尿路造口患者自护能力现状及其影响因素分析

目的 调查尿路造口患者出院后自护能力的现状并分析其影响因素,旨在为该类患者自护能力的干预性研究提供依据.方法 于2019年6—9月选取门诊就诊的尿路造口患者为调查对象,采用一般资料调查表、造口自我护理量表-早期版(SSCS-ESV)、中文版造口接受度问卷、自尊量表、社会影响量表(SIS)进行调查.结果 共收回有效问卷1...     

微视频联合行动导向教学法在尿路造口住院患者中的应用

目的探讨微视频联合行动导向教学法在膀胱癌回肠膀胱术后尿路造口住院患者健康教育中的应用效果。方法选取广西壮族自治区某三级甲等医院泌尿外科2018年1月—12月因膀胱癌行回肠膀胱术患者86例,按住院时间先后分为试验组42例和对照组44例。试验组采用微视频联合行动导向教学法的健康教育方案,对照组采取常规健康教育方案。比较两组尿路造口自我护理能力、并发症发生率及健康教育满意度。结果试验组尿路造口自我护理能力为(14.18±3.92)分,明显高于对照组的(9.20±4.60)分;造口周围皮肤炎症发生率为2.4%(1/42),明显低于对照组的18.2%(8/44);健康教育满意度为(91.41±6.47)分,明显高于对照组的(85.25±11.71)分,以上数据比较,差异均有统计学意义(P<0.05)。结论应用微视频联合行动导向教学法实施健康教育能有效提高尿路造口住院患者的自我护理能力,减少造口相关并发症的发生。     

Long-term effects of an intensive-practical diabetes education program on HbA1c and self-care

ObjectiveThe purpose of this study was to implement an intensive and practical diabetes education program (DEP) and evaluate its long-term effects and its impact on psychosocial variables. It was hypothesized that the DEP would improve patients' metabolic control (A1c hemoglobin – HbA1c), technical knowledge, self-efficacy and frequency of self-care and decrease barriers and other parameters such as the body mass index (BMI) and LDL cholesterol. These results should be maintained at one-year follow-up.Design and settingThe sample was composed of 40 patients with diabetes type I who attended a diabetes outpatient clinic. A repeated measures design, considering medical and psychosocial variables at six months and one year, was used.ResultsResults have statistical and clinical implications. They revealed significant changes that were maintained at one-year follow-up in HbA1c, barriers to self-care, frequency of self-care, knowledge about the disease and perceived self-efficacy. The areas of self-care where the fewest changes took place were diet and exercise, which are highly related to cardiovascular risk factors and are very present in patients with diabetes. Specifically, no changes were observed in BMI or LDL cholesterol.ConclusionThe intensive DEP proved to be effective, although specific efforts should be made in certain areas to ensure longer-lasting benefits. Besides, including not only educational but also psychological strategies in patients' education to motivate them to make real lifestyle changes should be a priority in the design of any DEP.     

How do patients develop self-care behaviors to live well with heart failure?: A focus group interview study

BackgroundHeart failure (HF) requires distinctive lifelong self-care behaviors. However, self-care behaviors in the context of HF are poorly understood. Exploring how to develop self-care behaviors among patients with HF can help nurses understand patient perspectives and promote effective patient engagement with self-care for a healthy transition to living well with HF.AimTo explore how patients with HF adhere to self-care and create self-care agency after HF diagnosis by examining their experiences.MethodsFocus group interviews (FGI) were conducted to explore views from patients with HF who attended a cardiology outpatient clinic. Five focus groups (FGs) with a total of 25 participants with a mean age of 66.64 ± 7.97 were interviewed. FGs ranged in size from three to seven individuals. All interviews were recorded, transcribed, and analyzed using a thematic analysis approach.FindingsAnalysis revealed four main themes: (a) Patient perspectives on living with HF; (b) Health information-seeking behaviors; (c) Motivation and readiness regarding HF self-care; and (d) Healthy transitions. This study shows that accepting and understanding HF is an important first step for patients to move forward with managing their disease and living well with HF.ConclusionOur study shows that patients motivate themselves to engage in self-care behaviors when they perceive HF as a chronic disease with an uncertain and unpredictable illness trajectory and gain sufficient health information. Moreover, perceived social support and self-efficacy are essential components in creating HF self-care agency. Healthcare professionals should provide education and social support and encourage patients to adopt self-care behaviors.     

