Self-care strategies for the management of bowel symptoms following sphincter-saving surgery for rectal cancer

The primary aim of this article is to identify the self-care strategies that patients use to manage bowel symptoms experienced following sphincter-saving surgery for rectal cancer. Comparisons will be made with self-care strategies used by patients to manage chronic fecal incontinence and the bowel symptoms associated with other chronic bowel diseases, such as irritable bowel syndrome and inflammatory bowel disease. Published studies and conceptual literature from 2000-2010 were the data sources. Three major themes emerged from the literature reflecting the self-care strategies used by patients to manage bowel symptoms: functional self-care strategies (e.g., taking medication), social activity-related self-care strategies (e.g., planning social events), and alternative self-care strategies (e.g., complementary therapies). An analysis of studies highlighted that, through the process of trial and error, patients learned the strategies that were most effective in the management of their bowel symptoms. Knowledge of such strategies will be beneficial to healthcare professionals when educating patients about effective management of bowel symptoms following sphincter-saving surgery.     

Health promotion in heart failure--a paradigm shift

For people living with heart failure, levels of health exist along a continuum in correlation with the illness experience. A focus on health promotion rather than only disease or symptom management expands opportunities for self-care and presents an emerging paradigm shift in the care of people with heart failure. Results from 2 studies revealed that few health-promoting behaviors were reported by patients with heart failure until a focused intervention that emphasized health promotion as part of self-care was implemented.     

心力衰竭患者家庭关怀度与自我护理状况的相关性研究

目的探讨心力衰竭（心衰）患者的家庭关怀度与自我护理状况的相关性,为促进患者的自我护理提供依据。方法按方便抽样的原则,采用家庭关怀度指数问卷、心衰自我护理指数量表,测量144例住院心衰患者的家庭关怀度和自我护理状况,分析家庭关怀度与自我护理状况的相关性。结果本组心衰患者家庭关际度较好,总得分为（7．49±3．03）分;自我护理总体状况处于低水平,总得分为（156．23±38．51）分;其中,自我护理维持、自我护理管理和自我护理信心的得分分别为（54．38±10．41）分、（49．14±21．33）分和（53．02±13．74）分。家庭关怀度与自我护理状况呈正相关（r=0.21,P〈0.05）。结论心衰患者对症状的处理和信心有待提高。家庭关怀度对心衰患者的自我护理具有一定的促进作用,故在心衰患者自我护理的干预中应充分发挥家庭功能的作用。     

慢性心力衰竭病人自我护理状况的调查

[目的 ]了解慢性心力衰竭病人自我护理状况。 [方法 ]应用慢性心力衰竭自我护理量表 ,对 90例慢性心力衰竭病人的自我护理维持、自我护理决策及自我护理评估状况进行调查。[结果 ]慢性心力衰竭病人自我护理维持较好的为遵医嘱服药 (70 .0 % ) ,但对症状识别率较差。 [结论 ]慢性心力衰竭病人自我护理状况在中等水平以上 ,健康教育时要教会病人识别心力衰竭症状 ,并采取综合措施。     

Self-care behaviour of patients with heart failure

Heart failure-related self-care behaviour is important to optimize outcomes for patients with heart failure. Such behaviours include adherence to medication, diet and exercise, but self-care also refers to such things as seeking assistance when symptoms occur, and daily weighing. The study aim was to describe heart failure-related self-care behaviour, to test the effect of education and support on self-care behaviour and to discuss limitations. Data were collected from 128 heart failure patients during their hospital stay and at 1-, 3-, and 9-month follow-ups. Concepts from Orem's general theory of nursing were used to describe heart failure-related self-care behaviour and its limitations. The effects of intensive systematized and planned education from a nurse in hospital and at home were evaluated in an experimental design. Results showed that education enhanced self-care behaviour significantly at 1 and 3 months after discharge. Despite intensive education and support, patients did not manifest all self-care behaviours that might be expected. Patients in both the intervention and control groups described limitations in knowledge, judgement/decision-making and skills. It can be concluded that supportive-educative intervention is effective in enhancing heart failure-related self-care behaviour early after discharge. To optimize such intervention, more emphasis must be placed on behavioural strategies (e.g. self-medication), social support (e.g. from family members) and reinforcement (e.g. home visits).     

What do patients know about their heart failure?

Positive health outcomes for heart failure (HF) patients depend on patient participation in the selection and use of appropriately focused heart failure self-care. To produce a system of heart failure self-care, patients must have an adequately developed fund of highly specialized antecedent knowledge. This research found that knowledge needed to produce heart failure self-care was deficient in a diverse sample of heart failure patients. Low levels of knowledge were especially evident in the areas of heart failure medications, weight monitoring, and being able to recognize the correct definition of heart failure. Although being older and being more highly educated were associated with higher levels of HF knowledge, HF knowledge scores were uniformly low across gender and racial groups. If nurses are going to be instrumental in helping heart failure patients achieve positive health outcomes, creative strategies to provide information and increase the knowledge necessary to produce HF self-care need to be developed and tested.     

