Motivationsförderung bei chronischen Schmerzpatienten

Readiness to change attitudes and behavior is an important prerequisite for coping with chronic pain in respect to self management. Using the transtheoretical model (TTM), the stages are described as precontemplation, contemplation, preparation, action and maintenance. The process depends on the patient’s decisonal balance as well as the subjective weighting of the advantages and disadvantages of certain behavior patterns; the level of self efficacy also plays a role. To encourage the readiness to change and self motivation, a helpful concept to be used in medical and psychological consultations is motivational interviewing, whereby together with the patient, the perceived advantages and disadvantages of the necessary changes are considered. Giving more weight to the advantages is attempted in order to move the decisional balance in the direction of behavioral change and maintenance.     

Motivational readiness for chronic pain patients

Readiness to change attitudes and behavior is an important prerequisite for coping with chronic pain in respect to self management. Using the transtheoretical model (TTM), the stages are described as precontemplation, contemplation, preparation, action and maintenance. The process depends on the patient's decisional balance as well as the subjective weighting of the advantages and disadvantages of certain behavior patterns; the level of self efficacy also plays a role. To encourage the readiness to change and self motivation, a helpful concept to be used in medical and psychological consultations is motivational interviewing, whereby together with the patient, the perceived advantages and disadvantages of the necessary changes are considered. Giving more weight to the advantages is attempted in order to move the decisional balance in the direction of behavioral change and maintenance.     

The Application of Motivational Theory to Cardiovascular Risk Reduction

The level of motivation sustained by an individual has been identified as a primary predictor of success in sustained cardiovascular risk factor modification efforts. This article reviews the primary motivational theories that have been used to explain and predict cardiovascular risk reduction. Specifically, the application of the Health Belief Model, Health Promotion Model, Theory of Reasoned Action, Theory of Planned Behavior and Self-efficacy Theory to the initiation and maintenance of cardiovascular health behavior is addressed. The implication of these theories for the development of nursing interventions as well as new directions for nursing research and practice in the study of individual motivation in health behavior change are discussed.     

Comment aborder l’éducation thérapeutique d’un patient obèse ? La motivation du patient… et du médecin: une des clefs du succès thérapeutique ?

Losing weight is a long, complicated, fastidious process that can quickly become discouraging for both patient and doctor. A chief difficulty in the management of obesity, widely described by a number of authors, is arousing and maintaining patient motivation. In the educational therapy of the obese patient, the motivational interview is an extremely useful tool in this respect. The aim of this article is to provide general practitioners with tools for assessing the likely success of the treatment and also for helping patients change their behaviour in the long-term. The challenge for the doctor is to optimise treatment by making patient motivation the primary issue in a progressive, stepby- step behaviour modification program. This process is demonstrated by a practical example involving patient attitudes to physical activity, via a fast, simple questionnaire.     

Comment aborder l’éducation thérapeutique d’un patient obèse ? La motivation du patient... et du médecin: une des clefs du succès thérapeutique ?

Losing weight is a long, complicated, fastidious process that can quickly become discouraging for both patient and doctor. A main difficulty in the management of obesity, widely described by a number of authors, is arousing and maintaining patient motivation. In the educational therapy of the obese patient, the motivational interview is an extremely useful tool in this respect. The aim of this article is to provide general practitioners with tools for assessing the likely success of the treatment and also for helping patients change their behaviour in the long-term. The challenge for the doctor is to optimise treatment by making patient motivation the primary issue in a progressive, step-by-step behaviour modification program. This process is demonstrated by a practical example involving patient attitudes to physical activity, via a quick, simple questionnaire.     

Preliminary report on the efficacy of using a diet behavioral modification protocol to control glycemic levels in a patient with type 1 diabetes

Diet control has been an important integrant part of diabetic treatment programs. However, studies have reported that diet control is the most difficult component of the diabetic self-management program for diabetic patients to follow. Many researches support the positive effects of behavioral modification on diet control. In this paper, we designed a diet behavioral modification protocol and applied this protocol to a patient with type 1 diabetes based on the transtheoretical model. Initial results indicate that this protocol helps this patient improve her HbA1c value.     

