Integrated self-management support provided by primary care nurses to persons with chronic diseases and common mental disorders: a scoping review.

AIM: To map integrated and non-integrated self-management support interventions provided by primary care nurses to persons with chronic diseases and common mental disorders and describe their characteristics. DESIGN: A scoping review. DATA SOURCES: In April 2020, we conducted searches in several databases (Academic Research Complete, AMED, CINAHL, ERIC, MEDLINE, PsycINFO, Scopus, Emcare, HealthSTAR, Proquest Central) using self-management support, nurse, primary care and their related terms. Of the resulting 4241 articles, 30 were included into the analysis. REVIEW METHODS: We used the Rainbow Model of Integrated Care to identify integrated self-management interventions and to analyze the data and the PRISMS taxonomy for the description of interventions. Study selection and data synthesis were performed by the team. Self-management support interventions were considered integrated if they were consistent with the Rainbow model's definition of clinical integration and person-focused care. RESULTS: The 30 selected articles related to 10 self-management support interventions. Among these, five interventions were considered integrated. The delivery of the interventions showed variability. Strategies used were education, problem-solving therapies, action planning, and goal setting. Integrated self-management support intervention characteristics were nurse-person relationship, engagement, and biopsychosocial approach. A framework for integrated self-management was proposed. The main characteristics of the non-integrated self-management support were disease-specific approach, protocol-driven, and lack of adaptability. CONCLUSION: Our review synthesizes integrated and non-integrated self-management support interventions and their characteristics. We propose recommendations to improve its clinical integration. However, further theoretical clarification and qualitative research are needed. IMPLICATION FOR NURSING: Self-management support is an important activity for primary care nurses and persons with chronic diseases and common mental disorders, who are increasingly present in primary care, and require an integrated approach. IMPACT: This review addresses the paucity of details surrounding integrated self-management support for persons with chronic diseases and common mental disorders and provides a framework to better describe its characteristics. The findings could be used to design future research and improve the clinical integration of this activity by nurses.

Co-design, implementation, and evaluation of an expanded train-the-trainer strategy to support the sustainability of evidence-based practice guides for registered nurses and social workers in primary care clinics: a developmental evaluation protocol.

BACKGROUND: The implementation of evidence-based innovations is incentivized as part of primary care reform in Canada. In the Province of Québec, it generated the creation of interprofessional care models involving registered nurses and social workers as members of primary care clinics. However, the scope of practice for these professionals remains variable and suboptimal. In 2019, expert committees co-designed and published two evidence-based practice guides, but no clear strategy has been identified to support their assimilation. This project's goal is to support the implementation and deployment of practice guides for both social workers and registered nurses using a train-the-trainer educational intervention. METHODS/DESIGN: This three-phase project is a developmental evaluation using a multiple case study design across 17 primary care clinics. It will involve trainers in healthcare centers, patients, registered nurses and social workers. The development and implementation of an expanded train-the-trainer strategy will be informed by a patient-oriented research approach, the Kirkpatrick learning model, and evidence-based practice guides. For each case and phase, the qualitative and quantitative data will be analyzed using a convergent design method and will be integrated through assimilation. DISCUSSION: This educational intervention model will allow us to better understand the complex context of primary care clinics, involving different settings and services offered. This study protocol, based on reflective practice, patient-centered research and focused on the needs of the community in collaboration with partners and patients, may serve as an evidence based educational intervention model for further study in primary care.

The Influence of Contextual Factors on the Process of Formulating Strategies to Improve the Adoption of Care Manager Activities by Primary Care Nurses.

BACKGROUND: Primary care nurses are well-suited to provide care management for common mental disorders, but their practices depend on context. Various strategies can be considered to improve the adoption of nursing care manager activities, but data from implementation studies rarely address strategy formulation. AIM: To analyze the influence of contextual factors on strategy formulation to improve the adoption of care manager activities by primary care nurses. METHOD: A qualitative multiple case study in three primary care clinics was carried out. Data were collected through individual interviews (n = 32) and observations (n = 7), working group meetings, and relevant documents. Thematic analysis was conducted. RESULTS: Contextual factors influenced strategy formulation through organizational readiness for change, which resulted from tension for change and perceived organizational ability to implement change. Tension for change was generated through the perceived gap between patient needs and service availability, perceived compatibility with the nurses work environment, and their assessment of their capacity to perform care manager activities or acquire the necessary skills. CONCLUSION: Future studies should give sufficient attention to implementation strategy formulation and consider the dynamic role of organizational readiness for change when facilitating the adoption of evidence-based practices for common mental disorders in primary care.