Vascular risk management through nurse-led self-management programs.

In current clinical practice, adequate cardiovascular risk reduction is difficult to achieve. Treatment is primarily focused on clinical vascular disease and not on long-term risk reduction. Pertinent to success in vascular risk reduction are proper medication use, weight control, healthy food choices, smoking cessation, and physical exercise. Atherosclerotic vascular disease and its risk constitute a chronic condition, which poses specific requirements on affected patients and caregivers who should be aware of the chronicity. In patients with vascular disease, there is lack of awareness of their chronic condition because of the invisibility of most risk factors. In other patient groups with chronic illness, self-management programs were successful in achieving behavioral change. This strategy can also be useful for patients with vascular disease to adapt and adhere to an improved lifestyle. Self-management refers to the individual's ability to manage both physical and psychosocial consequences including lifestyle changes inherent to living with a chronic condition. Interventions that promote self-management are based on enhancing self-efficacy. In self-management, attention can be given to what is important and motivational to the individual patient. In this article the challenge of nursing care promoting self-management for patients with vascular risk and how this care can be applied will be explained. Nurses can play a central role in vascular risk management with a self-management approach for patients with chronic vascular disease. In vascular prevention clinics, nursing care can be delivered that includes medical treatment of vascular risks (hypertension, hypercholesterolemia, hyperglycemia, and hyperhomocystinemia) and counseling on promoting self-management (changes in diet, body weight, smoking habits, and level of exercise). Nursing interventions based on self-management promotion can provide a new and promising approach to actually achieve vascular risk reduction.     

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.     

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.     

Finding common ground: patient-centeredness and evidence-based chronic illness care

Health outcomes for patients with major chronic illnesses depend on the appropriate use of proven pharmaceuticals and other therapeutic technologies, and effective self-management by patients. Effective chronic illness care then bases clinical decisions on the best, rigorous scientific evidence, or evidence-based medicine. Effective support for patient self-management includes efforts to increase patient participation in care and collaborative goal-setting and planning of treatment. These interventions appear somewhat consistent with recent conceptualizations of patient-centered care. The consistent delivery of proven therapies and information and support for self-management requires practice systems organized for that purpose. The Chronic Care Model is a compilation of those practice system changes shown to improve chronic care. This paper explores the concept of patient-centeredness and its relationship to the Chronic Care Model. We conclude that the Model is both evidence-based and patient-centered and that these can be properties of health systems, and not just of individual practitioners.     

Implementation of Cluster-Based Management Strategies for Patients With Chronic Kidney Disease

Chronic kidney disease is a critical public health problem and health economic burden. This research adopted the clustering analysis method, which was used to divide 259 patients into 3 subgroups of patients, based on the situational leadership management. The goal was to discover the needs for patient management and a self-management support strategy applied to clinical care. At the same time, the aim was to constantly improve the ability of self-management for patients with chronic kidney disease to improve their physical and mental health, to realize the diversification of slow disease management, and customization of care.     

