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Self-care
Kinds of Self-care Terms modified by Self-care Selected AbstractsEvaluation of NOC Measures in Home Care Nursing PracticeINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2003Gail M. Keenan PURPOSE To evaluate the reliability, validity, usefulness, and sensitivity of 89 NOC outcomes in two Visiting Nurse Associations in Michigan. METHODS Of a total 190 NOC outcomes 89 were assigned for testing. Interrater reliability and criterion validity were assessed a total of 50 times per outcome (on 50 different patients) across the study units. The total number of times the reliability and validity were assessed for each of the 89 measures studied ranged from 5,45. Three RN research assistants (RNRAs) oversaw and participated in data collection with the help of 15 clinicians. Convenience sampling was used to identify subjects. A roster of outcomes to be studied was maintained and matched with patient conditions whenever possible until the quota of outcomes assigned had been evaluated. Clinicians and RNRAs independently rated the outcomes and indicators applicable to the patient. NANDA diagnoses, NIC interventions, and medical diagnoses were recorded. FINDINGS A total of 258 patients (mean age 62) enrolled; 60% were women, 23% were from minority groups, and 78% had no college degree. Thirty-six of the 89 NOC measures were designated "clinically useful." The 10 outcomes with the highest interrater reliability were Caregiver Home Care Readiness; Caregiver Stressors; Caregiving Endurance Potential; Infection Status; Mobility Level; Safety Status: Physical Injury; Self-Care: Activities of Daily Living; Self-Care: Bathing; Self-Care: Hygiene; and Wound Healing: Secondary Intention. Criterion measurement and repeated ratings provided evidence to support the validity and sensitivity of the NOC outcomes. Evidence also suggested that NOC label level ratings could be a feasible, reliable, and valid method of evaluating nursing outcomes under actual use. For some measures, adjustments in the scales and anchors are needed to enhance reliability. For others, it may be unrealistic to reliably score in one encounter, thus scoring should be deferred until the clinician has adequate knowledge of the patient. CONCLUSIONS Continued study and refinement that are coordinated and integrated systematically strongly recommended. Comprehensive study in an automated system with a controlled format will increase the efficiency of future studies. [source] Early Menopause & Self-CareNURSING FOR WOMENS HEALTH, Issue 4 2002Gauging It's Impact on Holistic Health First page of article [source] Creating a Culture of Self-CareCLINICAL PSYCHOLOGY: SCIENCE AND PRACTICE, Issue 1 2009Jeffrey E. Barnett Psychologists are vulnerable to the effects of distress, which if left unchecked may lead to burnout, vicarious traumatization, and impaired professional competence. Smith and Moss (2009) provide a convincing call to action for the profession of psychology to give adequate attention to these important issues. This commentary adds to their excellent review and provides specific recommendations for individual psychologists for those who train graduate students, and for professional associations. A rationale is provided for the recommendations made and further guidance is provided for creating a culture of self-care in the profession of psychology. The importance of this approach as an ethical imperative is presented and strategies and recommendations are provided. [source] Self-care versus self-harm: piercing, tattooing, and self-injuring in eating disordersEUROPEAN EATING DISORDERS REVIEW, Issue 1 2005Laurence Claes Abstract Eating disordered patients seem to have a love,hate relationship with their bodies. Why do some decorate their bodies by means of tattooing and piercing, while others deliberately injure themselves and make parts of their body unattractive? We have explored this question in 101 eating-disordered patients by means of self-reporting questionnaires about the presence and characteristics of tattooing, piercing and self-injuring as well as the underlying motives. Furthermore, we studied the co-occurrence of impulsive behaviours as well as personality traits. In our patient sample, 11.9,per,cent had one or more tattoos, 25.7,per,cent a piercing and 64.9,per,cent showed some form of self-injurious behaviour (SIB). Tattooing and piercing are clearly driven by esthetical reasons, whereas SIB can have various explanations. All three behaviours were significantly more often linked to substance (ab)use. With respect to personality traits, piercing was positively linked to extraversion (positive affectivity) and openness, and negatively to conscientiousness. SIB, on the contrary, was positively linked to neuroticism (negative affectivity) and conscientiousness, and negatively to extraversion and openness. Tattooing did not show significant correlations with particular personality traits (probably due to the small number of tattooed patients). In summary, piercing and tattooing seem to reflect more self-care, and might protect some patients against more self-harm. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Self-care in adults with asthma: how they copeJOURNAL OF CLINICAL NURSING, Issue 4 2000Satu MÄkinen MScN ,,The purpose of this study was to find out how well adult asthma patients in Finland cope with self-care in three areas of asthma treatment. The areas of physical, psychological and social asthma treatment were examined. Associations between demographic background data and self-care were also studied. ,,Data (n = 130) for the study were collected using a questionnaire specially developed for this study. A deductive perspective was employed in data analysis. ,,Respondents showed fairly good competence in self-care in all three areas of asthma treatment. However, up to 30% of the asthma patients had pets and 16% were smokers. ,,Extra stress was reduced by exercise and positive thinking. Humour was also important in helping most of the respondents cope mentally. ,,Social support played a significant part in fighting the sense of powerlessness which is caused by asthma. ,,According to the results, women coped better than men in the