Client Self-management Research Articles

Perspectives of major traumatic injury survivors on accessibility and quality of rehabilitation services in rural Australia

Purpose For the 30% of Australians who live in rural areas, access to rehabilitation services after sustaining a major traumatic injury can be challenging. This study aimed to explore the experience of rural major traumatic injury survivors accessing rehabilitation services. Materials and methods Semi-structured interviews were conducted with 21 rural major traumatic injury survivors (Mage = 47.86; SD = 11.35; Range: 21–61) who were an average of seven years post-injury (SD = 3.10; Range: 3.25–13.01). Transcribed interviews were thematically analysed. Results Four themes were identified: (1) Managing the transition back to local services, (2) Independence and determination to get better, (3) Rehabilitation is an ongoing process, and (4) Limited service access and quality. While injury-related symptoms persisted for many participants, they expressed strong determination for independence and self-management of their recovery. Barriers to accessing rehabilitation services included poor knowledge of local services, travel burden, financial costs, and a lack of local practitioners experienced in major traumatic injury rehabilitation. Facilitating factors included financial, psychological, community, and informal supports. Conclusions To support recovery, future rural service models should improve consideration of factors resulting from living at a distance to services and harness independence to self-manage. IMPLICATIONS FOR REHABILITATION Rural major traumatic injury survivors need support to navigate numerous barriers to accessing rehabilitation services. Rural participants expressed their preference for greater involvement in planning their transition back home following hospitalisation and help to link with available services in their local area. Specialist training and support for rural rehabilitation practitioners is needed, to effectively treat impairments related to major traumatic injury, particularly psychological and cognitive difficulties. Future service delivery models should incorporate methods to locate rural services; facilitate telehealth access and client self-management; and provide financial and mental health support to both rural survivors of major traumatic injury and their carers.

Exploration of volunteers as health connectors within a multicomponent primary care-based program supporting self-management of diabetes and hypertension.

Volunteers support health and social care worldwide, yet there is little research on integrating these unpaid community members into primary care. 'Health Teams Advancing Patient Experience, Strengthening Quality through Health Connectors for Diabetes Management' (Health TAPESTRY-HC-DM) integrates volunteer 'health connectors' into a community- and primary care-based program supporting client self-management in Hamilton, Canada. Volunteers supported clients through goal setting, motivation, education and connections to community resources and primary care. This study aimed to create and apply a volunteer program evaluation framework to explore: (a) volunteer training effectiveness (learning online content, in-person training, self-efficacy in role tasks, training overall); (b) feasibility of program implementation (process measures, reflections on client encounters, understanding of volunteer roles/responsibilities, client perspectives on volunteer program); and (c) effects of volunteering on volunteers (health outcomes, self-efficacy, value of volunteering). A concurrent triangulation, mixed-methods design was used. Data were collected in 2016, sources included: volunteer online training quizzes, focus groups, self-efficacy survey, Veterans RAND 12-Item (VR-12) survey, in-person training feedback forms and narratives of client visits; client interviews; and quantitative implementation data. Quantitative data analysis included descriptive statistics, paired samples t tests, and effect size (Cohen's d). Qualitative data used descriptive thematic analysis. Nineteen volunteers and 12 clients participated in this evaluation. Findings demonstrate the volunteer program evaluation framework in action. Online training increased knowledge. In-person training received largely positive evaluations. Self-efficacy was high post-training and higher after volunteering. VR-12 sub-scale means increased descriptively. Volunteers understood themselves as healthcare system connectors, feeling fulfilled with their contributions and learning new skills. They identified barriers including not having the resources and skills of healthcare professionals. Clients found volunteers were a major program strength, appreciating their company and regular goals follow-up. Using a volunteer program evaluation framework generated rich and comprehensive data demonstrating the feasibility of bringing volunteers into primary care.

