Maximizing stroke recovery using patient self-care self-efficacy.

Self-care self-efficacy is a compensatory mechanism that may lead to improved psychological adaptation poststroke. Nurses working with stroke patients may use self-care self-efficacy interventions to help the patients achieve a successful recovery. This article describes the four components of self-efficacy, and discusses their application to stroke patients in rehabilitation. Self-care self-efficacy interventions have the potential to decrease depression and increase quality of life for patients after stroke, and may become a valuable tool for nurses who practice in rehabilitation settings. The use of self-care self-efficacy techniques by nurses helps to motivate patients to succeed in their self-care after stroke.     

Patient self-medication--a change in hospital practice

Aims and objectives. The purpose of this study was to evaluate the effectiveness of a self‐medication programme (SMP) for inpatients of the Nursing Convalescent Unit, a 26‐bed unit with medical and surgical patients. Background. Self‐medication is an important part of self‐management of chronic illness. Self‐medication is a way of allowing patients to give themselves their medications in hospital after receiving education instead of the usual practice of medications administered by a Registered Nurse (RN). Design. The pilot study was undertaken over a six‐month period to examine the relationship between a programme of self‐medication and patient knowledge and adherence to medication regimens, number of medication errors, efficiency in relation to the number of nursing hours associated with the SMP, patient and nursing satisfaction. Methods. A total of 220 patients participated in the study. The SMP included three levels of patient self‐administration of medications: level one, medications administered by a RN; level two, self‐medication directly supervised by a RN and level three, self‐medication indirectly supervised by a RN. Outcome measures included staff and patient satisfaction, number of medication errors, time taken by nurses to undertake activities related to the SMP and the number of patients who achieved levels two and three. Results. Study findings showed that 45% of patients remained on level one, 26% achieved level two and 29% achieved level three. There were no patient initiated medication errors during the study period. Efficiencies were identified in staff workload associated with patient discharge procedures. Overall, nurses perceived that the SMP increased their knowledge of medications and contributed to effective patient education. Conclusions. In selected patients, the SMP was an effective aid for improving adherence to medication regimens. Relevance to clinical practice. Collaboration between nurses, medical staff, pharmacists, patients and carers is integral to the success of in hospital SMP.     

New measures of diabetes self‐care agency,diabetes self‐efficacy,and diabetes self‐management for insulin‐treated individuals with type 2 diabetes

Aims and objectives. To develop and refine three new scales that measure diabetes self‐care agency, diabetes self‐efficacy and diabetes self‐management to reflect the American Diabetes Association current standards of diabetes care and the American Association of Diabetes Educators self‐care behaviours. And, to establish the clarity, consistency and content validity of the scales. Background. There is a need to have valid and reliable instruments or scales to assess an individual’s diabetes self‐care agency, self‐efficacy and self‐management to plan appropriate interventions that can be effective in improving glycaemic control and delaying or preventing diabetes‐related complications. Design. A methodological design was used to conduct this study. Methods. Ten clinicians and 10 insulin‐treated individuals with type 2 diabetes (T2DM) from a diabetes care center in the southern USA participated in this study. Analysis consisted of inter‐rater agreement to determine clarity and consistency with standards of diabetes care and content validity of individual items on the scales (I‐CVI) and the overall scales (S‐CVI/Ave) to determine relevance for current diabetes care practice. Results. All I‐CVI and S‐CVI/Ave of the DSES exceeded the minimum acceptable criteria. All I‐CVI and the S‐CVI of the DSMS also exceeded the minimum accepted criteria, except for one item that had I‐CVI = 0·70. Evaluation of the items and the directions of the scales by the sample of insulin‐treated individuals with T2DM exceeded the minimum criteria of 80% inter‐rater agreement. Relevance to research and clinical practice. Further psychometric testing of the scales with samples of insulin‐treated individuals with diabetes is warranted and will lay the groundwork for further research and clinical practice to enhance the capability, confidence and actual performance of diabetes self‐management activities among insulin‐treated individuals with T2DM. Conclusions. The scales can be used by diabetes care providers to assess and follow‐up individuals with diabetes who need intense case management. They also can be the measures of choice to conduct future research to test the effects of interventions among insulin‐treated individuals with T2DM.     

Predictive validity of the Depression Coping Self-Efficacy Scale (DCSES)

The Depression Coping Self-Efficacy Scale (DCSES) was developed to measure depressed individuals' confidence in their ability to follow treatment recommendations. The purpose of this study was to evaluate the validity of the DCSES as a unidimensional measure of depression coping self-efficacy. Data were collected from depressed psychiatric inpatients at admission and discharge (n = 99), and 6-8 weeks post-discharge (n = 75). Exploratory factor analysis yielded a single factor solution accounting for 48.8% of the variance with an eigenvalue of 12.7. DCSES scores at discharge were related to self-reported levels of functional impairment (FI), depression symptom distress, and suicidal ideation (SI), and predicted rehospitalization 6-8 weeks later. Patients with lower DCSES scores at discharge showed less improvement in depression coping self-efficacy from admission to discharge.     

Conceptualization and Nursing Implications of Self‐Imposed Activity Limitation Among Community‐Dwelling Elders

ABSTRACT The purposes of this paper are to explore, from a theoretical perspective, explanations for why some community‐dwelling elders self‐impose activity limitations (SIALs); to develop an integrated explanation for SIAL from a nursing perspective; and to identify some clinical implications of relevance to public health nursing practice. Activity limitation is an important risk factor for functional decline, morbidity, and mortality among community‐dwelling elders. Many studies have focused on disease and environmental influences on activity limitations. The intrinsic processes associated with voluntary or SIAL in old age among otherwise physically and mentally capable elders are poorly understood and little studied. The conceptualization of SIAL provides nurses with an understanding of an understudied aging phenomenon and helps nurses understand how elders see activities related to their life priorities. The conceptual framework will facilitate future qualitative and quantitative study of SIAL, assist nurses in the development of a new gerontological nursing theory, and design of interventions for elders with activity limitations. Public health nurses with a better understanding of SIAL may be able to help elders improve or maintain their independence.     

A concept analysis of suicidal behavior

Suicidal behavior is a significant global public health problem. Despite this, many health care professionals remain unaware of the distinction among suicidal behavior, self‐mutilation, and deliberate self‐harm. The aim of this study was to conduct a concept analysis of suicidal behavior. Method: Walker and Avant's 8‐step method of concept analysis was used to examine the concept of suicidal behavior. Sources for analysis were identified using a systematic search of Medline, CINAHL, ProQuest Nursing & Allied Health Source, and the reference lists of related journal articles. Results: Suicidal behavior was found to be associated with a constellation of external hazards and internal crises, lack of coping mechanisms and social support structures, and degree of suicidal intent, which, in the worst‐case scenario, results in successful suicide. The antecedents of suicidal behavior are vulnerability characteristics that make painful events seem unbearable, and the consequences are death or failed suicide. In cases of failure, the medical consequences may be serious and long lasting. Conclusions: Defining the concept of suicidal behavior provides a basis for public health nurses to better understand suicidal behavior, thus improving their ability to care for suicidal patients during home visits.