title: Spheres of clinical nurse specialist practice influence evidence-based care for patients with atrial fibrillation.
abstract: OBJECTIVE
  The purpose of this article is to review atrial fibrillation (AF) and its consequences, to present sources of published evidence-based guidelines for management of AF, and to highlight multifaceted clinical nurse specialist (CNS) interventions that promote positive outcomes for patients with AF.
  
  
  BACKGROUND
  The number of people with AF is expected to increase from 2.3 million to more than 5 million in the next 50 years. AF is associated with increased mortality, morbidity, healthcare expenditures, and decreased quality of life. Recognition of the growing number of AF cases and adverse consequences of AF led to development of evidence-based guidelines for AF management. Although nurses in diverse settings are accountable for providing evidence-based care for patients with AF, the guidelines have not been widely disseminated to nurses.
  
  
  METHODS
  This discussion includes a review of the adverse consequences of AF and a summary of management of recently detected AF with a focus on recommendations for nursing activities/interventions that are supported by evidence-based guidelines. Multifaceted strategies directed toward nurses and nursing practice, patients/clients, and organizations/systems that are linked to published CNS competencies and outcomes are highlighted.
  
  
  RESULTS
  CNS influence in all 3 spheres of CNS practice promotes positive outcomes that include improved patient/client functioning and self-management, reduced complications of treatment, decreased fragmentation of care, advancement of professional nursing practice, adherence to regulatory standards, and development of patient care processes that are supported by published guidelines.
  
  
  CONCLUSIONS
  With the use of the strategies discussed, clinical nurse specialists, whose spheres of influence include nursing and nursing practice, patients/clients, and organizations/systems, promote improved patient outcomes through implementation of evidence-based guidelines for AF management.
authors.affiliation: Division of Medical Cardiovascular Nursing, Mayo Clinic M-90 Saint Marys Hospital, Rochester, MN 55905, USA. mccabe.pamela2@mayo.edu
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: McCabe
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000451:nursing* / Q000628:therapy; D002983:Clinical Competence; D019317:Evidence-Based Medicine; D006801:Humans; D009720:Nurse Clinicians; D024802:Nurse's Role; D009730:Nursing Assessment; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic