Skip to main content
×
×
Home

Practice nurses and obesity: professional and practice-based factors affecting role adequacy and role legitimacy

  • Christine Nolan (a1) (a2), Ann Deehan (a3), Ann Wylie (a4) and Roger Jones (a5)
Abstract
Aim

This qualitative study explored the professional and practice-based factors affecting the role legitimacy and adequacy of practice nurses in managing obese patients.

Background

There are strong clinical, financial and practical reasons for tackling obesity in UK general practice. Although practice nurses may seem to be in an ideal position to manage obesity, there remain questions about their role adequacy (sense of self-efficacy in responding to patients’ problems) and role legitimacy (their perceived boundaries of professional responsibility and right to intervene).

Methods

Semi-structured face-to-face interviews were conducted with 22 practice nurses in Lambeth, Southwark and Lewisham in South London. Interviews were digitally recorded and transcribed. Key themes were identified following coding of the data.

Findings

Factors that positively affected nurses’ role adequacy and legitimacy were: their belief that obesity management was part of their chronic disease management and health promotion remit; their confidence in their own communication skills and ability to build rapport with patients; having attended training and being supported to take extra time for obesity management. Factors negatively affecting their role legitimacy and adequacy were: their low awareness and use of guidance; lack of knowledge of referral options; limited knowledge and use of non-medical and non-persuasive approaches; perceived lack of expertise in motivating patients, as well as in nutrition, child obesity and assessment; belief that there were some contexts in which it was more appropriate to raise the issue than others; lack of culturally appropriate materials and language barriers; belief that they had limited impact on outcome and that the patient is responsible for lack of success. Other factors negatively affecting their role adequacy and legitimacy included their ambivalence about the effectiveness of the interventions offered; perceived lack of priority for obesity management within practices; lack of time; workload and lack of clarity on protocols and roles within the practice.

