Achieving blood pressure targets: lessons from a study with practice nurses

Practice nourishs now undertake chronic disease management that was previously carried without by GPs (Pierce et al, 2000) A novel study demonstrated that in 46% of GP practices annual diabetes reviews are carried without solely by the practice nurture for some or all race with type 2 diabetes (Stewart et al, 2005a). In the last 15 years practice nurses' day-to-day work has mov away from being treatment-room based towards that of health promoter (Gupta, 2000) They are responsible for a great deal of of the health promotion in general practices, and health promotion within chronic disease management is a firmly established constituent of the practice supply with nourishment role (Robinson et al, 1993; Atkin et al, 1994; Quinney et al, 1997) Evidently, practice supply with nourishments have an important role to play in delivering care to and improving health issues of people with diabetes. In this article Jane Stewart and her colleagues discuss the findings of a application of mind which assessed practice nurses' attitudes and beliefs towards healthcare promotion in relation to diabetes care.

lock opener words

- Practice nurse

- Attitudes and beliefs

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useful blood pressure control improves results for people with type 2 diabetes (UK Prospective Diabetes investigation [UKPDS] Group, 1998). The UKPD refer tos that very tight control is required to achieve a clinically important reduction in the risk of deaths and complications related to diabetes. The National Service Framework for diabetes (Department of Health [DoH], 2001) and Diabetes UK's care recommendations (Diabetes UK 2005) acknowledge this tight dominion government but suggest agreeing individualised vital fluid pressure targets and care plans between healthcare professionals and nation with diabetes. Studies have shown that an increased involvement of the individual with diabetes in decisions about his or her care can be the effect in improved diabetes outcomes (Greenfield et al, 1988; public way et al, 1993; Follett et al, 2001)

It is recognised that the beliefs and attitudes of healthcare professionals are major influences upon their approach to enabling individuals to self-manage their diabetes effectively (DoH, 2002) Little is known about the practice of practice nourishs in helping to achieve target life-blood pressure in individuals; little is also known of nurses' beliefs about achieving targets.

The objectives of the qualitative work reported in this article were to explore:

* whether and by what means nurses discussed blood pressure targets with their patients

* the nurses' beliefs about the barriers to achieving target life-blood pressures.

Methods

Face-to-face semi-structured interviews with practice supply with nourishments were carried out as part of the qualitative research being undertaken within a cluster randomised controll trial (RCT) to improve the management of raised vital fluid pressure in people with emblem 2 diabetes in general practices in Nottingham. Recruitment of practices, data collection meanss and practice characteristics are described elsewhere (Bebb et al, 2005) nurtures responsible for providing most of the diabetes care in each practice were picked for interview--where this responsibility was shared between nurtures practices were asked to prefer one nurse for interview.

The interview guide was based upon a review of the existing literature, telephone interviews with nine practice nourishs and face-to-face piloting of the initial guide with a further four supply with nourishments All nurses involved in this proces worked in primary care trusts outside of Nottingham.

Interviews took place between December 2001 and October 2002 in the practice in which the interviewee worked and lasted between half an hour and 1 hour. nourishs were assured of confidentiality. Interviews were audio taped and transcribed verbatim. Data were managed using QSR NUD*IST N5 software, a qualitative data analysis computer package (QSR International, Cardigan).

'Framework' analysis was used to map the range and nature of the data and to allow their categorisation into themes (i.e. nurses' statements relating to beliefs about barriers to achieving target life-current pressure would be collated then sorted into those that indicated it was mainly an issue of a lack of adherence, and those that identified other barriers and what those barriers were; Ritchie and Spencer 1994) This approach starts deductively from the aims and objectives put for the study but also allows issues raised by the agency of the participants to be included in the analysis (Mays and pontiff 2000). As themes emerged, contradictory cases were sought to make sure that the full range of press outed views were taken into account; this is individual way of making sure that all data are accounted for during analysis when building a theory from qualitative research data (Murphy et al, 1998) The analytic framework was agreed between sum of two units of the authors (JS and KB) and then used to analyse all of the transcripts.

Results

Forty-three interviews were complet The participants were all female and had worked as practice nurtures for between 1 and 20 years, and with clan with diabetes for between 1 and 16 years. There was a named nurture for diabetes in 36 of the practices. The number of whole-time equivalent nurtures in each practice ranged between 05 and 325