Building evidence to support best practice specialist nursing services for people with Parkinson's disease in regional communities: An Integrative Literature Review

Background: Parkinson’s disease is a chronic, neurodegenerative, incurable, complex and disabling neurological condition. In Australia and worldwide, the prevalence of Parkinson’s compared to other neurological conditions is exceeded only by dementia. The median time from onset to death is 12.2 years, and in Australia, an estimated 89% live most of those years at home, with the remaining 11% living in residential facilities. As our population ages prevalence is increasing and is higher in rural and remote areas. Disease progression is a major driver of costs and carer burden due to increasing dysfunction in motor and cognitive capacity, leading to increasing risk of hospital and residential care admission and a need for specialist services. Integrated, specialist nursing care is largely absent in regional communities, leading to lower health related quality of life and poorer management of the condition compared to urban areas.
Method: A four-stage integrative framework guided the literature review undertaken to identify evidence-based models of care specifically focused on the role of the community based specialist neurological nurse caring for people with Parkinson’s. Data on models of care from the selected articles were analysed and aggregated to synthesise findings and inform decision making at the clinical and policy level.
Results: Fourteen models of specialist nursing care from five countries are included in the review. Best practice outcomes focused on improving quality of life through nurse-led clinics, early intervention strategies, specialist neurological assessment, technological advances such as telemedicine, multidisciplinary and interdisciplinary collaboration, support for family and carers and greater in-reach into acute facilities.
Conclusions: Specialist primary nursing services that maximise the scope of the nursing role, are multidisciplinary and use the latest technological advances are more likely to be sustainable and cost effective for service providers and people with Parkinson’s in regional communities.