Understanding how general practice nurses support adult lifestyle risk reduction: An integrative review

Abstract

Aim: To review the literature exploring how general practice nurses support lifestyle risk reduction. Design: Integrative literature review. Sources: CINAHL, Emcare, MEDLINE, Proquest and Scopus were searched for peerreviewed primary research published in English from 2010 to 2022. Methods: Sixteen papers met the inclusion criteria and were assessed for methodological quality using the Mixed Methods Appraisal Tool. Findings were extracted and thematically analysed. Results: Four themes described general practice nurses: (1) Establishing relational connections; (2) Empowering active participation; (3) Engaging mutual motivation and (4) Enabling confident action. General practice nurses used complex interpersonal, risk communication and health coaching skills to build collaborative partnerships that supported patients' self-determination and self-efficacy. While mutual motivation and confidence were reciprocally enabling, gaps in skills, experience and knowledge plus time, resource and role constraints limited general practice nurses' ability to support lifestyle risk reduction. Conclusion: General practice nurses play a key role in lifestyle risk reduction. Ongoing education, funding, organizational and professional support are needed to enhance their commitment, confidence and capacity.

Understanding factors affecting implementation success and sustainability of a comprehensive prevention program for cardiovascular disease in primary health care: a qualitative process evaluation study combining RE-AIM and CFIR

“…These findings are consistent with other studies describing the need for adequate funding, along with sufficient time and resources to facilitate the uptake of preventive actions in general practice and to mitigate the role constraints practitioners experience within current health systems (Volker et al, 2017;Alageel et al, 2018). Such support is also essential to enhance the continuity of preventive care and implementers' commitment, confidence, and capacity to expand their scope of practice to systematically taking up preventive tasks (James et al, 2019;Morris et al, 2022). In accordance with our insights stipulating the structural integration of health promotion and prevention into existing work processes and systems, evidence recommends policy makers to facilitate the delivery of such interventions during routine practice (Keyworth et al, 2020).…”

“…Limitations of relevant competences have been previously identified as a barrier to nurses' active involvement in preventive care (Volker et al, 2017). Our experiences are consistent with literature describing the need for ongoing education for upskilling existing nursing profiles to a more advanced level (James et al, 2019;Casey et al, 2022;Morris et al, 2022), especially with regard to patient-centered communication (James et al, 2020b), behavior change theories and counseling, and motivational interviewing; optimizing nurses' effectiveness in communicating about lifestyle risk reduction and the reduction of chronic disease (James et al, 2020a;Hills et al, 2022). Pioneering countries in integrating nurses in general practice, such as the United Kingdom, Australia, and Canada, demonstrate that introducing quality standards, linked with quality performance reimbursement, may support ongoing professionalization, unambiguous articulation of roles and scope, and development of formal educational and career pathways, hereby enabling nurses to practice to their full scope in primary health care teams (Parker et al, 2009;Halcomb et al, 2017).…”

Integrated person‐ and people‐centred primary care for diabetes in low‐ and middle‐income countries: The nurses' perspective on patient needs

“…This interest in evolving towards a more horizontal collaborative relationship between two motivated people facilitates behavioural change (Morris et al, 2022). Apart from a warm empathic attitude, identified by both nurses and people with T2D, some skills are necessary to engage in an intercultural dialogue like the ability to speak Quechua.…”

“…An essential element of this programme will be to capacitate PHC providers in diabetes management and prevention. Timely recognition of risk factors will allow for timely diagnosis and directed screening (Morris et al, 2022). A population screening for type 2 diabetes has an uncertain impact on all-cause mortality (Peer et al, 2020).…”

“…Both stakeholders seemed to have doubts about self‐care. Nurses identified the need to motivate people for self‐care, but gave it a lower importance than patient education, notwithstanding its essential role (Kamei et al, 2017; Morris et al, 2022). People with T2D gave a lower‐than‐average importance rating to the statements: ‘having a journal to register and follow‐up foods, symptoms, blood sugar… daily’ and ‘having the capacities to control a device to check blood sugar’ (Leyns et al, 2021).…”