Rise of the NP

Nurse practitioners have a role to play in evaluation and research into best practice, attendees at a recent conference were told.

Professor Sandy Middleton, director of the Nursing Research Institute – a joint initiative between St Vincent’s Health Australia (Sydney) and Australia Catholic University – says nurse practitioners must be champions for change.

“Nurse practitioners are our most senior nurse clinicians,” she says. “Nurse practitioner roles now are centred around models of care, so we need to look at ways that they can work with the team to improve service delivery and patient outcomes.”

Speaking at the Conference of the Australian College of Nurse Practitioners in September, Middleton discussed the role of the NP in successfully translating evidence into practice.

Using a recent study in which she looked at ways of improving the management of fever, hyperglycemia and swallowing in 36 NSW stroke services, Middleton showed research can be translated into practice in a “very short space of time”.

Whilst it can take up to 17 years to put research into practice, the study showed that it’s possible to implement changes much earlier.

“[This study shows it is] possible to implement research into practice and to do so quite close to the time the research is published,” Middleton says. “However, dedicated funding and resources are required to achieve this.”

Strategies such as barrier identification, education, reminders and support for clinical champions potentially could be used in any clinical specialty to change practice to bring it in line with evidence, she says.

A previous clinical trial also conducted by the researchers implementing the above techniques, saw a reduction in death and dependency within 90 days following a stroke.

Margo Asimus, nurse practitioner wound management for the Greater Newcastle Cluster – Hunter New England Local Health District, also spoke on the importance of implementing research in practice.

Asimus, who is also the Australian Wound Management Association national president, says, “It’s important to keep up to date because you are the clinical expert and as a clinical expert you do need to be on the cutting edge."

“The role of the nurse practitioner – matter what specialty they are in – is really about holistic assessment and how we bring all pieces of the puzzle together to benefit the patient," Asimus said. "You do need to know what’s happening nationally and internationally and be able to critique the research and the literature and put that evidence into local clinical practice.”

He pointed to a 2012 study that evaluated the effectiveness of an NP-led clinic at attending procedures using a low-frequency ultrasound wound debridement device for patients suffering from slow-to-heal wounds.

In an 18-month period, 182 procedures were performed on 65 patients with various wound types. Sixty-three per cent of the wounds were opened for longer than 12 months.

As a result of the treatment, 85 per cent of the patients treated had their wounds completely healed or reduced in size by greater than 50 per cent within their treatment period. Wound infection was avoided and admissions for cellulitis or surgical debridement did not occur in this study population.

“[Low-frequency ultrasound wound debridement] is an advanced procedure that is within the scope of a nurse practitioner specialising in wound management,” Asimus says. “Application of best practice has increased the wound healing rates, cost efficiencies and early escalations of patients at risk of failure to heal. It is a true example of the benefit of translating the best available evidence into local clinical practice to improve patient outcomes.”

Asimus says one of the biggest challenges NPs face in dealing with chronic wounds is continuing to promote the message of best practice derived from latest evidence. Some colleagues that are not current may continue to rely on ritualistic practice that has no measured response.

“This can be challenging whilst rewarding, as nurse practitioners have the responsibility to change and improve practice and in my case this is in the area of wound management.”

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