Exploring the provision of diabetes nutrition education by practice nurses in primary care settings

BACKGROUND: High-quality nutrition education is recommended as an essential component of diabetes care. In the UK, there has been a gradual shift of inter-professional boundaries with respect to providing nutritional care for people with type 2 diabetes. Only a minority now regularly receive advice from a dietitian. Instead, increased demands for nutrition education are being absorbed by practice nurses. The present study seeks to explore this situation through the views of practice nurses on the services that they provide and the issues they face. METHODS: A qualitative approach using semi-structured interviews was employed. Practice nurses were recruited using purposive sampling, and nine were interviewed. Data were analysed using the Framework Method. The Theoretical Domains Framework from the COM-B ('capability', 'opportunity', 'motivation' and 'behaviour') model of behaviour change, as increasingly employed to explore the behaviour of healthcare professionals, was used to further frame the findings. RESULTS: Practice nurses reported that ongoing diabetes nutrition education only took place at annual review appointments and was limited to 5-10 min. They described how they are expected to take on a more advanced role in diabetes nutrition education than they can provide and are becoming increasingly isolated in this role as a result of a lack of time, practical and informational support, and training standards and provision. CONCLUSIONS: A range of service improvements led by dietitians, which focus on strengthening the working environment and enhancing professional support available for practice nurses who provide diabetes nutrition education, could improve quality of care and health outcomes in people with diabetes within current time restraints.