[The structural paradigm of nursing care for patients with chronic illness: clinical experience with diabetic outpatients (III)].

The purpose of this study was to clarify a nursing paradigm of care for patients with chronic illness. Data were derived from fieldnotes of direct patient care for 111 diabetic outpatients. These fieldnotes included nursing intervention, conversation process, patient response to the nurse, the nurse's decision making process, and the nurse's reflections after intervention. Interpretive analysis identified nursing goals, nursing interventions, clinical judgment, and the nature of the patient-nurse relationship. Five nursing goals of patient-oriented care were identified: compliance, self-management, self-acceptance, independence, and self-actualization. Five approaches for nursing intervention also were identified: directed, facilitating, acknowledging, mutually responding, and mutually cooperating. From these findings, a nursing paradigm of care was conceptualized. As nursing goals became more "holistic", the patient-nurse relationship became more intimate, and the patients' competency to participate in the management of their own diabetic care became greater. This paradigm should assist nurses in judging and selecting the proper care for the needs of each patient.