Development Of Self-management Skills Research Articles

فعالية برنامج تدريبى لتنمية مهارات إدارة الذات وأثره على مفهوم الذات الأکاديمى لدى المضطربين انفعاليا من تلاميذ المرحلة الإعدادية

هدفت الدراسة إلى الکشف عن فعالية برنامج لتنمية مهارات إدارة الذات وأثره على مفهوم الذات الأکاديمى لدى المضطربين انفعاليا من تلاميذ المرحلة الإعدادية، وتکونت عينة الدراسة من (30) تلميذة من ذوى الاضطرابات الانفعالية، مقسمة إلى مجموعة تجريبية وتتضمن (15) تلميذة، ومجموعة ضابطة (15) تلميذة. واستخدمت الباحثة الأدوات التالية: مقياس الاضطرابات الانفعالية، مقياس إدارة الذات، مقياس مفهوم الذات الأکاديمى، برنامج تدريبى لتنمية مهارات إدارة الذات. وتوصلت الدراسة إلى النتائج التالية: 1. وجود فروق ذات دلالة إحصائية بين متوسطى رتب درجات المجموعة التجريبية فى القياسين القبلى والبعدى على مقياس إدارة الذات لصالح القياس البعدى. 2. وجود فروق ذات دلالة إحصائية بين متوسطى رتب درجات المجموعة التجريبية ورتب درجات المجموعة الضابطة فى القياس البعدى على مقياس إدارة الذات لصالح المجموعة التجريبية. 3. وجود فروق ذات دلالة إحصائية بين متوسطى رتب درجات المجموعة التجريبية فى القياسيين القبلى والبعدى على مقياس مفهوم الذات الأکاديمى لصالح القياس البعدى. Abstract This study aimed to investigate the effectiveness of training program for developing self-management skills and its impact on academic self-concept of preparatory stage pupils with emotional disorders. The sample of current study consisted of (30) female pupils with emotional disorders in the second grade of preparatory school, divided into two groups: an experimental group which included (15) female pupils, and control group which included (15) female pupils. The study included the following instruments: emotional disorder scale, self-management scale, academic self-concept scale and a training program for developing self-management skills. The results of this study revealed that: 1- There were significant differences between the mean scores of pre and post measurements for experimental group on self-management scale for post measurements. 2- There were statistically significant differences between the mean scores of the experimental group and the control group in the post measurement on the self-management scale for the experimental group. 3- There were significant differences between the mean scores of pre and post measurements for experimental group on academic self-concept scale for post measurements.

Nursing clinical practice changes to improve self-management in chronic obstructive pulmonary disease.

To propose nursing clinical practice changes to improve the development of patient self-management. Chronic obstructive pulmonary disease is one of the main causes of chronic morbidity, loss of quality of life and high mortality rates. Control of the disease's progression, the preservation of autonomy in self-care and maintenance of quality of life are extremely challenging for patients to execute in their daily living. However, there is still little evidence to support nursing clinical practice changes to improve the development of self-management. A participatory action research study was performed in a medicine inpatient department and the outpatient unit of a Portuguese hospital. The sample comprised 52 nurses and 99 patients. For data collection, we used interviews, participant observation and content analysis. The main elements of nursing clinical practice that were identified as a focus for improvement measures were the healthcare model, the organization of healthcare and the documentation of a support decision-making process. The specific guidelines, the provision of material to support decision-making and the optimization of information sharing between professionals positively influenced the change process. This change improved the development of self-management skills related to the awareness of the need for 'change', hope, involvement, knowledge and abilities. The implemented changes have improved health-related behaviours and clinical outcomes. To support self-management development skills, an effective nursing clinical practice change is needed. This study has demonstrated the relevance of a portfolio of techniques and tools to help patients adopt healthy behaviours. The involvement and participation of nurses and patients in the conceptualization, implementation and evaluation of policy change are fundamental issues to improve the quality of nursing care and clinical outcomes.

Pain Catastrophizing and Negative Mood States After Spinal Cord Injury: Transitioning From Inpatient Rehabilitation Into the Community.

We studied pain catastrophizing and negative mood states in adults with SCI. Catastrophizing was higher in those with depression, but only after discharge from hospital into the community. Results provide direction for improving treatment of pain catastrophizing in adults with SCI who are depressive and anxious.

