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Success and failure in integrated models of nursing for long term conditions: Multiple case studies of whole systems
Journal article   Peer reviewed

Success and failure in integrated models of nursing for long term conditions: Multiple case studies of whole systems

Susan Procter, Patricia Mary Wilson, Fiona Brooks and Sally Kendall
International journal of nursing studies, Vol.50(5), pp.632-643
2013
DOI: https://doi.org/10.1016/j.ijnurstu.2012.10.007
PMID: 23131723
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Abstract

Case study Chronic care model Chronic disease management Community matron Long term conditions Nurse specialists Primary care nursing Whole systems analysis
Background Current projections indicate that the UK faces a 252% increase in people aged over 65 with one or more long term conditions (LTC) by 2050. Nurses, managing their own caseloads and clinics, working across sectors and organisational boundaries and as part of a wider multi-disciplinary team, are frequently seen as key to managing this growing demand. However, the evidence base informing the nursing role in managing LTC, the most effective configuration of the multi-disciplinary team and the policy evidence relating to the infrastructure required to support cross organisational working, remains weak. Objectives To explore, identify and characterise the origins, processes and outcomes of effective chronic disease management models and the nursing contributions to such models. Design Case study whole systems analysis using qualitative interview methods. Settings Two community matron services, two primary care (GP) practice nursing services, two hospital based specialist nursing services were purposefully sampled from across England and Wales. Participants Selection criteria were derived using a consensus conference. The nurses in the service, all patients and carers on the caseload, members of the multi-disciplinary team and stakeholders were invited to participate. Methods Semi-structured interviews with all participants, thematic analysis within a whole system framework. Results The study found high levels of clinical nursing expertise which in the case of the community matrons was meeting the aim of reducing hospital admissions. Both the primary care and hospital nurse specialist indicate similar levels of clinical expertise which was highly valued by medical colleagues and patients. Patients continued to experience fragmented care determined by diagnostic categories rather than patient need and by the specific remit of the clinic or service the patient was using. Patient data systems are still organised around the impact on services and prevalence of disease at an individual level and not around the patient experience of disease. Conclusion Nurses are making a major contribution to meeting the policy objectives for long term conditions. Primary care nurses and hospital nurse specialists do broadly similar roles. The scope of the nursing roles and services studied were idiosyncratic, opportunistic and reactive, rather than planned and commissioned on an analysis of local population need.

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UN Sustainable Development Goals (SDGs)

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#3 Good Health and Well-Being

Source: InCites

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Citation topics
1 Clinical & Life Sciences
1.14 Nursing
1.14.1189 Primary Care Models
Web Of Science research areas
Nursing
ESI research areas
Clinical Medicine
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