social area of self-care. [source] The meaning of self-care for people with chronic illnessJOURNAL OF NURSING AND HEALTHCARE OF CHRONIC ILLNE SS: AN INTERNATIONAL INTERDISCIPLINARY JOURNAL, Issue 3 2010Debbie Kralik RN kralik d, price k & telford k (2010) Journal of Nursing and Healthcare of Chronic Illness2, 197,204 The meaning of self-care for people with chronic illness Aim., To reveal the meaning of self-care as described by men and women living with chronic conditions. Background., Chronic illness self-care and self-management are terms that have been used interchangeably in the literature. Self-care in the context of chronic illness has received some research attention, but remains an under-explored concept. Methods., Conversation data were gathered using longitudinal email groups facilitated by the first author over a 21-month period between 2003,2005, with 42 men and women living with chronic illness. Results., Self-care is a process of adaptation in response to learning about oneself and about ways to live well with illness. Developing capacity to self care impacted significantly on the way participants experienced illness, their view of themselves and of their future. Conclusions., People living with chronic illness describe the process of self-care as transformational in terms of feelings about their selves and reclaiming a sense of order. It enables them to move forward with a sense of the future. The primary health care principle of holistic assessment, taking account of the wider context of people's lives, is of heightened importance when educating about self-care. Relevance to clinical practice., Health care workers can assist people by acknowledging that chronic illness self-care is a process that gradually evolves and is borne out of listening to the person's priorities and finding ways for strategies to fit harmoniously alongside those priorities. [source] Australian occupational therapy practice in acute care settingsOCCUPATIONAL THERAPY INTERNATIONAL, Issue 3 2001Dr Susan D. Griffin Lecturer, Faculty of Health Sciences Abstract A national sample of occupational therapists was surveyed to explore the nature of Australian occupational therapy practice in acute care settings. Self-care was the major client need that therapists reported they addressed, with an initial interview being the most common assessment procedure. Client education was the most frequently used intervention. The most important skills therapists reported for effective practice in acute care were time management, quick clinical reasoning and lateral thinking. Important workplace characteristics included a cooperative health-care team and early referral. Therapists reported that their most important resources were supportive senior therapists and a well-resourced equipment pool. Three attitudinal factors emerged. Therapists in interdisciplinary teams and those with more experience had more positive attitudes. Younger therapists experienced more concern about not being able to do more for their patients. Results suggest a need for graduates to be better prepared in some skill areas and to have more realistic expectations of practice in this area. Department managers need to ensure younger therapists receive adequate support from senior therapists. Further research is needed to determine how best to provide this support and to further examine the influence of the education experience on practice expectations. Copyright © 2001 Whurr Publishers Ltd. [source] Characterisation of user-defined health status in older adults with intellectual disabilitiesJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 6 2008J. M. Starr Abstract Background Older adults with Intellectual Disabilities (ID) have an excess disease burden that standard health assessments are designed to detect. Older adults with ID have a broader concept of health with dimensions of well being in addition to absence of disease in line with the World Health Organization's health definition. We sought to characterise user-defined health status in a sample of older adults with ID. Methods We administered a user-led health assessment to 57 adults with ID aged 40 years and over. Cluster analysis on user-defined health themes of participation, nutrition and hygiene/self-care identified clear separation of participants into a healthier and a less healthy group. Results Disease burden (P = 0.002) and medication use (P = 0.003) were greater in the less healthy group. The healthier group were taller (P = 0.005), stronger (P = 0.005) and had better vision (P < 0.001) than the less healthy group. Constipation (P = 0.014), urinary incontinence (P < 0.001) and faecal incontinence (P < 0.001) were commoner in the less healthy group. There were few significant differences between health groups on the majority of standard physical-examination items. Conclusions There is considerable overlap between user-defined health and that assessed by standard instruments. In addition, user-defined health encompasses aspects of physical fitness not captured by traditional disease-based health models. [source] Improving Heart Failure Self-Management Support by Actively Engaging Out-of-Home Caregivers: Results of a Feasibility StudyCONGESTIVE HEART FAILURE, Issue 1 2008John D. Piette PhD The benefits of heart failure (HF) care management have been demonstrated, yet health systems are often unable to meet patients' needs for support between outpatient visits. Informal care provided by family or friends is a low-cost, and potentially effective, adjunct to care management services. The authors evaluated the feasibility of augmenting HF care management with weekly, automated assessment and behavior change calls to patients, feedback via the Internet to an out-of-home informal caregiver or CarePartner (CP), and faxes to the patient's health care team. The program included 52 HF patient-CP pairs participating for an average of 12 weeks. Patients completed 586 assessments (92% completion rate) and reported problems that might otherwise have gone unidentified. At follow-up, 75% had made changes in their self-care as a result of the intervention. The CP program may extend the impact of HF telemonitoring beyond what care management programs can realistically