Framework for roles and responsibilities of nurses innurse-led cardiovascular disease clinics in primary health care: An integrative review

Abstract

Background: Cardiovascular disease (CVD) is a global health issue. Literature has shown that primary care nurse-led cardiovascular disease clinics improve cardiac patient outcomes. These clinics improve the level of services provided, increase patient satisfaction, and decrease the mortality rate.
Aim: This literature review aims to identify the roles and responsibilities of nurses working in CVD nurse-led clinics and to identify the outcomes of these nurse-led clinics.
Method: Whittemore and Knafl’s framework guided this integrative review. Seventeen studies published between 2017 and 2022 were included in the review. The Mixed-Method Appraisal Tool was used to assess the quality of the studies.
Results: Three themes emerge in this literature review: roles and responsibilities of nurse-led CVD clinics, the impact of nurse-led CVD clinics, and the qualifications of nurses working in these clinics.
Conclusions: This integrative review identifies a framework for the roles and responsibilities of nurse-led CVD clinics and highlights the positive patient outcomes. This framework will help CVD nurse-led clinics to meet the needs of patients and achieve a high level of patient satisfaction.

Keywords

Nurse-led clinic / Cardiovascular disease / Role and responsibilities / Outcome

References

[1] Frieden T, Jaffe M. Saving 100 million lives by improving global reatment of hypertension and reducing cardiovascular disease risk factors. The Journal of Clinical Hypertension. 2018; 20(2): 208-11. PMid:29370471. https://doi.org/10.1111/jch.13195

[2] World Health Organization. 2021 Jul. Available from:Cardiovascular diseases (CVDs) [Internet]. Available from: https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)

[3] Al-Absi HRH, Refaee MA, Rehman AU, et al. Risk factors and comorbidities associated to cardiovascular disease in Qatar: a ma-chine learning based case-control study. 2021; 9: 29929-41. https://doi.org/10.1109/ACCESS.2021.3059469

[4] Khachfe H, Refaat M. Bibliometric analysis of cardiovascular dis-ease research activity in the Arab world. ICF Journal. 2018; 15: 25-8. https://doi.org/10.17987/icfj.v15i0.554

[5] Songli M, Zeying Q, Yang Y, et al. Influence of life satisfaction on quality of life: mediating roles of depression and anxiety among cardiovascular disease patients. Clinical Nursing Research. 2021; 30(2): 215-24. PMid:32757768. https://doi.org/10.1177/1054773820947984

[6] Hsu Y, Wang R, Bai C. Significant impacts of work-related cere-brovascular and cardiovascular diseases among young workers: a nationwide analysis. International Journal of Environmental Re-search and Public Health. 2019; 16(6): 961. PMid:30889818. https://doi.org/10.3390/ijerph16060961

[7] Gheorghe A, Griffiths U, Murphy A, et al. The economic burden of cardiovascular disease and hypertension in low-and middle-income countries: a systematic review. BMC Public Health. 2018; 18(1): 1-11. PMid:30081871. https://doi.org/10.1186/s12889-018-5806-x

[8] Hare DL, Toukhsati SR, Johansson P, et al. Depression and cardio-vascular disease: a clinical review. European Heart Journal. 2014; 35(21): 1365-72. PMid:24282187. https://doi.org/10.1093/eurheartj/eht462

[9] Salti N.Non-communicable diseases (NCD) in the Middle East and North Africa:what macroeconomic savings can be expected from achieving SDG Target 3.4 [Internet]. 2020 Sep. Available from: https://files.emrsdgslearn.net/uploads/Cost%20of%20NCDs.pdf

[10] Randall S, Crawford T, Currie J, et al. Impact of community-based nurse-led clinics on patient outcomes, patient satisfaction, patient access and cost effectiveness: a systematic review. International Journal of Nursing Studies. 2017; 73: 24-33. PMid:28531549. https://doi.org/10.1016/j.ijnurstu.2017.05.008

[11] Pleh D, Rosted E, Thomsen T. Key competences of outpatient nurses, as perceived by patients attending nurse-led clinics-an integra-tive review. Journal of Clinical Nursing. 2021; 30(3-4): 311-22. PMid:33169469. https://doi.org/10.1111/jocn.15557

[12] Drury V, Aw A, Lee A. An integrative literature review of the effec-tiveness of nurse-led clinics in ophthalmology. Insight (American Society of Ophthalmic Registered Nurses). 2017; 42(2): 22-8.

