The nursing contribution to chronic disease management: A discussion paper Angus Forbes * , Alison While King’s College London, The Florence Nightingale School of Nursing & Midwifery, Primary and Intermediate Care Department, James Clerk Maxwell Building, Waterloo Road, London SE1 8WA, United Kingdom Received 14 December 2007; received in revised form 24 June 2008; accepted 29 June 2008 Abstract This paper explores the nature of the nursing contribution to chronic disease management (CDM) and identifies a number of key nursing activities within CDM both at the individual patient and care system levels. The activities were identified following a detailed review of the literature (160 reports and studies of nursing practice) relating to three tracer disorders: diabetes, chronic obstructive pulmonary disease and multiple sclerosis. The paper examines these activities collectively to generate models expressing some of the core functions of nursing within CDM. The paper illustrates some of the changing characteristics of nursing roles within CDM. More fundamentally, the paper questions the position of nursing in relation to the technologies that define CDM systems and proposes four levels of contribution: the nurse as technology; the nurse as technologist; the nurse as system engineer; and the nurse as architect. These different levels reflect distinctions in the nature of the nursing gaze and power relations within the health care workforce. The paper also highlights how nurses are failing to develop the evidence for their practice in CDM. The paper concludes that there is a need for some clear principles to guide clinical practice and encourage innovation in CDM. It is argued that the principles should not be rule-bound but define a distinctive nursing gaze that will position the nursing profession within the health care system and in relation to other professions. The gaze should incorporate the needs of the individual patient and the care system that they inhabit. # 2008 Elsevier Ltd. All rights reserved. Keywords: Chronic disease; Nursing activities; Technology; Care systems What is already known about this topic?  Chronic diseases are rapidly increasing.  Specific nursing roles have been developed to help man- age chronic diseases.  Nurses deliver a large proportion of the CDM provided in both primary and secondary care. What this paper adds?  Describes some specific activities that define the nursing contribution to CDM.  Proposes new models which identify the nursing contri- bution to CDM at the individual and system levels.  Sets challenges for nursing to define its relationship to health care provision and development. 1. Introduction Chronic diseases are: ‘illnesses that are prolonged, do not resolve spontaneously, and are rarely cured completely’ www.elsevier.com/ijns Available online at www.sciencedirect.com International Journal of Nursing Studies 46 (2009) 120–131 * Corresponding author. Tel.: +44 20 7848 3367; fax: +44 20 7848 3230. E-mail address: angus.forbes@kcl.ac.uk (A. Forbes). 0020-7489/$ – see front matter # 2008 Elsevier Ltd. All rights reserved. doi:10.1016/j.ijnurstu.2008.06.010