An integrative literature review to examine the provision of self-management support following transient ischaemic attack.

To identify the types of self-management support that have been provided to persons with transient ischaemic attack and the evidence for the effectiveness of these programmes. Self-management is a key element for the effective management of chronic conditions. For persons with transient ischaemic attack, secondary stroke prevention is a recognised standard of care. Best practice guidelines indicate that persons who have experienced transient ischaemic attack should be supported to develop self-management skills. However, it is not clear how best to support the development of these skills. An integrative literature review was conducted. A search was conducted using Medline, Embase, HealthSTAR, CINAHL and PsycINFO. Published quantitative and qualitative studies, abstracts or dissertations describing the provision, experience or outcomes of self-management interventions for people with transient ischaemic attack, and published in English before March 2016, were included. Articles were selected and rated separately by two reviewers. The American Academy for Cerebral Palsy and Developmental Medicine Level of Evidence and Conduct Rating tools were used for rating. Interventions were described and compared, and evidence was presented using the traffic lighting system. Sixteen interventions representing a variety of group- and individual-based interventions were identified. Interventions differed in target population, content, structure, duration and outcomes. Only four interventions were specifically designed for persons with transient ischaemic attack. While evidence to support self-management interventions is promising, there is limited evidence to support any one intervention. However, one good-quality randomised controlled trial supports the provision of a group self-management programme for improving blood pressure control. There are numerous interventions to support self-management by persons with transient ischaemic attack. More research is needed to determine which approaches are most effective. Given the limited evidence to support any one program for persons with TIA, clinicians and programs that provide self-management support should evaluate and monitor outcomes to ensure client needs are being met.

Self-management in young adults with bipolar disorder: Strategies and challenges

BackgroundEarly adoption of effective self-management strategies for bipolar disorder (BD) results in better clinical outcomes and increased quality of life. Therefore, facilitation of these strategies in young adults who are early in their illness course is vital. However, an understanding of self-management practices and needs of young adults with BD is lacking. This study explores young adult’s perspectives of disorder self-management practices and challenges. MethodsYoung adults with BD completed an online survey about disorder management strategies and challenges. Self-management was investigated through self-report and ratings of literature-derived strategies. Results were analysed using descriptive statistics and qualitative thematic analysis. ResultsEighty-nine participants aged 18–30 (M=24.4; SD=3.9) completed the survey. Adherence to treatment, disorder psychoeducation, and sleep-management were the strategies rated most helpful. Six participant-reported self-management strategies were identified (1) Maintaining a healthy lifestyle; (2) Treatment attendance and adherence; (3) Participation in meaningful activities; (4) Engagement with social support; (5) Meditation and relaxation practices; and (6) Symptom monitoring. The most common self-management challenges experienced by young adults concerned the nature of the disorder, interpersonal relationships, and stigma. LimitationsParticipants likely represent a sub-set of young adults engaged with healthcare and therefore may not be representative of the population. ConclusionsStrategies reported vital by those successfully managing their disorder are not adequately utilised by young adults with BD. Both differences in strategy use and perceived self-management challenges represent important areas of clinical support and intervention. This increased understanding will help facilitate self-management skill development in this population.

Parents in transition: Experiences of parents of young people with a liver transplant transferring to adult services.

Predictors of successful transition from pediatric to adult services include ability to self-manage and engage with healthcare services. Parents have a key role in healthcare management throughout childhood and adolescence including encouraging development of self-management skills in their children. Transition to adult services can be challenging for parents and young people, yet parents' views regarding transition remain largely unexplored. Nine parents of pediatric liver transplant recipients (15.2-25.1 yr) participated in semistructured interviews. Interviews were analyzed using IPA. Analysis revealed three key themes: "emotional impact of transplantation," "protection vs. independence," and "ending relationships and changing roles." Parents expressed the dichotomous nature of the desire to promote independence in their child while still maintaining control and protection, and discussed how changing roles and relationships were difficult to navigate. Parents are important facilitators of young people's development of self-management skills for successful transfer to adult services. Parents should be supported to move from a "managerial" to a "supervisory" role during transition to help young people engage independently with the healthcare team. Findings support the development of interventions for parents to emphasize their role in transition and guide the transfer of self-management skills from parent to young person.