deliver. [source] "I Am Not Alone": The Feasibility and Acceptability of Interactive Voice Response-Facilitated Telephone Peer Support Among Older Adults With Heart FailureCONGESTIVE HEART FAILURE, Issue 3 2007Michele Heisler MD Patient self-management is a critical determinant of heart failure (HF) outcomes, yet patients with HF are often frail and socially isolated, factors that may limit their ability to manage self-care and access clinic-based services. Mobilizing peer support among HF patients is a promising strategy to improve self-management support. In this pilot, the authors evaluated the feasibility and acceptability of an interactive voice response (IVR)-based platform to facilitate telephone peer support among older adults with HF. Participants completed a baseline survey, were offered a 3-hour training session in peer communication skills, and were paired with another patient who had HF. Participants were asked to contact their partner weekly using a toll-free IVR phone system that protected their anonymity and provided automated reminders if contacts were not made. Times and duration of participants' telephone contacts were monitored and recorded. After the 7-week intervention, participants completed surveys and brief face-to-face interviews. The authors found high levels of use and satisfaction and improvements in depressive symptoms among the 20 pilot study participants. An IVR peer-support intervention is feasible, is acceptable to patients, and may have positive effects on patients' HF social support and health outcomes, in conjunction with structured health system support, that warrant more rigorous evaluation in a randomized trial. [source] The Forensic Inpatient Observation Scale (FIOS): development, reliability and validityCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 3 2001Irma G.H. Timmerman Introduction Re-offending, as a measure of success in forensic psychiatry, gives no information about other behaviours that may have changed. The development of the Forensic Inpatient Observation Scale (FIOS), an observation instrument to assess the non-offending functioning of forensic patients, is described. Study 1 In the first study the development of the initial item pool of the FIOS is described. This resulted in an instrument consisting of 78 items and seven scales. The internal reliability of the scales ranged from 0.78 to 0.91. The inter-rater reliability of the scales varied from 0.50 to 0.85 and the test,retest reliability over a period of three weeks was high for most scales, ranging from 0.74 to 0.89. Study 2 In the second study the FIOS was developed further in another sample of forensic patients. This time exploratory factor analysis with Varimax rotation and post hoc reliability analysis were applied to determine the factor structure among the items. This resulted in an item pool of 35 items, among which six factors could be distinguished that closely resemble the factor structure of the FIOS in study one: (1) self-care, (2) social behaviour, (3) oppositional behaviour, (4) insight offence/ problems, (5) verbal skills and (6) distress. Most items have high loadings on the factor they are assigned; 29 items have a loading of 0.60 or higher. The internal consistency of the scales ranges from 0.73 to 0.91 and the scales appear to be measuring independent constructs. Twenty-five out of the 35 items have an inter-rater correspondence of 90% or higher and 30 out of 35 items have an inter-rater correspondence of 87.5% or higher. The inter-rater reliability on the scale level, however, was somewhat less satisfying with correlations ranging from 0.50 to 0.69. Discussion It is argued that training the observers on a more regular basis will improve the inter-rater reliability. There is some evidence for the convergent validity of the FIOS. The FIOS has some advantages over existing inpatient scales in that it is developed specifically for forensic patients, it does not particularly focus on axis 1 symptoms but includes oppositional behaviour and attitudes to offending. Copyright © 2001 Whurr Publishers Ltd. [source] Findings from a multidisciplinary clinical case series of females with Rett syndromeDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 5 2003Hilary Cass BSc FRCPCH Systematic data from a multidisciplinary clinical assessment of a large series of females with Rett syndrome (RS; n=87) is presented. Participants' ages ranged from 2 years 1 month to 44 years 10 months. Areas assessed included oromotor skills, feeding problems, growth, breathing abnormalities, mobility, postural abnormalities and joint deformities, epilepsy, hand use and stereotypies, self-care, and cognitive and communication skills. Many previously reported trends in the presentation of RS over time were confirmed, notably the increasingly poor growth and near pervasiveness of fixed joint deformities and scoliosis in adulthood. In contrast, there was a slight trend towards improved autonomic function in adulthood, whereas feeding difficulties increased into middle childhood and then reached a plateau. Improvements in mobility into adolescence were followed by a decline in those skills in adulthood. Levels of dependency were high, confirming findings from previous studies. Despite the presence of repetitive hand movements, a range of hand-use skills was seen in individuals of all ages. Cognitive and communication skills were limited, but there was little evidence of deterioration of these abilities with age. These findings confirm that RS is not a degenerative condition and indicate that intervention and support to maintain and increase motor skills, daily living skills, and cognitive and communicative functioning are appropriate targets for individuals with RS. [source] Are clinical practical guidelines (CPGs) useful for health services and health workforce planning?DIABETIC MEDICINE, Issue 5 2010A critique of diabetes CPGs Diabet. Med. 27, 570,577 (2010) Abstract Aims, Chronic disease management is increasingly informed by clinical practice guidelines (CPGs). However, their implementation requires not only knowledge of guideline content by clinicians and practice processes that support implementation, but also a health workforce with the capacity to deliver care consistent