Abstract
Aims: To understand self-management support (SMS) by delineating and analysing, in depth, the perceptions and experiences of nurses providing SMS for patients with long-term conditions (LTCs).
Background: SMS from health care providers (HCps) is essential to assist in patients' self-management (SM) behaviours, and, thus, improve their quality of life. Among various HCps, nurses are best positioned to facilitate SMS in partnership with patients, as nurses spend significant amounts of time with patients. Additionally, the therapeutic role fulfilled by nurses includes the provision of education, guidance, and nursing care; tasks that are deeply interrelated with SMS. To date, there is little evidence explaining nurses' point of view towards SMS for patients with LTCs, including nurses' perceptions, attitudes, experiences, and understandings of their roles and responsibilities in SMS. Therefore, identifying, conceptualising, and understanding SMS, as viewed from the perspective of nurses, will allow for greater clarity as to the appropriate principles and standards for nursing practice in provision of SMS to patients with long-term conditions.
Methods: To research this question about nurses' perceptions of SMS, an integrative review was conducted. A literature search was carried out between October 2021 July 2022. Seven academic databases were searched for studies identifying research relating to nurses' points of view in the provision of SMS across a range of international healthcare settings. Studies were critically appraised for methodological quality utilising the Joanna Briggs Institute (JBI) Quality Appraisal Framework. Data extraction was then performed on all studies selected for inclusion. The review followed Whittemore and Knafl's methodology for integrative reviews, with the process of data analysis specifically utilising Braun and Clarke's reflective thematic analysis.
Results: A total of sixteen studies met the inclusion criteria and attained the cut-off JBI scores for relevance and reliability, when subjected to quality appraisal, to be selected for inclusion in this review. The review identified the facilitators and challenges nurses encounter and the range of approaches or profiles that nurses undertake in implementing SMS. Thematic analysis identified one main theme and three sub-themes.
Conclusion: By incorporating nurses' perspectives, this review expands the conceptualisation of SMS from a medical-oriented approach to a wider view that encompasses biopsychosocial aspects of patients; and challenges, dilemmas, and support needs of nurses. The nursing profession is identified as an important fit for taking a leading role and assuming greater responsibilities in facilitating SMS for patients with LTCs. Nurses will benefit from taking a broad view and attuning approach, incorporating reflection and therapeutic relationships with person-centred care.
Relevance to Clinical practice: In their clinical work, nurses who undertake SMS roles with patients who have LTCs need to possess and be able to apply skills, concepts, and philosophies of care to provide better support for each individual patient. This literature review synthesises existing understandings and experience around SMS perceived from the nurse's point of view, contributing further detail and conceptual understanding to the role of nurses in the provision of SMS to people with LTCs, and offers recommendations for interpretation and translation of these understandings into practice. Further research is required to ascertain how the specific cultural contexts and the health system influences SMS and nurses' point of view and experiences of SM and SMS in specific healthcare contexts, such as in Aotearoa New Zealand to capture the experiences of M?ori patients in particular; a population about which more primary research is needed.