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Practice nurses and the facilitation of self-management in primary care

Macdonald, Wendy, Rogers, Anne, Blakeman, Tom and Bower, Peter (2008) Practice nurses and the facilitation of self-management in primary care Journal of Advanced Nursing, 62, (2), pp. 191-199. (doi:10.1111/j.1365-2648.2007.04585.x). (PMID:18394031).

Record type: Article


Aim: 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.

Method: 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.

Findings: 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.

Conclusion: 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

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Published date: 2008
Organisations: Faculty of Health Sciences


Local EPrints ID: 343050
ISSN: 0309-2402
PURE UUID: 97775ef2-cd82-4f97-aef4-e153d70294f4

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Date deposited: 21 Sep 2012 13:10
Last modified: 18 Jul 2017 05:25

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Author: Wendy Macdonald
Author: Anne Rogers
Author: Tom Blakeman
Author: Peter Bower

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