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ABSTRACT

Objectives: As a response to the increasing burden of chronic illness there has been a succession of self-care initiatives which have the potential to alter the relationship between professional and patient. This poster will present findings of a qualitative study which explored how patient expertise was interpreted, defined and experienced by both patients and health professionals, and how self-management and patient expertise is enhanced or impeded.
Design: Over 100 patients and health professionals participated in the research. The latter group included doctors, nurses and physiotherapists. Data was collected through semi-structured interviews, focus groups and observation.
Results: Analysis of the data from patients suggested a typology of patient expertise that had developed over time. Responses to active self-management could be mapped on overt-covert and acceptor-challenger axes. Factors influencing the typology were patients� responses to National Health Service provision, their response to the emotional consequence of having a chronic illness, their motive for information seeking regarding their condition, and the patient�s style of communication within the clinical consultation.
The findings indicated that professionals had varied responses to differing presentations of patient expertise. Compared to the other professionals, nurses were the most anxious regarding patient expertise. This appeared linked with a lack of professional confidence and unfounded fears regarding litigation in self-management. However, clinical nurse specialists often provided a disconfirming case to this. In addition, many patients described nurses as being the most effective professional in helping them meet the emotional consequences of living with a chronic disease.
Conclusion: Within the context of an ever-increasing remit for nurses within chronic disease management, the poster will explore the implications of these findings. Drawing on the example of the clinical nurse specialists the paper will conclude with role and environmental characteristics that facilitate nurses' enablement of active self-management.

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