General practice nurse views of interactiona lstrategies necessary for lifestyle risk communication

Problem

Due to increases in chronic disease and the ageing population, presentations in general practice are more complex. General practice nurses (GPNs) provide an important role in chronic disease management (CDM), creating ideal opportunities for conversations about lifestyle risk. Patients perceive that GPNs can complete most activities required for CDM and their ongoing relationships with their patients support and enable lifestyle risk conversations. Addressing lifestyle risk is complex, involving environmental, social and personal mechanisms to support behaviour change. Practitioner-patient dynamics and environments are important to support patients’ confidence for behaviour change. Patients with complex needs are particularly vulnerable, where engagement is difficult due to poor clinician communication and time constraints, patient ill-health, poor health literacy or means to make healthy choices. Interactional factors support rapport and approachability but little is known about how interactions support lifestyle risk communication. In this context, this study aims to explore GPN views of interactional strategies needed for lifestyle risk communication.

Approach

This research forms part of a larger mixed methods study seeking to understand how GPNs perceive and communicate lifestyle risk. Fifteen general practice nurses from 14 practices were recruited between August 2017 and March 2018 from South East New South Wales and Canberra regions, Australia. Participants were from a mix of urban and rural centres as well as corporate and small business practices. Semi-structured interviews were audio-recorded and transcribed verbatim. Interviews were uploaded to NVivo version 11 and analysis informed by Braun and Clark.

Findings

Due to the volume of data, the first of four themes is reported here. ‘Relational factors’ described two subthemes (i) communication techniques and (ii) relational continuity necessary for lifestyle risk communication. These included patient-centred and authoritarian communication techniques, active listening, conversing in a realistic way, giving palatable amounts of information and understanding patient communication needs necessary for engagement. Relational continuity, required familiarity and rapport, approachability and specific methods such as “chipping” and “digging” away as needed for lifestyle risk communication. Being approachable and maintaining rapport with patients was seen as necessary for ongoing relationships and effective communication about lifestyle risk. In this environment, successes and failures in behaviour change could be openly discussed.

Consequences

To assist in addressing increased patient need in chronic disease prevention and management, this research suggests ways for GPNs and practices to optimise GPNs’ role in lifestyle risk reduction interventions. Lifestyle risk communication requires repeated interactions and environments where person-centred communication can occur. However, ongoing training and workplace support for nurse-patient interactions, including visibility of the nurses’ role, would better support patient need in general practice.