[13] Whittemore R, Knafl K. The integrative review: updated method-ology. Journal of Advanced Nursing. 2005; 52(5): 546-53. PMid:16268861. https://doi.org/10.1111/j.1365-2648.2005.03621.x

[14] Coskun S, Duygulu S. The effects of nurse led transitional care model on elderly patients undergoing open heart surgery: a random-ized controlled trial. European Journal of Cardiovascular Nursing: Journal of the Working Group on Cardiovascular Nursing of the Eu-ropean Society of Cardiology. 2022; 21(1): 46-55. PMid:33821999. https://doi.org/10.1093/eurjcn/zvab005

[15] McLachlan A, Aldridge C, Lee M, et al. The development and first six years of a nurse-led chest pain clinic. New Zealand Medical Journal. 2019; 132(1489): 39-47.

[16] O’Toole K, Chamberlain D, Giles T. Exploration of a nurse practitioner-led phase two cardiac rehabilitation programme on atten-dance and compliance. Journal of Clinical Nursing. 2020; 29(5-6):785-93. PMid:31793120. https://doi.org/10.1111/jocn.15133

[17] Savarese G, Lund L, Dahlström U, et al. Nurse-led heart failure clinics are associated with reduced mortality but not heart failure hos-pitalization. Journal of the American Heart Association. 2019; 8(10): e011737. PMid:31094284. https://doi.org/10.1161/JAHA.118.011737

[18] Woo BFY, Tam WWS, Rangpa T, et al. A nurse-led integrated chronic care e-enhanced atrial fibrillation (NICE-AF) clinic in the commu-nity: a preliminary evaluation. International Journal of Environmen-tal Research and Public Health. 2022; 19(8): 4467. PMid:35457336. https://doi.org/10.3390/ijerph19084467

[19] Corones-Watkins K, Theobald K, White K. Outcomes of a ran-domised pilot trial of a nurse-led clinic for patients after percutaneous coronary intervention. Australian Critical Care. 2019; 32(4): 285-92. PMid:31280772. https://doi.org/10.1016/j.aucc.2018.06.009

[20] Ingram S, Quirke M, Loo B. An advanced nurse-led clinic for pa-tients following percutaneous coronary intervention. British Journal of Cardiac Nursing. 2020; 15(10): 1-11. https://doi.org/10.12968/bjca.2020.0089

[21] da Silva ATM, de Fátima Mantovani M, Moreira RC, et al. Nursing case management for people with hypertension in primary health care: a randomized controlled trial. Research in Nursing & Health. 2020; 43(1): 68-78. PMid:31710134. https://doi.org/10.1002/nur.21994

[22] Michelsen HO, Nilsson M, Scherstén F, et al. Tailored nurse-led cardiac rehabilitation after myocardial infarction results in better risk factor control at one year compared to traditional care: a retro-spective observational study. BMC Cardiovascular Disorders. 2018; 18(167). PMid:30111283. https://doi.org/10.1186/s12872-018-0907-0

[23] Rivera-Caravaca JM, Gil-Perez P, Lopez-García C, et al. A nurse-led atrial fibrillation clinic: impact on anticoagulation therapy and clinical outcomes. International Journal of Clinical Practice. 2020; 74(12): e13634. PMid:32745337. https://doi.org/10.1111/ijcp.13634

[24] Lee JH, Kang SM, Kim YA, et al. Clinical outcomes of a nurse-led post-discharge education program for heart-transplant recipi-ents: a retrospective cohort study. Applied Nursing Research. 2021; 59: 151427. PMid:33947514. https://doi.org/10.1016/j.apnr.2021.151427

[25] Liljeroos M, Strömberg A. Introducing nurse-led heart failure clinics in Swedish primary care settings. European Journal of Heart Failure. 2019; 21(1): 103-9. PMid:30338881. https://doi.org/10.1002/ejhf.1329

