Professional and organizational obstacles to establishing a new specialist service in primary care: case study of an epilepsy specialist nurse.

摘要

BACKGROUND: Few evaluations of the effectiveness of specialist nurse-led services explore the nurse's experiences, attitudes and qualities. This can help us to understand why a service has the effects it does and to inform new specialist nurses of potential difficulties. AIM: To explore the experiences, feelings and perceived problems of providing a new specialist nurse service from the nurse's perspective. METHODS: This was a case study nested within a controlled trial that assessed the effectiveness of an epilepsy specialist nurse-led service on the quality of patient care. In-depth interviews were conducted with the specialist nurse at the end of the first and second year of the new service. Interviews were audio-tape recorded and transcribed verbatim. Transcribed text was methodically coded and themes were identified. A descriptive account, summarizing the findings of both interviews, was written based on the thematic coding of text. RESULTS: Overall, the epilepsy nurse felt a sense of achievement and believed that the service had had a beneficial impact on both patients and health care professionals in the locality. However, she experienced many operational problems, especially adapting to a primary care setting, difficulties in meeting practice staff and in motivating them, and contending with a heavy workload. These problems were partly attributable to her lack of community work experience and more generally to the structure of the service. CONCLUSIONS: Findings indicate that specialist nurses responsible for providing primary care services would benefit from having theoretical knowledge and practical experience of working in the community prior to starting in post. The aims of a service need to be consistent with the available resources. Accounts of other specialist nurse's experiences of providing a primary care service could help to reduce set up time. Finally, support in the form of a coherent team is important to avoid feelings of professional isolation and to maximize effective use of specialist skills.