自我效能理论与糖尿病健康教育理论的联系及应用进展

对自我效能理论与糖尿病健康教育理论,如健康信念模式、动机访谈技术、跨理论模式、授权教育模式的联系及应用效果进行综述,提出在糖尿病病人教育的不同阶段需结合多种健康教育理论,以提高病人的自我效能水平。     

Clinical teacher self-efficacy: A concept analysis

Self-efficacy is a well-researched concept and a key component of Bandura's Social Cognitive Theory. Teacher self-efficacy is widely researched within education; it affects student achievement and motivation as well as teacher performance and commitment. Minimal information exists on teacher self-efficacy within clinical settings of practice professions which likely affects patient outcomes. This paper provides background on self-efficacy and teacher self-efficacy; it then addresses clinical teacher self-efficacy using the Walker and Avant (2005) method for concept analysis. Assumptions, definitions, characteristics, antecedents and consequences of the concept of clinical teacher self-efficacy are discussed and represented visually, and exemplified as cases within nursing education. Implications and recommendations are suggested for the applicability of clinical teacher self-efficacy within clinician education and practice.     

PROMs: a novel approach to arthritis self-management

Despite our knowledge of many effective education techniques, there is little evidence that clinicians have incorporated them into their daily practices. One of the reasons for the underutilization of patient education may be that physicians are expecting the specialist nurses to provide this service, whereas the nurses lack any formal protocol for patient education in standard clinical practice. Self-management programmes are now acknowledged as a key element of quality care. A high priority for research is the development and diffusion of patient education strategies that are tailored to address patient needs and applicable for the standard day to day practice. This paper describes the rationale and design of the 'Joint Fitness Program' which is a new patient-based educational programme integrating patient-reported outcome measures (PROMs) and self-management for people with inflammatory arthritis. This education programme, which illustrates how theory can explicitly be translated into practice, addresses PROMs as an objective tool to assess the educational needs of patients with arthritis and uses the PROMs to design an education programme and not just evaluate the disease activity.     

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.     

Behavioral facilitation of medical treatment for headache--part II: Theoretical models and behavioral strategies for improving adherence

This is the second of 2 articles addressing the problem of noncompliance in medical practice and, more specifically, compliance with headache treatment. The companion paper describes the problem of noncompliance in medical practice and reviews literature addressing compliance in headache care (Behavioral Facilitation of Medical Treatment for Headache--Part I: Review of Headache Treatment Compliance). The present paper first summarizes relevant health behavior theory to help account for the myriad biopsychosocial determinants of adherence, as well as patient's shifting responsiveness or "readiness for change" over time. Appreciation of health behavior models may assist in optimally tailoring interventions to patient needs through instructional, motivational, and behavioral treatment strategies. A wide range of specific cognitive and behavioral compliance-enhancing interventions are described, which may facilitate treatment adherence among headache patients. Strategies address patient education, patient/provider interaction, dosing regimens, psychiatric comorbidities, self-efficacy enhancement, and other behavioral interventions.     

健康教育对老年手术患者自我效能感的影响

目的探讨健康教育对老年手术患者自我效能感的影响。方法对120例老年手术患者实施行为干预、社会支持、疾病知识教育,比较健康教育前后患者自我效能感的差异。结果健康教育后老年患者日常生活、健康行为、药物治疗及遵医行为得分均较健康教育前高(均P<0.05)。结论健康教育可增强老年手术患者的自我效能感,是提高患者治疗依从性,建立健康行为方式的有效方法。     

Producing Clinically Meaningful Reductions in Disability: A Causal Mediation Analysis of a Patient Education Intervention

Patient education is recommended as first-line care for low back pain (LBP), although its efficacy for providing clinically meaningful reductions in disability has been questioned. One way to improve treatment effects is to identify and improve targeting of treatment mechanisms. We conducted a pre-planned causal mediation analysis of a randomized, placebo-controlled trial investigating the effectiveness of patient education for patients with acute LBP. 202 patients who had fewer than six-weeks’ duration of LBP and were at high-risk of developing chronic LBP completed two, one-hour treatment sessions of either intensive patient education, or placebo patient education. 189 participants provided data for the outcome self-reported disability at three-months and the mediators, pain self-efficacy, pain catastrophizing, and back beliefs at one-week post treatment. This causal mediation analysis found that pain catastrophizing (mediated effect, -0.64; 95% Confidence Interval [CI], -1.31 to -0.15) and back beliefs (mediated effect, -0.51; 95% CI, -1.15 to -0.02) partly explained the effect of patient education on disability but pain self-efficacy did not (mediated effect, -0.40; 95% CI -1.13 to 0.28). Considering the mediator-outcome relationship, patient education would need to induce an 8 point difference on the pain self-efficacy questionnaire (0-60); an 11 point difference on the back beliefs questionnaire (9-45); and a 21 point difference on the pain catastrophizing scale (0-52) to achieve a minimally clinically important difference of 2 points on the Roland Morris Disability Questionnaire (0-24).PerspectiveUnderstanding the mechanisms of patient education can inform how this treatment can be adapted to provide clinically meaningful reductions in disability. Our findings suggest that adapting patient education to better target back beliefs and pain self-efficacy could result in clinically meaningful reductions in disability whereas the role of pain catastrophizing in acute LBP is less clear.     

