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Hospital in the Home (HITH) model of care was developed to support the COVID-19 response and the need to deliver care in new ways to ensure secondary care services were free to deliver care to the sickest patients and not be overwhelmed by the COVID-19 patients needing hospital-level care. Intermediate Care Services, led by nursing and allied health stepped up to the challenge and collaborated on the development of the HITH model of care with defined pathways. This provided hospital-level acute health services in the home that was a clinically safe alternative option to inpatient care. The establishment of HITH released bed capacity and resources and therefore prevented the need for expanding hospital inpatient capacity at a time where resources and staff were constrained. Care delivery was achieved by utilising both in-person visits and telehealth. Technology supported the care delivery which allowed patients, whanau (family) and clinicians to be connected.

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AIM: To explore what is known about nurses' experiences and perceptions of running nurse-led clinics. BACKGROUND: Nurse-led clinics were established to address health care needs. In collaboration with medical practitioners, advanced practice nurses may take a selected group of patients and manage their ongoing healthcare independently. Their experiences in running nurse-led clinics directly impact patient satisfaction and clinical outcomes. DESIGN: Scoping review of the peer-reviewed literature. DATA SOURCE: Systematic search through CINAHL, Medline, PsycINFO and Web of Science databases from January 2010 to September 2023. REVIEW METHODS: This scoping review is guided by the updated methodological guidance for the conduct of scoping review from Joanna Briggs Institute. RESULTS: Of 2747 retrieved articles, 15 were included in this review. Synthesis of the findings revealed that nurses believed implementing nurse-led clinics was beneficial to themselves, patients, and healthcare systems. However, they faced challenges in running nurse-led clinics, including insufficient support, teamwork obstacles and lack of role recognition. CONCLUSION: Nurses need to be proactive in promoting their clinics and overcoming challenges. Healthcare organizations are responsible for creating a positive culture to support nurse-led services. Future research should focus on ways to increase global awareness of nurse-led clinics.

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This article presents the findings of a service evaluation of a specialist urogynaecology service and highlights the implications for nursing practice. AIMS: To evaluate the overall patient experience and the degree to which individual needs were being met, and make improvements to service delivery. METHOD: A cross-sectional survey questionnaire was sent to a random sample of women (n=350) who were registered on the electronic patient record system from January to June 2020. Two items on the questionnaire related specifically to communication with patients during the first COVID-19 lockdown in March 2020. Routine service data were collected and included in descriptive statistical analysis. Qualitative themes were thematically analysed. RESULTS: The response rate was 39% (n=137). More than 90% of respondents felt listened to during consultations with nursing and medical personnel, and had trust and confidence in their clinical expertise, felt involved with decisions about care and felt comfortable with intimate examinations. Negative responses related to poor communication with administration and rescheduling appointments. CONCLUSION: Findings resulted in a departmental review of admin processes, which resulted in improvements to administrative systems, staff training, communication and information giving, and directly benefited patients.

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While the transport and retrieval of critically ill children has been extensively researched and audited, nurse-led repatriation and retrieval of non-critical children and neonates has only recently become a full-time nursing position in Northern Ireland. In January 2020, the Northern Ireland Specialist Transport and Retrieval (NISTAR) service developed a nurse-led transport team for this patient population and created a new role - the non-critical paediatric transport nurse - which incorporates the skills of a children's nurse. The aim of the service is to transport children and neonates safely between the regional paediatric unit and local district general hospital paediatric wards in Northern Ireland. The nurse-led service also transfers children with non-critical complex cardiac conditions between paediatric wards in Northern Ireland and the national centre for paediatric cardiology and cardiothoracic surgery in Dublin, Ireland. This article describes the role of the nurse-led transport team and discusses clinical governance, training requirements and the safe transfer of children with complex cardiac conditions. The NISTAR team won the child health category at the 2021 RCN Nursing Awards.

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Healthcare transition involves the purposeful and planned process of preparing, empowering and supporting young people with long-term conditions and their families when they are moving from child to adult services. Transition is a series of events that provides the young person with the knowledge and skills they require to be able to function in adult services. Until recently little has been done to address the perceived barriers and challenges involved in transition. In this article, the authors discuss the challenges associated with effective transition and describe their experience of implementing a healthcare transition pathway using a quality improvement model.

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INTRODUCTION: Psychiatric hospitalization is an opportunity to provide evidence-based tobacco treatment to optimize cessation efforts among people living with mental illnesses (MI). The purpose of this study was to examine the effectiveness of nurse-driven initiatives to enhance tobacco treatment within an inpatient psychiatric setting. AIMS: We assessed the 4-year impact of implementing a nurse-led tobacco treatment service offered to 11,314 inpatients at admissions in a tobacco-free psychiatric facility in Kentucky. METHOD: Through a time-series design, we compared the differences in rates of screening for tobacco use and providing treatment from September to December 2015 (prior to implementing the nurse-led tobacco treatment services) to each subsequent year in a 4-year period (2016-2019). RESULTS: Approximately 60.0% of inpatients were persons using tobacco during the assessment period. Although there were no changes in tobacco use prevalence over the 4-year evaluation duration, there were significant increases in the provision of practical counseling and Food and Drug Administration-approved nicotine replacement therapies for persons using tobacco. CONCLUSIONS: Our findings support the effectiveness of implementing tobacco treatment programs at the organizational level. Psychiatric hospitalizations provide an opportunity to optimize nurse-driven efforts to deliver tobacco treatment to people with MI. Similar models of nurse-led tobacco treatment services can be adopted within inpatient and other mental and behavioral health settings.