with CPGs. This has a health services planning as well as a health workforce dimension. However, it is not known whether CPGs are described in a way that can inform health services and health workforce planning and potentially drive better quality care. This study aimed to ascertain whether CPGs are useful for health service and health workforce planning. Methods, This question was explored taking diabetes mellitus as a case study. A systematic search of Medline, EMBASE, CINAHL and Scopus was carried out to identify all CPGs relating to the management of diabetes mellitus in the primary healthcare setting. The search was limited to guidelines published in the English language between 2003 and 2009. The quality of guidelines was assessed against a subset of criteria set by the Appraisal of Guidelines for Research and Evaluation (AGREE) collaboration. Results, Seventy-five diabetes-related CPGs were identified, of which 27 met the inclusion criteria. In terms of quality, many guidelines adopted evidence-based recommendations for diabetes care (59%) and most were endorsed by national authorities (70%). With regards to coverage of 17 identified subpopulations, guidelines were generally selective in the populations they covered. Whilst many provided adequate coverage of common complications and comorbidities, approaches to management for those with reduced capacity for effective diabetes self-care were largely absent, except for indigenous populations. Conclusions, Clinical practice guidelines are potentially useful for health services and health workforce planning, but would be more valuable for this purpose if they contained more detail about care protocols and specific skills and competencies, especially for subpopulations who would be expected to have reduced capacity for effective self-care. If service planning ignores these subgroups that tend to require more resource-intensive management, underprovision of services is likely. [source] Reversible cognitive deterioration after a single episode of severe hypoglycaemia: a case reportDIABETIC MEDICINE, Issue 12 2004T. Kubiak Abstract A case of a male 34-year-old Type 1 diabetic patient who experienced a prolonged severe hypoglycaemic episode is presented. After the hypoglycaemic event, the patient suffered from moderate to severe neuropsychological impairments. On the basis of neuropsychological assessment results, diabetes therapy was modified (less complex insulin regimen, fixed insulin doses and fixed carbohydrate distribution). At a follow-up examination (3 months), presumable complete recovery of cognitive function was observed. This case demonstrates the possible detrimental neuropsychological effects of severe hypoglycaemia, that, in this case, turned out to be reversible. It highlights the clinical implications of impaired cognitive function on self-care and self-management abilities and the usefulness of neuropsychological testing in clinical diabetes care. [source] Diabetes control and complications: the role of glycated haemoglobin, 25 years onDIABETIC MEDICINE, Issue 7 2004S. L. Jeffcoate Abstract The long-term complications of diabetes have major consequences for individual subjects and growing healthcare delivery and cost implications for society. Evidence for the benefits of good glycaemic control, as monitored by glycated haemoglobin measurements, has been developed in the 25 years since they were introduced to the point where HbA1c assays play central roles in patient management, clinical guidance and audit, and clinical trial design. In this review this evidence is examined and three classes of uncertainty identified that diminish confidence in the effectiveness of these roles for HbA1c. 1Analytical variability between different methods for HbA1c has restricted the application of clinical targets and this problem has recently been addressed by reference method standardization. There are two approaches to this which result in different HbA1c values and this discrepancy needs to be resolved. 2Biological variability in HbA1c values between individuals also restricts its predictive role when applied to populations. The correlations between HbA1c measurements and various components of glycaemia (overall, fasting, postprandial) are still uncertain and differences in protein glycation and de-glycation are greater between subjects than often thought. The influence of variability in erythrocyte life span is an area where research is needed, especially in diabetic subjects. 3Clinical variability is the most important and complex area of uncertainty. A predictive link between HbA1c and clinical outcomes is not as clear-cut as often stated. The correlation with the development of microvascular disease is well established in Type 1 diabetes, but in Type 2 subjects (90% of those with diabetes) the evidence that HbA1c monitoring is of value in predicting or preventing macrovascular disease is not strong, although it is the major cause of morbidity and early death in this group. It is recommended that, as a matter of urgency, these issues be examined, particularly within the context of self-care in diabetes. Diabet. Med. **, ***,*** (2003) [source] The Effect of Male Incubation Feeding, Food and Temperature on the Incubation Behaviour of New Zealand RobinsETHOLOGY, Issue 6 2010Rebecca L. Boulton Because of finite resources, organisms face conflict between their own self-care and reproduction. This conflict is especially apparent in avian species with female-only incubation, where females face a trade-off between time allocated to their own self-maintenance and the thermal requirements of developing embryos. We recorded incubation behaviour of the New Zealand robin (Petroica longipes), a species with female-only incubation, male incubation feeding and high nest predation rates. We examined how male incubation feeding, ambient temperature and food availability (invertebrate biomass) affected the different components of females' incubation behaviour and whether incubation behaviour explained variation in nest survival. Our results suggest that male incubation feeding rates of 2.8 per hour affect the female's incubation rhythm by reducing both on- and off-bout duration, resulting in no effect on female nest attentiveness, thus