• chronic disease management;
  • general practice;
  • grounded theory;
  • patient satisfaction;
  • practice nurses

mahomed r., st john w. & patterson e. (2012) Understanding the process of patient satisfaction with nurse-led chronic disease management in general practice. Journal of Advanced Nursing68(11), 2538–2549.


Aims.  To investigate the process of patient satisfaction with nurse-led chronic disease management in Australian general practice.

Background.  Nurses working in the primary care context of general practice, referred to as practice nurses, are expanding their role in chronic disease management; this is relatively new to Australia. Therefore, determining patient satisfaction with this trend is pragmatically and ethically important. However, the concept of patient satisfaction is not well understood particularly in relation to care provided by practice nurses.

Design.  A grounded theory study underpinned by a relativist ontological position and a relativist epistemology.

Methods.  Grounded theory was used to develop a theory from data collected through in-depth interviews with 38 participants between November 2007–April 2009. Participants were drawn from a larger project that trialled a practice nurse-led, collaborative model of chronic disease management in three Australian general practices. Theoretical sampling, data collection, and analysis were conducted concurrently consistent with grounded theory methods.

Results.  Patients undergo a cyclical process of Navigating Care involving three stages, Determining Care Needs, Forming Relationship, and Having Confidence. The latter two processes are inter-related and a feedback loop from them informs subsequent cycles of Determining Care Needs. If any of these steps fails to develop adequately, patients are likely to opt out of nurse-led care.

Conclusion.  Navigating Care explains how and why time, communication, continuity, and trust in general practitioners and nurses are important to patient satisfaction. It can be used in identifying suitable patients for practice nurse-led care and to inform the practice and organization of practice nurse-led care to enhance patient satisfaction.