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Primary care nurses struggle with lifestyle counseling in diabetes care: a qualitative analysis

机译：基层护理护士在糖尿病护理中与生活方式咨询抗争：定性分析

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Background Patient outcomes are poorly affected by lifestyle advice in general practice. Promoting lifestyle behavior change require that nurses shift from simple advice giving to a more counseling-based approach. The current study examines which barriers nurses encounter in lifestyle counseling to patients with type 2 diabetes. Based on this information we will develop an implementation strategy to improve lifestyle behavior change in general practice. Method In a qualitative semi-structured study, twelve in-depth interviews took place with nurses in Dutch general practices involved in diabetes care. Specific barriers in counseling patients with type 2 diabetes about diet, physical activity, and smoking cessation were addressed. The nurses were invited to reflect on barriers at the patient and practice levels, but mainly on their own roles as counselors. All interviews were audio-recorded and transcribed. The data were analyzed with the aid of a predetermined framework. Results Nurses felt most barriers on the level of the patient; patients had limited knowledge of a healthy lifestyle and limited insight into their own behavior, and they lacked the motivation to modify their lifestyles or the discipline to maintain an improved lifestyle. Furthermore, nurses reported lack of counseling skills and insufficient time as barriers in effective lifestyle counseling. Conclusions The traditional health education approach is still predominant in primary care of patients with type 2 diabetes. An implementation strategy based on motivational interviewing can help to overcome 'jumping ahead of the patient' and promotes skills in lifestyle behavioral change. We will train our nurses in agenda setting to structure the consultation based on prioritizing the behavior change and will help them to develop social maps that contain information on local exercise programs.
机译：背景技术一般情况下，生活方式建议对患者的预后影响不大。促进生活方式的改变，要求护士从简单的建议转变为基于咨询的方法。当前的研究探讨了护士在生活方式咨询中对2型糖尿病患者造成的障碍。基于这些信息，我们将制定一种实施策略，以改善一般实践中生活方式的改变。方法在定性的半结构化研究中，对与荷兰人有关糖尿病护理的一般做法的护士进行了十二次深度访谈。解决了在咨询2型糖尿病患者的饮食，身体活动和戒烟方面的具体障碍。邀请护士反思患者和实践层面的障碍，但主要是自己作为辅导员的角色。所有采访均进行录音和转录。借助于预定框架分析数据。结果护士在患者水平上感觉到最大的障碍。患者对健康生活方式的知识有限，对自己的行为的了解也有限，并且他们缺乏改变生活方式或保持良好生活方式的纪律的动力。此外，护士报告说缺乏咨询技巧和时间不足是有效生活方式咨询的障碍。结论在2型糖尿病患者的初级保健中，传统的健康教育方法仍然占主导地位。基于动机面试的实施策略可以帮助克服“跳到病人前面”并提高生活方式改变的技能。我们将在议程设置中对护士进行培训，以根据行为改变的优先顺序来组织咨询，并将帮助他们制定包含当地锻炼计划信息的社交地图。

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