Practice nursing is an integral component of British and New Zealand primary care, but in Australia it remains an emerging specialty. Despite an increased focus on the Australian practice nurse role, there has been limited strategic role development, particularly relating to national health priority areas. This paper reports the third stage of a Project exploring the Australian practice nurse role in the management of cardiovascular disease (CVD). This stage involved a consensus development conference, undertaken to identify strategic, priority recommendations for practice nurse role development. Key issues arising from the conference included:
1. Practice nurses have an important role in developing systems and processes for CVD management;
2. A change in the culture of general practice is necessary to promote acceptance of nurse-led CVD management;
3. Future research needs to evaluate specific models of care, incorporating outcome measures sensitive to nursing interventions;
4. Considerable challenges exist in conducting research in general practice; and
5. Changes in funding models are necessary for widespread practice nurse role development.
The shifting of funding models provides evidence to support interdisciplinary practice in Australian general practice. The time is ripe, therefore, to engage in prospective and strategic planning to inform development of the practice nurse role.
Received 4 December 2006 Accepted 21 March 2007
practice nursing; general practice; cardiovascular disease; Australia; consensus development conference
BURDEN OF CARDIOVASCULAR DISEASE AND ACHIEVING EVIDENCE-BASED PRACTICE
Cardiovascular disease (CVD) is increasingly recognised as an important health concern (Australian Institute of Health and Welfare (AIHW) 2004). The economic and social burden of CVD has a significant impact on individuals, their families and the community. In 2001, one in five Australians had CVD, with 1.1 million disabled as a result (AIHW 2004).
Although many evidence-based CVD guidelines exist (National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand 2004), the implementation of these into usual care represents considerable challenges, particularly in general practice (Fuat, Hungin & Murphy 2003; Grol & Grimshaw 2003; Phillips, Marton & Tofler 2004). However, in order to moderate short and long term treatment goals, CVD management must extend into community settings (Krum 1997). Historically, the focus of Australia's health system has been on acute, episodic management, rather than on integrated systems of care (New South Wales Department of Health 2005). Yet it is the integration of a range of services from multiple care providers that is critical to best meet the needs of the chronically ill (New South Wales Department of Health 2005).
MODELS OF CARE TO IMPROVE CVD OUTCOMES
To date, the literature has primarily focussed on acute care based models of nurse-led service delivery in CVD (McAlister et al. 2001; Page, Lockwood & Conroy-Hiller 2005). These interventions only address a subset of the population often in the later stages of the illness course and are potentially not efficacious or effective in all settings. To effect significant improvements in health outcomes, future interventions need to consider novel methods of consumer engagement at all stages of the illness trajectory. Given their position within the familiar and accessible environment of general practice and the potential for prolonged engagement with the individual consumer, the practice nurse represents a potentially useful adjunct to current models of CVD management (Halcomb et al. 2004).
PRACTICE NURSING IN AUSTRALIA
Practice nursing in Australia has reached a critical point at which decisions must be made regarding professional development, policy, research and scholarship (Halcomb, Patterson & Davidson 2006). …