title: Working with older people with multiple long-term conditions: a qualitative exploration of nurses' experiences.
abstract: OBJECTIVE
  (1) to generate in-depth insights into how nurses are working with older people with multiple long term conditions; (2) to gain an understanding of how nurses perceive professional patient navigation; and (3) to explore the barriers and facilitators to nurses adopting a navigation role in the context of Primary Health Care practice.
  
  
  BACKGROUND
  Internationally, Primary Health Care has been identified as the main navigation point for older people with multiple long term conditions. Navigation models have been developed in cancer care but there is a lack of research in the context of Primary Care. There is also little evidence about the extent to which current work patterns of nurses providing care for this patient group fit with professional patient navigation models.
  
  
  METHODS
  A descriptive exploratory qualitative study.
  
  
  METHODS
  Semi-structured audio recorded telephone interviews were conducted in 2012 with nurses in New Zealand who were working with older people with multiple long term conditions (n = 42) Interviews were transcribed verbatim and entered into Nvivo 9 for thematic analysis.
  
  
  RESULTS
  The key themes represent patterns of nursing work as; system work, relationship work and patient work. While nurses lacked a coherent understanding of patient navigation as a concept, the way they worked had some elements in common with professional navigation models.
  
  
  CONCLUSIONS
  Further research involving older people in co-designing patient navigation approaches in Primary Health Care is needed to inform these types of service development and translate action from existing health policy.
authors.affiliation: School of Nursing, Department of Medical and Health Sciences, University of Auckland, New Zealand.
authors.forename: Susan
authors.initials: S
authors.lastname: Waterworth
authors.forename: Merryn
authors.initials: M
authors.lastname: Gott
authors.forename: Deborah
authors.initials: D
authors.lastname: Raphael
authors.forename: John
authors.initials: J
authors.lastname: Parsons
authors.forename: Bruce
authors.initials: B
authors.lastname: Arroll
mesh_terms: D000368:Aged; D002908:Chronic Disease; D006299:Health Services for the Aged; D006801:Humans; D009740:Nursing Staff / Q000523:psychology*; D036301:Qualitative Research
keywords: long term conditions; older people; patient navigation; primary health care