Objective: Policymakers increasingly focus their attention on stimulating patients' self-management. Critical reflection on this trend is often limited. A focus on self-management does not only change nurses' activities, but also the values underlying the nurse-patient relationship. The latter can result in ethical dilemmas. Methods: In order to identify possible dilemmas a qualitative study consisting of semi-structured interviews was conducted. Six experts on self-management and medical ethics and 15 nurses participated. Results: Nurses providing self-management support were at risk of facing three types of ethical dilemmas: respecting patient autonomy versus reaching optimal health outcomes, respecting patient autonomy versus stimulating patient involvement, and a holistic approach to self-management support versus safeguarding professional boundaries. Conclusion: The ethical dilemmas experienced by nurses rest on different views about what constitutes good care provision and good self-management. Interviewed nurses had a tendency to steer patients in a certain direction. They put great effort into convincing patients to follow their suggestions, be it making the 'right choice' according to medical norms or becoming actively involved patients. Practice implications: Because self-management support may result in clashing values, the development and implementation of self-management support requires deliberation about the values underlying the relationship between professionals and patients.

Chronic disease, Ethics, Nurses, Self-management
dx.doi.org/10.1016/j.pec.2015.05.017, hdl.handle.net/1765/91680
Patient Education and Counseling
Erasmus School of Health Policy & Management (ESHPM)

Dwarswaard, J, & van de Bovenkamp, H.M. (2015). Self-management support: A qualitative study of ethical dilemmas experienced by nurses. Patient Education and Counseling, 98(9), 1131–1136. doi:10.1016/j.pec.2015.05.017