title: Converting to insulin in primary care: an exploration of the needs of practice nurses.
abstract: BACKGROUND
  In order to optimize glycaemic control, substantial numbers of people with type 2 diabetes may require transfer from oral medication to insulin therapy. Although insulin conversion is traditionally a specialist secondary care function, as nursing roles change and expand there is growing pressure for this to be performed within primary care. However, little is known about the potential barriers to such a change, particularly from the standpoint of the frontline staff involved.
  
  
  OBJECTIVE
  The study aimed to explore the views of practice nurses in the United Kingdom (UK) about converting diabetic patients from oral hyperglycaemic agents to injected insulin within primary care, and to investigate what structures and resources might be useful in supporting such a change.
  
  
  METHODS
  Semi-structured interviews were conducted with 25 practice nurses, and interpreted using content analysis to extract key conceptual themes from the transcribed interview texts.
  
  
  RESULTS
  Most of the nurses felt that converting to insulin in primary care had considerable benefits for patients. However, issues of time, training, confidence about performing the change, and the adequacy of support systems, both for patient and nurse, emerged as the main perceived barriers to performing insulin conversions in primary care. Worries about legal and accountability issues surrounding the nurse prescribing elements were also raised.
  
  
  CONCLUSIONS
  Where insulin conversion within primary care is being considered, it is suggested that specific training is provided for practice nurses and general practitioners, protected time is made available, and a team-working approach is fostered to prevent isolation and boost patient support. Formal mentoring or supervision support for practice nurses may also help them to adapt to this new approach.
  
  
  CONCLUSIONS
  These findings are based on the views of nurses from a single UK locality, and so widespread consultation is recommended before applying them in other settings.
authors.affiliation: Mid Devon Research Group, Wyndham House Surgery, Silverton, Devon, UK. c.j.greaves@ex.ac.uk
authors.forename: Colin J
authors.initials: CJ
authors.lastname: Greaves
authors.forename: Patricia
authors.initials: P
authors.lastname: Brown
authors.forename: Rohini T
authors.initials: RT
authors.lastname: Terry
authors.forename: Christine
authors.initials: C
authors.lastname: Eiser
authors.forename: Pam
authors.initials: P
authors.lastname: Lings
authors.forename: J W
authors.initials: JW
authors.lastname: Stead
mesh_terms: D000284:Administration, Oral; D001291:Attitude of Health Personnel; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000451:nursing; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D009722:Nurse Practitioners; D011320:Primary Health Care; D006113:United Kingdom
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin