AN ASSESSMENT OF NURSE LED CLINICS ON HEALTHCARE AND SERVICE DELIVERY

CHAPTER ONE

INTRODUCTION

Background of the study 

Since providing healthcare is still difficult, attention has been drawn to redesigning health services, which includes creating nurse-led clinics. Even though it's widely accepted that nurse-led services improve healthcare delivery, progress must be guided by a review of the available data.

In the 1980s, the phrase "nurse-led clinic" first appeared in print. There is no doubt that nurses were in charge of clinics before this period, including those that provided generalist health education and treatment, mother and baby education, and midwifery education (O'Brien 2019). But specialised clinics started to appear along with new nursing practice models and an increased emphasis on nursing education at academic institutions as opposed to just hospital-based nursing education (Hatchett 2018). Government policy makers started working with academics to develop recommendations for training and evaluating nurses using standardised competency frameworks. These guidelines led to the expansion of nursing positions and the creation of registered Nurse Practitioners. 

Nurses started to take on roles that were previously exclusive to medical staff and expanded their practice. Examples of this include managing women's health clinics and working in chronic disease management clinics (Eley 2019). These clinics found outcomes such as improved patient satisfaction, reduced pain, better adherence to care plans, and increased job satisfaction, which validated the concept of nurse-led clinics. Nurse-led clinics started to grow and gain recognition as a new type of healthcare service in the 1990s.

Several of the identified studies provided strong evidence of the efficacy of nurse-led clinics in terms of patient satisfaction. Data from these studies show a substantial correlation between patient satisfaction and characteristics of care and service delivery in nurse-led clinics, including lower first-attendance wait times, improved communication, greater health advice, self-care and management, and follow-up treatment. Patient compliance with treatment and trust/belief in care pathways can be significantly impacted by the therapeutic relationship that exists between nurses and patients. Compared to doctors, nurses can spend more time talking with patients and frequently have superior listening and counselling skills. Patients are encouraged to speak more candidly because of the more laid-back and sympathetic environment this fosters. Relationships and patient satisfaction with care are enhanced when the nurse approaches the patient's problems from a more holistic perspective. This may provide hints for a more accurate and prompt diagnosis and course of therapy for patient problems (Rume, 2018).

According to research, nurse-led clinics have proven to be a successful way to reduce patient wait times. They have also given junior medical staff members more time to handle more complex patient care, such as clinical concerns in ward settings, admission evaluations in emergency departments, and surgical training in operating rooms. The capacity of the nurse to share the workload of the medical staff resulted in a reduction in patient waiting times and an improvement in service delivery. In addition to being able to quickly see and treat patients referred by general practitioners (GPs) and accurately triage them, senior nurses working in nurse-led clinics can help reduce waiting times and relieve some of the medical pressure.

A number of causes, such as the worldwide physician shortage, the rise in chronic illness, and the increased awareness of nurses' broader roles in healthcare, are contributing to the shift towards NLCs (World Health Organisation, 2020). Studies have indicated that patient outcomes can be enhanced by nurse-led care, especially in underserved and rural areas where access to specialised medical services is frequently restricted. According to Sibbald et al. (2019), there has been a correlation between this model and lower hospital admission rates, higher patient satisfaction ratings, and better care quality.

A number of nations have incorporated nurse-led clinics into their primary care networks, including treatments like immunisations, wound care, routine exams, and health education. Their capacity to provide comprehensive, patient-centered care that prioritises preventive and self-management makes a significant contribution to the delivery of healthcare services (Currie et al., 2021). This method lessens the long-term strain on healthcare systems by empowering patients to efficiently manage their health in addition to addressing urgent health issues.

Nevertheless, despite these achievements, nurse-led clinics have not yet reached their full potential, especially in low- and middle-income countries (LMICs), where the healthcare systems are frequently overworked and underfunded (Rosa et al., 2021). In these situations, the inclusion of NLCs in the provision of healthcare services can greatly increase patient access; nevertheless, issues with infrastructure, policy support, and training still need to be resolved. Therefore, evaluating these clinics' effects on service outcomes and healthcare delivery is essential to comprehending how important a part they play in enhancing health systems throughout the world.

According to recent research, nurse-led clinics' efficacy is directly correlated with the nurses' competencies, the range of services provided, and the degree of cooperation with other medical professionals (Bodenheimer & Bauer, 2016). To promote NLC expansion and make sure they are suitably equipped to meet the rising demands of healthcare service delivery, continuous evaluation and research are necessary as healthcare continues to change.

