NURSE-LED CLINICS IN INDIA, AN INNOVATIVE APPROACH IN PATIENT MANAGEMENT.

Nurse-led clinics focus on managing the conditions like hypertension, diabetes, asthma, tuberculosis, pre-chemotherapy preparation, chemotherapy administration, chemotherapy symptoms management, Screening clinics and Antenatal and postnatal care. A qualitative on of Oncology analysis of


History and Scope of Nurse-Led Clinics
The term Nurse-led clinics has emerged from dates back nursing literature only. Although historically, nurses seems to be more independent in terms of running clinics of some sort which had been merged in later times with department of medicine only, where the term Nurse-led clinics had been replaced with Team-led clinics.

Need of Nurse-Led Clinics
In the most populous country like India, the doctor patient ratio is less than the prescribed limit by World Health Organization (1:1000). To improve the health status of people, there is a need to focus on the primary prevention, and maintaining the health at the first level, i.e. in the community. The health education services provided by nurses in the community and hospitals help to make people aware about acute and chronic illnesses.
In many Low and Middle socio economic countries, clinics are managed by nurses to overcome the shortage of doctors. Moreover studies showed the evidence that patients are more satisfied with nurses' clinics in terms of cost, accessibility and time spent to clear their concerns and doubts. 5 Nurse-led clinics focus on managing the conditions like hypertension, diabetes, asthma, tuberculosis, prechemotherapy preparation, chemotherapy administration, chemotherapy symptoms management, Screening clinics and Antenatal and postnatal care.
A qualitative study, conducted on patients' evaluation of Nurse-led Oncology Review clinics, analysis of patients' responses revealed that 60% patients judged the service to be excellent and 34% to be very good, whereas no one judged the service as fair or poor. Moreover patients demonstrated very high level of patient satisfaction regarding quality of the service. 6

Scope of Nurse Led Clinics
Nurses, in todays' times have expanded their role and scope out of hospitals, where they are working with people who are in acute need to get comprehensive and skilled care in cost effective way like home care nurse, geriatric nurses, palliative care nurses and nurse educators.
Nurse-led clinics are outpatient clinics that is run or managed by registered nurses only. Nurse led clinics will help the nurses to be autonomous, professional competent and manage patients caseloads. Nurses can adopt various roles in the clinics as an educator like diabetic councillor, chemotherapy councillor, antenatal and postnatal councillor, educating about various disease conditions and their prevention. She can act as Psychological supporter which can listen to patient's concern and fears and nurses can be the primary assessor for health check-ups and investigations and can refer the patients to required department like medicine, dermatology or surgery etc.
Likewise, in many countries, nurses have streamlined the clinics in the community to provide education regarding prevention of acute and chronic diseases, early identification and management of disease related complications. Nurses are working with patients of their own specialization as they are being enriched with knowledge and skilled in super-specialized arena.

Advantages
The main advantage of these clinics are patients don't need to wait for consultations especially for those health problems which can be easily and effectively handled by nurses, at low cost. This will reduce the workload of physicians and they can better spend their time on critical patients.
Similarly, the cancer patients receiving chemotherapy usually have lack of awareness regarding their diagnosis, procedures, chemotherapy cycles, side effects, what to take in diet and what to avoid. Most of the times patients search their diagnosis on the internet using various search engines for acquiring knowledge about disease conditions and its management. Sometimes, information provided on the internet may not be authenticated which can either frightened the patient or can put the patient in harm.
This harm can be prevented by providing accurate information from a proficient health care professionals. This task can be best managed by nurses, as they spent most of the time in caring the patient.
Nurse led chemotherapy clinics will be a great advantage to both patients and hospitals, where a nurse councillor will council the patient before initiating chemotherapy, educate them about various diagnostic tests and their importance, premedication and chemotherapy administration in an efficient manner, dealing very diligently with chemotherapy side effects and preventing them before their occurrence by using evidence based practice like use of ginger candies to control nausea, flavoured ice chips to prevent mucositis, ice caps to control alopecia etc. In this manner, she can be first-hand manager of their patients by keeping track of health records with collaboration of oncologists, radio-physicists. These day care clinics should be in large number in many cities to reduce hospital cost, travel cost and psychological distress of patient and family members.

Challenges
A challenge to the expansion of nurse-led clinics is the narrow scope of nursing syllabus, where nurses are taught theoretically more, but competency is lacking in each area of nursing. There is no clear job specifications for nurses working in hospitals. Moreover nurses are not willing to change and come out of their traditional thinking of obeying doctors' commands.