University of Hertfordshire, UK.
Int J Nurs Stud. 2012 Jan;49(1):2-14. doi: 10.1016/j.ijnurstu.2011.10.023. Epub 2011 Nov 16.
The global response to the rise in prevalence of chronic disease is a focus on the way services are managed and delivered, in which nurses are seen as central in shaping patient experience. However, there is relatively little known on how patients perceive the changes to service delivery envisaged by chronic care models.
The PEARLE project aimed to explore, identify and characterise the origins, processes and outcomes of effective chronic disease management models and the nursing contributions to the models. Design, settings and participants Case study design of seven sites in England and Wales ensuring a range of chronic disease management models. Participants included over ninety patients and family carers ranging in age from children to older people with conditions such as diabetes, respiratory disease, epilepsy, or coronary heart disease.
Semi-structured interviews with patients and family carers. Focus groups were conducted with adolescents and children. A whole systems approach guided data collection and data were thematically analysed.
Despite nurses' role and skill development and the shift away from the acute care model, the results suggested that patients had a persisting belief in the monopoly of expertise continuing to exist in the acute care setting. Patients were more satisfied if they saw the nurse as diagnostician, prescriber and medical manager of the condition. Patients were less satisfied when they had been transferred from an established doctor-led to nurse-led service. While nurses within the study were highly skilled, patient perception was guided by the familiar rather than most appropriate service delivery. Most patients saw chronic disease management as a medicalised approach and the nursing contribution was most valued when emulating it.
Patients' preferences and expectations of chronic disease management were framed by a strongly biomedical discourse. Perceptions of nurse-led chronic disease management were often shaped by what was previously familiar to the patient. At a strategic level, autonomous nursing practice requires support and further promotion to wider society if there is to be a shift in societal expectation and trust in the nurse's role in chronic disease management.
全球应对慢性病患病率上升的措施集中于管理和提供服务的方式，其中护士被视为塑造患者体验的核心。然而，对于慢性病管理模式所设想的服务提供方式的改变，患者如何感知，我们知之甚少。
PEARLE 项目旨在探索、确定和描述有效的慢性病管理模式的起源、过程和结果，以及护理对这些模式的贡献。
设计、地点和参与者：采用英格兰和威尔士七个地点的案例研究设计，以确保涵盖多种慢性病管理模式。参与者包括 90 多名患者和家属，年龄从儿童到老年人不等，所患疾病包括糖尿病、呼吸道疾病、癫痫或冠心病等。
对患者和家属进行半结构化访谈。对青少年和儿童进行焦点小组讨论。全系统方法指导数据收集，对数据进行主题分析。
尽管护士的角色和技能得到了发展，并且从急性护理模式转变，但结果表明，患者仍然坚信专业知识的垄断仍然存在于急性护理环境中。如果患者认为护士是疾病的诊断者、处方者和医疗管理者，他们会更满意。当他们从成熟的医生主导的服务转至护士主导的服务时，他们会感到不满。尽管研究中的护士技能很高，但患者的看法受到熟悉的服务模式而非最合适的服务模式的影响。大多数患者将慢性病管理视为一种医学方法，而当护理模式效仿该方法时，其贡献最受重视。
患者对慢性病管理的偏好和期望受到强烈的生物医学话语的影响。对护士主导的慢性病管理的看法往往受到患者先前熟悉的因素的影响。在战略层面上，如果要改变社会对护士在慢性病管理中的角色的期望和信任，自主护理实践需要得到支持和向更广泛的社会进一步推广。
