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Asthma care research undermines the value of qualified practice nurses

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Nurse specialists have criticised suggestions that trained lay people can deliver asthma self-management education as effectively as practice nurses. They argue the money would be better spent on nurse training.

Researchers from Imperial College London and Manchester University studied 418 patients with asthma for two years, during which half received self-management education from a practice nurse and half from a trained lay educator. Both nurses and lay educators made management changes and all patients had an individual asthma action plan.

The researchers found no significant difference in the number of patients requiring unscheduled care, such as a hospital visit, during the study period – 29.8% in the nurse-led group and 30.5% in the lay educator group.

‘Patients were as satisfied with care by a lay educator as with care by a nurse, and the clinical outcomes were almost identical,’ they said. ‘Alternatives to health professional delivery of patient education programmes need to be explored,’ they added.

However, the 15 lay educators attended an intensive two-day training course and also had access to a distance-learning programme, as well as support from health professionals. The 46 practice nurses received a one-day update programme.

Jane Scullion, respiratory nurse consultant at University Hospitals Leicester, said: ‘Practice nurses had a lot less input and training during this study than the lay educators.

‘What this reflects is the lack of investment in practice nurse training in asthma, despite this often being the practice nurse’s role,’ she said. ‘It seems that well-trained lay persons can have outcomes comparable to poorly trained practice nurses.’

Vikki Knowles, clinical lead for the charity Asthma UK, added: ‘Lay educators are not governed [by codes of practice] in the same way as nurses and I am concerned about how this system would be “policed” to ensure adequate levels of support and education.

‘It seems short-sighted to train lay people when we could be investing in nurses, or HCAs, who already have more rounded healthcare backgrounds,’ she added.

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