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
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
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. http://dx.doi.org/10.1016/j.pec.2015.05.017