no support for the female-nutritional hypothesis. The incubation behaviours that we measured did not explain nest survival, despite high nest predation rates. Increased ambient temperature caused an increase in off-bout duration, whereas increased food availability increased on-bout duration. While males play a vital role in influencing incubation behaviour, female robins attempt to resolve the trade-off between their own foraging needs and the thermal requirements of their developing embryos via alternating their incubation rhythm in relation to both food and temperature. [source] Information technology supporting diabetes sel-care: a pilot studyEUROPEAN DIABETES NURSING, Issue 1 2007A Halkoaho MSc Diabetes Nurse Specialist Abstract Although diabetes is a lifelong, incurable disease, people can live a full and normal life, provided that they receive appropriate and well-planned care. The care of people with diabetes should be organised as flexibly as possible to suit individual lifestyles. Information technology has become a useful tool to support functional patient,professional relationships and improve care balance. The Self-Care System software tool set by ProWellness is one such tool. Users can enter blood glucose data by using a computer, modem and mobile phone and diabetes nurses can monitor the situation from their own computer and, if necessary, give instructions by sending a SMS (text) message to the patient's mobile phone. This pilot study investigated whether the Self-Care System application supports people with diabetes and can be used as a diabetes education method. The study was carried out in the municipal consortium for healthcare of Siilinjärvi and Maaninka. Nine individuals with diabetes and three diabetes nurses were selected to participate in the study. Data were collected by questionnaire and interview. People with diabetes were sent a questionnaire and the nurses were interviewed. Content analysis was carried out on the interview data. The results suggest that the Self-Care System software supports and motivates diabetes self-care. The nurses felt that the application was useful when changes, such as starting insulin treatment, were introduced. The application was further described as effective and motivating in short-term intensive diabetes education and monitoring; however, both nurses and patients disliked the mechanical nature of the software. Copyright © 2007 FEND. [source] ,I'm the Boss': testing the feasibility of an evidence-based patient education programme using problem-based learningEUROPEAN DIABETES NURSING, Issue 1 2004K Wikblad FEND Professor in Diabetes Nursing Abstract Patient education programmes have shown only small to modest effects on diabetes self-care and metabolic control. Despite that, almost all diabetes teams agree that patient education is an extremely important part of the treatment of diabetes. It is, therefore, important to identify components of successful patient education as a basis for creating and testing an evidence-based education programme. In a review of controlled studies evaluating patient education such components were identified and these were then used in building up the new programme. This programme, called ,I'm the Boss', is based on the notion that the patient is an active care participant, setting his own self-care goals, and is the one responsible for his own life. The content of the programme did not, therefore, focus on diabetes as such, but on life with diabetes. Six themes were explored during six three-hour weekly sessions. The educational method used was problem-based learning. This method is founded in cognitive theory and views the learner as active in seeking knowledge and able to solve the self-care problems identified. The aim of this study was to explore the feasibility of the programme which was tested in four small groups (five to eight participants) of diabetic patients together with two facilitators. After completing the programme, the patients participated in focus group interviews to evaluate the programme. They identified both positive and negative factors. After each session the two facilitators reflected upon the group dynamics. In particular, problems with allowing patients to be the experts should be highlighted. This programme has been modified according to the evaluation and it is now being tested in a randomised, controlled, multicentre study. Copyright © 2004 FEND. [source] Self-care versus self-harm: piercing, tattooing, and self-injuring in eating disordersEUROPEAN EATING DISORDERS REVIEW, Issue 1 2005Laurence Claes Abstract Eating disordered patients seem to have a love,hate relationship with their bodies. Why do some decorate their bodies by means of tattooing and piercing, while others deliberately injure themselves and make parts of their body unattractive? We have explored this question in 101 eating-disordered patients by means of self-reporting questionnaires about the presence and characteristics of tattooing, piercing and self-injuring as well as the underlying motives. Furthermore, we studied the co-occurrence of impulsive behaviours as well as personality traits. In our patient sample, 11.9,per,cent had one or more tattoos, 25.7,per,cent a piercing and 64.9,per,cent showed some form of self-injurious behaviour (SIB). Tattooing and piercing are clearly driven by esthetical reasons, whereas SIB can have various explanations. All three behaviours were significantly more often linked to substance (ab)use. With respect to personality traits, piercing was positively linked to extraversion (positive affectivity) and openness, and negatively to conscientiousness. SIB, on the contrary, was positively linked to neuroticism (negative affectivity) and conscientiousness, and negatively to extraversion and openness. Tattooing did not show significant correlations with particular personality traits (probably due to the small number of tattooed patients). In summary, piercing and tattooing seem to reflect more self-care, and might protect some patients against more self-harm. