Evaluating the clinical nurse specialist. A review

doi:10.1016/0020-7489(94)90066-3

International Journal of Nursing Studies

Volume 31, Issue 6, December 1994, Pages 561-571

https://doi.org/10.1016/0020-7489(94)90066-3 Get rights and content

Abstract

This paper reviews evaluative studies on the role of clinical nurse specialists and aims to describe and categorise research according to the methods used. By using the structure, process and outcome framework a clear pattern of research development and evidence emerges. It appears that significant benefits accrue for patients from the contribution of nurse specialists, but more experimental studies with combined methods should now be applied to this area.

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The role of the consultant radiographer - Experience of appointees
2010, Radiography
Citation Excerpt :
These comprise professional leadership and consultancy, practice and service development, and education training and development but that roles are rooted in the domain of expert clinical practice. The clinical element has been well demonstrated in nursing,5–7 and within radiography.8–10 The non-medical consultant literature included papers on transformational leadership,11 problem areas,12 and role guidance.13
To explore the experience of the first consultant practitioners appointed; including the appointment process, nature of the role, their perceptions of success and challenges.
This was a whole population study of the known consultant radiographers appointed up to March 2005. It consisted of 3 phases. The first compared appointees job descriptions with the Department of Health guidance, the second collected contextual information using a questionnaire, and the third explored postholders experiences using telephone interviews.
Ten of the possible twelve appointees participated. All posts were established according to the guidelines, with largely similar job descriptions allowing for the different clinical specialist areas. All were very positive in their perceptions of their role, and faced similar challenges. They were strongest in their expert clinical practice working but had strong training and leadership roles. The number working at strategic level was low with limited research and few published papers, although there were notable exceptions.
The first appointees demonstrated notable successes, strongest in the expert clinical practice element of roles, with evidence of team leadership, and involvement in training and education. Strategic engagement was disappointing, with little research being undertaken. Their experience was that the nature of consultancy was poorly understood by peers and medical colleagues.
Evaluation of a MS Specialist Nurse Programme
2006, International Journal of Nursing Studies
Specialist nurses are being promoted as a means of improving the health care provided to people with multiple sclerosis (MS).
To identify the impact of a programme of MS specialist nurses on MS health care provision and on the health and well-being of peoople with MS.
A quasi-experimental design comparing an intervention group in which new MS nurse posts were installed with a control group that had no MS nurse posts.
Six neurological services in four English regions.
Seven hundred and fifty-three of the 1510 people invited to participate returned completed questionnaires at baseline. Follow-up of participants was 82% with 616 patients participating in the main outcome analysis.
Data were collected prospectively before the appointment of the MS nurses and then at 12 and 24 months. Data were collected via a postal questionnaire comprising questions related to care processes (information provision and care quality) and health outcome measures, hospital admissions, MS complications, health-related quality of life (SF36) and disease impact (MS Impact Scale-29). Analysis repeated measures in CAT MOD for process variables and ANCOVA to longest follow-up for outcome measures.
Information provision was higher in the intervention group (68% (n=153) compared to 53% (n=98) at 24 months) but no significant improvement was observed in information provision through time compared to the control group. There was an increase in the availability of a contact person in the intervention group, at 24 months 83% (n=42) had a contact person compared to 44% in the control (p=0.01). The only significant finding in relation to MS complications was a reduction of 17% in the incidence of pressure ulcers in the intervention sites compared to a 3% reduction in the control (p<0.001). In relation to the disease and health-related quality of life measures, the intervention group showed a small but significant (p<0.05) worsening in the physical and symptom scales of the SF36 compared to the control (mean differences: physical function −2.81, CI −5.45 to −0.1; bodily pain −4.09, CI −7.2 to −0.9; general health −5.35, CI −8.1 to −2.5; and energy and vitality −2.82, CI −5.5 to −0.1). No differences were observed in relation to disease impact or psychosocial well-being, although a relative benefit in mental health (with a 7.8 point advantage on the SF36 mental health scale, p=0.04) was observed in some of the intervention sites for people with relapsing/remitting MS.
