Hawke’s Bay practice nurses’ perceptions of the delivery of diabetes care

Abstract

This research asked the question, what are Hawke’s Bay practice nurses’ perspectives, experiences and expectations of providing diabetes care in the primary health care setting? This involved interviewing registered nurses working in the primary care setting providing diabetes care to patients in Hawke’s Bay, New Zealand.

Whilst there is a vast amount of literature about models of care for the management of long-term conditions in the primary healthcare setting, much of it does not apply well to the healthcare system or population of New Zealand. There is also much variation regarding the definition and practice of a dedicated diabetes nurse’s role. The literature also explores potential barriers and enablers to diabetes care for both patients and health providers delivering the care, but none is specific to New Zealand nursing.

This research is a qualitative study using face-to-face, semi-structured interviews to obtain rich data from ten registered nurses providing diabetes care in primary care, employed by nine different clinical practices. A general inductive approach was used to analyse the data and identify key themes.

This research is the first in New Zealand to explore the registered nurses’ roles and perceptions of providing diabetes care in primary care. The nurses interviewed described what care they were delivering, the influences on this, their perceived effectiveness of the care they provided and how they measured this. It found much variability in the role, even within this one province. This variability is influenced by a number of factors including: the background experience and confidence of the nurse providing diabetes care; the support provided by the employing practice and tools the practice utilises; and the time allocated to diabetes management in the practice configuration.

The findings of this research have implications for both the primary and secondary healthcare service teams involved in the coordination and delivery of diabetes care in New Zealand. Recommendations include implementing an educational framework for practice nurses providing diabetes care, and developing service guidelines and standards of care to ensure equitable care for all patients with diabetes, regardless of which practice or care provider they attend. The increasing rates of diabetes, and complications that arise from the disease, demands a commitment to the development of advanced nursing practice to improve the delivery of diabetes care across New Zealand.