Activities of home-based heart failure nurse specialists: a modified narrative analysis.

BACKGROUND: Heart failure nurse specialists strive to optimize patients' outcomes in home-based settings. OBJECTIVE: To document the activities of home-based heart failure nurse specialists. METHOD: A modified narrative analysis of clinical notes of home-based heart failure nurse specialists during a 12-month period was used. RESULTS: Data analysis revealed 7 key activities of home-based heart failure nurse specialists: (1) monitoring signs and symptoms and reinforcing patients' self-management: identifying trends and appropriate action; (2) organization, liaison, and consultation with other health professionals to deal with changes in clinical status; (3) clarifying and reinforcing patients' self-care strategies; (4) assisting patients in their desire to avoid institutionalized care; (5) identifying patients' psychosocial issues: dealing with social isolation; (6) providing support: journeying with patients and patients' families; and (7) helping patients and patients' families deal with death and dying. CONCLUSIONS: A major proportion of the activities of home-based heart failure nurse specialists are related to facilitating communication between health professionals and providing information and support to patients and patients' families.     

Development of self-care educational material for patients with heart failure in Japan: a pilot study

This study assessed the need for information regarding heart failure and self-care, developed self-care educational material, and investigated the feasibility of the material. A total of 22 hospitalized heart failure patients (mean age: 63 years) completed a self-administered questionnaire. We found that more than 90% of patients desired information, particularly about heart failure symptoms, time to notify healthcare providers, prognosis, and exercise/physical activity. After examining the eight existing brochures for Japanese heart failure patients, we developed self-care educational material. This was based on heart failure guidelines and on the results of our inquiry regarding information needs. Finally, a pilot study was conducted in nine hospitalized heart failure patients (mean age: 57 years). None of the patients had difficulty reading or understanding the educational material. The self-administrated questionnaire survey revealed that comprehension of the following improved after the educational sessions with the material: heart failure symptoms, medication, weighing, sodium intake, and fluid intake (P < 0.05). In conclusion, heart failure patients have a great need for information about heart failure. Our pilot study suggests that the material was readable and had a beneficial effect on heart failure comprehension.     

Pain, fatigue, and sleep disturbances in oncology outpatients receiving radiation therapy for bone metastasis: a pilot study.

Pain and fatigue are two of the most common problems experienced by oncology patients. This study evaluated 24 oncology patients who were receiving radiation therapy for bone metastases to (1) describe the patterns of pain intensity and fatigue severity over a 48-hour period; (2) evaluate for sleep disturbances; (3) describe the relationships between these symptoms and various treatment characteristics; and (4) describe the self-care strategies used by patients to manage pain and fatigue. Patients reported moderate amounts of pain and fatigue. Average pain scores did not vary significantly over a 48-hour period. However, patients reported significantly lower fatigue scores in the morning compared to the evening. In addition, patients experienced significant sleep disturbances, with a mean sleep efficiency index of 70.7% (estimated using wrist actigraphy). Patients with lower Karnofsky Performance Status scores reported more sleep disturbances. In addition, patients who had received a higher percentage of their radiation treatment reported more sleep disturbances. Patients used a variety of self-care strategies to manage pain and fatigue. Additional research is warranted to describe more completely the patterns of pain, fatigue, and sleep disturbances in oncology outpatients receiving radiation therapy.     

Self-care model based on the theory of unpleasant symptoms in patients with heart failure

AimsThis study aimed to test and develop the self-care model based on the theory of unpleasant symptoms in patients with HF.BackgroundAlthough self-care may reduce unpleasant symptoms of heart failure (HF), reported rates of effective self-care in HF patients are very low. Modifiable factors, including disease severity, anxiety, depression, social support, unpleasant symptoms, and self-efficacy are considered to influence self-care, but little is known about their overall impact on self-care.MethodsA model-testing design was used. Covariance structure analysis using the maximum likelihood method was used to evaluate the hypothetical model.ResultsA total of 209 subjects participated in the study. The model-fit indexes of the final model were χ² = 163.473, Normed χ² = 1.796, RMSEA = 0.054, IFI = 0.986, CFI = 0.986, GFI = 0.915, and AGFI = 0.873. Disease severity and anxiety had an indirect effect on self-care through unpleasant symptoms. Depression and social support had an indirect effect on self-care through self-efficacy. Lower unpleasant symptoms and higher self-efficacy were associated with greater self-care. These predictors explained 61.9% of variance in self-care.ConclusionFindings from this study could underscore the need to consider nursing strategies that relieve unpleasant symptoms and improve self-efficacy to enhance self-care in HF patients.     

