J. Dwarswaard

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

AIMSnTo unravel outpatient nurses views on the role of people with chronic conditions in self-management, nurses own support role and to establish how these views relate to nurse-led self-management interventions.nnnBACKGROUNDnProviding self-management support is a core task of nurses in outpatient chronic care. However, the concept of self-management is interpreted in different ways and little is known about nurses views on patients role in self-management and nurses own support role.nnnDESIGNnQualitative design.nnnMETHODSnIndividual semi-structured interviews were held in 2012-2013 with outpatient nurses at a university medical hospital in the Netherlands. After transcription, data-driven codes were assigned and key elements of views and experiences were discussed in the research team. Finally, insights were merged to construct and characterize types.nnnRESULTSnTwenty-seven nurses were interviewed. The analysis identified three divergent views on self-management support: adhering to a medical regimen; monitoring symptoms; and integrating illness into daily life. These views differ with respect to the patients role in self-management, the support role of the nurse and the focus of activities, ranging from biomedical to biopsychosocial. The first two were mainly medically oriented. Nurses applied interventions consistent with their individual views on self-management.nnnCONCLUSIONnNurses had distinct perceptions about self-management and their own role in self-management support. Social and emotional tasks of living with a chronic condition were, however, overlooked. Nurses seem to lack sufficient training and practical interventions to provide self-management support that meets the integral needs of patients with a chronic condition.

Rhetoric or reality? What nurse practitioners do to provide self-management support in outpatient clinics: an ethnographic study.

AIMS AND OBJECTIVESnTo describe how nurse practitioners enact their role in outpatient consultations, and how this compares to their perception of their responsibility for patients with chronic conditions.nnnBACKGROUNDnNurse practitioners working with patients with chronic conditions seek to support them in self-managing their diseases.nnnDESIGNnAn ethnographic study.nnnMETHODSnEpisodic participant observations (in total 48xa0hours) were carried out combined with formal interviews. The study population consisted of a purposive sample of nurse practitioners working in five outpatient clinics related to chronic care in one university medical centre in the Netherlands. Two different types of clinics were selected, namely (1) for patients with episodic flare-ups and (2) for patients with diseases requiring life-saving procedures.nnnRESULTSnThe nurse practitioners perceived the monitoring of patients treatment as their main professional responsibility. Four monitoring strategies could be distinguished: assessing health conditions, connecting with patients, prioritising treatment in daily living and educating patients.nnnCONCLUSIONnWhile nurse practitioners considered building a relationship with their patients of utmost importance, their consultations were mostly based on a conventional medical model of medical history taking. Little attention was paid to the social, psychological and behavioural dimensions of illness. Nurse practitioners in this study seemed quite successful in their extension into medical territory, but moving patients illness perceptions to the background was not conducive to self-management support.nnnRELEVANCE TO CLINICAL PRACTICEnBy their medical subspecialty expertise, nurse practitioners have a major role in the longitudinal process of the management of chronic diseases treatment. Supporting patients to reduce the impact of the disease and its complications requires nurse practitioners to develop new coaching strategies designed to meet patients individual needs.

What factors influence nurses’ behavior in supporting patient self-management? An explorative questionnaire study

