Practice nurses' perceptions of their contribution to the care of individuals with chronic health conditions : an exploratory descriptive study : a thesis submitted in partial fulfilment of the requirements for the degree of Master of Philosophy in Nursing at Massey University

Abstract

The release of the New Zealand Primary Health Care (PHC) Strategy (King, 2001), placed an increased emphasis on the provision of healthcare in the community or primary health care setting, and in particular on the role of PHC nursing. Alongside this, new roles are being created which practice nurses are expected to fulfil such as 'Care Plus', which is an initiative of the PHC strategy providing funding for increased care of people with high needs due to chronic conditions or terminal illness. Practice nurses are health care providers in general practice settings, and it is assumed that they make a significant contribution to the health of individuals with chronic conditions. In this study an exploratory descriptive approach was used to explore practice nurses' perceptions of their contribution to the care of individuals with chronic conditions. The total number of participants was eleven. Thematic content analysis was used to develop themes from the data. Overall practice nurses described three key areas of contribution: The preparation of the individual for an appointment at the general practice, care provided by the practice nurse at the general practice, and the giving of information. Each theme consisted of a considerable level of complex processes employed by the practice nurses, with all being inextricably interwoven within the care. A number of dualities were apparent that impact on the contribution practice nurses perceive they make to individuals with chronic conditions, within the reality of their practice contexts. The systems within which the practice nurse participants described working posed certain challenges to the fulfilment of the role of registered nurse. Recommendations include the significance of the development and maintenance of nurse-client relationships, achieving a balance between the organisation provided by computerised systems and client centred care, and the concept of adequate time for interactions with individuals. Recommendations regarding nursing's role in acknowledgment of the individual as an active participant in care, the recognition of an individual's right of choice regarding ongoing contact with the general practice, and a need to recognise a focus of care as support of client self-management also arise from this study.