The main purpose of the study was to confirm the hypothesis that consultation with CNS or RN in a drug-monitoring clinic has a significant positive impact on the well being of patients with rheumatoid arthritis. The study involved a single blinded randomized controlled trial over a period of three years. Subjects were chosen from the rheumatology out patient setting in a district general hospital with a drug monitoring service. A total of 71 subjects who were starting out on anti-rheumatic therapy were randomly assigned to either the interventional or the control group. While the interventional group was supervised by the CNS to assess patient needs (using Pendelton's framework) alongside drug safety evaluation, the control group was seen by an outpatient staff nurse purely for drug safety concerns. Both the groups were assessed periodically for their scores on the Arthritis impact measurement scales (AIMS) and Rhematology Attitude Index (RAI) as well as the Disease Activity Score. The interventional group fared well in all these indexes during the course of the study and at the endpoint. The research has definite bearings for evidence-based nursing approach and the positive outcome of the study attests that the integration of clinical practice and scientific evidence is the key to improving the quality of health care. This study has clearly shown how evidence-based nursing could optimize treatment and outcome in a hospital outpatient setting. [Ryan et al., 2006]

The clinical implications are profound. The emergence of the nurse as a specialist caregiver creates a dynamic leap in terms of improving standards across the whole spectrum of health care. Evidence-based nursing approach is a vital link in bridging the existing chasm between advancements in medical technology and healthcare delivery. This research is relevant for nurse specialists as important members of the healthcare workforce who are more and more involved in evidence-based decision-making. Ultimately the research also impacts the patients as receivers of care as evidence-based medicine is the new platform of care delivery that calls for resource optimization at every level in the healthcare setting. This research is another supporting evidence to the cause of evidence-based practice, which the hospital administration should promote. This would also give new impetus for the nursing force as evidence-based nursing would motivate nurses and increase their job satisfaction. This is particularly important at a time when hospitals are struggling with high attrition rate and nursing shortage. The success of this study could be emulated in other clinical settings. This would involve a coordinated approach from the nursing staff, doctors and the hospital administration.

Conclusion

All the articles reviewed in this paper expounded the crucial role of Nurses in the prevention of preventable adverse events and in improving the overall quality of care. While Considine and Botti (2004) and Pipe et.al (2005) discussed the importance of pro-active nursing practice and the implementation of evidence-based nursing approach in the clinical setting, Ryan et al. (2006) was a study which reported the success of implementing an integrated evidence-based practice system. That is, the first two articles that were reviewed were basically a literature review of several earlier studies and presented a theoretical viewpoint....

The final study was the practical implementation of the evidence-based nursing care. It is clear that nurses are constrained in terms of the interventions that they could initiate. However, the fact remains that a vast majority of the nursing staff do not respond independently though the patient parameters are abnormal and critical. Time is of essence and in such situations delay resulting from waiting for interventions by senior physicians would exacerbate patients condition leading to adverse events. Besides the interventions that they could directly initiate, nurses also have the responsibility of initiating EMT action, calling for direct medical staff support and thus play a central role in the prevention of adverse events and the delivery of optimal care. The new, evolving role of the nurse is that of a proactive and evidence-based care provider. The successful implementation of this change however, would necessitate a revamp of the organizational structure and dynamics to permit smooth and effective communication and to create an environment where the nurse could participate more independently as well as in excellent coordination with other caregivers.
Bibliography

Teri Britt Pipe; Kay E. Wellik; Vicki L. Buchda; Carol M. Hansen; Dana R. Martyn, 2005, "Implementing Evidence-Based Nursing Practice," Urol Nurs. 25(5): 365-370, Available at, http://www.medscape.com/viewarticle/514532

Ryan, S, Hassell, a.B, Lewis, M, & Farrell, a. (2006). Impact of a Rheumatology Expert Nurse on the well-being of patients attending a drug monitoring clinic. Journal of Advanced Nursing, 53(3), 277 -286.

Considine, J. & Botti, M. (2004) Who, when and where? Identification of patients at risk of an in-hospital adverse event: Implications for nursing practice. International Journal of Nursing Practice. 10: pp. 21-31

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