Self‐management support in routine primary care by nurses

Westland, Heleen; Schröder, Carin D.; Wit, J. de; Frings, Judith; Trappenburg, Jaap C.A.; Schuurmans, Marieke J.

doi:10.1111/bjhp.12276

Cited by 20 publications

(27 citation statements)

References 41 publications

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“…Thus, the fulcrum of motivation and sense of competence in TPE resides in nurses' and nursing assistants' general ability to handle their emotions and those of patients. This result supports previous findings showing that nurses' behaviours in TPE were more oriented towards assessing and advising, that is towards medical tasks, which they master, than towards collaborative goal‐setting and emotional management (Duprez et al, ; Elissen et al, ; ter Maten‐Speksnijder, Dwarswaard, Meurs, & van Staa, ; Westland et al, ) where they feel less competent (Nichols, Vallis, Boutette, Gall Casey, & Yu, ). Nevertheless, healthcare professionals recognize the great importance of addressing psychosocial issues for optimal TPE (Nichols et al, ), but still lack adequate and effective training for this (Duprez, Vandecasteele, Verhaeghe, Beeckman, & Van Hecke, ).…”

Section: Discussionsupporting

confidence: 89%

Nurses' and nursing assistants' emotional skills: A major determinant of motivation for patient education

Lelorain

Bachelet

Wortel

et al. 2019

Journal of Advanced Nursing

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Aims To explore professionals' (i.e. nurses and nursing assistants) motivation for Patient Education according to their emotional skills. Design A cross‐sectional study using a convenience sample of professionals completing self‐reported questionnaires assessing their general emotional skills and their Patient‐Education‐related sense of competence, autonomy and relatedness, according to the theory of basic psychological needs. Methods Professionals from 27 French hospitals working in various departments completed paper and web‐based questionnaires between January 2015 ‐ May 2017. Mediation analyses were performed controlling for the already known variables associated with motivation for patient education. Results Usable questionnaires (N = 185) were analysed. Professionals' emotional skills were associated with their motivation for Therapeutic Patient Education both directly and indirectly (i.e. partial mediation) via a higher sense of competence in Patient Education. Among the covariates, professionals who had received a high‐level training in Patient Education, those with a high recognition of their work in patient education and nurses (compared with nursing assistants) were the most motivated. Conclusion Professionals' emotional skills are the mainstay of their motivation for Patient Education. Training should aim to develop these skills so that professionals can manage their own emotions better (e.g. frustration when faced with non‐motivated patients) and those of patients (e.g. discouragement) and thus effectively support patient self‐management. Impact The study addressed nurses' and nursing assistants' motivation for patient education. Their emotional skills were directly and indirectly – via a higher sense of patient‐education‐related competence – associated with higher motivation. Training for professionals should therefore develop their emotional skills.

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Section: Discussionsupporting

confidence: 89%

Nurses' and nursing assistants' emotional skills: A major determinant of motivation for patient education

Lelorain

Bachelet

Wortel

et al. 2019

Journal of Advanced Nursing

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“…The intervention structure and BCTs were relatively new to the nurses, as they were not specifically trained in applying and tailoring the BCTs prior to their participation in the Activate trial. Another study examining self-management support by primary care nurses in routine care found that nurses seldom focus on behaviour change and infrequently use effective techniques to support this change [33]. This strengthens the need for such training and support, because nurses are in a key position to deliver behaviour change interventions in primary care [11].…”

Section: Discussionmentioning

confidence: 99%

Nurses’ perceptions towards the delivery and feasibility of a behaviour change intervention to enhance physical activity in patients at risk for cardiovascular disease in primary care: a qualitative study