Iterative Design and Usability Testing of the Imhere System for Managing Chronic Conditions and Disability.

A novel mobile health platform, Interactive Mobile Health and Rehabilitation (iMHere), is being developed to support wellness and self-management among people with chronic disabilities. The iMHere system currently includes a smartphone app with six modules for use by persons with disabilities and a web portal for use by medical and rehabilitation professionals or other support personnel. Our initial clinical research applying use of this system provides insight into the feasibility of employing iMHere in the development of self-management skills in young adults (ages 18–40 years) with spina bifida (SB) (Dicianno, Fairman, et al., 2015). This article describes the iterative design of the iMHere system including usability testing of both the app modules and clinician portal. Our pilot population of persons with SB fostered the creation of a system appropriate for people with a wide variety of functional abilities and needs. As a result, the system is appropriate for use by persons with various disabilities and chronic conditions, not only SB. In addition, the diversity of professionals and support personnel involved in the care of persons with SB also enabled the design and implementation of the iMHere system to meet the needs of an interdisciplinary team of providers who treat various conditions. The iMHere system has the potential to foster communication and collaboration among members of an interdisciplinary healthcare team, including individuals with chronic conditions and disabilities, for a client-centered approach to support self-management skills.

Self-Management Skills in Chronic Disease Management: What Role Does Health Literacy Have?

Self-management-based interventions can lead to improved health outcomes in people with chronic diseases, and multiple patient characteristics are associated with the development of self-management behaviors. Low health literacy (HL) has been implicated in poorer self-management behaviors and increased costs to health services. However, the mechanisms behind this relationship remain unclear. Therefore, the aim of the current review is to assess the association between HL and patient characteristics related to self-management behaviors (i.e., disease-related knowledge, beliefs, and self-efficacy). The review comprised 3 phases: 1) database searches, 2) eligibility screening, and 3) study quality assessment and strength of evidence. Inclusion criteria specified that a valid HL screening tool was used, that at least one self-management behavior was assessed, and that patients had a chronic condition. An initial search generated a total of 712 articles, of which 31 studies fulfilled the eligibility criteria. A consistent association was found between low HL and poorer disease-related knowledge in respiratory diseases, diabetes, and multiple disease categories. A significant association between low HL and poorer self-efficacy was reported in cardiovascular diseases, diabetes, human immunodeficiency virus, and multiple disease categories. HL was significantly associated with poorer beliefs in respiratory, musculoskeletal, and cardiovascular diseases. The findings from the current review suggest that low HL may affect behaviors necessary for the development of self-management skills. Given that self-management strategies are core components for effective treatment of a range of chronic diseases, low HL poses a considerable health concern. Further research is needed to understand the mediating influence of HL on disease-related knowledge, self-efficacy, and beliefs. From this, HL-sensitive, self-management interventions ought to be devised and implemented.

Potential benefits of integrated COPD management in primary care

Chronic obstructive pulmonary disease (COPD) represents a major and progressive cause of morbidity and mortality worldwide, resulting in an important financial and health burden in coming decades. Pulmonary rehabilitation (PR) has been proven to be the most effective treatment in all patients in whom respiratory symptoms are associated with diminished functional capacity or reduced quality of life. Nevertheless, despite wide recommendation and proven efficacy, the use of PR is limited in daily practice. Reasons for these include low accessibility and availability, high costs, and lack of motivation to continue a healthy life style after treatment. By contrast, it has been demonstrated that primary care patients can be reactivated by formulating personal targets and designing individualized treatment plans in collaboration with their general practitioner or practice nurse. Based on these personal plans and targets, specific education must be provided and development of self management skills should be actively encouraged. Ideally, elements of pulmonary rehabilitation are tailored into a comprehensive primary care integrated disease management program. In that way, the benefits of PR can be extended to a substantially larger part of the COPD population, to reach even those with milder stages of disease. Favorable long-term effects on exercise tolerance and quality of life in a number of studies have been demonstrated in recent years, but broad introduction in the primary care setting still needs further justification in the form of a proper cost effectiveness analysis.

