Self-management in patients with end stage renal disease: exploring domains and dimensions.

The management and appropriate treatment of chronic disease are ongoing challenges in health care. As the population ages, the prevalence of chronic disease can be expected to increase. Since by definition there is no cure for chronic disease, controlling, minimizing, or managing its negative effects becomes a primary goal. In the self-management perspective, it is neither clinicians nor health care systems who must accomplish the bulk of chronic disease management but rather the patients themselves. Moreover, self-management has been shown to be associated with improved outcomes. Self-management is comprised of two domains: self-management of health care and self management of everyday life. Self-management of health care includes self-care activity, partnership in care, communication, self-care self-efficacy, and adherence. Self-management of everyday life entails achieving/maintaining "normality" in everyday roles and functioning. End stage renal disease (ESRD) is a chronic disease for which self-management is particularly relevant. Understanding the components of self-management may help patients and clinicians to embrace this approach, to enter the mutual relationship it requires, and to maximize positive outcomes for patients with ESRD.     

短信平台教育在慢性肾脏病患者自我管理中的应用

目的通过短信平台定期向慢性肾脏病患者发送自我管理及健康教育内容,以增强患者的自我效能、改善其自我管理能力。方法选择2011年11月至2012年4月瑞金医院肾脏内科诊断为慢性肾脏病1～4期且能独立查看手机短信的患者108例,按随机数字表法分为两组:短信对照组患者接受常规健康指导;短信干预组患者出院后,护士通过医院短信平台向患者手机定期发送短信,内容主要为自我管理及健康教育内容;比较两组患者出院后3个月的自我管理行为及自我效能。结果出院前,两组患者的自我管理行为及自我效能水平差异均无统计学意义(P>0.05);出院后3个月,短信干预组在运动锻炼、饮食控制、认知症状管理、与医生沟通等方面的自我管理得分及症状管理、疾病共性管理等方面的自我效能得分均高于对照组,差异有统计学意义(P<0.05)。结论短信平台教育能提高慢性肾脏病患者的自我管理能力,增强其自我效能。     

The self-management experience of people with mild to moderate chronic kidney disease.

This qualitative, exploratory study examined the self-management experiences of people with mild to moderate chronic kidney disease (CKD, Stages 1-3) to elicit participants' perceptions of health, kidney disease, and supports needed for self-management. Findings revealed a process of renegotiating life with chronic kidney disease, which encompassed Discovering Kidney Disease and Learning To Live With Kidney Disease. A number of themes were identified including searching for evidence, realizing kidney disease is forever, managing the illness, taking care of the self and the need for disease-specific information. The findings indicate participants with early CKD want to self-manage their illness in collaboration with health care providers. As well, people with early CKD need guidance and support from health professionals to successfully self-manage. Nephrology nurses are uniquely positioned to provide this support while collaborating with other care providers to facilitate self-management.     

Self-management, knowledge, and functioning and well-being of patients on hemodialysis.

Past research suggests that patients' self-management behavior and knowledge about their condition/treatment may impact functioning and well-being. Specific self-management activities used by patients on hemodialysis have included cooperative/participatory and protective/proactive strategies. In this cross-sectional study, measures of self-management and knowledge were administered to 372 patients on hemodialysis-from 17 dialysis facilities. Findings suggest that the patients studied were low self-managers. The most commonly used self-management strategies were the cooperative/participatory activities of self-care during hemodialysis and shared responsibility in care. Multiple linear regression showed self-care during hemodialysis to be positively associated with physical functioning, measured by the SF-12 Physical Component Summary (PCS-12) scale. Age, diabetes, and two protective/proactive strategies (selective symptom management and assertive self-advocacy) were negatively associated with the PCS-12. Selective symptom management was also negatively associated with mental health functioning measured by the SF-12 Mental Component Summary (MCS-12), whereas patient knowledge of kidney disease/treatment was positively associated with the MCS-12. Because past research has shown the SF-36 PCS and the MCS scores to be associated with mortality and hospitalizations, using cooperative/participatory self-management behaviors, minimizing the need for protective/proactive strategies, and increasing patients' knowledge of kidney disease may have long-term benefits.     