Characteristics and treatment of patients with heart failure in the emergency department.

INTRODUCTION: This study was conducted to develop a detailed profile of patients who come to the emergency department for heart failure treatment. METHODS: Patient interviews were supplemented by medical record reviews in a convenience sample of 57 participants. A structured interview guide included data concerning patient characteristics and ED treatment. RESULTS: Participants used a variety of self-care strategies before coming to the emergency department. Many of the patients studied (25%) reported barriers to medication adherence, such as memory problems and lack of knowledge regarding self-administration. The most frequently reported symptoms were breathing difficulties (88%), chest discomfort (35%), and fatigue (16%). Seventy-four percent of the participants were classified as specific activity scale class III or IV, indicating moderate to severe functional limitation. Mean quality of life at the time of interview was 5.1 (on a 1 to 10 scale). Length of stay was < or = 2 days for 33%. DISCUSSION: A number of the findings of this study have implications for ED nurses. For example, almost one third of the patients studied had not received directions for a low-sodium diet during hospitalization, when fluid volume overload with sodium retention was the most common cause of hospitalization in a study of patients with decompensated heart failure. Hospital lengths of stay of no more than 2 days suggest that early detection and treatment of acute heart failure may reduce the need for ED visits for some patients. Patients need education and support with self-help strategies and need to better understand the administration of their medication.     

Self-care strategies for depressive symptoms in people with HIV disease

AIM: This paper reports a study with people living with HIV to examine the experience of depressive symptoms, self-care symptom management strategies, symptom outcomes in response to those strategies, and sources from which the strategies were learned. BACKGROUND: Depressive symptoms are common, under-diagnosed and under-treated in people living with HIV. These symptoms have been associated with lower medication adherence, risky behaviours and poorer health outcomes. METHODS: The study was based on the model of symptom management developed by the University of California San Francisco School of Nursing Symptom Management Faculty. Thirty-four HIV+ men and women from a larger study of symptom self-care strategies (n = 422) reported experiencing depressive symptoms. Data were collected from this subset on the Web, by mail and in-person using the critical incident technique. RESULTS: Depressive symptoms were described using 80 words and phrases clustered into eight categories: futility, sadness, loneliness/isolation, fatigue, fear/worry, lack of motivation, suicidal thoughts and other. A total of 111 self-care strategies were coded into six categories: practising complementary/alternative therapies, talking to others, using distraction techniques, using antidepressants, engaging in physical activity, and using denial/avoidant coping. Sources of information for strategies used were trial and error (31%), healthcare providers (28%), family and friends (20%), classes/reading (8%), clergy (8%), support groups (4%) and other (3%). Overall, 92% of the self-care strategies used were reported as helpful, 4% were sometimes helpful and 4% were not helpful. CONCLUSIONS: People living with HIV use numerous effective self-care strategies to manage depressive symptoms. Further study is needed to validate the use of these strategies across populations, to standardize dose, duration and frequency, and to measure their effectiveness.     

A systematic review of heart failure dyadic self-care interventions focusing on intervention components,contexts, and outcomes

BackgroundHaving support from an informal carer is important for heart failure patients. Carers have the potential to improve patient self-care. At the same time, it should be acknowledged that caregiving could affect the carer negatively and cause emotional reactions of burden and stress. Dyadic (patient and informal carer) heart failure self-care interventions seek to improve patient self-care such as adherence to medical treatment, exercise training, symptom monitoring and symptom management when needed. Currently, no systematic assessment of dyadic interventions has been conducted with a focus on describing components, examining physical and delivery contexts, or determining the effect on patient and/or carer outcomes.ObjectiveTo examine the components, context, and outcomes of dyadic self-care interventions.DesignA systematic review registered in PROSPERO, following PRISMA guidelines with a narrative analysis and realist synthesis. Data Sources: PubMed, EMBASE, Web of Science, PsycINFO, and Cochrane Central Register of Controlled Trials were searched using MeSH, EMTREE terms, keywords, and keyword phrases for the following concepts: dyadic, carers, heart failure and intervention. Eligible studies were original research, written in English, on dyadic self-care interventions in adult samples.Review methodsWe used a two-tiered analytic approach including both completed studies with power to determine outcomes and ongoing studies including abstracts, small pilot studies and protocols to forecast future directions.ResultsEighteen papers – 12 unique, completed intervention studies (two quasi- and ten experimental trials) from 2000 to 2016 were reviewed.Intervention components fell into three groups – education, support, and guidance. Interventions were implemented in 5 countries, across multiple settings of care, and involved 3 delivery modes – face to face, telephone or technology based. Dyadic intervention effects on cognitive, behavioral, affective and health services utilization outcomes were found within studies. However, findings across studies were inconclusive as some studies reported positive and some non-sustaining outcomes on the same variables. All the included papers had methodological limitations including insufficient sample size, mixed intervention effects and counter-intuitive outcomes.ConclusionsWe found that the evidence from dyadic interventions to promote heart failure self-care, while growing, is still very limited. Future research needs to involve advanced sample size justification, innovative solutions to increase and sustain behavior change, and use of mixed methods for capturing a more holistic picture of effects in clinical practice.     

