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

Abstract

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.

Nurses’ experiences of self-management support for adults with tuberculosis and human immunodeficiency virus coinfection

“…The professional nurses provided self-management support to adults with TB-HIV coinfection by assessing and advising them on how to self-manage their symptoms, medications, nutrition and psychosocial problems, which is comparable to a study in Indonesia (Fauzi, Anggraini & Fatkhurohman 2021 ). Contrariwise, professional nurses did not provide nutrition-related self-management support to persons with chronic conditions in primary health settings in the United States of America (USA), UK and Canada (Beaudin et al 2022 ). The findings may have differed because patients in resource-limited settings (like Ghana) experience more food insecurity problems than those in high-income countries such as the USA and the UK.…”

Defining Self-Management for Solid Organ Transplantation Recipients: A Mixed Method Study

“…The concept of self-management can be traced back in the UK to the start of the 20th century, with care costs mounting and the policy agenda increasingly seeking health care and health service delivery solutions that are more patient-focused and recognise the central role of patients in the care process [ 1 ]. A recent delineation of self-management support types includes the following: information about condition and/or its management, provision of/agreement on specific clinical action plans, regular clinical review, monitoring of condition with feedback, practical support with adherence—medication or behavioural—provision of equipment, training/rehearsal for everyday activities, training/rehearsal for practical self-management activities, training/rehearsal for psychological strategies, social support, and lifestyle advice and support [ 2 ]. Thus, health professional support acknowledges the changing patient role and the expectation of increased active involvement in care through SM [ 3 ].…”

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

“…There are multiple benefits to self-management support, namely, improvement of biological markers (blood pressure, cholesterol), self-efficacy, and quality of life, as well as a decrease in depressive and anxious symptomatology and relapse [ 19 – 21 ]. Integrated self-management support for CD and CMD is proposed as a potential solution to improve health outcomes for this population [ 22 – 24 ]. However, current guidelines for the management of CD and CMD (e.g., NICE guidelines [ 15 ]) are not clear on the clinical integration of self-management support for this population, or with respect to its components [ 23 ].…”

“…A scoping review of integrated self-management support interventions for CD and CMD by primary care nurses clarified its main characteristics [ 24 ]. Using the Rainbow Model of Integrated Care by Valentijn et al [ 26 ], this review defines clinical integration of self-management support as “coordination of person-focused care for a complex need at stake in a single process across time, place and discipline.” Four main attributes of integrated self-management support were proposed: person-focused self-management support (holistic; based on the person’s needs, priorities, preparation, knowledge, and health literacy); co-created self-management support (personalized; egalitarian nurse-person relationship); shared responsibility and joint agreement on the self-management support (tailored follow-up; common agreement; individualized and shared action plan); and person-coordinated self-management support [ 24 ].…”

“…A scoping review of integrated self-management support interventions for CD and CMD by primary care nurses clarified its main characteristics [ 24 ]. Using the Rainbow Model of Integrated Care by Valentijn et al [ 26 ], this review defines clinical integration of self-management support as “coordination of person-focused care for a complex need at stake in a single process across time, place and discipline.” Four main attributes of integrated self-management support were proposed: person-focused self-management support (holistic; based on the person’s needs, priorities, preparation, knowledge, and health literacy); co-created self-management support (personalized; egalitarian nurse-person relationship); shared responsibility and joint agreement on the self-management support (tailored follow-up; common agreement; individualized and shared action plan); and person-coordinated self-management support [ 24 ]. Integrated self-management support interventions encompassed activities such as therapeutic education, problem-solving, goal setting, support for medication management and self-care, among others aimed at promoting healthy behaviours and managing both CD and CMD [ 24 ].…”