Australian Nurses in General Practice Based Heart Failure Management: Implications for Innovative Collaborative Practice

• Published in: European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology 2004-07, Vol.3 (2), p.135-147
• Main Authors: Halcomb, Elizabeth, Davidson, Patricia, Daly, John, Yallop, Julie, Tofler, Geoffrey
• Format: Article
• Language: English
• Subjects: Attitude of Health Personnel; Australia; Cooperative Behavior; Evidence-Based Medicine; Family Practice - organization & administration; Heart Failure - epidemiology; Heart Failure - therapy; Humans; Models, Nursing; Nurse Practitioners - organization & administration; Nurse's Role; Nursing Evaluation Research; Patient Care Team - organization & administration; Physician-Nurse Relations; Primary Health Care - organization & administration; Public Health; Randomized Controlled Trials as Topic
• ISSN: 1474-5151; 1873-1953
• DOI: 10.1016/j.ejcnurse.2004.02.002

Background: The growing global burden of heart failure (HF) necessitates the investigation of alternative methods of providing co-ordinated, integrated and client-focused primary care. Currently, the models of nurse-coordinated care demonstrated to be effective in randomized controlled trials are only available to a relative minority of clients and their families with HF. This current gap in service provision could prove fertile ground for the expansion of practice nursing [The Nurse in Family Practice: Practice Nurses and Nurse Practitioners in primary health care. 1988, Scutari Press, London: Impact of rural living on the experience of chronic illness. Australian Journal of Rural Health, 2001. 9: 235–240]. Aim: This paper aims to review the published literature describing the current and potential role of the practice nurse in HF management in Australia. Methods: Searches of electronic databases, the reference lists of published materials and the internet were conducted using key words including ‘Australia’, ‘practice nurse’, ‘office nurse’, ‘nurs∗’, ‘heart failure’, ‘cardiac’ and ‘chronic illness’. Inclusion criteria for this review were English language literature; nursing interventions for heart failure (HF) and the role of practice nurses in primary care. Results: There is currently a paucity of data evaluating the potential role for practice nurses in a reconfigured, collaborative health care system. Those studies that were identified were, largely, of a descriptive nature. In addition to identifying the practice nurse as a largely unexplored resource, key themes that emerged from the review include: (1) current general practice services face significant barriers to the implementation of evidence-based HF practice; (2) there is considerable variation in the practice nurse role between general practices; (3) there are significant barriers to the expansion of the practice nurse role; (4) multidisciplinary interventions can effectively deliver secondary prevention strategies; (5) practice nurses can potentially facilitate these multidisciplinary interventions; and (6) practice nurses are favorably perceived by consumers although there is some confusion about the nature of their role. Conclusion: On the basis of this literature review, practice nurses represent a potentially useful adjunct to current models of service provision in HF management. Further research needs to comprehensively investigate the role of the practice nurse in the Australian contex