1. Implementing, embedding and integrating self-management support tools for people with long-term conditions in primary care nursing: A qualitative study.
- Author
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Kennedy, Anne, Rogers, Anne, Bowen, Robert, Lee, Victoria, Blakeman, Tom, Gardner, Caroline, Morris, Rebecca, Protheroe, Joanne, and Chew-Graham, Carolyn
- Subjects
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CHRONIC disease treatment , *POVERTY areas , *AUTONOMY (Psychology) , *BEHAVIOR modification , *COMMUNICATION , *DECISION making , *EMPLOYEES , *EXPERIENCE , *FAMILY medicine , *HEALTH behavior , *INTERVIEWING , *MATHEMATICAL models , *RESEARCH methodology , *MEDICAL office nursing , *NURSE-patient relationships , *NURSES , *NURSING practice , *PATIENT compliance , *PATIENT education , *GENERAL practitioners , *PRIMARY health care , *PROFESSIONS , *RESEARCH funding , *HEALTH self-care , *TEACHING aids , *DISEASE management , *QUALITATIVE research , *THEORY , *OCCUPATIONAL roles , *RANDOMIZED controlled trials , *CHANGE management , *PATIENT-centered care , *DESCRIPTIVE statistics - Abstract
Background: An implementation gap exists between policy aspirations for provision and the delivery of self-management support in primary care. An evidence based training and support package using a whole systems approach implemented as part of a randomised controlled trial was delivered to general practice staff. The trial found no effect of the intervention on patient outcomes. This paper explores why self-management support failed to become part of normal practice. We focussed on implementation of tools which capture two key aspects of self-management support - education (guidebooks for patients) and forming collaborative partnerships (a shared decision-making tool). Objectives: To evaluate the implementation and embedding of self-management support in a United Kingdom primary care setting. Design: Qualitative semi-structured interviews with primary care professionals. Settings: 12 General Practices in the Northwest of England located within a deprived inner city area. Participants: Practices were approached 3-6 months after undergoing training in a selfmanagement support approach. A pragmatic sample of 37 members of staff - General Practitioners, nurses, and practice support staff from 12 practices agreed to take part. The analysis is based on interviews with 11 practice nurses and one assistant practitioner; all were female with between 2 and 21 years' experience of working in general practice. Methods: A qualitative design involving face-to-face, semi-structured interviews audio- recorded and transcribed. Normalisation Process Theory framework allowed a systematic evaluation of the factors influencing the work required to implement the tools. Findings: The guidebooks were embedded in daily practice but the shared decision- making tools were not. Guidebooks were considered to enhance patient-centredness and were minimally disruptive. Practice nurses were reluctant to engage with behaviour change discussions. Self-management support was not formulated as a practice priority and there was minimal support for this activity within the practice: it was not auditable; [ABSTRACT FROM AUTHOR]
- Published
- 2014
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