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The role of nurses in leading the design and delivery of primary health care services to address health inequities is growing in prominence, specifically in rural Australia. However, limited evidence exists to inform nurse‐led primary health care in this context. Based on a focus group with nursing executives and semi‐structured interviews with registered nurses we describe nurse experiences of leading the design of a primary health care service in rural Australia and nurse transition to and practice in this service. Nurse experiences were analysed using reflexive thematic analysis. The study reveals the centrality of relational integration in service design and nurse acquisition of relational practice as it relates to nurse to care recipient and nurse to nurse relationships. Tensions between primary health care nurses and their peers, and resultant de‐valuing of primary health care practice, are described. The acquisition of nurse professional agency draws attention to investments required to position nurses to lead and sustain care innovations external to hospital settings. The authors propose that relational approaches may provide nurses with the opportunity to reframe their leadership and service contributions towards community literate primary health care provision and provide a pathway to professional emancipation from constrained practice expectations. [ABSTRACT FROM AUTHOR]

The article focuses on the advantages of group clinics for managing long-term conditions, especially type 2 diabetes (T2D). Topics include enhanced patient engagement through shared medical appointments, improved job satisfaction for general practice nurses (GPNs), and positive impacts on clinical outcomes and patient quality of life.

Why you should read this article: • To improve your knowledge of atopic eczema and its prescribed treatment regimens • To enhance your awareness of the challenges encountered in the self-management of atopic eczema • To read about strategies nurses can use to support families to self-manage atopic eczema successfully. Atopic eczema is common in childhood and can continue into adulthood. Adherence to treatment is a significant factor in its effective management, but the complexity of treatment regimens can make adherence challenging. Additionally, living with the condition can have adverse psychosocial consequences for young people in particular. This article discusses treatment regimens for moderate-to-severe atopic eczema and some of the challenges encountered by children, young people and families in self-managing the condition. The authors discuss strategies that can support families to achieve optimal self-management, namely online support tools, written action plans and nurse-led eczema clinics. [ABSTRACT FROM AUTHOR]

Introduction: Nurse-led primary care is a relatively rare model for primary care, but given nurses more holistic approach to medicine, can prove effective in both reducing costs and disparities in access and outcomes. The present study compares cost adjusted quality of care between a nurse-led primary care facility and the standard primary care. Design: To compare the cost adjusted quality of care between the standard primary care model and a nurse led primary care model the outcomes from a population of patients that visited each (control and experimental, respectively) are compared with respect to three complications of hypertension (stroke, heart attack, and coronary heart disease). Method: The number of three complications (stroke, heart attack, and coronary artery disease) from hypertension for the experimental population is estimated using time-to-event distributions estimated from the control population. Costs are estimated using the control population data. Results: It is found that the population that visited the nurse-led primary care facility had better cost adjusted outcomes than the population that visited the physician led facilities. We can attribute, at least, $3.7 million in costs not realized due to the quality of care provided by the nursing center. Conclusion: Nurse-led primary care is one way that the U.S. healthcare system could reduce costs while providing consistent quality of care. [ABSTRACT FROM AUTHOR]

Objectives To evaluate a strategy designed to optimize care and increase uptake of urate-lowering therapy (ULT) during hospitalizations for gout flares. Methods We conducted a prospective cohort study to evaluate a strategy that combined optimal in-hospital gout management with a nurse-led, follow-up appointment, followed by handover to primary care. Outcomes, including ULT initiation, urate target attainment and re-hospitalization rates, were compared between patients hospitalized for flares in the 12 months post-implementation and a retrospective cohort of hospitalized patients from 12 months pre-implementation. Results One hundred and nineteen and 108 patients, respectively, were hospitalized for gout flares in the 12 months pre- and post-implementation. For patients with 6-month follow-up data available (n  = 94 and n  = 97, respectively), the proportion newly initiated on ULT increased from 49.2% pre-implementation to 92.3% post-implementation (age/sex-adjusted odds ratio [aOR] 11.5; 95% CI 4.36, 30.5; P  < 0.001). After implementation, more patients achieved a serum urate ≤360 μmol/l within 6 months of discharge (10.6% pre-implementation vs 26.8% post-implementation; aOR 3.04; 95% CI 1.36, 6.78; P  = 0.007). The proportion of patients re-hospitalized for flares was 14.9% pre-implementation vs 9.3% post-implementation (aOR 0.53; 95% CI 0.22, 1.32; P  = 0.18). Conclusion Over 90% of patients were initiated on ULT after implementing a strategy to optimize hospital gout care. Despite increased initiation of ULT during flares, recurrent hospitalizations were not more frequent following implementation. Significant relative improvements in urate target attainment were observed post-implementation; however, for the majority of hospitalized gout patients to achieve urate targets, closer primary–secondary care integration is still needed. [ABSTRACT FROM AUTHOR]

Background: Young people receiving cancer treatment in the South Thames Children's, Teenagers' and Young Adults' Cancer Operational Delivery Network usually receive care across two or more NHS trusts, meaning transition into adult services can be challenging. Aim: To develop a planned, co-ordinated approach to transition across the network that meets National Institute for Health and Care Excellence guidance recommendations for transition and the cancer service specifications. Methods: A 2-year, nurse-led quality improvement (QI) project, using the principles of experience-based co-design. Outcomes: The QI project resulted in the development of six key principles of practice; refining and testing of a benchmarking tool; initiatives to facilitate first transition conversations; and the launch of an information hub. Conclusion: Robust QI processes, cross-network collaboration and wide stakeholder involvement required significant resource, but enabled deeper understanding of existing pathways and processes, facilitated the establishment of meaningful objectives, and enabled the testing of interventions to ensure the project outcomes met the needs of all stakeholders. [ABSTRACT FROM AUTHOR]

Objective: This article highlights key lessons learned while conducting a nurse‐led community‐based HIV prevention trial with youth experiencing homelessness (YEH), focusing on sexually transmitted infections testing and treatment, intervention sessions, community partnerships, and participant recruitment and retention. Design: The insights and experiences shared aim to inform future research and the design of interventions targeting populations at high risk, particularly when facing unanticipated challenges. By addressing these areas, the article contributes to the decision‐making for the design and delivery of effective strategies to improve the health outcomes among marginalized populations. Results: The findings underscore the importance of flexibility and active participant engagement, cultivating strong relationships with community partners, utilizing technology and social media, and fostering a diverse research team that represents the heterogeneity of youth experiencing homelessness across race/ethnicity, gender identity, sexual orientation, and lived experiences. Conclusions: These recommendations aim to enhance participant access, engagement, and retention, while promoting rigorous research and meaningful study outcomes for YEH. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic created barriers in the management of type 2 diabetes mellitus (T2DM) and worsened social determinants of health (SDOH). A New Hampshire primary care office worked to adhere to T2DM standards of care and began screening for SDOH. This project assessed adherence to quality metrics, hemoglobin A1C, and SDOH screening as telehealth utilization decreased. Local Problem: A1C values have increased at the practice, especially since COVID-19. The practice also began screening for SDOH at every visit, but there was need to assess how needs were being documented and if/how they were addressed. Methods: A retrospective chart review of patients with T2DM was performed. Demographic data and T2DM metrics were collected and compared with previous years and compared new versus established patients. Charts were reviewed to evaluate documentation of SDOH and appropriate referral. Interventions: The practice transitioned froman increased utliization of telehealth back to prioritizing in-office visits. The practice also began routinely screening for SDOH in 2020; however, this process had not been standardized or evaluated. Results: Adherence to nearly all quality metrics improved. Glycemic control improved after a year of nurse practitioner (NP) care, especially in new patients. All patients were screened for SDOH, but documentation varied, and affected patients had higher A1Cs, despite receiving comparable care. Conclusion: Nurse practitioners at this practice are adhering to American Diabetes Association guidelines, and A1C values improve under their care. Social determinants of health continue to act as unique barriers that keep patients from improving glycemic control, highlighting the need for individualized treatment of SDOH in T2DM care. [ABSTRACT FROM AUTHOR]

