Chronic illness self-management: taking action to create order

Background. This paper presents research that was framed by our early understandings about the ways that people incorporate the consequences of illness into their lives. The word ‘transition’ has been used to describe this process. We believed self‐management to be central to the transition process but this assertion required further research, hence this paper. Aim. The research aimed at understanding the way in which people who lived with chronic illness constructed the notion of self‐management. While the participants of this study were living with arthritis, the focus was on understanding the meaning of self‐management rather than the experience of living with the symptoms of arthritis. Approach. Data were generated when nine people living with arthritis were invited to write an autobiography about their life and experiences of living with illness. Two telephone interviews were recorded with each participant and then the research group (researchers and participants) convened for a discussion meeting. Findings. In contrast to health professionals who identify self‐management as structured education, participants identified self‐management as a process initiated to bring about order in their lives. Creating a sense of order, or self‐management, had four key themes (i) Recognizing and monitoring the boundaries, (ii) Mobilizing the resources, (iii) Managing the shift in self‐identity, (iv) Balancing, pacing, planning and prioritizing Conclusions. People learned about their responses to illness through daily life experiences and as a result of trial and error. They reconfigured their daily lives and reconstructed their self‐identity by exploring their personal limitations or boundaries. Self‐management of chronic illness has been considered as both structure and process, however it is the process of self‐management that we contend is central to the experience of transition. Relevance to clinical practice. Clinical nursing intervention for people with a long term illness may be enhanced when self‐management is approached from a broad, contextual perspective and self‐management processes are integrated into clinical practice. The challenge is for nurses to embrace processes in nursing practice that will facilitate interactions with clients without obstructing the diversity of perspectives, create an environment conducive to learning and engage individuals in identifying self‐management strategies that have meaning in their lives.     

Self‐care behaviours and trajectory management by people with scleroderma in northeastern Thailand

Scleroderma, particularly systemic sclerosis, is a chronic illness that affects a person's physical, emotional, psychosocial, and spiritual dimensions. To investigate self‐care deficits, health behaviours, and trajectory management of Thai people with systemic sclerosis, an exploratory case study method was used through interviews and patient records. Self‐care deficit nursing theory and the chronic illness trajectory framework guided the research. Twelve patients with systemic sclerosis were purposively recruited at a hospital clinic in the northeastern region of Thailand. Thai people living with systemic sclerosis developed specific self‐care agencies in each of 3 identified trajectory patterns to improve their health and well‐being. By applying the theory and framework that guided the research, nurses can promote self‐care behaviours and recognize situations along an illness trajectory that require intervention and management. The results extend the understanding of how people live and cope with systemic sclerosis.     

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.