Independence/dependence – a contradictory relationship? Life with a chronic illness

Abstract

This study shows that self-responsibility and self-control are meaningful values in the activities and decisions of everyday life. Dignity and being respected as an individual are closely connected to being able to manage on one's own and being independent of others' help. The study also shows that including other people into one's life situation can be an important sign of self-management. However, the critical interpretation shows that it is the view of the human being which determines whether help from others and self-managing on one's own can be combined. With a relational view of the human being, i.e. the basic condition that people always enter into relations of dependence, there is no contradiction between independence and dependence. In contrast, an individualist, liberalist view of the human being promotes an attitude of blaming oneself with the potential for feelings of inadequacy and guilt. The study also shows that seeking out treatment in the alternative medical sector maintain a form of continued self-control and self-responsibility. The study concludes that the nurse must work to qualify her/his sensory-based, situationally determined attentiveness and her/his view of the human being, which will include directing her/his attention towards the patient's view of the human being, values and ways of relating to oneself and to one's choices. The research design is qualitative and takes a phenomenological-hermeneutic approach. The data are based on interviews with 18 chronically ill patients, divided into three groups of six patients diagnosed with 'type I' diabetes, colitis ulcerosa and patients with coronary occlusion in the rehabilitation phase. Regardless of the diagnosis, the objective of the interview study was to highlight themes in the patients' views of health and illness related to their chronic condition and the significance of these views have for their mastery of everyday life. The research method is inspired by Paul Ricoeur.

The meaning of receiving help from home nursing care

“…Philosophers have for a long time emphasised the importance of relationships between human beings (9,10,11), this has also been confirmed empirically (12,13). The relationship between nurses and the patients of home nursing care unfolds in the latter's home, and it is important to remember that the home is a central place in the lives of elderly people (14).…”

The experience of being a participant in one’s own care at discharge and at home, following a severe acute exacerbation in chronic obstructive pulmonary disease: a longitudinal study

“…Thus, staying motivated for self-management is a challenge faced by almost all patients at some point; however, patients with depressed emotions, lack of acceptance by others and lack of support are particularly at risk of poor self-management motivation. According to Delmar et al (2006), taking responsibility for oneself implies the freedom to choose. Living with chronic illness implies that there is the opportunity to decide how one shall live with dignity and deal with the conditions at hand.…”

“…Not choosing is also an option. Making choices is often difficult and can be experienced as a choice between two evils (Delmar et al, 2006). The choice to smoke, as shown in our study, is an example of such a hard choice.…”

“…The choice to smoke, as shown in our study, is an example of such a hard choice. Delmar et al (2006) underscore that self-responsibility not only represents positive values but also involves feelings of self-blame, guilt, punishment and sin. Seen in this light, being responsible and seeking to fit COPD into everyday life can involve difficult decision-making and the emergence of difficult emotions.…”

“…Other research on patients’ needs following a hospital discharge after an AECOPD points to a need for personalized self-management advice about when and how to call for help (Gruffydd-Jones, Langley-Johnson, Dyer, Badlan, & Ward, 2007). Delmar et al (2006) showed that seeking help implies a balance between being dependent on help from others and independence of help from others. Thus, seeking help can imply a difficult choice between maintaining control and handing control over to others.…”