Nurse Care Coordination of Amyotrophic Lateral Sclerosis: A Critical Appraisal of the Process of Care

Saturday, 7 November 2015

Tricia L. Strombom, MSN, RN
Puget Sound VA Healthcare System, US Department of Veterans Affairs, Seattle, WA, USA

Purpose and Background/Significance:

The objective of the project is to determine the effect, of nurse care coordination (NCC) provided to the Amyotrophic Lateral Sclerosis (ALS) patient population, on patient activation in established evidence-based practice parameters (AHRQ, 2013). NCC provides direct patient engagement to manage the overall care process, including the development and communication of the treatment plan to all relevant stakeholders; and ensures that all treatment and care is delivered to meet the unique needs of the Veteran and their significant others (Gardner et al., 2007; CNSA, 2008).

Theoretical/ conceptual framework:

Rosswurm and Larrabee’s Model (1999), is the conceptual framework chosen for this project due to an emphasis on the process of determining the initial need for change through the comparison of internal quality indicators with data/EBP from outside the organization. This approach links the issues faced in the ALS Veteran population to standard intervention of the evidence and outcomes. 


A retrospective review of medical records will be used to examine the process of care for the ALS Veteran patient. The data focuses on current care practices identified as evidence-based practice parameters, which have been linked to improved outcomes (AHRQ, 2013; ANA, 2012).  Utilizing a convenience sample the criteria includes veterans greater than 25 years of age, with a confirmed diagnosis of ALS. The study excludes those who were less than 25 years of age, and had a diagnosis of primary lateral sclerosis, or are non-service connected.


Data will be analyzed using the descriptive techniques. All data will be  assessed throughout the process, to examine the correlations between the variable of nurse coordination (yes/no) and the selected AAN practice parameters, a Spearman’s Rho correlation will be calculated.


            Research has shown that ALS patients receiving active and aggressive Nurse Care Coordination in collaboration with an interdisciplinary care team, enhances survival, improves quality of life and provides for longer life expectancy (Traynor, Alexander, Corr, Frost, & Hardiman, 2003). This study will provide nursing science the data for further development of the Advanced Practice Nurse serving in an aggregate role of NCC.


Agency for Healthcare Research and Quality (AHRQ). (2013, June 11). Practice parameter update: the care of the patient with amyotrophic lateral sclerosis: multidisciplinary care, symptom management, and cognitive/behavioral impairment (an evidence based review). Rockville, MD, USA. Retrieved from

American Nurses Association. (2012). The Value of Nursing Care Coordination: A White Paper of the American Nurses Association. Washington, DC: ANA.

Rosswurm, M., & Larrabee, J. (1999). A model for change to evidence-based practice. Journal of Nursing Scholarship, 31(4), 317-22.

Traynor, B., Alexander, M., Corr, B., Frost, E., & Hardiman, O. (2003). Effect of a multidisciplinary amyotrophic lateral sclerosis (ALS) clinic on ALS survival: a population based study, 1996-2000. Journal of Neurology Neurosurgery Psychiatry, 75, 1258-61. doi:10.1136/jnnp.74.9.1258