Collaborative self-management strategies for patients with respiratory disease

The effectiveness of collaborative self-management of respiratory disorders has been most clearly demonstrated in asthma. In both adults and children with severe asthma requiring emergency care and hospitalizations, collaborative self-management can decrease not only the need for emergency care and hospitalization but also time lost from work and school, thereby increasing the patients' ability to be full and active participants in the community. Collaborative self-management is best provided in a comprehensive program that includes ready access to healthcare professionals, education, behavioral therapy, and peak-flow monitoring. The relative value of each of these components and the value of single components applied simultaneously is unclear. In some studies, asthma symptoms and medication adherence have also improved following implementation of collaborative self-management. The available data indicate that collaborative self-management should be considered as a potential therapeutic adjunct in the management of every patient with asthma and should be routinely employed with patients who have severe disease as defined by emergency room use and hospitalizations. Additional investigations should be conducted in patients with other respiratory diseases to define the role of collaborative self-management. Nonetheless, state-of-the-art medical care and the nature of the patient-physician relationship in the 1990s dictates that collaborative self-management be routinely employed in the optimal outpatient management of any individual who is interested in participating in his or her own healthcare. However, individualization of the practitioner-patient relationship is necessary. Not all patients desire to play an active role in their illness and its management. The personality, attitudes, and desires of individuals in assisting in their own management must be assessed. Theory would suggest that patients who do not appear to have an interest in self-management may have low self-efficacy that may be increased by educational efforts. Improved self-efficacy and active participation in disease management may result in beneficial outcomes. It is clear that the physician-patient relationship has changed over the past decade. As patients have been empowered to act in their own best interests, the physician's role as an educator and facilitator has become more prominent than ever. Even if medical investigations had not demonstrated any beneficial effects of collaborative self-management, patients have the right to participate in decisions affecting their healthcare and are increasingly exercising that right. Respiratory care practitioners are in a unique position to enhance collaborative self-management. In the home environment, RCPs can foster smoking cessation and serve as a liaison between patients and physicians.(ABSTRACT TRUNCATED AT 400 WORDS)     

Self-management education and support in chronic disease management

With the changing health care environment, prevalence of chronic health conditions, and burgeoning challenges of health literacy, obesity, and homelessness, self-management support provides an opportunity for clinicians to enhance effectiveness and, at the same time, to engage patients to participate in managing their own personal care. This article reviews the differences between patient education and self-management and describes easy-to-use strategies that foster patient self-management and can be used by health care providers in the medical setting. It also highlights the importance of linking patients to nonmedical programs and services in the community.     

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。     

Supporting self-management in patients with chronic illness

Support of patient self-management is a key component of effective chronic illness care and improved patient outcomes. Self-management support goes beyond traditional knowledge-based patient education to include processes that develop patient problem-solving skills, improve self-efficacy, and support application of knowledge in real-life situations that matter to patients. This approach also encompasses system-focused changes in the primary care environment. Family physicians can support patient self-management by structuring patient-physician interactions to identify problems from the patient perspective, making office environment changes that remove self-management barriers, and providing education individually and through available community self-management resources. The emerging evidence supports the implementation of practice strategies that are conducive to patient self-management and improved patient outcomes among chronically ill patients.     

Transformacion Para Salud: A Patient Navigation Model for Chronic Disease Self-management

Increased cost of chronic illnesses in United States is an urgent call to develop a cost effective approach to improve chronic disease self-management, especially among vulnerable populations. An emerging role for professionals and paraprofessionals is the patient navigator. We present an example of a conceptual framework, Transformation for Health, developed to underpin the training of certified community health workers (CHW) to deliver health care, preventive services, and health education for underserved populations to promote chronic disease self-management. Transformacion Para Salud (TPS), a patient navigation model for chronic disease self-management, was a two year demonstration program to develop a culturally sensitive intervention to facilitate patient behavior changes. Patients involved in the TPS intervention showed improvements in clinical and behavioral outcomes after twelve months of intervention. This article describes the conceptual basis and implementation of the TPS and discusses program evaluation, specific intervention outcomes, and implications for practice. Use of CHWs in the patient navigator role demonstrated a cost effective method to improve access to quality, cost-effective, primary health care services as well as to facilitate chronic disease self-management.     

The effects of patient–professional partnerships on the self-management and health outcomes for patients with chronic back pain: A quasi-experimental study

