An investigation into patients' and diabetes specialist nurses' experience of diabetes consultations in primary care.

摘要

The role of diabetes specialist nurses in delivering diabetes consultations has been recognised for more than a decade, particularly since the publication of the Standards for Specialist Education and Practice by the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) in 2001. However, evidence on how the consultation is delivered, together with patients’ experiences, is somewhat limited. This study examined diabetes specialist nurses’ and patients’ consultation experiences in primary care. It also investigated the process and outcome of these diabetes consultations.udThis research utilised a sequential mixed methods single approach design in which qualitative was followed by quantitative investigation. In the qualitative stage, 7 diabetes specialist nurses and 7 patients were interviewed separately, followed by observations of 7 nurse-patient consultations. The data from the interviews were analysed thematically, whereas the data from nurse patient consultations were examined though conversation analysis (CA). The investigation continued quantitatively, where the questionnaires were developed based on the qualitative findings and adaptation of the Consultation Quality Index (CQI-2). Following on from a pilot study, the questionnaires were sent to adult patients with diabetes (n=150) and 40 completed questionnaires were returned for statistical analysis. The qualitative and quantitative findings were then merged in a matrix diagram to reveal holistic findings on consultation experiences.udThe thematic analysis of patients’ interviews produced five themes which were: ‘I don’t like living with diabetes’, ‘Daily problems’, ‘Coping with my diabetes’, ‘How the nurses approach me’ and ‘My expectations toward the diabetes specialist nurses’ . In contrast, the themes from the nurses focused not only on the diabetes consultation but also care management issues: ‘Current problems’, ‘My expectations towards the patients’, ‘Consultation approaches’, ‘Personal development’ and ‘Team working’. Details on the sequence and scope of consultations were obtained from conversation analysis which highlighted the approaches commonly used by the diabetes specialist nurses. The statistical analysis showed associations between partnership and empathy (P=0.01), empathy and outcome (P= 0.005), information giving and consultation time (P= 0.05). The integration of qualitative and quantitative findings suggested ‘Consultation stages’ as a theme, and also four themes related to consultation experiences: ‘Day to day hurdle’, ‘Knowing each other’, ‘Shared expectations’and ‘Working together’.udThis study has identified the value and processes of the nurse-patient consultation in diabetes care from a nursing context. In general, the patients experienced their consultations with the DSNs positively. They highlighted key personal characteristics of the nurses. Similarly, the nurses considered their role in delivering consultation as crucial. Some challenges were evident including patients’ behaviours, the diabetes knowledge of other health care professionals and the lack of administrative support. The association between the nurses’ empathetical approaches and the patients’ outcomes needs further investigation.