Graves Helen, Garrett Christopher, Amiel Stephanie A, Ismail Khalida, Winkley Kirsty
Diabetes Research Group, Division of Diabetes & Nutritional Sciences, Faculty of Life Sciences and Medicine, King's College London, SE5 9RJ, UK.
Diabetes Research Group, Division of Diabetes & Nutritional Sciences, Faculty of Life Sciences and Medicine, King's College London, SE5 9RJ, UK.
Prim Care Diabetes. 2016 Oct;10(5):376-82. doi: 10.1016/j.pcd.2016.03.001. Epub 2016 Mar 19.
Evidence for the efficacy of psychological skills training as a method of supporting patients' self-management is growing, but there is a shortage of mental health providers with specialist diabetes knowledge to deliver them. Primary care nurses are now increasingly expected to learn and use these techniques. This study explores nurse experience of training in six psychological skills to support patients' self-management of type 2 diabetes.
Semi-structured interviews elicited themes relating to nurses' experiences of participating in a trial of a psychological intervention, the Diabetes-6 study (D-6). Nurses were employed in GP surgeries in 5 South London boroughs. Thematic framework analysis was used to compare and contrast themes across participants. Nine nurses delivering the intervention (n=11), and 7 from the control intervention (n=12, no psychological element) were interviewed.
Three key themes were identified: (i) positive and negative impact of D6 on nurses' practice: positives included patient empowerment; negatives included patients' capacity to engage; (ii) professional boundaries including concerns about over-stepping role as a nurse and (iii) concerns about degree of support from physicians at participating practices in integrating psychological and diabetes care.
Primary care nurses report that psychological skills training can have a positive impact on patient care. Significant role adjustment is required, which may be aided by additional support from the practice team. Qualitative evaluation of effectiveness of psychological interventions may reveal processes that hinder or contribute to efficacy and translation. Appropriate support is necessary for primary care nurses to deliver psychological therapies with confidence.
心理技能训练作为支持患者自我管理方法的有效性证据日益增多，但缺乏具备糖尿病专科知识的心理健康服务提供者来实施这些训练。现在越来越期望初级保健护士学习并运用这些技巧。本研究探讨护士参与六项心理技能训练以支持2型糖尿病患者自我管理的经验。
通过半结构化访谈引出与护士参与心理干预试验（糖尿病-6研究，D-6）的经验相关的主题。护士受雇于伦敦南部5个行政区的全科医生诊所。采用主题框架分析法对参与者的主题进行比较和对比。对9名实施干预的护士（共11名）和7名来自对照干预组（共12名，无心理干预成分）的护士进行了访谈。
确定了三个关键主题：（i）D6对护士实践的积极和消极影响：积极方面包括增强患者权能；消极方面包括患者参与的能力；（ii）专业界限，包括对超越护士角色的担忧；（iii）对参与诊所的医生在整合心理护理和糖尿病护理方面提供支持程度的担忧。
初级保健护士报告称，心理技能训练可对患者护理产生积极影响。需要进行重大的角色调整，实践团队的额外支持可能会有所帮助。对心理干预效果的定性评估可能会揭示阻碍或促进疗效及转化的过程。初级保健护士要自信地提供心理治疗，适当的支持是必要的。
