The purpose of this study was to investigate nurses’ roles within nurse-led chemotherapy clinics. There has been a rapid expansion and development of nursing roles and responsibilities in oncology, but little understanding of how roles are enacted and their impact on patient experiences and outcomes. This was a two stage approach comprising a survey of UK oncology specialist nurses followed by an ethnographic study of nurses’ roles in nurse led chemotherapy clinics. Ethics approval was obtained prior to each study; research and development approval was obtained from each hospital site prior to Study 2. Study 1 used a questionnaire survey to explore the scope of nurses’ roles. A purposive sample of oncology specialist nurses perceived to be undertaking nurse-led clinics was obtained using snowball methods. Data analysis included descriptive and inferential statistics. Study 2 used ethnographic methods to explore nurses’ roles in nurse-led chemotherapy clinics, which included clinical observations, interviews with nurse participants and studying documentation (protocols) for nurse-led chemotherapy clinics. Findings were coded and thematic analysis undertaken. In study 1, 103 completed questionnaires were received with a response rate of 64%, however analysis identified 79 (76.7%) nurses undertaking nurse-led clinics, therefore statistical analysis was limited to this sample of 79 nurses. An additional 12 (11.7%) nurses wanted to undertake nurse-led clinics, therefore findings from this group were analysed separately. There was little congruence between nurses’ titles and clinical roles, with significant differences in practice between different groups of nurses, in relation to history-taking (p=.036), assessing response to treatment (p=.033). Although there was no difference in the number of nurses undertaking clinical examinations (p=.065), there were differences in the nature of examinations undertaken, including respiratory (p= .002). There were also significant differences between groups of nurses in relation to nurse prescribing (p<.0001). Study 2 included observations (61 consultations by 13 nurses) and interviews (n=11). There was variability in patient numbers within nurse-led clinics, identifying implications for service delivery and sustainability. Disparities in nurses’ roles and responsibilities revealed four different levels of nurse-led chemotherapy clinics, from chemotherapy administration to totally nurse-led clinics. The identification of four levels of nurse-led chemotherapy is a new finding, and suggests a framework for nurse-led chemotherapy clinics that could link with nurse competencies and training. Five main themes were identified in study 2; a central theme of autonomy linked with themes of knowledge, skills, power and beliefs. A key finding was the reduced emphasis on compassionate care with greater medical (clinical) responsibilities within nurses’ roles, and poor communication skills by some nurses. Despite a great diversity in oncology specialist nurses’ roles, the lack of clarity in roles and responsibilities is creating confusion. Similarly the rapid increase in nurse-led chemotherapy clinics has been ad hoc with no formal evaluations. Although nurses in study 2 perceived they were providing holistic care there was no evidence of this in observations, and nurses appear to use a medical model care based on doctor-nurse substitution, which may have led to reduced emphasis on nursing skills and compassionate care.

Self-management support (SMS) is considered an effective approach to chronic pain (CP) management. However, the provision of SMS for chronic pain patients faces challenges within primary care facilities in Ontario. An innovative SMS program led by a Registered Nurse (RN) at the Bruyère Family Health Team in Ottawa has been created for chronic pain patients. The goal of this program is to improve the current chronic pain management using SMS in an outpatient facility by harnessing the skills of primary health care team members. The hope would be that this program could be spread and scaled across other programs in the region. This thesis exists in two parts: 1. Evaluate the RN-led chronic pain self-management program to determine its effectiveness in terms of self-reported pain scales and Morphine Equivalence Quotient (MEQ) 2. Understand the perspectives of health care practitioners, administrators and patients within the RN-led chronic pain self-management program Patients meet with the RN for initial face-to-face visit for an hour, for SMS and then for at least one follow up visit. The primary outcome variables of interest were their self-reported pain evaluated using validated pain scales. Opioid use was also assessed before and after the porgram based on the MEQ. Results were analyzed using SPSSversion20. An online questionnair was distributed to team members. All responses were conceptually arranged into a SWOT analysis, which will be directed toward the ongoing management needs of the clinic. Between January 2016 and August 2018, 125 patients were seen of these 58 patients (12 males and 46 females) had at least one follow up appointment with the RN. In 46.2% of the population there was a decrease in their total opioid dose from their first to their last appointment and of these 4 patients (15.4%) had a daily MEQ of 0 by their last appointment. There was a significant average difference between patient’s daily MEQs at their first and last appointment (t20= 2.245, p<0.05). On average patients came into their first appointment with a daily MEQ of 23.88 higher than at their last visit (95% CI [1.69, 46.07]). Staff and patients who participated in the online survey identified the following strengths: multidisciplinary approach, increased accessibility for patients, cost effectiveness, better patient engagement, and no refills of opioids Canada needs a better strategy to manage the CP epidemic. This chronic pain self-management program led by an RN focuses on a multidisciplinary approach that is readily accessible to patients and integrated within primary care to best meet and prioritize the needs of chronic pain patients.