Development of a core competency program for patient educators.

Many healthcare disciplines provide patient education, yet few receive specific training in the field. This article describes the assessment, development, implementation, and evaluation of a patient education core competency/orientation program for patient educators. This model can be applied and tailored to specific disciplines to improve the knowledge, understanding, and application of patient education theory, principles, and practice.     

Understanding and enhancing patient compliance with diabetic regimens

Behavioral research on patient compliance with regimens to manage diabetes has suffered from lack of conceptual rigor, although a handful of recent studies and reviews are more theoretically oriented. The present review proposes a comprehensive conceptual framework in the context of learning theory to explain patient compliance and to derive approaches for enhancing compliance. The conceptual framework is the health belief model (HBM) expanded to include the concept of perceived self-efficacy. This expanded model may both serve as an agenda for future research as well as a set of guidelines for the education of patients with diabetes. A variety of educational interventions is recommended for use in patient education provided they succeed in reinforcing relevant health beliefs, behavioral skills, and the sense of self-efficacy. The problem of long-term maintenance, of particular significance in chronic disease management, is addressed by the relapse prevention model derived from social learning theory and emphasizing self-efficacy and the learning of coping skills.     

Effects of a self-management arthritis programme with an added exercise component for osteoarthritic knee: randomized controlled trial

AIM: This paper is a report of a study to assess the effect of an adapted arthritis self-management programme with an added focus on exercise practice among osteoarthritic knee sufferers. BACKGROUND: Osteoarthritis of the knee is a major source of loss of function in older people. Previous studies have found self-management programmes to be effective in increasing arthritis self-efficacy and in mastery of self-management practice. METHOD: A randomized control trial was carried out from December 2002 to May 2003 and 120 participants (65.9%, including 67 in intervention group and 53 in control group) completed the 16-week postintervention assessments. Outcome measures included arthritis self-efficacy, use of self-management techniques, pain intensity and daily activity. FINDINGS: At 16 weeks, there was a 'statistically' significant improvement in the arthritis self-efficacy level (P 相似文献   

基于行动研究实践理论的健康教育对直肠癌造口患者自我效能和自护能力的影响

目的探讨基于行动研究实践理论的健康教育对直肠癌造口患者自我效能和自护能力的影响。方法选择2017年1月至2019年1月我院收治的直肠癌造口患者80例,将其随机等分为对照组和观察组,对照组进行常规健康教育,观察组基于行动研究实践理论开展健康教育,3个月后比较两组患者自我效能调查量表以及自护能力量表(ESCA)评分。结果干预后3个月观察组患者造口照顾、饮食选择、社交、劳动信心、生活自理信心、性生活信心评分均高于对照组,差异具有统计学意义(P<0.05);护理技能、自我责任、健康知识水平、自我概念评分均高于对照组,差异具有统计学意义(P<0.05)。结论基于行动研究实践理论的健康教育通过观察、反思,不断改进行动干预,能够有效提升直肠癌造口患者自护能力与自我效能,值得临床推广应用。     

基于行为转变理论的健康教育对牙周病患者口腔保健自我效能与口腔卫生的影响

目的探讨基于行为转变理论的健康教育对牙周病患者口腔保健自我效能与口腔卫生的影响。方法选取我院2017年1月至2018年6月收治的120例牙周病患者为研究对象,随机等分为对照组与观察组,对照组采用常规健康教育,观察组采用基于行为转变理论的健康教育,比较两组患者教育前及教育后3个月口腔保健自我效能及口腔卫生水平。结果教育前两组口腔保健自我管理效能及口腔卫生状况评分比较差异无统计学意义(P>0.05),教育后两组口腔保健自我效能评分及口腔卫生状况均较教育前有所改善(P<0.05),且教育后观察组口腔保健自我效能评分高于对照组(P<0.05),观察组软垢指数、龈沟出血指数、牙龈指数均低于对照组(P<0.05)。结论基于行为转变理论的健康教育能够提高牙周病患者口腔保健自我效能,改善口腔卫生状况。     