[26] Ortiz-Bautista C, Morán-Fernández L, Díaz-García M, et al. Evalua-tion of a nurse-led intervention program in heart failure: a random-ized trial. Medicina Clínica. 2019; 152(11): 431-7. PMid:30314739. https://doi.org/10.1016/j.medcli.2018.08.005

[27] Ibrahim A, Chongprasertpon N, Heelan M, et al. Outcomes of nurse-led clinic for patients treated with percutaneous coronary intervention: a retrospective analysis. Applied Nursing Research. 2019; 49: 19-22. PMid:31495414. https://doi.org/10.1016/j.apnr.2019.07.005

[28] Premkumar S, Ramamoorthy L, Pillai A. Impact of nurse-led cardiac rehabilitation on patient’s behavioral and physiological parameters after a coronary intervention: a pilot randomized controlled trial. Journal of Family and Community Medicine. 2022; 29(1): 17-23.

[29] Rhiantong J, Malathum P, Monkong S, et al. Outcomes of an ad-vanced practice nurse-led continuing care program in people with heart failure. Pacific Rim International Journal of Nursing Research. 2019; 23(1): 32-46.

[30] You J, Wang S, Li J, et al. Usefulness of a nurse-led program of care for management of patients with chronic heart failure. Medical Science Monitor. 2020; 26: e920469. https://doi.org/10.12659/MSM.920469

[31] Doumen M, Westhovens R, Vandeputte M, et al. The perception of stakeholders on the applicability of nurse-led clinics in the management of rheumatoid arthritis. Rheumatology Advances in Practice. 202; 5(Supplement_2): ii45-52. PMid:34755028. https://doi.org/10.1093/rap/rkab052

[32] Berglund C, Gustafsson E, Johansson H, et al. Nurse-led outpatient clinics in oncology care-patient satisfaction, information and conti-nuity of care. European Journal of Oncology Nursing: the Official Journal of European Oncology Nursing Society. 2015; 19(6): 724-30. PMid:26071199. https://doi.org/10.1016/j.ejon.2015.05.007

[33] Coleman S, Havas K, Ersham S, et al. Patient satisfaction with nurse-led chronic kidney disease clinics: a multicentre evalua-tion. Journal of Renal Care. 2017; 43(1): 11-20. PMid:28156054. https://doi.org/10.1111/jorc.12189

[34] Connolly C, Cotter P. Effectiveness of nurse-led clinics on health-care delivery: an umbrella review. Journal of Clinical Nursing. 2021; 32(9-10): 1760-7. PMid:34970816. https://doi.org/10.1111/jocn.16186

[35] Tracy FM, O’Grady ET. Hamric and Hanson’s advanced practice nursing: an integrative approach ( 6th ed.). Elsevier. 2019.

[36] Davis K, Eckert M, Hutchinson A, et al. Effectiveness of nurse-led services for people with chronic disease in achieving an out-come of continuity of care at the primary-secondary healthcare interface: a quantitative systematic review. International Journal of Nursing Studies. 2021; 121: 103986. PMid:34242979. https://doi.org/10.1016/j.ijnurstu.2021.103986

[37] Coster S, Watkins M, Norman I. What is the impact of professional nursing on patients’ outcomes globally? An overview of research evidence. International Journal of Nursing Studies. 2018; 78: 76-83. PMid:29110907. https://doi.org/10.1016/j.ijnurstu.2017.10.009

[38] Whiteford C, White S, Stephenson M. Effectiveness of nurse-led clin-ics on service delivery and clinical outcomes in adults with chronic ear, nose and throat complaints: a systematic review. JBI Database of Systematic Reviews and Implementation Reports. 2016; 14(4): 229-56. PMid:27532317. https://doi.org/10.11124/JBISRIR-2016-2237

[39] Chan RJ, Marx W, Bradford N, et al. Clinical and economic outcomes of nurse-led services in the ambulatory care setting: a systematic review. International Journal of Nursing Studies. 2018; 81: 61-80. PMid:29518623. https://doi.org/10.1016/j.ijnurstu.2018.02.002