The influence of outreach in the development of the nurse consultant role in critical care: cause or effect?
BACKGROUND
Critical care nurse consultant roles have evolved against a background of service innovation that has resulted in the development of critical care outreach services. Despite compelling evidence that there was a serious problem with the management of critically ill patients in the ward environment, there is little evidence to support outreach as a concept or as a role for nurse consultants.


OBJECTIVE
The aims for this part of the study were to:


METHODS
A national postal survey of all 72 critical care nurse consultants in post in England by August 2003; response rate 72% (n = 52). All data was entered on to a computer anonymously and analysed using SPSS version 11.5. A factor analysis revealed a sub-set of nurse consultants who had a significantly greater involvement in outreach activity.


RESULTS
Critical care nurse consultants have a high involvement in the development of care for critically ill patients outside the traditional boundaries of critical care. A sub-set emerged that has a significantly greater involvement in outreach activity. This includes roles such as working with an individual or team to develop their practice (whole group mean involvement score M = 4.45, outreach M = 4.88, p < 0.001); developing education outside the ICU/HDU (whole group M = 4.13, outreach M = 4.88, p < 0.001) and receiving nurse led referrals from the wards (whole group M = 3.92, outreach M = 4.81, p < 0.001).


CONCLUSIONS
Given the lack of evidence for outreach, organisations should consider the high level of involvement of the nurse consultant outside the traditional boundaries of the ICU/HDU.
Dawson
Deborah
D
General Critical Care, 1st Floor St. Jame's Wing, St. George's Hospital NHS Trust, London, UK. deborah.dawson@stgeorges.nhs.uk
McEwen
Andy
A
D001291:Attitude of Health Personnel; D003253:Consultants / Q000523:psychology; D003422:Critical Care / Q000458:organization & administration*; D003625:Data Collection; D004509:Education, Nursing, Continuing; D004739:England; D019317:Evidence-Based Medicine; D005163:Factor Analysis, Statistical; D006301:Health Services Needs and Demand; D006757:Hospital Units / Q000458:organization & administration*; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D007857:Leadership; D009720:Nurse Clinicians / Q000458:organization & administration* / Q000523:psychology; D024802:Nurse's Role; D009731:Nursing Audit; D015403:Nursing Evaluation Research; D015404:Nursing Methodology Research; D009741:Nursing Staff, Hospital / Q000193:education; D017410:Practice Guidelines as Topic; D017009:Professional Autonomy; D011785:Quality Assurance, Health Care; D012017:Referral and Consultation / Q000458:organization & administration; D011795:Surveys and Questionnaires