The project
In preparation for the clinics, a number of'medical' reviews were
observed in order to explore how medical staff assessed the
patient and what problem-solving approaches were adopted.
The approach varied depending on the doctor and his/her level
of experience. While more junior doctors asked the patient if
there were any specific problems, it appeared that the more
experienced doctor structured the questioning around how the
patient managed specific aspects of his/her care or if his/her
functional abilities had altered. Once again it was evident that
there was a lack of a practical problem-solving advice.
Following these sessions, the patient's medical and nursing
notes were obtained and reviewed with the consultant to
discuss and agree suitable patients that may benefit the most
from a nursing review. At this stage previous poor attendees
could also be identified, as this would be useful to see if a
different approach might improve attendance rates. Once a
suitable hst was completed, clinic appointment letters were
posted, and it was considered important to highlight to the
patients that during their appointment they would see the
specialist nurse instead of a doctor. To reassure patients it was
also highlighted that should there be a need to see a doctor one
would be available at the clinic. Following a meeting with the
clinic coordinator, it was requested that if patients cancelled or
re-arranged their appointment, the team would be alerted, and
the patient would be asked if the reason was owing to being
seen by a nurse instead of a doctor.
Once the project was established, the ward manager and
discharge liaison sister (G grade) held a series of clinic
sessions that commenced in June 2002. Two fortnightly
clinics were held that month, and monthly clinics held
thereafter until October 2002.