Convalescence following coronary surgery: a group experience.

The patient who has heart surgery and returns home will experience many problems in adjusting to a modified lifestyle. Successful rehabilitation depends on many factors-the knowledge the patient has about his condition, his own motivation and the support he receives from family and friends. If he has received good teaching in the hospital, his task will be much easier. But is in-hospital teaching enough? Current nursing research suggests that patients are more receptive to health teaching after they have returned home and benefit from sharing experiences with a group. The author describes the results of an investigation into the concerns of convalescent coronary patients and their wives and tells how group sessions helped ease their transition from hospital to a productive lifestyle.     

The relationships between disability level, health-promoting lifestyle, and quality of life in outpatients with systemic lupus erythematosus

The purpose of this study was to explore the relationships between disability, health-promoting lifestyle and quality of life in SLE outpatients. Cross-sectional research design and purposive sampling were used in this study. One hundred and twenty-nine SLE outpatients from a medical center were sampled. Questionnaires, including the Visual Analogue Scale, Pittsburgh Sleep Quality Index, and The Hospital Anxiety and Depression Scale, were adopted in order to survey subject disabilities in terms of pain, fatigue, quality of sleep, anxiety, and depression. Health-promoting lifestyle was measured using the Health-Promoting Lifestyle Profile, while quality of life data were collected using Short-Form 36. Hierarchical regressions and a Sobel test were the major statistical procedures employed. Study results indicated that SLE patient self-reported pain and fatigue related to the SLE disease to be 27.7 +/- 26.2 and 37.4 +/- 26.6, respectively. Seventy-two percent of SLE patients were reported to be troubled by poor sleep quality, while 20%-32% suffered from severe anxiety and depression. The Health-Promoting Lifestyle Profile total score for SLE patients was 61.5 +/- 17.2. In terms of SLE patient quality of life (QOL), physical component summary (PCS) and mental component summary (MCS) scores were 45.3 +/- 9.1 and 43.8 +/- 9.7, respectively. Based on the hierarchical regressions and Sobel test, it was revealed that the health-promoting lifestyle has no significant effect on the physical component summary (p > .05). Fatigue was the mediator factor of health-promoting lifestyle to physical component summary of quality of life. Nevertheless, health-promoting lifestyle has a significant effect on the mental component summary (p <.05). Interestingly, the results showed facilitating health- promoting lifestyle in SLE patient could not enhance physical component summary of quality of life directly without an improvement in fatigue disability; however, facilitating health-promoting lifestyle had a direct and positive effect on the mental component summary of quality of life.     

A diversified patient education program for transplant recipients

Patients who receive a solid organ transplant not only have many learning needs, but also lifestyle changes related to the transplant. Previous experiences with health care, beliefs about health, language and reading skills, cultural influences, education preparation, and disabilities are a few of the factors that influence how each patient learns posttransplantation, and adjusts to a new lifestyle. Staff nurses on our transplant unit have taken these factors into consideration when developing various concrete teaching tools that include a book, medication card, color-coded medication guide, audiocassette, computer printouts, and clinical pathways. Because each patient comes with a unique story, approaches for patient learning are individualized by the nursing staff. The use of the tools, combined with an individualized and nonjudgmental approach, has created a caring environment for patient learning.     

Rationing organs using psychosocial and lifestyle criteria

The role of patient psychosocial and lifestyle characteristics in decisions about the allocation of scarce health care resources has not been examined. In this national survey using the Criteria for Selection of Transplant Recipient (CSTR) Scale, organ transplant coordinators (N = 559) identified the psychosocial and lifestyle criteria they believe should be considered in patient selection/rejection for organ transplant. Using factor analysis to reduce the data, six factors were identified: current lifestyle/psychiatric problems, family/socioeconomic issues, habits, controlled lifestyle/psychiatric issues, cost, and stigmatized conditions. Patients who were in prison for a serious crime, used cocaine, had AIDS, or were HIV positive (criteria making up the Stigma factor), were more likely to be labeled for exclusion from transplant than those with other psychosocial/lifestyle characteristics. When transplant coordinators perceived that patients' psychosocial and lifestyle problems were under control or corrected, they were more likely to consider them for a transplant. For all but the cost factor, criteria were most stringent for heart transplants. Although over 90% of the coordinators assessed patients and participated in patient selection for transplant, master's prepared nurses were more likely than nurses with other educational preparation to be involved in organ recipient selection. These findings can serve as a prototype for how decisions are made for allocating other scarce health care resources. © 1998 John Wiley & Sons, Inc. Res Nurs Health 21: 327–337     

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.     

