Self-care Autonomy Research Articles

Nursing interventions to promote dyspnea self-management of complex chronic patients: An integrated review

ObjectivesChronic dyspnea, a distressing symptom in patients with complex chronic conditions, is linked to higher risks of mortality. This study aimed to identify nursing interventions that could improve self-management for complex chronic patients, thereby enhancing control over chronic dyspnea. The findings intend to guide nursing care strategies that promote self-management among this population. MethodsWe searched the databases Medline, Scopus, Web of Science, CINAHL, Cochrane Database of Systematic Reviews (CDSR), and Joanna Briggs Institute (JBI) databases were searched in December 2023. We included adult patients with complex chronic conditions with chronic dyspnoea. The team screened articles collaboratively, using Rayyan software. A qualitative appraisal was performed according to JBI Critical Appraisal Checklist tools. The review protocol is registered under the number CRD42023456021. ResultsOur review included 18 studies that explored a variety of interventions for chronic dyspnea. We identified pharmacological interventions (such as oxygen therapy and inhalation treatments) and non-pharmacological approaches (including educational programs, breathing exercises, fluid intake management, body awareness techniques, peer support, emotional intelligence training, and the use of web applications). Those interventions empower patients, improve their ability to fulfill life roles, mitigate emotional distress, and improve overall quality of life. Nursing care can be crucial in enabling individuals to achieve independence and autonomy in self-care. ConclusionsPromoting self-management for chronic dyspnea in complex chronic patients requires a holistic approach, encompassing multidisciplinary interventions, individualized self-care education, peer engagement, and technological support. Current research on self-management inadequately addresses interventions targeting patient behaviour change. It highlights the need to delve deeper into the self-management process. Further research is needed to expand the evidence base and refine these interventions.

Exploring the Health Behaviors of Young Adults Who Are Blind in South Korea

Introduction: Compared to sighted people, not only do people who are blind have multiple comorbidities and exhibit early mortality, but they also display high-risk health behaviors. To prevent problematic health behaviors affecting health-related quality of life and well-being, understanding the shared patterns of health behaviors among individuals with visual impairments, including blindness, is essential. Methods: This qualitative study explored the hidden constructs and patterns of health behaviors among employed young adults who are blind using a multiple case study analysis. Eight participants with self-reported total blindness were recruited via convenience sampling and recruitment postings. Results: The mean age was 27.43 ± 6.32 years with a range of 20–39 years. Seven males and one female completed the one-on-one telephone interviews. The study discovered eight patterns of health behaviors of young adults who are blind: (a) leading a sedentary lifestyle with physical inactivity, (b) eating irregularly and not cooking, (c) avoiding uncertainty and illness, (d) facing disability stigma in health care services, (e) seeking online information related to medical care, (f) sharing health-related information within the blind community, (g) receiving unreadable formats of health-related information, and (h) aiming for independence and autonomy in self-care. The following categorized health behavior constructs were extracted: perceived health problems, experiential attitude toward health care systems, health beliefs, perceived facilitators, and barriers. Discussion: The findings indicate that young adults who are blind prefer independent health-related activities. The identified problematic health behaviors were correlated to inaccessible healthcare resources. Implications for Practitioners: More accessible health resources enhancing the independence of young adults who are blind are needed to promote their health behaviors. For instance, more accessible fitness facilities and personalized exercise programs in workplaces and communities can motivate the physical activity of young adults who are blind.

Social connectedness and supported self-management of early medication abortion in the UK: experiences from the COVID-19 pandemic and learning for the future

Medication abortion has been established globally as safe and effective. This modality has increased accessibility and the opportunity to centre individual autonomy at the heart of abortion care, by facilitating self-managed abortion. Previous research has shown how self-managed abortion is beneficial in myriad settings ranging from problematic to (relatively) unproblematic contexts of access. In this paper we explore the relationship between self-management and sources of support (including health professionals, family, and friends); as well as considering issues of reproductive control and autonomy. Drawing on qualitative, experience-centred interviews, we utilise the concept of social connectedness to examine how supported self-managed abortion was experienced in the United Kingdom during the COVID-19 pandemic. Overall, self-management was welcomed, with participants speaking positively about managing their own abortion at home. However, a sense of connectedness was crucial in helping participants deal with difficult experiences; and functioned to support individual autonomy in self-care. This paper is the first to examine factors of connection, support, and isolation, as experienced by those undergoing self-managed abortion in the UK in detail. Our research suggests a continued need to advocate for high quality support for self-managed abortion, as well as for choice of abortion method, to support patient-centered care.