No description available.

No description available.

Sjuksköterskeledda mottagningar har blivit ett framgångsrikt sätt att ta hand om stora patientgrupper som lider av kroniska sjukdomar som diabetes, astma och hjärtsvikt (Eklund, 2009). I Sverige lider fyra av tio kvinnor och fem av tio män, av övervikt eller fetma (SCB, 2012). Fetma är ett globalt folkhälsoproblem som leder till en mängd allvarliga konsekvenser, både fysiska, psykiska och sociala, och har blivit en allt större utmaning för vårt samhälle att finna lösningar och effektiva behandlingar till (WHO, 2013). På senare tid har sjuksköterskeledda överviktsmottagningar etablerats. Syftet med denna uppsats är att beskriva omvårdnadsåtgärder vid sjuksköterskeledd överviktsmottagning. Uppsatsen är en litteraturstudie baserad på både kvalitativa och kvantitativa artiklar. De resultat som framkommit talar för att sjuksköterskeledda omvårdnadsåtgärder på överviktsmottagning utgår från ett holistiskt synsätt där sjuksköterskans uppgift är att stödja patienten och i partnerskap med denne utarbeta en personcentrerad omvårdnad som omfattar både kropp och själ. / Nurse led clinics have successfully been taking care of large groups of patients suffering from chronic diseases such as diabetes, asthma and heart failure (Eklund, 2009). In Sweden today, four out of ten women and five out of ten men, suffers from overweight or obesity (SCB, 2012). Obesity is a global public health problem leading to a host of serious consequences, physical, psychological and social, and has become an ever greater challenge for our society to find solutions and effective treatments for (WHO, 2013). Recently nurse led obesity clinics has been established. The purpose of this paper is to describe nursing interventions in nurse led obesity clinic. The thesis is a literature study based on both qualitative and quantitative items. The results obtained suggest that nurse led interventions in overweight clinic is based on a holistic approach where the nurse's role is to support the patient and in partnership with him or her develop a person-centered care that encompasses both body and soul.

Sammanfattning Bakgrund: Kronisk ledgångsreumatism eller Reumatoid Artrit (RA) är en kronisk inflammatorisk ledsjukdom och är den vanligaste artritsjukdomen vars huvudsymtom är ledvärk. RA finns i alla folkgrupper, dock med varierande prevalens. I Skandinavien ligger prevalensen på ca 0,7 %. Etnologin till RA är en blandning av genetiska och omgivningsrelaterade faktorer. Att leva med RA påverkar patienten fysiskt, känslomässigt, psykologiskt och även socialt vilket leder till att hela livssituationen påverkas. Syfte: Syftet med litteraturstudien var att beskriva erfarenheter av sjuksköterskeledd mottagning hos patienter med reumatoid artrit samt beskriva undersökningsgruppen i de inkluderade artiklarna. Metod: En litteraturstudie med beskrivande design. Huvudresultat: Patienternas erfarenhet av sjuksköterskeledd mottagning var möten i en varm, vänlig och familjär atmosfär. Vården beskrevs som personcentrerad och kompetent och var baserad utifrån varje individs speciella behov. Sjuksköterskans specialistkunskaper värderades högt och uppgavs skapa en känsla av trygghet hos patienten. Den sjuksköterskeledda mottagningen upplevdes som lättillgänglig, flexibel och skapade kontinuitet i vården. Tillgängligheten medförde också att patienten visste när och hur de skulle kontakta sjuksköterskan. Patientens erfarenhet var att en god kommunikation med vårdpersonalen, gav en ömsesidig respekt och ingav patienten ökat förtroende. Slutsats: Slutsatsen av denna studie är att sjuksköterskeledd mottagning kan skapa ett mervärde för patientens omvårdnad. Den erbjudna vården representerade för deltagarna trygghet, hopp och förtroende. För att ett mervärde ska skapas är det av största vikt med god kommunikation och relationskapande, vilket i sin tur ger trygghet och skapar en grundläggande möjlighet för hälsofrämjande omvårdnad. / Abstract Background: Chronic arthritis rheumatism or rheumatoid arthritis (RA) is a chronic inflammatory joint disease and is the most common arthritis disease, in which headache is joint pain. RA is present in all populations, with varying prevalence. In Scandinavia, the prevalence is approximately 0.7%. The ethnology of RA is a combination of genetic and environmental factors. Living with RA affect the patient physically, emotionally, psychologically and socially, meaning that the whole life situation is affected. Aim: The purpose of the literature study was to describe the experiences of nurse-led clinics for patients with rheumatoid arthritis and to present the study groups described in the articles included. Methods: A descriptive literature study Main results: Patients' experiences of nurse-led clinics were encounters in a warm, friendly and familiar atmosphere. The care was described as person-centered and competent provided and based on each individual's special needs. The nursing specialist skills were highly valued and described to create a sense of security for the patient. The nurse-led clinic was reported readily available, flexible and to create stability in the care. The accessibility also meant that the patients were aware of when and how to contact the nurse. The patient's experience was that good communication with the healthcare staff provided a mutual respect and instilled an increased patient confidence. Conclusion: The conclusion of this study was that nurse-led clinics could add value for the patient nursing care. This offered care represented familiarity, hope and confidence for the patients. To achieve added value, good communication and relationship are of the utmost importance, which in turn provide security and create a fundamental possibility in health-promoting care.

