Engaging general practice nurses in chronic disease self-management support in Australia: insights from a controlled trial in chronic obstructive pulmonary disease
Walters, JAE and Courtney-Pratt, H and Cameron-Tucker, H and Nelson, M and Robinson, A and Scott, J and Turner, P and Walters, EH and Wood-Baker, R, Engaging general practice nurses in chronic disease self-management support in Australia: insights from a controlled trial in chronic obstructive pulmonary disease, Australian Journal of Primary Health, 18, (1) pp. 74-79. ISSN 1448-7527 (2012) [Refereed Article]
The growing burden of chronic disease will increase the role of primary care in supporting self-management and health-behaviour change. This role could be undertaken to some extent by the increased practice nurse work-force that has occurred over recent years. Mixed-methods were used to investigate the potential for general practice nurses adopting this role during a 12-month randomised controlled study of telephone-delivered health-mentoring in Tasmanian practices. Nurses (general practice and community health) were trained as health-mentors to assist COPD patients to identify and achieve personal health related goals through action plans. Of 21% of invited practices responding, 19 were allocated to health-mentoring but general practice nurses were unable to train as health-mentor in 14 (74%) principally due to lack of financial compensation and/or work load pressure. For five general practice nurses trained as health-mentors, roles currently included some chronic disease management, but training enhanced their self-management understanding and skills and increased the focus on patient-partnership, prioritising patients’ choices and achievability. Difficulties that lead to early withdrawal of health-mentors were competing demands, insufficient time available, phone calls having lower priority than face-to-face interactions and changing employment. Skills gained were rated as valuable, applicable to all clinical practice and transferable to other health care settings. Although these results suggest training can enhance general practice nurses’ skills to deliver self-management support in chronic disease, there are significant systems barriers that will also need to be addressed through funding models and organisational change.
behaviour change, health mentoring, qualitative research