Working with older people with multiple long-term conditions: a qualitative exploration of nurses' experiences

Aims. (1) to generate in-depth insights into how nurses are working with older people with multiple long term conditions; (2) to gain an understanding of how nurses perceive professional patient navigation; and (3) to explore the barriers and facilitators to nurses adopting a navigation role in the context of Primary Health Care practice. Background. Internationally, Primary Health Care has been identified as the main navigation point for older people with multiple long term conditions. Navigation models have been developed in cancer care but there is a lack of research in the context of Primary Care. There is also little evidence about the extent to which current work patterns of nurses providing care for this patient group fit with professional patient navigation models. Design. A descriptive exploratory qualitative study. Methods. Semi-structured audio recorded telephone interviews were conducted in 2012 with nurses in New Zealand who were working with older people with multiple long term conditions (n = 42) Interviews were transcribed verbatim and entered into Nvivo 9 for thematic analysis. Findings. The key themes represent patterns of nursing work as; system work, relationship work and patient work. While nurses lacked a coherent understanding of patient navigation as a concept, the way they worked had some elements in common with professional navigation models. Conclusion. Further research involving older people in co-designing patient navigation approaches in Primary Health Care is needed to inform these types of service development and translate action from existing health policy.