vacations, pregnancy, and any other lifecycle changes). [ABSTRACT FROM AUTHOR]

Copyright of RIIS: Revista de Investigação & Inovação em Saúde is the property of RIIS: Revista de Investigacao & Inovacao em Saude and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This is part 2 of an article exploring the endocrinopathies associated with cancer treatments, a growing area of care. More than 80% of all childhood cancers are treatable and the number of survivors of childhood cancer is increasing, but up to two thirds of these children reportedly present with significant health problems resulting from their treatments and about 25% of survivors have endocrine problems. This article explains how an understanding of oncology and endocrinology enables nurse specialists to educate young people about their past treatment, and its implications for their current and future health. It focuses on the specific endocrine risks to survivors of childhood cancer following treatment with chemotherapy and radiotherapy. This is the final article in a series that has illustrated the breadth of work undertaken by nurse specialists in endocrinology and oncology. [ABSTRACT FROM AUTHOR]

Head and neck cancer (HNC) patients face a number of ongoing health-related quality-of-life issues, even five years after treatment. NICE guidelines stipulate that long-term support and rehabilitation should be provided in the community, working closely with primary and specialist care. The first funded team to provided dedicated care to HNC patients, known as CHANT, was set up in South East London. Here we report trends in service provision over the first two years, and the views of patients. [ABSTRACT FROM AUTHOR]

Aspinal F., Gridley K., Bernard S. & Parker G. (2012) Promoting continuity of care for people with long-term neurological conditions: the role of the neurology nurse specialist. Journal of Advanced Nursing 68(10), 2309-2319. Abstract Aims. To identify service models that provided care co-ordination for people with long-term neurological conditions in the UK. Background. The successful management of long-term neurological conditions needs sophisticated management across several health, social care and other service boundaries, as well as involvement of people with long-term neurological conditions and their support network. Yet, fragmentation of, and limited access to, support has been evident for over 20 years. Design. This study employed a mixed-method approach, including a systematic review, qualitative case studies and a quantitative national survey. This paper reports findings from the qualitative case study element of the research. Methods. In-depth (qualitative) case studies were conducted in six neurology 'service systems' in the UK representing geographic and demographic diversity. The research took place between November 2007-May 2008. The concept of 'continuity of care' was used as a framework for our case studies. Qualitative methods, including telephone and face-to-face interviews, were used to explore people's experience of continuity of care. Data were managed and analyzed using the Framework technique. Findings. Neurology nurse specialists were able to contribute to all elements of continuity of care for people with long-term neurological conditions. Conclusion. Their specialist knowledge about the condition and local services, flexibility, co-ordinating role, and their holistic and collaborative approach to practice, are key factors in nurse specialists promoting continuity of care. Nurse specialists exist in many different clinical areas and in many countries. Findings about the importance of their role in promoting continuity of care have important implications for UK and international policy and practice. [ABSTRACT FROM AUTHOR]

Background: Diabetes Co-management in General Practice (DCGP) is a regional project being implemented in general practices in areas of Melbourne. Aims: To increase access to co-ordinated diabetes services and prevent avoidable diabetes-related hospital admissions through improved care, self-management, education and support. Methods: Credentialed Diabetes Educators (RN-CDEs) co-manage diabetes care with the patient and general practitioner, using evidence based management, care plans and referrals. Contact can be at the clinic, home visits, or via 24 hour phone support. Involvement of the RN-CDE within the general practice includes checking databases, establishing recall systems, and practice nurse support. Results: There is marked cultural diversity among patients (n=1571). The majority have non-English speaking backgrounds. Screening rates for HbA1c have improved (78.6% to 85.3%, p<0.05). Number of patients meeting HbA1cbelow 7% has increased (29,6% to 39.2%, p<0.001). There were significant reductions in diabetes related emergency department presentations at six month review (n=896, p<0.001), 12 month review (n=490, p<0.001) and 18 month review (n=215, p=0.013), and hospital admissions at six month review (n=896, p<0.001), 12 month review (n=490, p<0.001) and 18 month review (n=215, p<0.01). RN-CDEs have responded to 607 unscheduled contacts from patients and carers. Conclusion: This article describes the experiences and outcomes of a general practice based project using diabetes specialist nurses. The project is successful in providing coordinated education and care, integrating the role of the RN-CDE into general practice clinics, and improving health outcomes for people with diabetes. [ABSTRACT FROM AUTHOR]

To determine the effects of community based nurses specialising in Parkinson's disease on health outcomes and healthcare costs.Two year randomised controlled trial in 438 general practices in nine randomly selected health authority areas of England.1859 patients with Parkinson's disease identified by the participating general practices.Survival, stand-up test, dot in square test, bone fracture, global health question, PDQ-39, Euroqol, and healthcare costs.After two years 315 (17.3%) patients had died, although mortality did not differ between those who were attended by nurse specialists and those receiving standard care from their general practitioner (hazard ratio for nurse groupvcontrol group 0.91, 95% confidence interval 0.73 to 1.13). No significant differences were found between the two groups for the stand-up test (odds ratio 1.15, 0.93 to 1.42) and dot in square score (difference−0.7,−3.25 to 1.84). Scores on the global health question were significantly better in patients attended by nurse specialists than in controls (difference−0.23,−0.4 to−0.06), but no difference was observed in the results of the PDQ-39 or Euroqol questionnaires. Direct costs for patient health care increased by an average of£2658 during the study, although not differentially between groups: the average increase was£266 lower among patients attended by a nurse specialist (−£981 to£449).Nurse specialists in Parkinson's disease had little effect on the clinical condition of patients, but they did improve their patients’ sense of wellbeing, with no increase in patients’ healthcare costs. [ABSTRACT FROM AUTHOR]