The specialist nurse programme was found to impact positively on the provision of MS-related health care. However, there was very limited evidence that the programme led to any improvements in disease-related problems, impact or health-related quality of life, These findings were in part explained by the inherent difficulties of measuring effects in evaluations of complex phenomena such as a nursing role. The deterioration observed in the intervention group on the physical outcome measures was explained by a selection bias in which people with worsening health were more likely to seek contact with a specialist nurse. It is contended that future research in this area may be better directed toward identifying specific interventions that nurses and other health professionals might employ in addressing the many problems confronting people with MS.
Women's experiences of information, psychological distress and worry after treatment for gynaecological cancer
2005, Patient Education and Counseling
Sensitive, appropriate patient information is considered to be an important element in the psychological support of patients. Specialist nurses are seen to have a key responsibility for this work. With regard to gynaecological cancer, evidence suggests that women do not get optimum psychological care. This study set out to explore women’s experiences of information, psychological distress and worry after treatment for gynaecological cancer. The study was a survey (not an RCT) and 70 patients from two specialist gynaecological oncology centres were interviewed at the time of diagnosis/initial treatment and again at 6 months. The semi-structured schedule included recognised instruments to assess; sources of information, concerns, and psychological distress. Both initially and at 6 months there was evidence of a considerable burden of worry; over half the women had four or more significant concerns related to their illness experience. However, women who had initial support from a clinical nurse specialist at the time of diagnosis experienced a clinically significant reduction in their level of psychological distress 6 months from diagnosis. Hospital linked professional sources of information were well used at the time of diagnosis, but by 6 months many patients were using non-professional sources such as television, magazines and newspapers. This study suggests that support from a clinical nurse specialist may be able to assist psychological recovery. However, to be effective in this area nurses should be skilled and willing to assess the individual’s need for help with information, and managing their worry.
A study of continuing nurse education in Malta: The importance of national context
2005, Nurse Education Today
The literature recommends that in the light of the constant changes in the contexts in which nurses perform [Buerhaus, P., 1997. The future of the nurse labour market. Image 29(4), 313–318], nurse education systems should incorporate specialised and continuing education [Lenera, V., 1987. The Nurse and the Future: Role and Function. In: Health Care and Nurse Education in the 21st Century. Commission of the European Communities, Brussels; Castledine, G., McGee, P., 1998. Advanced and Specialist Nursing Practice, Blackwell Science Ltd., Oxford; Chiarella, M., 1998. Developing the credibility of continuing education. Nurse Education Today 10, 70–73 ]. Using a qualitative approach, the research study reported in this article explored views of student and qualified nurses in Malta about such educational opportunities. Data were collected using questionnaires administered by post to student and qualified nurses in Malta (n = 172) [Fenech Adami, M., 2002. An exploratory study of the adequacy of the nurse education system in Malta. PhD Thesis. University of Aberdeen.]. In congruence with the literature, the findings revealed widespread support for and interest in specialised and continuing education in general [Nolan, M., 1994. Continuing professional education: identifying the characteristics an effective system. Journal of Advanced Nursing 22, 551–560; Wilson-Barnett, J., 1994. Evaluating the clinical nurse specialist – a review. International Journal of Nursing Studies 31(6), 561–571]. However, some of the findings challenge that which is recommended in the literature. The findings should contribute to the effective development of specialised and continuing education opportunities in Malta. Moreover, by their divergence from the literature, these findings illustrate that nurse education should always be planned against a backdrop of the context in which it is to be delivered. In turn, the findings point out the importance of researching education within specific contexts rather than simply extrapolating research evidence and subsequent recommendations on nurse education from one national context to another.
