The emotional boundary seesaw model to help cancer clinical nurse specialists work with patients who challenge them.

Receiving a diagnosis of cancer and receiving treatment can be physically and psychologically onerous for cancer patients. Alongside their nursing skills, cancer clinical nurse specialists (CCNSs) are trained to provide psychological support, assessment and intervention following a cancer diagnosis. Mental health specialists, usually clinical psychologists, provide clinical supervision to CCNSs to support them with this. One of the regular themes that comes up in clinical supervision with CCNSs is how to maintain a supportive and therapeutic relationship with 'challenging' patients. These patients may be considered challenging because they are inconsistent, demanding or ambivalent about their care, which puts a strain on the relationship with their CCNS. By using the emotional seesaw model to reflect on and attend to the emotional boundaries of the relationship, within clinical supervision, these challenging relationships can be understood and managed, and better outcomes for the patient can be achieved.

What influences specialist palliative care nurses working in a community setting to engage with research?

AIMS: The aim of this research was to understand what influences specialist palliative care nurses working in a community setting to engage with research. METHODS: Qualitative research using interviews with community based clinical nurse specialists (CNS). FINDINGS: A total of five themes were identified: research negativity and enthusiasm, clinical focus, audits, organisational support and keeping up to date. CONCLUSION: Except for audit activity, CNS do not view the research pillar as an integral part of their clinical role. Previous research education may not give the CNS the breadth of research skills that they require. The advance professional apprenticeship may resolve these education issues. Managers and organisations need to prioritise EBP skills; supporting nurses with both education and EBP mentors to develop these skills. Nurses require ongoing time to engage with research activity and use these skills to improve both their own clinical practice and those who use them as a research resource.

The role of advanced practice nurses in improving healthcare outcomes for patients with chronic kidney disease: A scoping review protocol.

INTRODUCTION: The number of patients with chronic kidney disease is increasing worldwide; previous studies have suggested that advanced practice nurses, including nurse practitioners and clinical nurse specialists, with expert practice skills can provide high-quality care and solve complex healthcare problems. In general, nurse practitioners are generalist nurses who work as autonomous clinicians with whole personal care. Clinical nurse specialists, in contrast, are nurses with advanced nursing knowledge and skills for individuals or specific populations. Their roles are independent and different; however, similarities exist in their role in potentially improving healthcare outcomes. Although two previous studies described the role of nephrology nurse practitioners, they were systematic reviews, and their outcomes were limited. To clarify the overall aspect of advanced practice nurses' role, it is necessary to extract the studies illustrating advanced practice nurses' practices for patients with chronic kidney disease. OBJECTIVE: This study aims to map the literature describing the role of advanced practice nurses in improving healthcare outcomes for patients with chronic kidney disease. MATERIALS AND METHODS: This scoping review will be conducted using the Joanna Briggs Institute methodology for scoping review. Online databases will be searched across MEDLINE (PubMed), CINAHL (EBSCOhost), Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Web of Science. Only studies published in English will be included, and no date limit will be set. Chronic kidney disease, renal replacement therapy, and advanced practice nurses as keywords and related search terms will be used. Two independent reviewers will screen the title and abstract/full-text; in case of discrepancy, a third reviewer will make the final decision. The results will be extracted and presented following the review question concerning the study characteristics, patients' characteristics, condition of chronic kidney disease, and role of advanced practice nurses.

Role of the addiction clinical nurse specialist in acute hospital settings.

BACKGROUND: The role of an addiction clinical nurse specialist (ACNS) is focused on individuals who misuse drugs and alcohol, and several benefits of the role have been identified in the literature. When people who misuse substances are admitted to acute general hospitals, there is an opportunity to engage with them and ensure they access support services to facilitate their recovery. AIM: To determine general nurses' experience of caring for patients who misuse substances, and to gauge nurses' views on the implementation of an ACNS role in an acute general hospital. METHOD: This study used a qualitative design involving online interviews with 11 hospital nurses. FINDINGS: Many participants felt that an ACNS could provide them with education and support around substance misuse, while also advocating for patients who misuse substances, reducing stigma and enhancing patient care. CONCLUSION: Participants indicated several benefits to implementing an ACNS role in their hospital, such as ensuring that patients who misuse substances experienced continuity of care which began at admission, was followed-up during inpatient stays and was maintained in the community.

A Clinical Nurse Specialist in Home Healthcare.

