Spirometry (lung function assessment) is an essential tool for the chronic disease management of chronic obstructive pulmonary disease (COPD). Chronic disease monitoring for COPD was introduced in 2004 and included spirometry for target achievement and financial remuneration within the Quality and Outcomes Framework of the General Medical Services Contract. However, practice nurses have anecdotally struggled to gain competence and expertise with the spirometric procedure and interpretation post 2004, despite the successful achievement of financial targets within the general practice setting. A sequential exploratory mixed methods study (Tashakkori and Teddlie, 2003) was undertaken within a University Health Board in Wales to determine what, if any, barriers exist for practice nurses undertaking spirometry assessment and interpretation for the chronic disease management of COPD. Quantitative data were collected via an online questionnaire. Qualitative interviews were conducted and analysed using an analysis framework method (Ritchie et al, 2003). The methodological framework of the feminist transformative lens (Caracelli and Greene, 1997) was utilised to gain an understanding of the barriers practice nurses faced in the gaining of competence with spirometry assessment and interpretation within the wider professional context. The quantitative results confirmed the anecdotal reports of difficulty with spirometry and demonstrated that lack of training was the greatest reason for lack of confidence in spirometric interpretation, followed by lack of clinical time and lack of general practitioner (GP) support. The qualitative results demonstrated that practice nurses are commonly working as disenfranchised isolated practitioners within general practice teams, and are commonly undertaking a procedure in which they are not highly confident. Recommendations for development of future clinical practice are: mandatory training with assessment of competency to improve skills with spirometry, in addition to supervisory support and training of GP colleagues. Other recommendations include: a greater focus on inter-professional team working to reduce professional isolation and disenfranchisement of practice nurses, and for practice nurses to actively contribute to local and national initiatives to improve spirometry services in the long term.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:685534 |
| Date | January 2016 |
| Creators | Faulkner, Trudy |
| Publisher | Cardiff University |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://orca.cf.ac.uk/91215/ |
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