title: Managing patients with heart failure: a qualitative study of multidisciplinary teams with specialist heart failure nurses.
abstract: OBJECTIVE
  The purpose of this study was to explore the perceptions and experiences of health care clinicians working in multidisciplinary teams that include specialist heart failure nurses when caring for the management of heart failure patients.
  
  
  METHODS
  We used a qualitative in-depth interview study nested in a broader ethnographic study of unplanned admissions in heart failure patients (HoldFAST). We interviewed 24 clinicians across primary, secondary, and community care in 3 locations in the Midlands, South Central, and South West of England.
  
  
  RESULTS
  Within a framework of the role and contribution of the heart failure specialist nurse, our study identified 2 thematic areas that the clinicians agreed still represent particular challenges when working with heart failure patients. The first was communication with patients, in particular explaining the diagnosis and helping patients to understand the condition. The participants recognized that such communication was most effective when they had a long-term relationship with patients and families and that the specialist nurse played an important part in achieving this relationship. The second was communication within the team. Multidisciplinary input was especially needed because of the complexity of many patients and issues around medications, and the participants believed the specialist nurse may facilitate team communication.
  
  
  CONCLUSIONS
  The study highlights the role of specialist heart failure nurses in delivering education tailored to patients and facilitating better liaison among all clinicians, particularly when dealing with the management of comorbidities and drug regimens. The way in which specialist nurses were able to be caseworkers for their patients was perceived as a method of ensuring coordination and continuity of care.
authors.affiliation: University of Oxford, Oxford, United Kingdom Margaret.glogowska@phc.ox.ac.uk.
authors.forename: Margaret
authors.initials: M
authors.lastname: Glogowska
authors.affiliation: University of Bristol, Bristol, United Kingdom.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Simmonds
authors.affiliation: University of Keele, Keele, United Kingdom.
authors.forename: Sarah
authors.initials: S
authors.lastname: McLachlan
authors.affiliation: University of Bristol, Bristol, United Kingdom.
authors.forename: Helen
authors.initials: H
authors.lastname: Cramer
authors.affiliation: University of Sheffield, Sheffield, United Kingdom.
authors.forename: Tom
authors.initials: T
authors.lastname: Sanders
authors.affiliation: University of Bristol, Bristol, United Kingdom.
authors.forename: Rachel
authors.initials: R
authors.lastname: Johnson
authors.affiliation: University of Keele, Keele, United Kingdom.
authors.forename: Umesh T
authors.initials: UT
authors.lastname: Kadam
authors.affiliation: University of Oxford, Oxford, United Kingdom.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Lasserson
authors.affiliation: University of Bristol, Bristol, United Kingdom.
authors.forename: Sarah
authors.initials: S
authors.lastname: Purdy
mesh_terms: D001291:Attitude of Health Personnel; D003142:Communication; D019468:Disease Management; D004739:England; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D007407:Interviews as Topic; D009720:Nurse Clinicians / Q000523:psychology*; D010348:Patient Care Team / Q000592:standards*; D010820:Physicians / Q000523:psychology*; D036301:Qualitative Research
keywords: comorbidities; diagnosis/prognosis; heart failure; medications; patient education; unplanned hospital admissions