Abstract
BackgroundThe evidence base for a range of psychosocial and behavioural interventions in managing and supporting patients with long-term conditions (LTCs) is now well-established. With increasing numbers of such patients being managed in primary care, and a shortage of specialists in psychology and behavioural management to deliver interventions, therapeutic interventions are increasingly being delivered by general nurses with limited training in psychological interventions. It is unknown what issues this raises for the nurses or their patients. The purpose of the study was to examine the challenges faced by non-specialist nurses when delivering psychological interventions for an LTC (chronic fatigue syndrome/myalgic encephalomyelitis [CFS/ME]) within a primary care setting.MethodsA qualitative study nested within a randomised controlled trial [ISRCTN 74156610] explored the experiences and acceptability of two different psychological interventions (pragmatic rehabilitation and supportive listening) from the perspectives of nurses, their supervisors, and patients. Semi structured in-depth interviews were conducted with three nurse therapists, three supervisors, and 46 patients. An iterative approach was used to develop conceptual categories from the dataset.ResultsAnalyses identified four sets of challenges that were common to both interventions: (i) being a novice therapist, (ii) engaging patients in the therapeutic model, (iii) dealing with emotions, and (iv) the complexity of primary care. Each challenge had the potential to cause tension between therapist and patient. A number of strategies were developed by participants to manage the tensions.ConclusionsTensions existed for nurses when attempting to deliver psychological interventions for patients with CFS/ME in this primary care trial. Such tensions should be addressed before implementing psychological interventions within routine clinical practice. Similar tensions may be found for other LTCs. Our findings have implications for developing therapeutic alliances and highlight the need for regular supervision.
Highlights
The evidence base for a range of psychosocial and behavioural interventions in managing and supporting patients with long-term conditions (LTCs) is well-established
The management of long-term conditions (LTCs) has changed considerably over the past decade, resulting in such health problems being principally managed within primary care by general practitioners (GPs) and practice nurses (PNs), with support by specialist services when
A growing evidence base exists for the effectiveness of a range of psychological interventions that are increasingly important in the management of LTCs including chronic obstructive pulmonary disease [3], rheumatoid arthritis pain [4], and chronic pain [5,6], though this evidence base largely comes from secondary care [7]
Summary
The evidence base for a range of psychosocial and behavioural interventions in managing and supporting patients with long-term conditions (LTCs) is well-established. With increasing numbers of such patients being managed in primary care, and a shortage of specialists in psychology and behavioural management to deliver interventions, therapeutic interventions are increasingly being delivered by general nurses with limited training in psychological interventions. Primary care nurse-led clinics have proven effective in a providing care for a range of LTCs, including chronic pain [12], medically unexplained symptoms [13], irritable bowel syndrome [14], and diabetes [15]. This is likely to be an increasingly common model for care. Such therapeutic interventions will be more frequently delivered by generalist primary care nurses with limited training in psychology or mental health
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