bTairawhiti District Health Board, Otorhinolaryngology Department, Gisborne Hospital, 423 Ormond Rd, Gisborne, New Zealand
Abstract
Introduction: The Ear Nurse Specialist (ENS) service, started in 1975 as a primary health initiative, now extends to include outpatient clinics in hospitals. There are 27 nurses employed in the ENS role. ENSs mostly work in community settings, operating mobile ear clinics equipped to deliver otoscopic expertise to the wider community and to families who have difficulty with transport. Mobile clinics deal specifically with children and the hospital clinics with adults and children. Geographical isolation and demographic spread of the population within New Zealand mean children in rural and urban areas do not have ready access to health services. ENSs visit on a regular basis in fully equipped vans. Objectives: Community – Identify children with potentially serious middle ear disease and hearing loss at an early age. Provide a nursing treatment service to prevent long-term effects of hearing loss in children. Secondary – Provide expert, cost-effective clinical intervention, reducing waiting times for acute and chronic ear disease. Methods: Mobile clinics visit areas identified with high failure rates in tympanometry and pure tone audiometry. High-risk children are immediately diagnosed and treated appropriately and quickly referred for surgical intervention. Ongoing follow-up is maintained. The ENS service, working in outpatient settings, alongside ORL Consultants, has evolved to become clinically vital, enabling the consultants to concentrate on more serious ear disease. Large numbers of patients are seen and treated earlier, preventing long, unnecessary waiting lists. Results: There have been significant reductions in the long-term effects of chronic ear disease in children. Furthermore, increased awareness of early prevention programs has helped to reduce national screening failures. Conclusions: The ENS has a pivotal role in ear health care for children, families, and communities. They have succeeded in meeting primary health goals by providing accessible, affordable, acceptable, and appropriate services for all communities.
E-mail address: [email protected]
doi:10.1016/S0531-5131(03)01129-4
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Contents
1. Introduction
The Ear Nurse Specialist service has been operating in New Zealand for over 25 years, starting in the 1970s as a primary health community initiative [1] It has now extended to include the secondary health area, namely, the outpatient ear, nose, and throat departments in hospitals. There are at present over 27 nurses employed in the ear nurse specialist role, and the number continues to grow.
2. Discussion
The main objectives of the ear nurse specialists working in the community clinics are
- to identify children with potentially serious middle ear disease and hearing loss and
- to provide a nursing treatment service to prevent the long-term effects of hearing loss in children (Fig. 1).
Due to geographical isolation and the demographic spread of the population within New Zealand [2], many children in rural and urban areas do not have ready access to health services [3].
Most nurses work in a community setting operating mobile ear clinics, which are able to deliver the service to the wider community. The mobile clinics are for children only, and visit rural, urban, and inner city locations targeting socioeconomically disadvantaged areas with high unemployment and a lack of public health facilities. The Mobile Ear Clinic Service is greatly appreciated by these communities. Thus, children with chronic middle ear disease, particularly otitis media with effusion (and associated hearing loss), can be diagnosed early and treated appropriately [4]. This, in turn, saves numerous visits to consultant hospital clinics, allowing only those with more serious conditions to be referred for consultant assessment.
Ear nurse specialists in some areas have authority to refer directly to the surgical waiting list for grommet insertion. The end result is one of restored hearing for the child, as well as prevention of developmental delays (Fig. 2).
2.1. Ear nurse specialist skills and competencies
Ear nurse specialists are expected to have
- an in-depth knowledge of ear anatomy,
- a broad knowledge of conductive and sensori-neural hearing loss,
- diagnostic skills in outer and middle ear disease,
- understanding of conservative treatment and monitoring progress,
- expert competency in otoscopy, microscopy, instrument use, and aural toilet techniques,
- ability to refer to medical and specialist services when necessary,
- empathy with varying cultures,
- educational and teaching skills,
- social skills for the provision of family support,
- enthusiasm, motivation, and
- the ability to work well with other health professionals [5].
Their field of work also includes the promotion of ear health, especially in children.
Emphasis is on preventative measures and associated factors such as encouraging a smoke-free environment and promoting breast-feeding.
Ear health education is provided to a wide variety of health, education, and social services groups, as well as to families and the children themselves.
The Ear Nurse Specialist Service is free, provided by the public health system. Referrals are received from parents, caregivers, general practitioners, ear, nose, and throat specialists/registrars, public health and plunket nurses (child health nurses), allied health professionals, Maori health providers, teachers, pre-school/Kohanga Reo and community educators, and vision–hearing technicians (involved with the hearing screening programmes in preschools and schools).
Ear nurse specialists support Maori (indigenous people) health programs [6] and readily provide assistance whenever needed. The Maori people are aware of the chronic ear problems of their communities and have developed their own health programs aimed at the prevention of otitis media (Fig. 3).
Some ear nurse specialists have been, and continue to be, involved in passing on their skills to medical and community health workers in remote Pacific Islands where the prevalence of otitis media, both chronic and suppurative, is high. Ear nurse specialists have also been part of ear, nose, and throat medical teams.
The ear nurse specialist, working in the outpatient setting, provides a secondary level of health care complementing the ear, nose, and throat consultant. This service has evolved over the years to become a vital clinical contributor to the smooth running of departments, enabling the consultants to concentrate on more serious conditions (Fig. 4).
The benefits and strengths of this are
- reduces waiting times – early intervention;
- allows consultants to see more serious cases; reduces suffering;
- reduces damage from untreated infections;
- child has shorter time with conductive hearing loss as a result of otitis media with effusion;
- improves outcomes;
- reduces the need for hospitalisation (otitis externa, complications from otitis media);
- consultants feel supported and less pressured and have confidence in the ear nurse specialist; and
- links to other services are closely maintained within the multidisciplinary health arena, ensuring continuity of health "messages."
3. Conclusion
The impact made by the ear nurse specialist role in New Zealand over the last 20 years has resulted in an improvement in children's ear health. It has also been a source of comfort to adults with minor ear conditions, such as wax removed with ease for those with hearing aids, and has assisted in creating an awareness of hearing loss and the consequences to other health professionals.
The ear nurse specialist has a pivotal role in ear health care for children, families, and communities and has succeeded in meeting primary and secondary health goals by providing an accessible, affordable, acceptable, and appropriate service for communities.