How nurses' attitudes and actions can influence shared care.

Background: Patients with long-term conditions may benefit from involvement in decision-making and the management of their condition. This requires nurses to have a training role, which may conflict with their traditional identity as nurses.

Aim: To explore the differences in attitudes and behaviours of 'carer' and 'trainer' nurses to patients taking increasing responsibility and control of their own care on long-term haemodialysis wards.

Design: Qualitative comparison of different nursing styles.

Methods: Semi-structured interviews were undertaken with 30 patients and 44 nurses between September and November 2012. Participants were recruited from seven haemodialysis units in the UK. Data were analysed thematically using codes derived from theories associated with the research questions.

Findings: 'Carer' nurses give bite-sized chunks of information to their patients about diet and medication. Treatment decisions are made with minimal patient discussion and all aspects of dialysis are performed by staff. Nurses who are most like trainers encourage patients to have a broader understanding of their condition and genuinely involve patients in decisions. Such nurses are happy to encourage appropriate patients to self-dialyse.

Conclusion: Initiatives to enable patients with chronic illnesses to look after themselves have the potential to empower patients, aid recovery and save money. However, such initiatives can create tension between the carer identity of nurses and their role as trainers. To encourage haemodialysis patients to dialyse themselves, nurses need to: educate for broad understanding and empowerment; participate in patient-led decision-making about diet and lifestyle; and encourage shared decision-making for medication and dialysis.