Comparison of a computer assisted learning program to standard education tools in hospitalized heart failure patients

Background

Education, coaching and guidance of patients are important components of heart failure management.

Aim

The aim of this study was to compare a computer assisted learning (CAL) program with standard education (brochures and oral information from nurses) on knowledge and self-care in hospitalized heart failure patients. Satisfaction with the CAL program was also assessed in the intervention group.

Methods

A quasi-experimental design was used, with a convenience sample of in-hospital heart failure patients. Knowledge and self-care were measured using the Dutch Heart Failure Knowledge Scale and the European Heart Failure Self-care Behaviour Scale at hospital admission, at discharge and after a 3-month follow-up. Satisfaction with the CAL program was assessed at hospital discharge using a satisfaction questionnaire. Within and between groups, changes in knowledge and self-care over time were tested using a mixed regression model.

Results

Of 65 heart failure patients screened, 37 were included in the study: 21 in the CAL group and 16 in the usual care group. No significant differences in knowledge (p = 0.65) or self-care (p = 0.40) could be found between groups. However, both variables improved significantly over time in each study group (p<0.0001).

Conclusions

Both educational strategies increased knowledge and improved self-care. The design did not allow isolation of the effects of standard education usual care from CAL. Economic and clinical outcomes of both methods should be evaluated in further research.     

The suitability of motivational interviewing versus cognitive behavioural interventions on improving self-care in patients with heart failure: A literature review and discussion paper

BackgroundChronic heart failure remains a major public health concern due to its high prevalence and disease burden. Although self-care has been advocated as the sustainable solution, it remains inadequate. Recent studies have shown the potential of integrating structured counselling elements into traditional educational programs to enhance self-care but the optimal counselling method remains unclear.AimTo compare the applicability of cognitive behavioural interventions and motivational interviewing on improving self-care behaviours in patients with chronic heart failure.MethodA systematic three-step search strategy was used to identify studies that incorporated cognitive behavioural interventions and/or motivational interviewing to improve heart failure self-care. Quantitative and qualitative trial studies that met the inclusion criteria were appraised using the Joanna Brigg's Institute criteria.ResultsMotivational interviewing showed higher potential in improving HF self-care behaviours, but sustainability remains unclear. Cognitive behavioural interventions only showed effectiveness when applied to patients with comorbid depressive symptoms. Statistically significant results were only elucidated upon statistical adjustments and examination of behaviours individually. Potential effective components of CBI include setting up environmental reminders, addressing misconceptions and skills-training while that of MI was the communication style.ConclusionMI and CBI could be used synergistically by extracting their key effective components to strengthen the intention-behaviour link in improving HF self-care behaviours. MI could be used to enhance the intention to change by evoking ambivalence and change talk. CBI could be used to enhance problem-solving skills and set environmental reminders to strengthen the translation of intention to behaviour.     

A situation-specific theory of heart failure self-care

Heart failure, a common syndrome in developed countries worldwide, is associated with poor quality of life, frequent rehospitalizations, and early death. Self-care is essential to improving outcomes in this patient population. The purpose of this article is to describe a situation-specific theory of heart failure self-care in which self-care is defined as a naturalistic decision-making process involving the choice of behaviors that maintain physiologic stability (maintenance) and the response to symptoms when they occur (management). Self-care maintenance is further defined to encompass routine symptom monitoring and treatment adherence. Self-care management is characterized as a process initiated by symptom recognition and evaluation, which stimulates the use of self-care treatments and treatment evaluation. Confidence in self-care is thought to moderate and/or mediate the effect of self-care on various outcomes. Four propositions were derived from the self-care of heart failure conceptual model: (1) symptom recognition is the key to successful self-care management; (2) self-care is better in patients with more knowledge, skill, experience, and compatible values; (3) confidence moderates the relationship between self-care and outcomes; and (4) confidence mediates the relationship between self-care and outcomes. These propositions were tested and supported using data obtained in previous research. Support of these propositions provides early evidence for this situation-specific theory of heart failure self-care.