荆州地区高血压患者健康促进生活方式水平的现状调查

目的调查荆州地区高血压患者的健康生活方式水平及其影响因素,为进一步开展健康促进活动提供理论依据。方法便利抽样法选择湖北省荆州地区1000名符合条件的高血压患者,采用健康促进生活方式中文修订版量表对其进行调查,并分析调查结果。结果荆州地区高血压患者健康促进生活方式的总体水平较高(平均得分占问卷总分的61.83%);女性患者、年龄偏小(平均年龄为50.65岁)、患病时间较长的患者拥有较好的健康生活方式(均P0.05);不同居住地点、文化程度及经济状况的高血压患者健康生活方式差异无统计学意义(均P0.05)。结论荆州地区高血压患者的健康促进生活方式总体水平较高,尤其是在健康责任方面水平最高,其次是人际关系方面和营养需求方面;而在体力活动方面水平最低;女性患者、年龄较小的患者、患病时间较长的患者容易拥有健康的生活方式。应针对患者的个体情况给予有针对性的健康指导。     

Common questions in managing hyperlipidemia

Hyperlipidemia is a serious disease that affects the health and well-being of many, and further complicates other chronic illnesses. When treating a patient who has a lipid disorder, it is wise to take a global approach to the problem by assessing the patient's history and risk factors, collaborating on developing a healthy lifestyle plan to which the patient can commit, and initiating appropriate therapy when indicated.     

What Do Primary Care Providers and Nurses Need to Know About Managing Chronic Pain?

Pain is the leading reason Americans seek health care access. Worldwide, more than 1.5 billion people are suffering from chronic pain. Unfortunately, providers are not equipped to manage patients with chronic pain as many advanced programs provide little to no education on pain management. Additionally, there are limited research articles on managing chronic pain, let alone regarding alternative treatment options for chronic pain. The patient presented in this case study is a 66-year-old woman who presents for a follow up regarding chronic pain. The case study outlines the success a patient found using alternative options other than opioid medication with lifestyle changes and a newer medication called low-dose Naltrexone (LDN). The purpose of this case study is to present a patient who has found success in managing chronic pain through alternative treatments and help the provider be able to educate patients on the importance of lifestyle changes to increase the prescribing and compliance of alternative treatment options.     

Weight Loss: A Patient and Physician’s Perspective

This article, co-authored by a patient affected by obesity and an obesity medicine specialist, discusses the patient’s experience of living with the disease and using many different weight loss approaches until finding a lifestyle program that was appropriate for her metabolism. The physician discusses the scientific basis of insulin resistance, and why the chosen lifestyle program worked so well for this individual.     

Behavior Modification: A Patient and Physician’s Perspective

This article, co-authored by a patient affected by obesity and an obesity medicine specialist, discusses the patient’s experience of living with the disease and using many different weight loss approaches until finding a lifestyle program that was appropriate for her metabolism. The physician discusses the scientific basis of insulin resistance, and why the chosen lifestyle program worked so well for this individual.     

Losec (omeprazole/MSD)

The treatment of patients with Zollinger-Ellison syndrome has represented a challenge in the past. Losec Delayed-Release Capsules may provide these patients with a well-tolerated alternative, allowing them a more natural lifestyle. In addition, Losec may also offer benefits to the patient suffering from severe gastroesophageal reflux disease in whom traditional therapy is not providing adequate results. Knowledge of this newer medication and its advantages and disadvantages will allow the nurse to take an active role in patient instruction regarding this therapy.     

You can do it if you set your mind to it: a qualitative study of patients with coronary artery disease

