Competency in shaping one's life: Autonomy of people with type 2 diabetes mellitus in a nurse-led, shared-care setting; a qualitative study

Background: In the Netherlands diabetes specialist nurses play an important role in specialized, long-term care for the chronically ill. One of the goals of nurse-led, shared care is to encourage chronically ill people to participate actively in selecting the organisation and interventions of care. This paper reports the findings of a study to determine which concepts of autonomy people with type 2 diabetes use in a nurse-led, shared-care setting. Objectives: The aim of this article was to portray how people with type 2 diabetes mellitus who are being cared for by diabetes specialist nurses in a shared-care unit view autonomy. Design and setting: This qualitative study used in-depth interviews and was carried out in a nurse-led, shared-care unit in the Netherlands. Participants: The study population consisted of 15 people who were enrolled for at least 1 year at the nurse-led, shared-care unit and who lived independently at home. Method: Data were analysed with a grounded-theory-like method. Result: The core category, 'competency in shaping one's life', described how people with diabetes exercise their autonomy. Seven categories that emerged were considered dimensions of autonomy. The dimensions were: identification, self-management, welcomed paternalism, self-determination, shared decision-making, planned surveillance, and responsive relationship. Conclusion: Autonomy is a multi-dimensional, dynamic and complex construct. Further research is needed to investigate which decision-making processes patients with type 2 diabetes use in a nurse-led, shared-care setting.