PURPOSE: Opportunities and challenges in home healthcare are discussed from the perspective of a gerontological clinical nurse specialist who has served as an expert clinician, administrator, and compliance director of a home health agency in the Midwest United States. DESCRIPTION: Home-based nursing care requires a distinct set of knowledge and skills centered on the home environment and the way the home health patient responds emotionally and physically to become confident and self-sufficient. A Theoretical Framework for Home-Based Professional Nursing Practice is presented identifying the 6 concepts (primacy of home, patient authority, patient self-management, caregivers as collaborators, interprofessional clinical team collaboration, nurse autonomy) that are building blocks to describe the experience of patients in their homes and interactions with providers. The quality of clinical care and documentation influence reimbursement for care and the financial survival of the home health agency. OUTCOME: Six management priorities both within the administrative office and the clinical teams are highlighted to improve quality of care, promote efficiency, and retain staff. CONCLUSION: Exciting opportunities are available for the clinical nurse specialist in home-based care.

A Compendium of Clinical Nurse Specialist Roles in a Canadian Health Authority.

Interior Health in British Columbia advocates for and supports advanced practice nurses, inclusive of regional clinical nurse specialists (CNSs). CNSs develop evidence-informed programs, education, policies and practice standards. The article uses an advanced practice nursing framework to anchor two case studies: (1) the operationalization and implementation of a regional CNS role in primary care and (2) the use of a knowledge translation strategy to build clinical capacity in serious illness conversations. These case studies embody the CNS role and provide a voice for CNSs to communicate the ways in which their advanced practice nursing role is pivotal in healthcare system transformation and for providing quality patient care.

Oncology Nursing Society's Genomics and Precision Oncology Learning Library Resources for Nursing Practice.

Oncology nurses need an understanding of genomic science to provide optimal care, yet they may have limited background in how this science guides treatment. The Oncology Nursing Society (ONS) responded to this identified need.

The Birth and Development of the Lactation Consultant Profession (1980-2007): An Interview With Chele Marmet (Part II).

The remarkable world-changing growth of International Board Certified Lactation Consultants (globally over 35,000 IBCLCs in 2023), as the internationally recognized lactation professional since Chele Marmet conceptualized the field in 1977, demonstrates its importance for society and breastfeeding dyads. The early 1980s was a seminal time in the development of lactation care as a allied health field with specialized knowledge, study, and certification. Chele Marmet played a significant role as an innovator and activist during all these major changes. In this interview, she details these historic events, which she is elaborating further in her upcoming memoir.Although the terms LC and lactation professional have commonly been used to refer to those working clinically with breastfeeding families, in this article both terms refer only to the International Board Certified Lactation Consultant (IBCLC). JHL has a policy not to use the term LC (Dodgson, 2016, 2020); our rationale is that this term is currently too vague and is often misused by those with less education and experience than IBCLCs. However, we have used LC in this article at times when referring to lactation professionals prior to the development of the international board examination. This article is the second part of the interview; Part I was published in the previous JHL issue (February 2014). This interview has been transcribed with minor editing for ease of reading. (CM = Chele Marmet, JD = Joan Dodgson).

Pharmacotherapy in the heart transplant recipient: A primer for nurse clinicians and pharmacists.

Heart transplantation (HT) is the definitive treatment for eligible patients with end-stage heart disease. A major complication of HT is allograft rejection which can lead to graft dysfunction and death. The guiding principle of chronic immunosuppression therapy is to prevent rejection of the transplanted organ while avoiding oversuppression of the immune system, which can cause opportunistic infections and malignancy. The purpose of this review is to describe immunosuppressive management of the HT recipient-including agent-specific pharmacology and pharmacokinetics, outcomes data, adverse effects, clinical considerations, and recent guideline updates. We will also provide recommendations for medical prophylaxis of immunosuppressed patients based on the most recent clinical guidelines. Additionally, we highlight the importance of medical therapy adherence and the effect of social determinants of health on the long-term management of HT. HT recipients are a complex and high-risk population. The objective of this review is to describe basic pharmacotherapy in HT and implications for nurses and pharmacists.

National Association of Clinical Nurse Specialists Affiliate Support for Professional Growth of Clinical Nurse Specialist Students.