血液透析患者自我效能与自我管理行为的相关性分析

目的 探讨血液透析患者自我效能与自我管理行为之间的相关性.方法 采用美国Stanford大学慢性疾病教育研究中心的自我效能量表和自我管理行为问卷对89例血液透析患者进行调查.结果 本组89例血液透析患者自我效能平均得分为（6.55±1.97）分.其中自我效能水平高者20例占22.47％,自我效能水平中等者39例占43.82％,自我效能水平低者30例占33.7％.89例血液透析患者自我效能水平为（38.51±10.91）分,自我管理行为水平为（76.38±14.88）分;多元线性回归分析显示,职业及医疗费用对家庭的影响是血液透析患者自我管理行为的主要的影响因素（P＜0.05）;血液透析患者自我效能与自我管理行为之间呈正相关（r=0.43,P＜0.01）.结论 血液透析患者自我效能与自我管理行为之间存在密切关系,临床工作者应依据自我效能理论为依据,调动患者的自身潜能,通过护理干预来提高患者自我管理行为.     

Relationship between illness representation and self-efficacy

AIM: This paper reports a patient survey exploring the possible relationship between illness perception and self-efficacy following a cardiac event, and the implications this could have for nursing practice. BACKGROUND: Cardiac rehabilitation guidelines endorse the need to improve psychological care; suggesting that individualized support will improve the effectiveness of cardiac rehabilitation. Surveys, however, continue to identify that psychosocial factors are poorly assessed. Illness representation and self-efficacy are two prominent research approaches that have been developed as separate foci for the treatment of patients. METHOD: A cross-sectional survey with patients diagnosed with either myocardial infarction or angina over an 8-month period in two hospitals. The Illness Perception Questionnaire, General Self-Efficacy Questionnaire, Cardiac Diet Self-efficacy Instrument and Cardiac Exercise Self-efficacy Instrument were used, alongside two specifically-designed scales: the Diet Outcome Expectation and Exercise Outcome Expectation Scales. RESULTS: The results indicate that there is a significant relationship between illness perception and self-efficacy. The greater patients' perceived consequences of the heart condition, the lower was the general self-efficacy available to cope with the condition. Further, the longer the perceived time the condition will affect the patient, the higher the specific self-efficacy to maintain a change of diet or exercise regime. CONCLUSION: The findings identify that, in the initial phase of recovery, nursing practice needs to focus on the key variables of "consequence" and "timeline" in order to increase patients' confidence in their ability to cope (self-efficacy).     

Educating nurses and patients to manage heart failure.

Patient education is an important component in the management of patients with heart failure and nurses are increasingly involved in this area. This paper reviews the literature on education to patients with heart failure and the education and training for heart failure nurses. Patients with heart failure need education in order to adapt to their chronic syndrome and perform self-care. The education process often starts during the hospital admission, but must continue in the outpatient setting. Nurses need to be skilled in assessing the requirements and level of the education given to the individual. Computer-based education has been found to be a preferred and effective compliment to the education provided by health care professionals. The effect of new materials and methods needs to be evaluated in order to improve the overall effectiveness of the education provided. The patient with heart failure should have an active role in this development and evaluation. The heart failure nurse needs to be experienced in cardiac care, have an ability to work independently in order to be delegated responsibilities such as drug titration and patient assessment. This requires optimal experience, training and education for advanced practice. In order to develop and evaluate the education of patients with heart failure and the overall effectiveness of heart failure nurses in this regard, national and international collaborations are needed.     

Joint appointments: another dimension to building bridges

For many years nurse education has been under close scrutiny, with particular focus on the links between what is taught in the classroom and what is practised. Since the onset of the United Kingdom Central Council for Nursing and Midwifery's Project 2000: A new preparation for practice, concerns have been raised over the potential for an even greater gap between theory and practice. Within this concept, the development of joint appointments between education and service providers has been an issue of much debate within the nursing profession in recent years.This paper explores the complexity of the role and shares the writer's personal experiences as a joint appointee between University College Worcester and Worcester Royal Infirmary NHS Trust. The issues discussed demonstrate how by supporting nurses in their development of practice, research, policy and teaching, joint appointments can contribute directly and indirectly to providing a first class nursing service for patients.     