Older person’s experience of PT4Ageing—A programme on self-management «support» in chronic illness

ObjectiveThis study sought to describe the experience of a group of older adults who participated in a chronic illness self-management program. MethodsThe study employed a qualitative phenomenological approach. Participants were eight elders and data collected using semi-structured interviews Data was analysed using thematic analysis. ResultsFive themes emerged from the analysis: (1) Tips to improve our daily lives, (2) I was always motivated, (3) Sharing and mutual help, (4) They made us believe we were capable (5). It would be great if it did not end here. Globally, the participants of the program described their experience as very positive. They identified gains from participating in the program, such as learning strategies to help them cope with their health problems, improving their ability to manage their illnesses more autonomously and building social support, that even persisted after the conclusion of the intervention. ConclusionThe findings of this study provide insight into how older adults experience a program for the self-management of chronic illness. For the development of future programs, support building must be considered. Older adults who participate in self-management programmes exhibit improved self-efficacy in relation to the management their chronic illnesses and greater autonomy in self-care.

Child self-care autonomy in health (scale for parents): development, internal structure, and sex/age correlates.

Autonomy in self-care practices in the health sphere is a critical characteristic for the survival of humans throughout the life span. Notably, however, the current literature lacks psychometrically sound instruments that measure this phenomenon among children without diagnosed chronic health conditions. The purpose of the present exploratory study was to develop, test, and provide data regarding the reliability and validity of the Child Self-Care Autonomy in Health (CSAH) scale. The piloted version of the CSAH yielded an 11-item instrument designed to reflect the parent's perspective in measuring the extent of autonomy in self-care actions related to health for a child, whether diagnosed with a chronic illness or not. Data were collected through an online survey of a non-random sample of Russian-speaking parents currently residing in Russia (N = 349). The analysis focused on scale structure via principal component analysis and age/sex associations. The proposed CSAH may be of interest to social workers, health professionals, and parents seeking to ascertain schoolers' autonomy in self-care practices in the health sphere and support building a stronger self-care mindset.

Acceptability of Mobile App-Based Motivational Interviewing and Preferences for App Features to Support Self-Management in Patients With Type 2 Diabetes: Qualitative Study.

Patients with type 2 diabetes mellitus (T2DM) experience multiple barriers to improving self-management. Evidence suggests that motivational interviewing (MI), a patient-centered communication method, can address patient barriers and promote healthy behavior. Despite the value of MI, existing MI studies predominantly used face-to-face or phone-based interventions. With the growing adoption of smartphones, automated MI techniques powered by artificial intelligence on mobile devices may offer effective motivational support to patients with T2DM. This study aimed to explore the perspectives of patients with T2DM on the acceptability of app-based MI in routine health care and collect their feedback on specific MI module features to inform our future intervention. We conducted semistructured interviews with patients with T2DM, recruited from public primary care clinics. All interviews were audio recorded and transcribed verbatim. Thematic analysis was conducted using NVivo. In total, 33 patients with T2DM participated in the study. Participants saw MI as a mental reminder to increase motivation and a complementary care model conducive to self-reflection and behavior change. Yet, there was a sense of reluctance, mainly stemming from potential compromise of autonomy in self-care by the introduction of MI. Some participants felt confident in their ability to manage conditions independently, while others reported already making changes and preferred self-management at their own pace. Compared with in-person MI, app-based MI was viewed as offering a more relaxed atmosphere for open sharing without being judged by health care providers. However, participants questioned the lack of human touch, which could potentially undermine a patient-provider therapeutic relationship. To sustain motivation, participants suggested more features of an ongoing supportive nature such as the visualization of milestones, gamified challenges and incremental rewards according to achievements, tailored multimedia resources based on goals, and conversational tools that are interactive and empathic. Our findings suggest the need for a hybrid model of intervention involving both app-based automated MI and human coaching. Patient feedback on specific app features will be incorporated into the module development and tested in a randomized controlled trial.

Penguatan Positif untuk meningkatkan rawat diri pada anak Autism Spectrum Disorder

Individuals with autistic disorders need to always be trained in terms of self-care by themselves. The purpose of this study was to increase self-care autonomy in children with autism, namely bathing, dressing and brushing their teeth. This research uses a qualitative case study approach with one subject. Collecting data using interview, observation and The Childhood Autism Spectrum Test (CAST). The intervention was carried out using the positive reinforcement method with reinforcements in the form of hugs and praise. The intervention was carried out in five sessions. The results of the intervention showed an increase in self-care skills in the form of bathing, dressing and brushing teeth. Thus it can be said that the positive reinforcement method can improve self-care autonomy in children with autism spectrum disorder.