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BACKGROUND: Nurse navigators are an emerging workforce providing care to people with multiple chronic conditions. The role of the navigators is to identify patients requiring support in negotiating their health care. PURPOSE: A critical discourse analysis was used to examine qualitative data collected from nurse navigators and consenting navigated patients to identify key indicators of how nurse navigators do their work and where the success of their work is most evident. DISCUSSION: Nurse navigators help patients who have lost trust in the health system to re-engage with their interdisciplinary health care team. This re-engagement is the final step in a journey of addressing unmet needs, essential to hospital avoidance. CONCLUSION: Nurse navigators provide a continuum of authentic and holistic care. To acknowledge the true value of nurse navigators, their performance indicators need to embrace the value-added care they provide.

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The role of nurse consultant was introduced in the late 1990s to strengthen leadership in nursing, improve patient outcomes and enhance the quality of healthcare services. Nurse consultants have a wide-ranging remit that includes expert practice, professional leadership and consultancy, education, and service development. In this article, the author reflects on her experience of being one of the first nurse consultants, which included setting up nurse-led clinics, maintaining professional relationships with medical colleagues and assuming increasing responsibility for services. The article also examines the changes that the nurse consultant role has undergone since its inception in the 1990s.

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Atrial fibrillation is a common cardiac arrhythmia and is the most frequent arrhythmia experienced by older people. It is caused by chaotic electrical activity in the atria, leading to an irregular and often rapid heart rate. Atrial fibrillation is associated with an increased risk of ischaemic stroke, resulting from the turbulent blood flow in the atria. This article details the presentation of, and risk factors associated with, developing atrial fibrillation, the importance of reducing the risk of adverse events such as stroke, and the treatment options available. It also outlines the nursing role in the care of patients with the condition, as part of a multidisciplinary team approach.

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BACKGROUND: With the increasing burden of chronic and age-related diseases, and the rapidly increasing number of patients receiving ambulatory or outpatient-based care, nurse-led services have been suggested as one solution to manage increasing demand on the health system as they aim to reduce waiting times, resources, and costs while maintaining patient safety and enhancing satisfaction. OBJECTIVES: The aims of this review were to assess the clinical effectiveness, economic outcomes and key implementation characteristics of nurse-led services in the ambulatory care setting. DESIGN: A systematic review was conducted using the standard Cochrane Collaboration methodology and was prepared in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. DATA SOURCES: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library, MEDLINE EBSCO, CINAHL EBSCO, and PsycINFO Ovid (from inception to April 2016). REVIEW METHODS: Data were extracted and appraisal undertaken. We included randomised controlled trials; quasi-randomised controlled trials; controlled and non-controlled before-and-after studies that compared the effects of nurse-led services in the ambulatory or community care setting with an alternative model of care or standard care. RESULTS: Twenty-five studies of 180,308 participants were included in this review. Of the 16 studies that measured and reported on health-related quality of life outcomes, the majority of studies (n = 13) reported equivocal outcomes; with three studies demonstrating superior outcomes and one demonstrating inferior outcomes in comparison with physician-led and standard care. Nurse-led care demonstrated either equivalent or better outcomes for a number of outcomes including symptom burden, self-management and behavioural outcomes, disease-specific indicators, satisfaction and perception of quality of life, and health service use. Benefits of nurse-led services remain inconclusive in terms of economic outcomes. CONCLUSIONS: Nurse-led care is a safe and feasible model of care for consideration across a number of ambulatory care settings. With appropriate training and support provided, nurse-led care is able to produce at least equivocal outcomes or at times better outcomes in terms of health-related quality of life compared to physician-led care or standard care for managing chronic conditions. There is a lack of high quality economic evaluations for nurse-led services, which is essential for guiding the decision making of health policy makers. Key factors such as education and qualification of the nurse; self-management support; resources available for the nurse; prescribing capabilities; and evaluation using appropriate outcome should be carefully considered for future planning of nurse-led services.

