Practice nurse involvement in the management of adults with type 2 diabetes mellitus attending a general practice: results from a systematic review.

AIM: Using the methodology of the Joanna Briggs Institute, a systematic review of current research was performed to determine if the addition of management by nurses had been more effective in improving clinical outcomes of patients with type 2 diabetes attending a general practice compared with standard care. METHODS: A three-step literature search was conducted for suitable English studies with quantitative clinical outcomes that had been published from January 1990 to May 2014. Randomised controlled trials (RCTs) were particularly sought after; however, other research designs were considered. Articles were assessed by two independent reviewers for methodological validity, prior to inclusion in the review, using standardised critical appraisal instruments from the Joanna Briggs Institute. When possible, quantitative data were pooled in statistical meta-analysis. RESULTS: Seven studies were of suitable quality and relevance for the review: these included three randomised control trials; two cluster- RCTs; a cluster, nonrandomised, controlled before-after study; and a cluster observational cohort study. These studies yield evidence that nurse management in addition to standard general practitioner care leads to modest improvements in blood pressure and total cholesterol levels in adults with type 2 diabetes attending a general practice. CONCLUSION: Meta-analysis identified modest, significant improvements amongst participants in nurse management interventions (NMIs) in the following clinical outcomes: mean SBP, mean DBP and mean total cholesterol. The majority of outcomes studied did not show any advantage to adding NMIs to general practitioner care. Two studies reported significant improvements of participants with poor control in mean haemoglobin A1c. An RCT that investigates the effect of NMIs on patients, with poor control in regard to clinical outcomes and cost effectiveness, is recommended.

Palliative care case conferences in long-term care: views of family members.

AIMS AND OBJECTIVES: This paper examines the use of structured Palliative Care Case Conferences in long-term care. The issues families bring to the Palliative Care Case Conference, their level of distress prior to the conference, the extent to which these issues are addressed by staff and family satisfaction with this process are described. BACKGROUND: In most developed countries, up to 30% of older people die in long-term care. A palliative approach generally refers to the resident and family as the 'unit of care'. Interventions, which include family in palliative care, are required in this setting. DESIGN: Descriptive and thematic results from the intervention arm of a pre-post, sequential mixed method study. METHODS: Examination of documents of 32 resident/family dyads participating in a Palliative Care Case Conference, and interviews with the residents' family postintervention. RESULTS: Main concerns raised by family members prior to a Palliative Care Case Conference were physical and medical needs, pain, end-of-life care planning and nutrition and hydration. Families rated a high level of concern, 7.5 on a 10-point rating scale, prior to the Palliative Care Case Conference. A formalised Palliative Care Case Conference process ensured issues relating to end-of-life care planning, pastoral care, pain and comfort and physical and medical needs were well documented by staff. Issues relating to care processes and the family role in care were less well documented. All families, interviewed postintervention, recommended Palliative Care Case Conferences; and over 90% of families felt their issues were addressed to their satisfaction. Families also reported an increased understanding of the resident's current and future care. CONCLUSIONS: The Palliative Care Case Conference in long-term care provides an important platform for family to voice concerns. Palliative Care Case Conference documentation indicates that staff are attending to these issues, although more reference to concerns relating to care processes and the family role could be made. IMPLICATIONS FOR PRACTICE: Increased communication between staff and family, in the form of a Palliative Care Case Conference, may reduce stress, anxiety and unwanted hospitalisations during the palliative phase.

Physical and functional implications of aquatic exercise for nursing home residents with dementia.

Exercise has reported benefits for those with dementia. In the current study we investigated the feasibility of delivery and the physical and functional benefits of an innovative aquatic exercise program for adults with moderate to severe dementia living in a nursing home aged care facility. Ten adults (88.4 years, inter quartile range 12.3) participated twice weekly for 12 weeks. Anthropometric and grip strength data, and measures of physical function and balance were collected at baseline and post-intervention. Feasibility was assessed by attendance, participation, enjoyment and recruitment. Following exercise, participant's left hand grip strength had improved significantly (p = .017). Small to moderate effect sizes were observed for other measures. A number of delivery challenges emerged, but participant enjoyment, benefits and attendance suggest feasibility. Aquatic exercise shows promise as an intervention among those with dementia who live in a nursing home aged care facility. Greater program investigation is warranted.

Watermemories: a swimming club for adults with dementia.

The purpose of this article is to describe the conceptual model and implementation strategies of an evidence-based, aquatic exercise program specifically targeting individuals with dementia-The Watermemories Swimming Club (WSC). Physical exercise not only improves the functional capacity of people with dementia but also has significant effects on other aspects of quality of life such as sleep, appetite, behavioral and psychological symptoms, depression, and falls. Additionally, exercise can improve a person's overall sense of well-being and positively enhance their sociability. The WSC was designed to increase physical exercise while being easy to implement, safe, and pleasurable. Many challenges were faced along the way, and we discuss how these were overcome. Implications for nurses are also provided.

The effectiveness of nurse-led care in general practice on clinical outcomes in adults with type 2 diabetes.

BACKGROUND: In Australia, diabetes was identified as a national health priority area in 1996; nevertheless the prevalence of type 2 diabetes has increased dramatically since then. Nurses have been working within Australian general practices for several decades but only in recent years has the role of the practice nurse in primary health care increased. OBJECTIVES: This review aims to identify the effectiveness of nurse-led care in general practice as compared to general practitioner care on clinical outcomes in adults with type 2 diabetes. INCLUSION CRITERIA: Participants were adults (aged >18 years), with diabetes type 2 attending a general/family practice.Interventions of interest include nurse-led care in general practice in which the nurse is identified as taking a lead role in the care of patients with type 2 diabetes compared to general practitioner-led care.To evaluate the effectiveness of nurse-led diabetes care in general practice, this review sought randomised controlled trials as the study design of choice. Other research designs such as controlled clinical trials, interrupted time series and controlled before and after designs were also considered.The outcomes of interest were clinical outcomes including changes in systolic and diastolic blood pressure, body mass index, cholesterol levels, HbA1c (glycated haemoglobin) and fasting blood glucose. SEARCH STRATEGY: A three step literature search was conducted for English language articles from January 1990 to December 2011. METHODOLOGICAL QUALITY: Quantitative papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardised critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument. DATA COLLECTION: Quantitative data was extracted from papers included in the review using the standardised data extraction tool from the Joanna Briggs Institute. The data extracted included specific details about the interventions, populations, study methods and outcomes of significance to the review question and specific objectives. DATA SYNTHESIS: Data from quantitative papers, where possible, were pooled in statistical meta-analysis using the Meta-Analysis of Statistics Assessment and Review Instrument. Additionally, RevMan 5 was used for presenting forest plots of the meta-analysis. RESULTS: The electronic search yielded 804 potentially relevant papers of which 49 papers appeared to satisfy the criteria for inclusion and full texts of these papers were assessed against the inclusion criteria by two independent reviewers. From these papers, five were included in the review, four randomised control trials and one quasi-experimental study. These articles provided evidence that nurse-led care improves blood pressure and cholesterol levels for patients with type 2 diabetes attending a general practice. CONCLUSIONS: There is some evidence to support the use of nurse-led care in general practice for patients with type 2 diabetes. IMPLICATIONS FOR PRACTICE: If nurse-led care is implemented in the care of people with type 2 diabetes consideration needs to be given to the use of clinical algorithms, goal setting, individualised care plans, self management and follow up of lifestyle risk factors. IMPLICATION FOR RESEARCH: More randomised controlled trials are required to assess the efficacy of nurse-led care including cost effectiveness.