Occupational therapy services and perception of integration of these at primary healthcare level in South Africa

BACKGROUND: Literature indicates that access to rehabilitation services in South Africa is limited. Recent policy documents by the National Department of Health related to disability and rehabilitation propose the integration of occupational therapy services in primary healthcare (PHC). However, the implementation strategies concerning integration are not clear as there is inadequate evidence locally on the occupational therapy service provision in PHC even though there is growing evidence internationally PURPOSE: This study sought to determine the services provided by occupational therapists in PHC and to explore the perceptions of the occupational therapists on the integration of occupational therapy services within the PHC reengineering streams of the National Health Insurance (NHI METHOD: A two-phase explanatory sequential mixed method strategy was utilised in this study. A quantitative survey was sent to members of the occupational therapy professional association and an organisation of professionals providing rehabilitation services in rural communities. Qualitative data were then collected using semi-structured interviews with five therapists who completed the survey FINDINGS: Findings from this study showed there is increasing alignment of occupational therapy services in PHC with the community-based rehabilitation (CBR), the Social Model, the International Classification of Functioning, Disability and Health (ICF), and the Medical Model using client self-management and case-management intervention approaches. The majority of occupational therapists are currently based in district hospitals (42%), community health centres (16%), community organisations (8%), and clinics (8%). Those working in the community indicated they work in a multidisciplinary team (MDT). They also use PHC service delivery models to manage people with disabilities (PWDs). Occupational therapists in PHC have a strong perception of their relevance in the PHC reengineering streams, despite the numerous barriers and few facilitators to the integration of occupational therapy services in the PHC reengineering streams of the NHI CONCLUSION: The perception of the study participants is that occupational therapy service integration in the PHC reengineering streams will lead to improved healthcare. However, they are also of the opinion that integration will not happen without advocacy from occupational therapists or occupational therapy being adequately supported in PHC Key words: Occupational therapy, primary health care re-engineering, integration, National Health Insurance, universal health coverage

Effect of a nurse case management intervention for hypertension self-management in low-income African Americans

Poor health outcomes of chronically ill low-income adults are costly in both fiscal and human terms. One-third of Americans have hypertension and 43%) with high rates of exacerbations and complications [28, 10]. Low-income African American adults face life situations complicated by limited resources, high environmental and social risks, a high burden of stress and limited access to healthcare, all of which contribute to a substantial risk for multiple chronic conditions [10, 11, 19]. These factors may also contribute to a low sense of trust in the healthcare system, low self-efficacy regarding self-management behaviors to control hypertension, poor chronic disease management and costly sequelae [6, 19]. Thus, new intervention models and systems of care that are consumer-driven must be developed to improve outcomes. Client self-management of chronic diseases has emerged as a key factor in improved health outcomes [8]. We tested the effect of an innovative Ecological Nurse Case Management (ENCM) intervention on perceived stress, self-efficacy, self-management behaviors (SMB), and health status of low-income, chronically ill, African American adults. We hypothesized ENCM would reduce stress and increase self-efficacy and positively impact health status. We expected that that clients receiving this intervention would show decreased blood pressure (B/P), body mass index (BMI) and waist circumference (WC).

Home Care Case Managers' Integrated Care of Older Adults With Multiple Chronic Conditions: A Scoping Review.

The purpose of this scoping review was to explore peer-reviewed research and gray literature to examine the extent, range, and nature of available research that describes how home care case managers (HCCMs) provide integrated care for older adults with multiple chronic conditions (MCCs); identify how case management standards of practice correspond with functions of integrated care; identify facilitators and barriers to case management and integrated care delivery; and propose a framework to describe how HCCMs can use case management standards to provide integrated care to older adults with MCCs. Community, home care settings. Scoping review; older adults older than 65 years with MCCs, case managers and health care professionals who provide care for older adults with MCCs. The study findings demonstrated that HCCMs consistently used the case management standards assessment, planning, implementation, and evaluation to provide all professional and clinical integrated care functions, and were least likely to use the standards of identification of client and eligibility for case management and transition to provide professional and clinical integrated care functions. In addition, HCCM use of professional and clinical integrated care functions was inconsistent and varied based on use of case management standards. All case management standards and integrated care functions were found to be both facilitators and barriers, but were more likely to facilitate HCCM work. Interestingly, the standards of assessment, planning, and implementation were more likely to facilitate functional integration, whereas the integrated care functions of intra- and interpartnerships, shared accountability, person centered of care, and engagement for client self-management were more likely to facilitate normative integration. We also found that HCCMs use case management standards and integrated care functions to provide care for older adults with MCCs at the professional (meso) and clinical (micro) levels. Variations in HCCM practice may impact the delivery of case management standards when caring for older adults with MCCs. This has implications for the comprehensiveness and consistency of HCCM practice, as well as interdisciplinary health professional and the client's awareness of the HCCM role when providing integrated care to older adults with MCCs within home settings. The greatest facilitators and barriers to integrated care are those case management standards and clinical and professional integrated care functions that focus on partnerships, collective and shared responsibility and accountability, coordinated person centered of care for clients, and ensuring engagement and partnership in self-management. This indicates the need for development of case management policies and programs that support the work of HCCMs in the delivery of seamless and collaborative case management and integrated care functions that foster collaboration and partnership-building efforts. The development of a new case management and integrated care conceptual framework that includes case management standards, professional and clinical integrated care functions would guide HCCM integrated care practice, policy and research to support client and family-centered care, and foster shared values for sustainable partnerships across care settings.

