54. Patient and carer access to community-based specialist heart failure care and management: Exploring the perceptions of heart failure specialist nurses

Karen Spilsbury, Research Fellow, Health Sciences (Research), University of York, York, United Kingdom
Co authors: Jill Pattenden & Karl Atkin
ks25@york.ac.uk

Abstract:

Background:

Heart failure presents significant resource implications for health services. During recent years there have been increasing opportunities for nurses to provide specialist services to contribute to heart failure care and management (Department of Health 2000b). However, little is known about the development of community-based heart failure specialist nurse services.

Aim:

This study aims to explore heart failure specialist nurses’ (HFSNs) perspectives and experiences of:
1. Whether, and how, the development of HFSN services are enabling patients and their carers to access community-based specialist care
2. Whether, and how, the service is extending knowledge on effective methods of managing heart failure amongst the multi-disciplinary team.

Methods:

A longitudinal qualitative interview study of community-based HFSN services in 7 purposively sampled PCTs. Semi-structured interviews were carried out with 23 HFSNs at two time points (2005 and 2006). The delivery of specialist care and the work of HFSNs are understood using a theoretical framework of access (Aday et al. 1998) and interactionist perspectives of occupational boundaries (Hughes 1984). All interviews were audio-recorded and transcribed verbatim. Thematic analysis was used to identify themes within and across the PCTs.

Findings:

The main themes include: HFSNs’ responses to developing services and use of services by patients and carers; tackling inequalities in access; managing ‘appropriate’ and ‘inappropriate’ hospital admissions; ‘identity work’; integrating with existing services and mediating care boundaries; establishing ‘expertise’ and extending knowledge of heart failure management.

Discussion:

The study highlights processes of the HFSN service integration within existing services and scope for maximising the potential of the service for diverse heart failure populations. Whilst HFSNs identify the importance of improving patient access to HFSN services, it is not known whether improving access leads to better patient and carer outcomes and efficient use of resources. These findings make an important contribution to practice, policy and research.

Biography:

Karen Spilsbury is a Research Fellow in the Department of Health Sciences, University of York. Karen is a nurse by background, graduating in 1993, and gaining clinical experience in neurorehabilitation and general medicine. Her portfolio of research includes evaluations of nursing and healthcare roles (nurse-led care, specialist nurses and health care assistants), nursing skill mix in care homes, patient and carer experiences of care, and systematic reviews of the effectiveness of interventions for informal carers.