Investigating and implementing change within the primary health care nursing team

Primary care is developing rapidly with significant impacts on the nursing team. Such changes have brought inter-professional team-working into sharper focus, particularly community care and collaborative working. This paper: examines the nursing roles within a general practice; describes the perspectives of service users; identifies areas of change; clarifies core and specialist skills; defines new roles among the primary health care nursing team; proposes a new model of working; and identifies appropriate education. The project was set in a general practice in south-west England and used an action research methodology. The objectives were to create a change in practice and to develop and refine existing theory to underpin nursing roles. Throughout the research regular team meetings allowed reflection and discussion about research findings and progress. Data were collected from multiple sources, including team workshops, patient focus group interviews, and individual interviews with GPs, practice managers and area managers. Reflective diaries and a patient survey were also used. The analysis of the quantitative and qualitative data collected from patients formed a basis for practice development and facilitated the team's reflection on the areas of change. Overall high satisfaction with services and care was expressed in the patient interviews and the questionnaire. The themes from the data highlighted areas important for patients and helped in shaping the new roles and responsibilities for team members. Regarding the team perspective, the data indicated many areas that could be considered for development. The community nursing team decided to concentrate on three key areas: child health, leg ulcer management, and cardiovascular health. The research concludes that action research presents some problems and challenges but is a useful approach to developing team-working in primary health care.     

Nothing for Me or About Me,Without Me: Codesign of Clinical Decision Support

Background  Partnerships among patients, families, caregivers, and clinicians are critical to helping patients lead their best lives given their specific genetics, conditions, circumstances, and the environments in which they live, work, and play. These partnerships extend to the development of health information technology, including clinical decision support (CDS). Design of these technologies, however, often occurs without a profound understanding of the true needs, wants, and concerns of patients and family members. Patient perspective is important not only for patient-facing applications but for provider-facing applications, especially those intended to support shared decision-making. Objectives  Our objective is to describe models for effectively engaging patients and caregivers during CDS development and implementation and to inspire CDS developers to partner with patients and caregivers to improve the potential impact of CDS. Methods  This article serves as a case study of how two patient activists successfully implemented models for engaging patients and caregivers in a federal program designed to increase the uptake of research evidence into clinical practice through CDS. Models included virtual focus groups, social media, agile software development, and attention to privacy and cybersecurity. Results  Impact on the federal program has been substantial and has resulted in improved CDS training materials, new prototype CDS applications, prioritization of new functionality and features, and increased engagement of patient and caregiver communities in ongoing projects. Among these opportunities is a group of developers and patient activists dedicated and committed to exploring strategic and operational opportunities to codesign CDS applications. Conclusion  Codesign and implementation of CDS can occur as a partnership among developers, implementers, patients, cybersecurity and privacy activists, and caregivers. Several approaches are viable, and an iterative process is most promising. Additional work is needed to investigate scalability of the approaches explored by this case study and to identify measures of meaningful inclusion of patients/caregivers in CDS projects.     

心肌梗死病人自我功效与健康行为的调查分析

目的　调查和分析心肌梗死病人的自我功效与健康行为。方法　运用Bandura自我功效理论 ,对 6 0例心肌梗死病人的自我功效与健康行为进行描述相关性研究。结果　自我功效与健康行为呈正相关。受教育程度和家庭人均收入与自我功效和健康行为呈正相关。住院次数与自我功效和健康行为呈负相关。结论　在护理实践和教育中重视病人的自我功效对健康行为的促进作用     

Difference in predictors of self efficacy and compliance between diabetic and non diabetic patients who underwent coronary artery bypass surgery

Background: Compared to their non-diabetic peers, diabetic patients who undergo coronary artery bypass surgery (CABG) face greater complications and poorer outcomes. Identifying related risk factors is essential to improving post-CABG outcomes in this vulnerable population. Improving self-efficacy and compliance can further improve patient outcomes over the long term. Purpose: This study compared differences in self-efficacy predictors and compliance between diabetic and non-diabetic patients who received coronary artery bypass surgery. Method: We used a cross-sectional design with convenience sampling. A total of 350 patients were recruited from two medical centers and one teaching hospital. Instruments used included a demographics questionnaire, chronic disease self-efficacy questionnaire and compliance scale. SPSS 17.0 for Windows was used to analyze data. Results: Results found self-efficacy positively associated with compliance in both groups. The non-diabetic group had higher self-efficacy and lower compliance than the diabetic group. In the diabetic group, gender, compliance, education, employment status and marital status were all predictors of self-efficacy, with self-efficacy the single predictor of compliance. In the non-diabetic group, compliance, primary care provider, education, time since surgery, gender and exercise were predictors of self-efficacy. Self-efficacy, primary care provider, employee status prior surgery were all predictors of compliance. Conclusions: Results provide valuable information regarding the impact of diabetes on CABG patient outcomes and differences in predictors of self-efficacy and compliance between diabetic and non-diabetic patients. Healthcare providers can promote healthy behavior and enhance quality of life by providing patient support tailored to their characteristics and considering the factors associated with better self-efficacy vs. compliance.