SELF MANAGEMENT PROGRAM OF CLIENT WITH ARTRITIS LITERATURE REVIEW

Osteoarthritis is a chronic disease that is common in the elderly and may recur and take place so that it can lead to progressive joint destruction during the client does not maintain regular lifestyle. Hence the need for an integrated program such as Self-Management that involves the client in arthritis management, decisions on the handling and treatment, so that the client actively participate in the management of the disease.The purpose of this literature review is to explain to the client's self-management of arthritis based on scientific research journal literature sources related.The method used in the writing of this literature review is surf the internet from Proquest databases, Google Scholar, Medscape and EBSCO using keywords Self-Management of, programs, and arthritis. Data were obtained, systematically arranged and conducted a discussion.Self-Management of the program is an effective way to prevent a decrease in motor activity and physical disability in the elderly, especially the client, so the client can improve the quality of life better. Advanced research related to self-management program on the client arthritis and community-based services can be applied to this program in Indonesia in particular

Navigating Interprofessional Spaces: Experiences of Clients Living with Parkinson’s Disease, Students and Clinical Educators

ABSTRACTWhen students in interprofessional education and practice programmes partner with clients living with a long-term condition, the potential for a better client and educational experience is enhanced when the focus is on client self-management and empowerment. This paper reports the findings from a phenomenological study into the experiences of five clients, six speech language therapy students, eight physiotherapy students, and two clinical educators participating in a university clinic-based interprofessional programme for clients living in the community with Parkinson’s Disease. Collaborative hermeneutic analysis was conducted to interpret the texts from client interviews and student and clinical educator focus groups held immediately after the programme. The overarching narratives emerging from the texts were: “client-centredness”; “who am I/why am I here?”; “understanding interprofessional collaboration and development”; “personal and professional development, awareness of self and others”; “the environment - safety and support”. These narratives and the meanings within them were drawn together to develop a tentative metaphor-based framework of “navigating interprofessional spaces” showing how the narratives and meanings are connected. The framework identifies a temporal journey toward interprofessional collaboration impacted by diverse identities and understandings of self and others, varying expectations and interpretations of the programme, intra- and interpersonal, cultural and contextual spaces, and uncertainty. Shifts in being and doing and uncertainty appear to characterise client-driven, self-management focused interprofessional teamwork for all participants. These findings indicate that students need ongoing opportunities to share explicit understandings of interprofessional teamwork and dispel assumptions, since isolated interprofessional experiences may only begin to address these temporal processes.

Embedding Socio-Behavioral Frameworks in Community Rehabilitation: Evaluation of a Service Change Program

ABSTRACTBackground: Paradigms which emphasize the social determinants of health and client self-management, and approaches which promote health behavior change, are rarely operationalized within rehabilitation settings. The aim of this study was to investigate the processes required for this model of care change within an existing allied health community rehabilitation service. Methods: The service change program consisted of training elements in the areas of the social determinants of health, client self-management and health behavior change techniques as well as associated operational changes to reflect this paradigm shift. Results: The training packages implemented appear to have improved staff knowledge and skills within these socio-behavioral areas. Clinicians self-reported improvement with client care; however, these changes were not reflected in the chart audit. Conclusions: Clinician training is required to build both knowledge and skills in the areas of the social determinants of health, client self-management and health behavior change principles. In addition, clinicians should be equipped with frameworks to assist with operationalizing these principles.