Factors associated with stoma quality of life among stoma patients

BackgroundQuality of life (QOL) concerns in patients with stomas is a globally important health issue. Currently, a lack of understanding into which factors influence QOL post-colostomy hinders the ability of health care professionals to provide appropriate instruction and care needed to improve a patient's QOL.ObjectivesTo determine the level of stoma-specific QOL and to determine which factors associate with stoma-specific QOL among patients with a stoma.MethodsA convenience sample of 76 patients with stomas was recruited from patients who presented to the ward for checkup in a tertiary hospital in Beijing. Quality of life, self-care, and hope were assessed in patients by the Stoma-QOL, stoma self-care agency scale, and Herth Hope Index, respectively. Statistical analyses were performed using Pearson correlation, t-test, and multiple linear regression analysis.ResultsOur stoma-QOL survey demonstrated that stoma patients experienced difficulties functioning in work and social situations, had issues with sexuality and body image, and difficulties with stoma function. Patients expressed concerns related to the stoma itself such as finding privacy to empty the pouch, problems with leakage, and difficulties participating in social activities. Multiple linear regression analysis indicated that self-care agency and hope were the main influencing factors and explained 23.4% of the variance of stoma function and 17.8% of the variance of work/social function.ConclusionQOL in patients with a stoma was not ideal. Our findings demonstrate that following stoma implantation, improvements in self-care and inspiring hope in patients played an important role in bettering their stoma-QOL. The strength of our study is that we adopted a stoma-specific questionnaire instead of a general scale such as EORTC C30.     

A Nonrandomized Pretest Posttest Study on the Impact of an Educational Pain Management Program on Nurses’ Knowledge and Attitudes Regarding Pain in a Middle Eastern Country

BackgroundAlthough nurse's knowledge and attitudes regarding pain management has been sufficiently studied worldwide, the impact of an educational intervention program in improving such attitudes and knowledge has not been likewise researched, especially in Middle Eastern countries.AimsTo examine nurses’ knowledge and attitudes regarding pain at a university hospital in Lebanon before and after the introduction of a pain management educational program. And to assess the relationship between the characteristic of nurses and their pain knowledge.MethodsDesign; A nonrandomized pretest posttest study design was used. Setting; A university hospital in Lebanon. Participants; Included 183 nurses using the Nurses' Knowledge and Attitudes Survey Regarding Pain questionnaire. The pain educational intervention was based on the principles of Ajzen's theory of planned behavior.ResultsA significant difference between the pre and post test scores was noted (p = .016). Questions answered correctly by 80% of participants were related to questions about pain, pain assessment and management, and questions related to medications, such as correct dosages and opioid side effects were not answered correctly by the majority of nurses. There were significant associations between test scores and the nurses’ educational level, their age, and their years of experience. Nurses who worked in critical care units, the emergency department and oncology had higher scores than nurses who worked on general units.ConclusionsDespite the intensive pain education provided at our institution, the pain knowledge of nurses remains below that recommended level which indicates a dire need for more intensive and continuous education in order to provide a pain free environment.     

健康教育路径对提高肠造口病人自我护理能力的效果观察

目的 探讨健康教育路径对提高肠造口病人自我护理能力的效果.方法 将83例肠造口病人随机分为观察组(42例)和对照组(41例,),观察组采用肠造口病人健康教育路径方法,对照组采用随机健康教育方法.结果 两组病人在自我护理能力和满意度的差异均有统计学意义(P<0.05).结论 对肠造口病人采用健康教育路径方法,能提高病人的自我护理能力和满意度.     