BackgroundSelf-management may be a lifelong task for patients with chronic back pain. Research suggests that chronic pain self-management programmes have beneficial effects on patients’ health outcome. Contemporary pain management theories and models also suggest that a good patient–professional partnership enhances patients’ ability to self-manage their condition.Objectives(1) To investigate whether there is a reciprocal relationship between self-management of chronic back pain and health-related quality of life (HRQoL); (2) to examine the impact of a good patient–professional partnership on HRQoL, either directly, or indirectly via change in the ability to self-manage pain.Design and settingThis quasi-experimental study was designed to take place during routine service appointments and conducted in a community-based pain management service in the United Kingdom. A patient–professional partnership was established in which patients were actively involved in setting up goals and developing individualised care plans. Through this, health professionals undertook patients’ health needs assessment, collaborated with patients to identify specific problems, provided written materials and delivered individualised exercise based on patients’ life situation. Patients were recruited following initial consultation and followed up three months later.ParticipantsA total of 147 patients (65% female) with a mean age of 48 years (standard deviation (SD): 14 years) were enrolled in the study. Of these, 103 subjects completed the study. Patients were included if they were aged 18 and over, suffered from chronic back pain, had opted in to the clinic and had sufficient ability to read and understand English. Patients were excluded if they opted out this service after the initial assessment, suffered from malignant pain or required acute medical interventions for their pain relief.MethodsSelf-reported measures of HRQoL, patient–professional partnerships and self-management ability were collected at baseline and three months later. Pathways proposed were depicted using structural equation modelling.ResultsThere was no association between patients’ self-management ability and HRQoL at baseline. However, a positive direct effect was detected at three months (−0.38, p < 0.01). A patient–professional partnership was not found to be beneficial for patients’ HRQoL through a direct pathway, but via an indirect pathway where self-management was a mediator (−19.09, p < 0.01).ConclusionsThis study suggests that the increase in patients’ self-management ability may lead to improvement in HRQoL after pain management support provided in a partnership with health professionals. A good patient–professional partnership appears to be beneficial as an augmentation to self-management practice for patients with chronic back pain.     

Intervisit Management of Patients With Diabetes: Synchronized Phone Calls

The US health care model continues to struggle with providing chronic disease management. Innovation focusing on improving care delivery systems to bridge this gap will be necessary to improve chronic care in the United States. This quality improvement project focused on patients with type 2 diabetes. This innovation was designed to change patient and provider engagement in follow-up care by providing a protected synchronous time in the form of a scheduled phone call to work on glycemic goals through improving patient’s diabetes self-management techniques and, when appropriate, medication titration. A standardized tool (the Diabetes Treatment Satisfaction Questionnaire) was used to assess patient satisfaction with this intervention.     

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。     

十二指肠溃疡患者自我管理水平的影响因素

目的了解十二指肠溃疡患者自我管理水平的现状,并探讨其影响因素。方法便利抽样选择2012年1月至2014年3月期间在南方医科大学南方医院消化科就诊的十二指肠溃疡患者200例,采用《慢性病自我管理研究测量表》中的自我管理行为量表及自我效能量表,对其进行自我管理水平的调查,并分析其影响因素。结果十二指肠溃疡患者总体自我管理行为得分为(12.26±1.90)分,自我管理水平中等偏低。主要影响因素为自我效能、文化程度和工作压力,3个因素共同解释自我管理水平变异的20.4%。结论通过对十二指肠溃疡患者自我管理水平及其影响因素分析,进行有针对性的健康教育和护理干预,有助于使患者从被动管理疾病到主动参与疾病管理,提高患者自我管理水平,减少复发率,有效提高治愈率及患者的生活质量。     

Interprofessional care of people with multiple chronic conditions: An open-access resource for nursing educators

Nurses, nurse practitioners, and other healthcare professionals must be prepared to care for the growing population of patients with multiple chronic conditions, to promote patient engagement, patient self-management, and for interprofessional collaboration. Interprofessional Care of Individuals with Multiple Chronic Conditions is an open-access eLearning course designed to prepare students with these skills. The course features multimedia presentations, interactive exercises, and an immersive “day in the life of a patient-centered medical home” in which learners make decisions, receive feedback, and experience consequences in the context of real-world video scenarios. Three hundred thirty-four nurse practitioner students participated in the educational program. To evaluate the program, we conducted a paired-samples t-test to compare scores on pre and posttest evaluation surveys. There was a significant difference in the scores for applying the Chronic Care Model t (df) = 15.99; p < 0.001, coaching for self-management t (df) = 11.04; p < 0.001 and interprofessional collaboration t (df) = 3.86; p < 0.00. The majority of students were satisfied or very satisfied with the modules. Students found the immersive video scenarios to be the best feature of the course. The course is available to assist students in gaining the ability to care for patients with chronic illnesses within interprofessional practice settings.     