Background: Emerging adulthood (18–25 years old) is a distinct developmental period in which multiple life transitions pose barriers to engaging in healthy lifestyle behaviors that reduce cardiovascular disease risk. There is limited theory-based research on African American emerging adults. Objective: This article introduces a synthesized empirically testable situation-specific theory for cardiovascular disease prevention in African American emerging adults. Methodology: Im and Meleis' integrative approach was used to develop the situation-specific theory. Results: Unlocking Population-Specific Treatments to Render Equitable Approach and Management in Cardiovascular Disease is a situation-specific theory developed based on theoretical and empirical evidence and theorists' research and clinical practice experiences. Discussion: African American emerging adults have multifaceted factors that influence health behaviors and healthcare needs. Unlocking Population-Specific Treatments to Render Equitable Approaches and Management in Cardiovascular Disease has the potential to inform theory-guided clinical practice and nursing research. Recommendations for integration in nursing practice, research, and policy advocacy are presented. Further critique and testing of the theory are required. [ABSTRACT FROM AUTHOR]

Objectives: To explore the presence of specialist outpatient nursing activity in care for kidney transplant recipients in Spain and to determine the level of competence development of this activity according to the Advanced Practice Nurse model. Design: Descriptive, cross‐sectional study. Participants and Measurements: All outpatient nurses specialising in renal transplantation in the 39 transplant hospitals in Spain were included. To fulfil the study objectives, an ad hoc questionnaire and the 'Advanced Practice Nurse Role Definition Instrument (IDREPA)' were administered to assess the nurses' level of competence development. Results: Of the facilities included in the study, 25 (64.1%) had posttransplant nursing activity, 13 (33.3%) had pretransplant nursing activity and 11 (28.2%) had nursing activity involving kidney donor candidates. Twenty‐seven specialist nurse's offices were identified. The results of the IDREPA reflect the presence of advanced practice in the domains of 'expert care planning' and 'comprehensive care'. Three (11.1%) nurses met all criteria for advanced nursing practice. Conclusion: The results on specialised outpatient nursing activity at the 39 transplantation facilities in Spain indicate a low presence of this type of activity, with an even lower presence of advanced practice nurses. Implications for Clinical Practice: Management teams should consider investing in the quality of care provided by advanced nurse practice to ensure that suitable treatment is provided and better clinical outcomes are obtained. [ABSTRACT FROM AUTHOR]

The article highlights the transformative journey of a nurse-turned-activist who founded a not-for-profit organization, Her Heart, dedicated to addressing the alarming statistics and barriers faced by women in heart health. Topics include her diverse career trajectory, challenges in setting up the organization, and innovative solutions such as an online directory to connect women with female cardiologists and Australia's first online risk assessment tool tailored for women.

Background: The COVID-19 pandemic and its social restrictions accelerated the expansion of virtual clinical care, and this has been reported to be safe, low cost and flexible. Aim: This study aimed to examine nursing practices and patient satisfaction with unscheduled nurse-led virtual care for people with diabetes. Methods: A cross-sectional descriptive survey of clinical nurse specialists and patients was carried out, using an activities log for nursing practices and a satisfaction and enablement survey for callers. Findings: Patients reported high satisfaction levels and greater self-confidence in keeping themselves healthy after receiving virtual care. Most calls (74.8%) from patients were for advice and education. Each call led to an average of 2.5 actions for the clinical nurse specialist. Conclusion: The service is highly valued and is effective, but adds to the nurse workload burden. [ABSTRACT FROM AUTHOR]

Cardiac rehabilitation (CR) is a comprehensive and multidisciplinary secondary prevention care in coronary heart disease (CHD). There are barriers at the patient and health system levels that prevent CR from being utilized. Cardiac telerehabilitation led by nurses (Ne-CTR) can alleviate the obstacles to participation in CR. A patient perspective can improve CR access. This study was the first pre-program investigation to clarify the status of knowledge and participation in CTR. We sought to clarify the acceptability, the reasons for rejection, the desired form, components, and associated factors with the components needed for (Ne-CTR) in patients with CHD. The study aimed to help develop a protocol for Ne-CTR for Chinese patients with CHD. A cross-sectional study was conducted between 2020 and 2021. Hospitals in four provinces in China were included. The participants were 671 patients with CHD in hospitals located in three regions of China. A self-administered questionnaire collected information about demographics, knowledge, and participation in CTR, acceptability, preferred medium, and components of Ne-CTR. Student's t- test, analysis of variance, and multiple linear regression analyzed the factors associated with component needs. All the analyses were conducted using IBM SPSS version 25.0. Most participants (n = 434, 66.77%) had a poor understanding and participation in CTR. In addition, 65.38% (n = 439) of participants were willing to accept the Ne-CTR program, and 43.56% (n = 98) identified safety as reasons for not accepting such a program. In the group accepting Ne-CTR, 35% chose hospital-designed professional applications as a medium for Ne-CTR when offered. Education (4.44 ± 1.056) and drug information (4.44 ± 1.040) had the highest average need score. Education, monthly income, marital status, previous CTR participation, and health insurance were associated with the demand level scores of Ne-CTR. This study demonstrated high levels of need for Ne-CTR among patients with CHD and identified the desired medium, components, and associated factors of Ne-CTR. These findings provide reference information for the construction of a Ne-CTR program. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the clinical effectiveness and implementation strategies of telecare consultations in post-stroke nurse-led clinics. Background: Telecare consultations could be an alternative to conventional in-person consultations and improve continuity of care for stroke survivors following their discharge from hospital. Previous studies utilizing telecare consultations only focused on testing their clinical effectiveness on stroke survivors; the appropriateness and feasibility of adopting this new delivery modality in a real-world setting were not examined. Design: A Type II hybrid effectiveness-implementation design will be adopted. Methods: Eligible stroke survivor participants will be randomly assigned to the intervention group (telecare consultation) or control group (usual in-person clinic consultation). Both groups will receive the same nursing intervention but delivered through different channels. The Reach, Effectiveness, Adoption, Implementation, Maintenance framework will be used to evaluate the clinical effectiveness and implementation outcomes. The primary outcome is the non-inferiority of the degree of disability between the two groups at 3 months into the intervention and at 3 months post-intervention. The paper complies with the SPIRIT guidelines for study protocols adapted for designing and reporting parallel group randomized trials. Conclusion: The findings of this study will provide key insights into the processes for implementing and adopting telecare consultations into long-term services for poststroke patients. Impact: This study contributes to the translation of telecare consultations for stroke survivors into real-life settings. If effective, this program may provide guidance for expanding telecare consultations to other post-stroke nurse-led clinics or to patients with other chronic diseases. Trial Registration: This study has been registered at clini caltr ials. gov (identifier: NCT05183672). Registered on 10 January 2022. [ABSTRACT FROM AUTHOR]

