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Purpose: Creation and implementation of a nursing consultative model can promote positive outcomes for specific patient populations. Using evidence-based practice (EBP) to create a solid framework is essential to the model’s success whereby effective consultant nurses draw on a set of attributes. Enabling consultative nurses to fulfill their responsibilities at an autonomous level requires expertise and the ability to apply three key processes as identified by Manley (2001). These include transformational leadership, emancipatory processes, and practicing expertly.
Description: Using Manley’s EBP framework as a nursing consultative model, our institution created a unit-based service to assist with the management of hospitalize d peritoneal dialysis (PD) patients. PD is a chronic therapy that many patients perform independently while at home. When these patients become hospitalized, they may not be admitted to a dedicated area which specializes in their PD care. This possibility can leave the nurses caring for them feeling unprepared to meet their unique needs and the patients questioning nurse’s competence. Additionally, the prescribed PD therapy requires dedicated time to ensure orders and supplies are appropriate. As a solution, a quaternary academic medical center created a unit-based, nurse-driven consultative model. This was identified as a need by an advanced medical unit since many PD patients were historically admitted to the area. Subsequently, this intervention has provided nurses with the knowledge and skill to autonomously move across service lines while bringing this specialized therapy to patients. Clinical nurses were recruited through a volunteer process. Training was provided by the unit-based clinical nurse specialist who performed didactic learning sessions individualized validation of skills, in-the-moment education, and shoulder-to-shoulder support. A communication system was also created on a secured texting platform using bidirectional messaging between nurses across service lines and providers.
Evaluation/outcome: Over an 18-month period, 22 nurses were trained in PD therapy and are competent in the care they provide. The average daily PD census across the hospital is 2 patients. In FY 2021 there were 852 PD patients. 70% (597) of the hospital’s admitted PD patients are assigned to the described medical unit, while the remaining (255) patients are placed on various units based on admitting service. Consultative nurses deliver all PD therapies and interventions to patients in need once alerted through the texting platform. Nurses spend an average of 6 hours a day dedicated to the needs of the PD population. No unintended outcomes related to PD therapy have been reported. Finally, trained nurses verbalized increased confidence with therapy delivery and a better understanding of the PD treatment for the patient.
Conclusions/implications: Creating and sustaining a PD nurse consultative model is a viable solution to provide therapy to this specialized hospitalized patient population. This strategy can provide a positive patient experience which can be linked to good outcomes. Likewise, implementation of a similar model like can improve nursing’s competence and skill level.
Evidence-based references 1. Dewing, J., Reid, B. (2003). A Model for Clinical Practice Within the Consultant Nurse Role. Nursing Times. Vol: 99 (9); 30.