Specialist Community Nurses: A Critical Analysis of Their Role in the Management of Long-Term Conditions
Abstract
:1. Introduction
2. Methods and Data Sources
2.1. Definition
2.2. Aim
2.3. Narrative Review
2.4. Types of Studies
2.5. Inclusion/Exclusion Criteria
2.6. Data Sources
2.7. Search Methods, Study Selection and Quality Assessment
3. Results and Discussion
3.1. Community Nursing Interventions with COPD Patients
3.2. Community Nursing Interventions with Patients with Musculoskeletal Conditions
3.3. Summary
3.4. Discussion
4. Conclusions
References
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Systematic Reviews | ||||||
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Authors, Date, Location | Study Design | Sample | Intervention | Outcomes | Main Findings | Comments |
Smith et al. 2001, UK | 4 RCTs | Severe and moderate COPD | Outreach nurse in home | Mortality, service utilization | No differences in severe COPD patients, benefit with moderate COPD patients; considerable missing data in some studies | Nurse provided support, education, monitoring and liaison with physicians |
Ram et al. 2004, Scotland | 7 RCTs | COPD patients presenting at ER with exacerbation | Patients randomized to home support by a specialist respiratory nurse or regular hospital care | Hospital re-admissions, mortality | No significant differences in outcomes (i.e. home care had not negative outcomes). Patients and carers in both groups preferred care at home | Specialist respiratory nurses had frequent visits &/or telephone contact with patients and direct access to medical advice |
Taylor et al. 2005, UK | 9 RCTs | Patients were inpatient, outpatient & community based with moderate or severe COPD | Intervention was led by nurses & included case management, education, support, coordination of services | Mortality, health related quality of life, psychological well being, disability or pulmonary functioning | There were no differences between groups on long-term follow-up including mortality, health related quality of life, psychological well being, disability or pulmonary functioning | Studies were led, coordinated or delivered by nurses. Little robust evidence to support nurse management of chronic disease services for community patients |
Tinker & While 2006, UK | 23 studies & 3 systematic reviews, all designs included. | Patients with moderate to severe COPD | Focus on key interventions as recommended by NICE guidelines (smoking cessation, dyspnea management, exercise, hospital-at-home, palliative care and telephone follow-up) | Outcomes relevant to type of study, i.e. hospital-at-home, dyspnea reduction, smoking cessation. | 5 relevant studies indicating no adverse effect of hospital-at-home (4) and some positive benefit of symptom management and service utilization | Interventions were delivered by specialist respiratory nurses (in 4 studies) and community nurses (1 study) |
Effing et al.2007, The Netherlands | 14 RCTs 1 non-random trial | Clinical diagnosis of COPD, patients with asthma were excluded | COPD education and/or self-treatment guidelines (i.e. an action plan). | Health related quality of life (HRQoL), symptoms, number and severity of exacerbations, self-treatment of exacerbations, hospital admission, ER visits, days lost from work, lung function, exercise capacity | The studies showed a significant and clinically relevant reduction in hospitalizations, a small but significant improvement in dyspnoea and improved HRQoL. No effects were found in number of exacerbations, ER-visits, lung function, exercise capacity, and days lost from work. | Difficult to identify if interventions took place in outpatient department or home and role of community nurse (if any) |
Caress et al. 2009, UK | 35 studies, all designs | COPD patients | Interventions of early discharge/hospital at home (HH) case management and self–care or similar models. | Range of outcomes including mortality, service utilization, re-admission rates and other variables such as quality of life (QoL), knowledge & satisfaction with care | Early discharge/hospital at home – no negative outcomes & in some cases positive outcomes. Case management/self-care – QoL, knowledge, satisfaction with care increased. Mixed findings on medical outcomes | Few details on the type of nursing care was provided in most reports |
Empirical Studies | ||||||
Authors, Date, Location | Study Design | Sample | Intervention | Outcomes | Main Findings | Comments |
Candy et al. 2007, UK | Postal survey of respiratory healthcare workers and findings compared with 2 systematic reviews | 234 COPD specialist nursing services | Type of service documented | Most services addressed chronic disease management | Majority of services (71%) addressed chronic disease management for which there is little empirical evidence of effectiveness | This is the first survey of specialist nurse service provision |
Kwok et al.. 2007, Hong Kong | RCT | 77 CNS 80 controls | Post discharge home visits and access to community nurse specialist, telephone follow-up & medical support from designated physician | Prevention of readmission, length of stay, physical functioning & psychological variable | No significant differences between groups | Home care delivered by community nurse specialist |
Sridhar et al. 2008, UK | RCT | 122 COPD patients | Nurse-led intermediate care program. pulmonary including rehabilitation & self management education, written personalized COPD action plan, monthly telephone calls, 3 monthly home visits by a specialist nurse for two years | Hospital readmission rates, unscheduled primary care visits | No differences in re-admission rates or in exacerbations between groups. Higher mortality in control group | Home care delivered by specialist nurse |
