Nurses' Challenges When Managing Patients with Hypertension in Primary Care: A Qualitative Study

Abstract

Background: The role of primary care nurses is expanding significantly due to increasing healthcare demand. This role expansion poses various challenges to the nurses that can impact patient care. Using hypertension care as an example, this study aimed to explore the diverse roles played by primary care nurses and the challenges they faced when performing these roles.

Methods: An exploratory qualitative study was conducted among nurses in 5 public primary care clinics in Singapore. Purposive sampling was employed to ensure nurses of different cadre and experiences were included. An experienced qualitative researcher conducted the interviews until data saturation was reached. The interviews were audio-recorded, transcribed verbatim, checked and analysed thematically using NVivo (version 14).

Results: Thirteen nurses of varying age (25-65 years) and experience level (staff nurse to advanced practice nurse) were interviewed. The nurses' traditional duties in primary care settings included patient triaging, immunisation administration, management of acute and chronic conditions including regular health monitoring, wound care, supporting medication adherence, general lifestyle counselling and mentoring junior nurses. However, they performed expanded clinical roles for hypertension care with additional responsibilities that included counselling on home-BP monitoring and medication titration using motivational interviewing. The key challenges they faced in managing hypertension were: (i) time and manpower constraint, (ii) lack of continuity of care, (iii) lack of clear guidelines, (iv) inefficient workflows, (v) overlapping and competing services, (vi) lack of knowledge and training and (vii) lack of home BP readings from patients.

Conclusion: This study contributes to the ongoing conversation on the future of nursing, highlighting the importance of balancing professionalism with the increasing demands of healthcare. Our results emphasise the need for strategic planning and role clarification through clear communication of job descriptions, routine reviewing of clinical workflows, targeted training and support for nurses in performing their diverse roles, and fostering regular multidisciplinary meetings to define, communicate and support evolving nursing responsibilities in primary care.

Keywords: hypertension care; nurses’ roles; primary care; workforce challenges.