Daily routines, short-term priorities, and nurses’ role hamper self-management support in a hospital setting: A mixed methods study

Abstract

Background: Self-management support is widely considered a critical aspect of nursing. Still, many studies indicate that nurses frequently experience difficulties in daily practice. Objective: To gain a deeper understanding of the factors perceived by nurses to impede or promote their support of patients’ self-management within the dynamic environment of the in-patient hospital setting. Design: Mixed methods design. Participants: Nurses (n = 269) working in a teaching hospital in the Netherlands completed a questionnaire. Subsequently, 38 nurses participated in interviews. Methods: The SEPSS-36 questionnaire assessed nurses’ self-efficacy and performance in self-management support. Semi-structured interviews were conducted to address salient results from the questionnaire, focusing on factors influencing self-management support, goal setting, follow-up care, and the nurse's role in a hospital setting. Results: the response rate for the questionnaire study was 62 %. A paired t-test revealed a significant mean difference of 6.30 95 % CI [5.91–6.69] p ≤ 0.001 between nurses’ perceived self-efficacy (mean = 18.34/24) and their actual performance (mean = 12.03/24) in self-management support. The interviews revealed that nurses typically focus on medical procedures and maintaining patients’ functional status. Spending time with patients to offer emotional support was viewed as ‘something extra’ rather than a core part of their job. High patient turnover hindered nurses from having meaningful conversations with patients. Conclusions: Short-term priorities such as ‘getting the work done’ dominate nurses’ daily tasks in hospital wards, leading them to overlook often the benefits of supporting patient self-management. This narrow view of their responsibilities can hinder patient care, whereas adopting a broader perspective on the patient journey could be very beneficial.

Keywords

• Chronic disease
• Hospitals
• Nursing
• Self-management
• Questionnaires