AIMS OF THE STUDY: To gain increased knowledge and understanding of what it means to be afflicted with coronary artery disease (CAD) and how it affects the life/lifestyle of the individual. BACKGROUND: Research has documented that education, counselling and behavioural interventions are important elements of cardiac rehabilitation and compliance with treatment. Compliance is generally better with medical treatment than with recommended lifestyle changes. Another influencing aspect is locus of control, i.e. people's own understanding of control is the foundation for the decisions patients make more or less consciously regarding compliance with caring/nursing, treatment and lifestyle changes. METHODS: Eight individuals with diagnosed coronary artery disease were interviewed about their life situation, and the opportunities and obstacles they encountered in making lifestyle changes. These interviews were transcribed and then analysed using a hermeneutic approach. FINDINGS: The findings included three areas: (1) The causes of coronary artery disease describing different factors, such as heredity, lifestyle and demands. (2) Difficulties in the work of rehabilitation, which was explained in terms of informants' feelings of confusion, uncertainty and sadness. (3) Successful rehabilitation consisted of two factors: the personality of the individual patient and external support. CONCLUSIONS: Patients may comply well with follow-up visits but less with lifestyle changes. By identifying different 'characteristics', 'prerequisites' and 'difficulties' that describe patients' compliance, it should be possible to make treatment more individual. Nurses have a significant role in supporting these patients since they are more accessible than physicians. Nurses also have a responsibility to work together with patients to empower them, in order to make their lifestyle changes and self-care activities manageable.     

The dramatic encounter: experiences of taking part in a health conversation

Aim. The purpose of this study was to describe lived experiences of a health conversation from the perspective of participants who, in the course of a health check, had been informed that they were at increased risk of cardiovascular heart disease. Background. The modern lifestyle has created an increased occurrence of cardiovascular heart disease. Counselling about lifestyle changes to prevent disease is an important duty of nurses in primary healthcare when encountering patients with risk factors such as diabetes, hypertension and hypercholesterolemia. It is well known that accomplishing lifestyle changes is complicated. Research has shown the importance of assuming the patient perspective in pedagogical encounters and that nurses involved in patient teaching need more knowledge about the learning person. Design. Written narratives about the health conversation followed by interviews with open‐ended questions. Nine informants from the Skaraborg Project participated. Methods. A phenomenological analysis was chosen to describe the participants ’ experiences and to visualise the meaning of the new knowledge obtained in the encounter. Results. Three themes were identified; ‘The unavoidable message’, ‘Reflection on the content of the conversation’ and ‘The pedagogical encounter’. Sub ‐ themes show the variations of meaning owing to the participants’ previous life experiences. Conclusions. The nurse must be aware of differences in perceptions concerning the health conversation and possible consequences for the life situation. The health conversation encounter requires preparedness and a pedagogical awareness as well as an ability to recognise the person’s need for understanding and level of motivation to make lifestyle changes. Relevance to clinical practice. Time and space must be created for health conversations and follow‐up of cardiovascular heart disease to achieve a preventive pedagogical encounter in primary healthcare.     

Human responses to traumatic brain injury.

A traumatic brain injury can have devastating effects on the patient and the family. The patient with TBI faces deficits that influence life after hospitalization. With the use of specific nursing therapies, human responses to TBI can be treated and a patient can return to a satisfactory lifestyle.     

Factors influencing nurses' judgements about self-neglect cases

From the perspective of the practising nurse self‐neglect may best be understood in terms of a set of complex and often poorly defined clinical problems in which two key clinical issues are ‘how do I judge whether this person has the capacity make decisions about their lifestyle?’ and ‘do we need to treat this person using mental health legislation?’ These are taxing questions as judging if a patient has the capacity to make decisions about their lifestyle choices is difficult for even the most experienced clinicians. Such determinations require nurses to form a judgement as to mental capacity of the patient. We do not know what patient characteristics and in what combination nurses use these when making these judgements. This factorial survey aimed to identify which patient characteristics influenced Registered Nurses’ judgements on decision‐making capacity and decisions on the use of interventions which require statutory interventions in cases of self‐neglect. Judgements on decision‐making capacity were overwhelmingly predicted by information of the patients’ mental health status. Nurses place patients in one of three broad categories of no mental illness, minor mental illness and severe mental illness. This categorization appears to operate as a fast and frugal heuristic indicating that nurses may use mental status as a cognitive screen to work from in judging self‐neglect. Although there is a correlation between the severity of mental illness and the capacity for making decisions they are not the same. This study shows the continued work that needs done in educating nurses not only about self‐neglect but also about the role a patient’s mental status may have in assessment of problems.     

