title: Nurses' responses to expert patients: the rhetoric and reality of self-management in long-term conditions: a grounded theory study.
abstract: 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.
authors.affiliation: Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield AL10 9AB, UK. p.m.wilson@herts.ac.uk
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Wilson
authors.forename: Sally
authors.initials: S
authors.lastname: Kendall
authors.forename: Fiona
authors.initials: F
authors.lastname: Brooks
mesh_terms: 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