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Experiences of oral care in patients with haematological malignancies or head and neck cancerEUROPEAN JOURNAL OF CANCER CARE, Issue 3 2003ASSISTANT PROFESSOR , K.E.O. ÖHRN RDH The aim of the present study was to investigate cancer patients' experiences of oral hygiene information, oral care and self-care, information on oral complications, examination of the oral cavity, and ability to eat and drink during cancer treatment, and to explore patient attitudes to oral examination and oral hygiene. The sample consisted of 41 consecutive patients treated with radiotherapy for head and neck cancer (n = 18) or with chemotherapy for haematological malignancies (n = 23). Patients were interviewed at the end of radiotherapy or the second/third chemotherapy cycle. Compared with patients receiving chemotherapy, those who received radiotherapy had significantly more often visited hospital dentistry, been informed about oral complications and oral hygiene, received instructions in oral hygiene procedures, and been examined by hospital staff. More of the radiotherapy patients experienced oral symptoms and difficulties to eat and drink during treatment. There were no significant differences between the groups with regard to patient experiences of the oral hygiene procedures. Only one patient objected to having hospital staff discuss oral hygiene procedures, and three did not want hospital staff to examine their oral cavity. Patients undergoing radiotherapy or chemotherapy need to be monitored during treatment with regard to their oral status and oral symptoms and complications. There are no acceptable reasons for allowing patients to suffer from oral symptoms that can be reduced. [source] The Diabetes Continuity of Care Scale: the development and initial evaluation of a questionnaire that measures continuity of care from the patient perspective,HEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 6 2004Lisa R. Dolovich PharmD MSc Abstract The purpose of the present study was to develop and pilot test a questionnaire to assess continuity of care from the perspective of patients with diabetes. Seven patient and two healthcare-provider focus groups were conducted. These focus groups generated 777 potential items. This number was reduced to 56 items after item reduction, face validity testing and readability analysis, and to 47 items after a preliminary factor analysis. Readability was assessed as requiring 7,8 years of schooling. Sixty adult patients with diabetes completed the draft Diabetes Continuity of Care Scale (DCCS) at a single point in time to assess the validity of the instrument. Patients completed the draft DCCS again 2 weeks later to assess test,retest reliability. A provisional factor analysis and grouping according to clinical sense yielded five domains: access and getting care, care by doctor, care by other healthcare professionals, communication between healthcare professionals, and self-care. The internal consistency (Cronbach's alpha) for the whole scale was 0.89. The test,retest reliability was r = 0.73. The DCCS total score was moderately correlated with some of the measures used to establish construct validity. The DCCS could differentiate between patients who did and did not achieve specific process and clinical indicators of good diabetes care (e.g. Hba1c tested within 6 months). The development of the DCCS was centred on the patient's perspective and revealed that the patient perspective regarding continuity of care extends beyond the concept of seeing one doctor. Initial testing of this instrument demonstrates that it has promise as a reliable and valid measure in this area. [source] A policy analysis of the Expert Patient in the United Kingdom: self-care as an expression of pastoral power?HEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 3 2001Patricia M. Wilson BEd (Hons) NursEd RGN NDN Abstract The rise in chronic illness and comorbidity in Western society has resulted in an increasing emphasis on self-care initiatives. In the United Kingdom this is exemplified by the Expert Patient policy. This paper discusses the Expert Patient initiative as an example of the State's third way approach to public health. The extent to which this policy challenges conventional power relationships between professional and patient, and fosters equal partnership is examined. In particular, how expert is defined and whether a professional understanding of the term is reconcilable with a patient's expertise is debated. The paper argues that the Expert Patient initiative is unlikely to reconstruct chronic illness and may further complicate the State's responsibility in meeting the needs of those with chronic illness. Issues of power within self-care are explored to illuminate the policy, and this paper argues that the Expert Patient initiative is an example of Foucault's notion of pastoral power. Although the Expert Patient policy focuses on the rights and responsibilities of those with chronic illness, this paper concludes that there is no corresponding strategy to challenge professionals' assumptions toward those with chronic illness. [source] Investing time in health: do socioeconomically disadvantaged patients spend more or less extra time on diabetes self-care?HEALTH ECONOMICS, Issue 6 2009Susan L. Ettner Abstract Background: Research on self-care for chronic disease has not examined time requirements. Translating Research into Action for Diabetes (TRIAD), a multi-site study of managed care patients with diabetes, is among the first to assess self-care time. Objective: To examine associations between socioeconomic position and extra time patients spend on foot care, shopping/cooking, and exercise due to diabetes. Data: Eleven thousand nine hundred and twenty-seven patient surveys from 2000 to 2001. Methods: Bayesian two-part models were used to estimate associations of self-reported extra time spent on self-care with race/ethnicity, education, and income, controlling for demographic and clinical characteristics. Results: Proportions of patients spending no extra time on foot care, shopping/cooking, and exercise were, respectively, 37, 52, and 31%. Extra time spent on foot care and shopping/cooking was greater among racial/ethnic minorities, less-educated and lower-income patients. For example, African-Americans were about 10 percentage points more likely to report spending extra time on foot care than