Challenges of nurse delivery of psychological interventions for [LTCs] in primary care: a qualitative exploration [...]of [CFS/ME], 2011, Peters et al

Peters, S., Wearden, A., Morriss, R. et al. Challenges of nurse delivery of psychological interventions for long-term conditions in primary care: a qualitative exploration of the case of chronic fatigue syndrome/myalgic encephalitis. Implementation Sci 6, 132 (2011). https://doi.org/10.1186/1748-5908-6-132

https://implementationscience.biomedcentral.com/articles/10.1186/1748-5908-6-132


Abstract

Background

The evidence base for a range of psychosocial and behavioural interventions in managing and supporting patients with long-term conditions (LTCs) is now well-established. With increasing numbers of such patients being managed in primary care, and a shortage of specialists in psychology and behavioural management to deliver interventions, therapeutic interventions are increasingly being delivered by general nurses with limited training in psychological interventions. It is unknown what issues this raises for the nurses or their patients. The purpose of the study was to examine the challenges faced by non-specialist nurses when delivering psychological interventions for an LTC (chronic fatigue syndrome/myalgic encephalomyelitis [CFS/ME]) within a primary care setting.

Methods
A qualitative study nested within a randomised controlled trial [ISRCTN 74156610] explored the experiences and acceptability of two different psychological interventions (pragmatic rehabilitation and supportive listening) from the perspectives of nurses, their supervisors, and patients. Semi structured in-depth interviews were conducted with three nurse therapists, three supervisors, and 46 patients. An iterative approach was used to develop conceptual categories from the dataset.

Results
Analyses identified four sets of challenges that were common to both interventions: (i) being a novice therapist, (ii) engaging patients in the therapeutic model, (iii) dealing with emotions, and (iv) the complexity of primary care. Each challenge had the potential to cause tension between therapist and patient. A number of strategies were developed by participants to manage the tensions.

Conclusions
Tensions existed for nurses when attempting to deliver psychological interventions for patients with CFS/ME in this primary care trial. Such tensions should be addressed before implementing psychological interventions within routine clinical practice. Similar tensions may be found for other LTCs. Our findings have implications for developing therapeutic alliances and highlight the need for regular supervision.


[Authors include Carolyn Chew-Graham, Christopher F Dowrick, Karina Lovell, Joanna Brooks, Greg Cahill]

 

Posted to facilitate retrieving.

Reference for the quote "The bastards don't want to get better" but I think interesting beyond that.

The context of the quote:

"There have been one or two times where I have been worried because they have got angry at the patients...that anger has been communicated to the patients. Their frustration has reached the point where they sort of boiled over... there is sort of feeling that the patient should be grateful and follow your advice, and in actual fact, what happens is the patient is quite resistant and there is this thing like you know, 'The bastards don't want to get better'...I think it's a difficult thing for all therapists and I think basically over the time you just basically learn to cope with it, and but they have not had time.' (Supervisor)"

 

Agreed. The better training needed, of course, is the correct biomeducal model of ME.

IME unreasonable expectations are somewhat common in medical settings. I've been told not to react to pain when being cut by a scalpel - this with inadequate anesthetic. A similar circumstance has happened to a loved one, more than once.

Pain seems to be something that is frequently downplayed by some in medicine. I've been advised never to use the word "pain". How else does one describe this? I've got a shooting ......, or a constant ...., or a gnawing ......! Good grief!
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