Support workers as agents for health behavior change: An Australian study of the perceptions of clients with complex needs, support workers, and care coordinators

ABSTRACTAn expanding aging population has placed increased demands on health care resources in many countries. Enhancing community aged care support workers’ role to support greater client self-management and reablement is therefore timely. This article presents perceptions of the impact of an Australian practice change initiative designed to enhance knowledge, skills, and confidence of support workers to support behavior change in clients with complex health care needs. A comprehensive training program was delivered in 2013. Methods included thematic analysis of interviews with clients, focus groups with support workers and coordinators, and collection of case studies of client/support worker behavior change interactions. Client, support worker, and coordinator responses were highly positive, reporting improvement in the quality of interactions with clients, client health outcomes, care coordination, communication, and teamwork. Mental health literacy remained the biggest knowledge gap. This research showed that support workers are ideally placed to be more actively involved in motivating clients to achieve behavior change goals.

Five-Year Bibliometric Review of Genomic Nursing Science Research.

This bibliometric review profiles the focus, dissemination, and impact of genomic nursing science articles from 2010 to 2014. Data-based genomic nursing articles by nursing authors and articles by non-nurse principal investigators funded by the National Institute of Nursing Research were categorized into the Genomic Nursing Science Blueprint nursing areas. Bibliometric content analysis was used. A total of 197 articles met the inclusion criteria. Of these, 60.3% were on biologic plausibility, 12.1% on client self-management, 11.1% on decision making or decision support, 8.1% on family, and 4.0% on communication, with the remaining 4.0% of articles focused on other topics. Few (11.6%) addressed healthcare disparities in the study purpose. Thirty-four references (17.2%) were cited 10 or more times. Research-based genomic nursing science articles are in the discovery phase of inquiry. All topics were investigated in more than one country. Healthcare disparities were addressed in few studies. Research findings from interdisciplinary teams were disseminated beyond nursing audiences, with findings addressing biologic discovery, decision making or support, and family being cited most frequently. Gaps in the reviewed articles included cross-cutting themes, ethics, and clinical utility. Interdisciplinary research is needed to document clinical and system outcomes of genomic nursing science implementation in health care. Although the review identifies areas that are encountered in clinical practice, relevance to practice will depend on evaluation of findings and subsequent development of clinical guidelines.

Self-management abilities and quality of life among frail community-dwelling individuals: the role of community nurses in the Netherlands.

The objective of the study was to determine whether community nurses in the Netherlands improve self-management abilities and quality of life of frail community-dwelling people. This longitudinal study was performed in the context of a larger evaluation study of the 'Zichtbare Schakels'(Visible Link) programme, conducted to determine the quality of care provided by community nurses to community-dwelling frail people in Rotterdam, the Netherlands. For the current study, clients seen by community workers in Rotterdam between July 2013 and November 2014 participated. Data were gathered via personal interviews by the community nurses as part of care delivery at the start (T0; n=220) and end of care delivery (T1; n=111 - the remaining 109 clients were still receiving care) to evaluate and improve quality of care. We measured client's quality of life (using the EQ5D), self-management abilities (using the Self-Management Ability Scale) and background characteristics. Results showed that clients seen by the community nurses especially experience problems when it comes to usual activities and pain/discomfort. Furthermore, quality of life was much worse among clients of the community nurses (0.51) than among frail older (aged ≥70years) people in Rotterdam (0.61), Dutch patients with chronic illnesses [CVD (0.83), COPD (0.79) or diabetes (0.83)] and older (aged ≥65years) people who had recently been hospitalised (0.80). Significant improvements were seen in client's self-management and quality of life over time. Self-management abilities at T0 and changes in self-management abilities (T1 - T0) clearly predicted quality of life at T1. Investing in community health nurses may be beneficial for the improvement of self-management abilities and quality of life among very frail people in the community.