The transition after hospitalization is a vulnerable period when adverse events like unplanned readmissions may occur. Unplanned readmissions with patients undergoing chemotherapy that are the result of gaps in communicating the discharge plan may be preventable. Several transitional care interventions have been explored, and one of these is the nurse discharge phone call. This project explored the effect of a nurse-led transitional discharge phone call within 30-days after hospital discharge on unplanned readmission due to chemotherapy among patients in the medical-oncology compared to patients without a nurse-led transitional discharge phone call. A nurse-led transitional discharge phone call was implemented within 48 to 72 hours after discharge from the medical-oncology unit of a hospital in the northeastern region of United States to determine its effectiveness in reducing the number of unplanned readmissions due to chemotherapy. The Donabedian model, the Iowa model of evidence-based practice to promote quality care, the diffusion of innovation theory, and the health belief model served as the theoretical underpinnings of the project. Seven patients undergoing chemotherapy received the discharge phone call, and none were readmitted due to cancer-related complications. The unplanned hospital readmission rate was 0% compared to the 14.17% in 2017. The findings of this project might contribute to positive social change by helping the community of patients on chemotherapy to have a better transition process through acquiring necessary information for their postdischarge care and thus mitigating the possible causes of unplanned hospital readmission.

Abstract The original intention for the Partnership Community Worker (PCW) project in 2006 was for it to be an extension of the Pegasus Health General Practice and furthermore to be a bridge between the community and primary healthcare. It was believed that a close working relationship between the Practice Nurse and the PCW would help the target population of Māori, Pacifica and low income people to address and overcome their perceived barriers to healthcare which included: finance, transport, anxiety, cultural issues, communication, or lack of knowledge. Seven years later although the PCW project has been deemed a success in the Canterbury District Health Board annual reports (2013-14) and community and government agencies, including the Christchurch Resettlement Service (2012), many of the Pegasus Health General Practices have not utilised the project to its full extent, hence the need for this research. I was interested in finding out in the first instance if the model had changed and, if so why, and in the second instance if the promotional material currently distributed by Pegasus Health Primary Health Organisation reflected the daily practice of the PCW. A combination of methods were used including: surveys to the Pegasus Health General Practices, interviews with PCWs, interviews with managers of both the PCW host organisations and referring agencies to the PCW project. All the questions asked of all the participants in this research were focussed on their own perception of the role of the PCW. Results showed that the model has changed and although the publications were not reflecting the original intention of the project they did reflect the daily practice of the PCWs who are now struggling to meet much wider community expectations and needs. Key Results: Partnership Community Worker (PCW) interviews: Seventeen PCWs of the 19 employed were interviewed face to face. A number expressed interest in more culturally specific training and some are pursuing qualifications in social work; for many pay parity is an issue. In addition, many felt overwhelmed by the expectations around clients with mental health issues and housing issues now, post-earthquakes. Medical Practice surveys: Surveys were sent to eighty-two Pegasus Health medical practices and of these twenty five were completed. Results showed the full capacity of the PCW role was not clearly understood by all with many believing it was mostly a transport service. Those who did understand the full complexity of the role were very satisfied with the outcomes. PCW Host Community Manager Interviews: Of the ten out of twelve managers interviewed, some wished for more communication with Pegasus Health management because they felt aspects of both the PCW role and their own role as managers had become blurred over time. Referring organisations: Fifteen of the fifty referring community or government organisations participated. The overall satisfaction of the service was high and some acknowledged the continuing need for PCWs to be placed in communities where they were well known and trusted. Moreover results also showed that both the Canterbury earthquakes 2010-2011 and the amalgamation of Partnership Health PHO and Pegasus Health Charitable Limited in 2013 have contributed to the change of the model. Further future research may also be needed to examine the long term effects on the people of Canterbury involved in community work during the 2011-2014 years.

