Chronic illness self-management: taking action to create order.
BACKGROUND
This paper presents research that was framed by our early understandings about the ways that people incorporate the consequences of illness into their lives. The word 'transition' has been used to describe this process. We believed self-management to be central to the transition process but this assertion required further research, hence this paper.


OBJECTIVE
The research aimed at understanding the way in which people who lived with chronic illness constructed the notion of self-management. While the participants of this study were living with arthritis, the focus was on understanding the meaning of self-management rather than the experience of living with the symptoms of arthritis.


METHODS
Data were generated when nine people living with arthritis were invited to write an autobiography about their life and experiences of living with illness. Two telephone interviews were recorded with each participant and then the research group (researchers and participants) convened for a discussion meeting.


RESULTS
In contrast to health professionals who identify self-management as structured education, participants identified self-management as a process initiated to bring about order in their lives. Creating a sense of order, or self-management, had four key themes (i) Recognizing and monitoring the boundaries, (ii) Mobilizing the resources, (iii) Managing the shift in self-identity, (iv) Balancing, pacing, planning and prioritizing


CONCLUSIONS
People learned about their responses to illness through daily life experiences and as a result of trial and error. They reconfigured their daily lives and reconstructed their self-identity by exploring their personal limitations or boundaries. Self-management of chronic illness has been considered as both structure and process, however it is the process of self-management that we contend is central to the experience of transition.


CONCLUSIONS
Clinical nursing intervention for people with a long term illness may be enhanced when self-management is approached from a broad, contextual perspective and self-management processes are integrated into clinical practice. The challenge is for nurses to embrace processes in nursing practice that will facilitate interactions with clients without obstructing the diversity of perspectives, create an environment conducive to learning and engage individuals in identifying self-management strategies that have meaning in their lives.
Kralik
Debbie
D
School of Nursing and Midwifery, University of South Australia, RDNS Research Unit, Royal District Nursing Service (SA Inc), Glenside, South Australia. dkralik@bigpond.net.au
Koch
Tina
T
Price
Kay
K
Howard
Natalie
N
D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000368:Aged; D001168:Arthritis / Q000517:prevention & control / Q000523:psychology; D001294:Attitude to Health; D001828:Body Image; D002908:Chronic Disease / Q000523:psychology*; D005260:Female; D006801:Humans; D007389:Internal-External Control; D008016:Life Change Events; D008019:Life Style; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D024802:Nurse's Role; D015404:Nursing Methodology Research; D010353:Patient Education as Topic; D012648:Self Care / Q000379:methods* / Q000523:psychology; D012649:Self Concept; D012803:Sick Role; D011795:Surveys and Questionnaires