What factors influence nurses' behavior in supporting patient self-management? An explorative questionnaire study.
BACKGROUND
A major challenge for nurses in hospital care is supporting chronically ill patients in self-managing their chronic condition. Self-management support requires a broad range of competencies and is often regarded as difficult to implement in daily practice. So far, we have no insight in nurses' behavior in daily practice with regard to self-management support and what factors may influence their behavior.


OBJECTIVE
The aim of this survey was to explore (i) the self-reported behavior on self-management support of nurses in a university hospital; and (ii) the factors influencing this behavior.


METHODS
Total sample approach with cross-sectional design.


METHODS
Nurses employed by a university hospital received an invitation for the research through e-mail containing a link to the survey. Of the 2054 nurses who had been invited to participate, 598 responded (29.11%). The entire questionnaire was completed by 379 nurses, 32 of whom indicated they did not work with patients on a daily basis. After excluding those 32, the final sample included 347 valid responses (16.9%). 90.5% of the respondents was female, mean age was 38.8 years.


METHODS
In a web-based questionnaire, the self-efficacy and performance in self-management support instrument (SEPSS-36) was used, with additional questions about attitude, subjective norms, and perceived barriers for self-management support.


RESULTS
This study shows that nurses are self-confident of their capabilities to support self-management. They also feel that most of the time they acted accordingly. Still, a significant gap between self-efficacy and behavior of self-management support was found (p<0.001). Nurses themselves perceive lack of time and patients' lack of knowledge as barriers for self-management support, but this did not influence their behavior (p>0.05). Regression analysis showed that perceived lack of own knowledge, the presumed absence of a patients' need for self-management support, and nurses' self-efficacy in self-management support are factors that influence the behavior of self-management support. 41.1% of the variance of behavior is explained by these three factors.


CONCLUSIONS
This study shows a significant gap between self-reported self-efficacy and behavior in self-management support in nurses working in a university hospital. To enhance self-management support, managers and educators should take these influential factors into account. A third of the nurses did not report a need for additional training on self-management support. This implies that programs should also aim to improve reflective skills and raising awareness.
Research Centre Innovations in Care, Rotterdam University of Applied Sciences, The Netherlands; Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands. Electronic address: s.m.van.hooft@hr.nl.
Susanne M
SM
van Hooft
Research Centre Innovations in Care, Rotterdam University of Applied Sciences, The Netherlands.
Jolanda
J
Dwarswaard
Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
Roland
R
Bal
Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
Mathilde M
MM
Strating
Research Centre Innovations in Care, Rotterdam University of Applied Sciences, The Netherlands; Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
AnneLoes
A
van Staa
D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D009726:Nurses / Q000523:psychology*; D010361:Patients / Q000523:psychology*; D012648:Self Care; D020377:Self Efficacy; D057566:Self Report; D011795:Surveys and Questionnaires
Barriers; Chronic care; Competency; Nurses; Self-care; Self-efficacy; Self-management support; Survey methodology