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Potential for Self-Management in Chronic Care: Nurses’ Assessments of Patients

Bos-Touwen, Irene; Dijkkamp, Evelien; Kars, Marijke; Trappenburg, Jaap; De Wit, Niek; Schuurmans, Marieke

doi: 10.1097/NNR.0000000000000103
FEATURE ARTICLES
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Background Although self-management interventions are, to some extent, individualized in clinical practice, the decision-making process is not fully understood. Exploring nurses' clinical reasoning about how and to what extent they currently tailor self-management support can provide new insights, enhancing process and outcome of chronic care.

Objectives The aim of this study was to explore how nurses assess chronic patients concerning the potential of self-management and clinical reasoning with regard to tailoring care to the individual patient.

Methods A qualitative study was conducted using grounded theory. Semistructured interviews were held with 15 nurses working within chronic care. All interviews were carried out from February to July 2013.

Results All nurses provided individualized care; however, a nurse's view of self-management influenced how tailoring was performed. Substantial differences were seen in patient assessments and how care was individualized. Patients' motivation, capacities, mindset, needs, and preferences were obtained through communication, experience, intuition, and trusting relationships. A typology with four patient types emerged: the unmotivated patient, the patient with limited capacities, the oblivious patient, and the ideal patient. Nurses elaborated on using different approaches for patients in each of these groups.

Discussion A nurse's perception of self-management substantially impacted how care was individualized. Patient assessment was the key driver of tailoring, which was performed in various ways, and influenced how and the extent to which care was individualized. To enable responding to the unique wishes and needs of individual patients, both scientific and educational efforts need to be directed toward systematic assessments of patient capacity to self-manage their disease.

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Irene Bos-Touwen, MSc, MD, and Evelien Dijkkamp, MSc, is Research Fellow, Nursing Science, Department Rehabilitation, Nursing Science & Sports, University Medical Center Utrecht, The Netherlands.

Marijke Kars, PhD, RN, is Assistant Professor, Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.

Jaap Trappenburg, PhD, PT, is Assistant Professor, Nursing Science, Department Rehabilitation, Nursing Science & Sports, University Medical Center Utrecht, The Netherlands.

Niek De Wit, PhD, MD, is Professor, Family Medicine, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.

Marieke Schuurmans, PhD, RN, is Professor, Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.nursingresearchonline.com).

Accepted for publication April 13, 2015.

The authors would like to thank all the nurses who participated in this study.

The authors declare no conflicts of interest.

Corresponding author: Irene Bos-Touwen, MSc, MD, Department Rehabilitation, Nursing Science & Sports, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands (e-mail: i.d.touwen-3@umcutrecht.nl).

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