The nurse practitioner-client therapeutic encounter: an integrative review of interaction in aged and primary care settings.

AIMS: To review the key features of the nurse practitioner-client interaction in the thera-peutic encounter to inform the development of nurse practitioner-led memory clinics. BACKGROUND: Nurse practitioners spend significant time interacting with clients and their families/caregivers yet there is limited research on this interaction during therapeutic encounters in aged and primary care contexts. DESIGN: Integrative review. DATA SOURCES: Electronic search of CINAHL, Embase, Medline, PsychINFO, PubMed, Scopus, Web of Science 2004-2013; hand search of the Journal of Advanced Nursing, Journal of the American Academy of Nurse Practitioners and Journal of Clinical Nursing. REVIEW METHODS: Integrative literature review using Whittemore and Knafl's methodology. RESULTS: Ten published studies were included, representing over 900 nurse practitioners and their clients. Three key factors of nurse practitioner-client interaction were identified: nurse practitioner expertise and the influence of the therapeutic encounter context; affirming exchange as a bedrock of communication; and high levels of client engagement. In aged and primary care settings, where the therapeutic encounter requires and allows longer consultations, such as nurse practitioner-led memory clinics, patient-centred approaches can engage clients in consultations using a biopsychosocial framework, resulting in improved client satisfaction and, potentially, increased adherence to treatment plans. Nurse practitioners who are open and respectful, who encourage patients to provide more information about their lives and condition and are perceived by the client to be empathetic, are providing affirmation to the client. CONCLUSION: Affirming interactions are a key feature of successful therapeutic encounters when time and context do not allow or warrant the full repertoire of patient-centred communication.

Open referral policy within a nurse-led memory clinic: patient demographics, assessment scores, and diagnostic profiles.

BACKGROUND: Memory clinics, typically led by multidisciplinary teams and requiring health professional referral, are one means of providing diagnosis and care coordination for dementia. Nurse-led clinics may provide an effective and alternative means to dementia diagnosis, and open referral policies may minimize existing barriers to accessing a diagnosis, but evidence is needed. METHODS: Patients attending a one-day per week nurse-led memory clinic over a 25-month period during 2011-2013 (n = 106) completed comprehensive cognitive assessments and were diagnosed by an aged care nurse practitioner. Descriptive statistics detail the demographics, assessment scores, and diagnostic profiles of patients. Comparable data from published literature was identified, and the differences were analyzed qualitatively. RESULTS: One hundred and six patients were assessed with the key differences from other data sets being history of falls more common, higher mean Mini-Mental State Examination scores, and fewer dementia diagnoses. Sixty-four patients (60%) were self-referred to the nurse-led memory clinic, of which 19 (30%) were diagnosed with mild cognitive impairment (MCI) or dementia. Overall, forty-eight patients (45%) received diagnoses of MCI or dementia. CONCLUSIONS: An open referral policy led to a high proportion of patients being self-referred, and nearly a third of these were diagnosed with cognitive impairment or dementia. Open referral policies and nurse-led services may overcome some of the barriers to early diagnosis that are currently experienced. Considering an aging population worldwide and the associated increases in cognitive impairment, which benefits from early identification and intervention, this paper provides an alternative model of nurse-led assessment.

Supportive care of rural women with breast cancer in Tasmania, Australia: changing needs over time.

Providing for patients' psychosocial needs is a potential means of minimising cancer morbidity. Needs assessments can guide responsive patient-centred care. A longitudinal survey of women with early breast cancer consulting a breast nurse in a primarily rural state of Australia was undertaken to measure unmet supportive care needs, identify changes in unmet needs across time and compare results with previous studies. Needs assessments were completed with the Supportive Care Needs Survey (SCNS) at 1 month (n = 74) and 3 months (n = 83) post-diagnosis. Access to services was also examined. High levels of psychological and health system and information needs were identified at 1 month post-diagnosis, but these decreased significantly at 3 months post-diagnosis. Sexuality domain needs increased significantly during the same time. Compared to a previous SCNS study of rural women with breast cancer, unmet supportive care needs in this study were significantly lower than previously reported, although assistance with energy levels (i.e. fatigue) continues to be an unmet need for women with breast cancer. Results suggest there have been positive cultural changes within healthcare systems, specifically in better informing patients and providing support. Although services appear to be more responsive to breast cancer patients, significant unmet needs still exist.