Search

Aim: To explore clinical decision-making by comparing the processes used by three groups of nurses in the emergency departments of three hospitals: in Norway, Finland and Ireland., Background: Clinical decision-making in an emergency department environment is a complex process often occurring in times of crisis. It is an important aspect contributing to the quality of care. However, empirical research is limited regarding the decision-making process in different nursing roles., Methods: In accordance with the consolidated criteria for reporting qualitative research, a qualitative and observational study was conducted to explore clinical decision-making by comparing the processes used by three groups of nurses in the emergency departments of three hospitals: in Norway, Finland and Ireland. Six Registered Nurses, six Nurse Specialists and six Nurse Practitioners were observed. A total of 40 hours of observation was made at each setting according to a structured observation guideline, followed by clarifying questions. The data material was analysed by means of a qualitative manifest and latent content analysis., Results: Three themes arose: acting in accordance with routines, previous experience and intuition; considering patient experience; and facilitating new alternatives based on critical thinking. The Registered Nurses mainly used the first approach, the Nurse Specialists used the first and the second approaches, and the Nurse Practitioners used all three approaches., Conclusions: The results highlight the differences in decision-making processes between these groups. Nurse Practitioners were the only group that facilitated and evaluated new alternatives using their clinical autonomy, such as stepping up and making independent and collaborative decision-making., Implication: The results can be used in countries developing advanced practice nursing education and defining their scope of practice to inform stakeholders., (© 2024 The Authors. International Nursing Review published by John Wiley & Sons Ltd on behalf of International Council of Nurses.)

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]

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: Anticipatory prescribing (AP) of injectable medications in advance of clinical need is established practice in community end-of-life care. Changes to prescribing guidelines and practice have been reported during the COVID-19 pandemic., Aims and Objectives: To investigate UK and Ireland clinicians' experiences concerning changes in AP during the COVID-19 pandemic and their recommendations for change., Methods: Online survey of participants at previous AP national workshops, members of the Association for Palliative Medicine of Great Britain and Ireland and other professional organisations, with snowball sampling., Results: Two hundred and sixty-one replies were received between 9 and 19 April 2020 from clinicians in community, hospice and hospital settings across all areas of the UK and Ireland. Changes to AP local guidance and practice were reported: route of administration (47%), drugs prescribed (38%), total quantities prescribed (35%), doses and ranges (29%). Concerns over shortages of nurses and doctors to administer subcutaneous injections led 37% to consider drug administration by family or social caregivers, often by buccal, sublingual and transdermal routes. Clinical contact and patient assessment were more often remote via telephone or video (63%). Recommendations for regulatory changes to permit drug repurposing and easier community access were made., Conclusions: The challenges of the COVID-19 pandemic for UK community palliative care has stimulated rapid innovation in AP. The extent to which these are implemented and their clinical efficacy need further examination., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To explore how Epilepsy Specialist Nurses in the Republic of Ireland enacted their clinical role., Methods: Qualitative descriptive design that involved individual and focus group interviews, observation and documentary analysis. Data were collected from 12 Epilepsy Specialist Nurses working in five hospital-based epilepsy services in Ireland, 24 multidisciplinary team members, and 35 people with epilepsy and their family members were involved. Data were analysed in NVivo using an inductive and deductive approach., Results: Epilepsy Specialist Nurses work out of a value base that gives primacy to collaboration. active participation, relationship-based care, and respect for the voices of PWE and family members. They are key players in empowering people to self-manage their illness, Core dimensions of their clinical role includes: performing a comprehensive assessment to inform care and treatment; providing person-centred education; monitoring the impact of care and treatment; providing education to family members and significant others; providing psychosocial care to optimise psychological wellness; co-ordinating care to enhance patients' journey; and quality assuring patient information., Conclusion: Findings from this study highlight the key role ESNs played as members of the MDT in building and supporting PWE's capacity to self-manage their illness. However, they also indicate deficits in the provision of information on sudden unexpected death in epilepsy and how to disclose a diagnosis of epilepsy by the ESN, as well deficits in their knowledge and confidence in supporting people experiencing significant mental health morbidities., (Copyright © 2019 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: To report the leadership role and change activities of epilepsy specialist nurses (ESNs) in Ireland; findings from the SENsE study., Method: A mixed methods study design was used, involving 12 epilepsy specialist nurses working in five units in Ireland, 24multidisciplinary team members working with them, and 35 people with epilepsy and their family members. Data were collected using individual and focus group interviews, observation and documentary analysis., Results: Five key areas in which ESNs demonstrated leading on the change agenda were identified. These included: Initiating new clinical practice developments; Building capability within the multidisciplinary team; Developing education programmes and resources for people with epilepsy, family and the public; Exerting influence through membership of committees and lobbying; and Advancing the ESN role., Conclusion: Though the epilepsy specialist nurse role was first established in the UK in 1988, much of the literature that discusses or describes the ESN role is founded on anecdotal evidence, or focusses on their clinical expertise. Findings from this study provide empirical evidence that the ESNs were involved as key players in leading changes within the services, in the education of others, and the continuous advancement of epilepsy care., (Copyright © 2018 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.)