Globally, nurses' contribution to informed health policy decisions is limited, as there are many barriers to Nurse led change to successfully influence the HIV and AIDS policy process. In South Africa nurses at all levels of health care are not involved or consulted during the formulation of the HIV and AIDS workplace policy. This has led to concern about the absence of nurses at the policy table. This study forms part of a larger international study programme entitled: “Strengthening Nurses’ Capacity in HIV and AIDS Policy Development in Sub–Saharan Africa and the Caribbean”. This programme of international research aims to empower nurses to become involved in the policy process (formulation, implementation and evaluation) in order to strengthen health systems in the areas of HIV and AIDS care. Nurses' absence at the policy table prompted the researcher to explore and describe barriers to Nurse led change to influence HIV and AIDS workplace policy. Phase 1 of the research consisted of a literature review to identify barriers to Nurse led change to influence the HIV and AIDS workplace policy. Management's opinion about the human resource management capacity and problems experienced working in an HIV and AIDS environment was obtained through a quantitative and qualitative empirical method of data collection and analysis. Frontline nurses' perspective was obtained through qualitative interviewing to identify problems experienced with policy in an HIV and AIDS workplace environment. A mixedmethod triangulation research design was used to achieve the objectives of phase 1 of the study, and strategies applied included exploratory, descriptive and contextual designs. The analysis of the data contributed to the identification and classification of problems experienced by nurses to influence HIV and AIDS workplace policy at macro, meso and microlevel, resulting in the formulation of fifty–nine (59) concluding problem statements. These concluding statements formed the basis for the strategy development for Nurse led change to influence HIV and AIDS workplace policy, which was the only objective of the second phase of the research. The strategy for Nurse led change to influence HIV and AIDS workplace policy was developed by using a strategic process to determine the vision, mission, values, principles, assumptions, strategic objectives and functional tactics based on the concluding problem statements. Finally, the research was evaluated, limitations were identified and recommendations were formulated for practice, education, research and policy. / Thesis (Ph.D. (Nursing))--North-West University, Potchefstroom Campus, 2011.

Globally, nurses' contribution to informed health policy decisions is limited, as there are many barriers to Nurse led change to successfully influence the HIV and AIDS policy process. In South Africa nurses at all levels of health care are not involved or consulted during the formulation of the HIV and AIDS workplace policy. This has led to concern about the absence of nurses at the policy table. This study forms part of a larger international study programme entitled: “Strengthening Nurses’ Capacity in HIV and AIDS Policy Development in Sub–Saharan Africa and the Caribbean”. This programme of international research aims to empower nurses to become involved in the policy process (formulation, implementation and evaluation) in order to strengthen health systems in the areas of HIV and AIDS care. Nurses' absence at the policy table prompted the researcher to explore and describe barriers to Nurse led change to influence HIV and AIDS workplace policy. Phase 1 of the research consisted of a literature review to identify barriers to Nurse led change to influence the HIV and AIDS workplace policy. Management's opinion about the human resource management capacity and problems experienced working in an HIV and AIDS environment was obtained through a quantitative and qualitative empirical method of data collection and analysis. Frontline nurses' perspective was obtained through qualitative interviewing to identify problems experienced with policy in an HIV and AIDS workplace environment. A mixedmethod triangulation research design was used to achieve the objectives of phase 1 of the study, and strategies applied included exploratory, descriptive and contextual designs. The analysis of the data contributed to the identification and classification of problems experienced by nurses to influence HIV and AIDS workplace policy at macro, meso and microlevel, resulting in the formulation of fifty–nine (59) concluding problem statements. These concluding statements formed the basis for the strategy development for Nurse led change to influence HIV and AIDS workplace policy, which was the only objective of the second phase of the research. The strategy for Nurse led change to influence HIV and AIDS workplace policy was developed by using a strategic process to determine the vision, mission, values, principles, assumptions, strategic objectives and functional tactics based on the concluding problem statements. Finally, the research was evaluated, limitations were identified and recommendations were formulated for practice, education, research and policy. / Thesis (Ph.D. (Nursing))--North-West University, Potchefstroom Campus, 2011.