Rhetoric or reality? What nurse practitioners do to provide self‐management support in outpatient clinics: an ethnographic study

Aims and objectives To describe how nurse practitioners enact their role in outpatient consultations, and how this compares to their perception of their responsibility for patients with chronic conditions. Background Nurse practitioners working with patients with chronic conditions seek to support them in self‐managing their diseases. Design An ethnographic study. Methods Episodic participant observations (in total 48 hours) were carried out combined with formal interviews. The study population consisted of a purposive sample of nurse practitioners working in five outpatient clinics related to chronic care in one university medical centre in the Netherlands. Two different types of clinics were selected, namely (1) for patients with episodic flare‐ups and (2) for patients with diseases requiring life‐saving procedures. Results The nurse practitioners perceived the monitoring of patients’ treatment as their main professional responsibility. Four monitoring strategies could be distinguished: ‘assessing health conditions’, ‘connecting with patients’, ‘prioritising treatment in daily living’ and ‘educating patients’. Conclusion While nurse practitioners considered building a relationship with their patients of utmost importance, their consultations were mostly based on a conventional medical model of medical history taking. Little attention was paid to the social, psychological and behavioural dimensions of illness. Nurse practitioners in this study seemed quite successful in their extension into medical territory, but moving patients’ illness perceptions to the background was not conducive to self‐management support. Relevance to clinical practice By their medical subspecialty expertise, nurse practitioners have a major role in the longitudinal process of the management of chronic diseases’ treatment. Supporting patients to reduce the impact of the disease and its complications requires nurse practitioners to develop new coaching strategies designed to meet patients’ individual needs.