Spheres of clinical nurse specialist practice influence evidence-based care for patients with atrial fibrillation
ABSTRACT The purpose of this article is to review atrial fibrillation (AF) and its consequences, to present sources of published evidence-based guidelines for management of AF, and to highlight multifaceted clinical nurse specialist (CNS) interventions that promote positive outcomes for patients with AF.
The number of people with AF is expected to increase from 2.3 million to more than 5 million in the next 50 years. AF is associated with increased mortality, morbidity, healthcare expenditures, and decreased quality of life. Recognition of the growing number of AF cases and adverse consequences of AF led to development of evidence-based guidelines for AF management. Although nurses in diverse settings are accountable for providing evidence-based care for patients with AF, the guidelines have not been widely disseminated to nurses.
This discussion includes a review of the adverse consequences of AF and a summary of management of recently detected AF with a focus on recommendations for nursing activities/interventions that are supported by evidence-based guidelines. Multifaceted strategies directed toward nurses and nursing practice, patients/clients, and organizations/systems that are linked to published CNS competencies and outcomes are highlighted.
CNS influence in all 3 spheres of CNS practice promotes positive outcomes that include improved patient/client functioning and self-management, reduced complications of treatment, decreased fragmentation of care, advancement of professional nursing practice, adherence to regulatory standards, and development of patient care processes that are supported by published guidelines.
With the use of the strategies discussed, clinical nurse specialists, whose spheres of influence include nursing and nursing practice, patients/clients, and organizations/systems, promote improved patient outcomes through implementation of evidence-based guidelines for AF management.
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ABSTRACT: The interest in finding ways to bridge the gap between nursing research and implementation of findings into practice has been increasing. Clinical nurse specialists (CNSs) may be a bridge between frontline nurses and current developments in practice. While several researchers have studied the use of evidence by nurses in general, no known studies have been focused specifically on the use of evidence by CNSs. The purpose of this pilot study was to develop an understanding of the sources, nature, and application of evidence used by CNSs in practice and to investigate the feasibility of conducting a qualitative study focused on the CNS role in relation to evidence use in practice. This pilot study is a descriptive exploratory design in the qualitative paradigm. Seven CNSs from a large Western Canadian health region were interviewed. Interview transcripts were reviewed for recurrent themes about sources of evidence, evidence use, and barriers and facilitators to evidence use. CNSs access and use evidence from a variety of sources. All CNSs indicated that research literature was a primary source of evidence and research was used in decision-making. Peers and experience were also important sources of evidence. CNSs used the Internet extensively to consult research databases, online sources of evidence, and to contact peers about current practice. CNSs also gathered evidence from frontline nurses, healthcare team members, and families before decision-making. The choice of evidence often depended upon the type of question they were attempting to answer. Barriers cited by CNSs support previous research and included lack of time, resources, and receptivity at clinical and organizational levels. Facilitators included peers, organizational support, and advanced education. CNSs in Canada have advanced education and clinical expertise and many are employed in roles that permeate organizational management and clinical nursing care. It is suggested that qualitative research in naturalized settings that investigates the role of CNSs in relation to the dissemination of evidence in nursing practice needs attention.Worldviews on Evidence-Based Nursing 02/2007; 4(2):86-96. DOI:10.1111/j.1741-6787.2007.00086.x · 2.32 Impact Factor