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Lenzen SA, Daniëls R, van Bokhoven MA, van der Weijden T, Beurskens A. Development of a conversation approach for practice nurses aimed at making shared decisions on goals and action plans with primary care patients. BMC Health Serv Res 2018; 18:891. [PMID: 30477566 PMCID: PMC6258162 DOI: 10.1186/s12913-018-3734-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 11/19/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Primary care nurses play a crucial role in setting personal goals and action plans together with chronically ill patients. This may be a challenge for practice nurses, who are often trained to adopt protocol-based work routines. The aim of this study was to systematically develop a conversation approach, and a corresponding training course, for practice nurses aimed at making shared decisions about goals and actions with their chronically ill patients. METHODS The 6-step iterative Intervention Mapping protocol was used as a framework. This paper describes the first four steps of the protocol. After the first step, in which literature studies as well as qualitative studies were conducted, the overall aim and objectives for the approach were formulated (step 2). In step 3, methods and strategies for the approach were chosen, which were translated into practical components in step 4. In addition, a pilot study was conducted. RESULTS The main objectives of the approach focus on the ability of practice nurses to explore the patients' perspectives from a holistic point of view, to explicitly formulate goals and action plans, to tailor shared decision making about goals and action plans to individual patients, and to continuously reflect on work-related attitudes. The approach consists of a practical framework for shared decision making about goals and actions. The framework involves a tool for exploring patients' perspectives and a tool for identifying patient profiles, to facilitate tailoring shared decision making. A comprehensive training course for practice nurses was developed. CONCLUSION We systematically developed a conversation approach, involving a practical framework with several tools, which aims to support practice nurses in making shared decisions about goals and actions with their patients. As practice nurses need support in their learning process to be able to share decisions with patients, we also developed a comprehensive training course for them. The approach and the training course were developed in close collaboration with important stakeholders. Some critical factors for the implementation of the approach were revealed. These factors will be addressed in the next step, a process evaluation (not part of this paper).
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Affiliation(s)
- Stephanie Anna Lenzen
- Research Centre for Autonomy and Participation for People with a Chronic Illness, Zuyd University of Applied Sciences, Nieuw Eyckholt 300, 6419, DJ, Heerlen, the Netherlands.
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.
| | - Ramon Daniëls
- Assistive Technology in Healthcare, Zuyd University of Applied Sciences, Heerlen, the Netherlands
| | - Marloes Amantia van Bokhoven
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Anna Beurskens
- Research Centre for Autonomy and Participation for People with a Chronic Illness, Zuyd University of Applied Sciences, Nieuw Eyckholt 300, 6419, DJ, Heerlen, the Netherlands
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
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Hailu FB, Hjortdahl P, Moen A. Nurse-Led Diabetes Self-Management Education Improves Clinical Parameters in Ethiopia. Front Public Health 2018; 6:302. [PMID: 30406070 PMCID: PMC6206899 DOI: 10.3389/fpubh.2018.00302] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/02/2018] [Indexed: 02/02/2023] Open
Abstract
Background: Unlike in developed countries, the clinical effectiveness of diabetes self-management education (DSME) is not well-studied in the African context. Thus, this study sought to determine effects of DSME on clinical outcomes among type 2 diabetic (T2DM) patients in Ethiopia. Methods: Before-and-after controlled study design was employed, with random assignment of 116 T2DM adult patients to a nurse-led DSME group and 104 to a treatment-as-usual (comparison) group. A nurse-led DSME with six sessions supported with illustrative pictures handbooks and fliers was customized to local conditions and delivered by trained nurses over 9 months. Our primary outcome was a change in the proportion of people with target glycated hemoglobin (HbA1c ≤ 7%). We used chi-square test and mixed model analysis. Results: Seventy-eight (67%) and 64 (62%) participants assigned to intervention and comparison, respectively completed the study, and included in the final analysis. Mean HbA1c was significantly reduced by 2.88% within the intervention group and by 2.57% within the comparison group. However, change in the proportion of participants with target HbA1c and end-line mean HbA1c difference between the groups were not significant. Adjusted end-line fasting blood sugar (FBS), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were significantly lower in the intervention group, by 27 ± 9 mg/dL, 12 ± 3, and 8 ± 2 mmHg, respectively. Conclusion: After 9 months of nurse-led DSME, HbA1c was significantly reduced within both groups but there was no significant difference in HbA1c between groups. The intervention also showed some clinically significant effects on blood pressure and FBS. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT03185689, retrospectively registered on June 14, 2017 on ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT03185689.