Third year student nurses perceptions of the role and impact of Clinical Nurse Specialists: A multi-centred descriptive study
2004, Clinical Effectiveness in Nursing
The United Kingdom (UK) National Health Service (NHS) has experienced a rapid expansion in the number of clinical nurse specialist (CNS) posts in the last two decades. Despite this, there is limited robust evidence that evaluates the role and impact that the CNS makes. Furthermore there is reportedly considerable confusion and inconsistency surrounding the titles, descriptions, qualifications and grading of CNS posts. It is against this background the findings from this multi-centre descriptive survey are presented which explored final year `soon to be qualified' student nurses' perceptions of the CNS role and the impact they had on care delivery and other members of the nursing team.
A specially designed self report instrument was distributed to 269 student nurses undertaking pre-registration adult branch nurse education at three higher education institutions in England and Scotland. A response rate of 82% (n=220) was obtained. The instrument contained a combination of open and closed questions. Quantitative data were analysed using SPSS (v 11.0) and a thematic approach as described by Miles and Huberman (1994) was used to categorise responses to the open ended items.
The results indicate that the students had encountered clinical nurse specialists during their education. The students ranked CNS' in the fields of diabetes, palliative care and acute pain as the most frequent recipient of patient referrals. The students recognised the added value brought to patient care by involvement of a CNS in care delivery and valued the CNS as a source of knowledge and support to both themselves and other staff. Students also identified a number of disadvantages associated with the CNS role. These included role conflict and potential for deskilling nurses fulfilling a generalist role. This paper will discuss the findings and offer possible explanations for the results.
Impact of the palliative care clinical nurse specialist on patients and relatives: A stakeholder evaluation
2002, European Journal of Oncology Nursing
Within the last decade, there has been a rapid expansion in the United Kingdom of clinical nurse specialists (CNSs), yet there has been limited evidence of their effectiveness. The clinical area of palliative care has one of the largest numbers of CNSs which has particularly started to escalate in the acute hospital setting. Following the Calman-Hine Report and the more recent NHS Cancer Plan, it is anticipated that the number of CNSs in palliative and cancer care is likely to grow. In light of the current policy emphasis of Clinical Governance and Clinical Effectiveness, there is an urgent need to demonstrate the contribution that CNSs make.
This paper presents the qualitative findings of an evaluation study on the impact of the CNS within a palliative care team in a large acute hospital in the North-West of England. A stakeholder evaluation that encompassed tape-recorded semi-structured interviews to explore how the stakeholders saw the impact of the CNS within palliative care was performed. Twenty-seven interviews were conducted with stakeholders across the hospital setting including senior nurses, consultants, junior doctors and nurses representing the different grades. Data were analysed for emerging themes utilizing a case and cross-case analysis.
The results indicated that the CNSs within palliative care in an acute hospital are seen to be potentially beneficial for both patients and relatives. This paper will focus on exploring these perceived benefits, which included symptom control, psychological care and being an advocate for patients and relatives.

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View full text

Evaluating the clinical nurse specialist. A review

Abstract

Evaluation and time documentation for the clinical nurse specialist

Clin. Nurse Spec.

A comparative study of outpatient care as perceived by renal transplant recipients

ANNA J.

A rehabilitation clinical nurse specialist: evaluation of the role in a home health care setting

Hol. Nurs. Prac.

The role and function of clinical nurse specialists in England and Wales

The advanced nurse practitioner: part 1

Nursing Standard

Good communication heralds successful integration: evaluating the roles of community specialists and general nurses

Prof. Nurse

A model for developing evaluation strategies

Costs and benefits of clinical nurse specialists

Clin. Nurse Spec.

Role development and functions

Clinical nurse specialist role evaluation

Oncol. Nursing Forum

Clinical nurse specialist subroles: foundations for entrepreneurship

Clin. Nurse Spec.

A study to evaluate the intervention of a nurse visiting patients with disabling chest disease in the community

J. Adv. Nursing

Evaluating the impact of a clinical nurse specialist

Clin. Nurse Spec.

Cost analysis and the clinical nurse specialist

Nurs. Manag.