Healthcare is undergoing a period of rapid change in response to complex economic factors and changes in patterns of care. The rising costs of institutional care and the need to reduce hospital waiting lists is putting considerable pressure on community based support for patients. Sophisticated treatments such as Duodopa and DBS are being given to Parkinson´s patients and this presents a number of challenges that nurses are well able to address.

Patient education, support and the identification and anticipation of care needs are important factors in ensuring quality of life and preventing complications in Parkinson's. Breakdown of care in the community may be precipitated by ignorance of self-management strategies. This is enormously expensive in financial, work and psychological terms. PDNS are ideally placed to help with the problems the disease can present. A literature review demonstrates how diverse the role of the PDNS can be. Noble (1998) outlines the contributions a nurse specialist can make to the multidisciplinary care patients require. Other authors have suggested the diversity of patient carer interaction within this role: Calne (1994) suggests the nurses have a major role to play in patient education, emotional and lifestyle counselling and information services. She also comments on issues such as sexual dysfunction, something rarely discussed with physicians. The unique role of this nurse, she suggests, is in the co-ordination of services and in pharmacotherapy as part of the care team.

Whitehouse (1994) suggests that the nurse can act as a link between the patient, hospital and community services to meet the needs of both patient and carer. Taira (1992) concentrates on educational and emotional support, diet, medication and exercise, whilst Vernon (1989) suggests that the role of the nurse includes health assessment, medication instruction, monitoring and liaison with other members of the health care team and patient and family.

Fitzsimmons and Bunting (1993) stress the contribution that nurses can make to the fulfilment of quality of life, life satisfaction, self-esteem and physical health and also the importance of goal setting with the family. Next