自我效能理论与糖尿病健康教育理论的联系及应用进展

对自我效能理论与糖尿病健康教育理论,如健康信念模式、动机访谈技术、跨理论模式、授权教育模式的联系及应用效果进行综述,提出在糖尿病病人教育的不同阶段需结合多种健康教育理论,以提高病人的自我效能水平。     

Toward the development of a motivational model of pain self-management

Adaptive management of chronic pain depends to a large degree on how patients choose to cope with pain and its impact. Consequently, patient motivation is an important factor in determining how well patients learn to manage pain. However, the role of patient motivation in altering coping behavior and maintaining those changes is seldom discussed, and theoretically based research on motivation for pain treatment is lacking. This article reviews theories that have a direct application to understanding motivational issues in pain coping and presents a preliminary motivational model of pain self-management. The implications of this model for enhancing engagement in and adherence to chronic pain treatment programs are then discussed. The article ends with a call for research to better understand motivation as it applies to chronic pain self-management. In particular, there is a need to determine whether (and which) motivation enhancement interventions increase active participation in self-management treatment programs for chronic pain.     

提高血液透析患者液体摄入依从性的干预方式与效果评价

目的探讨阶段变化护理干预模式提高血液透析(HD)患者液体摄入依从性的近期效果。方法选择上海市三级甲等医院门诊透析中心HD患者58例,分为干预组30例和对照组28例,干预组由研究者实施以阶段变化理论为指导的为期3个月的护理干预。对照组接受常规宣教。比较两组患者透析间期体重增长(IDWG)与干体比值、不依从的天数与程度等。结果3个月后干预组患者IDWG与干体重的比值、不依从天数显著低于对照组(P<0.001);依从程度明显高于对照组(P<0.001);干预组患者的液体摄入依从行为所处阶段明显高于干预前(P<0.001)。结论阶段变化护理干预模式是提高HD患者液体摄入依从性行之有效的方法。     

The management of the obese diabetic patient

The prevalence of obesity and diabetes is increasing in the United States and worldwide. These diseases are predicted to explode to epidemic proportions, unless appropriate counteractive measures are taken. Several large studies (DCCT, UKPDS, Kumamoto) clearly showed that intensive glycemic control in the diabetic patient reduced microvascular complications and improved mortality. Despite this, the NHANES III showed that only 50% of diabetics have been able to achieve a HgbAic level that is less than 7%; this suggests the need for a re-evaluation of our approach to these patients. The management of the obese diabetic patient involves glycemic control and weight reduction. These goals are particularly difficult to achieve in the obese diabetic patient because progressive beta-cell dysfunction and increasing insulin resistance necessitates the administration of increasingly higher dosages of insulin, which, in turn, promotes weight gain. A vicious cycle may ensue. Lifestyle modifications with diet and exercise are an essential part of the management of the obese diabetic patient. These measures alone are often insufficient and concomitant pharmacologic therapy is usually required to achieve glycemic and weight control. Oral agents that improve glycemia, decrease insulin resistance, and limit weight gain are desirable. Because of the progressive nature of diabetes, glycemic control with monotherapy often deteriorates over time, which necessitates the addition of other pharmacologic agents, including insulin. When insulin therapy is required in the treatment of the obese diabetic patient, combinations with oral agents that have been shown to minimize the amount of exogenous insulin that is required, may minimize weight gain. In addition, the obese diabetic patient who is poorly controlled with maximum oral hypoglycemic therapy may benefit from weight-reducing agents, such as sibutramine or orlistat. The introduction of these agents at other points in the management of the obese diabetic patients have been successful. Finally, for the severely obese diabetic patient, bariatric surgery may be the only effective treatment. Gastric bypass has been unequivocally shown to produce significant weight loss and improve glycemic control on a long-term basis in the obese diabetic patient. It is recommended that physicians avail themselves of all of these strategies in the management of the obese patient who has type 2 diabetes.     

The transtheoretical model and primary care: "The Times They Are A Changin'"

PURPOSE: To identify the transtheoretical model and the five stages of change that assist to bring about behavioral change. A case study is presented to illustrate how the model can be applied by primary care nurse practitioners (NPs) to assist patients toward a healthier lifestyle. DATA SOURCES: Scientific literature, theoretical framework, and case study. CONCLUSIONS: The transtheoretical model has implications in primary care to assist NPs in assessing what stage a patient may be in, offering encouragement to promote a healthier lifestyle change, and reassessing the patient to maintain the desired healthy behavior. IMPLICATIONS FOR PRACTICE: Primary care NPs can use the transtheoretical model to better advance patients into a healthy behavioral change. Documentation of the current stage a patient is in can promote continuity of care among providers, outline specific health promotion initiatives to enhance patient care, and provide documentation during regulatory inspections.     