Background: The quality of life for individuals with chronic wounds is diminished due to poor health-related outcomes and the financial burden of wound care. The literature has shown nurse-led wound care to have a positive impact on wound healing and psychosocial wellbeing. However, there is minimal research investigating the lived experience of attending a nurse-led clinic for chronic wounds. The purpose of this study was to explore the client and family experience of attending a nurse-led clinic for chronic wounds. Methods: Qualitative descriptive study. Semi-structured telephone interviews were transcribed verbatim and thematic analysis was undertaken. Results: Twelve clients and two family members participated, and the average length of interviews was 20 min. Three main themes emerged: (1) expecting and managing pain; (2) receiving expert advice and reflecting on previous care; and (3) managing the cost of care. There was an emphasis on the impact of chronic wounds on pain and the ability to complete the activities of daily living. Expert advice, client satisfaction and physical accessibility were highlighted as benefits of the clinic. Cost and minimal client education were identified as challenges of the clinic. Conclusions: The findings demonstrated that chronic wounds have a significant impact on the client and family attending the nurse-led clinic. Comprehensive pain assessment, improved social support, better client education and cost-effective care is required to optimise the experience for people attending the nurse-led clinic. Nurse-led wound care has been shown to improve client outcomes, but there is minimal research on the lived experience of attending a nurse-led wound clinic. The findings demonstrate that clients and family members were satisfied with their experience in the nurse-led clinic, and highly regarded the expert advice they received and the physical accessibility of the location. To improve the client and family experience of the nurse-led clinic, there needs to be a greater focus on pain management, improving social support, providing client education and enabling cost-effective care. [ABSTRACT FROM AUTHOR]

The global prevalence of people with diabetes mellitus (PWD) is rapidly increasing. Nurses can provide diabetes care for PWD in several areas. Interventions led by nurses can support PWD for effective management of diabetes, which can positively improve clinical outcomes. Nurse-led diabetes self-management education (DSME) is an effective strategy to manage diabetes mellitus (DM) since it improves self-care practice and knowledge regarding diabetes. PWD often need to stay in hospitals longer, which involves poorer patient satisfaction and clinical outcomes. Nurse-led clinics for DM management are a new strategy to possibly ameliorate the disease management. Diabetes specialist nurses can play an important role in improving diabetes care in inpatient settings. Various studies have revealed that nurses can independently provide care to PWD in collaboration with various other healthcare providers. Studies also demonstrated that the nurse-led education-receiving group showed a significantly reduced level of average glycosylated haemoglobin A1c level. Moreover, nurse-led interventions often result in significant improvements in diabetes knowledge, psychological outcomes, self-management behaviours, and physiological outcomes. The purpose of this literature review was to identify the impact of nurse-led interventions on diabetes management. Moreover, in this review, a number of nursing interventions and the nurses' roles as educators, motivators as well as caregivers in DM management have been extensively discussed. This article also summarises the outcomes that are measured to evaluate the impact of nursing interventions and the strategies to overcome the existing and emerging challenges for nurses in diabetes care. [ABSTRACT FROM AUTHOR]

Coronary artery disease (CAD) is one among the major causes of mortality in patients all around the globe. It has been reported by the World Health Organization (WHO) that approximately 80% of cardiovascular diseases could be prevented through lifestyle modifications. Management of CAD involves the prevention and control of cardiovascular risk factors, invasive and non-invasive treatments including coronary revascularizations, adherence to proper medications and regular outpatient follow-ups. Nurse-led clinics were intended to mainly provide supportive, educational, preventive measures and psychological support to the patients, which were completely different from therapeutic clinics. Our review focuses on the involvement and implication of nurses in the primary and secondary prevention and management of cardiovascular diseases. Nurses have a vital role in Interventional cardiology. They also have major roles during the management of cardiac complications including congestive heart failure, atrial fibrillation and heart transplantation. Today, the implementation of a nurse-led tele-consultation strategy is also gaining positive views. Therefore, a nurse-led intervention for the management of patients with cardiovascular diseases should be implemented in clinical practice. Based on advances in therapy, more research should be carried out to further investigate the effect of nurse-led clinics during the long-term treatment and management of patients with cardiovascular diseases. [ABSTRACT FROM AUTHOR]

Background: To improve preventative health screening in regional Victoria, Australia, a collaborative student-led health prevention strategy was initiated. The aim of this study is to evaluate the impact of four health check clinics using a free 'pop-up' format within community settings. Methods: A mixed methods, explanatory sequential design was used to explore community health data and participant experiences in utilising the free health check clinics. The clinics were delivered over 6 months and located in three different communities within the regional government area. Descriptive statistics were used to analyse participant health data and a thematic analysis was utilised to determine themes from participant feedback and health outcomes. Results: The clinics were attended by 188 community members, largely impacted by government lockdowns during the coronavirus disease 2019 (COVID-19) pandemic. Health check results indicate the population is overweight and at high risk of diabetes. Participants enjoyed the free and convenient nature of the health check program and the location of the venues. Feedback from participants indicate the health education provided was useful and advocated for changes in current behaviours. Many embraced the new information and community connections and made changes to improve their future health. Others claimed to enjoy the clinic experience but reported no action from the recommendations. Conclusions: Evaluation of the health check clinics indicate they had a minor, yet positive impact on the local community in increasing engagement with preventative screening strategies. COVID-19 restrictions impacted participant numbers and thus more research is needed in a time where community movement is not limited. Access to preventative health care and screening is often challenging in regional areas. Free student-led pop-up health check clinics provide improved access and convenience, offering health education and early intervention strategies that aim to reduce future chronic health within the local population. This study demonstrates how community collaboration is able to provide screening services, support healthy behaviour change and strengthen the development of future health practitioners. [ABSTRACT FROM AUTHOR]

