Respect for autonomy versus health promotion

Introduction: In 2011 5,3 million people had a chronic disease. Secondly patients want to have more influence in regulating their own disease. Self-management is increasingly being mentioned as a possible solution. However the practice learns that this involves ethical dilemmas, which nurses are often confronted with. <br/>Aim: ‘What factors are important for nurses who promote self-management in patient with a chronical disease to maintain a healthy lifestyle, while taking into account de patients’ autonomy?<br/><br/>Method: a literature search was done in databases Pubmed and Cochrane. Inclusion criteria were: Qualitative research studies published after 2003 in English or Dutch language, concerning adult patients with a chronical disease and related to the nursing profession.<br/>Secondly a semi-structural interview was done with two dialysis care professionals and transcripted verbatim. <br/>Results: Six studies met the selection criteria and were used to answer the question. The literature data indicate five factors that influence self-management: (1) Professional attitude of nurses: nurses use their own values and convictions in ethical decisions which leads to moral conflicts (2) Shared-decision making: sharing knowledge as a professional with the patient is a significant component in giving the patient autonomy (3) Patient directed support contributes to the success of self-management (4) Change of the traditional relation as professional-patient into a professional cooperation (5) Reflection on ethical dilemmas.<br/>During the semi-structural interviews as most important aspects of self-management were mentioned that patients must be informed adequately and supported by making decisions. Patients autonomy must be central in the organization of care. <br/><br/>Conclusion: Within self-management the patient should be in a central position. While performing self management care, nurses can be confronted with personal opinions that conflict with patients’ values. Shared decision making, patient directed support, professional attitude of the caregivers and reflection on ethical dilemmas, are key elements for effective self-management. <br/>