The nutritional needs of people living with COPD: a concurrent mixed methods study of the role of the general practice nurse

Wilson, Neil (2019) The nutritional needs of people living with COPD: a concurrent mixed methods study of the role of the general practice nurse. Doctoral thesis (PhD), Manchester Metropolitan University.

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Abstract

Chronic Obstructive Pulmonary Disease (COPD) affects an estimated 1.2 million people across England, equating to 2% of the overall population. The respiratory disease can be diagnosed and managed in the community, the audit of which is one of the key quality indicators for General Practice. It is within this setting that general practice nurses have a key role in caring for people living with the disease. This study aimed to examine the role of the general practice nurse in the diagnosis and management of nutritional care of people living with COPD. The study was guided by a pragmatic philosophical approach resulting in a mixed methods design to examine the role of the general practice nurse in the nutritional care of people living with COPD across Greater Manchester, UK. The quantitative phase utilised a questionnaire, to survey 201 general practices in phase one across Greater Manchester, which led to phase two of the research, where eight qualitative unstructured interviews across seven of the ten boroughs of Greater Manchester. Phase one of the quantitative data was analysed using SPSS Version 19. The qualitative data were analysed using the framework of thematic analysis as presented by Braun and Clarke (2006). The survey of general practice nurses (GPNs) demonstrated that whilst there were similarities across general practices in Greater Manchester with COPD care (in line with the quality outcomes framework QOF), there was diverse practice relating to nutritional care of the same group of patients. GPNs predominately perceived their practice, in the care of those living with COPD to align with an advanced or intermediate way (in line with the model by Upton et al, 2007). The qualitative interviews provided some context to practice with seven main themes emerging from the data including: biomedical task orientated care; financial drivers; time and resources; nutrition and COPD; confidence and diabetes care; inter-professional/nurse-to-nurse relationships and education; training; and role vulnerability. It was evident that the quality outcomes framework (QOF) influenced nursing practice across many of the themes identified in the analysis. This is the first study to examine the role of the GPN in the nutritional care of people living with COPD in the community, and to discuss the impact of the QOF on the delivery of care. The care of people living with COPD in the community is largely undertaken by general practice nurses. Practice nurses provide care in accordance with the Quality Outcomes Framework (2004), that financially rewards practices for compliance, but is seen to inhibit holistic COPD care. Many participants lacked confidence when providing nutritional care for people living with COPD, which resulted in an assumption that such care should be aligned with another service or professional. A model to connect the person with their nurse, GP, dietitian and rehabilitation services could enhance a holistic and more rounded approach for COPD care, which incorporates nutritional practice as part of a whole person’s treatment plan.