Loss of speech and functional impairment in Alzheimer's disease-related primary progressive aphasia: predictive factors of decline

We aimed to identify features associated with different disease trajectories in Alzheimer's disease (AD)-related primary progressive aphasia (PPA). We considered 23 patients diagnosed with AD-related PPA. All patients underwent neuropsychological evaluation, 18F-Fluorodeoxyglucose-PET brain scan, CSF biomarkers measurement and APOE genotype analysis at baseline and underwent neurological follow-up for a mean time of 3 years. Patients who progressed to total loss of speech (TLoS+) had greater impairment in writing and higher t-tau concentration as compared to TLoS– patients. Patients who progressed to loss of functional autonomy (LoFA+) had greater impairment in single-word comprehension as compared to patients who maintained autonomy in self-care. Furthermore, 18F-FDG-PET SPM analyses revealed different brain metabolic patterns between TLoS+ and TLoS– and between LoFA+ and LoFA–. In conclusion, linguistic profile, CSF t-tau and brain metabolic pattern might be useful tools to predict progression to total loss of speech and loss of functional autonomy in AD-related PPA patients.

Measures of Participation in Persons With Musculoskeletal Conditions.

Measures of Participation in Persons With Musculoskeletal Conditions.

Relationship between pressure ulcer risk based on Norton Scale and on the "Eating/Drinking" need assessment.

To study the relationship between pressure ulcer risk evaluated by the Norton Scale and inadequate fulfilment of Need 2 (Eating/Drinking) from the 14-need classification designed by Virginia Henderson. Assessing nutritional status and skin condition to implement preventive measures are important nursing interventions. Our hospital's standard procedure requires recording Norton Scale and Henderson Eating/Drinking Assessment results. This was a descriptive cross-sectional study, analysing case histories of 219 patients in medical/surgical wards for >24hr with nursing care recorded in the GACELA Care computer application. Patient sociodemographic variables and evaluation concepts from the Norton Scale and Eating/Drinking were studied. A statistically significant relationship (p<0.05; 95% CI: 0.61, 2.83) was seen between inadequate Eating/Drinking need fulfilment and increased pressure ulcer risk. Pressure ulcer risk was generally low in the sample, with mainly no or minimum risk (77.3%); the oldest age group had the highest risk. Self-care autonomy was the most frequently assessed item in Eating/Drinking (42%). A relationship was found between Norton Scale risk results and Eating/Drinking need assessment results. The greater the pressure ulcer risk, the more likely was inadequate need satisfaction (poor nutritional status). To help identify pressure ulcer risk, nurses should assess patients' eating independence. Safeguarding nutritional status and preventing pressure ulcers are nursing skills associated with quality nursing care.

Terapia por caixa de espelho e autonomia no autocuidado após acidente vascular cerebral: programa de intervenção

Terapia por caixa de espelho e autonomia no autocuidado após acidente vascular cerebral: programa de intervenção

MAIN CAREGIVER’S EXPERIENCE IN MEETING SELF-CARE NEEDS AMONG ADOLESCENTS WITH ASD IN PONTIANAK MUNICIPALITY, WEST BORNEO, INDONESIA: A QUALITATIVE STUDY

Background: Autism spectrum disorder (ASD) is a complex developmental disorder, increasing in number, faster than that of other developmental disorders in the world. This complex disorder affects a child’s self-autonomy, which is important for individual self-care.Objective : This study is to explore main caregivers’ experience to meet self-care needs among adolescents with ASD in Pontianak, West Borneo, Indonesia.Methods: Qualitative semi-structured in-depth interviews were done with 7 main caregivers that have lived together and taken care of the adolescents with ASD in Pontianak Municipality, West Borneo Province. Sampling was taken with purposive sampling (maximum variation). Source (interviews) and method (observations of self-care activities and documents like photos, learning reports and field notes) triangulations were taken on 1 participant and 7 autistic adolescents. Participants’ statements were recorded by using a voice recorder, and then transcribed, coded, interpreted, and categorized in order that sub-topics and main topics could be formed.Results: The study identified five main topics: i.e., 1) Autonomy in self-care; 2) Care effort; 3) Feelings, support, and expectations. Three findings of the study emphasize the potentials of children with autism to be autonomous in daily self-care.Conclusions: Adolescents with ASD can potentially meet the needs of their daily care independently.

