Paper
Wednesday, July 21, 2004
This presentation is part of : Chronic Care
Carving a Role for Nurses in Chronic Heart Failure Management in Primary Care
Elizabeth J. Halcomb, RN, BN, Nursing Research Unit, School of Nursing, Family & Community Health, Nursing Research Unit, School of Nursing, Family & Community Health, University of Western Sydney, Parramatta, New South Wales, Australia
Learning Objective #1: Identify the contemporary role of the practice nurse in the implementation of evidence-based primary care for chronic heart failure
Learning Objective #2: Identify the barriers and facilitators to utilising the practice nurse as a conduit for the implementation of evidence-based practice
Background: In Australia, some 99 000 hospital admissions occurred with heart failure (HF) as a principal diagnosis or a major contributory factor during 2000(1). Health outcomes can be improved by fostering compliance and implementation of evidence-based therapies(8-10). Various acute care initiatives have provided evidence for such improvements(3, 11-14). Indeed, in New South Wales such programs have received significant government support (15). It is a logical extension of these initiatives to broaden implementation beyond acute care to general practice settings to not only achieve sustainable benefits in health outcomes but also to likely reduce disease progression.

Aim: The aim of this study was to identify the contemporary role of the practice nurse in the implementation of evidence-based primary care for chronic heart failure.

Method: To identify system and process issues creating barriers to applying evidence-based practice, three strategies were utilised. Firstly, a comprehensive literature review provided an insight into the needs of practice nurses and general practitioners, in addition to identifying perceived barriers to subsequent interventions. Secondly, a national postal survey explored the current practice nurse role, their demographics and needs. Finally, telephone interviews were utilised to further explore issues identified from the survey.

Results: In addition to the general optimism expressed by practice nurses for role expansion, several key themes emerged; current general practice services face significant barriers to the implementation of evidence-based HF practice, there is considerable variation in the practice nurse role, there are significant barriers to role expansion, multidisciplinary interventions can effectively deliver secondary prevention strategies, practice nurses can potentially facilitate multidisciplinary interventions, and practice nurses are favorably perceived by consumers although there is some confusion about the nature of their role.

Conclusion: There is significant potential to improve health outcomes in those with CHF utilizing practice nurses to deliver evidence-based primary care.

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Sigma Theta Tau International
July 21, 2004