Can a standardized needs assessment be used to improve the care of people with severe mental disorders? A pilot study of ‘needs feedback’ The care programme approach (CPA) was introduced in the United Kingdom in 1991 to ensure that the needs of people with mental health problems are met appropriately. Many community psychiatric nurses (CPNs) act as ‘key workers’ under the CPA. Recent evidence suggests that the CPA is not particularly effective at meeting the needs of this vulnerable group, but it might be possible to enhance the CPA by introducing a more ‘needs-led’ approach to the planning of nursing care. ‘Needs feedback’ is a technique for enhancing the CPA. Needs feedback begins with a standardized assessment of patients’ psychiatric and social needs by a nurse specialist. The patient’s CPN is then provided with information on: (a) the needs identified; (b) why these needs have been identified; (c) the interventions required to meet the identified needs; and (d) how these interventions may be obtained. In the pilot study reported in this paper, 20 patients with severe mental disorder were evaluated before and after their CPN received needs feedback. All patients were living in the community and being managed by CPNs under the CPA. Outcome was assessed 6 months after the feedback in terms of: mental state, social behaviour and number of ‘unmet’ needs. Needs feedback was found to be compatible with the CPA in that it proved acceptable to CPNs and patients. Significant improvements were seen in the number of ‘unmet’ needs and the level of anxious/depressive symptoms. Improvements approaching significance were seen for social functioning and negative psychiatric symptoms, but not for positive psychiatric symptoms. This pilot study suggests that needs feedback may improve the quality of nursing assessment and care planning within the CPA. Further controlled investigations of needs feedback are justified. [ABSTRACT FROM AUTHOR]

The Society for the Prevention and Relief of Cancer was established by Douglas Macmillan before the advent of the welfare state, with the aim of providing voluntary nursing care for people in their own homes. He had witnessed his father's painful experience of the disease and wanted to improve the lives of other people with cancer. The organisation has gone through many changes in the intervening 100 years, with involvement in the hospice movement, the development of the cancer nurse specialist role, provision of specialist beds and a focus on patient outcomes. Today, the organisation's modern incarnation, Macmillan Cancer Support, is one of the UK's biggest cancer charities. [ABSTRACT FROM AUTHOR]

Introduction: In Ireland, more Diabetes Nurse Specialists DNS have been introduced into the community as part of a national programme to standardise and improve diabetes care. DNS support the delivery of a new model of care whereby uncomplicated type 2 diabetes T2DM is managed in primary care, and complicated T2DM is managed between primary and secondary care. Historically diabetes care in Ireland has often been delivered in an unstructured way, with a lack of integration between primary and secondary care. Given this context we wanted to understand the experiences of community-based DNS in supporting the delivery of integrated care. Methods: We purposively sampled DNS from community-based respondents to a national survey n=25, according to four administrative regions of the National Health Service. We conducted focus groups and interviews using a semi-structured topic guide. Interviews were digitally recorded and transcribed into NVivo V.11 for coding and analysis. Coding was data-driven, with a focus on DNS actions or behaviours, the causes and conditions, and any consequences of those actions. Results: Nineteen DNS participated in two focus groups n=8, and 11 individual interviews. Lacking guidance on their role, DNS felt setting up their service was a case of 'sink or swim'; they used initiative to establish the service. DNS adapted to working with a 'whole different MDT' in the community. They lacked the 'safety net' of the hospital team to check things with and 'bounce ideas off'. As a result they worked more autonomously and perceived themselves to be 'practicing at a higher level', which some felt was 'daunting'. For some, this highlighted the importance of maintaining their expertise and specialist skills. DNS needed to 'blend in' with how things were done in GP practices; being flexible and responsive to the practice's experience in diabetes. The lack of a shared record between settings meant patient information from hospital appointments was not readily accessible by DNS at practices and vice versa, making patient follow-up and case discussion difficult. DNS often acted as an information link, sometimes 'the only link, [or] bit of integration between the hospital and GP'. DNS felt managers and consultants did not understand their role, creating difficulty when negotiating certain aspects, including flexible working hours. One community DNS found integrating care difficult when not seen as part of the team. DNS needed to explain their role which required 'quite good interpersonal skills' and initiative on their part. Discussions: Community-based DNS used initiative to respond to challenges presented by the healthcare context. Conclusions: Challenges included how the role was introduced, understanding by management and colleagues, and characteristics of the health system e.g. ICT infrastructure. Lessons learned: DNS may need to be better supported to deliver their role to ensure effective delivery of integrated diabetes care. Limitations: This study is limited to DNS in Ireland; the findings may not reflect experiences of DNS in other countries working in a health service with different characteristics. Suggestions for future research: Future work should evaluate ongoing changes to DNS support. [ABSTRACT FROM AUTHOR]

