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Clinical Nurse Specialist Collaboration With a Community-Based Palliative Care Program: An Evidence-Based Practice
Patrice Renee Fedel1, Gwen Pennington
1Author Affiliations: Clinical Nurse Specialist Prescriber Lead (Dr Fedel), Advocate Aurora Health Care; and Clinical Nurse Specialist (Dr Pennington), Aurora Health at Home.
A clinical nurse specialist (CNS) improved care coordination in a community palliative care program. While not significantly impacting readmissions or ED visits, the CNS role enhanced patient support and medical management.
Area of Science:
- Healthcare Delivery
- Palliative Care
- Nursing Practice
Background:
- Palliative care is shifting from inpatient to community-based models to support patients at home.
- Healthcare systems are exploring various care delivery models for community-based palliative care.
- Evaluating the role of clinical nurse specialists (CNS) within these evolving programs is crucial.
Purpose of the Study:
- To assess the impact of a clinical nurse specialist (CNS) collaborating with a community palliative care team.
- To evaluate the effect on quality outcomes, including care coordination, 30-day readmissions, and emergency department (ED) utilization.
Main Methods:
- An evidence-based practice project utilizing a preimplementation and postimplementation design.
- Quantitative analysis of 30-day readmissions and ED utilization data.
- Qualitative data collection through a focus group with the community-based palliative care team to explore the CNS role.
Main Results:
- The addition of a CNS did not significantly alter 30-day readmission rates or ED visits.
- A notable outcome was an increase in social work visits following CNS intervention.
- Focus group findings indicated the CNS enhanced care coordination, nursing support, education, and medical management.
Conclusions:
- Both quantitative and qualitative data suggest the CNS positively influenced care coordination and quality outcomes.
- Further investigation over an extended period is recommended to fully ascertain the CNS's long-term impact on the palliative care team.