Nurses' responses to expert patients: the rhetoric and reality of self-management in long-term conditions: a grounded theory study.
BACKGROUND
Against the backdrop in the western world of increasing prevalence of chronic disease, active and informed patients and a policy emphasis on self-management, this English study explored health professionals' responses to expert patients.


OBJECTIVE
To:


METHODS
A grounded theory approach was utilised with two concurrent data strands.


METHODS
A relatively affluent English county including community, primary and secondary care settings.


METHODS
Via purposeful and theoretical sampling 100 health professionals (nurses, doctors, physiotherapists) and 100 adults affected by chronic disease participated.


METHODS
Focus groups, interviews and observation.


RESULTS
Nurses were found to be most anxious about expert patients when compared to other professionals, which appeared to be linked with a lack of professional confidence and unfounded fears regarding litigation. However, nurse specialists often provided a negative case for this. As a whole, nurses were most able to meet the emotional needs of patients, but apart from nurse specialists did not articulate this as a skill.


CONCLUSIONS
Apart from nurse specialists the majority of nurses appeared limited in appropriately facilitating self-management. It is suggested that this is linked to an ongoing nursing culture of patient as passive, an over-emphasis on empirical knowledge and a feeling of vulnerability on the nurses' part towards expert patients. The findings also indicate a rhetoric rather than reality of autonomous nursing roles within the chronic disease management agenda.
Wilson
Patricia M
PM
Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield AL10 9AB, UK. p.m.wilson@herts.ac.uk
Kendall
Sally
S
Brooks
Fiona
F
D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D002908:Chronic Disease / Q000451:nursing / Q000523:psychology; D004739:England; D005260:Female; D017144:Focus Groups; D006801:Humans; D008134:Long-Term Care / Q000379:methods / Q000523:psychology; D008297:Male; D009722:Nurse Practitioners / Q000523:psychology; D024802:Nurse's Role / Q000523:psychology; D009723:Nurse-Patient Relations; D015404:Nursing Methodology Research; D009740:Nursing Staff / Q000523:psychology*; D010358:Patient Participation / Q000379:methods / Q000523:psychology; D011320:Primary Health Care; D011637:Public Health Nursing; D036301:Qualitative Research; D012648:Self Care / Q000379:methods / Q000523:psychology; D011795:Surveys and Questionnaires