Nurses’ support of hospitalized patients’ self-management

Abstract

Self-management is the individual’s ability to prevent or, when necessary, handle the consequences of health problems. Supporting the patients’ self-management is essential to future healthcare and aligns with the new thinking about health as ‘the ability to adapt and to self-manage in the face of social, physical, and emotional challenges’ rather than the absence of disease. To investigate how nurses can support patients’ self-management during hospitalization, we performed several studies. We conducted semi-structured interviews with patients to explore their motives for or not to perform self-management during hospital admission. The findings show that nurses can support inpatients’ self-management by discussing hospital stay expectations and inviting patients to participate. Patients’ motives to self-manage during hospitalization can also be strengthened by providing information about what the patient can do to stimulate recovery or prevent complications. In addition, we conducted focus group interviews with nurses to assess their perceptions of patients’ self-management during hospitalization and their support in this regard. Nurses have a positive attitude towards self-management, but they often take over care tasks and decisions from patients, more often than is necessary given the patient’s condition. It seems unclear to nurses what is expected of them in the field of self-management support and they experience few opportunities to carry out this activity. We explored how nurses support the self-management of hospitalized patients through verbal communication during routine nursing care through overt, non-participant observations of nurses working morning, afternoon, and evening shifts on three nursing wards. The findings show that while nurses have methods to support hospitalized patients’ self-management, this does not appear to be an integral part of daily practice. Nurses ask patients about their self-management at home and encourage patients to express their opinions and to be involved in the care process. However, this usually happens ad hoc, in short conversations during the performance of other care tasks, and often as a one-way flow of information from nurse to patient. To map out the current state of research concerning self-management support during hospitalization we conducted a scoping review of the literature. Most activities identified by this review are part of regular nursing care. Nevertheless, the focus on patients’ self-management may influence their content. A relatively new self-management support activity highlighted in the review is the transfer of responsibility for care tasks to patients during hospitalization. Nurses sometimes transfer responsibility for ADL tasks to the patient, but do this much less for other self-management tasks that the patient must perform after discharge. Based on the aforementioned studies, we developed a draft conceptualization of nurses’ support of hospitalized patients’ self-management and determine the appropriateness and completeness of this conceptualization in a Delphi study. The expert panel consisted of three groups of participants: patients, nurses and researchers. The final version of the conceptualization consists of 56 nursing activities categorized into 6 sets. The activities of the conceptualization should not be considered in isolation, but rather as a coherent whole from which to choose, depending on the needs, wishes, and possibilities of the patient.