Davisson Erica A, Swanson Elizabeth A
Erica A. Davisson, MSN, RN-BC, is a PhD candidate and research assistant at the University of Iowa College of Nursing. She also continues to work as a staff nurse at the University of Iowa Hospitals and Clinics. Her research focuses on staff nurses' decision making during discharge planning for patients with heart failure. Elizabeth A. Swanson, PhD, RN, is Associate Professor at the University of Iowa College of Nursing. Dr. Swanson is the author of 64 journal articles and book chapters and 11 edited books. She is a part of a work group defining the value of the discipline of nursing. Dr. Swanson serves as a reviewer for five nursing journals.
Prof Case Manag. 2018 Jan/Feb;23(1):10-18. doi: 10.1097/NCM.0000000000000244.
Rural status confounds chronic disease self-management. The purpose of this qualitative, descriptive study was to evaluate the nurse-led "Living Well" chronic disease management program reporting patient recruitment and retention issues since program initiation in 2013. The Chronic Care Model (CCM) was the guiding framework used to reinforce that interdisciplinary teams must have productive patient interactions for their program(s) to be sustainable.
A rural, Midwest county clinic's chronic disease management program.
Observations, interviews, and within- and across-case coding were used. Patients' responses were analyzed to identify (1) reasons for recruitment and retention problems and (2) program elements that were viewed as successful or needing improvement. A convenience sample of 6 rural, English-speaking adults (65 years or older, with no severe cognitive impairment) with at least one chronic condition was recruited and interviewed.
Themes emerged related to nurse knowledge, availability, and value; peer support; overcoming barriers; adherence enhancement; and family/friends' involvement. Patients reported engagement in self-management activities because of program elements such as support groups and productive nurse-patient interactions. Interdisciplinary communication, commitment, and patient referral processes were identified as reasons for recruitment and retention issues.
Findings substantiated that certain elements must be present and improved upon for future rural programs to be successful. Interdisciplinary communication may need to be improved to address recruitment and retention problems. It was clear from patient interviews that the nurse coordinators played a major role in patients' self-management adherence and overall satisfaction with the program. This is important to case management because results revealed the need for programs of this nature that incorporate the vital role of nurse coordinators and align with the CCM value of providing a supportive community health care resource for patients with chronic disease.
农村地区的情况使慢性病自我管理变得复杂。这项定性描述性研究的目的是评估自2013年项目启动以来，由护士主导的“生活得好”慢性病管理项目，该项目报告了患者招募和留存方面的问题。慢性病护理模式（CCM）是指导框架，用于强化跨学科团队必须与患者进行有效的互动，其项目才能可持续发展。
中西部一个乡村县诊所的慢性病管理项目。
采用观察、访谈以及案例内和案例间编码。对患者的回答进行分析，以确定（1）招募和留存问题的原因，以及（2）被视为成功或需要改进的项目要素。招募并访谈了6名农村地区、讲英语的成年人（65岁及以上，无严重认知障碍），他们至少患有一种慢性病，作为便利样本。
出现了与护士知识、可及性和价值；同伴支持；克服障碍；增强依从性；以及家人/朋友参与相关的主题。患者报告称，由于支持小组和有效的护患互动等项目要素，他们参与了自我管理活动。跨学科沟通、投入程度和患者转诊流程被确定为招募和留存问题的原因。
研究结果证实，未来农村项目要取得成功，必须具备并改进某些要素。可能需要改善跨学科沟通，以解决招募和留存问题。从患者访谈中可以清楚地看出，护士协调员在患者的自我管理依从性以及对项目的总体满意度方面发挥了主要作用。这对病例管理很重要，因为结果表明需要这类纳入护士协调员重要作用并符合慢性病护理模式为慢性病患者提供支持性社区医疗资源这一价值理念的项目。