行经皮肝动脉化疗栓塞术的肝癌患者自我管理体验的质性研究

目的 了解行经皮肝动脉化疗栓塞术(transcatheter arterial chemoembolization, TACE) 的肝癌患者的疾病历程及自我管理体验, 分析患者的自我管理需求。方法 采用目的抽样法, 选取某三级甲等医院12名行TACE术治疗的肝癌患者进行面对面半结构化深入访谈, 运用Colaizzi的现象学分析方法对资料进行分析。结果 通过对访谈结果的阅读、分析和提炼, 提出6个主题:(1)对疾病结局的无奈;(2)担心癌症复发;(3)对经济负担及家庭角色转变的主观感受;(4)症状管理能力较强;(5)角色管理及情绪管理能力不足;(6)自我管理知识缺乏, 希望得到医护人员的专业指导。结论 行TACE术肝癌患者面临多重情感障碍, 并缺乏自我管理意识及相关知识;医护人员应提供个体化的自我管理教育, 并联合社区医护人员共同开展患者的自我管理支持服务。     

Factors influencing self-management in chronic obstructive pulmonary disease: an integrative review

BackgroundChronic obstructive pulmonary disease is a common, chronic and burdensome condition requiring the individual to engage in a range of self-management strategies. The capacity to engage in self-management is dependent on a range of internal (e.g. personal) and external (e.g. health service) factors.ObjectivesThis paper seeks to define self-management, identify the determinants which influence the individual's ability to cope and adjust to living with chronic obstructive pulmonary disease in the community, and identify implications for clinical practice and research.DesignIntegrative review.Data sourcesMedline, Embase, PubMed, CINAHL, Google Scholar.Review methodsIntegrative review using prospective research questions. Papers were included in the review if they were published in peer reviewed journals and written in English between 2000 and 2010. Articles were accepted for inclusion if they discussed the determinants that influenced self-management of chronic obstructive pulmonary disease in the community. Confirmation of results and discussion themes was validated by specialists in chronic obstructive pulmonary disease and complex care.FindingsSelf-management is less well characterised in chronic obstructive pulmonary disease compared with other chronic conditions. Functional limitation and the need to balance disease management with everyday life are the two key elements that patients face in managing their condition. Provider characteristics, socioeconomic status and health literacy are sparsely discussed yet are known to influence chronic obstructive pulmonary disease self-management.ConclusionsChronic obstructive pulmonary disease self-management must be a key focus internationally as the disease incidence increases. Collaborative care is required between patients and health providers in order facilitate patients in confident management of their condition.     

慢性肾脏病患者自我管理行为的质性研究

目的了解慢性肾脏病患者的自我管理行为,为临床护理提供参考依据。方法采用质性研究中现象学研究法,对15例2～4期慢性肾脏病患者进行深度访谈、收集资料,并采用Mile和Huberman的内容分析法对访谈记录进行系统分析和归纳。结果经资料分析,提炼出就医行为、情绪管理、遵医行为3个主题;患者能根据疾病症状采取适当的自我管理行为。结论慢性肾脏病患者的自我管理行为尚好,但仍需加强医务人员在患者自我管理中的作用,鼓励社会支持系统参与慢性肾脏病患者的自我管理。     

肾移植受者出院后自我管理行为与自我效能的相关性研究

目的探讨肾移植受者出院后的自我管理行为、自我效能及两者之间的关系。方法应用《慢性病自我管理研究测量表》中的自我管理行为量表、自我效能量表分别调查203名出院后肾移植受者的自我管理行为和自我效能。结果肾移植受者的自我管理行为中耐力锻炼时间较长,体能锻炼、认知性症状管理实践、与医生的交流得分较低,肾移植患者术后的自我效能较稳定,自我管理行为与自我效能呈显著正相关（P〈001）。结论肾移植受者出院后的自我管理行为需要改善,自我管理行为与自我效能关系密切,可通过健康教育提高患者的自我效能,进而改善其自我管理行为。     

