title: Competency in shaping one's life: autonomy of people with type 2 diabetes mellitus in a nurse-led, shared-care setting; a qualitative study.
abstract: BACKGROUND
  In the Netherlands diabetes specialist nurses play an important role in specialized, long-term care for the chronically ill. One of the goals of nurse-led, shared care is to encourage chronically ill people to participate actively in selecting the organisation and interventions of care. This paper reports the findings of a study to determine which concepts of autonomy people with type 2 diabetes use in a nurse-led, shared-care setting.
  
  
  OBJECTIVE
  The aim of this article was to portray how people with type 2 diabetes mellitus who are being cared for by diabetes specialist nurses in a shared-care unit view autonomy.
  
  
  METHODS
  This qualitative study used in-depth interviews and was carried out in a nurse-led, shared-care unit in the Netherlands.
  
  
  METHODS
  The study population consisted of 15 people who were enrolled for at least 1 year at the nurse-led, shared-care unit and who lived independently at home.
  
  
  METHODS
  Data were analysed with a grounded-theory-like method.
  
  
  RESULTS
  The core category, 'competency in shaping one's life', described how people with diabetes exercise their autonomy. Seven categories that emerged were considered dimensions of autonomy. The dimensions were: identification, self-management, welcomed paternalism, self-determination, shared decision-making, planned surveillance, and responsive relationship.
  
  
  CONCLUSIONS
  Autonomy is a multi-dimensional, dynamic and complex construct. Further research is needed to investigate which decision-making processes patients with type 2 diabetes use in a nurse-led, shared-care setting.
authors.affiliation: Faculty of Health Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands. a.moser@student.unimaas.nl
authors.forename: Albine
authors.initials: A
authors.lastname: Moser
authors.forename: Harry
authors.initials: H
authors.lastname: van der Bruggen
authors.forename: Guy
authors.initials: G
authors.lastname: Widdershoven
mesh_terms: D000359:Aftercare / Q000458:organization & administration; D000368:Aged; D003299:Cooperative Behavior; D003657:Decision Making; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control* / Q000523:psychology; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D016294:Models, Nursing; D008960:Models, Psychological; D009426:Netherlands; D009720:Nurse Clinicians / Q000458:organization & administration / Q000523:psychology; D024802:Nurse's Role / Q000523:psychology; D009723:Nurse-Patient Relations; D015404:Nursing Methodology Research; D010358:Patient Participation / Q000379:methods / Q000523:psychology*; D026684:Personal Autonomy; D036301:Qualitative Research; D012648:Self Care / Q000379:methods / Q000523:psychology*; D020377:Self Efficacy; D012654:Self-Care Units / Q000458:organization & administration; D011795:Surveys and Questionnaires