BACKGROUNDnA major challenge for nurses in hospital care is supporting chronically ill patients in self-managing their chronic condition. Self-management support requires a broad range of competencies and is often regarded as difficult to implement in daily practice. So far, we have no insight in nurses behavior in daily practice with regard to self-management support and what factors may influence their behavior.nnnOBJECTIVESnThe aim of this survey was to explore (i) the self-reported behavior on self-management support of nurses in a university hospital; and (ii) the factors influencing this behavior.nnnDESIGNnTotal sample approach with cross-sectional design.nnnPARTICIPANTS AND SETTINGnNurses employed by a university hospital received an invitation for the research through e-mail containing a link to the survey. Of the 2054 nurses who had been invited to participate, 598 responded (29.11%). The entire questionnaire was completed by 379 nurses, 32 of whom indicated they did not work with patients on a daily basis. After excluding those 32, the final sample included 347 valid responses (16.9%). 90.5% of the respondents was female, mean age was 38.8 years.nnnMETHODSnIn a web-based questionnaire, the self-efficacy and performance in self-management support instrument (SEPSS-36) was used, with additional questions about attitude, subjective norms, and perceived barriers for self-management support.nnnRESULTSnThis study shows that nurses are self-confident of their capabilities to support self-management. They also feel that most of the time they acted accordingly. Still, a significant gap between self-efficacy and behavior of self-management support was found (p<0.001). Nurses themselves perceive lack of time and patients lack of knowledge as barriers for self-management support, but this did not influence their behavior (p>0.05). Regression analysis showed that perceived lack of own knowledge, the presumed absence of a patients need for self-management support, and nurses self-efficacy in self-management support are factors that influence the behavior of self-management support. 41.1% of the variance of behavior is explained by these three factors.nnnCONCLUSIONnThis study shows a significant gap between self-reported self-efficacy and behavior in self-management support in nurses working in a university hospital. To enhance self-management support, managers and educators should take these influential factors into account. A third of the nurses did not report a need for additional training on self-management support. This implies that programs should also aim to improve reflective skills and raising awareness.

The complexity of shaping self-management in daily practice

Many countries are giving patients a more active role in health care, on both the individual and collective level. This study focuses on one aspect of the participation agenda on the individual level: self‐management. The study explores self‐management in practice, including the implications of the difficulties encountered.

Use of Online Self-Management Diaries in Asthma and COPD: A Qualitative Study of Subjects' and Professionals' Perceptions and Behaviors

BACKGROUND: Online self-management diaries are used to support patients self-management skills and facilitate associated behavioral changes. Although web-based diaries are well-known as a potential self-management tool, reasons that patients use (or do not use) self-management diaries, as well as perceptions and behaviors related to diary use, remain largely unknown. METHODS: Semistructured interviews (n = 30) were conducted with health-care professionals and subjects to understand perceptions and behaviors related to self-management diary use for asthma and COPD in 2 hospitals in Rotterdam, The Netherlands. RESULTS: Subjects in this study used self-management diaries to improve their knowledge of the disease, cope more consciously with their disease, feel in control, and discuss outcomes from the self-management diaries with their health-care professionals. Two subjects reported that they used the self-management diary to cope more effectively with their disease and recognized an exacerbation and acted by adjusting their medications. Both health-care professionals and subjects experienced practical barriers in integrating self-management diaries into their regular practices. Subjects reasons for nonuse were related to the intervention, the disease, and subject-provider contact. CONCLUSIONS: Health-care professionals should help patients use self-management diaries by collaboratively developing an individual treatment plan and by showing patients how to use the diaries to recognize and act on an exacerbation. Together with the suggestions made for improving the self-management diaries, this will aid in the integration of self-management diaries into regular health-care practice and enhance patients self-management of their disease.

Verpleegkundige ondersteuning bij zelfmanagement en eigen regie

Onder redactie van AnneLoes van Staa, Ada ter Maten-Speksnijder en Lausanne Mies. Dit boek helpt verpleegkundigen, studenten verpleegkunde en verpleegkundig specialisten het zelfmanagement van mensen met chronische aandoeningen te ondersteunen. Dat behoort tot de kerntaak van elke verpleegkundige. Het boek geeft daarvoor de kennis, traint de vaardigheden en bespreekt de gewenste attitude, zoals een open houding, goede gespreksvoering en samenwerking met de patient en andere (mantel)zorgverleners.