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Aims To implement and evaluate a nurse-led, multi-agency drop-in clinic for young people with attention deficit hyperactivity disorder (ADHD). Method A repeated measures observational study over 12 months exploring clinic attendance and user satisfaction, crisis management and did not attend (DNA) rates, consultant time spent with patients, benefits to quality of care, and service flexibility. Results A total of 62 service users participated. A significant improvement in service user experience was observed (P=0.001). Crisis management attendances significantly increased (P=0.005). DNA rates did not reduce significantly (P=0.057). Service users attended for their medication review before or on their due date (P=0.011). Those who needed to were able to spend more time with the staff (P=0.001). Conclusion The clinic improved service accessibility and flexibility. It allowed adherence to clinical guidance, including uptake of psychosocial interventions. There was an overwhelmingly positive improvement in service user experience. Importantly, as contact with the ADHD nurse specialists increased, this significantly reduced the amount of time consultant community paediatricians spent with service users. Further research should examine the cost-effectiveness and longitudinal effect of the drop-in model.

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Patients receiving intravenous therapy require reliable venous access. Typically patients with poor peripheral access or requiring long-term treatment from an outpatient antibiotic therapy (OPAT) service need to receive secondary care input for safe central line placement, and radiological confirmation of the correct line tip placement where necessary, if treatment is to proceed as planned. Technological developments that enable accurate ultrasound-guided vein selection and electrocardiograph (ECG)-guided central line tip placement have eliminated the need for radiological or fluoroscopic confirmation of correct tip placement for peripherally placed central catheters (PICCs). This article outlines the development of an out-of-hospital nurse-led PICC insertion service using the Sherlock 3CG® Tip Confirmation System (C.R Bard) to meet the needs of patients requiring long-term intravenous treatment from an OPAT service, and its impact on reducing treatment delays and the need for secondary care intervention.

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Peripherally inserted central catheters (PICCs) play a fundamental role in patient care in a variety of clinical and healthcare settings. Tip location is important for both safety and efficacy. New technologies may offer the possibility of safer, more efficient and more effective insertion. A prospective evaluation was carried out of a system providing real-time information on the tip's location, direction, and depth during insertion in a total of 488 patients at a single centre (65 patients in the initial study, plus follow-on case series reports in 423 patients). No tip malpositions were reported and, as a result, the institution has been able to waive the requirement for confirmatory chest X-ray after PICC insertion, thus minimising the delay before the PICC can be used and increasing staff and patient confidence in the procedure.

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This was a cross-sectional study using an online survey to evaluate the provision of nurse-led and delivered services within genitourinary medicine in the UK. Results showed that such services are being widely utilised and are generally well supported by medical staff. The delivery of nurse-led and delivered services appears to be quite variable. Clinical guidelines and standards may help to ensure a more uniform approach to these services and help to maintain high standards of care.

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AIM: To develop and implement a respiratory clinical-nurse-specialist-led chronic obstructive pulmonary disease (COPD) 'in-reach service' for an emergency admission unit within a large acute county hospital. METHOD: Data collected during the service development were compared with existing data when no COPD in-reach service was available. Data were compared on average length of stay, readmission rates, 'early assisted discharge' and patient experience. FINDINGS: The COPD in-reach service reduced average length of stay for COPD patients by 2.53 days and readmission rates were reduced by an average of 4.5 per month; 17% of patients were discharged on an early assisted discharge scheme, and overall patients felt more prepared and ready for discharge. CONCLUSION: The COPD in-reach service has been proven to be of great benefit both financially and in terms of patient experience.

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The purpose of this study was to evaluate grown-up congenital heart (GUCH) patients' experiences and satisfaction with the delivery of a nurse specialist service, including perceived priorities and recommendations for future service delivery. A service evaluation utilizing descriptive, cross-sectional survey principles was conducted over a 2 year period. Postal questionnaires were sent to three patient cohorts (general adult n = 747; pregnancy n = 202; learning disability n = 72). Quantitative data were analysed using descriptive statistics. The majority of respondents were satisfied with the nursing care provided, including information provision, time made available to discuss needs, emotional support, well-being, self-management and symptom distress. Priority areas included timely information and advice; specialist knowledge and expertise; effective care coordination, monitoring and support. Accessibility, contact and responsiveness were dominant. A majority of patients agreed that their first, second and third-rated priorities had been met. Findings identified strong commitment, support and satisfaction with the GUCH nurse specialist service.

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PURPOSE: There are two million people in the UK living with cancer and this figure is rising each year. The consequences of cancer and its treatment are devastating and many patients suffer long-term effects for years after completion of treatment. National UK policy recognises that current follow-up fails to meet patients' survivorship needs and new methods of service-delivery are required. An analysis of local service provision in a London teaching hospital demonstrated that the needs of patients with lymphoma were not being met. The aim of this project was to develop a nurse-led service that would provide comprehensive survivorship care for patients with lymphoma. METHOD: A nurse-led survivorship service was implemented using a comprehensive service development framework and was evaluated through a variety of methods such as a patient satisfaction questionnaire, note audit, waiting time audit and an analysis of patients comment and suggestions. RESULTS: The project was successfully implemented with risk management and advanced practice requirements addressed. It was demonstrated that patients were satisfied with the new service, the quality of documentation had improved and waiting times were reduced. CONCLUSION: This work adds to the current survivorship knowledge-base and provides evidence that nurses can provide safe and effective survivorship care for patients with lymphoma.

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