Nurses' experience of managing adults living with multimorbidity: A qualitative study

Abstract

Background The number of adults living with two or more chronic conditions is increasing worldwide. Adults living with multimorbidity have complex physical, psychosocial and self‐management care needs. Aim This study aimed to describe Australian nurses' experience of care provision for adults living with multimorbidity, their perceived education needs and future opportunities for nurses in the management of multimorbidity. Design Qualitative exploratory. Methods Nurses providing care to adults living with multimorbidity in any setting were invited to take part in a semi‐structured interview in August 2020. Twenty‐four registered nurses took part in a semi‐structured telephone interview. Results Three main themes were developed: (1) The care of adults living with multimorbidity requires skilled collaborative and holistic care; (2) nurses' practice in multimorbidity care is evolving; and (3) nurses value education and training in multimorbidity care. Conclusion Nurses recognize the challenge and the need for change in the system to support them to respond to the increasing demands they face. Impact The complexity and prevalence of multimorbidity creates challenges for a healthcare system configured to treat individual disease. Nurses are key in providing care for this population, but little is known about nurses' experiences and perceptions of their role. Nurses believe a person‐centred approach is important to address the complex needs of adults living with multimorbidity. Nurses described their role as evolving in response to the growing demand for quality care and believed inter‐professional approaches achieve the best outcomes for adults living with multimorbidity. The research has relevance for all healthcare providers seeking to provide effective care for adults living with multimorbidity. Understanding how best to equip and support the workforce to meet the issues and demands of managing the care of adults living with multimorbidity has the potential to improve patient outcomes. Patient or Public Contribution There was no patient or public contribution. The study only concerned the providers of the service.

Nurses’ Challenges to Developing Interpersonal Relationships During Integrated Care for Complex Patients

“…14 Recent qualitative and mixed-methods studies of individuals with multimorbidity and complexity also reported that these patients expect nurses to be more cognizant of their living situations and social care needs and develop therapeutic interpersonal relationships to enhance the delivery of integrated and compassionate care. 2,15,16 Families of individuals with multimorbidity and complexity and health care teams are important partners in the delivery of person-centered integrated care. 17,18 Scoping reviews have highlighted that enhanced collaboration among health care professionals and families of patients is crucial for the delivery of integrated care.…”

“…Individuals with multimorbidity and complexity (i.e., complex patients) have multifaceted and emerging complex care needs requiring integrated patient care. 1 - 3 These individuals often live with multimorbidity (ie, two or more chronic conditions) and/or mental health issues, limited education, low socioeconomic status, and/or polypharmacy. 4 Integrated patient care is defined as “patient care that is coordinated across professionals, facilities, and support systems; continuous over time and between visits; tailored to the patients’ needs and preferences; and based on shared responsibility between patient and caregivers for optimizing health.” 5 (p113) Person-centeredness is the core dimension of integrated care, 6 and nurses, patients and their families, and health care teams are the key partners in integrated patient care, among others.…”

How is complexity measured and detected among community dwelling older people aged 65 years and over? A scoping review

“…Community nurses report increased complexity among older people, requiring additional time and resources to deliver appropriate care (McGeorge, 2011;Whitehead et al, 2021Whitehead et al, , 2023.…”

“…Clinical need relates to the types of chronic conditions, how they interact and how they are managed from a medical perspective, the person's understanding of the conditions and how they impact how they live (Whitehead et al, 2023). Thinking about the disease alone or excluding disease when determining the level of complexity could result in a shifted focus, the ICF excluding dementia is an example of this (Spoorenberg et al, 2015).…”

“…Community nurses report increased complexity among older people, requiring additional time and resources to deliver appropriate care (McGeorge, 2011; Whitehead et al, 2021, 2023). Psychosocial, environmental and safety factors contribute to complexity (Gray, 2020; Mann et al, 2021).…”