Chronic diseases and natural hazards: impact of disasters on diabetic, renal, and cardiac patients

BACKGROUND: Inadequately controlled chronic diseases may present a threat to life and well-being during the emergency response phase of disasters. Chronic disease exacerbations (CDE) account for one of the largest patient populations during disasters, and patients are at increased risk for adverse outcomes. OBJECTIVE: The objective of this study was to assess the burden of chronic renal failure, diabetes, and cardiovascular disease during disasters due to natural hazards, identify impediments to care, and propose solutions to improve the disaster preparation and management of CDE. METHODS: A thorough search of the PubMed, Ovid, and Medline databases was performed. Dr. Miller's personal international experiences treating CDE after disasters due to natural hazards, such as the 2005 Kashmir earthquake, are included. DISCUSSION: Chronic disease exacerbations comprise a sizable disease burden during disasters related to natural hazards. Surveys estimate that 25-40% of those living in the regions affected by hurricanes Katrina and Rita lived with at least one chronic disease. Chronic illness accounted for 33% of visits, peaking 10 days after hurricane landfall. The international nephrology community has responded to dialysis needs by forming a well-organized and effective organization called the Renal Disaster Relief Task Force (RDRTF). The response to the needs of diabetic and cardiac patients has been less vigorous. Patients must be familiar with emergency diet and renal fluid restriction plans, possible modification of dialysis schedules and methods, and rescue treatments such as the administration of kayexalate. Facilities may consider investing in water-independent extracorporeal dialysis techniques as a rescue treatment. In addition to patient databases and medical alert identification, diabetics should maintain an emergency medical kit. Diabetic patients must be taught and practice the carbohydrate counting technique. In addition to improved planning, responding agencies and organizations must bring adequate supplies and medications to care for diabetic, cardiac, and renal patients during relief efforts. CONCLUSIONS: By recognizing and addressing impediments to the care of chronic disease exacerbations after natural disasters, the quality, delivery, and effectiveness of the care provided to diabetic patients during relief efforts can be improved.     

膝关节置换者的自我管理模式

背景：自我管理模式是一种新型的疾病干预模式,可显著改善患者的健康行为及健康状况,同时减少住院天数和次数,降低医疗费用,已日渐成为人工膝关节置换后康复的研究热点,但其研究多集中在西方国家,国内报道较少。目的：探讨自我管理模式在膝关节置换患者康复中的应用价值。方法：选择膝关节置换住院患者84例,随机分为对照组和实验组,实验组采取自我管理模式,对照组采取常规教育模式,利用自我管理调查表、膝关节评分、住院时间和膝关节屈曲达90°所需时间来评价干预效果,比较两组干预前后相关参数的变化。结果与结论：两组患者自我管理得分和膝关节评分均有提高,实验组显著优于对照组（P〈0.05）;住院天数和膝关节屈曲90°所需时间均有缩短,实验组显著低于对照组（P〈0.05）。结果显示自我管理模式可有效提高膝关节置换患者自我管理能力,改善膝关节功能,提高生活质量。     

Asthma management across the life span: applications for the adult and older adult

Asthma is one of the most common and chronic diseases of adults and creates substantial health problems. The disease must be diagnosed appropriately, its severity assessed, and treatment prescribed that matches the level of severity. Patient education in self-management techniques and attention to the problems of adherence are essential for long-term management. Comorbid conditions should be suspected and treated when asthma becomes difficult to control. Asthma in the elderly is a challenging but frequent problem that requires particular attention to controlling the causes of excessive morbidity and mortality. All health care professionals have an important role in controlling this common disease.