Kralik Debbie, Koch Tina, Price Kay, Howard Natalie
School of Nursing and Midwifery, University of South Australia, RDNS Research Unit, Royal District Nursing Service (SA Inc), Glenside, South Australia.
J Clin Nurs. 2004 Feb;13(2):259-67. doi: 10.1046/j.1365-2702.2003.00826.x.
This paper presents research that was framed by our early understandings about the ways that people incorporate the consequences of illness into their lives. The word 'transition' has been used to describe this process. We believed self-management to be central to the transition process but this assertion required further research, hence this paper.
The research aimed at understanding the way in which people who lived with chronic illness constructed the notion of self-management. While the participants of this study were living with arthritis, the focus was on understanding the meaning of self-management rather than the experience of living with the symptoms of arthritis.
Data were generated when nine people living with arthritis were invited to write an autobiography about their life and experiences of living with illness. Two telephone interviews were recorded with each participant and then the research group (researchers and participants) convened for a discussion meeting.
In contrast to health professionals who identify self-management as structured education, participants identified self-management as a process initiated to bring about order in their lives. Creating a sense of order, or self-management, had four key themes (i) Recognizing and monitoring the boundaries, (ii) Mobilizing the resources, (iii) Managing the shift in self-identity, (iv) Balancing, pacing, planning and prioritizing
People learned about their responses to illness through daily life experiences and as a result of trial and error. They reconfigured their daily lives and reconstructed their self-identity by exploring their personal limitations or boundaries. Self-management of chronic illness has been considered as both structure and process, however it is the process of self-management that we contend is central to the experience of transition.
Clinical nursing intervention for people with a long term illness may be enhanced when self-management is approached from a broad, contextual perspective and self-management processes are integrated into clinical practice. The challenge is for nurses to embrace processes in nursing practice that will facilitate interactions with clients without obstructing the diversity of perspectives, create an environment conducive to learning and engage individuals in identifying self-management strategies that have meaning in their lives.
本文介绍了一项研究，该研究基于我们早期对人们将疾病后果融入生活方式的理解。“转变”一词被用来描述这一过程。我们认为自我管理是转变过程的核心，但这一断言需要进一步研究，因此撰写了本文。
该研究旨在了解慢性病患者构建自我管理概念的方式。虽然本研究的参与者患有关节炎，但重点是理解自我管理的意义，而非患有关节炎症状的体验。
邀请九位患有关节炎的患者撰写关于他们的生活及患病经历的自传，从而收集数据。对每位参与者进行了两次电话访谈，然后研究小组（研究人员和参与者）召开了一次讨论会。
与将自我管理视为结构化教育的健康专业人员不同，参与者将自我管理视为为给生活带来秩序而启动的一个过程。营造秩序感或自我管理有四个关键主题：（i）识别和监测界限；（ii）调动资源；（iii）管理自我认同的转变；（iv）平衡、调整节奏、规划和确定优先事项。
人们通过日常生活经历以及试错了解自己对疾病的反应。他们通过探索个人局限或界限来重新安排日常生活并重构自我认同。慢性病的自我管理一直被视为既有结构又有过程，但我们认为自我管理过程才是转变体验的核心。
当从广泛的背景视角看待自我管理并将自我管理过程融入临床实践时，对长期患病者的临床护理干预可能会得到加强。挑战在于护士要在护理实践中采用有助于与患者互动而又不妨碍观点多样性的过程，营造有利于学习的环境，并促使个体确定对其生活有意义的自我管理策略。