Background: The Coordinated Transitional Care (CTraC) program is a telephone‐based, nurse‐driven program shown to decrease readmissions. The aim of this project was to implement and evaluate an adapted version of CTraC, Supportive CTraC, to improve the quality of transitional and end‐of‐life care for veterans with serious illness. Methods: We used the Replicating Effective Programs framework to guide adaptation and implementation. An RN nurse case manager (NCM) with experience in geriatrics and palliative care worked closely with inpatient and outpatient care teams to coordinate care. Eligible patients had a life‐limiting diagnosis with substantial functional impairment and were not enrolled in hospice. The NCM identified veterans at VA Boston Healthcare System during an acute admission and delivered a protocolized intervention to define care needs and preferences, align care with patient values, optimize discharge plans, and provide ongoing, intensive phone‐based case management. To evaluate efficacy, we matched each Supportive CTraC enrollee 1:1 to a contemporary comparison subject by age, risk of death or hospitalization, and discharge diagnosis. We used Kaplan–Meier plots and Cox‐Proportional Hazards models to evaluate outcomes. Outcomes included palliative and hospice care use, acute care use, Massachusetts Medical Orders for Life Sustaining Treatment documentation, and survival. Results: The NCM enrolled 104 veterans with high protocol fidelity. Over 1.5 years of follow‐up, Supportive CTraC enrollees were 61% more likely to enroll in hospice than the comparison group (n = 57 vs. 39; HR = 1.61; 95% CI = 1.07–2.43). While overall acute care use was similar between groups, Supportive CTraC patients had fewer ICU admissions (n = 36 vs. 53; p = 0.005), were more likely to die in hospice (53 vs. 34; p = 0.008), and twice as likely to die at home with hospice (32.0 vs. 15.5; p = 0.02). There was no difference in survival between groups. Conclusions: A nurse‐driven transitional care program for veterans with serious illness is feasible and effective at improving end‐of‐life outcomes. [ABSTRACT FROM AUTHOR]

The American Academy of Ambulatory Care Nursing (AAACN) recognizes a paradigm shift represented by the volume of health care delivery flowing from episodic acute care encounters to long-term relationships. This shift presents opportunities to further recognize and prepare nurse graduates for the complex and expanded role of the ambulatory care registered nurse (RN). This position paper discusses the current state of the RN role in ambulatory care and provides a vision for the future. The paper further identifies challenges, poses possible solutions, and highlights the AAACN position on the role of the ambulatory care RN. [ABSTRACT FROM AUTHOR]

Background: Bronchial asthma is a non-communicable disease demanding long-term adherence to medical treatment and self-management. The effectiveness of a Nurse-Led Clinic for the management of long-term illness is well established. In our setup, we intend to establish a Nurse-Led Clinic. Before establishing one, it is essential to explore stakeholders' perspectives on the feasibility of a Nurse-Led Clinic for the self-management of bronchial asthma. Objective: The study was done to explore stakeholders' opinions on the Nurse-Led Clinic's feasibility for the self-management of bronchial asthma. Methods: Five doctors, six nurses, and 11 patients were taken as stakeholders using the purposive sampling technique. A pre-validated semi-structured opinionnaire having a Content Validity Index (CVI) of 0.82 was used. Face-to-face individual interviews were conducted. The data triangulation and dependability were ensured. Results: After the thematic analysis, themes were categorized into two sections based on the common and different questions for all the stakeholders. The major themes of both sections were as follows: Nurse-Led Clinic-A perceived helpful initiative, strengthening the Nurse-Led Clinic, current obstacles/restorative measures in the management of bronchial asthma, a glance at the current scenario, patient satisfaction with doctors' consultation, and challenges Nurse-Led Clinic may face and related remedial measures. Conclusion: All stakeholders favored the idea of a Nurse-Led Clinic for the self-management of bronchial asthma. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To learn about one method for raising the profile of general practice nursing as a career for students • To acknowledge the importance of general practices offering clinical placements to nursing students • To appreciate the value for patients and general practices of undertaking health checks in the community Due to a lack of placements, many nursing students do not have the opportunity to experience primary care during preregistration education. Nurses on Tour, a series of student-led health roadshows, was piloted at ten GP practices in Northumberland during the summer of 2022, providing health checks to patients and enabling 48 students from all fields of nursing to experience primary care as a learning environment. This pilot project also aimed to raise the profile of general practice nursing among students and showcase students' skills and value to general practices. This model of student practice and supervision could be adapted to suit different localities and become a valuable part of preregistration education while promoting primary care as a first destination or future career option for students. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To read about an audit and re-audit of advanced nurse practitioner-led oral anti-cancer medicine practice in a hospital and then in the community • To understand how the implementation of a quality improvement plan can address gaps in practice identified on audit • To appreciate the importance of adherence to best practice standards to ensure safe and quality patient care Healthcare in the Republic of Ireland experienced a shift in the delivery of services during the coronavirus disease 2019 (COVID-19) pandemic. In the authors' hospital, patients receiving oral anticancer medicines had their care transferred from the hospital-based oncology day unit, initially to a hospital-based advanced nurse practitioner- (ANP-) led oncology service then to a community-based ANP-led oncology service. A retrospective audit of the assessment, monitoring, patient education and prescribing practices for adult patients attending the ANP-led hospital oncology service was undertaken in March 2021. A quality improvement plan was subsequently developed and implemented and the audit was repeated in February 2022 following transition to an ANP-led community-based oncology service. The re-audit showed a marked improvement in the standard of care delivered to adults receiving oral anti-cancer medicines from an ANP in the community. [ABSTRACT FROM AUTHOR]

Introduction: Educating patients and families about self-care is one of the important roles of nurses in Nurse-led clinics (NLCs). NLCs need standards for guiding the practice of nurses. A standard is an authoritative statement that sets out the legal and professional basis of nursing practice. This paper seeks to report the development of practice standards for patient and family education in NLCs. Methods: This project used a Sequential-Exploratory mixed methods design. Before the study, we conducted a literature review to identify gaps. Directed content analysis was used in phase 1. The second phase involved two focus groups. The third phase involves two rounds of modified Delphi. Results: Twenty-nine participants were interviewed, and 1816 preliminary codes were formed in phase 1. 95 standards were grouped into three main categories (structure, process, and outcome). In the first focus group, experts eliminate 32 standards. Experts eliminate 8 standards after the second stage of the focus group. After two rounds of Delphi, the final version of the standard consists of 46 standards (13 structure, 28 process and 5 outcome). Conclusions: Nurses and institutions could benefit from practice standards for patient education in the NLCs, which consist of 46 statements in three domains, as a guide for clinical activities and a tool to gauge the quality of patient education in NLCs. The developed standards in this study can guide new and existing NLCs and help them evaluate ongoing activities. Providing patient education in NLCs based on standards can improve patients' outcomes and promote their health. Highlights: • Existence of practice standards for patient education in NLCs is necessary. • Structure standards necessary for the establishment of NLCs. • Process standards guide practice in NLCs. • Outcome standards used for evaluation of NLCs performance. [ABSTRACT FROM AUTHOR]

