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J Health Organ Manag. 2008;22(3):294-308.

Dependence and identity: nurses and chronic conditions in a primary care setting.

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National Primary Care Research and Development Centre, University of Manchester, Manchester, UK.



This paper aims to explore the ways in which practice nurses engage in identity work in the context of chronic disease management in primary care and assess the extent to which this is compatible with the identities promoted in government policy.


The paper draws on qualitative interviews with nurses applying the concepts of "identity threat" and Hegel's Master-Slave dialectic to explore the implications of nurse-patient interdependence for identity in a policy context which aims to promote self-management and patient empowerment.


The nurses in the study showed little sign of adapting their identities in line with government policies intended to empower health care "consumers". Instead, various aspects of identity work were identified which can be seen as helping to defend against identity threat and maintain and reproduce the traditional order.


The paper provides information on barriers to self-management that are likely to inhibit the implementation of government policy.


Whilst much has been written on the extent to which patients are dependent on health professionals, the issue of professional dependence on patients has received much less attention. The paper hightlights how viewing the nurse-patient relationship in the context of a struggle for mastery related to identity represents a departure from traditional approaches and sheds light on hitherto unexplored barriers to self-management.

[Indexed for MEDLINE]

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