PURPOSE/OBJECTIVES: The purpose of this article was to describe how a National Association of Clinical Nurse Specialists affiliate partnered with a local university to engage clinical nurse specialist (CNS) students, enhance its mission and activities, and create succession planning opportunities, while providing mentorship and professional growth opportunities. DESCRIPTION OF THE PROJECT: Academic preparation of CNS students endeavors to instill professionalism. A 3-pronged partnership incorporating the inclusion of a student liaison on the board, presentation of student clinical work at the affiliate's annual conference, and development of a student scholarship was implemented. OUTCOMES: Membership in professional nursing organizations for a CNS student provides exposure and access to professional development resources, socialization to the role, rewarding networking opportunities with peers and colleagues, and leadership development. Anecdotal feedback demonstrated a better understanding of the CNS role, increased confidence, and enhanced knowledge on topics such as legislative advocacy as well as experiences of sharing clinical challenges with CNS colleagues. CONCLUSION: Partnership with the local university allowed the affiliate to maintain the influx of new CNSs, which sustains membership, nurtures the growth of new CNSs, and ensures the influx of new ideas. Furthermore, membership in professional nursing organizations is imperative to address the opportunities that exist in healthcare.

Clinical Nurse Specialist Role Advocacy: Quantifying the Financial Contributions Via Development of a Scorecard.

PURPOSE/OBJECTIVES: The purpose of this article is to guide the clinical nurse specialist in constructing a scorecard to track clinical outcomes and identify the associated financial impact. DESCRIPTION OF THE PROJECT/PROGRAM: Creation of a scorecard highlighting the financial impact of the clinical nurse specialist team was used to disseminate financial outcomes to hospital executive stakeholders, allowing the clinical nurse specialist team to demonstrate its clinical and financial value. OUTCOME: During development and ongoing maintenance of the scorecard, the clinical nurse specialist team cultivated skills to identify the financial impact of projects. The team also utilized financial implications of individual and group projects to prioritize work. At the end of fiscal year 2022, the clinical nurse specialist team demonstrated revenue generation of $29 890 and cost avoidance of $2 854 807.30. The clinical nurse specialist scorecard was presented quarterly to the chief nursing officer, who shared with executive leadership. CONCLUSION: Clinical nurse specialists are positioned to make significant and positive financial impact to organizations. A scorecard presented to executive leadership offers a clinical nurse specialist team a tool to capture and disseminate a clinical nurse specialist team's unique financial contribution at the system level.

Oncology Clinical Nurse Specialists Practice in the Outpatient Setting.

PURPOSE/OBJECTIVES: With rapidly evolving oncology care, the role of the outpatient clinical nurse specialist is most valuable and essential. The purpose of this article is to describe the role of the clinical nurse specialist in the ambulatory oncology settings and highlight the clinical nurse specialists' unique influence across the spheres of impact. DESCRIPTION OF THE PROJECT/PROGRAM: This article shares several contributions of an outpatient clinical nurse specialist, which include ways this role impacts nursing practice, patient care, and standardizing organizational guidelines. A method of recording the clinical nurse specialists' encounters or indirect consults was also utilized to provide a process to log consultation received in the day-to-day practice. Work exemplars were included to further demonstrate the impact of this role in this setting. CONCLUSION: Outpatient clinical nurse specialist need is rising especially in the oncology setting where the majority of cancer care and treatment is delivered. It is important to continue to disseminate and highlight the value it brings to the organization.

Enhancement of Preoperative Mental Health Assessment Through Clinical Nurse Specialist Project Leadership.

PURPOSE/OBJECTIVES: The aim of the project was to discern whether a collaborative, consultative-rich, clinical nurse specialist-led project could increase completion rates of a patient health questionnaire for depression and a generalized anxiety disorder questionnaire with appropriate referrals in adult patients in the ambulatory and hospital settings of a robust cardiovascular surgery practice before cardiovascular surgery. DESCRIPTION OF PROJECT: The Define, Measure, Analyze, Improve, Control implementation methodology guided this quality improvement project. The workflow was analyzed in collaboration with stakeholders, and barriers to and facilitators of questionnaire completion were identified. Interpreter services partnerships were enhanced and used for patients with a preferred language other than English. Weekly data analysis assessed ongoing questionnaire completion rates. OUTCOME: Documented completion rates of questionnaires improved across ambulatory and hospital settings by 15%. Patients with a preferred language other than English had an 80-percentage-point increase in documented questionnaire completion. CONCLUSION: Clinical nurse specialists are poised to lead projects because of their use of the collaborative and consultative core competencies. A formal electronic health record report was established for monitoring outcomes. Embedding questionnaire administration within the standard workflow of ambulatory and hospital staff makes administering questionnaires preoperatively a sustainable practice in both settings.

