Background Self-care is a strategy for providing out-of-hospital care and promoting patients’ independence. However, evidence suggests that some healthcare professionals practise with paternalistic attitudes that are fundamentally opposed to self-care.

Aim To explore the attitudes, beliefs and behaviours of community nurses towards patient self-care and identify the barriers to self-care.

Method This study used Q methodology combined with naturally occurring focus groups. A concourse of 25 Q-statements was developed based on the literature and a ‘Q-table’ was created on which participants rank the Q-statements, known as a Q-sort. A total of 29 community nurses participated in four focus groups. Each focus group created a Q-sort, and these were combined into one Q-sort table for analysis.

Findings From the Q-sort data and the focus group discussions, it was identified that patient safety concerns often mean that community nurses restrict self-care to those they believe will comply with a prescribed care regimen. It was also found that some nurses adopt a biomedical model of care that does not address patients’ psychological and social needs, and which inhibits their self-care. Another finding was that older people often view the role of the nurse as a ‘caregiver’, which is reinforced by the lack of focus on self-care in the aim and function of the community nursing service.

Conclusion For self-care to be successful, the author suggests that paternalistic safety concerns should be relaxed in favour of patient autonomy. Community nurses should also ensure that they adopt a biopsychosocial model of care to meet patients’ holistic needs. A focus on self-care must be integral to the function and purpose of community nursing services to drive forward a change in culture.