Recent Research About Nursing, July 2013
This is part of the July 2013 issue of Sharing Nursing's Knowledge.
NP-Doctor Co-Management of Geriatric Cases Leads to Improved Outcomes
New research finds that geriatric patients with chronic conditions may have better outcomes if their cases are co-managed by a nurse practitioner (NP) and a physician than by a physician alone.
David Reuben, MD, chief of the Geriatrics Division in the Department of Medicine at the David Geffen School of Medicine at the University of California, Los Angeles, reports on the research leading to that conclusion in the June 2013 issue of the Journal of the American Geriatrics Society. Reuben and colleagues studied the cases of 485 patients who had one of four chronic conditions: falls; urinary incontinence (UI); dementia/Alzheimer's disease; or depression. Some of their cases were managed by doctors alone, and others were co-managed by doctors and NPs.
The researchers then examined individual patients' charts, assessing the quality of their care using several specific quality indicators. They found that patients whose cases were co-managed generally had better care, and significantly better care for some conditions. "Quality scores for all conditions (falls, 80 percent vs. 34 percent; UI, 66 percent vs. 19 percent; dementia, 59 percent vs. 38 percent) except depression (63 percent vs. 60 percent) were higher for individuals who saw a NP," they wrote.
One contributing factor was that NPs were more likely to take detailed patient histories—nearly twice as likely with patients who had problems falling, for example. In addition, NPs were nearly three times as likely to discuss treatment options with patients suffering from urinary incontinence.
Nurse-Led Interventions Help Patients Control Diabetes Symptoms
A new study finds that a nurse-led intervention helped patients with diabetes gain better control of their disease. Preliminary findings from the study were reported at a recent meeting of the American Association of Clinical Endocrinologists by Jacob Cohen, MD, a resident in internal medicine at the University of California, San Francisco, Fresno Medical Center.
Cohen compared results of two groups of diabetes patients. The first group participated in nurse-led training sessions at a diabetes medication management clinic. The second group participated in those same trainings at the clinic, and also received ongoing training from a nurse for up to three months. During that time, the nurse helped patients begin their use of insulin, and taught them to titrate insulin to an optimum dose.
Cohen subsequently compared the health outcomes of both groups and found that all patients reduced their levels of glycosylated hemoglobin A1c (HbA1c) as well as their fasting home glucose levels over the course of the year-long study. However, the patients who had received ongoing nurse-led training had significantly better results. "Nurse-led medication management clinic significantly improved short-term glycemic control," Cohen reported. "The reduction of HbA1c was 2.5 times higher in the patients who received simultaneous diabetes self-management training than [it was among] those who did not.”
Better Nurse Staffing Leads to Better Experience for Cancer Patients
Cancer patients at hospitals with more cancer specialist nurses have a better experience of care, according to a new study conducted in England.
Researchers at the University of Southampton reviewed data from the 2010 National Cancer Patient Experience Survey, which solicited the views of more than 67,000 patients at 158 National Health Service Trusts—the English health care system’s local health care organizations.
The analysis revealed that patients at better staffed trusts were more likely to report receiving what they deemed to be sufficient emotional support from the nurses and other staff caring for them. In addition, women receiving chemotherapy for breast cancer in trusts with the most clinical nurse specialists per patient were 34 percent more likely to believe that hospital staff did everything possible to control the side effects of chemotherapy.
The study appeared in the June 6, 2103 issue of the Journal of Health Services Research and Policy.