早期情景模拟联合微视频在膀胱癌尿流改道术患者健康教育中的应用效果

目的探讨早期情景模拟联合微视频在膀胱癌尿流改道术患者健康教育中的应用效果。方法选取2019年1月至2020年12月因膀胱癌行根治性全膀胱切除及尿流改道术的39例患者为研究对象,分为研究组和对照组。研究组为2020年1月至12月20例患者,采取早期情景模拟联合微视频的健康教育方案;对照组为2019年1月至12月19例患者,采取常规健康教育方案。比较两组患者快速康复的依从性、尿路造口自我护理能力、健康教育的满意度、术后并发症的发生率及15天内返院率。结果研究组患者快速康复的依从性高于对照组(两组完全依从/部分依从/不依从人数分别为:17/3/0、 11/5/3,P<0.05);研究组患者尿路造口自我护理能力评分[(16.9±1.3)分]高于对照组[(11.5±2.4)分](P<0.05);研究组患者对健康教育的满意度评分[(95.0±2.2)分]高于对照组[(81.0±4.0)分](P<0.05);研究组患者术后并发症发生率(2/20)低于对照组(8/19)(P<0.05);研究组患者15天内返院率(2/20)低于对照组(8/19)(P<0.05)。结论早期情...     

Nivel de adaptación de la autoimagen y mecanismos de defensa en ancianos con estoma complicado

ObjectiveOstomy patients face a number of problems that impact negatively on their personal welfare. The aim of this research is determine the nature and intensity of the relationship between the level of self-concept adaptive mode and the consistent use of coping strategies of older adults with a stoma.MethodologyQuantitative, correlational and transversal. VIVEROS 03 and CAPS surveys were applied in 3 hospitals in the City of Durango, México. The study included 90 older adults with an intestinal elimination stoma with complications. Kendall's Tau-b coefficient was the non-parametric test used to measure this association.ResultsMost older adults analyzed (61.3 < % < 79.9) are not completely adapted to the condition of living with an intestinal stoma. There is also a moderate positive correlation (0,569) between the level of adaptation of the older adults with a stoma and the conscious use of coping strategies.ConclusionsThe presence of an intestinal stoma represents a physical and psychological health problem that is reflected in the level of adaptation of the self-image. Elderly people with a stoma use only a small part of defense mechanisms as part of coping process. This limits their ability to face the adversities related to their condition, potentially causing major health complications.     

Self care programs and multiple sclerosis: physical therapeutics treatment - literature review

ObjectiveTo clarify the therapeutic education program impact with multiple sclerosis patients, literature review. Highlight contents and efficacy.MethodA non-systematic review on Medline, PubMed and Cochrane library databases from 1966 to 2010 using the following keywords: “multiple sclerosis”, “self-care”, “self-management” and specific symptoms keywords. Clinical trials and randomized clinical trials, as well as literature reviews published in English, French and German will be analyzed.ResultsCounseling is a part of the non-pharmacological management of chronic illnesses such as multiple sclerosis. Symptoms’ diversity and the different clinical forms limit standardized programs of self-care management, applicable to patients. In the literature review, counseling programs have often low metrology. A behavior change with patients and medical staff could exist. To empower the patient, to reduce symptoms’ impact and to improve treatment access are the aims of educational therapy.ConclusionTherapeutic education program for multiple sclerosis patients could progress with their standardization and assessment, for each sign. To promote the educational therapy of multiple sclerosis patients, a specific training for medical staff, as specific financing are necessary.     

