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.     

Using self-efficacy theory to educate a patient with chronic obstructive pulmonary disease: A case study of 1-year follow-up

Self-efficacy is important in determining which activities or situations an individual will perform or avoid. This is a case study report to explore the utility of structured education programme on strengthening self-efficacy in an older adult with chronic obstructive pulmonary disease (COPD). To comprehensively evaluate this intervention, a combined qualitative and quantitative approach was used. Although qualitative data were collected following the interview guide, quantitative data were collected by the demographic data form and the COPD Self-Efficacy Scale (CSES) at the preprogramme and postprogramme stage. The patient's self-efficacy scores improved after 8 weeks of the structured education programme and remained relatively constant on all the repeated measurements after education. Qualitative data were identified as 'difficulties' and 'facilities'. This study indicates that, by applying a self-efficacy theory, a planned education programme could be useful in improving both short-term and long-term self-efficacy in patients with COPD.     

Applying two minds theory to self‐management of Type 1 diabetes

Two minds theory (TMT) offers a new approach to changing health behavior. Here, TMT is applied to self‐management of Type 1 diabetes. TMT can be conceptualized as a cycle where a stimulus produces an immediate Intuitive system response leading to health behavior, followed by a conscious narrative system response that is temporally delayed. Narrative responses do not produce behaviors directly but instead lead to conscious beliefs about past events and behavioral intentions for the future, both of which become part of the material considered by the intuitive system in selecting future behaviors. Because of the temporal delay between intuitive behavior and narrative interpretation, and the nonconscious nature of intuitive thought, there is often a gap between intentions and behaviors. This has implications for nursing practice. First, nurses should consider that patient‐reported impressions of the past or future are fundamentally narrative system responses and understand that these may be less predictive of behavior than biopsychosocial measures that are more temporally immediate. Second, nurses can use TMT to inform new strategies for behavior change interventions. For diabetes self‐management, nurses can encourage individuals to leverage environmental cues to prompt self‐management (tricking the intuitive system), provide rewards for self‐management (training the intuitive system), or engage the narrative system via planning, reframing, or attention practices for healthier future decisions. Overall, the TMT addresses the gap between intentions and behavior and should be further developed to inform behavioral health interventions.     

Peer‐led diabetes self‐management programme for community‐dwelling older people in China: study protocol for a quasi‐experimental design

Aim. A protocol for a new peer‐led self‐management programme for community‐dwelling older people with diabetes in Shanghai, China. Background. The increasing prevalence of type 2 diabetes poses major public health challenges. Appropriate education programmes could help people with diabetes to achieve self‐management and better health outcomes. Providing education programmes to the fast growing number of people with diabetes present a real challenge to Chinese healthcare system, which is strained for personnel and funding shortages. Empirical literature and expert opinions suggest that peer education programmes are promising. Design. Quasi‐experimental. Methods. This study is a non‐equivalent control group design (protocol approved in January, 2008). A total of 190 people, with 95 participants in each group, will be recruited from two different, but similar, communities. The programme, based on Social Cognitive Theory, will consist of basic diabetes instruction and social support and self‐efficacy enhancing group activities. Basic diabetes instruction sessions will be delivered by health professionals, whereas social support and self‐efficacy enhancing group activities will be led by peer leaders. Outcome variables include: self‐efficacy, social support, self‐management behaviours, depressive status, quality of life and healthcare utilization, which will be measured at baseline, 4 and 12 weeks. Discussion. This theory‐based programme tailored to Chinese patients has potential for improving diabetes self‐management and subsequent health outcomes. In addition, the delivery mode, through involvement of peer leaders and existing community networks, is especially promising considering healthcare resource shortage in China.     

Cues for nursing diagnosis of ineffective self-management of fluid and dietary restrictions in dialysis therapy in Japan

PURPOSE. We aimed to identify the cues of expert nurses and validate the cue information on the defining characteristics for a nursing diagnosis of ineffective self‐management of fluid and dietary restrictions in dialysis therapy in Japan. METHODS. We used qualitative interviews and two‐round Delphi studies. FINDINGS. The expert nurses regarded four signs of unmaintained fluid and dietary restrictions as major defining characteristics and nine other cues as minor defining characteristics. CONCLUSIONS. Expert nurses in dialysis therapy regard symptoms of health behavior as major cues for nursing diagnosis of ineffective self‐management of fluid and dietary restrictions in dialysis therapy. IMPLICATIONS FOR NURSING PRACTICE. Verification of the clinical validity and development of a specific, clinically useful database on nursing diagnoses are required.     

临床护理人员护理能力与自我概念的关系

目的 调查临床护理人员护理能力与自我概念的现状,分析二者之间的相关性,探讨护理能力的影响因素.方法 采用护理能力量表和田纳西自我概念量表对153名临床护理人员进行调查分析.结果 临床护理人员的护理能力条目均分为(5.31±0.72)分,自我概念条目均分为(3.95±0.33)分,护理能力总分与自我概念总分之间呈正相关(...     

Patient‐tailored self‐management intervention for older adults with hypertension in a nursing home

Aims and objectives. This study was to evaluate the effects of a patient‐tailored self‐management intervention on (1) blood pressure control and (2) self‐care behaviour, exercise self‐efficacy and medication adherence among Korean older hypertensive patients in a nursing home. Background. Little is known about whether a patient‐tailored self‐management for nursing home residents with hypertension is likely to advance the care of this growing population worldwide. Design. A non‐equivalent comparison group design. Methods. Forty‐seven patients (23 and 24 in the intervention and comparison groups, respectively) participated in the study. No one withdrew during the eight‐week study period. Hypertensive patients in the intervention group received health education and tailored individual counselling for eight weeks to enhance the self‐management. Results. The mean age of patients was 77·4 years. Patients were on hypertensive medications for 11·8 years; only 36 of them took medications without assistance. The baseline comparisons of the patients with and without 8‐week intervention did not differ for clinical and demographic variables and outcome measures. Blood pressure decreased when comparing the baseline to eight weeks later from baseline; moreover, blood pressure was significantly reduced only in patients who received the intervention. Self‐care behaviour and exercise self‐efficacy significantly increased over time only in those who were in the intervention group. However, no significant difference was observed in medication adherence between the two groups. Conclusions. Patient‐tailored self‐management intervention was a practical approach for decreasing blood pressure and increasing self‐care behaviour in older hypertensive patients in a nursing home. Further studies are needed to validate these findings using a larger sample with long‐term follow‐up. Relevance to clinical practice. A patient‐tailored intervention is feasible not only to empower nursing home residents with hypertension for their care, but also to offer a qualified training and guidelines to nursing home staffs, expanding their professional competence in clinical practice.