Self-management is a complex concept that is not consistently defined or interpreted. It’s interpretation varies depending on philosophic, societal, and cultural norms and values. Self management is generally used in the context of discussing the self care people engage in for their chronic conditions. Further,  there is the assumption that the self-care associated with the term “self-management” is based on patients’ making decisions and implementing behaviors based on some knowledge of their condition and their providers’ treatment recommendations. 

Self-management generally includes the assumption that individual’s with chronic conditions have developed some expertise in managing their illnesses through living with them on a daily basis.  Based on this assumption, self-management is often viewed as a way to empower individuals with chronic conditions.

Yet, the increased focus on self-management has been met with some criticism.   Wilkinson and Whitehead (2009) suggest that the expectation of self-management often occurs without the necessary changes to the societal, economic, and political structures impacting on an individual’s ability to successfully self-manage their chronic disease, and with an expectation that the individual will be able to manage the disease process when the health care system has failed in doing so. 

Redman (2005) agrees that patients are often inadequately prepared to adequately engage in self-management, but that nurses have an ethical responsibility to see that their patients receive the essential elements of care, including the ability to manage the disease on a daily basis.

We often assume that our patients have more knowledge and skills than they actually possess. It is our responsibility to ensure that they have the knowledge and skills and resources to participate in the self-management activities that we recommend. Historically, we have often failed to do so. This is still an area of clinical practice that is in its infancy. However, it is gaining more recognition, particularly with the increasingly widespread use of the Chronic Care Model as a guide for chronic disease care.

References:

Wilkinson, A., & Whitehead, L. (2009). Evolution of the concept of self-care and implications for nurses: A literature review. International Journal of Nursing Studies, 46, 1143-1147.

Redman, B.K. (2005). The ethics of self-management preparation for chronic illness. Nursing Ethics, 12(4), 360-369.