Delivery of Insomnia Management by General Practice Nurses: A Qualitative Analysis of Patient Perspectives
Authors List
Nicole Grivell1, Elizabeth Hoon2, Ching Li Chai-Coetzer1,3, Jeffrey Fuller4, R. Doug McEvoy1
1. Adelaide Institute for Sleep Health/FHMRI Sleep, Flinders University, South Australia
2. Discipline of General Practice, University of Adelaide, South Australia;
3. Southern Adelaide Local Health Network, SA Health, South Australia
4. College of Nursing and Health Sciences, Flinders University, South Australia
Introduction
Cognitive behavioural therapy for insomnia (CBTi) is the recommended treatment for chronic insomnia but with an estimated 10-15% of the population living with chronic insomnia, there are insufficient numbers of practitioners to provide this care. Research shows that insomnia can successfully be managed by nurses within primary care, however patient attitudes towards nurse-delivered insomnia management have not been explored. This study investigated patient perspectives towards the delivery of insomnia management by general practice nurses to inform the design and implementation of patient-centred models of care.
Methods
A qualitative study within a process evaluation of a pilot study of nurse-delivered sleep health care conducted in one general practice in Adelaide. Semi-structured telephone interviews were conducted with patients with insomnia who were offered nurse-delivered brief behavioural therapy for insomnia or nurse-supported online CBTi. Thematic Analysis was conducted to identify themes and patterns within the data.
Results
Eleven patients participated (6 males; age mean [range] 59 years [29-72]; time at practice 14.3 years [4-21]; Sleep Condition Indicator 9.5 [3-14]). Three major themes were identified: 1. Patients are supportive of general practice nurses providing care for uncomplicated insomnia; 2. Trust in practice nurse-delivered insomnia care is influenced by relationships with the general practitioner (GP) and the general practice; 3. The nature of the nursing profession is well suited to chronic insomnia care. Participants reported confidence in practice nurses providing insomnia management on the condition that they had sufficient knowledge and that a referral to a GP or psychologist was available for cases of complex insomnia. Endorsement by the GP and trust in their general practice increased patient confidence in nurse-delivered insomnia care.
Conclusions
Patient acceptance of practice nurse-delivered insomnia care supports further research into developing a role for practice nurses within insomnia management. The findings of this work will be tested and explored further within a large implementation study conducted in multiple general practices.
Funding: This study has been supported by PhD scholarships from Flinders University, Flinders Foundation and an NHMRC Centres for Research Excellence Grant, and by an NHMRC Partnership Project.
Nicole Grivell1, Elizabeth Hoon2, Ching Li Chai-Coetzer1,3, Jeffrey Fuller4, R. Doug McEvoy1
1. Adelaide Institute for Sleep Health/FHMRI Sleep, Flinders University, South Australia
2. Discipline of General Practice, University of Adelaide, South Australia;
3. Southern Adelaide Local Health Network, SA Health, South Australia
4. College of Nursing and Health Sciences, Flinders University, South Australia
Introduction
Cognitive behavioural therapy for insomnia (CBTi) is the recommended treatment for chronic insomnia but with an estimated 10-15% of the population living with chronic insomnia, there are insufficient numbers of practitioners to provide this care. Research shows that insomnia can successfully be managed by nurses within primary care, however patient attitudes towards nurse-delivered insomnia management have not been explored. This study investigated patient perspectives towards the delivery of insomnia management by general practice nurses to inform the design and implementation of patient-centred models of care.
Methods
A qualitative study within a process evaluation of a pilot study of nurse-delivered sleep health care conducted in one general practice in Adelaide. Semi-structured telephone interviews were conducted with patients with insomnia who were offered nurse-delivered brief behavioural therapy for insomnia or nurse-supported online CBTi. Thematic Analysis was conducted to identify themes and patterns within the data.
Results
Eleven patients participated (6 males; age mean [range] 59 years [29-72]; time at practice 14.3 years [4-21]; Sleep Condition Indicator 9.5 [3-14]). Three major themes were identified: 1. Patients are supportive of general practice nurses providing care for uncomplicated insomnia; 2. Trust in practice nurse-delivered insomnia care is influenced by relationships with the general practitioner (GP) and the general practice; 3. The nature of the nursing profession is well suited to chronic insomnia care. Participants reported confidence in practice nurses providing insomnia management on the condition that they had sufficient knowledge and that a referral to a GP or psychologist was available for cases of complex insomnia. Endorsement by the GP and trust in their general practice increased patient confidence in nurse-delivered insomnia care.
Conclusions
Patient acceptance of practice nurse-delivered insomnia care supports further research into developing a role for practice nurses within insomnia management. The findings of this work will be tested and explored further within a large implementation study conducted in multiple general practices.
Funding: This study has been supported by PhD scholarships from Flinders University, Flinders Foundation and an NHMRC Centres for Research Excellence Grant, and by an NHMRC Partnership Project.