Does a novel teaching approach work? A Students' perspective

BackgroundThere is always a call for educational reform and further research to improve educational programs. The continuous development of new educational approaches is a work in progress. Educational strategies like team-based learning, flipped classroom, and lottery-based token economy, were used to develop a novel teaching approach.AimThis study had two major goals. The first goal was to introduce a novel teaching approach in professional healthcare academies. The second goal was to get an in-depth understanding, from the students' perspective, about the benefits and limitations of this new teaching approach.MethodThe study was conducted using a qualitative, phenomenological research design. Third and fourth-year nursing students completed reflective journals to describe their personal experience with the new teaching approach at the end of the semester. The students' responses were analyzed and coded using Kember's four-category coding schema for reflective writing, to extract themes using thematic analysis.FindingsSeventy-five students completed and returned their reflective journals. The analysis showed various challenges and facilitators/benefits of the students' experiences. The themes that emerged from the analysis were: lack of exposure vs. a sense of achievement; lack of teamwork skills vs. role fulfillment; working with new people vs. conflict resolution; variation vs. collaboration/creativity; time management vs. constructive competition; wasting resources vs. flexibility, and proactivity/active engagement. These themes summarized why the new teaching approach worked and what barriers students faced with the new assembly.ConclusionResults from the current study demonstrated the great potential of the new teaching approach. Recommendations for future research were also discussed.     

What participants learn,with, from and about each other during inter-professional education encounters: A qualitative analysis

BackgroundSafe healthcare requires teamwork and collaboration. To meet the needs of healthcare organizations and professionals, inter-professional education, is no longer an optional educational trend but rather a mandate of accrediting health education agencies.ObjectiveIn an effort to better understand the impact of inter- professional educational activities, this study sought to explore via qualitative methods what nursing and medical students learn with, from, and about one another during a week - long simulation-based inter-profession education course.DesignA convenience sample of post-course survey responses from students participating in a week-long, inter-professional, simulation-based patient safety course was used to longitudinally explore what participants learn with, from, and about each other.SettingsThe setting for this study was a research university located in the southeast United States.ParticipantsThe participants included a total of 272 second semester accelerated option Bachelor of Nursing students and 599 medical students entering the 3rd year of their program that participated in an annual patient safety course. The study analyzed responses of students to questions in a post-course survey regarding educational outcomes while learning with students from a different profession.ResultsIn the responses from 871 students collected over four years, the following key themes emerged. Students: 1) articulated learning the importance of contributions of other professions to the healthcare team, 2) expressed an appreciation for areas where their colleagues' training was superior to their own; and 3) identified deficiencies in their own knowledge and skill sets.ConclusionThe findings of this study provide a basis for developing more specific curricular content as part of inter-professional education endeavors to strengthen constructive views of healthcare professions, foster a more collaborative shared mental model, and to correct perceived misconceptions.     

Study protocol: The Technology-Enhanced Coaching (TEC) program to improve diabetes outcomes – A randomized controlled trial

BackgroundRacial and ethnic minority adults with diabetes living in under-resourced communities face multiple barriers to sustaining self-management behaviors necessary to improve diabetes outcomes. Peer support and decision support tools each have been associated with improved diabetes outcomes.Methods290 primarily African American adults with poor glycemic control were recruited from the Detroit Veteran's Administration Hospital and randomized to Technology-Enhanced Coaching (TEC) or Peer Coaching alone. Participants in both arms were assigned a peer coach trained in autonomy-supportive approaches. Coaches are diabetes patients with prior poor glycemic control who now have good control. Participants met face-to-face initially with their coach to review diabetes education materials and develop an action plan. Educational materials in the TEC arm are delivered via a web-based, educational tool tailored with each participant's personalized health data (iDecide). Over six months, coaches call their assigned participants once a week to provide support for weekly action steps. Data are also collected on an Observational Control group with no contact with study staff. Changes in A1c, blood pressure, other patient-centered outcomes and mediators and moderators of intervention effects will be assessed.Results290 participants were enrolled.DiscussionTailored e-Health tools with educational content may enhance the effectiveness of peer coaching programs to better prepare patients to set self-management goals, identify action plans, and discuss treatment options with their health care providers. The study will provide insights for scalable self-management support programs for diabetes and chronic illnesses that require high levels of sustained patient self-management.     