 Statement of the problem

In response to the growing need for easily accessible and effective healthcare services, nurse-led clinics have grown more and more common in international healthcare systems. These nurse-run clinics offer a variety of services, such as preventative care, health promotion, and chronic disease management. But even with their expanding role in the provision of healthcare, there is still a big knowledge vacuum on their overall influence on healthcare and service delivery, especially in poor nations like Nigeria. Concerns concerning the sufficiency of resources, the standard of treatment, and patient outcomes are brought up by the scant research on the efficiency of nurse-led clinics. Furthermore, it is yet unknown how much nurse-led clinics can lower healthcare costs, enhance patient happiness, and ease the stress on already overworked healthcare systems (Smith & Abood, 2023).

The changing role of nurses in healthcare systems, which calls for more training in clinical decision-making, patient management, and leadership, exacerbates this issue even further. The quality of treatment given depends greatly on the nursing skills of the clinic managers, but the influence of these clinics on healthcare delivery as a whole has not been sufficiently evaluated in previous research (Johnson et al., 2022). Therefore, this study seeks to fill the gap by critically assessing the impact of nurse-led clinics on healthcare delivery, evaluating their effectiveness in improving patient outcomes, and identifying challenges associated with their implementation.

1.3 Objectives of the Study 

The primary objective of this study is to assess nurse led clinics on healthcare and service delivery. Specifically the study seeks:

To find out the level of availability of nurse led clinics in Nigeria.

To explore the impact of nurse-led clinics on healthcare and service delivery in Nigeria.

To examine the challenges and barriers faced by nurse-led clinics in providing efficient healthcare services in Nigeria.

To propose strategies for improving the operational efficiency and scalability of nurse-led clinics for enhanced healthcare delivery in Nigeria.

1.4 Research Questions

The following research questions will be answered in this study:

What is the level of availability of nurse led clinics in Nigeria?

What are the impact of nurse-led clinics on healthcare and service delivery in Nigeria?

What are the challenges and barriers faced by nurse-led clinics in providing efficient healthcare services in Nigeria?

What are the strategies for improving the operational efficiency and scalability of nurse-led clinics for enhanced healthcare delivery in Nigeria?

1.5 Research Hypothesis

The stated hypothesis will validate this study:

Ho1: There is no significant impact of nurse led clinics on healthcare and service delivery in Nigeria.

Ha1: There is a significant impact of nurse led clinics on healthcare and service delivery in Nigeria.

1.6 Significance of the study

This study will provide valuable insights into how nurse-led clinics can effectively address these challenges, offering a viable solution to the healthcare shortages experienced in many communities. It will demonstrate how NLCs contribute to enhanced patient care and the decongestion of tertiary healthcare facilities, leading to more efficient healthcare delivery.

This study will also highlight the advantages of nurse-led clinics for the management of chronic illnesses, health promotion, and preventative care. It has been demonstrated that nurse-led clinics' emphasis on patient education, chronic illness management, and individualised care plans improves patient outcomes. This study will add to the body of evidence supporting the extension of nurses' responsibilities in primary care settings by analysing the performance of NLCs and highlighting their ability to offer holistic, patient-centered care. Policy proposals for bolstering nurse-led healthcare models as part of national healthcare initiatives may result from this, especially in nations with overburdened healthcare systems.

Furthermore, because the study's conclusions demonstrate the cost-effectiveness of nurse-led clinics, they will be crucial for healthcare administrators and legislators. By minimising hospital admissions through preventative care and reducing the need for physician-led treatments in specific areas, NLCs have the potential to lower healthcare costs. Making educated judgements about healthcare financing and the best use of human resources in the field requires this kind of knowledge.

Additionally, by offering actual data on the skills needed by clinicians and nurse managers to successfully lead and run these clinics, this study will advance nursing practice and education. 

1.7 Scope of the study

The study aims to assess nurse led clinics on healthcare and service delivery in Nigeria. Empirically, this study assesses the level of availability of nurse led clinics in Nigeria, the impact of nurse-led clinics on healthcare and service delivery in Nigeria, the challenges and barriers faced by nurse-led clinics in providing efficient healthcare services in Nigeria and propose strategies for improving the operational efficiency and scalability of nurse-led clinics for enhanced healthcare delivery in Nigeria.

1.8 Limitation of the study

Like in every human endeavour, the researchers encountered slight constraints while carrying out the study. The significant constraint was the scanty literature on the subject owing that it is a new discourse thus the researcher incurred more financial expenses and much time was required in sourcing for the relevant materials, literature, or information and in the process of data collection, which is why the researcher resorted to a limited choice of sample size. Additionally, the researcher will simultaneously engage in this study with other academic work. However in spite of the constraint all these constraint were downplayed to give the best.

1.9 Definition of terms

Nurses: Nurses are healthcare professionals trained to care for individuals, families, and communities to help them achieve and maintain optimal health. They provide medical care, administer medications, monitor patient conditions, and offer support and education to patients and their families.

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