VOL: 97, ISSUE: 34, PAGE NO: 44
JANE SCULLION, MSc, BA, RGN, is respiratory nurse consultant, Glenfield Hospital, and part-time clinical fellow, Aberdeen University Department of General Practice and Primary CareThe specifics of the role of a nurse consultant have been defined as expert practice, professional leadership and consultancy, education and training, service development and research and evaluation.
The specifics of the role of a nurse consultant have been defined as expert practice, professional leadership and consultancy, education and training, service development and research and evaluation.
It is evident that the development of these areas will be needs-led within the district of appointment (NHS Executive, 1999; Department of Health, 1999). The roles are multidimensional and promote and develop clinical nursing while promoting a culture of effective patient and health care services (Manley, 1997).
In Leicestershire it was apparent that the clinical remit in a well-established respiratory centre with excellent respiratory nurse specialists and a reputable pulmonary rehabilitation team meant that the role should be both complementary and supplementary. Issues surrounding interface care and the care of patients handicapped by their chronic disease were a perceived area for development.
Respiratory disease can be chronic and disabling and even patients who have received the correct medical diagnosis and optimal treatment can be left with considerable residual handicap. Definitions of handicap incorporate the disadvantage for a given individual, resulting from impairment or disability that limits or prevents fulfilment of a normal role (Royal College of Physicians, 1986).
Patients with chronic lung disease can have a degree of handicap in many areas of their overall functioning. In addition, they often experience a marked deterioration in their health status to the extent that even a limited amount of breathlessness can be both disturbing and debilitating, and there is little correlation between the patient's perception of dyspnoea and actual physiological measurements.
While there is considerable agreement on treatment and management, it is clear that there is a group of patients who, despite maximum medical management and pulmonary rehabilitation, still have problems. At best current treatments, although valuable, are essentially palliative in nature, with insufficient evidence to conclude that specific outpatient therapies alter the progression of disease. Although increased survival is an important goal, minimising symptoms and improving ability to function on a day-to-day basis may be more pertinent to patients' needs (Caverley and Bellamy, 2000).
For the patient with chronic respiratory disease, care management should offer control of symptoms, prevention of deterioration, prevention of complications and improved health status. While the conventional medical consultation may cover certain aspects of care, there is both insufficient time and a different focus to the consultation to address all the patient's concerns. In the area of chronic disease management, there is a unique opportunity to address the situations and problems resulting from the disease process and not just the medical treatment associated with the diagnostic label.
Respiratory care requires a directional philosophy for the development of district-wide services and the provision of an integrated service across the interface of primary and secondary care. This has incorporated a close working relationship with other team members and also enabled me to utilise my personal interest in the psychology of chronic illness.
A nurse consultant cannot work in isolation and should be another member of the existing team, not merely a change in title for a current role. The bottom line for any development has to be whether or not it actually improves patient care.
Professional leadership and consultancy has involved working with established groups - the RCN Respiratory Nurses' Group, the Association of Respiratory Nurse Specialists and the East Midlands Respiratory Nurses' Group. In terms of service developments, working with colleagues has led to the establishment of an interface clinic to establish appropriate referral pathways for respiratory patients and to provide complementary clinics in primary care.
Membership of various strategy groups and advisory panels has assisted in initiating patient-focused and rational service developments. For research and development support within the Institute for Lung Health, the British Thoracic Society research committee and a part-time clinical fellowship in the Aberdeen University general practice and primary care department have strengthened links both in primary care and in collaborative research.
I have taken many opportunities for education and training, including working with various groups such as practice nurses, GPs, nursing students, colleagues, the National Asthma Campaign, respiratory educational centres and the pharmaceutical industry. Working on conference-planning and presenting has been hard work but fun and proves that we have a voice and should not be afraid to use it.
Taking up a consultant post has been a time of both professional and personal development for me. There has been close scrutiny of the role and it is evident that it requires rigorous evaluation. What works for one district may be untenable in another, so the need for the post should be carefully thought through.
The highs of the job have been many, especially the development of a clinical role, and working with patients is a constant reminder of the impact nurses can have on patients' lives. There has been an enormous amount of support and enthusiasm for the post and as yet no low point, but I shall wait and see.