The introduction of long‐acting injectable buprenorphine preparations for opioid use disorder has been widely heralded as a breakthrough treatment, with several studies indicating positive results when using these medications. In many locations, nurse practitioners prescribe, administer, and monitor long‐acting injectable preparations. The objective of this paper is to explore whether a reduction in dispensed needles and syringes is attributable to increased nurse practitioner prescribing of LAIB. We used a retrospective audit of needles dispensed through the health service needle and syringe program vending machine, and individuals treated with long‐acting injectable buprenorphine by the nurse practitioner led model. In addition, we examined potential factors that may influence changes in the number of needles dispensed. Linear regression found that each individual with opioid dependence treated with long‐acting injectable buprenorphine was associated with 90 fewer needles dispensed each month (p < 0.001). The nurse practitioner led model of care for individuals with opioid dependence appears to have influenced the number of needles dispensed at the needle and syringe program. Although all confounding factors could not be discounted entirely, such as substance availability, affordability, and individuals obtaining injecting equipment elsewhere, our research indicates that a nurse practitioner led model of treating individuals with opioid use disorder influenced needle and syringe dispensing in the study setting. [ABSTRACT FROM AUTHOR]

In 2009, 98.0% of people with mental illness in Sierra Leone were not receiving treatment, partly due to the absence of public psychiatric facilities outside the capital. In response to this situation, the Ministry of Health and Sanitation rolled out nurse-led mental health units (MHUs) to every district. This study evaluates the barriers and facilitators to mental health service delivery in decentralised MHUs in Sierra Leone using key informant interviews and focus group discussions with 13 purposefully sampled clinical staff and senior management personnel. The interviews were audio-recorded, translated from Krio if necessary, transcribed, and analysed using manifest content analysis. The findings suggest that factors affecting nurse-led mental health service delivery include small workforce and high workload, culture and beliefs, risks, lack of safety measures and required resources, outdated policies, poor salaries, lack of funds for medication, distance, power, influence, and stigma. Factors that could facilitate nurse-led mental health services include: increasing motivation, increasing the workforce, knowledge sharing, mentorship, availability of medication, passion and modern psychiatry. The findings contribute towards understanding the challenges and opportunities faced by the recently established nurse-led decentralised mental health services across Sierra Leone, in order to address the large mental health treatment gap. We hope the findings will inform further policy and planning to improve the quality of decentralised mental healthcare. [ABSTRACT FROM AUTHOR]

Aims The aim of this systematic review was to critique research examining the use of nurse-led clinics for head and neck cancers. Method This review was conducted using the Pickering systematic literature review framework. Searching during November 2021, research published between 2011--2021 from the databases MEDLINE, Scopus, PsychINFO, Cochrane and CINAHL was appraised using the Mixed Methods Appraisal Tool (MMAT), descriptive quantitative analysis and thematic analysis. Results A total of 134 articles were recovered, with 13 studies included for analysis. Of these, seven were cohort studies, four were observations-based and five were randomised control trials. Furthermore, 12 of these studies highlighted the role of an outpatient clinicbased nurse practice, and four were based on the generalised role of an advanced practice nurse. Of all 13 studies, only one was based in Australia, with the majority based in either Europe (7) or the USA (8). Conclusion Nurse-led clinics for head and neck cancer follow ups show promising results to improve patients' quality of life. All 13 studies showed an increase in patient-reported quality of life. Further research may be required to study the financial and resource availability for the utilisation of nurse-led clinics in the future. Impact This study addressed a gap in knowledge of the success and distribution of nurse-led clinics in the field of head and neck cancers. Overall, there is a strong outcome of feasibility and quality patient outcomes for nurse-led clinics. However, there are low sample sizes in the articles found. This may have future impacts on policy and resource funding for further development of nurse-led services; however, further research will be required. [ABSTRACT FROM AUTHOR]

Persons who are incarcerated (PWAI) suffer from a disproportionately higher number of physical and mental health conditions. While most jails and prisons provide onsite healthcare, community correctional centers often do not and accessing community healthcare is challenging due to insurance issues, inadequate health literacy, mistrust, and long waits for appointments. A registered nurse‐led wellness clinic provides a viable solution to addressing the healthcare needs of PWAI in a community correctional setting. Through a community‐academic partnership between a college of nursing and two community correctional transitional centers for men, a registered nurse (RN) faculty member and nursing students provide onsite healthcare. Services include, but are not limited to, acute and chronic disease management, case management, healthcare navigation, and health education. In the first 2 years of operation, there have been 587 new resident health assessments, 882 RN visits, and 152 group education sessions. RN visits have been primarily for: connection to resources (42.6%), medication management (15.6%), and acute conditions (12%). A RN‐led wellness clinic is an innovative way to address health needs for PWAI. While this model of care focuses on an academic RN faculty practice at community correctional centers it could be replicated across community settings. [ABSTRACT FROM AUTHOR]

Achieving better hypertension control for patients requires thinking outside of typical clinic visits. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To enhance your understanding of the benefits of a nurse-led clinic for patients receiving PARP inhibitors and other systemic anticancer treatments • To recognise that those responsible for leading and delivering a nurse-led service require the relevant training and competencies • To appreciate the importance of creating a business case when setting up a nurse-led clinic Nurse-led chemotherapy clinics are an essential part of UK oncology services. The approval of oral poly (adenosine diphosphate (ADP)-ribose) polymerase (PARP) inhibitors as maintenance treatment for people with platinum-responsive advanced ovarian cancer has provided patients with a new treatment option. However, due to their side effect profile, patients on these treatments require additional monitoring which can necessitate changes to the design of outpatient services. Nurse-led clinics designed specifically for patients receiving PARP inhibitors have been effective in addressing the additional monitoring requirements. This article provides a practical guide to developing a nurse-led clinic for patients receiving PARP inhibitors for advanced ovarian cancer and other systemic anticancer treatments. [ABSTRACT FROM AUTHOR]

Rheumatoid arthritis (RA) is an extremely prevalent chronic inflammatory rheumatic disease. This study explores the experiences of patients with RA under nurse-led care, the roles that nurses play, and the outcomes achieved when applying the patient-centered care (PCC) approach. A purposive sample of 12 participants who had been diagnosed with RA for at least 1 year were recruited from a nurse-led rheumatology clinic. They were also receiving treatment with disease-modifying antirheumatic drugs. All of the participants reported high levels of satisfaction with the care they received in the nurse-led clinic, along with high levels of medication adherence. The nurses were highly accessible to the participants, and they regularly communicated information regarding their symptoms, medication, and treatment management. These findings illustrate the importance of the holistic care that nurses provide to their patients, as the participants agreed that nurse-led services could have a wider outreach in hospitals and the community. [ABSTRACT FROM AUTHOR]