Copyright
Corresponding author
Correspondence to: Christine Nolan, Flat 2, 105-107 South Norwood Hill, London SE25 6BY, UK. Email: csnolan26@yahoo.com
References
Hide All
Brunner, E.J., Rees, K., Ward, K., Burke, M.Thorogood, M. 2007: Dietary advice for reducing cardiovascular risk. Cochrane Database of Systematic Reviews 4, Art. No.: CD002128. DOI: 10.1002/14651858.CD002128.pub3.
Butland, B., Jebb, S., Kopelman, P., McPherson, K.Thomas, S., Mardell, J.Parry, V. 2007: Foresight tackling obesities: future choices – project report, second edition. London: Department for Innovation, Universities and Skills.
Counterweight Project Team. 2005: The impact of obesity on drug prescribing in primary care. British Journal of General Practice 55, 743749.
Counterweight Project Team. 2008: Evaluation of the Counterweight Programme for obesity management in primary care: a starting point for continuous improvement. British Journal of General Practice 58, 548554.
Department of Health. 1992: The health of the nation: a strategy for health in England. London: The Stationery Office.
Department of Health. 2000a: Coronary Heart Disease. National Service Framework. London.
Department of Health. 2000b: The NHS plan – a plan for investment, a plan for reform. London.
Department of Health. 2006: Care pathway for the management of overweight and obesity. London: Department of Health.
Epstein, L.Ogden, J. 2005: A qualitative study of GP's views of treating obesity. British Journal of General Practice 55, 750754.
Ewles, L.Simnett, I. 2003: Promoting health: a practical guide. London: Bailliere Tindall.
Galuska, D.A., Will, J.C., Serdula, M.K.Ford, E.S. 1999: Are health care professionals advising obese patients to lose weight? Journal of the American Medical Association 282, 15761578.
Health Departments of Great Britain. 1989: General practice in the National Health Service: the 1990 contract. London: HMSO.
Hiddink, G.J., Hautvast, J.G., van Woerkum, C.M., Fieren, C.J.van ‘t Hof, M.A. 1997: Consumers’ expectations about nutrition guidance: the importance of primary care physicians. American Journal of Clinical Nutrition 65, (6 Suppl), 1974S1979S.
Hoppe, R.Ogden, J. 1997: Practice nurses’ beliefs about obesity and weight related interventions in primary care. International Journal of Obesity & Related Metabolic Disorders: Journal of the International Association for the Study of Obesity 21, 141146.
Lean, M.E. 2000: Obesity: burdens of illness and strategies for prevention or management. Drugs of Today 36, 773784.
Loughran, H., Hohman, M.Finnegan, D. 2010: Predictors of role legitimacy and role adequacy of social workers working with substance-using clients. British Journal of Social Work 40, 239256.
Maryon-Davis, A. 2005: Weight management in primary care: how can it be made more effective? Proceedings of the Nutrition Society 64, 97103.
Mercer, S. 2009: How useful are clinical guidelines for the management of obesity in general practice? British Journal of General Practice 59, 863868.
Mercer, S.W.Tessier, S. 2001: A qualitative study of general practitioners’ and practice nurses’ attitudes to obesity management in primary care. Health Bulletin 59, 248253; available from: http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-0038813491&partnerID=40
Michie, S. 2007: Talking to primary care patients about weight: a study of GPs and practice nurses in the UK. Psychology, Health and Medicine 12, 521525; available from: http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-34548582104&partnerID=40
National Audit Office. 2001: Tackling obesity in England: report by the Comptroller and Auditor General. London: Stationery Office.
National Institute for Health and Clinical Excellence (NICE). 2006: Obesity: guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children. London: NICE clinical guideline 43.
Nelson, P., Adamson, A.Moore, H. 2006: Conducting randomised controlled trials in primary care: lessons from an obesity management trial. British Journal of General Practice 56, 674679; available from: http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-33748705390&partnerID=40
Prochaska, J.O., DiClemente, C.C.Norcross, J.C. 1992: In search of how people change: applications to addictive behaviors. American Psychologist 47, 11021114.
Prout, H., Butler, C.Kinnersley, P. 2003: A qualitative evaluation of implementing a randomized controlled trial in general practice. Family Practice 20, 675681.
Shaw, K., Gennat, H., O'Rourke, P.Del, M.C. 2006: Exercise for overweight or obesity. Cochrane Database of Systematic Reviews 4, Art. No.: CD003817. DOI: 10.1002/14651858.CD003817.pub3.
Shaw, K., O'Rourke, P., Del., M.C.Kenardy, J. 2005: Psychological interventions for overweight or obesity. Cochrane Database of Systematic Reviews 2, Art. No.: CD003818. DOI: 10.1002/14651858.CD003818.pub2.
Shaw, S., Cartwright, A.K.J., Spratley, T.Harwin, J. 1978: Responding to drinking problems. London: Croom Helm.
Skinner, N., Roche, A.M., Freeman, T.Addy, D. 2005: Responding to alcohol and other drug issues: The effect of role adequacy and role legitimacy on motivation and satisfaction. Drugs: Education, Prevention and Policy 12, 449463.
Torgerson, J.S., Hauptman, J., Boldrin, M.N.Sjöström, L. 2004: XENical in the prevention of diabetes in Obese subjects (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients. Diabetes Care 27, 155162.
Tuomilehto, J., Lindström, J., Eriksson, J.G., Valle, T.T., Hämäläinen, H., Ianne-Parikka, P., Keinänen-Kiukaanniemi, S., Laakso, M., Louheranta, A., Rastas, M., Salminen, V.Uusitupa, M. 2001: Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. New England Journal of Medicine 344, 13431350; available from: http://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-0035799806&partnerID=40
Turner, K., Shield, J.Salisbury, C. 2009: Practitioners’ views on managing childhood obesity in primary care: a qualitative study. British Journal of General Practice 59, 856862.
Wing, R.R.Hill, J.O. 2001: Successful weight loss maintenance. Annual Review of Nutrition 21, 323341.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Primary Health Care Research & Development
  • ISSN: 1463-4236
  • EISSN: 1477-1128
  • URL: /core/journals/primary-health-care-research-and-development
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed