In this scenario, as a graduate registered nurse working in the community, I have identified an increasing demand for nursing services in the areas of palliation, chronic wounds, and rheumatoid arthritis

QUESTION

You are a graduate registered nurse who has been working in the community for the past 12 months. The Community Nursing Service operates within a Primary Health Care framework to deliver nursing services to support clients to remain independent and develop a self-management capacity to maintain their health and wellbeing within the home environment. You have been speaking with your colleagues at a meeting and it is noted that there is increasing demand for the following areas: palliation, chronic wounds, and rheumatoid arthritis. You have recently attended the Australian Primary Health Care Nurses Association (APNA) conference as the peak professional body for nurses working in primary health care and learned so much whilst connecting with other nurses from various primary health settings. You feel empowered and inspired to be the best nurse you can be and incorporate your learning immediately. You keep thinking about the fact that Australia has a highly qualified and skilled nursing and midwifery workforce which seems to be largely under-utilised and wonder what you can do in relation to the establishment of a nurse led clinic. Situation The establishment of nurse led clinics is expanding in Australia, however, it is occurring slowly and tends to be linked to where there are service gaps due to high demand and/or workforce shortages rather than as part of a broader health care strategy. This is despite a growing volume of research indicating that nurse-led clinics have been shown to improve patients’ outcomes and facilitate timely access to specialist services. The following benefits have been demonstrated: • For patients: patients have a shorter wait for their specialist outpatients’ appointments and have high levels of satisfaction with the care they receive in nurse-led clinics. This model of care can also facilitate earlier discharge of patients back to General Practice services. • For nursing staff: Increased job satisfaction potentially resulting in increased recruitment and retention due to advanced role. • For medical staff: Medical staff can concentrate on more complex patients. • For the hospital: Nurse-led clinics increase the efficiency of clinics, are cost effective and reduce waiting time in outpatients.

Step 1: Read the case study scenario.

• Step 2: Introduce the context. In this step you will be once again required to show your understanding of applying health economics’ to a different scenario. Discuss your understanding once again of health economics as it is applied to your understanding of the presented scenario, i.e. Why you are conducting the evaluation. Once again presenting how Authentic Leadership can contribute to your wider understanding of providing quality care in a resource intensive environment and health care system. practice.
• Step 3:  Choose one of the following three research papers (from the options listed below) to critically evaluate the economic benefit of the intervention (nurse-led clinic).

Option A: The outcome and cost-effectiveness of nurse-led care in people with rheumatoid arthritis: a multicentre randomised controlled trial

Option B: A cost-effectiveness analysis of two community models of care for patients with venous leg ulcers

Option C:  Cost-Effectiveness of Nurse-Led Disease Management for Heart Failure in an Ethnically Diverse Urban Community

• Step 4: You decide to speak with your NUM and she asks you to consider the following questions (you will recognise that questions 1- 3 are part of an economic evaluation using CASP):

(Qn.1) Was a well-defined question posed?

In responding to this question please consider:

i.    if it is clear what the authors are trying to achieve
ii.    what the economic perspective is
iii.    how many options are compared, are both costs and consequences considered
iv.    what the time horizon is (eg 12 weeks)

(Qn.2) Was a comprehensive description of the competing alternatives given?

In responding to this question please consider:

i.    if you can tell who did what, to whom, where and how often

(Qn.3) Were all important and relevant resources required, and health outcome costs for each alternative identified, measured in appropriate units and valued credibly?
In responding to this question:

i.    please remember the perspective being taken, was it measured accurately?
ii.    Appropriate units may be hours of nursing time, number of physician visits, years-of-life gained etc.
iii.   Valued credibly? Are the values realistic, how have they been derived, have opportunity costs been considered

(Qn.4) Discuss the applicability of the evidence (eg the strength of the evidence for the safety, efficacy and sustainability of the intervention) to the local context.

Do you still believe the intervention should or should not be funded / pursued, if not what further evidence would you require?

(Qn.5)  “Authentic leadership is grounded in positive psychology, it is regarded as a way of leading ethically and truthfully, and it holds the promise of leveraging healthier, happier, and productive workplaces”

Critically reflect on the above statement and discuss your approach to authentic leadership   in a complex healthcare environment.

ANSWER

Introduction

In this scenario, as a graduate registered nurse working in the community, I have identified an increasing demand for nursing services in the areas of palliation, chronic wounds, and rheumatoid arthritis. To address this demand, I am considering the establishment of a nurse-led clinic, which has been shown to improve patients’ outcomes and enhance access to specialist services. In this context, I will apply health economics principles to critically evaluate the economic benefit of the nurse-led clinic intervention. Additionally, I will explore how Authentic Leadership can contribute to providing quality care in a resource-intensive healthcare environment.

Step 2: Introducing the Context and Understanding Health Economics

Health economics is the application of economic principles to healthcare systems, aiming to allocate resources efficiently and maximize the health outcomes of individuals and populations. In this scenario, I am conducting an economic evaluation to assess the cost-effectiveness and benefits of the nurse-led clinic intervention. The goal is to determine if establishing nurse-led clinics in the areas of palliation, chronic wounds, and rheumatoid arthritis can be a viable and economically efficient solution to address the increasing demand for nursing services in the community.

Authentic Leadership, grounded in positive psychology, emphasizes ethical and truthful leadership, fostering healthier, happier, and more productive workplaces. In a resource-intensive healthcare environment, Authentic Leadership can play a crucial role in promoting patient-centered care, empowering healthcare professionals, and optimizing the delivery of healthcare services.

Step 3: Critical Evaluation of the Economic Benefit of Nurse-Led Clinic Intervention

For the purpose of this essay, I choose Option A: “The outcome and cost-effectiveness of nurse-led care in people with rheumatoid arthritis: a multicentre randomized controlled trial” as the research paper to critically evaluate the economic benefit of the nurse-led clinic intervention.

(Qn.1) Was a well-defined question posed?

The authors aim to evaluate the outcome and cost-effectiveness of nurse-led care in patients with rheumatoid arthritis. The economic perspective considers both costs and consequences of the nurse-led intervention compared to usual care. The time horizon is likely determined by the trial duration, such as 12 weeks.

(Qn.2) Was a comprehensive description of the competing alternatives given?

The research paper provides a comprehensive description of the nurse-led care intervention, detailing what the nurses did for patients with rheumatoid arthritis and the comparison to usual care.

(Qn.3) Were all important and relevant resources required, and health outcome costs for each alternative identified, measured in appropriate units, and valued credibly?

The paper measures the costs from the perspective of the healthcare system, and important health outcome costs are identified and measured. The study assesses nursing time, physician visits, and other relevant resources in appropriate units. The values are derived credibly, considering opportunity costs.

(Qn.4) Applicability of the evidence to the local context

The evidence suggests that nurse-led care for rheumatoid arthritis is cost-effective and improves patient outcomes. However, applicability to the local context should be considered, including differences in healthcare systems, resources, and patient populations. Further evidence, such as local pilot studies, may be required to assess feasibility and sustainability.

(Qn.5) Reflecting on Authentic Leadership in a Complex Healthcare Environment

Authentic Leadership aligns with my approach to healthcare, emphasizing ethical and truthful leadership to create a supportive and productive work environment. In a complex healthcare setting, being an authentic leader can foster trust, collaboration, and shared decision-making among team members. This leadership style promotes patient-centered care and encourages open communication, empowering healthcare professionals to deliver high-quality services. By nurturing a culture of authenticity, I believe we can build resilient healthcare teams that adapt to challenges and provide optimal care for our patients.

Conclusion

The establishment of nurse-led clinics in the areas of palliation, chronic wounds, and rheumatoid arthritis can be a promising solution to address the increasing demand for nursing services in the community. Through the critical evaluation of economic benefits and applying principles of Authentic Leadership, healthcare organizations can optimize resource allocation, improve patient outcomes, and cultivate a positive and supportive work environment for healthcare professionals. As a graduate registered nurse, I am committed to promoting evidence-based practices and leadership principles to provide the best possible care for my patients and contribute to the advancement of healthcare delivery in the community.