New measures of diabetes self‐care agency,diabetes self‐efficacy,and diabetes self‐management for insulin‐treated individuals with type 2 diabetes

Aims and objectives. To develop and refine three new scales that measure diabetes self‐care agency, diabetes self‐efficacy and diabetes self‐management to reflect the American Diabetes Association current standards of diabetes care and the American Association of Diabetes Educators self‐care behaviours. And, to establish the clarity, consistency and content validity of the scales. Background. There is a need to have valid and reliable instruments or scales to assess an individual’s diabetes self‐care agency, self‐efficacy and self‐management to plan appropriate interventions that can be effective in improving glycaemic control and delaying or preventing diabetes‐related complications. Design. A methodological design was used to conduct this study. Methods. Ten clinicians and 10 insulin‐treated individuals with type 2 diabetes (T2DM) from a diabetes care center in the southern USA participated in this study. Analysis consisted of inter‐rater agreement to determine clarity and consistency with standards of diabetes care and content validity of individual items on the scales (I‐CVI) and the overall scales (S‐CVI/Ave) to determine relevance for current diabetes care practice. Results. All I‐CVI and S‐CVI/Ave of the DSES exceeded the minimum acceptable criteria. All I‐CVI and the S‐CVI of the DSMS also exceeded the minimum accepted criteria, except for one item that had I‐CVI = 0·70. Evaluation of the items and the directions of the scales by the sample of insulin‐treated individuals with T2DM exceeded the minimum criteria of 80% inter‐rater agreement. Relevance to research and clinical practice. Further psychometric testing of the scales with samples of insulin‐treated individuals with diabetes is warranted and will lay the groundwork for further research and clinical practice to enhance the capability, confidence and actual performance of diabetes self‐management activities among insulin‐treated individuals with T2DM. Conclusions. The scales can be used by diabetes care providers to assess and follow‐up individuals with diabetes who need intense case management. They also can be the measures of choice to conduct future research to test the effects of interventions among insulin‐treated individuals with T2DM.     

A technology‐based information and coaching/support program and self‐efficacy of Asian American breast cancer survivors

Women's self‐efficacy for coping with breast cancer is one of the key factors that lead to successful breast cancer survivorship. Due to the cultural stigma linked to breast cancer (e.g., breast cancer is a genetic disease), Asian Americans are known as a high‐risk group within breast cancer survivors. However, healthcare providers are challenged to promote women's self‐efficacy while considering their cultural beliefs and attitudes. In this study, the efficacy of a technology‐based information and coaching/support program was examined in improving self‐efficacy for coping with breast cancer among Asian American survivors. A randomized repeated measures control group study was conducted with 67 Asian American breast cancer survivors. The questions on background characteristics, the Personal Resource Questionnaire, the Perceived Isolation Scale, the Supportive Care Needs Survey Short Form 34, and the Cancer Behavior Inventory were used. The data were analyzed using repeated measurement analyses, χ² tests, and decision tree analyses. There were significant increases in the self‐efficacy scores of both control and intervention groups over time (p = .017). However, the increase in the control group's self‐efficacy scores was only up to post 1 month, and there was a decrease in the scores by post 3 months. When the participants were divided into high and low‐change groups based on the changes in their self‐efficacy scores for 3 months, the intervention group had more participants who belonged to the high‐change group (p = .036). The technology‐based intervention was effective in improving self‐efficacy for coping with breast cancer among Asian American breast cancer survivors.     

Precision and accuracy of point‐of‐care testing coagulometers used for self‐testing and self‐management of oral anticoagulation therapy

Summary. Background: Oral anticoagulation therapy is monitored by the use of the International Normalized Ratio (INR). Patients who perform self‐testing or self‐management use a point‐of‐care testing (POCT) coagulometer (INR monitor) to estimate their INRs. A precondition for a correct dosage of coumarins is a correct INR estimation, and the method and apparatus used for providing the INR measurements are crucial in this context. Several studies have been published regarding the precision and accuracy of these POCT coagulometers, and have led to diverse conclusions. It is difficult and challenging to perform an overview of the literature, owing to the vast amount of papers, with differences in design, statistical analysis, etc. Objectives: The aim of this systematic review was to analyze the current literature, especially regarding the precision and accuracy of the POCT coagulometers, to provide recommendations for clinical use and quality control, and to point out areas for future research. Methods: We included a total of 22 studies, of which four were characterized as high‐quality studies. Results: The precision of the POCT coagulometers was generally adequate for clinical use. Their performance in terms of accuracy has to be viewed in the context of the inherent inaccuracies of INR measurements. Conclusions: The accuracy of POCT coagulometers seems, in this respect, to be generally acceptable, and they can be used in a clinical setting.     

Concept analysis of self‐mutilation

Title. Concept analysis of self‐mutilation. Aim. This paper is a report of a concept analysis to define and describe self‐mutilation. Background. Although there has been an increased interest in self‐mutilation, as evidenced by recent publication of opinion literature, anecdotal reports and a few clinical studies, the concept has not been well developed to guide nursing research and interventions. Method. Definitions and uses of self‐mutilation were obtained in a comprehensive review of the health, psychology and education literature up to April 2007 to identify the defining attributes, antecedents and consequences. Walker and Avant’s concept analysis strategy was the organizing framework. Findings. Self‐mutilation is the intentional act of tissue destruction with the purpose of shifting overwhelming emotional pain to a more acceptable physical pain. Antecedents of self‐mutilation are impaired coping skills and an unhealthy response to situations that cause unbearable emotional stress. Limited research suggests that risk factors for self‐mutilation may be White race, adolescent age, female sex and history of sexual abuse as a child. Although self‐mutilation allows the individual to gain control over emotions and provides a diversion from emotional pain, a release of endorphins after the physical damage that contributes to the feeling of relief supports an addictive maladaptive coping cycle of pain, relief, shame and self‐hate. Conclusion. The theoretical definition of the concept of self‐mutilation offers the basis for nurses to develop interventions to provide competent care when discovering injuries that are self‐inflicted.