Role of the Clinical Nurse
Specialist
The clinical nurse specialist
(CNS) plays a major role in the
management of patients with CKD,
as well as in the maintenance of
their well-being. As an expert clinician,
the CNS performs a thorough
assessment of the patient for any
signs of co-morbidities such as anemia.
The nephrology CNS also may
assess patient response to treatment
through blood tests for Hgb and
iron stores, and recommend dosage
adjustments for prescribed medications.
The CNS is an expert resource
on CKD-related anemia for other
nurses. Moreover, the CNS collaborates
with other members of the
multidisciplinary team, and acts as
a facilitator between the patient
and other health care providers.
This fortifies the provision of multidisciplinary
care, ensures comprehensive
disease management for
the patient, and allows the patient
to make health-related decisions
more effectively (Harrison &
Watson, 2011).
As an educator, the CNS helps
clinical care nurses develop competence
in working with anemic
patients with CKD. For example,
the CNS may develop formal educational
programs concerning diagnosis
guidelines, anemia management
guidelines, appropriate protocols
for followup, and special considerations
in patients with cancer or
hypertension. Moreover, the CNS
has a major role in educating
patients about their disease process,
symptom management, nutritional
status, and medication regimen
(Murphy et al., 2010). The CNS may
provide disease and treatment
updates to medical and nursing
staff. In collaboration with the multidisciplinary
team, the CNS can
create protocols for the management
of anemia, and develop or
participate in revision of guidelines
and policies (Wickham, 2014). This
increases the uniformity of patient
management, expands evidencebased
practice, and improves
patient outcomes and treatment
adherence. The use of these protocols
may improve patients' Hgb values
and decrease ineffective
response to treatment (Murphy et
al., 2010).
A randomized controlled trial
assessed the efficacy of a nurse-led
CKD management program (Wong,
Chow, & Chan, 2010). Participants
included CNSs and generalist nurses.
Findings indicated significant
improvement in patient adherence
and several measures of quality of
life, along with overall improvement
in patient satisfaction, as a
result of nurse involvement.