Purpose: Smoking cessation interventions should be promoted in cancer centers to improve clinical outcomes among cancer patients and the quality of life of cancer‐free patients and survivors. The aim of the present study was to examine long‐term abstinence (1, 3, and 5 years) among smokers who received an intensive nurse‐led smoking cessation intervention. Design: A prospective follow‐up study was conducted in a smoking cessation clinic in Barcelona. Methods: The study included 479 smokers who received a nurse‐led smoking cessation intervention that included motivational interviewing, psychological support, behavioral change counseling, promotion of smoke‐free policies, and relapse‐prevention strategies, as well as pharmacotherapy if necessary, for 12 months. We calculated overall and sex‐specific 1‐, 3‐, and 5‐year abstinence probabilities (Kaplan–Meier curves) and adjusted hazard ratios (aHRs) of relapse with 95% confidence intervals (CIs) using Cox regression. Findings: The overall probability of abstinence at 1 and 5 years was 0.561 (95% CI: 0.516–0.606) and 0.364 (95% CI: 0.311–0.417), respectively. Females had a higher, but not significant, hazard ratio for relapse compared to males (aHR = 1.180; 95% CI: 0.905–1.538). Attending <5 visits was the most remarkable determinant of relapsing compared to attending 5–9 visits or ≥10 visits, both overall and by sex (p for trend: overall, p < 0.001; males, p = 0.007; and females, p < 0.001). Conclusions: Abstinence probability decreased over the 5‐year follow‐up but was relatively high. Males had higher abstinence rates than females in all follow‐up periods. Completeness of the intensive intervention was the main predictor of cessation. Clinical Relevance: Smoking cessation interventions should consider sex and incorporate strategies to increase adherence to obtain higher long‐term abstinence rates. [ABSTRACT FROM AUTHOR]

Aims: To evaluate whether patients with HIV enrolled in Linkage to Care (hospital‐based only) or Linkage to Care Plus (nurse‐led hospital‐to‐community transitional care) programmes fare better on clinical outcomes; and to investigate how factors such as substance use, mental health or health‐related social needs contribute to these outcomes. Background: Social determinants of health contribute to poor HIV outcomes such that only 57% of people living with HIV have achieved the goal of viral suppression nationally, and 50% are retained in clinical care. The programmes evaluated here aimed to increase HIV appointment attendance, retention in care, viral suppression and decrease acute care utilization and mitigate social needs via hospital‐to‐community transitional support. Design: A retrospective observational cohort study. Methods: We conducted a retrospective patient chart review abstracting data over three time periods between 2017 and 2020 to conduct this longitudinal programme evaluation. Results: Both programmes had meaningful effects on increasing HIV appointment attendance and viral suppression; Linkage to Care Plus experienced the largest gains. Older age was associated with viral suppression, and housing insecurity and mental health conditions were associated with increased emergency department utilization. Conclusion: Hospital‐only and nurse‐led hospital‐to‐community transitional care programmes can positively influence HIV care outcomes. There is a need for enhanced attention and accountability related to health‐related social needs, especially housing, and mental and behavioural health, to end the HIV epidemic. Impact Globally, we are striving to end the HIV epidemic with evidence‐informed interventions. The nurse‐led hospital‐to‐community and the hospital‐only interventions evaluated here improved HIV outcomes with most gains realized by the nurse‐led transitional care model. Integrating lessons from these programmes, with increased attention and accountability for addressing social needs, can improve practice and policies to achieve programmatic and national goals related to HIV and other diseases, and more critically, to meet the goals of the people we serve. Patient or public contribution: Patients, staff and leadership at the University of Maryland Institute of Human Virology JACQUES Initiative and University of Maryland Medical Center THRIVE clinic contributed to the design and implementation of the programmes and informed the programme evaluation study. [ABSTRACT FROM AUTHOR]

Background: Healthcare provision remains challenging leading to a focus on health service redesign including the development of nurse‐led clinics. While there is a belief that nurse‐led services positively impact on healthcare delivery, it is necessary to inform development through examination of the evidence. Methods: A search was conducted of Cumulative Index of Nursing and Allied Health Literature, MEDLINE, EMBASE, Scopus and the Cochrane Library for systematic reviews evaluating the effectiveness of nurse‐led clinics when compared with usual care published between 2015 and 2020. Outcomes of interest were clinical outcomes, patient satisfaction and patient access to health care. Study quality was appraised using the AMSTAR 2 tool (A MeaSurement tool to Assess Systematic Reviews). A narrative analysis was conducted. Results: From 681 identified studies, nine were included, with reporting quality rated from very low to high quality. Patient clinical outcomes were reported as equal to or better than usual care across all studies included. There was evidence of high levels of patient satisfaction with nurse‐led clinics across the included systematic reviews. While access to health care was the least reported variable, there were reports that access to health care increased or patient reliance on other healthcare providers reduced due to nurse‐led clinics. Conclusions: Despite the heterogeneous nature of the systematic reviews, along with some quality issues in reporting, there was evidence that nurse‐led services provided comparable or superior care to usual care with high levels of patient satisfaction. There was a lack of reporting on the impact of nurse‐led clinics on patient access to health care; further research is required on this area. Health service managers should consider nurse‐led clinics an effective innovation in health service provision. [ABSTRACT FROM AUTHOR]

Background: Nutrition nurses work in multidisciplinary and nurse-led outpatient clinics. The daily nutrition nurse-led 'hot' clinic in this study sees patients for enteral or home parenteral nutritional support. Appointments may be for routine procedures or emergency reviews. Aims: This study aimed to identify activities and procedures performed in the nutrition nurse-led clinic, identifying admission avoidance activity. Methods: Nurse-held records for the period from April 2018 to March 2020 were reviewed retrospectively. Data were collated in an Excel spreadsheet for analysis and results are presented using descriptive statistics. Results: Records covered a total of 590 patients, 294 men and 296 women with a median age of 59 years, and 606 procedures. Key activities were troubleshooting enteral feeding tubes (29%), insertion of fine-bore nasogastric feeding tubes (18%) and management of home parenteral nutrition issues (11%). The presenting problem or issue was resolved in 90% of patients, with no need for hospital admission or additional medical review. Conclusion: The nutrition nurse-led clinic provides an efficient and cost-effective service, preventing hospital admission and emergency department attendance in most cases. [ABSTRACT FROM AUTHOR]

The article discusses the implementation and outcomes of nurse-led evidence-based educational sessions and emergency simulations at an outpatient cardiology imaging center in Alaska to help improve emergency skills of staff. The study evaluated the impact of Basic Life Support or Advanced Cardiovascular Life Support training courses on the knowledge, awareness and confidence of outpatient healthcare staff when responding to medical emergencies.