Background An MDT-led educational class for parents of children newly diagnosed with JIA was developed with the aims of improving parental knowledge and confidence in managing a child with JIA. Our clinical observations were that a number of our patients had inaccurate ideas of what JIA was, three to six months into treatment. This is in-line with studies indicating that memory for medical information is often poor and inaccurate especially when the patient is anxious. Research also indicates the importance of patients developing an understanding of the condition and treatment which can aid in a number of improved outcomes including adherence. Our aim was to provide parents with an opportunity to increase their knowledge regarding JIA, addressing the medical and psychological management in a relaxed environment separate from a clinic appointment, without their children present. Several families had also requested to meet other parents for peer support and practical advice. Methods Parents of children newly diagnosed with JIA were invited to attend a session held in the evening at the NOC. Sessions were also conducted by the team at outreach clinics throughout the region. The programme was tailored to the child's developmental stage and included information about JIA and its management from the advanced nurse specialist, physiotherapist, occupational therapist, paediatric psychologist and an experienced parent. Prior to the session, parents completed a short questionnaire to assess their confidence in managing their child's condition and their understanding of JIA and treatment. Responses were measured on a ten point VAS scale. This was then repeated on completion of the session. Qualitative data regarding parent experience was also captured. Results Due to the large geographical area, attendance was approximately 50%. Parents' understanding about JIA and treatment on average increased 2.6 points on VAS scale, parent's confidence in managing their child increased on average 2.9 points. Parents reported the sessions were useful to explore what support is available, information regarding future management, importance of exercise, the emotional and psychological impact of JIA and how to manage it. 100% of parents reported their pre session aims were met. Conclusion Parental knowledge and confidence in managing their child's condition was shown to increase in all those who attended, demonstrated by increases in VAS scores. Sessions allowed parents to access information from specialist paediatric rheumatology professionals and meet with peers in a relaxed environment. Consideration is currently being given to the use of social media to boost attendance through a virtual session. We are planning to follow-up parents to see if the increase in VAS scores is maintained Conflicts of Interest The authors declare no conflicts of interest. [ABSTRACT FROM AUTHOR]

Background Biologic therapies have revolutionised the management of patients with rheumatological conditions; with considerable cost to the NHS. The switch of originators to biosimilar products was challenging. We aim to share our experience of adalimumab biosimilar switch and believe this is reflective of the challenges experienced in some other centres. The development of biosimilar aims to challenge the excesses of pharma profits by encouraging competition in the market place. Previous switches to intravenous biosimilar products had been uneventful. We were informed that the trust was implementing switch of biologics to biosimilar and later told biosimilar A was the biosimilar version allocated to us. This was a decision beyond the Trust, with NHS England deciding on the allocation. For our Trust, biosimilar A was allocated for patients weighing 30kg requiring a 40mg dose and biosimilar B allocated for patients weighing less than 30kg requiring a 20mg dose (NB: no 20mg preparation available for biosimilar A). Patients commenced on biosimilar B 20mg preparation can remain on biosimilar B and move on to its 40mg preparation once they weigh 30kg. Biosimilar A, the cheaper of the two preparations, contains preservative, citrate. Both biosimilars are double the volume of the originator biologic. Case a biologic-naïve 16 year-old patient was the first to be treated with the chosen biosimilar A, and, upon self-administrating; the patient clearly expressed a high level of pain. Following the experience with the patient the team felt that this was not an appropriate option. Methods With the feedback from the patient, rheumatology team highlighted the issues and focussed on high quality patient centred care not just focussing on the short term cost saving option but understanding that the patient engagement and compliance is cost saving in the long run. The team enquired with other specialities and regional paediatric rheumatology centres regarding their biosimilar switch. Results Liaising with the High cost pharmacy team, we successfully obtained authorisation to prescribe biosimilar B. We promptly switched the patient to biosimilar B and prescribe this now for all suitable to switch and new patients. So far there have been no negative comments or issues from the switch to the citrate free product. Conclusion It is vital that we provide an evidence based cost saving medication to treat children with long term conditions. However when new medications are being introduced, there needs to be greater consideration for the paediatric population which currently seems lacking. Collaborative working with the high cost pharmacy team, regular communications with other specialities, adult colleagues and involving the national nurse specialists group greatly benefitted us in managing this situation. More studies are required to identify patient factors involved in these scenarios. Conflicts of Interest The authors declare no conflicts of interest. [ABSTRACT FROM AUTHOR]

This article discusses findings from a report by the Brain Tumour Charity on the experiences of treatment and care in the UK of more than 1,000 people with low and high-grade tumours. The report highlights the positive effects of access to clinical nurse specialists on symptom management, mental health and wellbeing. However, it notes that patients with low-grade tumours do not receive equity of access. The survey recommends that the government and health bodies review the number of nurses specialising in the care of patients with brain tumours. [ABSTRACT FROM AUTHOR]