Four perspectives on self-management support by nurses for people with chronic conditions: A Q-methodological study

Background: Self-management support is a major task of nurses in chronic care. Several conceptualizations on what self-management support encompasses are described in the literature. However, nurses' attitudes and perceptions related to self-management support are not known. Objective: To reveal distinctive perspectives of nurses toward self-management support in chronic care. Design and methods: A Q-methodological study was conducted in which nurses rankordered 37 statements on self-management support. Thereafter they motivated their ranking in semi-structured interviews. Participants and setting: A purposive sample of 49 Dutch nurses with a variety of educational levels, age, and from different healthcare settings was invited by e-mail to participate in the study. Thirty-nine nurses (aged 21-54 years) eventually participated. The nurses worked in the following settings: hospital (n = 11, 28%), home-care (n = 14, 36%), mental health care (n = 7, 17%), elderly care (n = 6, 15%) and general practice (n = 1, 3%). Results: Four distinct perspectives on the goals for self-management support were identified: the Coach, the Clinician, the Gatekeeper and the Educator perspective. The Coach nurse focuses on the patient's daily life activities, whereas the nurses of the Clinician type aim to achieve adherence to treatment. The goal of self-management support from the Gatekeeper perspective is to reduce health care costs. Finally, the Educator nurse focuses on instructing patients in managing the illness. Conclusions: The changing role of chronic patients with regard to self-management asks for a new understanding of nurses' supportive tasks. Nurses appear to have dissimilar perceptions of what self-management support entails. These distinct perceptions reflect different patient realities and demand that nurses are capable of reflexivity and sensitivity to patient needs. Different perspectives toward self-management support also call for diverse competencies and consequently, also for adaptation of educational nursing programs.