Lifestyle changes: effects on an obese patient

Obesity is often caused by an unhealthy lifestyle, which is a composite of various individual behaviors. Nurses may assist obese patients to lose weight and avoid chronic disease by identifying risky lifestyle behaviors and helping to develop improvement strategies. This article describes the nursing experience of the authors in caring for an obese patient who had made several unsuccessful attempts to reduce weight. An intervention approach was used to review the patient's lifestyle. Using self-regulation theory, the authors identified that the patient's fat-related daily behavior included: lack of exercise, high-fat diet, and daily snacks consumed even late at night. The authors also helped the patient discover the reasons underlying his fat- related behavior and his previous failed attempts to lose weight and to develop a feasible improved approach that considered such. After six weeks of care, the patient's body weight had reduced and body fat and body mass index had decreased with no relapse. The patient further lost significant weight and body fat during the three-month follow up period. The authors would like to share with nursing professionals this approach to weight loss, with the hope that this case study can contribute to medical efforts to help obese patients not only lose weight but also prevent chronic illnesses.     

脑出血169例疾病知识与生活方式调查分析

目的:探讨脑出血患者疾病知识掌握情况及与生活方式的关系,为减少脑出血发生率采取护理干预措施.方法:选择2003年1月～2010年12月收治的169例脑出血患者,采用自行设计的"脑出血相关疾病知识调查问卷"、"脑出血患者生活方式调查问卷"进行调查.结果:脑出血患者疾病知识掌握较差,存在明显不良生活方式,两者间呈中度正相关(P＜0.05,P＜0.01);且相对于男性,女性有较好的生活方式(P＜0.01).结论:加强各级宣教,使广大群众掌握疾病知识,调整不良生活方式,降低脑出血的发病率.     

The short- and long-term motivational effects of a patient education programme for patients with coronary artery bypass grafting

PURPOSE: An important rehabilitation aim following coronary artery bypass graft (CABG) surgery is to modify cardiovascular risk factors positively. Among the most potent possibilities for improvement of these factors is a lifestyle change in terms of increasing sports exercise, changing diet patterns, stress reduction, etc. An indispensable condition for these changes is the motivation to implement the necessary changes. In our working group a patient education programme was developed aimed at enhancing the motivation for lifestyle change, which was already applied in a cardiac surgery hospital. In evaluating the programme, we could observe that various cognitive factors of motivation for lifestyle change had dropped in untreated patients and risen in patients participating in the programme. Based on these preliminary findings we examined the motivation for lifestyle change one year after CABG surgery. METHOD: Each patient was evaluated for his/her value in motivation for lifestyle change using a 30-item questionnaire which measures the six factors Vulnerability, Intention, Social Expectations, Outcome Expectation, Self-Efficacy Expectation, and Perceived Severity two days before CABG surgery as well as ten days and one year after CABG surgery. Between January and May 2002 patients in usual care were investigated as control group (n=70). From January to May 2003, n=70 patients had the opportunity to take part in a comprehensive patient education programme that was provided by a specifically trained psychologist. Data from 108 patients could be evaluated one year after CABG surgery (response rate=77.1%). The programme had comprised individualized units, as well as a group lecture. If partners were available they were included in the process. RESULTS: One year after CABG surgery no significant differences between the control group and the intervention group could be found. CONCLUSION: The positive effects of the patient education programme measured ten days after surgery were found to have vanished one year after the operation. A possible reason is the short duration of the programme. Long-term, structured aftercare programmes should help stabilize the positive effects obtained in the short term.     

A multidisciplinary approach to chronic pain

Chronic pain often is frustrating to nurses and patients, since many times it has not been responsive to traditional medical approaches. The purpose of this article is to discuss the chronic pain syndrome and the role of nursing within a multidisciplinary chronic pain rehabilitation program designed to return the patient to a functional lifestyle. The purpose and rationale for each treatment modality within the pain management program is described, although the treatment plans are individualized for every patient. Nurses play a crucial role, because they are the only professionals who are constantly available to the patient. Nurses collect data and continually assess the patient to develop comprehensive nursing care plans. In this intensive educational program, nurses also assist in teaching the patient positive health practices to control the pain. Further evaluations of these chronic pain rehabilitation programs are needed.     

Using the Transtheoretical Model to Facilitate Behavior Change in Patients with Chronic Illness

Nurse practitioners spend a considerable amount of time encouraging patients with chronic illness to acquire positive behaviors such as exercising and self-monitoring, and to stop negative behaviors like smoking and intake of foods high in fat. These lifestyle changes can be facilitated through use of the transtheoretical model of stages and processes of behavior change. The significance is that it assists health care providers in developing interventions that are specifically focused for the patient depending on stage of readiness to change. The application of the model in the practice setting is discussed, and a specific example of activities developed for use in patients with asthma is given. The protocols can be adapted for any patient who needs to make lifestyle behavior changes.