ABSTRACT
Background
Practice Nurses (PN) play an increasing role in chronic disease management, however,
this role is poorly defined.
Question
How do Practice Nurses in New Zealand, Canada and the United Kingdom manage chronic
disease?
Aim
This systematic review aims to identify the barriers and facilitators for practice
nurses in New Zealand (NZ), Canada and the United Kingdom (UK) when caring for patients
with a chronic disease. To determine how Practice Nurses in three high income countries
manage chronic disease.
Methods
We searched Scopus, Web of Science, Cumulative Index to Nursing and Allied Health
Literature, (CINAHL), and MEDLINE in February 2021. The initial search yielded 495
articles. Four hundred and sixty-four articles were excluded because they did not
address the research question or included the community nurse or nurse practitioner.
Nine articles with a total sample size of 1050 PN participants met the inclusion criteria.
Findings
Six main themes were identified that outline the barriers and facilitators to the
role of the practice nurse when managing chronic disease: financial incentives, funding,
power differences between the nurse and patient and the nurse and doctor, time, education,
and role ambiguity.
Discussion
Policy initiatives across the three countries were replicated with similar barriers
and facilitators to the PN role.
Conclusion
Working within a context driven by incentive funding and competing demands can be
prohibitive to the effective management of chronic disease by the PN.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to CollegianAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Practice nurse involvement in general practice clinical care: Policy and funding issues need resoultion.Australian Health Review. 2014; 38: 301-305https://doi.org/10.1071/AH13107
American Academy of Family Physicians. (2020). Primary Care Collaborative. Retrieved from pcpcc.org/about/shared-principles.
- Nurses’ role in long-term conditions care.Kai Tiaki Nursing New Zealand. 2016; 22: 16-17
- Continuing education for primary health care practitioners in Ontario, Canada.Nurse Education Today. 2013; 33: 353-357https://doi.org/10.1016/j.nedt.2012.07.018
- Using thematic analysis in psychology.Qualitative Research in Psychology. 2006; 3: 77-101https://doi.org/10.1191/1478088706qp063oa
- Community health and wellness - Principles of primary health care.6th ed. Elsevier Australia, Chatswood, New South Wales, Australia2019
Critical Appraisal Skills Programme. (2021). Retrieved from https://casp-uk.net/.
- Contribution by primary health nurses and general practitioners to the Diabetes Annual Review (Get Checked) programme in Auckland, New Zealand.The New Zealand Medical Journal. 2013; 126 (Retrieved from): 15-26
- Are nurses more likely to report providing care plans for chronic disease patients then doctors? Findings from a New Zealand study.Chronic Illness. 2015; 11: 210-217https://doi.org/10.1177/1742395314567479
- The patient-centred medical home in the USA.Journal of Evaluation in Clinical Practice. 2011; 2: 373-375https://doi.org/10.1111/j.1365-2753.2010.01607.x
- The impact of funding changes on implementation primary health care policy.Primary Health Care Research and Development. 2012; 13 (doi:10.1017/S): 120-129
- NHS Can learn a lot from New Zealands health care system.The Guardian. 2014; (Retrieved from)
- New Zealand health system: Universalism struggles with persisting inequities.Lancet. 2019; 3: 432-442https://doi.org/10.1016/S0140-6736(19)31238-3
- Health policy and advanced practice nursing: Impact and implications.Springer Publishing Company, New York2014 (Vol. Unit IV)
- PRISMA2020: R package and ShinyApp for producing PRISMA 2020 compliant flow diagrams.Zenodo. 2021; https://doi.org/10.5281/zenodo.4287834
- The role of government policy in supporting nurse-led care in general practice in United Kingdom, New Zealand and Australia: An adapted realist review.Journal of Advanced Nursing. 2012; 68: 963-980https://doi.org/10.1111/j.1365-2648.2011.05870.x
- Primary Health Care Systems in Canada: Systems in Motion.The Milbank Quarterly. 2011; 89 (Retrieved from): 256-288
- Implementing, embedding and integrating self-management support tools for people with long-term conditions in primary care nursing: A qualitative study.International Journal of Nursing Studies. 2014; 51 (Retrieved from): 1103-1113https://doi.org/10.1016/j.ijnurstu.2013.11.008
