Australian nurses in general practice based heart failure management: implications for innovative collaborative practice.
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].


OBJECTIVE
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.


CONCLUSIONS
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 context with a view to developing effective and sustainable frameworks for clinical practice. In particular, high-level evidence is required to evaluate the efficacy of the practice nurse role compared to current disease management strategies.
Halcomb
Elizabeth
E
School of Nursing, Family and Community Health (SNFCH), College of Social and Health Sciences (CSHS), University of Western Sydney, Locked Bag 1797, Penrith DC 1797, NSW, Sydney, Australia. e.halcomb@uws.edu.au
Davidson
Patricia
P
Daly
John
J
Yallop
Julie
J
Tofler
Geoffrey
G
D001291:Attitude of Health Personnel; D001315:Australia; D003299:Cooperative Behavior; D019317:Evidence-Based Medicine; D005194:Family Practice / Q000458:organization & administration*; D006333:Heart Failure / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D016294:Models, Nursing; D009722:Nurse Practitioners / Q000458:organization & administration*; D024802:Nurse's Role; D015403:Nursing Evaluation Research; D010348:Patient Care Team / Q000458:organization & administration; D019555:Physician-Nurse Relations; D011320:Primary Health Care / Q000458:organization & administration; D011634:Public Health; D016032:Randomized Controlled Trials as Topic