血友病性关节炎患者自我管理困境的质性研究

目的 了解血友病性关节炎患者自我管理的困境体验,以期为制订符合患者需求的自我管理干预方案提供参考。 方法 采用现象学研究法,选取2019年12月—2020年9月北京市某三级甲等医院骨科病房的13例血友病性关节炎患者进行半结构式深入访谈。采用Colaizzi 7步分析法分析提炼主题。 结果 对血友病性关节炎患者自我管理造成困境的原因分为内因和外因2个方面,其中内因包括早期对疾病自我管理不重视、疾病管理知识获取途径存在差异以及经济压力大;同时受到外因如疾病的不确定性、社会支持覆盖范围有限、药物可及性差以及突发公共卫生事件等困扰,最终导致血友病性关节炎患者自我管理状态不佳。 结论 血友病性关节炎患者自我管理压力大、任务重,仍存在诸多问题和障碍。医护人员可联合照顾者,通过多途径健康教育帮助患者正确认识并执行疾病管理。同时利用远程医疗平台,探索罕见病患者自我管理的新模式。     

以自我管理理论为核心的云平台健康管理在慢性肾脏病患者延续护理中的应用

目的：探讨以自我管理理论为核心的云平台健康管理在慢性肾脏病患者延续护理中的应用效果,拓展慢性肾脏病患者的延续护理模式。方法：选取2020年10月至2021年3月肾科门诊患者160例,随机分为对照组和观察组各80例。对照组给予传统健康管理,观察组给予自我管理论理为核心的云平台健康管理,干预3个月。采用慢性肾脏病自我管理能力、慢性病自我效能及服药依从性量表调查患者干预前后自我管理能力、自我效能、服药依从性变化,同时观察患者干预前后临床实验室指标、饮食依从性的变化。结果：干预前,两组患者自我管理能力、自我效能、饮食及服药依从性、实验室指标比较差异无统计学意义（P>0.05）。干预后,两组患者自我管理能力、自我效能、饮食及服药依从性均高于干预前,且观察组优于对照组,差异有统计学意义（P<0.05）;观察组患者收缩压、舒张压、血尿酸、血磷较干预前下降,血白蛋白较干预前提高,且观察组收缩压及白蛋白优于对照组,差异有统计学意义（P<0.05）。结论：依托互联网医院发展,以自我管理理论为核心的云平台健康管理可及时发现并解决患者居家治疗过程中的潜在问题,提高患者的自我效能、自我管理能力...     

社区管理模式下2型糖尿病患者自我管理现状分析

目的：调查南京市社区卫生服务中心管理的糖尿病患者的自我管理行为现状并分析影响因素,为提高社区糖尿病管理质量提供依据。方法：采用目的抽样法,选取南京市2个社区卫生服务中心就诊并建立健康档案的2型糖尿病患者为研究对象,使用一般资料调查表、简化糖尿病自我管理行为量表进行调查。结果：129例2型糖尿病患者自我管理行为得分为(32.56±9.47)分,20例（15.5%）患者自我管理水平较好,足部护理维度得分率最低。年龄、教育程度、居住情况、糖化血红蛋白值是糖尿病患者自我管理行为的影响因素。结论：在社区管理模式下,糖尿病患者自我管理水平总体偏低,应采取具有针对性的个体化护理干预措施,以提升社区糖尿病管理质量和服务水平。     

结肠癌造口患者自我管理能力的现状及影响因素分析

目的:了解结肠癌造口患者自我管理能力的临床现状,并分析其影响因素。方法:选择2018年1至12月在广东省中医院治疗的191例结肠癌造口患者,应用一般情况调查表、社会支持量表(Social Support Rating Scale,SSRS)、肠造口患者自我管理问卷进行调查,数据采用SPSS22.0软件进行统计分析。结果:结肠癌造口患者的自我管理得分为(98.34±10.66)分,得分相对较低,症状管理、信息管理和心理护理的得分率均低于60%。回归分析结果显示:年龄、社会支持情况、文化程度、是否独居、造口护理情况、造口时间和住院次数均为自我管理得分的影响因素,共可解释69.5%的方差变异量。结论:结肠癌造口患者的自我管理能力相对不足,临床医护人员应加强评估并制订有针对性的健康教育策略,以提升其疾病自我管理能力,改善临床预后。     

