The ageing of the population and the increasing prevalence of many chronic diseases have strained health services, necessitating new strategies for the management of these diseases.1
Teamwork between physicians and nursing professionals is common in primary care. Within the Digestive System speciality, the role of the nurse is fundamental in the fields of endoscopy,2 colon cancer screening3 and hepatology4 and inflammatory bowel disease consultations.5
Pancreatology is a complex and constantly developing field. For this reason, the national commission of the speciality considers that in the near future it could constitute a subspeciality or specific training area within the Digestive System. The same is true for inflammatory bowel disease and gastrointestinal oncology.6 The role of nursing in this field is not well defined and there are few pancreas units with a dedicated nurse. In our opinion, this is an extremely useful resource and is in line with the multidisciplinary management of diseases, already common in other medical disciplines and in other areas of our speciality.
The functions that could be performed—and in our case are performed—by a dedicated nurse at pancreas consultations are:
- 1
Drug withdrawal support: in certain patients with pancreatic disease, such as those with chronic pancreatitis of toxic origin, cessation of drug use has important implications for their disease prognosis and quality of life.
- 2
Dietary and lifestyle advice: nutrition is a key issue in many pancreatic diseases. Adapting dietary habits and physical exercise to the characteristics of the patient and his/her disease is necessary to reduce the risk of malnutrition and related conditions such as loss of bone mineral mass and sarcopenia.
- 3
Improving patient education on medication: dosage, schedule, timing, safety and effectiveness.
- 4
Filtering of the first few visits so they can be adapted to the characteristics of the consultation, as well as prioritisation according to the potential severity of the condition.
- 5
Review and screening of results of complementary investigations: pancreatic disease consultations generate a large number of laboratory results, radiological, endoscopic, pathology tests, etc. Rarely is there dedicated time in the consultation to evaluate them.
- 6
Follow-up of stable and/or asymptomatic patients. In processes where there are clear protocols for action such as pancreatic cancer screening in situations of increased risk or in the follow-up of some cystic lesions, nursing visits could be included.
- 7
Notification of pending results: it is not uncommon for there to be a pending result when the patient attends his or her consultation. In addition, examinations may be requested, the results of which do not necessarily require an in-person visit, especially if the result is normal or of little clinical significance.
- 8
Appointment and test reminders for certain patients or scenarios: the follow-up of some asymptomatic or stable patients may require appointments in the near future or even more than one year hence. If such an appointment requires a prior test, patients often lose their appointment card or even the fact that they have to undergo such a test. To avoid duplication, it is important to ensure that the tests requested for each visit have been performed and reported beforehand.
- 9
Appointment management and coordination: some appointments need to be coordinated with others (e.g., CT scan after removal of a collection drain) or appointments need to be scheduled to a certain period of time (e.g., replacement of some pancreatic prostheses).
- 10
Patient liaison in the event of suspected complications: rapid access to a consultation in situations in which the patient's clinical condition worsens can avoid unnecessary visits to the accident and emergency department and can help to ensure that admissions are scheduled and coordinated with certain complementary investigations.
To implement these tasks it is essential to have excellent communication between professionals, to provide prior training to nursing staff, to have appropriate process protocols in place and, probably most important of all, to look beyond traditional working practices in order to achieve maximum efficiency of healthcare resources.