Evaluating the effectiveness of a clinical nurse specialist triage role in a specialist palliative care community service.

BACKGROUND: In 2017, a clinical nurse specialist (CNS) triaging role was created within a specialist palliative care community service (SPCCS) in Ireland to enhance the triage process. The aim of this study is to evaluate the effectiveness of the role regarding data collection and reporting. Structured feedback from healthcare professionals (HCPs) was obtained on the effects, challenges and sustainability of this role. METHODS: This study used a mixed-methods approach. A quantitative analysis of referrals triaged by the SPCCS CNS over 2 years (2018-2019) was performed. Two focus groups with HCP's within the same service were completed in January 2020 and one-to-one interviews were conducted. The quantitative and qualitative results were merged using a triangulation protocol. RESULTS: In 2017, new health service executive (HSE) standards to categorise the urgency of patient assessment were introduced. Quantitatively, an improvement within the triage process was seen, with an increase in compliance with national access standards. In 2018, compliance was 89.1%. In 2019, this was 96.8%, an improvement of 7.7%. A data discrepancy of 9.5% of referrals was noted over the first 9 months of 2018. After this, data documentation and congruency were seen to improve for the final 3 months of 2018 to 100% and remained at 100%. Qualitative data highlighted the benefits and challenges of the Triage CNS role. Mixed-methods correlation revealed corroboration between both using a triangulation protocol. CONCLUSION: The triage CNS role was pivotal as an initial point of referral contact. Increased compliance with national access standards occurred resulting in improvements in case and case-load management, information gathering, documentation, data collection and analysis.

Barriers and facilitators to giving prehabilitation advice by clinical nurse specialists and advanced nurse practitioners in oncology patients.

PURPOSE: This is the second article in this series on the knowledge, attitudes and beliefs of clinical nurse specialists (CNSs) and ANPs (advanced nurse practitioners) regarding prehabilitation advice in oncology patients, exploring the barriers and facilitators to giving prehabilitation advice by CNSs and ANPs in oncology patients. METHODS: A Cross-sectional online questionnaire opens for 3 months to establish the knowledge, attitudes and beliefs of ANPs and CNSs to prehabilitation disseminated through professional organisations and social media. RESULTS: The questionnaire gained (n = 415) responses. Prehabilitation advice was routinely given by 89% (n = 371) of respondents. Many (60%) identified a lack of guidance and referral processes as a barrier to giving prehabilitation advice; this corresponded between respondents' confidence to give prehabilitation advice and subsequent referrals (< 0.001). Other factors included time (61%), a lack of patient interest (44%) and limited relevance to patients (35%). CONCLUSION: The implementation of standardised nurse prehabilitation advice resources would enable CNSs and ANPs to provide personalised prehabilitation advice in their consultations.

Infection Control Nursing.

These nurses prevent patients from contracting avoidable infections.

Exploring the experiences of adults adjustment when living with a primary brain tumour.

BACKGROUND: Brain tumours are the ninth most common cancer in the UK, and account for 3% of all new cancer cases. AIM: To understand the impact of living with a primary brain tumour and identify adjustments that patients make in order to cope with their condition. This also encomapsses the impact of interventions like support groups in terms of care and therapeutic value. METHODS: After ethical approval, a qualitative approach was employed, which set out to interview 11 adult patients living with primary brain tumours. The interviews were conducted face-to-face and were semi-structured interviews. Interview data were coded and thematic analysis used. FINDINGS: Four themes were developed, namely: adjustment; loss of independence; support; and health and symptoms. CONCLUSION: Living with a brain tumour leads to an inevitable adjustment to maintain day-to-day life. The findings suggest there are a number of adjustments that patients make to maintain some independence. Many people valued the support they received from support groups, while others felt that the support they received was inadequate. The mandatory loss of a driving licence for people in the UK was the most concerning. Its removal led to a loss of confidence and made them immediately dependent on others for travel. While support was provided, there was an apparent omission in the provision of psychological support. Oncology and palliative care nurses are in key positions to explore psychological concerns and offer tailored support.

Raising awareness of acute kidney injury and improving patient care.

Nicola Geraghty, Lead Acute Kidney Injury/Renal Clinical Nurse Specialist, Calderdale and Huddersfield NHS Foundation Trust (Nicola.Geraghty@cht.nhs.uk) won the Bronze Award in the Renal Nurse of the Year category at the BJN Awards 2023.