Self-management support: A qualitative study of ethical dilemmas experienced by nurses

Dwarswaard, Jolanda; Bovenkamp, Hester van de

doi:10.1016/j.pec.2015.05.017

Cited by 43 publications

(77 citation statements)

References 27 publications

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“…This study shows that community nurses experience dilemmas in self‐management support when older adults, in their view, exhibit either considerable or little self‐direction or self‐reliance. This is in line with the literature about tensions that can arise within self‐management support when patients and healthcare professionals have different expectations about the preferred level and type of patient involvement (van de Bovenkamp & Dwarswaard, ; Doekhie et al, ; Dwarswaard & van de Bovenkamp, ; Kendall et al, ; Lawn et al, ; Redman, ).…”

Section: Discussionsupporting

confidence: 86%

“…The specific conflict we found display similarities with the ethical issues Dwarswaard and van de Bovenkamp () found among (mainly) hospital nurses in supporting self‐management by chronically ill‐adults and children. These were ‘patient autonomy versus optimal medical outcomes’ and ‘respecting patient autonomy versus stimulating patient involvement'.…”

Section: Discussionsupporting

confidence: 67%

“…When facing the conflict between ‘stimulating self‐reliance and self‐direction’, and ‘accepting a dependent attitude’, community nurses apply the strategies ‘empowering’, 'challenging’ and ‘tolerating’. The strategy ‘persuading’ is in line with a nurse's tendency to steer patients in a certain direction by convincing them to follow their suggestions or advice, as identified by Dwarswaard and van de Bovenkamp (). However, based on our results, we can conclude that nurses also seem to apply various other strategies when confronted with conflict in supporting self‐management.…”

Section: Discussionmentioning

confidence: 99%

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Community nurses' self‐management support in older adults: A qualitative study on views, dilemmas and strategies

Bolscher-Niehuis

Uitdehaag

Francké

2019

Health Soc Care Community

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Providing self‐management support is an appropriate task for community nurses. However, the support of self‐management sometimes triggers tensions in practice. The aim of this study was to explore community nurses' views of self‐management, the dilemmas community nurses face when providing support of self‐management by older adults and the strategies they use to solve these challenges. A qualitative study was performed to collect data. Twenty‐one community nurses from the eastern part of the Netherlands were recruited through purposive sampling. The interviews were audiotaped, transcribed verbatim and a thematic analysis was carried out. The results show that community nurses find it difficult to give a clear, definitive description of the concept of self‐management. They relate self‐management to ‘taking control of your own life’, ‘making your own choices and decisions’ and ‘being self‐reliant’. Situations in which older adults exhibit considerable or little self‐direction or self‐reliance can lead to conflicts in self‐management support, namely: 1) ‘striving for optimal health and well‐being versus respecting older adults' choices’ and 2) ‘stimulating self‐reliance and self‐direction versus accepting a dependent attitude’. Different strategies are applied to resolve these scenarios. In the first case, strategies of ‘adapting’, ‘persuading’ and ‘taking control’ are used, and for the second case ‘empowering’, challenging’ and ‘tolerating’ are used. Creating a clear and shared understanding of ‘self‐management’ and facilitating community nurses to reflect on their dilemmas and strategies might help them in supporting self‐management by older adults.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Community nurses' self‐management support in older adults: A qualitative study on views, dilemmas and strategies

Bolscher-Niehuis

Uitdehaag

Francké

2019

Health Soc Care Community

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“…Nurses tended to steer patients to follow their suggestions according to medical norms. This tendency is also found in another Dutch study (Dwarswaard & van de Bovenkamp, ). Nurses mostly queried patients about their behaviour in general terms and provided feedback on their behaviour.…”

Section: Discussionsupporting

confidence: 83%

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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“…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: 61%

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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Self-management support: A qualitative study of ethical dilemmas experienced by nurses

Cited by 43 publications

References 27 publications

Community nurses' self‐management support in older adults: A qualitative study on views, dilemmas and strategies

Community nurses' self‐management support in older adults: A qualitative study on views, dilemmas and strategies

Self‐management support in routine primary care by nurses

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

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