Primary care nurses struggle with lifestyle counseling in diabetes care: a qualitative analysis

BMC Family Practice

Research Article

Trudy van der Weijden¹  Glyn Elwyn²  Richard Grol³  Renate Jansink³  Jozé Braspenning³ 

[1] Department of General Practice, School for Primary Care and Public Health, Maastricht University, P.O. Box 616, 6200, Maastricht, MD, The Netherlands;Department of Primary Care and Public Health, School of Medicine, Cardiff University, Heath Park, CF14 4XN, UK;Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500, HB Nijmegen, The Netherlands;

关键词: Physical Activity;    Smoking Cessation;    Implementation Strategy;    Diet Counseling;    Practice Level;   

DOI  :  10.1186/1471-2296-11-41

 received in 2010-02-03, accepted in 2010-05-25,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundPatient outcomes are poorly affected by lifestyle advice in general practice. Promoting lifestyle behavior change require that nurses shift from simple advice giving to a more counseling-based approach. The current study examines which barriers nurses encounter in lifestyle counseling to patients with type 2 diabetes. Based on this information we will develop an implementation strategy to improve lifestyle behavior change in general practice.MethodIn a qualitative semi-structured study, twelve in-depth interviews took place with nurses in Dutch general practices involved in diabetes care. Specific barriers in counseling patients with type 2 diabetes about diet, physical activity, and smoking cessation were addressed. The nurses were invited to reflect on barriers at the patient and practice levels, but mainly on their own roles as counselors. All interviews were audio-recorded and transcribed. The data were analyzed with the aid of a predetermined framework.ResultsNurses felt most barriers on the level of the patient; patients had limited knowledge of a healthy lifestyle and limited insight into their own behavior, and they lacked the motivation to modify their lifestyles or the discipline to maintain an improved lifestyle. Furthermore, nurses reported lack of counseling skills and insufficient time as barriers in effective lifestyle counseling.ConclusionsThe traditional health education approach is still predominant in primary care of patients with type 2 diabetes. An implementation strategy based on motivational interviewing can help to overcome 'jumping ahead of the patient' and promotes skills in lifestyle behavioral change. We will train our nurses in agenda setting to structure the consultation based on prioritizing the behavior change and will help them to develop social maps that contain information on local exercise programs.

【 授权许可】

CC BY   
© Jansink et al; licensee BioMed Central Ltd. 2010