title: Self-management support: A qualitative study of ethical dilemmas experienced by nurses.
abstract: OBJECTIVE
  Policymakers increasingly focus their attention on stimulating patients' self-management. Critical reflection on this trend is often limited. A focus on self-management does not only change nurses' activities, but also the values underlying the nurse-patient relationship. The latter can result in ethical dilemmas.
  
  
  METHODS
  In order to identify possible dilemmas a qualitative study consisting of semi-structured interviews was conducted. Six experts on self-management and medical ethics and 15 nurses participated.
  
  
  RESULTS
  Nurses providing self-management support were at risk of facing three types of ethical dilemmas: respecting patient autonomy versus reaching optimal health outcomes, respecting patient autonomy versus stimulating patient involvement, and a holistic approach to self-management support versus safeguarding professional boundaries.
  
  
  CONCLUSIONS
  The ethical dilemmas experienced by nurses rest on different views about what constitutes good care provision and good self-management. Interviewed nurses had a tendency to steer patients in a certain direction. They put great effort into convincing patients to follow their suggestions, be it making the 'right choice' according to medical norms or becoming actively involved patients.
  
  
  CONCLUSIONS
  Because self-management support may result in clashing values, the development and implementation of self-management support requires deliberation about the values underlying the relationship between professionals and patients.
authors.affiliation: Research Centre Innovations of Care, Rotterdam University of Applied Sciences, The Netherlands; Department of Health Policy & Management, Erasmus University Rotterdam, The Netherlands. Electronic address: j.dwarswaard@hr.nl.
authors.forename: Jolanda
authors.initials: J
authors.lastname: Dwarswaard
authors.affiliation: Department of Health Policy & Management, Erasmus University Rotterdam, The Netherlands.
authors.forename: Hester
authors.initials: H
authors.lastname: van de Bovenkamp
mesh_terms: D000328:Adult; D002648:Child; D004993:Ethics, Nursing; D005260:Female; D006801:Humans; D008297:Male; D024802:Nurse's Role; D009723:Nurse-Patient Relations / Q000941:ethics*; D009726:Nurses; D036301:Qualitative Research; D012648:Self Care
keywords: Chronic disease; Ethics; Nurses; Self-management