The Power of nursing: Guiding patients through a journey of uncertainty

PurposeThe objective of this qualitative study was to understand the experiences of oncology nurses in patient counseling and support services in the ambulatory care setting.Methods and sampleA qualitative study was conducted using grounded theory methods. Data were generated through four focus group interviews with 21 oncology nurses currently providing counseling and support services for cancer patients in Japan. The content was analyzed based on a constant comparison approach.ResultsThe power of nursing was identified through three themes: connecting with the patient (shared needs); personalized coordination (shared action); and realizing the patient's potential (reassurance). Oncology nurses should guide patients through the uncertain cancer trajectory by identifying patients' true needs based on an established relationship, providing personalized coordination, and developing their potential. Patient-centered care can be provided in non-physical care settings such as counseling and support services.ConclusionsOur study describes the uniqueness and significance of nursing, and provides insights into realizing the full potential of nurses. This conceptual model can be used as a guide for practice and an educational tool to build professional identity of nurses. Oncology nurses can take a leadership role in enhancing the visibility of the nurses in multidisciplinary environments.     

Activity and Occupational Demands of Type Two Diabetes: The Voice of Mexican-American Older Adults

ABSTRACT

Type two diabetes mellitus has become a worldwide epidemic that directly or indirectly has impacted people everywhere. High incidence of diabetes in older adult Mexican-Americans poses serious, complex issues. Aim: The purpose of the study was to illuminate the cultural perspectives of highly motivated first-generation, bilingual Mexican-American older adults with T2DM, who accepted the activity and occupational demands and chose to follow the diabetes self-care regimen. Method: Emergent themes were extracted from focus groups using a phenomenological approach. Results: Themes were (1) “We had reasons”; (2) “Everyone had a different learning curve.”; (3) “Cultural issues made changing lifestyle difficult”; (4) and “Sharing helps us.” Conclusions: The inquiry revealed the shared perceptions and cultural nuances that may challenge Mexican-American people with diabetes, who try to adapt to lifestyle changes and occupational demands. Culturally-sensitive activity-based interventions that might facilitate self-care mastery were suggested. Future research is needed to facilitate OT reimbursement for self-care at the secondary prevention level.     

The current status of foot self-care knowledge,behaviours, and analysis of influencing factors in patients with type 2 diabetes mellitus in China

PurposeTo investigate the knowledge and behaviours on foot self-care in patients with type 2 diabetes mellitus; analyse the influential factors, and provide information for the intervention study.MethodsA total of 5961 patients with type 2 diabetes mellitus from 144 hospitals in China were included in the study. The investigation content included patients' demographic data, foot self-care knowledge and behaviours. The investigation tools were the questionnaires on the general diabetes information, on the foot self-care knowledge, and on the foot self-care behaviours.ResultsThe foot self-care knowledge was medium and the foot self-care behaviour was poor. The status of knowledge and behaviours were influenced by education, duration of diabetes mellitus, periodic inspection, and education about diabetic complications. Pearson analysis demonstrated that there was positive correlation between knowledge score and behaviour score (r = 0.27, p < 0.001).ConclusionsThe status of foot self-care knowledge and behaviours are not optimistic. According to the patients' own characteristics, the theory of knowledge, attitude and practice applies to encouraging patients to go for periodic inspection and education about diabetic complications so as to enhance the knowledge and promote the self-care behaviours.     

Low literacy self-care management patient education for a multi-lingual heart failure population: Results of a pilot study

PurposeThe purpose of this pilot study was to test the impact of language-free, low literacy self-care management patient education materials in an ethnically diverse multilingual heart failure (HF) population.MethodsA one group pre-test–post-test design measured changes in self-care, knowledge and health-related quality of life (HRQL) after a 1 month intervention using language-free, low literacy self-care management patient education materials and delivered by a health educator.ResultsThe ethnically diverse sample (n = 21) was predominately male (72%), 48% Black, 42% Hispanic, and 28% marginal/inadequate literacy. There were significant improvements in self-care and knowledge but not HRQL.ConclusionsLanguage-free, low literacy self-care patient education may facilitate improved self-care and knowledge in diverse populations who are at risk for poor HF outcomes.