1.3.2 Defining and evaluating the contribution of nurses to chronic disease management (200)
Angus Forbes, Senior Lecturer, Florence Nightingale School of Nursing and Midwifery, King's College London, United Kingdom Co authors: Alison While & Freda Mold
Abstract:
This session will present the findings of a multifaceted literature review of the contribution of nurses to chronic disease management (CDM). This is a Department of Health funded review and part of a larger programme of work examining nursing roles in CDM.
Aim:
To examine the nature of the nursing contribution (conceptualisation) and provide an assessment of the impact of that contribution (effectiveness).
Method:
A systematic review was performed using a blend of protocol based searching, ‘snowballing’ and personal knowledge to identify the material for the review. The review focussed on diabetes, MS and COPD. The included material were critically appraised and subject to tabulative, narrative, meta-analysis and theoretical syntheses.
Findings:
The review provides an overview of the empirically proven impact of nurses on clinical structures, processes, outcomes and costs. The review presents models of key role developments such as hierarchical and lateral role expansion. Additional models detailing the contribution of nurses in relation to assessment, health promotion, clinical care and care organisation are presented. The review also explores the relationship between nurses and technology considering how new technologies such as the incorporation of telemedicine approaches are changing the working environment for nurses. The review found that in CDM the world of care is becoming increasingly virtual in nature, with nurses often providing the place of care (being the person through which the patient enters and is supported in the care system). The review considers whether nurses have been empowered by these innovations in CDM systems or have become alienated by them.
Conclusion:
Overall the review provides a comprehensive and in some ways provocative account of the nursing in CDM, providing some novel perspectives on the way nursing work and labour is constructed in CDM care systems. We hope the presentation of this review will stimulate some lively discussion.
Biography:
Angus Forbes is a senior lecturer in the Florence Nightingale School of Nursing and Midwifery at King’s College London, his main area of interest is in chronic disease management (diabetes and MS). Angus specialises in health services research and has completed studies: evaluating specialist nursing roles; modelling the transitions from child to adult care; developing learning needs analysis tools; developing a questionnaire to measure social capital; scoping the contribution of nurses to child health; and modelling the factors the predict diabetes outcomes in primary care. Currently he is working on a three year study funded by the SDO to examine the contribution of nurses to chronic disease focussing on diabetes, MS and COPD. He is also developing an intervention to support weight loss in patients with diabetes. In addition, Angus runs a programme of inter-professional diabetes courses. Angus has a clinical background in community nursing and primary health care, having worked in East London as a district nurse, health visitor and community practice teacher. He was previously a lecturer in health services research at UCL Medical School Primary Care Department.