A critical analysis of practice nurses' experiences of self-management in patients with chronic obstructive pulmonary disease

Background

Individuals with long term conditions are thought to manage their health more favourably through self-management, however in the United Kingdom there is a lack of evidence within the Practice Nurse population to demonstrate the use of this strategy in Chronic Obstructive Pulmonary Disease (COPD) patients.

Method

Phenomonological research was undertaken to critically analyse the experiences of Practice Nurses (PN’s) utilising self-management strategies in patients with COPD. Ethical approval was granted and 8 PN’s working within General Practice with responsibility for the regular review of patients with COPD were interviewed. Two focus groups using semi-structured interviews were undertaken and data was analysed using Colaizzis model (Colazzi 1978).

Results

Three key themes were identified: “Practice Nurse Perceptions”, “Practice” and “Resources”.

Practice Nurse perceptions in both focus groups highlighted that self-management was not appropriate for all patients with COPD. They identified that particular behaviours were required of the patient to enable them to self-manage effectively such as the use of a prescription as part of an action plan when the patient has an exacerbation of their condition. They perceived that patients’ experienced stigma in relation to their condition, which hindered their participation in self-management.

PN’s within both groups acknowledged the need for support from health professionals to assist patients to effectively self-manage their condition. Increased workload and time constraints for PN’s was a contributory factor in their ability to undertake self-management strategies in patients with COPD. Findings from the National Institute for Health Research suggest that tensions in health policy and inherent contradictions in the context of health care delivery are hampering the implementation of Chronic Disease Management (CDM) models (Kendall et al, 2010).

PN’s informed the researcher of a variety of self-management resources for improving the care of patients with COPD. However, 25% (N=2) participants out of the sample population did not perceive Pulmonary Rehabilitation (PR) as a useful tool for self-management. Participants in both groups voiced concerns regarding access to PR programmes however this was not a collective view. The National Institute for Clinical Excellence (NICE, 2011) COPD quality standard requires that service providers ensure multidisciplinary PR programmes are timely and accessible. However, a British Lung Foundation (BLF) survey (BLF, 2012) concluded that despite the introduction of the COPD Clinical Standards, Managed Clinical Networks were struggling to secure adequate funding to deliver the levels of basic provision required by patients(NHS Quality Improvement Scotland, 2010).

Participants in both focus groups were motivated to support self-management in individuals with COPD. They discussed the use of various resources they had developed and implemented within their practice. Both groups however discussed a desire for a “clearer structure” or “guideline” to enable them to carry out self-management.

Discussion

This research has demonstrated the lack of the use of an evidence base with COPD self-management and Practice Nursing. PN’s remain motivated to facilitate patients to self-manage COPD, however, there are major constraints within General Practice which mitigate against this.