title: Impact of clinical nurse specialists in multiple sclerosis--synthesis of the evidence.
abstract: BACKGROUND
  Multiple sclerosis is a chronic neurological condition demanding a broad range of interventions and support. Multiple sclerosis nurse specialists are emerging as a leading force in providing care to this group of patients.
  
  
  OBJECTIVE
  This review aimed to identify and synthesize the evidence on the role of clinical nurse specialists in meeting the care needs of people with multiple sclerosis.
  
  
  METHODS
  A systematic review of the literature addressing the role of the multiple sclerosis nurse specialist was undertaken. The review examined both the appropriateness and effectiveness of the multiple sclerosis nurse specialist role. The content of each item identified in the review was analysed, examining the structure, process and outcomes variables associated with the role. Materials containing an explicit methodology were critically appraised using established schedules and graded as strong, moderate or weak. The data were then synthesized in tables, thematically and using a quasi-judicial approach called the 'System of Reasoning'.
  
  
  RESULTS
  Fifty-five items were examined and most (53%; n = 18) were descriptive in nature. There was insufficient evidence to demonstrate that the multiple sclerosis nurse role makes a difference to care. However, evidence was found to support current descriptions of the role - meaning? and there appeared to be a good fit between the role and the care needs of people with multiple sclerosis.
  
  
  CONCLUSIONS
  A systematic overview of the attributes of the multiple sclerosis nurse role is provided which should help service providers, nurses and other professionals consider how multiple sclerosis nurse specialists roles can contribute to the care of people with this condition. While there is little current evidence of effectiveness for the multiple sclerosis nurse specialist role, there is evidence for its appropriateness, although more rigorous primary research is required to test this.
authors.affiliation: Primary and Intermediate Care Section, Florence Nightingale School of Nursing and Midwifery, King's College London, London, UK. angus.forbes@kcl.ac.uk
authors.forename: Angus
authors.initials: A
authors.lastname: Forbes
authors.forename: Alison
authors.initials: A
authors.lastname: While
authors.forename: Liz
authors.initials: L
authors.lastname: Dyson
authors.forename: Tricia
authors.initials: T
authors.lastname: Grocott
authors.forename: Peter
authors.initials: P
authors.lastname: Griffiths
mesh_terms: D006801:Humans; D016294:Models, Nursing; D009103:Multiple Sclerosis / Q000451:nursing*; D009720:Nurse Clinicians; D024802:Nurse's Role; D011787:Quality of Health Care