Although much of the care that respiratory patients receive at a primary, secondary and tertiary level is provided by nonspecialised nurses, patients in many European countries are seen and managed by respiratory nurse specialists. Respiratory nurses are engaged in the holistic care of patients with lung diseases, with the aim of maintaining the highest nursing standards, while working in collaboration with other members of a healthcare team. Specialist nurses work in various settings (inpatient and outpatient hospital departments and patients’ homes) and, in addition to providing patient care, they are often involved in preventive programmes (e.g. smoking cessation and patient education).
Respiratory nurses are sometimes involved in the development, clinical application and monitoring of new diagnostic and therapeutic procedures. They participate in research that aims to improve health and prevent disease, and collaborate in investigations involving patients with lung disease. Respiratory nurses are involved in almost all care programmes for patients with respiratory diseases including pulmonary hypertension, asthma, COPD, tuberculosis, transplantation, respiratory oncology, sleep disorders, and cystic fibrosis; they play a crucial and specific role in the care, education and self-management of patients within such programmes. In each care programme, they also have specific tasks: they monitor and treat patients, and ensure that patients adhere to the agreed therapy. As care moves away from the classical ‘clinic’ setting, respiratory nurses are also becoming active in the primary care of patients with COPD and asthma. This shift should be accompanied by proper education in the management of respiratory patients.
Respiratory nurses have an important role in patient education, the enhancement of patient self-management and the management of care. For more than 20 years, the British Thoracic Society (BTS) has recommended that respiratory nurse specialists should be attached to all respiratory medicine departments to act as a link between the hospital and the community. Several studies have examined the role of respiratory nurse specialists. It has been shown that they are effective in guiding self-management in asthma patients, and in coordinating an integrated care pathway focusing on identification, early intervention and management in COPD, including supervision of early hospital discharge and long-term care. An Australian study has shown the beneficial effects of domiciliary respiratory nurse intervention in the care of COPD patients: although mortality was unchanged, involvement of an outreach respiratory nurse as part of a shared-care approach resulted in improved health-related quality of life.
A programme in Kilkenny, Ireland has identified that comprehensive care plans for older people with chronic respiratory diseases need to include training for respiratory nurse specialists in hospitals and the community to address the following areas of patient care:
- use of long-term oxygen
- accurate diagnosis
- appropriate use of medication
- monitoring of treatment efficacy
- community/hospital rehabilitation programmes, where appropriate
- smoking cessation
- multidisciplinary assessment and intervention
- recognition of early warning signs of an exacerbation with rapid access to appropriate services
Similar programmes exist in Spain and are predominantly led by respiratory nurses. A recent meta-analysis has highlighted the effectiveness of nurse-led programmes and has particularly shown the effects on health-related quality of life.
In patients with complex therapeutic schemes (e.g. patients suffering from pulmonary hypertension, those on long-term oxygen therapy and those receiving noninvasive mechanical ventilation), specifically trained nurses are key to ensuring quality care. More and more tele-health applications are used and overseen by respiratory nurses, allowing for remote monitoring and the adjustment of therapy.
An increasingly important element of the specialist respiratory nurse’s role is to act as a clinical study nurse and coordinator. As respiratory nurses excel in providing patients with information at patients’ level of understanding, and are trained in patient interview skills and the techniques relevant to respiratory research, they often run clinical trial units and help engage patients in clinical trials.
Respiratory nursing websites (see Respiratory Nursing Websites below) describe the respiratory nurse’s role as promoting pulmonary health in individuals, families and communities, and caring for those with pulmonary dysfunction throughout their lifespan. Respiratory nursing care is preventive, acute or critical, and rehabilitative. A respiratory nurse may be employed as a staff nurse, clinical nurse specialist, nurse practitioner, nurse manager, supervisor, coordinator, director, executive, nurse educator, or research nurse; they are employed by hospitals, extended care centres, private companies, health departments, office practices and clinics. The Standards of Nursing Care for Adult Patients with Pulmonary Dysfunction developed by the Nursing Assembly of the American Thoracic Society (ATS) in 1989 offers a detailed guide to respiratory nursing clinical care.
Respiratory Nursing Websites:
Nurse.com - www.nurse.com
Respiratory Nursing Society www.respiratorynursingsociety.org
Association of Respiratory Nurse Specialists www.arns.co.uk
European Respiratory Society Nurses Group http://www.ersnet.org/assemblies/allied-respiratory-professionals/item/146-nurses.html
American Thoracic Society Nursing Assembly www.thoracic.org/assemblies/nur/index.php
Professional societies at a regional level have a key role to play in training and education. Much of the nursing care that respiratory patients receive is provided by professionally trained nurses. In many disease areas, however, there is a need for specifically trained nurses with a Masters-level degree or similar. Postgraduate education may allow respiratory nurses the opportunity to train to become leaders of care programmes. Within the ERS, the Nurses Group (part of the Allied Respiratory Professionals Assembly) ensures such training at a European level. Similarly, the ATS has a dedicated Nursing Assembly. Its mission statement summarises the aim of respiratory nurses as follows: 1) to prevent disease and disability in respiratory, critical care and sleep-related conditions; 2) to improve the management of symptoms resulting from these conditions; and 3) to enhance end-of-life and palliative care. The Assembly has also composed a formal list of research priorities for respiratory nurses.