Nurses as family learning brokers: shared management in childhood chronic kidney disease

Aim: To explore the contribution of nurses to families' learning in shared management of childhood chronic kidney disease. Background: From early in the disease course, nurses are involved in teaching families to share management. The failure of family members to share management can negatively influence children's clinical outcomes. Earlier studies discussed the value of nurses' involvement in chronic disease management and described learning by novices in organisations as a social activity involving communication brokers; however, little is known about the contribution of nurses to family learning in chronic kidney disease management. Design: A longitudinal qualitative study conducted in a regional kidney unit for children. Method: Data were obtained between September 2003–September 2005 from five families of children referred for management of conditions needing moderate/high levels of intervention and the four renal nurse-specialists involved in their management. Data sources were 30 semi-structured interviews, 19 postinterview case-note reviews and four mother/child learning diaries; analysis followed the principles of grounded theory. Results: In promoting family competence, nurses acted as learning brokers, demonstrating five distinct yet overlapping teaching activities: assessing learning needs, creating learning opportunities, implementing teaching strategies, acting as interpreters and ambassadors and assessing learning progress. Families highlighted the contribution of nurses as learning brokers in the process of shared disease management. Conclusion: Nurses' teaching activities in shared disease management are more important than previously reported. A clear distinction needs to be made between their contribution to management and to the promotion of family competence in shared management. Relevance to clinical practice: Recognition of nurses' distinct teaching activities can inform professionals' practice when caring for children with chronic disease and inform strategies to educate nurses and other professionals about the role of family learning broker.