A comparison of two different team models for treatment of diabetes mellitus in primary care

The importance of the nurse's role in the management of patients with type 2 diabetes has long since been emphasized. The aim of this study was to test the hypothesis that a structured organization of type 2 diabetes care, with a diabetes nurse working more independently of the general practitioner, has a significant impact on the patient's self-management and quality of care. The test consisted of 394 registered patients, all with an onset of diabetes mellitus occurring after the age of 34, at two primary health care (PHC) districts in Blekinge county in South Sweden. During one year all consultations for both doctors and nurses were analysed, and a structured telephone survey was carried out involving 364 patients who were 84 years or younger. A comparison between the two PHC centres was made regarding quality of care, frequency of consultation, patients' knowledge of their disease, and patients' self-management. The results showed that organizing care of type 2 diabetes in a structured way encourages better metabolic control in spite of less use of oral medication, and among the patients a greater knowledge of their disease and a more active self-management thus favouring implementation of local guidelines. Also, a difference was found in the patients' choice of contact with doctor or nurse regarding their diabetes and even other causes, which shifted the balance from doctor to nurse. This study provides support for organizing type 2 diabetes care in a structured way to increase the quality of care.     

基于综合转变模型的成人初显期强直性脊柱炎患者自我管理体验的质性研究

目的 探讨成人初显期强直性脊柱炎患者的自我管理的阻碍因素，为后期构建成人初显期强直性脊柱炎患者自我管理模式提供参考依据。方法 基于综合转变模型设计访谈提纲，采用描述性现象学研究方法，对14例成人初显期强直性脊柱炎患者进行面对面半结构式深度访谈，运用Colaizzi 7步法对访谈资料进行分析。结果 成人初显期强直性脊柱炎患者自我管理行为障碍共提炼3大主题，7个亚主题。意识阶段障碍因素：自我管理意愿、自我管理知识与技能、自我管理行为益处与后果感知；动机阶段障碍因素：健康管理信念、自我管理信息支持；行动阶段障碍因素：自我管理行为依从性、自我效能、家属与医护人员的支持和监督。结论 医护人员应强化患者自我管理意识，提升疾病风险感知水平；拓展专业信息支持途径，帮助患者树立正确健康管理信念；同时充分调动社会支持系统，积极探索适合我国国情的成人初显期AS患者疾病管理模式。     

妊娠期糖尿病患者共同照护管理平台的应用及效果评价

目的：探讨共同照护管理平台在妊娠期糖尿病患者中的应用及健康管理干预效果。方法：选择2020年2月至2021年1月在郑州市某三级甲等医院门诊及住院后回归社区的90例患者作为研究对象,使用信封法分为观察组和对照组。对照组采用科室常规的健康指导及随访管理,观察组采用共同照护管理平台进行管理。采用空腹血糖、餐后2 h血糖、糖化血红蛋白比较两组的血糖控制状况;采用糖尿病知识问卷比较两组的疾病相关知识掌握情况;采用糖尿病自我管理能力问卷比较两组的自我管理能力。结果：干预后,观察组血糖控制水平优于对照组,疾病相关知识掌握情况优于对照组,自我管理能力得分高于对照组,差异均有统计学意义（P<0.05）。结论：应用共同照护管理平台对妊娠期糖尿病患者进行健康管理,有利于提高其知识水平,改善患者的自我管理能力,达到控制血糖的目的。     

Home-based chronic care. An expanded integrative model for home health professionals

The Chronic Care Model (CCM) developed by is an influential and accepted guide for the care of patients with chronic disease. Wagner acknowledges a current healthcare focus on acute care needs that often circumvents chronic care coordination. He identifies the need for a "division of labor" to assist the primary care physician with this neglected function. This article posits that the role of chronic care coordination assistance and disease management fits within the purview of home healthcare and should be central to home health chronic care delivery. An expanded Home-Based Chronic Care Model (HBCCM) is described that builds on Wagner's model and integrates salient theories from fields beyond medicine. The expanded model maximizes the potential for disease self-management success and is intended to provide a foundation for home health's integral role in chronic disease management.     