- “On the margins and not the mainstream:” Case selection for the implementation of community based primary health care in Canada and New Zealand.International Journal of Integrated Care. 2017; 17: 15https://doi.org/10.5334/ijic.2501
- Team composition and chronic disease management within primary healthcare practices in eastern Ontario: An application of the Measuting Organizational Attributes of Primary Health Care Survey.Primary Health Care Research and Development. 2018; 19: 622-628https://doi.org/10.1017/S14634236180000257
- Nursing contributions to chronic disease management in primary care.The Journal of Nursing Administration. 2014; 44: 103-110https://doi.org/10.1097/NNA.0000000000000033
- Practice nurses and the facilitation of self-management in primary care.Journal of Advanced Nursing. 2008; 62: 191-199https://doi.org/10.1111/j.1365-2648.2007.04585.x
- Nurses in expanded roles to strengthen community-based health promotion and chronic care: Policy implications from an international perspective: A commentary.Israel Journal of Health Policy Research. 2018; 7https://doi.org/10.1186/s13584-018-0257-5
- Dependence and identity: Nurses and chronic conditions in a primary care setting.Journal of Health Organization and Management. 2008; 22: 294-308https://doi.org/10.1108/1477260810883558
- The implementation and impact of different funding initiatives on access to multidisciplinary primary health care and policy implicatins.Medical Journal of Australia. 2008; 88: S69-S72
Ministry of Health. (2019). Working as a nurse in New Zealand. Retrieved from https://www.health.govt.nz/our-work/nursing/nurses-new-zealand/working-nurse-new-zealand.
National Nursing Assessment Service. (2022). RN, RPN and LPN requirements in Canada. Retrieved from https://www.nnas.ca/nursing-requirements-in-canada/.
- Assessing chronic disease management in European health systems.European Observatory on Health Systems and Policies Concepts and Approaches. 2014; : 1-85
- Utilization of registered nurses in primary care teams: A systematic review.International Journal of Nursing Studies. 2017; 74: 15-23https://doi.org/10.1016/j.ijnurstu.2017.05.013
Nursing and Midwifery Council. (2022). Becoming a nurse. Retrieved from https://www.nmc.org.uk/education/becoming-a-nurse-midwife-nursing-associate/becoming-a-nurse/.
- Health care spending in the United States and other high income countries.The Journal of the American Medical Association. 2018; 319: 1024-1039https://doi.org/10.1001/jama.2018.1150
- Nursing activities for patients with chronic disease in family medicine groups: A multiple-case study.Nursing Inquiry. 2018; 67: 35-42https://doi.org/10.1111/nin.12250
- Rationale and standards for the systematic review of qualitative literature in health sciences research.Qualitative Health Research. 1998; 8: 341-351
- Cohort profile: The epidemiology of chronic diseases and multimorbidity. The EpiChron Cohort Study.International Journal of Epidemiology. 2018; 47: 382-384fhttps://doi.org/10.1093/ije/dyx259
- The feasability and acceptability of nurse-led chronic disease management interventions in primary care: An integrative review.Journal of Advanced Nursing. 2017; 74: 279-288https://doi.org/10.1111/jan/13450
- How do policy and institutional settings shape opportunities for community based primary health care? A comparison of Ontario Quebec and New Zealand.International Journal of Integrated Care. 2017; 17: 1-15https://doi.org/10.5335/ijic.2514
- A realist review: What do nurse-led self management interventions achieve for outpatients with a chronic condition?.Journal of Advanced Nursing. 2016; 73: 1255-1271https://doi.org/10.1111/jan.13189
- General Practice Nursing.McGraw Hill, Sydney2010
- Understanding the Australian Health Care System.3rd ed. Elsevier, Chatswood, New South Wales2016 (Vol. Section 1:4)
World Health Organization. (2018). Non communicable diseases key facts. Retrieved from https://www.who.int/en/news-room/fact-sheets/detail/noncommunicable-diseases.
Article info
Publication history
Published online: September 26, 2022
Accepted:
September 8,
2022
Received in revised form:
August 10,
2022
Received:
April 1,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Australian College of Nursing Ltd. Published by Elsevier Ltd.
