Nurse-led clinics for patients with chronic diseases in hospital and transmural care organizations.

OBJECTIVES

The objectives of this study were to elucidate the purpose, content, and organization of nurse-led clinics for patients with chronic diseases and to explore whether there are differences in the content and context of the nurse-led clinics and attention for the home situation between a transmural and a hospital setting.

SETTINGS: Transmural setting by which nurses work in both primary and secondary care and hospital setting where nurses are employed by a local hospital. Within the transmural setting, 4 nurse-led clinics were studied: heart failure, rheumatoid arthritis, Parkinson disease, and multiple sclerosis. Within the hospital setting, 3 nurse-led clinics were studied: heart failure, rheumatoid arthritis, and Parkinson disease.

METHODS

A multiple-case embedded design was used to investigate the content and context of the nurse-led clinics for patients with heart failure, rheumatoid arthritis, Parkinson disease, and multiple sclerosis in the transmural and hospital setting.

SAMPLE: One hundred twenty-one patient records, bimonthly telephone interviews with 218 patients, and face-to-face interviews with 7 nurses.

RESULTS

Nurses focus on disease itself, treatment, and the everyday life of the patient. In addition, nurses maintain contacts with colleagues and other disciplines both inside and outside the hospital. No influence of setting was found on the execution of nurse-led clinics.

CONCLUSIONS

Nurse-led clinics for chronically ill patients focus on all aspects of living with a chronic disease. The organizational context does not seem to contribute to the execution of the nurse-led clinics. Instead, this seems to be driven by patient needs, the definition of nursing and nursing competencies, and general developments in the nursing profession.

IMPLICATIONS: To improve nursing care for patients with chronic illnesses, changing the organizational context might not be useful.