Participatory action research: A strategy for improving self-care management in chronic obstructive pulmonary disease patients

Participatory action research (PAR) facilitates the change process in clinical practice and promotes knowledge development. This paper highlights the potential of PAR to implement changes in healthcare oriented for the development of self-care management skills in patients with chronic obstructive pulmonary disease (COPD). In COPD patients, the preservation of self-care autonomy and quality of life depends on the patients’ ability to adopt pharmacological treatments and behavioural changes. In a Portuguese central hospital nurses ( n = 52) have identified a gap between the nursing care and the perceived needs of the patients, and developed a healthcare solution based on a PAR methodology supported by an overlapping cycle of action and research. The PAR took place during 14 months. The PAR allowed the change in the care model in use, in the organization and the nursing care documentation. This change was focused on the development of self-care management skills, responding to the needs and expectations of those involved. The PAR proved to be an appropriate methodology to identify and implement changes that contribute to the safety, quality and access to healthcare.

Duodenopancreatectomía con técnica de Whipple

A 76-year-old woman underwent surgery for a suspected ampulloma. During admission, an extensive nursing care plan was designed due to the complexity of the intervention, the multiple devices required for the patient’s recovery and the psychological impact on the patient and her family produced by uncertainty about the cause of her disease until the results of pathological analysis became known. The nursing care process developed according to Virginia Henderson’s model was applied with problems of collaboration, nursing diagnoses and risk diagnoses, using the NANDA taxonomy. At discharge, the planned objectives had been achieved: progressive withdrawal of the distinct devices for a satisfactory outcome, autonomy in self-care of basic needs and collaboration of the family, who lost their fear of managing the situation.

Self-Care Autonomy and Outcomes of Intensive Therapy or Usual Care in Youth with Type 1 Diabetes

This article evaluated whether deviation from developmentally appropriate self-care autonomy moderated the effects of intensive therapy (IT) or usual care (UC) on glycosylated hemoglobin (HbA(1C)) in 142 youths with diabetes. Youths received an autonomy/maturity ratio (AMR) score at baseline that was a ratio of standardized scores on measures of self-care autonomy to standardized scores on measures of psychological maturity and were categorized by tertile split into low, moderate, and high AMR. Higher baseline AMR was associated with higher baseline HbA(1C) for IT and UC. Baseline AMR scores predicted glycemic outcomes from UC; the high AMR tertile showed deteriorating glycemic control over time, whereas the low AMR tertile maintained better glycemic control. All three AMR groups derived equal glycemic benefit from IT. Children with inordinate diabetes self-care autonomy may fare poorly in UC but these same children may realize less glycemic deterioration during IT.

Measuring self-care independence in children with cystic fibrosis: the Self-Care Independence Scale (SCIS).

We describe the development and psychometric properties of a survey tool designed to evaluate children's level of independence in their cystic fibrosis (CF) treatment. Children's self-care autonomy is important to measure and may have a direct effect on children's active involvement in their treatment and their adherence. Existing instruments that evaluate children's independence in their CF treatment fail to yield practical information that can help research and patient management. The Self-Care Independence Scale (SCIS) is a 44-item questionnaire that is completed by parents. The SCIS was completed by the parents of 76 patients with CF (ages 4-17 years). Youths completed two structured interviews, which screened patients for average or higher cognitive functioning (an inclusion criterion) and measured their CF treatment knowledge. Parents completed two other self-report questionnaires. Results indicated that the SCIS has acceptable internal consistency and good test-retest reliability. The construct validity of the SCIS was supported by positive correlations between patient age, number of years since diagnosis, and SCIS total scores. The concurrent validity of the SCIS was supported by correlations between a measure of nonillness-specific dependence and a measure of patient self-care knowledge. Children's SCIS total scores per age group are presented. This study supports the SCIS as a psychometrically sound measure of self-care independence in CF. This measure has several uses. For example, the SCIS may be a screening tool for adolescents who are preparing to transition to adult CF centers and who will need to assume more independence in their self-care. The SCIS may also be used to evaluate educational programs that promote self-care knowledge and skill in children with CF.

The development of a handicap assessment questionnaire: the Impact on Participation and Autonomy (IPA).

To report on the feasibility and psychometric properties in terms of homogeneity and construct validity of a newly developed handicap questionnaire focusing on person-perceived handicaps: the Impact on Participation and Autonomy (IPA). Cross-sectional. SETTING, subjects and outcome measure: One hundred consecutive individuals from the outpatient clinic of the department of rehabilitation of an academic hospital administered the new questionnaire IPA. The results show good homogeneity and construct validity of the IPA. Factor analysis showed that the scale consists of four factors, explaining 68% of the total variance: social relationships, autonomy in self-care, mobility and leisure, and family role. Homogeneity of the four subscales was considered good, Cronbach's alpha ranged from 0.84 (family role) to 0.87 (social relationships). Feasibility in terms of the number of missing values and administration time needed was satisfactory. The first results suggest that the IPA promises to be a useful handicap questionnaire. Further research is needed to establish test-retest reliability, convergent validity and responsiveness to change.