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Affiliation(s)
- Fikadu Balcha Hailu
- Faculty of Medicine, Institute for Health and Society, University of Oslo, Oslo, Norway.,School of Nursing and Midwifery, Jimma University, Jimma, Ethiopia
| | - Per Hjortdahl
- Faculty of Medicine, Institute for Health and Society, University of Oslo, Oslo, Norway
| | - Anne Moen
- Faculty of Medicine, Institute for Health and Society, University of Oslo, Oslo, Norway
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Lenzen SA, Stommel W, Daniëls R, van Bokhoven MA, van der Weijden T, Beurskens A. Ascribing patients a passive role: Conversation analysis of practice nurses’ and patients’ goal setting and action planning talk. Res Nurs Health 2018. [DOI: 10.1002/nur.21883] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Stephanie A. Lenzen
- Research Centre for Autonomy and Participation for People with a Chronic Illness; Zuyd University of Applied Sciences; Heerlen the Netherlands
- Department of Family Medicine; CAPHRI School for Public Health and Primary Care; Maastricht University; Maastricht the Netherlands
| | - Wyke Stommel
- Centre for Language Studies; Radboud University; Nijmegen the Netherlands
| | - Ramon Daniëls
- Research Centre for Autonomy and Participation for People with a Chronic Illness; Zuyd University of Applied Sciences; Heerlen the Netherlands
| | - Marloes A. van Bokhoven
- Department of Family Medicine; CAPHRI School for Public Health and Primary Care; Maastricht University; Maastricht the Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine; CAPHRI School for Public Health and Primary Care; Maastricht University; Maastricht the Netherlands
| | - Anna Beurskens
- Research Centre for Autonomy and Participation for People with a Chronic Illness; Zuyd University of Applied Sciences; Heerlen the Netherlands
- Department of Family Medicine; CAPHRI School for Public Health and Primary Care; Maastricht University; Maastricht the Netherlands
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Lenzen SA, van Dongen JJJ, Daniëls R, van Bokhoven MA, van der Weijden T, Beurskens A. What does it take to set goals for self-management in primary care? A qualitative study. Fam Pract 2016; 33:698-703. [PMID: 27411728 PMCID: PMC5161487 DOI: 10.1093/fampra/cmw054] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND There is an increasing number of patients with a chronic illness demanding primary care services. This demands for effective self-management support, including collaborative goal setting. Despite the fact that primary care professionals seem to have difficulties implementing goal setting, little information is available about the factors influencing the complexity of this process in primary care. OBJECTIVE The aim of this study was to contribute to an understanding of the complexity of self-management goal setting in primary care by exploring experts' and primary care professionals' experiences with self-management goal setting and viewpoints regarding influencing factors. METHODS A descriptive qualitative research methodology was adopted. Two focus groups and three individual interviews were conducted (total participants n = 17). Thematic content analysis was used to analyse the data. RESULTS The findings were categorized into four main themes with subordinated subthemes. The themes focus around the complexity of setting non-medical goals and around professionals' skills and attitudes to negotiate and decide about goals with patients. Furthermore, patients' skills and attitudes for goal setting and the integration of goal setting in the time available were formulated as themes. CONCLUSIONS Setting self-management goals in primary care, especially in family medicine, might require a shift from a medical perspective to a biopsychosocial perspective, with an increasing role set aside for the professional to coach the patient in expressing his self-management goals and to take responsibility for these goals.