Medical evaluation of Indochinese refugees

Abstract

Most patients with type 2 diabetes mellitus (T2DM) are overweight or obese. Both T2DM and overweight/obesity are associated with increased patient risk of cardiovascular events and mortality. Despite being the recognized cornerstone of treatment, weight loss and maintenance of weight loss are difficult for patients with T2DM, particularly as treatments for T2DM may cause weight gain. Sodium glucose cotransporter 2 (SGLT2) inhibitors, a new class of drug for the treatment of patients with T2DM, reduce renal glucose reabsorption, resulting in urinary glucose excretion. Due to the caloric loss associated with decreased glucose in urine, treatment with SGLT2 agents offers the benefit of weight loss to patients, as well as reduction in hyperglycemia. Clinical trials of SGLT2 inhibitors in patients with T2DM, ranging in length from 4 to 90 weeks, have shown patient weight reductions from baseline of up to 4.7 kg. Such weight loss may have beneficial effects on adherence to medication, glycemic control, and cardiovascular risk in patients with T2DM.     

Preliminary efficacy of a comprehensive HIV prevention intervention for abstinent adolescent girls: Pilot study findings

We developed and pilot‐tested a comprehensive HIV prevention/sexual risk reduction intervention with 54 sexually abstinent girls and estimated the effect of the intervention on three antecedents of sexual risk behavior: information, motivation, and behavioral skills. Girls ages 14–18 were randomized into either (a) an AbsPlus intervention or (b) a structurally equivalent control group. Assessments were obtained at baseline and 3 months follow‐up using audio computer assisted self‐interview. The intervention resulted in a large effect for information (d = 1.11); small to large effects for the motivational measures (d = .34–.88), and a moderate effect for a measure of behavioral skills (d = .67). The results indicate that antecedents of sexual risk behavior change were improved by a gender‐specific theoretically guided intervention. © 2009 Wiley Periodicals, Inc. Res Nurs Health 32:569–581, 2009     

Benefits and limitations of very-low-calorie diet therapy in obese NIDDM

Weight reduction is one of the most effective therapies for obese non-insulin-dependent diabetes mellitus (NIDDM), but the success rate with conventional diets has been disappointing. The development of very-low-calorie diets (VLCDs) over the last two decades has provided an alternative approach to the treatment of uncomplicated obesity and is increasingly being used to treat obese NIDDM. This review focuses on the role of VLCDs in the treatment of obese NIDDM, the mechanisms underlying their efficacy, and the controversies surrounding their use. VLCDs provide 400-800 cal/day of high-quality protein and carbohydrate fortified with vitamins, minerals, and trace elements. Weight loss is initially very rapid, followed by steady reduction at a rate of 1-3 kg/wk. Metabolic benefits occur quickly with only modest weight reduction, suggesting that caloric restriction plays a more critical role. Multiple mechanisms account for improved glycemic control, including reduced hepatic glucose output, increased insulin action in the liver and peripheral tissues, and enhanced insulin secretion. VLCDs have the added benefit of rapid improvement in concomitant medical problems, particularly hypertension and hyperlipidemia, that could otherwise accelerate the development of some diabetic complications. Numerous controversies surround VLCD therapy, the most critical of which is its safety. However, recent studies indicate that VLCDs are safe for use by obese NIDDM patients in a medical setting closely supervised by an experienced physician. Contraindications to the diet, side effects, and recommended management are reviewed, as well as the role of adjunctive treatments, including behavioral modification and exercise. We present the perspective that, in most cases, the numerous metabolic benefits derived from VLCD therapy by the obese NIDDM patient outweigh its risks. Furthermore, recent data suggest that VLCD therapy may provide long-term benefits to the obese diabetic patient, despite weight regain.     