Mental Health and Relational Self-Management Experiences of Patients with Type 2 Diabetes and Stage 3 Chronic Kidney Disease

Self-management (SM) behaviors reduce disease burden from advancing diabetic kidney disease. From a parent study about patients’ transition experience to SM, this study report presents coping resources that support SM and barriers from two focus group interviews (n = 6). Ethnographic analysis identified two patterns: (a) mental health self-management characterized by coping, and (b) relational self-management characterized by social support. Practice implications include focused assessment of perceived social support and social network, dating advisement, and workplace management. Future study considerations include inquiry about diabetes and dating relationships and workplace resources for SM support.     

建立膀胱肿瘤患者自我管理体系的研究

目的构建膀胱肿瘤患者自我管理体系,研究自我管理对膀胱肿瘤患者自我护理能力的影响。方法通过文献资料法、理论分析法、质性研究法及德尔菲（Delphi）专家咨询法,制订膀胱肿瘤患者自我管理体系。对100例膀胱肿瘤化疗患者（干预组）应用构建的评价标准进行健康教育,并与采用常规健康教育的100例患者（对照组）进行调查及治疗效果分析。结果构建涵盖病情管理、日常生活管理、情绪管理、信息管理4大维度I级指标4条、Ⅱ级指标12条、Ⅲ级指标50条的膀胱肿瘤尿路造口患者健康教育评价标准;通过护理干预,有效提高了膀胱肿瘤患者的自我护理能力及疾病相关知识掌握,差异有显著意义（P〈0．01）。结论本研究应用Delphi法构建的测评指标体系,可为临床或社区护士评估膀胱肿瘤高危人群,开展有针对性的健康教育和指导提供科学依据;对膀胱肿瘤患者自我管理进行干预,能提高患者自我管理能力及生活质量。     

A multimorbidity nurse practitioner-led clinic: Evaluation of health outcomes

BackgroundHealthcare services for people living with multiple chronic diseases have traditionally been organised around each condition, an approach which is neither resource-efficient nor convenient or effective for patients. The integrated nurse practitioner service reported here was developed to optimise patient experience and outcomes within a chronic disease self-management framework.AimTo evaluate patient outcomes following attendance at an integrated chronic disease nurse practitioner clinic for multimorbidity.MethodsA prospective service evaluation of adults with any combination of chronic kidney disease, diabetes and/or heart failure between June 2014 and December 2017. Demographic and clinical outcomes at entry and after 12 months of clinic attendance were collected from health records of all patients (n = 162); a subgroup also completed health-related quality of life and self-efficacy measures at entry and 12 months follow-up (n = 106).FindingsPatients attending the clinic had complex needs and poor health-related quality of life. Despite the complexity of their health problems, as a cohort blood pressure was well-controlled and self-efficacy for chronic disease management was relatively high. Over the first 12 months of integrated nurse practitioner care, there were large improvements in physical aspects of health-related quality of life and many patients achieved reductions in body mass index. Use of hospital inpatient and emergency services also decreased.DiscussionNurse practitioner-led services have the potential to reduce treatment burden and deliver integrated chronic disease management.ConclusionsThe multimorbidity clinic has improved health outcomes in this patient cohort and offers a model for enhanced primary care.     

基于网络的互动式健康教育对炎症性肠病患者疾病认知及自我管理行为的影响

目的 探讨基于网络的互动式健康教育对炎症性肠病患者知识水平和自我管理行为的影响。方法 选取2019年8月-2020年11月就诊于消化内科的113例炎症性肠病患者,按入院时间顺序将其分为对照组(57例)和干预组(56例)。对照组采用消化内科常规健康教育,干预组采用基于网络的互动式健康教育,比较2组干预前后的知识水平和自我管理行为能力。结果 干预6个月后,干预组一般知识、用药知识和并发症知识3个维度得分均高于对照组(P＜0.05);用药管理、饮食管理、疾病监测、情绪管理、生活管理和资源利用6个维度得分也高于对照组(P＜0.05)。结论 基于网络的互动式健康教育能有效提高患者的知识水平和自我管理行为能力。