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Affiliation(s)
- Stephanie Anna Lenzen
- Research Centre for Autonomy and Participation for People with a Chronic Illness, Zuyd University of Applied Sciences, Heerlen, The Netherlands and .,Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Jerôme Jean Jacques van Dongen
- Research Centre for Autonomy and Participation for People with a Chronic Illness, Zuyd University of Applied Sciences, Heerlen, The Netherlands and.,Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Ramon Daniëls
- Research Centre for Autonomy and Participation for People with a Chronic Illness, Zuyd University of Applied Sciences, Heerlen, The Netherlands and
| | - Marloes Amantia van Bokhoven
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Anna Beurskens
- Research Centre for Autonomy and Participation for People with a Chronic Illness, Zuyd University of Applied Sciences, Heerlen, The Netherlands and.,Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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Lenzen SA, Daniëls R, van Bokhoven MA, van der Weijden T, Beurskens A. Setting goals in chronic care: Shared decision making as self-management support by the family physician. Eur J Gen Pract 2014; 21:138-44. [DOI: 10.3109/13814788.2014.973844] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lhussier M, Eaton S, Forster N, Thomas M, Roberts S, Carr SM. Care planning for long-term conditions – a concept mapping. Health Expect 2013; 18:605-24. [PMID: 23565881 DOI: 10.1111/hex.12063] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2013] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE This article focuses on approaches within clinical practice that seek to actively involve patients with long-term conditions (LTCs) and how professionals may understand and implement them. Personalized care planning is one such approach, but its current lack of conceptual clarity might have impeded its widespread implementation to date. A variety of overlapping concepts coexist in the literature, which have the potential to impair both clinical and research agendas. The aim of this article is therefore to explore the meaning of the concept of care planning in relation to other overlapping concepts and how this translates into clinical practice implementation. METHODS Searches were conducted in the Cochrane database for systematic reviews, CINHAL and MEDLINE. A staged approach to conducting the concept mapping was undertaken, by (i) an examination of the literature on care planning in LTCs; (ii) identification of related terms; (iii) locating reviews of those terms. Retrieved articles were subjected to a content analysis, which formed the basis of our concept maps. (iv) We then appraised these against knowledge and experience of the implementation of care planning in clinical practice. RESULTS AND CONCLUSIONS Thirteen articles were retrieved, in which the core importance of patient-centredness, shared decision making and self-management was highlighted. Literature searches on these terms retrieved a further 24 articles. Our concept mapping exercise shows that whilst there are common themes across the concepts, the differences between them reflect the context and intended outcomes within clinical practice. We argue that this clarification exercise will allow for further development of both research and clinical implementation agendas.
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Affiliation(s)
- Monique Lhussier
- Northumbria University, Newcastle Upon Tyne, UK.,FUSE, UKCRC Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK
| | - Simon Eaton
- Year of Care Partnerships, Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, UK
| | | | - Mathew Thomas
- NHS County Durham and Darlington, Durham, UK.,NHS North East, Newcastle Upon Tyne, Tyne and Wear, UK
| | - Sue Roberts
- Year of Care Partnerships, Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Susan M Carr
- Northumbria University, Newcastle Upon Tyne, UK.,FUSE, UKCRC Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK
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Abstract
This article provides an overview of barriers to self-care, patients' perceptions and understanding of their chronic illness, interviewing techniques, and approaches nurse practitioners can use to reduce or eliminate barriers to self-care in adults with chronic conditions.
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LOH SIEWYIM, PACKER TANYA, TAN FOOLAN, XAVIER MONICA, QUEK KIAFATT, YIP CHINGHAR. Does a self management intervention lower distress in woman diagnosed with breast cancer?1. JAPANESE PSYCHOLOGICAL RESEARCH 2011. [DOI: 10.1111/j.1468-5884.2011.00491.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Embrey N. Exploring the lived experience of palliative care for people with MS, 3: Views of group support. ACTA ACUST UNITED AC 2009. [DOI: 10.12968/bjnn.2009.5.9.44096] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Nikki Embrey
- North Midland Regional MS Service, University Hospital, North Staffordshire, Princes Road, Hartshill, Stoke-upon-Trent ST4 7LN
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