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The nursing contribution to chronic disease management: a case of public expectation? Qualitative findings from a multiple case study design in England and Wales

Wilson, Patricia M., Brooks, Fiona, Procter, Susan, Kendall, Sally (2012) The nursing contribution to chronic disease management: a case of public expectation? Qualitative findings from a multiple case study design in England and Wales. International Journal of Nursing Studies, 49 (1). pp. 2-14. ISSN 0020-7489. (doi:10.1016/j.ijnurstu.2011.10.023) (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.2011.10.023

Abstract

Background The global response to the rise in prevalence of chronic disease is a focus on the way services are managed and delivered, in which nurses are seen as central in shaping patient experience. However, there is relatively little known on how patients perceive the changes to service delivery envisaged by chronic care models. Objectives The PEARLE project aimed to explore, identify and characterise the origins, processes and outcomes of effective chronic disease management models and the nursing contributions to the models. Design, settings and participants Case study design of seven sites in England and Wales ensuring a range of chronic disease management models. Participants included over ninety patients and family carers ranging in age from children to older people with conditions such as diabetes, respiratory disease, epilepsy, or coronary heart disease. Methods Semi-structured interviews with patients and family carers. Focus groups were conducted with adolescents and children. A whole systems approach guided data collection and data were thematically analysed. Results Despite nurses’ role and skill development and the shift away from the acute care model, the results suggested that patients had a persisting belief in the monopoly of expertise continuing to exist in the acute care setting. Patients were more satisfied if they saw the nurse as diagnostician, prescriber and medical manager of the condition. Patients were less satisfied when they had been transferred from an established doctor-led to nurse-led service. While nurses within the study were highly skilled, patient perception was guided by the familiar rather than most appropriate service delivery. Most patients saw chronic disease management as a medicalised approach and the nursing contribution was most valued when emulating it. Conclusions Patients’ preferences and expectations of chronic disease management were framed by a strongly biomedical discourse. Perceptions of nurse-led chronic disease management were often shaped by what was previously familiar to the patient. At a strategic level, autonomous nursing practice requires support and further promotion to wider society if there is to be a shift in societal expectation and trust in the nurse's role in chronic disease management.

Item Type: Article
DOI/Identification number: 10.1016/j.ijnurstu.2011.10.023
Uncontrolled keywords: Chronic disease; Delivery of health care; Disease management; Nurse's practice patterns; Patient-centred care
Subjects: R Medicine > RA Public aspects of medicine
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 11:04 UTC
Last Modified: 29 May 2019 12:04 UTC
Resource URI: https://kar.kent.ac.uk/id/eprint/39067 (The current URI for this page, for reference purposes)
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