whites and extra time spent was about 3,min more per day. Discussion: Extra time spent on self-care was greater for socioeconomically disadvantaged patients than for advantaged patients, perhaps because their perceived opportunity cost of time is lower or they cannot afford substitutes. Our findings suggest that poorly controlled diabetes risk factors among disadvantaged populations may not be attributable to self-care practices. Copyright © 2008 John Wiley & Sons, Ltd. [source] Attitudes and opinions of oral health and oral care among community-dwelling elderly subjects in Sweden: an interview studyINTERNATIONAL JOURNAL OF DENTAL HYGIENE, Issue 1 2004K Andersson Objective: The aim of this study was to investigate attitudes and opinions of old, independently living people about their oral health and how it has affected them through life. Material and methods: A random selection of 12 individuals was made in a group of 79 individuals who earlier participated in a study about self-reported oral health. The average age was 78.4 years. An interview guide was used as support to focus on oral health. The respondents themselves decided what was important within the topics. The respondents were encouraged to speak freely about their childhood, family, social relations, memories from early dental care, general health situation, experience from health care, life and their future. The interviews were recorded and extended from 60 to 90 min. All of them were transcribed and analysed with phenomenological method inspired by Giogi. The analysis was made by two researchers independently. After 11 interviews, no new information was found; similar opinions, answers and stories recurred. Results: Seven of 11 respondents were born and grown up in the countryside and had moved to Stockholm in the forties. Awareness about dental care was generally low. Many of them have terrible memories from early dental visits, and the dentist was authoritarian and rough. Many had no memories of brushing their teeth as a child. Most of the respondents went to dentists as adults and when they could afford to pay by themselves. After retirement, all have continuous dental care and have visited a dental hygienist during the last 20 years. Nine of 11 have regular contact with a dental hygienist. Most of them are satisfied with their oral health and want to continue being clean and healthy in the mouth. Conclusions: Most of the respondents experienced an improved oral health, information and instructions from the dental hygienist have affected their self-care. Many tell that they have become more aware and carry out the oral hygiene more carefully after retirement. All of them experience that oral health affects the quality of life. [source] Needs assessment in dementiaINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 4 2005A. M. Meaney Abstract Background Resource allocation and service development traditionally focuses on diagnostic categories and consequent perceived need. Identification of the actual level of need in the elderly with dementia, and the degree to which it is unmet is necessary to plan services both individually and as a group. The aim of this study was to characterise the needs of a sample of community dwelling elderly patients with dementia who were referred to an old age psychiatry service in Ireland between July 2002 and July 2003. Methodology Eighty-two consecutively referred community dwelling patients with ICD-10 diagnosis of dementia were assessed on The Care Needs Assessment Pack for Dementia (CareNap-D). Data on needs across seven domains (health and mobility, self-care and toileting, social interaction, thinking and memory, behaviour and mental state, housecare, community living) is presented (Reynolds T et al., 1998). Results Subjects had a mean of 33 (range: 13,56) identified needs. Approximately 1/3 of these were unmet with a mean of 13 (range: 0,37) and a mean of 20 (range: 4,39) were met. High levels of unmet need was identified in the domains of behaviour and mental state (84% of those with agitation) and of social interaction (79% of those with ,partaking in activities' need). The specific item of repetitive questioning occurred in 68 individuals and was unmet in 88% of these cases. Increasing age, lower MMSE score, and living alone were associated with greater total levels of unmet need. Conclusion This data underlines the degree of unmet need in the community dwelling elderly with dementia and the importance of developing a spectrum of services on the basis of the actual needs identified. Copyright © 2005 John Wiley & Sons, Ltd. [source] Coaching patients to self-care: a primary responsibility of nursingINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 2 2009Julie Pryor BA Aim., To explore the process nurses use to guide and support patients to actively re-establish self-care. Background., The movement of hospitalized patients from less to more independence is primarily a nursing responsibility. Studies of nursing practice in inpatient rehabilitation settings have begun to shed some light on this, but as yet there is limited understanding of the actual skills nurses use to support patients to re-establish self-care. Method., This study used grounded theory. Microanalysis and constant comparative analysis of data collected during interviews with, and observation of, registered and enrolled nurses during everyday nursing practice in five inpatient rehabilitation units facilitated open, axial and selective coding. Relevant literature was woven into the final theory. Findings., To facilitate patient transition from the role of acute care patient to rehabilitation patient actively reclaiming self-care, nurses engaged in a three-phase process known as coaching patients to self-care. The three phases were: easing patients into rehabilitation, maximizing patient effort and providing graduated assistance. Conclusion., Coaching patients to self-care is a primary activity and technology of rehabilitation nursing. Relevance to clinical practice., Patients in a variety of settings would benefit from nurses incorporating coaching skills into their nurse,patient interactions. [source] Use of over-the-counter medicines in childrenINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 