Is nurses’ self‐esteem interwoven with patients’ achievements? The concept of patient‐invested contingent self‐esteem

Abstract

Objectives To explore the notion of patient‐invested contingent self‐esteem (Pa‐CSE) and investigate its association to nurses’ self‐reported engagement in controlling or autonomy‐supportive interactions with chronic care patients. Background Considering the high number of patients sub‐optimally managing their chronic condition, nurses might experience a drop and rise in self‐worth when patients fail and succeed, respectively, in managing their chronic condition. This dynamic has not received prior research attention. Design Multivariate analysis employing cross‐sectional data according to STROBE guidelines. Methods Self‐reports among nurses employed in chronic care (N = 394) from eight randomly selected hospitals in Belgium. Exploratory factor analysis and stepwise linear regression analyses were conducted. Results Success‐based and failure‐based orientations could be distinguished and refer to nurses' tendency to associate, respectively, patients’ successes with feelings of professional success and self‐worth and patients’ failures with feelings of professional failure, shame and inadequacy. Nurses’ self‐esteem is fairly interwoven with patients’ achievements in the management of their chronic condition. A success‐based orientation was positively related to autonomy‐supportive care in case a failure‐based orientation was low. Nurses with a simultaneous success‐based and failure‐based orientation interacted in a more controlling way. Conclusions The findings of this study suggest that basing one's self‐worth on patients' accomplishments may be a double‐edged sword. Although tying one's personal glory to the successes of one's patient is related to greater patient participation and support of autonomy, these effects only emerge if nurses' self‐worth is not interwoven with patients' failures. In fact, having both success‐ and failure‐oriented contingent self‐worth is related to a more pressuring approach. Relevance to clinical practice To prevent nurses from developing inferior professional feelings when their patients fail to manage their condition, a reflective stance towards the impact of patients’ behaviour on the nurses' professional feeling of (in)adequacy is an important step to deal with such situations.

Nurses' perceptions of success in self‐management support: An exploratory qualitative study

“…Being dependent on others for your self‐worth, the so‐called contingency of self‐esteem can be a pitfall (Van der Kaap‐Deeder, Coorevits, & Vansteenkiste, 2015). It might lead to attempts to make the other person perform according to one's own norms (Duprez et al, 2019; Van der Kaap‐Deeder et al, 2015), a mechanism that we identified in the data. Boosting your self‐esteem upon others' achievements is not the most optimal way of building your self‐esteem as it is highly fragile (Kernis, Lakey, & Heppner, 2008).…”

“…Third, it is highly recommended that nurses create good patient contact, communication skills, and a person‐centered approach to establish an attuning approach rather than a directive approach (Figure 1). The Self‐Determination Theory can provide a theoretical foundation to help nurses to adopt an attitude of curiosity and interest, together with autonomy‐supportive communication, which is key to exploration, understanding, and participation (Duprez et al, 2019; Ryan et al, 2011). Additionally, self‐management support aligns well with the main concepts of skilled companionship, where the nurse, as a skilled companion, forms a partnership with the patient as an expert by experience (Dierckx de Casterlé, 2015; Titchen, 2001).…”

“…There is initial evidence that patients' behavior is, for some professionals, an onset for feelings of disillusionment (Lelorain, Bachelet, Bertin, & Bourgoin, 2017). In particular, patients who properly perform requisite health tasks for their chronic condition, seem to boost nurses' feelings of professional self‐esteem (Duprez, Vansteenkiste, Beeckman, Verhaeghe, & Van Hecke, 2019). A qualitative study approach might shed further light on the processes underlying perceived successfulness or disillusionment in self‐management support.…”

Public health nurses’ professional dignity: An interview study in Finland

“…It is not always easy to demonstrate self-respect and self-esteem [56][57][58][59] as a person and professional. These views mainly depend on different subjective, socio-contextual factors linked to the culture, the beliefs of individual workers in a particular milieu and the psychological dimensions and personality traits of that person.…”

Factors influencing nurses’ provision of self-management support for patients with chronic illnesses: A systematic mixed studies review

“…Nurses help patients modify their cognitive appraisal of the disease and its symptoms, adopt a positive illness management approach, and encourage health seeking behaviour (Denver, Barnard, Woolfson, & Earle, 2003;Richard & Shea, 2011;Schulman-Green et al, 2012;van Hooft, Dwarswaard, Jedeloo, Bal, & van Staa, 2015). This in turn encourages patients to take a central role in promoting their health through collaborative partnership (Duprez, Vansteenkiste, Beeckman, Verhaeghe, & Van Hecke, 2019). Today, no comprehensive definition of SMS encompasses these different aspects of support.…”