Well, who do I phone? Preparing for urgent care: a challenge for patients and service users alike

Vivien Coates, Adrian McCann, Natasha Posner, Kathleen Gunn, Kate Seers

Research output: Contribution to journalArticle

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Abstract

Aims and objectivesTo investigate factors influencing patients' self-management of urgent diabetes problems that precipitated unscheduled hospital care.BackgroundDiabetes is placing increasing resource demands on health services and current policy advocates management in primary care and community settings whenever possible. Such policy has implications for patient education and empowerment and on mechanisms within primary and community care to support the management of diabetes when urgent healthcare problems arise.DesignQualitative, descriptive investigation, across two contrasting sites.MethodsForty-five people admitted to hospital for urgent/emergency care due to diabetes-related problems were recruited from urban and rural localities in the UK. Semi-structured interviews were conducted and data analysed using nvivo version 8 and framework techniques.ResultsSelf-management of diabetes was typically habitual, and urgent problems that proved difficult to resolve necessitated recourse to unscheduled hospital care. Though skills relating to problem-solving, decision-making, resource use and formation of patient–provider partnerships were evident among some participants, these required further development. Evidence of action planning or self-tailoring skills was sparse.ConclusionsEducation plays an important role in assisting individuals to self-manage their diabetes on a daily basis, but urgent, unexpected health problems proved challenging for both patients and health service providers. A greater focus on empowering patients with core self-management skills is required to enhance ability to successfully manage unexpected diabetes complications, coupled with enhanced primary care resources, particularly out-of-hours.Relevance to clinical practiceThe importance of informal and structured diabetes education should not be underestimated; however, the challenge of improving skills such as problem-solving to manage urgent healthcare needs must be tackled. This study provokes debate regarding how best to deliver appropriate education and health services to cover urgent unscheduled care needs without automatically referring to emergency department hospital care.
LanguageEnglish
Pages2152-2163.
JournalJournal of Clinical Nursing
Volume24
Issue number15-16
Early online date16 Apr 2015
DOIs
Publication statusPublished - Aug 2015

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Ambulatory Care
Health Services
Primary Health Care
Self Care
Delivery of Health Care
Education
Patient Participation
Aptitude
Emergency Medical Services
Patient Education
Diabetes Complications
Hospital Emergency Service
Decision Making
Interviews
Health

Keywords

  • diabetes
  • health services
  • nursing
  • self-management skills
  • urgent care

Cite this

Coates, Vivien ; McCann, Adrian ; Posner, Natasha ; Gunn, Kathleen ; Seers, Kate. / Well, who do I phone? Preparing for urgent care: a challenge for patients and service users alike. In: Journal of Clinical Nursing. 2015 ; Vol. 24, No. 15-16. pp. 2152-2163.
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Well, who do I phone? Preparing for urgent care: a challenge for patients and service users alike. / Coates, Vivien; McCann, Adrian; Posner, Natasha; Gunn, Kathleen; Seers, Kate.

In: Journal of Clinical Nursing, Vol. 24, No. 15-16, 08.2015, p. 2152-2163.

Research output: Contribution to journalArticle

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N2 - Aims and objectivesTo investigate factors influencing patients' self-management of urgent diabetes problems that precipitated unscheduled hospital care.BackgroundDiabetes is placing increasing resource demands on health services and current policy advocates management in primary care and community settings whenever possible. Such policy has implications for patient education and empowerment and on mechanisms within primary and community care to support the management of diabetes when urgent healthcare problems arise.DesignQualitative, descriptive investigation, across two contrasting sites.MethodsForty-five people admitted to hospital for urgent/emergency care due to diabetes-related problems were recruited from urban and rural localities in the UK. Semi-structured interviews were conducted and data analysed using nvivo version 8 and framework techniques.ResultsSelf-management of diabetes was typically habitual, and urgent problems that proved difficult to resolve necessitated recourse to unscheduled hospital care. Though skills relating to problem-solving, decision-making, resource use and formation of patient–provider partnerships were evident among some participants, these required further development. Evidence of action planning or self-tailoring skills was sparse.ConclusionsEducation plays an important role in assisting individuals to self-manage their diabetes on a daily basis, but urgent, unexpected health problems proved challenging for both patients and health service providers. A greater focus on empowering patients with core self-management skills is required to enhance ability to successfully manage unexpected diabetes complications, coupled with enhanced primary care resources, particularly out-of-hours.Relevance to clinical practiceThe importance of informal and structured diabetes education should not be underestimated; however, the challenge of improving skills such as problem-solving to manage urgent healthcare needs must be tackled. This study provokes debate regarding how best to deliver appropriate education and health services to cover urgent unscheduled care needs without automatically referring to emergency department hospital care.

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