4 2003John McIntyre senior lecturer in child health ABSTRACT Objective To assess the reasons for over-the-counter (OTC) medicine use in children and the sociodemographic factors influencing this choice of self-care rather than GP consultation. Method Questionnaires were sent to the home address of a randomly generated list of children under 12 years of age from three GP practices in the East Midlands selected to represent bottom, middle and top tertiles of deprivation on the basis of the Jarman score. Analysis using chi-square and Mann-Whitney tests was used to identify associated factors (number of carers in the home, number of children, deprivation score, parent/carer's age, age and number of children in the house) of the responses. Setting Primary care setting in the East Midlands region of England. Key findings From 424 completed questionnaires returned (response rate 61%), 413 parents/carers had purchased OTC medicines. Fifty-one different products had been purchased, with analgesic/antipyretic and cough/cold remedies the most frequently bought. The most commonly reported reasons for parent/carer initiated medication were to avoid troubling the GP with minor childhood ailments (79% of respondents) and to have medicines available in case of future need (74%). Cost was a barrier to buying OTC medicines for the more deprived. Advice-seeking behaviour was associated with the symptom, the number of children, affluence and the age of the child. Conclusion Parent/carer initiated use of OTC medication is widespread, particularly for analgesic/antipyretic and cough/cold remedies. Differences in advice-seeking behaviour are associated with the presenting symptom and a variety of sociodemographic factors. [source] A critical review of appropriate conceptual models for use by coronary care nursesINTERNATIONAL NURSING REVIEW, Issue 1 2008F. Timmins bns ffnrcsi nfesc rnt rgn phd msc bsc Background:, There is little evidence of the extent of conceptual model use within cardiovascular nursing. Concern exists within nursing that nursing theory and conceptual model use within practice is less than optimal. It is further suggested that there is little evidence of nursing theory occupying its true position as the central tenet of nursing practice and cardiovascular nurses have been challenged to reconsider this aspect of practice. Aim:, The aim of this review is to explore the effectiveness of conceptual models used within cardiovascular nursing to further explore their potential benefit. Methods:, Using key terms, a search was conducted using electronic databases CINAHL and PUBMED; yielding seven papers that fulfilled selection criteria. Findings:, Few papers related to research studies in the area. However, of those identified significant examination and testing of concepts emerged within the studies. Rather than merely using concepts as an organizing framework or a component of the study, theories alluded to were scrutinized and consistently applied. Although studies identified mostly referred to specific testing and examination of aspects of conceptual models, the notion of self-care and support for clients emerges as a strong theme within the review. The relationship between nurse and client seemed to be pivotal in any noted improvements. Conclusions:, The findings have limited application to practice. In the absence of large-scale longitudinal studies, only selected aspects of conceptual models or theory were scrutinized. Further research is required in this area to identify conceptual models of nursing that are most appropriate for cardiovascular nursing care. [source] The current state of the center for the creation and dissemination of new Japanese nursing science: The 21st century Center of Excellence at Chiba University School of NursingJAPAN JOURNAL OF NURSING SCIENCE, Issue 1 2006Kazuko ISHIGAKI Abstract Aim:, The Center of Excellence for the Creation and Dissemination of a New Japanese Nursing Science at Chiba University School of Nursing is now in its third year of operation. This center aims to develop nursing science that is appropriate for Japanese culture and to internationally disseminate the importance of culturally based care. Our project seeks to systematically transform the art of nursing practise into a nursing science. Method:, To date, multiple frameworks have been created through the qualitative meta-synthesis of research on effective nursing care. To create a nursing science, these frameworks derived from meta-synthesis must be verified and internalized in nursing practise. Results:, After three years of research, the following findings are emerging: professional care relationships in nursing practise in Japan are characterized by the bidirectional process between the nurse and the client, in which both gradually undergo a transformation in order to establish a collaborative, therapeutic relationship; Japanese nurses emphasize the importance of understanding adolescent clients' subjective understanding of their own life with self-care, as well as social support; and the priority for community health nurses in Japan is to create support systems in the community, regardless of whether the intended client is an individual, a family, a specific group, or the community as a whole. Conclusions:, Our future efforts will focus on verifying our findings through interdisciplinary and international comparative research and by integrating various frameworks in order to create a new Japanese nursing science. [source] Nursing Interventions for a Chronically Ill, Nonadherent Teenager With a Psychiatric DiagnosisJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 4 2003Diane Sieben BSN ISSUES AND PURPOSE To describe the complex care of an adolescent with chronic psychiatric and medical problems. CONCLUSIONS The nonadherent, self-abusing, adolescent was empowered to progress developmentally, as well as medically. PRACTICE IMPLICATIONS A planned team approach helped the adolescent become more developmentally appropriate and independent in self-care. The care plan designed by nursing staff included a change in nursing focus, creative problem solving, team nursing, and utilization of multidisciplinary resources. [source] | |||||||||||||||||||||||||||||||||||||