An experience using the transtheoretical model of health behavior change to promote exercise in a type 2 diabetes patient

This case report shares our experience using the transtheoretical model of health behavior change to promote exercise in a type 2 diabetes patient. The patient was under our care from May through July 2006, during which time the patient was under regular observation and interviewed to collect data. A total of two outpatient consultations and five telephone interviews were conducted. An analysis of results showed the subject to be in the preparation stage of behavior change. To help move the subject into the action stage, the author promoted regular exercise through a variety of strategies, including self-reevaluation, self-change plan development, self-liberation, contingency management, social support search and environmental reevaluation. After nursing intervention, the subject maintained an exercise journal and arranged his own exercise plan. His exercise regimen gradually increased the frequency and intensity of exercise and further extended the scope of exercise to include regular exercise with family members. The author hopes that this case report may provide a reference for health professionals on the use of the transtheoretical model of health behavior change in the care of this type of patient.     

行为转变理论促进护士手卫生的效果研究

目的应用行为转变理论促进护士手卫生行为的改善。方法应用行为转变理论对2008年我院182名护士进行手卫生状况的促进性研究。依据该理论不同阶段的行为转变策略,制定干预计划。在意图期和准备期以问卷、现场观察和手部细菌培养了解护士手卫生认知、行为和手卫生状况,找准薄弱环节。以《手卫生行为自评问卷》让护士自评促进内省;准备期提供规范化和针对性的手卫生培训;准备期和行动期提供含醇擦手剂部分替代洗手环境的支持;行动期和维持期持续督促和及时反馈等。结果比较干预前后护士手卫生认知、行为自评、现场执行情况和手卫生状况。干预后护士手卫生认知、行为自评、现场执行率、正确洗手率和手卫生状况监测合格率均明显提高(P<0.05),且从认知到行为转变没有递减;克服了"知而不信"、"信而不行"的不良行为。结论应用行为转变理论能改善护士手卫生状况,对控制医院内感染发挥积极作用。     

以行为转变理论为指导的干预模式对社区高血压病患者血压控制及服药依从性的影响

目的 探讨行为转变理论为指导的干预模式对社区高血压患者血压控制及服药依从性的影响.方法 选择社区高血压患者116例,以年龄、性别、病程为条件按照1∶1比例进行配对,分配至g干预组及对照组,干预组以行为转变理论为指导进行干预,对照组给予常规护理,比较干预6个月后两组患者血压及服药依从性情况.结果 干预组患者服药依从性得分为（15.20±1.48）分,对照组为（13.44±2.42）分,两组比较差异有统计学意义（Z=-4.023,P＜0.01）;干预后干预组患者收缩压为（131.64 ±9.85）mm Hg,对照组为（136.25±10.20） mm Hg,两组比较差异有统计学意义（t=-2.344,P＜0.05）.结论 以行为转变理论为指导干预模式可提高高血压患者的服药依从性,改善血压控制情况,建议在社区高血压护理中推广应用.     

Lifestyle modification in the treatment of obesity: an educational challenge and opportunity

As many as two-thirds of adults in developed nations are overweight (body mass index (BMI)=25.0-29.9 kg/m2) or obese (BMI>or=30 kg/m2), and many of these individuals suffer from weight-related comorbidities such as hypertension, hyperlipidemia, and type II diabetes. On a more positive note, recent studies have demonstrated that losses as small as 5-10% of initial weight can improve these health complications. For example, the Diabetes Prevention Program demonstrated that a 7% reduction in initial weight, coupled with 150 min/week of physical activity, reduced the risk of developing type II diabetes by 58% compared with placebo. Behavioral treatment consistently induces weight losses in this range. This paper describes the behavioral treatment of obesity, including its short- and long-term results as well as approaches for improving the maintenance of lost weight. The terms "behavioral treatment," "lifestyle modification," and "behavioral weight control" are often used interchangeably, as they are in this paper. Lifestyle modification includes three principal components: diet, physical activity, and behavior therapy. The latter term, as applied to weight control, refers to a set of principles and techniques to help patients adopt new diet and exercise habits that can be sustained long term to promote health.     

Optimizing pumped insulin delivery

The use of portable devices for the subcutaneous infusion of insulin may facilitate the attainment of improved glycemic control in selected patients with insulin-dependent diabetes mellitus. Successful use of a program of continuous subcutaneous insulin infusion requires patient cooperation and motivation, routine monitoring of glycemia, and attention to food intake and activity. This article describes an approach by which patients may optimize glycemic control utilizing a set of algorithms based on patient-determined blood glucose measurements. The algorithms permit programming the insulin infusion device to achieve the desired control.