Australian nurses in general practice based heart failure management : implications for innovative collaborative practice

Background: The growing global burden of heart failure (HF) necessitates the investigation of alternative methods of providing co-ordinated, integrated and client-focused primary care. Currently, the models of nurse-coordinated care demonstrated to be effective in randomized controlled trials are only available to a relative minority of clients and their families with HF. This current gap in service provision could prove fertile ground for the expansion of practice nursing [The Nurse in Family Practice: Practice Nurses and Nurse Practitioners in primary health care. 1988, Scutari Press, London: Impact of rural living on the experience of chronic illness. Australian Journal of Rural Health, 2001. 9: 235ââ"šÂ¬Ã¢â‚¬Å“240]. Aim: This paper aims to review the published literature describing the current and potential role of the practice nurse in HF management in Australia. Methods: Searches of electronic databases, the reference lists of published materials and the internet were conducted using key words including ââ"šÂ¬Ã‹Å“Australiaââ"šÂ¬Ã¢"žÂ¢, ââ"šÂ¬Ã‹Å“practice nurseââ"šÂ¬Ã¢"žÂ¢, ââ"šÂ¬Ã‹Å“office nurseââ"šÂ¬Ã¢"žÂ¢, ââ"šÂ¬Ã‹Å“nurs*ââ"šÂ¬Ã¢"žÂ¢, ââ"šÂ¬Ã‹Å“heart failureââ"šÂ¬Ã¢"žÂ¢, ââ"šÂ¬Ã‹Å“cardiacââ"šÂ¬Ã¢"žÂ¢ and ââ"šÂ¬Ã‹Å“chronic illnessââ"šÂ¬Ã¢"žÂ¢. Inclusion criteria for this review were English language literature; nursing interventions for heart failure (HF) and the role of practice nurses in primary care. Results: There is currently a paucity of data evaluating the potential role for practice nurses in a reconfigured, collaborative health care system. Those studies that were identified were, largely, of a descriptive nature. In addition to identifying the practice nurse as a largely unexplored resource, key themes that emerged from the review include: (1) current general practice services face significant barriers to the implementation of evidence-based HF practice; (2) there is considerable variation in the practice nurse role between general practices; (3) there are significant barriers to the expansion of the practice nurse role; (4) multidisciplinary interventions can effectively deliver secondary prevention strategies; (5) practice nurses can potentially facilitate these multidisciplinary interventions; and (6) practice nurses are favorably perceived by consumers although there is some confusion about the nature of their role. Conclusion: On the basis of this literature review, practice nurses represent a potentially useful adjunct to current models of service provision in HF management. Further research needs to comprehensively investigate the role of the practice nurse in the Australian context with a view to developing effective and sustainable frameworks for clinical practice. In particular, high-level evidence is required to evaluate the efficacy of the practice nurse role compared to current disease management strategies.