Experiences of patients attending and participating in clinical nurse specialist-managed heart failure clinics : a thesis submitted to Massey University of Wellington in partial fulfillment of the requirements for the degree of Master of Philosophy (Nursing)

Abstract

It is very clear from discussions with patients attending outpatient clinics, that nurse-led clinics fulfilled an important function in the holistic care of patients with heart failure. Previously the biomedical model of health care dominated the health system and was considered all that was required. Knowledge about health care has improved greatly and this is in keeping with patients' expectations in today's world of easy access to Internet information. Ongoing health care therefore, needs to meet the needs of these patients in the interests of improved quality of life in a population with a significant chronic illness. This research sits in the mixed method paradigm, however the focus is predominantly qualitative using exploratory narrative inquiry informed by Polkinghorne (1988) to gain a perception of the meaningfulness of patients' experience of nursing clinics. The aim of this research is to explore what is important to the patients; to explore what the patient's perceive as their needs when they attend or participate in Heart Failure Clinical Nurse Specialist (HFCNS) clinics; to describe the experiences of patients attending the HFCNS services with the aim of gathering information to develop and improve the health care of these patients. All patients attending the nurse-managed heart failure secondary care clinic over an eight-week period were invited to fill in a questionnaire. Fifty-five patients completed the form. The aim of the questionnaire was to describe the clinic population demographics. Three short answer questions were also included to give direction for the interviews that were to follow. The six participants for interview were chosen purposely to give a range of age, gender and ethnicity that would be representative of the clinic population. Key themes for the patients were identified and included: gaining knowledge; making changes; partnership/mentorship; ethnicity/cultural perceptions; and collegial collaboration/ professional care. The research gave a clear picture of the patients' perceptions of the reality of the experience of nurse-managed secondary care clinics. Issues to do with cultural safety as well as general care presented a multi- faceted and complex canvas. Furthermore knowledge of ethnicity and cultural mores shows a need for ongoing efforts to be innovative in reducing disparities that persist in Maori and Pacific peoples' health and wellness. Overall the evidence indicates that nurse-managed heart failure clinics show positive outcomes for patients' perceived needs and, fill what was a gap in care.