Psychological distress is commonly reported in patients with advanced cancer. Family is considered a psychological supporter for patients during their cancer journey. This study aimed to examine the effect of a nurse-led family involvement program on anxiety and depression in patients with advanced hepatocellular cancer. This is a quasi-experimental study with a two-group, pre–post-test design. Forty-eight participants were recruited at a male medical ward in a university hospital in Southern Thailand, and assigned to either the experimental or the control group. The experimental group received the nurse-led family involvement program, while the control group received only conventional care. Instruments included a demographic data form, clinical data form, and the Hospital Anxiety and Depression Scale. Data analyses were performed using descriptive statistics, chi-square, Fisher's exact test, and t-test. The results revealed that the mean scores of anxiety and depression in the experimental group at post-test were significantly lower than on the pretest and significantly lower than those of the control group. The results indicate that a nurse-led family involvement program has a short-term effect on the reduction of anxiety and depression in male patients with advanced HCC. The program can be useful for nurses to encourage family caregivers to engage in patient care during hospitalization. [ABSTRACT FROM AUTHOR]

Background: Traditional Chinese Medicine (TCM) nurse‐led clinics (NLC) is an innovative working model in China, representing the specialization and extension of nurses' role. However, as a pioneer in TCM nursing, this new model of working is facing both opportunities and challenges because it is known little about the operational status of NLCs. Aims: To explore the experiences of nurses who work in NLC in TCM hospitals. Materials & Methods: A focused ethnographic study was conducted in three TCM hospitals affiliated with Guangzhou University of Chinese Medicine. We interviewed eleven nurses in those hospitals and observed seven of them working with patients. We used snowball sampling for data collection including interview, non‐participant observation and documents from medical records. All the data were processed as following steps: (a) coding for descriptive labels; (b) sorting for patterns; (c) identifying outliers or negative cases; (d) generalizing with construction and theories and (e) noting reflective remarks. Results: Nurse‐led clinics help nurses develop their skills and knowledge that are highly recognized by public since they meet the growing needs of patients and also relieve the workload of physicians in the hospitals. However, lack of specialization is still a major challenge in NLCs due to insufficiency of full‐time staff with specialized education, nurse‐led practice without standardized guidelines, restrictions on prescription right of nurses, and also inadequate support from hospitals. Discussions: As a revolutionary innovation of working model for nurses in TCM hospitals, NLCs could improve quality of care and lead to a comprehensive promotion of nursing career. However, there are several challenges on providing high quality care for patients whilst improving educational development of nurses. This study suggests that nurses, hospital administration and the government should cooperate with each other to develop standard nursing programs for NLCs. Conclusions: It is imperative to identify nursing roles, collect available resources, and develop supportive policies and training programs to enhance the quality of NLCs. [ABSTRACT FROM AUTHOR]

Realist reviews offer a method to understand why an intervention is successful or not. Many factors influence how complex healthcare interventions are delivered and this makes understanding what works difficult. Effectiveness depends on delivery context, and success in one setting does not guarantee the same result in alternate settings. How an intervention works (the underlying mechanisms) in a particular setting for one population group, may not work in the same way for a different group. A realist review provides an iterative theory-driven approach to help understand how and for whom and under what conditions an intervention works. [ABSTRACT FROM AUTHOR]

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Background Nurses play a major role in facilitating teleconsultations in nursing homes with remote physicians. Currently, evidence explicating their role in teleconsultations is lacking. As telemedicine usage grows, understanding the factors that enable or impede nurses' role in teleconsultations allows for more support in the provision of patient care through this modality. Objective This study sought to explore enablers and barriers nurses faced in facilitating geriatric teleconsultations in nursing homes. Methods A qualitative descriptive study using semi-structured interviews was conducted in Singapore, from July to November 2021. Purposive sampling of nursing home nurses was undertaken. Data were inductively analysed using Braun and Clarke's thematic analysis approach. Results Twenty-two nursing home nurses participated in the study. Six key themes were identified as enablers and barriers in nurse-facilitated geriatrics teleconsultations. Enablers included nurses' acknowledgement of teleconsultations as needs-orientated service, close partnership with the hospital-based geriatric service for training and workflow support and nurses' sense of empowerment in teleconsultation involvement. Barriers that existed were the nurses' lack of confidence in physical assessment and communication competencies, role conflict due to nurses' perceived inability to meet physicians' expectations and limited scope of practice in performing teleconsultation-related tasks and the presence of technology-related challenges. Conclusion The identification of enablers and barriers in teleconsultations for nursing home residents provides insights for future research and development in telemedicine-related implementation and educational interventions in long-term care. Developing strong partnerships between telemedicine providers and nursing homes, further enhancement of nurses' telemedicine competencies and optimising digital infrastructure are warranted. [ABSTRACT FROM AUTHOR]

Policymakers and researchers often suggest that nurses may play a crucial role in addressing the evolving needs of patients with complex conditions, by taking on advanced roles and providing nursing consultations. Nursing consultations vary widely across settings and countries, and their activities range from complementing to substituting traditional physician-led consultations or usual care. This study was aimed at describing the effects of nursing consultations with patients with complex conditions in any setting on patient outcomes (quality of life, physical status, psychosocial health, health behaviour, medication adherence, mortality, anthropometric and physiological outcomes, and patient satisfaction) and organisational outcomes (health resource use and costs). Umbrella review. We followed the Joanna Briggs Institute method for umbrella reviews. We searched PubMed, Embase, Cochrane Database of Systematic Reviews and CINAHL to identify relevant articles published in English, Dutch, French, Spanish or German between January 2013 and February 2023. We included systematic literature reviews, with or without meta-analyses, that included randomised controlled trials conducted in high-income countries. Reviews were eligible if they pertained to consultations led by specialised nurses or advanced nurse practitioners. Article selection, data extraction and quality appraisal were performed independently by at least two reviewers. We included 50 systematic reviews based on 473 unique trials. For all patient outcomes, nursing consultations achieved effects at least equivalent to those of physician-led consultations or usual care (i.e., non-inferiority). For quality of life, health behaviour, medication adherence, mortality and patient satisfaction, more than half the meta-analyses found statistically significant effects in favour of nursing consultations (i.e., superiority). Cost results must be interpreted with caution, because very few and heterogeneous cost-related data were extracted, and the methodological quality of the cost analyses was questionable. Narrative syntheses confirmed the overall conclusions of the meta-analyses. The effects of nursing consultations on patients with complex health conditions across healthcare settings appear to be at least similar to physician-led consultations or usual care. Nursing consultations appear to be more effective than physician-led consultations or usual care in terms of quality of life, health behaviour, mortality, patient satisfaction and medication adherence. Further analysis of the primary data is necessary to determine the patient populations and settings in which nursing consultations are most effective. Moderate study quality, diversity amongst and within systematic reviews, and quality of reporting hamper the strength of the findings. [ABSTRACT FROM AUTHOR]

Background: Almost half of Australian after-hours emergency department (ED) presentations are rated as 'non-urgent' by clinicians and are suggested to be managed by community-based services, such as general practice (GP). This paper reports patient reasons for presenting for medical care after hours, and reasons for selection of specific services across a health system. Methods: A cross-sectional survey was conducted across the Australian Capital Territory. Patients voluntarily completed questionnaires in waiting rooms during the after-hours periods of one weekday and one weekend in 2019 at 28/51 extended hours GPs, 3/3 medical deputising services (MDS), 3/3 nurse-led walk-in-clinics (WICs), and 2/2 public emergency departments (EDs). Results: Of 3371 presentations, 1992 patients completed a survey, with 58% from GPs (n = 1149), 16% from WIC (n = 317), 10% from MDS (n = 193), and 17% from EDs (n = 333). Most patients presented with self-rated new issues (n = 987, 49.5%) and were uncertain of the urgency of their issues (n = 723, 36.7%). Common reasons for presenting to WIC, MDS, and EDs included the problem occurring after hours, and patients concern about the issue. Common reasons for presenting to GP were related to personal preference for after-hours care. Conclusions: Patients present to after-hours medical services for both perceived need and convenience. Most patients appear to be self-selecting after-hours services appropriately aligned with advertised services; except for GP patients who were attending after hours for care that is often non-urgent and could be seen in usual working hours. This study should be replicated to account for local health systems, and coronavirus disease 2019 (COVID-19)-related changes to health care. Almost half of Australian after-hours emergency department (ED) presentations are rated as 'non-urgent' by clinicians and are suggested to be managed by community-based services, such as general practice (GP). Our survey shows that patient-perceived urgency and need for care are drivers towards ED and other community services. In contrast, most patients chose after-hours GP for convenience. Public messaging could be adapted to encourage appropriate and timely access to care after hours. [ABSTRACT FROM AUTHOR]

