Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.
School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.
Res Nurs Health. 2020 Jun;43(3):274-283. doi: 10.1002/nur.22018. Epub 2020 Mar 10.
Nurses play an important role in supporting patients in self-managing their chronic conditions. However, it is uncertain how nurses define their success and what might create feelings of disillusionment. This exploratory qualitative study sought to understand the origin, meanings, and processes underlying nurses' feelings of success in supporting patients to self-manage their life with a chronic illness. Semi-structured interviews were held with 16 nurses who were purposively sampled. Data were iteratively collected and analyzed (November 2017-September 2018). The origin and meaning of nurses' feelings of success in supporting patients in self-management converged around the intertwining of "maintaining and promoting health" as a primary goal in chronic care, while an "intrapersonal conflict" arises. Patients maintaining physical health by optimal medical management boost nurses' feelings of success, whereas patients dealing with sub-optimally provoke "an intrapersonal conflict". When nurses observe unhealthy patient behavior, this is difficult to accept as it conflicts with their normative ideas of good care and health. Nurses' perception of success is refined by three interconnected processes, namely "keeping on track", "considering own role," and "protecting self". Nurses experienced and processed success differently depending on whether they interacted with patients from a more directive approach or an attuning approach. This study highlighted the fact that nurses expect compliance from patients, and thereby often feel empty-handed. By adopting a broader perspective of what successful patient behavior is, nurses might be able to provide a more comprehensive meaning to their own success regarding the care of patients living with a chronic illness.
护士在支持患者自我管理慢性病方面发挥着重要作用。然而，护士如何定义自己的成功以及哪些因素可能导致他们产生幻灭感尚不确定。本探索性定性研究旨在了解护士在支持患者自我管理慢性病生活方面感到成功的根源、意义和过程。我们对 16 名护士进行了半结构化访谈，这些护士是通过目的性抽样选择的。数据是在 2017 年 11 月至 2018 年 9 月间进行反复收集和分析的。护士在支持患者自我管理方面感到成功的根源和意义集中在“维持和促进健康”作为慢性病护理的主要目标的交织上，同时也会出现“内在冲突”。患者通过最佳的医疗管理来维持身体健康，会增强护士的成功感，而患者处理欠佳则会引发“内在冲突”。当护士观察到患者不健康的行为时，他们很难接受，因为这与他们对良好护理和健康的规范观念相冲突。护士对成功的感知是由三个相互关联的过程来细化的，即“保持正轨”、“考虑自身角色”和“保护自我”。护士根据与患者的互动是采用更直接的方法还是更协调的方法，对成功的体验和处理方式也不同。这项研究强调了这样一个事实，即护士期望患者遵守医嘱，因此往往会感到束手无策。通过对成功的患者行为有更广泛的理解，护士可能能够为自己在照顾慢性病患者方面的成功提供更全面的意义。
