Nurses' views on patient self‐management: a qualitative study

Been-Dahmen, Janet; Dwarswaard, Jolanda; Hazes, Johanna M. W.; Staa, AnneLoes van; Ista, Erwin

doi:10.1111/jan.12767

Cited by 51 publications

(74 citation statements)

References 41 publications

(52 reference statements)

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“…Initially, they associated empathy negatively with endless listening and pretending to be interested, and their initial interaction and dialogues with the older adults were found to be scarce. Their unfamiliarity resulted in feelings of helplessness, which might have contributed to the steering behaviours noted in this study, as well as in several other studies,28 29 and demonstrated the need for introducing generic autonomy supportive conversational skills among nurses.…”

Section: Discussionsupporting

confidence: 63%

Evaluation of nurses’ changing perceptions when trained to implement a self-management programme for dual sensory impaired older adults in long-term care: a qualitative study

et al. 2016

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ObjectivesTo gain insights into the process of nurses’ changing perceptions when trained to implement a self-management programme for dual sensory impaired older adults in long-term care, and into the factors that contributed to these changes in their perceptions.DesignQualitative study alongside a cluster randomised controlled trial.Setting17 long-term care homes spread across the Netherlands.Participants34 licensed practical nurses supporting 54 dual sensory impaired older adults.InterventionA 5-month training programme designed to enable nurses to support the self-management of dual sensory impaired older adults in long-term care.Primary outcomesNurses’ perceptions on relevance and feasibility of the self-management programme collected from nurses’ semistructured coaching diaries over the 5-month training and intervention period, as well as from trainers’ reports.ResultsNurses’ initial negative perceptions on relevance and feasibility of the intervention changed to positive as nurses better understood the concept of autonomy. Through interactions with older adults and by self-evaluations of the effect of their behaviour, nurses discovered that their usual care conflicted with client autonomy. From that moment, nurses felt encouraged to adapt their behaviour to the older adults’ autonomy needs. However, nurses’ initial unfamiliarity with conversation techniques required a longer exploration period than planned. Once client autonomy was understood, nurses recommended expanding the intervention as a generic approach to all their clients, whether dual sensory impaired or not.ConclusionsLongitudinal data collection enabled exploration of nurses’ changes in perceptions when moving towards self-management support. The training programme stimulated nurses to go beyond ‘protocol thinking’, discovering client autonomy and exploring the need for their own behavioural adaptations. Educational programmes for practical nurses should offer more longitudinal coaching of autonomy supportive conversational skills. Intervention programming should acknowledge that change is a process rather than an event, and should include self-evaluations of professional behaviours over a period of time.Trial registration numberNCT01217502, Post-results.

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Section: Discussionsupporting

confidence: 63%

Evaluation of nurses’ changing perceptions when trained to implement a self-management programme for dual sensory impaired older adults in long-term care: a qualitative study

et al. 2016

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“…Adequate self‐management support implies that nurses share an understanding of their role and tasks in self‐management (Been‐Dahmen, Dwarswaard, Hazes, van Staa, & Ista, ). However, nurses vary in their understanding of what self‐management entails and predominantly perceive self‐management as incorporating the traditional biomedical approach, which is premised on compliance with professional advice, the monitoring of symptoms, and patients’ individual responsibility to self‐manage their chronic condition (Sadler, Wolfe, & McKevitt, ).…”

Section: Introductionmentioning

confidence: 99%

Self‐management support in routine primary care by nurses

Westland

Schröder

Wit

et al. 2017

British J Health Psychol

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Objectives. To examine how and to what extent self-management support, including behaviour change support, is provided by primary care nurses in routine consultations with chronically ill patients.Design. Observational study design.Methods. Routine consultations of primary care nurses in the Netherlands with chronically ill patients were audio-taped and analysed. The analysis identified health topics addressed according to health care standards, self-management topics addressed using a validated set of topics, and behaviour change techniques (BCTs) using the Behaviour Change Techniques Taxonomy v1.Results. Seventy-eight routine consultations of 17 primary care nurses with chronically ill patients were included in the analysis. Nurses addressed both health topics and selfmanagement topics in brief, fragmented, and often inconsistent manners. Dietary intake and physical activity were the most frequently addressed topics. Nurses applied 21 BCTs to target behaviour change, but the use of these techniques was mainly inconsistent and implicit. The most consistently used BCTs were review behaviour goal(s) (56.4%) and feedback on behaviour (51.3%).Conclusions. Nurses addressed both health topics and self-management topics in their routine consultations. The duration, frequency, and number of addressed topics differed throughout the consultations. Nurses tended to prioritize the monitoring and optimization of patients' medical treatment and provided limited self-management support. Nurses seldom deepened their focus on behaviour change and infrequently used effective techniques to support this change. Adoption of self-management in primary care, including behaviour change, might be enhanced if nurses consistently and explicitly use effective BCTs in their consultations.

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“…In terms of both statistical and practical respects, the key findings were that individuals with lower education levels had significantly poorer knowledge of their health condition and treatment; those with a mental health problem were worse at coping with the effect of their condition on their physical and emotional well‐being and smokers did not have as strong a partnership in treatment or ability to recognize and manage their symptoms as compared to non‐smokers. These key findings could facilitate nurse practitioners (Been‐Dahmen et al, ; van Hooft et al, ) and health systems to develop interventions that are better directed to individual needs.…”

Section: Discussionmentioning

confidence: 99%

Does the Partners in Health scale allow meaningful comparisons of chronic condition self‐management between men and women? Testing measurement invariance

Smith

Fairweather‐Schmidt

Harvey

et al. 2019

Journal of Advanced Nursing

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Aims To determine if the Partners in Health scale, pertinent to assessing patient chronic condition self‐management, operates equivalently for men and women. Background There are distinct gender‐based differences in self‐management behaviours and health perceptions. This may introduce non‐invariance in self‐report measures. Testing of measurement invariance is a recommended practice in nursing science to ensure robust metrics. Design A representative cross‐sectional population survey in South Australian. Method In 2014, 940 people responded to the South Australian Health Omnibus Survey, a battery of health‐related questions. MI and estimation of heterogeneity was tested using Bayesian confirmatory factor analysis. Results Findings showed self‐management constructs were interpreted equivalently between men and women. Observed population heterogeneity associated lower education levels with poorer illness and treatment knowledge, smokers with poorer treatment partnerships and mental health problems with lower coping capacity. Conclusion Approximate measurement invariance was achieved between men and women for Partners in Health scale. Impact There is a lack of well‐validated generic instruments, including investigation into gender variability, for measuring chronic condition self‐management behaviours. Lower education levels were found to connect with poorer knowledge of health condition and treatment. Mental health problems attenuated ability to cope with the effect of the condition. Findings can facilitate the development of better tailored interventions for self‐management of patients’ chronic condition/s.

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Nurses' views on patient self‐management: a qualitative study

Cited by 51 publications

References 41 publications

Evaluation of nurses’ changing perceptions when trained to implement a self-management programme for dual sensory impaired older adults in long-term care: a qualitative study

Evaluation of nurses’ changing perceptions when trained to implement a self-management programme for dual sensory impaired older adults in long-term care: a qualitative study

Self‐management support in routine primary care by nurses

Does the Partners in Health scale allow meaningful comparisons of chronic condition self‐management between men and women? Testing measurement invariance

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