Client Self-Management: Promoting Self-Help for Parents of Children in Foster-Care.

Drawing upon Foucault's concepts of power, this article shows how a course given to parents whose children are in foster-care encourages a particular form of self-management—most notably, that their internal dialogues must be altered so that the parents can view themselves as people in control of their behaviour who are in a position to choose new behaviour. The article is based on a qualitative study conducted in Norway and centres on the support and development of participants in the course. Study results show increased self-confidence and self-respect in the participants, both as individuals and as parents. In addition, significant benefits were stated as finding that they could verbalise and describe difficult events and emotions, experiencing being ‘normal’ within a group and receiving feedback. From the perspective of child protective services, dialogue with parents is central, as it not only commits clients to specific behaviours, but—more importantly—commits them to a particular inner dialogue about parenthood. The course can be seen as a management tool in which the parent's ‘self’ becomes the central object, seeking to contradict the conventional conception of parents with children in foster-care as having nothing to contribute to their children's upbringing.

Therapeutic Homework to Support Recovery From Severe Mental Illness

Therapeutic Homework to Support Recovery From Severe Mental Illness

Personal Action Plans: evaluating self-management initiatives in family law

AbstractPersonal Action Plans (PAPs) have been used to encourage client self-management within healthcare services, and are a novel innovation within legal services. This paper examines the use of PAPs by publicly funded family lawyers in England and Wales. It was intended that PAPs were written collaboratively between lawyers and clients in order to assist clients to clarify and resolve issues independently, and aid referrals to other service providers. Whereas self-management initiatives work best when service providers take a client-aligned approach, our research demonstrates that the PAPs were used as a means of managing clients’ expectations. We conclude by suggesting that while PAPs and other forms of self-management tools may work well in healthcare, they have limited potential in the provision of legal services for family law clients.

Implementing a chronic disease strategy in two remote Indigenous Australian settings: A multi‐method pilot evaluation

To test an evaluation framework designed to evaluate implementation of the North Queensland Indigenous communities between August and December 2005. Both communities are located in Cape York, North Queensland. Community A has an estimated population of around 600 people; Community B has an enumerated population of 750, although health centre records indicate a higher number. Process evaluation involved health centre staff in both communities; clinical audits used random samples from the adult population (each sample n = 30); ethnographic fieldwork was conducted with resident population. Health centre scores and qualitative findings using a System Assessment Tool; clinical audits--extent to which scheduled services recorded; selected primary health performance indicators; qualitative ethnographic findings. On almost all indicators, implementation of NQICDS had progressed further in Community A than in Community B; however, some common issues emerged, especially lack of linkages between health centres and other groups, and lack of support for client self-management. The evaluation framework is an effective and acceptable framework for monitoring implementation of the NQICDS at the primary health centre level.

Targeting community-dwelling urinary incontinence sufferers: A multi-disciplinary communitybased model for conservative continence services

This paper presents an argument that there is a need to provide services that target community-dwelling incontinence sufferers, and presents a demonstration case study of a multi-disciplinary, community-based conservative model of service delivery: The Waterworx Model. Rationale for approaches taken, implementation of the model, evaluation and lessons learned are discussed. In this paper community-dwelling sufferers of urinary incontinence are identified as an underserved group, and useful information is provided for those wishing to establish services for them.The Waterworx Model of continence service delivery incorporates three interrelated approaches. Firstly, client access is achieved by using communitybased services via clinic and home visits, creating referral pathways and active promotion of services. Secondly, multi-disciplinary client care is provided by targeting a specific client group, multi-disciplinary assessment, promoting client self-management and developing client knowledge and health literacy. Finally, interdisciplinary collaboration and linkages is facilitated by developing multidisciplinary assessment tools, using interdisciplinary referrals, staff development, multi-disciplinary management and providing professional education.Implementation of the model achieved greater client access, improvement in urinary incontinence and client satisfaction. Our experiences suggest that those suffering urinary incontinence and living in the community are an underserved group and that continence services should be community-focussed, multidisciplinary, generalist in nature.