Robinson Andrew, Courtney-Pratt Helen, Lea Emma, Cameron-Tucker Helen, Turner Paul, Cummings Elizabeth, Wood-Baker Richard, Walters Eugene Hayden
Faculty of Health Sciences, School of Nursing and Midwifery, University of Tasmania, Hobart, Tasmania, Australia.
J Clin Nurs. 2008 Nov;17(11c):370-9. doi: 10.1111/j.1365-2702.2008.02279.x.
To report on the process of transforming clinical practice amongst community nurses through a mentoring programme implemented to support self-management amongst community-based sufferers of chronic obstructive pulmonary disease.
The increasing incidence of and health burden from, chronic diseases has led to the emergence of more proactive, integrated chronic disease management approaches across the acute and primary care sectors. An important part of these approaches is the direct involvement of patients in their own care. Despite some difficulties with comparing the benefits of chronic disease self-management programmes, many evaluations report some benefit and all highlight the importance of health professionals in supporting self-management behaviours. In the primary care sector, community nurses are ideally situated to support these behaviours, but to do this effectively transformation of nursing practice must occur.
Qualitative, longitudinal study informed by action research methods and involving monthly group discussions with community nurse mentors.
Community nurses from four community health centres in Tasmania were trained in motivational interviewing techniques to promote self-management amongst chronic obstructive pulmonary disease patients. Nurses' mentoring experiences were monitored during group discussions and subjected to thematic analysis.
The paper reports the findings of the first 12 months of the project. In this phase, nurses experienced a transformation in their constructions of chronic obstructive pulmonary disease and their clinical practice. This involved a shift from a fatalistic, prescriptive, biomedical approach to a primary healthcare approach characterised by empathy, consultation, facilitation and a holistic focus.
Community nurses face challenges in supporting chronic disease self-management. These challenges can be overcome and a transformation in clinical practice instilled.
This study highlights that it is possible to support community nurses to take a lead role in the ongoing management of chronic disease in the community.
报告通过一项指导计划改变社区护士临床实践的过程，该计划旨在支持慢性阻塞性肺疾病社区患者的自我管理。
慢性病发病率的上升及其带来的健康负担促使急性和初级保健部门出现了更积极主动、综合的慢性病管理方法。这些方法的一个重要部分是患者直接参与自身护理。尽管在比较慢性病自我管理计划的益处方面存在一些困难，但许多评估报告了一些益处，并且都强调了卫生专业人员在支持自我管理行为方面的重要性。在初级保健部门，社区护士最适合支持这些行为，但要有效做到这一点，护理实践必须发生转变。
采用行动研究方法的定性纵向研究，包括与社区护士导师每月进行小组讨论。
对塔斯马尼亚四个社区卫生中心的社区护士进行动机性访谈技术培训，以促进慢性阻塞性肺疾病患者的自我管理。在小组讨论期间监测护士的指导经验，并进行主题分析。
本文报告了该项目前12个月的研究结果。在此阶段，护士对慢性阻塞性肺疾病的认知及其临床实践发生了转变。这涉及从宿命论、规范性的生物医学方法转向以同理心、咨询、促进和整体关注为特征的初级卫生保健方法。
社区护士在支持慢性病自我管理方面面临挑战。这些挑战是可以克服的，并且可以促使临床实践发生转变。
本研究强调，有可能支持社区护士在社区慢性病的持续管理中发挥主导作用。