Multidisciplinary Specialty Teams: A Self-Management Program for Patients With Advanced Cancer

Self-management has been shown to be an effective intervention to enable and empower patients with chronic illness to manage their health. Taking Early Action to Manage Self (TEAMS) is such an intervention, providing education and support to patients with advanced solid tumors to develop self-management skills. We conducted a study and surveyed health-care providers about their perceptions of multidisciplinary teams on the outcomes of this TEAMS intervention as well as factors that may influence its adoption into practice. The majority of respondents reported that the TEAMS program was feasible to practice and well suited to their patient population. In this article, the full results of this survey are presented, along with the emerging themes of empowerment and improved communication between patients and providers. In addition, facilitators and barriers to its adoption are explored. Although providers supported the adoption of the TEAMS program, provider resources to implement and maintain it need to be addressed prior to its widespread adoption.

65. Bridging The Gap: A New Model of Transition Care for Young Adults With Serious Chronic Conditions

65. Bridging The Gap: A New Model of Transition Care for Young Adults With Serious Chronic Conditions

Australian Health Professionals’ Attitudes Toward and Frequency of Use of Internet Supported Psychological Interventions

This study sought to gain an understanding of Australian health professionals’ attitudes toward and frequency of use of Internet Supported Psychological Interventions (ISPIs) with clients, and identify the benefits of and challenges in using ISPIs with clients. Eighty-six Australian health professionals completed an online survey. The majority of the sample (69.8%) used ISPIs with clients, but this use was focused on referring clients to self-help and educational web-based interventions, rather than using ISPIs as an adjunct to face-to-face therapy (for example, through video-conferencing sessions). Health professionals with higher perceptions of the usefulness and ease of use of ISPIs had more positive attitudes toward using ISPIs than health professionals with lower perceptions of the usefulness and ease of use of ISPIs. In turn, attitudes toward ISPIs mediated the relationship between perceptions of usefulness and frequency of use of ISPIs. Little experience in using ISPIs, limited knowledge of ISPIs, as well as client barriers to accessing ISPIs were highlighted as challenges in using ISPIs with clients. Benefits of ISPIs highlighted by health professionals included their being a useful adjunct to face-to-face sessions, encouraging clients to develop self-management skills, and reaching clients who might not otherwise engage in therapy. Health professional training in the use of ISPIs with clients could provide experience in and knowledge of the benefits of using ISPIs. This training may facilitate health professionals’ face-to-face work with clients while also help to promote tele-mental health services to clients who might otherwise have difficulty accessing face-to-face services.

Challenges to developing diabetes self-management skills in a low-income sample in North Carolina, USA.

High rates of diabetes diagnosis and poor diabetes outcomes are particularly significant in low-income, socially disadvantaged populations. Although many social and economic predictors of poor self-management outcomes are known, few studies have examined how these elements impact the ability to develop self-management capacities in low-income populations. This article presents new insights into low-income women's challenges and successes to becoming more adept self-managers. Interview data were collected in 2012 with a sample of low-income, middle-age women with type II diabetes recruited from a non-profit medical clinic serving low-income clients in North Carolina, United States. Data were analysed using a grounded theory approach. Developing self-management skills within disadvantaged life contexts involved negotiating three related, overlapping sub-processes: negotiating access to care systems, negotiating disruptions to diabetes self-management patterns, and negotiating self-care knowledge. Developing diabetes self-management skills is a long and arduous process. Data and analysis presented here help explain how disadvantaged life contexts can impact self-managers' efforts to develop self-management skills and why continued support is important for reducing and preventing future problems. These initial findings suggest that future studies and intervention development on the topic are warranted.

Factors associated with superior self-management skills among individuals with epilepsy

PurposeThis study aimed to determine whether the self-management skills of patients with epilepsy are associated with certain demographic, clinical, and psychosocial variables. MethodsA direct survey of 182 patients, including the Epilepsy Self-Management Scale, was conducted. ResultsOn univariate analysis, higher age, the occurrence of convulsions, and the use of religion as a coping mechanism were associated with higher self-management scores. On multiple linear regression, only age and the presence of convulsions remained independently significant. Older individuals employed more medication management skills. Those who experienced convulsions utilized more information management, seizure management, and lifestyle management skills. However, using binary logistic regression, we found that these subscales were not independently significant.The presence of superior self-management skills did not necessarily translate into decreased seizure frequency. ConclusionIndividuals with epilepsy who are older and experience convulsions generally have better self-management skills. This indicates that antecedents influence the development of self-management skills.

