title: Rhetoric or reality? What nurse practitioners do to provide self-management support in outpatient clinics: an ethnographic study.
abstract: OBJECTIVE
  To describe how nurse practitioners enact their role in outpatient consultations, and how this compares to their perception of their responsibility for patients with chronic conditions.
  
  
  BACKGROUND
  Nurse practitioners working with patients with chronic conditions seek to support them in self-managing their diseases.
  
  
  METHODS
  An ethnographic study.
  
  
  METHODS
  Episodic participant observations (in total 48 hours) were carried out combined with formal interviews. The study population consisted of a purposive sample of nurse practitioners working in five outpatient clinics related to chronic care in one university medical centre in the Netherlands. Two different types of clinics were selected, namely (1) for patients with episodic flare-ups and (2) for patients with diseases requiring life-saving procedures.
  
  
  RESULTS
  The nurse practitioners perceived the monitoring of patients' treatment as their main professional responsibility. Four monitoring strategies could be distinguished: 'assessing health conditions', 'connecting with patients', 'prioritising treatment in daily living' and 'educating patients'.
  
  
  CONCLUSIONS
  While nurse practitioners considered building a relationship with their patients of utmost importance, their consultations were mostly based on a conventional medical model of medical history taking. Little attention was paid to the social, psychological and behavioural dimensions of illness. Nurse practitioners in this study seemed quite successful in their extension into medical territory, but moving patients' illness perceptions to the background was not conducive to self-management support.
  
  
  CONCLUSIONS
  By their medical subspecialty expertise, nurse practitioners have a major role in the longitudinal process of the management of chronic diseases' treatment. Supporting patients to reduce the impact of the disease and its complications requires nurse practitioners to develop new coaching strategies designed to meet patients' individual needs.
authors.affiliation: Rotterdam University of Applied Sciences, Rotterdam, the Netherlands. speaj@hr.nl.
authors.forename: Ada J
authors.identifier: http://orcid.org/0000-0001-5012-1036
authors.initials: AJ
authors.lastname: Ter Maten-Speksnijder
authors.affiliation: Erasmus University Rotterdam and Rotterdam University of Applied Sciences, Rotterdam, the Netherlands.
authors.forename: Jolanda
authors.initials: J
authors.lastname: Dwarswaard
authors.affiliation: iBMG, Erasmus University Rotterdam, Rotterdam, the Netherlands.
authors.forename: Pauline L
authors.initials: PL
authors.lastname: Meurs
authors.affiliation: Erasmus University Rotterdam and Rotterdam University of Applied Sciences, Rotterdam, the Netherlands.
authors.forename: AnneLoes
authors.initials: A
authors.lastname: van Staa
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D000884:Anthropology, Cultural; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008875:Middle Aged; D009426:Netherlands; D009722:Nurse Practitioners; D024802:Nurse's Role; D057184:Practice Patterns, Nurses'; D012648:Self Care
keywords: advanced practice nursing; chronic care; ethnography; nurse practitioner; self-management support