What are patients’ perceptions of the nursing contribution within a Ministry of Health funded semi-structured programme currently known as CarePlus?

Abstract

Patients with chronic conditions have complex needs and receive care in both primary and secondary health care settings. As the largest primary health care workforce, nurses have the potential to fully support patients with chronic conditions especially when navigating health and treatment as well as applying self management strategies. This research project explores patient perception of the nursing contribution in the New Zealand CarePlus chronic care management programme. CarePlus is a primary health care funding stream established by the Ministry of Health in 2004. It provides additional funding for health providers regardless of discipline in general practice to see patients with chronic or terminal conditions more regularly during a twelve month period. The CarePlus programme involves nurses and/or general practitioners assisting patients to set health goals in relation to their conditions. Nursing roles are pivotal in the delivery of the CarePlus programme which focuses on setting health goals and fostering patient self management. Patient self management is critical, given that the burden of chronic conditions is increasing. Patients with chronic conditions have found additional care provided by CarePlus to be beneficial. This study seeks to identify specifically what the patient perceived as ‘additional care’ resulting from the nursing contribution. A qualitative methodology was used to collect data from a small purposive sample of participants with at least two chronic conditions and who were registered into the CarePlus programme within Hawkes Bay Primary Health Organisation (HBPHO). An iterative thematic content of data collection and analysis was undertaken. Data were categorised into themes and interpretive methodology used to develop a framework for analysing patient perceptions. Findings are presented in relation to literature and with transcript examples. Five themes emerged: Clinical Support, Coaching, Interpersonal Communication, Guide and Interpreter, and Working Toward Wellness. Understanding patient perceptions of their care will provide nurses with potential to enhance elements of that care and to better understand the context around which patients deal with their health issues as well as assist them to adopt chronic conditions management strategies. Implications and recommendations of how nursing roles may be better defined and aligned within the primary health care team are provided. Once established, it is important for these to be communicated to patients so that they feel confident with those roles and know what to expect from their primary health care team.