Engaging general practice nurses in chronic disease self-management support in Australia: insights from a controlled trial in chronic obstructive pulmonary disease
Julia A. E. Walters A E , Helen Courtney-Pratt B , Helen Cameron-Tucker A , Mark Nelson A , Andrew Robinson B , Jenn Scott C , Paul Turner D , E. Haydn Walters A and Richard Wood-Baker AA Menzies Research Institute, University of Tasmania, Private Bag 23, Hobart, Tas. 7000, Australia.
B School Of Nursing and Midwifery, University of Tasmania, Private Bag 121, Hobart, Tas. 7001, Australia.
C School Of Psychology, University of Tasmania, Private Bag 30, Hobart Tas. 7001, Australia.
D School of Computing and Information Systems, University of Tasmania, Private Bag 87 Hobart, Tas. 7001, Australia.
E Corresponding author. Email: Julia.Walters@utas.edu.au
Australian Journal of Primary Health 18(1) 74-79 https://doi.org/10.1071/PY10072
Submitted: 13 October 2010 Accepted: 18 May 2011 Published: 21 October 2011
Abstract
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 workforce that has occurred over recent years. Mixed methods were used to investigate the potential for general practice nurses to adopt 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 chronic obstructive pulmonary disease patients to identify and achieve personal health related goals through action plans. Of 21% of invited practices that responded, 19 were allocated to health mentoring; however, general practice nurses were unable to train as health mentors in 14 (74%), principally due to lack of financial compensation and/or workload pressure. For five general practice nurses trained as health mentors, their roles had previously included some chronic disease management, but training enhanced their understanding and skills of self-management approaches and increased the focus on patient partnership, prioritising patients’ choices and achievability. Difficulties that led to early withdrawal of health mentors were competing demands, insufficient time availability, 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 that training can enhance general practice nurses’ skills to deliver self-management support in chronic disease, there are significant system barriers that need to be addressed through funding models and organisational change.
Additional keywords: behaviour change, health mentoring, qualitative research.
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