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

Procter, Susan, Wilson, Patricia M., Brooks, Fiona, Kendall, Sally (2013) Success and failure in integrated models of nursing for long term conditions: Multiple case studies of whole systems. International Journal of Nursing Studies, 50 (5). pp. 632-643. ISSN 0020-7489. (doi:10.1016/j.ijnurstu.2012.10.007) (The full text of this publication is not currently available from this repository. You may be able to access a copy if URLs are provided)

The full text of this publication is not currently available from this repository. You may be able to access a copy if URLs are provided. (Contact us about this Publication)
Official URL
http://dx.doi.org/10.1016/j.ijnurstu.2012.10.007

Abstract

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 con?guration 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 speci?c 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.

Item Type: Article
DOI/Identification number: 10.1016/j.ijnurstu.2012.10.007
Uncontrolled keywords: Case study, Chronic care model, Chronic disease management, Community matron, Long term conditions, Nurse specialists, Primary care nursing, Whole systems analysis
Subjects: R Medicine > RA Public aspects of medicine
R Medicine > RC Internal medicine > RC952 Geriatrics
R Medicine > RT Nursing
Divisions: Faculties > Social Sciences > School of Social Policy Sociology and Social Research > Centre for Health Services Studies
Depositing User: Tony Rees
Date Deposited: 08 Apr 2014 09:21 UTC
Last Modified: 29 May 2019 12:04 UTC
Resource URI: https://kar.kent.ac.uk/id/eprint/39064 (The current URI for this page, for reference purposes)
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