Reliability and validity of a novel Haemophilia‐specific Self‐Efficacy Scale

Higher self-efficacy in chronic disease patients is associated with higher development of self-management skills and increased quality-of-life. Quantification and monitoring of self-efficacy is therefore of importance. Self-efficacy in haemophilia patients has received little attention due to lack of standardized scales. To validate the novel Haemophilia-specific Self-Efficacy Scale (HSES) in haemophilia patients on prophylactic home treatment, haemophilia patients aged 1-18years on prophylactic treatment ≥1year were included from three Dutch Haemophilia Treatment Centres. The HSES consists of 12 items, relating to perceptions of the ability to function on a day-to-day basis with regard to patient's disease. Retest was performed in a subsample. Validity was proven by the General Self-Efficacy Scale and by the health-related quality-of-life assessment tool Haemo-QoL. Data were analysed from 53 children (response 75%), with a mean age of 9.8years (SD 4.0). Mean total scale score of HSES was 55.5 (SD 4.7; range 38-60), with a ceiling effect of 17%. The HSES showed adequate internal consistency (Cronbach's alpha 0.72) and good test-retest reliability (Intra-Class-Correlation coefficient 0.75; P<0.01; n=37). The convergent validity was adequate as haemophilia-specific self-efficacy correlated significantly with general self-efficacy (r=0.38; P<0.01). High HSES scores correlated significantly with quality-of-life as measured by the Haemo-QoL (r=-0.42; P≤0.01). The novel HSES is a reliable and valid tool to assess self-efficacy in paediatric haemophilia patients on prophylactic home treatment. High self-efficacy correlated with higher quality-of-life, further underlining the importance to standardly assess, monitor and improve self-efficacy.

‘Getting there’: the impact of structured insulin management education in a high ethnic mix population with type 1 and type 2 diabetes

AbstractStructured education programmes support and enable people with diabetes to develop self‐management skills. Insulin management central to DAFNE is restricted to those with type 1 diabetes of at least six months' duration and on multiple dose regimens. DESMOND is available for all with type 2 diabetes but does not include guidance on how to self‐manage diabetes with insulin.Our aims were to develop an education programme for people with type 1 or 2 diabetes already on insulin and who may be using a variety of insulin regimens, to enable effective self‐management, improve confidence, reduce hypoglycaemia and enable peer group support.An evidence‐based curriculum, developed in line with NICE principles, was piloted. This consisted of three half‐day sessions held during a one‐month period with up to 10 participants and supporters invited to attend. Four further programmes were held; education was tailored to the individual needs of groups and verbal evaluation was undertaken. Anonymised patient satisfaction questionnaires were posted at programme completion. Audit included clinical data, demographics, patient satisfaction and health care professional assessment of content.There were 40 participants over five courses; 20% (n=8) were type 1, 68% (n=27) were male, average age was 58 years (range 35–82 years), and 55% were South Asian (n=22). In 38 of 40 participants where a recorded pre‐ and three months post‐intervention was available, an average HbA1c reduction of 1.18% was achieved – i.e. 9.02% reduced to 7.84% (75.1mmol/mol reduced to 62.2mmol/mol). Twenty‐five participants (62.5%) returned the survey form: 96% (24/25) said diabetes control improved, and all felt more confident to adjust insulin; 96% (23/24) felt more confident to treat ‘hypos’ (one stated ‘hypos’ had not reduced) and 96% (24/25) felt they learned more by attending the programme.This programme met participants' individual needs, increased confidence in insulin management and improved glycaemic control in a high ethnic mix poulation. Copyright © 2014 John Wiley &amp; Sons. Practical Diabetes 2014; 31(2): 54–57

Effective peer-to-peer support for young people with end-stage renal disease: a mixed methods evaluation of Camp COOL.

