Practice nurses and the facilitation of self-management in primary care.
OBJECTIVE
This paper is a report of a study to explore practice nurse involvement in facilitation of self-management for long-term conditions.


BACKGROUND
In the United Kingdom chronic disease services have shifted from secondary care to general practice and from general practitioners to practice nurses. A new United Kingdom General Practice contract requires adherence to chronic disease management protocols, and facilitating self-management is recognized as an important component. However, improving self-management is a relatively new focus and little is known about the ways in which nurses engage with patient self-management and how they view work with patients in chronic disease clinics.


METHODS
Semi-structured interviews with 25 practice nurses were carried out in 2004-2005. Interviews were audio-taped and transcribed verbatim. Analysis was informed by the 'trajectory model' and 'personal construct' theories.


RESULTS
Main themes in the early stages of work with patients were: categorization of patients, diagnosis, and patient education. First impressions appeared to determine expectations of self-management abilities, although these were amenable to change. Intermediate stages were 'ways of working' (breaking the task down, cognitive restructuring and addressing dissonance, modelling 'good' behaviour, encouragement, listening, involving carers and referral) and maintaining relationships with patients. However, in the longer-term nurses seemed to lack resources beyond personal experience and intuitive ways of working for encouraging effective self-care.


CONCLUSIONS
The ways of working identified are unlikely to be sufficient to support patients' self-management, pointing to a need for education to equip nurses with techniques to work effectively with patients dealing with longer-term effects of chronic illness.
Macdonald
Wendy
W
National Primary Care Research and Development Centre, Manchester, UK. wendy.macdonald@manchester.ac.uk
Rogers
Anne
A
Blakeman
Tom
T
Bower
Peter
P
D002908:Chronic Disease / Q000451:nursing*; D003142:Communication; D006302:Health Services Research; D006801:Humans; D007407:Interviews as Topic; D009722:Nurse Practitioners; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D010353:Patient Education as Topic / Q000379:methods; D011320:Primary Health Care / Q000458:organization & administration*; D012648:Self Care; D006113:United Kingdom