et al. 2018

Self Cite

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BackgroundSelf-management support is widely accepted for the management of chronic conditions. Self-management often requires behaviour change in patients, in which primary care nurses play a pivotal role. To support patients in changing their behaviour, the structured behaviour change Activate intervention was developed. This intervention aims to enhance physical activity in patients at risk for cardiovascular disease in primary care as well as to enhance nurses’ role in supporting these patients. This study aimed to evaluate nurses’ perceptions towards the delivery and feasibility of the Activate intervention.MethodsA qualitative study nested within a cluster-randomised controlled trial using semistructured interviews was conducted and thematically analysed. Fourteen nurses who delivered the Activate intervention participated.ResultsThree key themes emerged concerning nurses’ perceptions of delivering the intervention: nurses’ engagement towards delivering the intervention; acquiring knowledge and skills; and dealing with adherence to the consultation structure. Three key themes were identified concerning the feasibility of the intervention: expectations towards the use of the intervention in routine practice; perceptions towards the feasibility of the training programme; and enabling personal development.ConclusionsDelivering a behaviour change intervention is challenged by the complexity of changing nurses’ consultation style, including acquiring corresponding knowledge and skills. The findings have increased the understanding of the effectiveness of the Activate trial and will guide the development and evaluation of future behaviour change interventions delivered by nurses in primary care.Trial registrationClinicalTrials.gov NCT02725203.Electronic supplementary materialThe online version of this article (10.1186/s12875-018-0888-1) contains supplementary material, which is available to authorized users.

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“…Furthermore, the delity and quality of delivery varied within and across nurses, which is consistent with routine care [32] and might also have in uenced the real delivery of the intervention [33]. Moreover, despite our expectations and efforts, nurses submitted only a low number of audio-recordings across the intervention period, which might have over-estimated the delity of delivery as these consultations are likely to represent a 'best case' scenario [27].…”

mentioning

confidence: 88%

“…However, the delity of delivery of the BCTs was moderate and therefore showed room for improvement. In routine care, nurses insu ciently focused on behaviour change support and rarely applied BCTs [32]. Therefore, one could argue whether nurses were able to apply the BCTs correctly, despite the comprehensive training.…”

mentioning

confidence: 99%

Fidelity of primary care nurses’ delivery of a behaviour change intervention to enhance physical activity in chronic patients

Westland¹,

Trappenburg²,

Schuurmans³

et al. 2020

Preprint

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Background The effectiveness of a nurse-led intervention to enhance physical activity, the Activate intervention, was evaluated in primary care patients at risk for cardiovascular diseases in a cluster-randomised controlled trial (n = 195 patients, 31 general practices). To contribute to an accurate interpretation of the trial results, understanding of how the intervention works and enabling reproducibility, this study aimed to evaluate the fidelity of delivery of the Activate intervention by assessing: 1. self-reported fidelity of delivery; 2. observed fidelity of delivery; 3. quality of nurses’ delivery of the Activate intervention and 4. nurses’ beliefs about their capability, motivation, confidence and effectiveness towards delivering the Activate intervention, including behaviour change techniques. Methods An observational study was conducted. Nurses’ self-reported fidelity was evaluated using checklists (n = 279), and the observed fidelity and quality of delivery were examined using audio-recordings of intervention consultations (n = 44). Nurses’ beliefs towards delivering the intervention were assessed using questionnaires (n = 72). Results The self-reported fidelity was 87.6% and observed fidelity was 85.6%, representing high fidelity. The observed fidelity of applied behaviour change techniques was moderate (76.8%). The observed quality of delivery was sufficient and varied among nurses (mean 2.9; SD 4.4; range 0–4). Nurses’ beliefs about their capability, motivation, confidence and effectiveness towards delivering the intervention increased during the trial. Conclusions Nurses delivered most intervention components as intended with sufficient quality. Nurses believed they were capable, motivated and confident to deliver the intervention. They believed the intervention was effective to increase patients’ physical activity level. Despite the high fidelity and moderate fidelity of applied behaviour change techniques, the varying quality of delivery within and across nurses might have diluted the effectiveness of the Activate intervention. Trial registration: ClinicalTrials.gov NCT02725203 registered 31 March, 2016, https://clinicaltrials.gov/ct2/show/NCT02725203.

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Self‐management support in routine primary care by nurses

Cited by 20 publications

References 41 publications

Nurses' and nursing assistants' emotional skills: A major determinant of motivation for patient education

Nurses' and nursing assistants' emotional skills: A major determinant of motivation for patient education

Nurses’ perceptions towards the delivery and feasibility of a behaviour change intervention to enhance physical activity in patients at risk for cardiovascular disease in primary care: a qualitative study

Fidelity of primary care nurses’ delivery of a behaviour change intervention to enhance physical activity in chronic patients

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