BackgroundThe Camp COOL programme aims to help young Dutch people with end-stage renal disease (ESRD) develop self-management skills. Fellow patients already treated in adult care (hereafter referred to as ‘buddies’) organise the day-to-day program, run the camp, counsel the attendees, and also participate in the activities. The attendees are young people who still have to transfer to adult care. This study aimed to explore the effects of this specific form of peer-to-peer support on the self-management of young people (16–25 years) with ESRD who participated in Camp COOL (CC) (hereafter referred to as ‘participants’).MethodsA mixed methods research design was employed. Semi-structured interviews (n = 19) with initiators/staff, participants, and healthcare professionals were conducted. These were combined with retrospective and pre-post surveys among participants (n = 62), and observations during two camp weeks.ResultsSelf-reported effects of participants were: increased self-confidence, more disease-related knowledge, feeling capable of being more responsible and open towards others, and daring to stand up for yourself. According to participants, being a buddy or having one positively affected them. Self-efficacy of attendees and independence of buddies increased, while attendees’ sense of social inclusion decreased (measured as domains of health-related quality of life). The buddy role was a pro-active combination of being supervisor, advisor, and leader.ConclusionsCamp COOL allowed young people to support each other in adjusting to everyday life with ESRD. Participating in the camp positively influenced self-management in this group. Peer-to-peer support through buddies was much appreciated. Support from young adults was not only beneficial for adolescent attendees, but also for young adult buddies. Paediatric nephrologists are encouraged to refer patients to CC and to facilitate such initiatives. Together with nephrologists in adult care, they could take on a role in selecting buddies.

SP0158 Assessment and management of SLE in a nurse led clinic

SLE (systemic lupus erythematosus or lupus) is a multi-system auto-immune connective tissue disease of unknown aetiology. Common presenting features include flitting arhralgias usually without erosive damage to joints, erythematous rashes,...

Completeness and Satisfaction with the Education and Information Received by Patients Immediately after Kidney Transplant: A Mixed-Models Study

Self-management is important in ensuring good clinical results in kidney transplant recipients. It was unclear whether the current education program at a single kidney transplant center sufficiently prepares recent transplant recipients for the many complex self-management tasks required. To evaluate the completeness of and the satisfaction with the current inpatient kidney transplant education program and to determine recipients' needs for information in the first months after discharge. We used a concurrent mixed-methods design, including 31 kidney transplant recipients who were assessed via a semistructured interview (qualitative part) and a questionnaire specifically designed for this study, consisting of 30 Likert-type and open-ended questions (quantitative part). Kidney transplant patients reported having received extensive information about medication use after transplant surgery (antirejection medication, 93.5%). Information about healthy lifestyle (physical activity and rehabilitation, 54.8%), return to work (54.8%), and emotional coping (25.8%) was considered suboptimal, although most patients expressed a need for such information. Patients indicated a need for more concrete and practical information, not only during their hospital stay, but also in the long term after transplant. This is the first mixed-models approach showing that our education program immediately after transplant focuses on the transfer of factual knowledge, which seems to insufficiently train patients in developing self-management skills. Updates of our program are warranted to overcome the gaps in the information provided, to provide more practical tips, and to repeat education in the long-term after the transplant surgery, tailored to the patients' needs.

Person-centered psychopathology of schizophrenia: building on Karl Jaspers' understanding of patient's attitude toward his illness.

In this article, building on and extending Jaspers' concept of the "patient's attitude toward his illness" we draw attention to the active role that the person, as a self-interpreting agent engaged in a world shared with other persons, has in interacting with his/her basic disorder and in the shaping of psychopathological syndromes. This person-centered approach helps us to see patients as meaning-making entities rather than passive individuals and their attempt at self-understanding as not necessarily pathological and potentially adaptive. We describe 3 contemporary resources for a person-centered psychopathology: dialectical psychopathology, contemporary approaches to the meanings-causes debate, and value-based practice. Each of these provides a theoretical framework and practical resources for understanding the diversity of schizophrenic phenotypes, including symptom presentation, course, and outcome as a consequence of the different ways people with schizophrenia seek to make sense of the basic changes in self and world experiences. A person-centered approach, in building on patients' individual values and experiences as key aspects of their self-understanding of their psychosis, supports recovery and development of self-management skills.