Rizzi et al.. 2009, Italy | Non-randomized 2 group design | 108 home care (HC) 109 standard care | Outpatient clinical and functional assessments every six months by a specialist team including a pneumonologist, respiratory nurse, home evaluations of the patients at the request of patients and/or caregivers, and respiratory therapist visits (every two to three months or more frequently), liaison with the patient’s general practitioner | 10 year follow-up of mortality, exacerbations, hospital and intensive care use | HC group reduced lower mortality, exacerbations, hospital and intensive care use | Respiratory nurse was part of domiciliary team |
Authors, Date, Location | Study Design | Sample | Intervention | Outcomes | Main Findings | Comments |
---|---|---|---|---|---|---|
Roberts et al. 2003, UK | Postal survey of health professionals | 461 primary care organizations (5 professional roles in each of the organizations) | Type of community based musculoskeletal services provided | Organizations had one or more musculoskeletal services in their community | 71% provided one or more musculoskeletal services; Services led largely by physiotherapists (47%) and GPs (31%). Community nurses part of the service profile but role not identified. Also lack of evidence to support effectiveness of their services | Community nurses did not appear to have a role in community based musculoskeletal services |
Victor et al. 2005, UK | RCT | 22 GP practices | Primary care based patient education program – efficacy of nurse-led education program – program home visit and four 1 hour teaching sessions (intervention); education booklet only (control) | Quality of life - using SF-36; OA measure, arthritis helplessness index and patient knowledge questionnaire | No differences in groups in depression, OA knowledge or pain and physical ability | Lack of benefit of a nurse led primary care-based patient education program |
Rosemann et al. 2006, Germany | Qualitative: semi-structured interviews | 20 patients with OA; 20 GPs and 20 practice nurses | Hypothesis that patients lack information on disease, medication, and possible approaches | Evidence base on non-surgical treatment options; attitudes towards large involvement of practice nurse in care of patients with OA | Practice nurses had little involvement in diagnosing OA and in treatment; barriers against involvement: lack of knowledge about disease and treatment. Patients feel that pain and disability are addressed in-adequately by GPs | Patients require more information on how to manage pain and disability |
Nicholaides-Bouman et al. 2007, The Netherlands (Process evaluation) Nicholaides-Bouman et a.l 2004, (Trial design details) | RCT | 160 older people with health problems (95 (63%) with musculoskeletal problems) 170 controls received usual care | 8 nurse visits over 18 months; visits in intervention group received visits from same nurse every 2 months. Visiting protocol and older assessment system and EasyCare Questionnaire used to detect further problems | Process evaluation of home visiting program; participants’ experiences with visits. Effect on health status and care utilization (outcome from RCT not yet complete) | 151 received visits. 95 participants had musculoskeletal problems, from these there were 220 (14%) problems, and 249 (14%) were provided with interventions. Health visiting program by home nurses is appreciated by older people as many problems are detected and interventions such as advice or referrals were provided | Papers reports on process evaluation, trial not yet published so no results on health status and care utilization |
Wetzels et al. 2008, The Netherlands | RCT | 51 patients with mild hip or knee OA to intervention group; 53 to control group | Support patients’ self management of OA symptoms using a practice-based nurse. Nurse aimed to change lifestyle behavior, by improving mobility and physical functioning | Patients’ mobility (Timed up and GO Test); Patient Reported Functioning (Arthritis specific scale – Dutch AIMS2 SF) | Nurse-based intervention did not improve older OA patient’s mobility and functional status or use of health care resources. | Nurses provided home visits and telephone follow–up. Sample was small. Supports findings of Victor et al’s (2005) study that nurse-led education program with OA did not benefit these patients |
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McHugh, G.A.; Horne, M.; Chalmers, K.I.; Luker, K.A. Specialist Community Nurses: A Critical Analysis of Their Role in the Management of Long-Term Conditions. Int. J. Environ. Res. Public Health 2009, 6, 2550-2567. https://doi.org/10.3390/ijerph6102550
McHugh GA, Horne M, Chalmers KI, Luker KA. Specialist Community Nurses: A Critical Analysis of Their Role in the Management of Long-Term Conditions. International Journal of Environmental Research and Public Health. 2009; 6(10):2550-2567. https://doi.org/10.3390/ijerph6102550
Chicago/Turabian StyleMcHugh, Gretl A., Maria Horne, Karen I. Chalmers, and Karen A. Luker. 2009. "Specialist Community Nurses: A Critical Analysis of Their Role in the Management of Long-Term Conditions" International Journal of Environmental Research and Public Health 6, no. 10: 2550-2567. https://doi.org/10.3390/ijerph6102550
APA StyleMcHugh, G. A., Horne, M., Chalmers, K. I., & Luker, K. A. (2009). Specialist Community Nurses: A Critical Analysis of Their Role in the Management of Long-Term Conditions. International Journal of Environmental Research and Public Health, 6(10), 2550-2567. https://doi.org/10.3390/ijerph6102550