Lack of access to primary and behavioral healthcare is prevalent in communities experiencing systematically greater obstacles to healthcare. This study describes the implementation of the Coordinated Care Model in a nurse-led primary care clinic and identifies the essential factors for sustained integration. A mixed-methods explanatory sequential study design was used to collect and analyze quantitative and qualitative data. Participants reported an overall statistically significant mean increase (M = 2.47, SD ± 2.01, p < 0.001) in the level of integration pre-and post-integration. Qualitative results indicated that the optimization and accentuation of team strengths, the Lundeen model of holistic care, and addressing physical and psychological barriers lead to sustained level of integration. Integrated practices are essential in assessing and supporting the holistic needs of individuals, families, and communities. Future studies should examine facilitators or impediments to integrated practice in other healthcare settings, long-term health outcomes of clients in integrated care, and the cost-effectiveness of integration. [ABSTRACT FROM AUTHOR]

Aims: To investigate the scope of practice of nurse‐led services for people experiencing homelessness, and the influence on access to healthcare. Design: A scoping review. Data Sources: On 20 November 2020, the following databases were searched: CINAHL, Embase, MEDLINE, PubMed and Scopus. Review Methods: Included studies focused on people experiencing homelessness aged 18 years and over, nurse‐led services in any setting and described the nursing scope of practice. Studies were peer‐reviewed primary research, published in English from the year 2000. Three authors performed quality appraisals using the mixed methods assessment tool. Results were synthesized and discussed narratively and reported according to the PRISMA‐ScR 2020 Statement. Results: Nineteen studies were included from the United States (n = 9), Australia (n = 4), United Kingdom (n = 4) and Canada (n = 2). The total participant sample size was n = 6303. Studies focused on registered nurses (n = 10), nurse practitioners (n = 5) or both (n = 4), in outpatient or community settings. The nursing scope of practice was broad and covered a range of skills, knowledge and attributes. Key skills identified include assessment and procedural skills, client support and health education. Key attributes were a trauma‐informed approach and building trust through communication. Important knowledge included understanding the impact of homelessness, knowledge of available services and the capacity to undertake holistic assessments. Findings suggest that nurse‐led care facilitated access to healthcare through building trust and supporting clients to access services. Conclusion: Optimized nursing scope of practice can facilitate access to healthcare for people experiencing homelessness. Key factors in enabling this include autonomy in nursing practice, organizational support and education. Impact The broad range of skills, knowledge and attributes reported provide a foundation from which to design an educational framework to optimize the nursing scope of practice, thereby increasing access to healthcare for people experiencing homelessness. [ABSTRACT FROM AUTHOR]

Aim: The aim was to describe vascular risk factors in Australian adults with diabetes attending an Indigenous primary care nurse‐led diabetes clinic. Design: This was a cross‐sectional descriptive single‐site study. Methods: Vascular risk factor data were extracted from the electronic health records of participants in the nurse‐led integrated Diabetes Education and Eye disease Screening (iDEES) study at a regional Victorian Indigenous primary health‐care clinic between January 2018 and March 2020. Results: Of 172 eligible adults, 135 (79%) provided data. Median (IQR) age was 56 (46–67) years; 89% were Indigenous; 95% had Type 2 diabetes of median (IQR) duration of 6 (2–12) years and 48 (36%) were male. Median HbA1c, blood pressure, cholesterol (total; LDL and HDL), triglycerides, eGFR, CRP and BMI were 8.0% (64 mmol/mol), 127/78 mm Hg, 4.2; 1.9; 1.1 mmol/L, 2.3 mmol/L, 89 ml/min/1.73 m2, 7.0 mg/L and 32.4 kg/m2. Of nine clinical risk factors, the median (IQR) number of risk factors at target was 4 (3–5) for women and 3 (2–5) for men, pχ2 = 0.563. Clinical targets for BMI, HbA1c, blood pressure, triglycerides, total cholesterol, LDL cholesterol, urine albumin: creatinine ratio, HDL cholesterol and smoking were met by 14%, 34%, 38%, 39%, 44%, 52%, 54%, 62% and 64%, respectively. Conclusion: A nurse‐led model of integrated clinical risk factor assessment and diabetes education identified suboptimal levels of clinical risk factor control for avoiding diabetes chronic complications amongst Australian adults with diabetes in an Indigenous primary care setting. Impact A nurse‐led model of diabetes care integrating clinical risk factor assessment into a diabetes education service is achievable. Understanding by stakeholders, including people with diabetes, their clinicians and health services, of the importance of regular monitoring of risk factors impacting diabetes complications is important. The novel nurse‐managed iDEES primary‐care model of care can assist. Trial registration: This study was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12618001204235). [ABSTRACT FROM AUTHOR]

Background: Nurse led noncommunicable diseases (NCD) clinic may address the significant shortage of human resource for health for managing common NCDs. The objective of this study is to assess the feasibility and effectiveness of nurse-led NCD clinic for identification, prevention, and management of common NCDs. Materials and Methods: A quasi experimental study was conducted at a Public Health Dispensary in periurban community of Northern India. Situational analysis and stakeholders' interview were done based on which the clinic was setup and run over a period of 2 months by registered nurses and nursing students to offer screening, health education and appropriate referral. The primary outcome of study was proportion of population screened, prevalence of common NCDs, risk factors modification, medication adherence, and patient satisfaction. Results: It was feasible to run a nurse led clinic in terms of availability of space, equipment to run the clinic and human resource. A total of 455 individuals aged ≥30 years were enrolled using the total enumeration sampling technique. There was a significant increase in screening rates from 0.29% to 3.7% in nurse-led NCD clinic. There was significant mean change in systolic blood pressure (18.75 ± 6.92 mm Hg), diastolic blood pressure (4.4 ± 3.71 mm Hg), random blood sugar (33.36 ± 38.49 mg/dl) Body Mass Index, and waist circumference (P < 0.01) among the population screened. Medication adherence significantly increased from 7.8% to 76.4% (P < 0.01) after 2 months of nurse-led NCD clinic. Conclusion: Task sharing for managing common NCDs in nurse-led NCD clinic was feasible and effective in increasing screening rates, medication adherence, and risk factors modification among studied population. [ABSTRACT FROM AUTHOR]