What support is needed to self-manage a rheumatic disorder: a qualitative study

BackgroundToday, patients are expected to take an active role in the form of self-management. Given the burden of a rheumatic disorder, the patients cannot be expected to self-manage on their own. In order to develop self-management interventions that fit patients’ needs and preferences, it is essential to examine patients’ perspective on how support can be optimized. This study aimed to identify support needs of outpatients with rheumatic disorders and preferences for who should provide self-management support.MethodsA qualitative study was conducted using focus groups and individual interviews with outpatients with rheumatic disorders treated in a Dutch university hospital. Interview data was analysed with Directed Content Analysis and coded with predetermined codes derived from our model about support needs of chronically ill patients. This model distinguished three types of support: instrumental, psychosocial and relational support.ResultsFourteen patients participated in two focus group interviews and six were interviewed individually. Most patients preferred an active role in self-management. Nonetheless, they notably needed support in developing skills for self-managing their rheumatic disorder in daily life. The extent of support needs was influenced by disease stage, presence of symptoms and changes in one’s situation. A trusted relationship and partnership were conditional for receiving any kind of professional support. Patients wanted to be seen as experienced experts of living with a rheumatic disorder. Acquiring specific disease-related knowledge, learning how to deal with symptoms and fluctuations, talking about emotional aspects, and discussing daily life issues and disease-related information were identified as important elements of self-management support. It was considered crucial that support be tailored to individual needs and expertise. Professionals and relatives were preferred as support givers. Few patients desired support from fellow patients.ConclusionSelf-management was primarily seen as patient’s own task. Above all, patients wanted to be seen as the experienced experts. Professionals’ self-management support should be focused on coaching patients in developing problem-solving skills, for which practical tools and training are needed.

Teaching self-management support in Dutch Bachelor of Nursing education: A mixed methods study of the curriculum

BACKGROUNDnNurses are expected to support people to self-manage. Student nurses therefore need to master competencies that include the assessment of peoples needs and preferences, and shared decision-making, whilst respecting and enhancing peoples autonomy. Adapting nurse education programmes to meet this goal requires insight into the practice of teaching self-management support. In order to reveal this practice, one can distinguish between the intended, the taught, and the received curriculum.nnnOBJECTIVESnThis study aimed to explore how Dutch Bachelor of Nursing students are educated to support peoples self-management in clinical practice.nnnDESIGNnMixed methods.nnnMETHODS AND PARTICIPANTSnFocus group meetings with 30 lecturers, and qualitative semi-structured interviews with four coordinators and four (associate) professors of four Dutch schools for Bachelor of Nursing. Syllabuses were screened for learning objectives related to self-management. A survey measuring self-efficacy and behaviour regarding self-management support was distributed among 444 final-year students of these schools, resulting in 238 valid responses (response rate 53.6%).nnnRESULTSnMuch attention is paid in the curriculum to assessment of peoples preferences and healthcare education but less attention is given to teaching the arrangement of follow-up care. The study further reveals that students have problems transferring theory into practice, and that they experience conflicting values between their nurse education and internships.nnnCONCLUSIONSnCurrently, students are taught to provide people with self-management support by learning about theoretical models, developing communication skills, and reflecting on their internships. This approach seems inadequate to prepare students for this task in daily practice. A shared view on self-management support based on authentic situations, having role models at university and on internships and empowering students may enable them to better support people to self-manage.

Self-management challenges and support needs among kidney transplantation recipients : A qualitative study

AIMSnThis study investigated self-management challenges and support needs experienced by kidney transplant recipients.nnnBACKGROUNDnAfter kidney transplantation, recipients are expected to take an active role in self-management. However, evidence suggests that nurses experience difficulties operationalizing self-management support. Greater insight into the recipients perspective could help to improve the adequacy and efficacy of nurse-led self-management support.nnnDESIGNnA cross-sectional qualitative study.nnnMETHODSnFocus groups and individual interviews were carried out with kidney transplant recipients treated in a Dutch university hospital. Directed content analysis (DCA) was used.nnnRESULTSnForty-one kidney transplant recipients participated. Challenges after transplantation included becoming an expert patient, adjusting daily life activities, dealing with medical regimen, forming relationships with nurses, dealing with social consequences, dealing with emotions related to transplantation and the donor and improving self-image. To be able to deal with these challenges, participants wished to receive disease specific knowledge and instruction, share personal experiences with fellow patients, share and discuss not only medical but also emotional and social issues with nurses and wanted to be encouraged through positive feedback. One-size fits all education was considered insufficient in meeting their needs.nnnCONCLUSIONSnAfter kidney transplantation, recipients experienced various challenges in dealing with the medical, emotional and social tasks. Current support from nurses overlooked recipients emotional and social support needs. Nurses need adequate tools and training to be able to meet recipients self-management support needs.