The purpose of this assignment is to compare and contrast the current literature related to advanced nursing practice. And to relate this literature to my practice and the role of the palliative care nurse across clinical settings.
In my current role as a pain nurse specialist, I am involved in the care and management of patients with intrathecal (IT) catheters mainly for patients with intractable cancer pain. Patients who have been tried and failed on escalating doses of various opiates, and continue to have unsatisfactory pain management with intolerable side effects are often referred to our service for consideration for an intrathecal catheter. Intrathecal catheters have been used for many years now in effort to target the specific pain pathways within the spinal cord, as the medication is delivered directly into the Central nervous system, only small doses are required, and therefore patients experience less side effects, with improved pain control (Myers, J. Chan, V., Jarvis, V., Walker-Dilks, C., 2010). The majority of these patients are approaching the end stages of their disease process, therefore we work quite closely with the hospital Palliative care service when the patient in an inpatient. However post discharge we visit the patients weekly in their own homes, this often involves working at an advanced nursing level, working autonomously, assessing the patient and titrating medication via their IT pump, with some direction from the doctor at Auckland hospital. However this role also involves providing the patient and their family with an element of palliative care also, they often require additional emotional support at this stage.
In 2002 the World health organization (WHO) defined palliative care as
" An approach that improves the quality of life of patients and their families facing he problems associated with life threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual."
Advanced nursing practice refers to nurses working at an expanded level of practice within a specialized area. Advanced practice is generally defined as the integration of practical knowledge, clinical experience, theoretical knowledge and research base, education, and may involve organization leadership (ANA, 1995). The term advanced practice has been given to various roles within nursing, such as Clinical nurse specialists (CNS), nurse practitioners (NP's) and other specialized roles within nursing, such as the anaesthetic nurse (Davies, Hughes, 1995).
The literature related to advanced nursing practice and palliative care was reviewed using online databases, such as Medline, Ovid, Pubmed and the Cumulative index for nursing and allied health literature (CINAHL). Key words used in the search, were 'advanced practice nursing', 'Clinical nurse specialist', 'nurse practitioner', 'palliative care' and 'nurse prescribing".
After reviewing the literature, three articles were selected, and will be summarized below.
In 2004 Aigner et al did a comparative study of nursing resident outcomes between care provided by NP/Physicians, compared to Physicians only. The study was based in Texas, USA. The main objective of the study was to determine how the standard of care for nursing homes residents compares when provided by either NP/Physician, or physician only.
Eight nursing homes were evaluated, and two hundred and three residents were randomly blinded. Chi-squared tests were used for comparison for the data analysis.
Four outcomes were selected to assess the quality of the care provided by the two groups, they were, patients charts were retrospectively reviewed and the following outcome assessed-
Number of presentations to the emergency department (ED), the cost of the visit, and the diagnosis.
Number of hospital admissions in general, and...
References: Aigner, M., Drew, S., Phipps, J.,. (2004). A comparative study of nursing home resident outcomes between care provided by nurse practitioners/physicians versus physicians only. _JAMDA_, 16-23.
ANA. (1995 ). _Advanced nursing practice_.
Davies, B. H., A.,. (1995). Clarification of advanced nursing practice:characteristics and competence. _Clinical nurse specialist, 9_(3), 156-160.
Joshi, M., Chambers, W., (2010) Pain relief in palliative care:a focus on interventional pain management, _Expert review of neurotherapeutics, 10,5,_ 747.
Meier, D., Beresford, L., (2006) Advanced practice roles in Palliative care:a Pivotal role and perspective, _Journal of palliative care medicine, 9 (3),_ 624-627
Ministry of Health
Myers, J., Chan, V., Jarvis, V., Walker-Dilks, C.,. (2010). Intraspinal techniques for pain management in cancer patients:a systematic review. _Support cancer care, 18_, 137-149.
Nursing council of New Zealand. (2013). Nurse prescribing consultation document.
O 'Connor, M., Lee, S., Aranda, S. (2012) _Palliative care nursing-A guide to practice.,_ Ausmed publications, North Melbourne , Austrailia.
World health organisation. (2002). _Palliative care plan_.
Ryan-Wooley, M., G., Lucker, K. (2007). Prescribing by specialist nurses in cancer and palliative care:results of a national survey. _Palliative medicine, 21_, 273-277.
Stenner, K., . Carey, N., Courternay, M.,. (2012b). Prescribing for pain-how do nurses contribute? A national questionnaire survey. _Journal of clinical nursing, 21_, 3334-3345.
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