Patient Self-care Management Research Articles

Motivational Interviewing: Improving Confidence With Self-care Management in Postoperative Thoracolumbar Spine Patients.

Motivational Interviewing: Improving Confidence With Self-care Management in Postoperative Thoracolumbar Spine Patients.

Abstract WP493: Benefit of an Advanced Practice Nurse-Led Stroke Telemonitoring Program

Introduction: Hypertension (HTN) remains the leading modifiable risk factor for stroke. Recently updated guidelines from the American Heart Association support a blood pressure (BP) goal of ≤ 130/80 mmHg and home blood pressure monitoring (Benjamin et al., 2017). The purpose of this evidence-based practice change project was to implement a new home blood pressure telemonitoring (HBPT) program for stroke patients with HTN, promote self-care management and reduce secondary stroke risk. Methods: An advanced practice nurse (APN) led 16-week HBPT pilot project was implemented to monitor blood pressure (hospital admission, discharge, 7-days HBPT and 30-days post discharge) and perception of the HBPT experience. Eligibility for HBPT was determined by the stroke team in collaboration with case management. Home care nurses assured home delivery of the HBPT device and educated the patient/family on device management. Daily readings were transmitted to the home care dashboard and monitored for alerts. Patients returned to the stroke office 30-days post discharge for evaluation of BP and HBPT experience. Results: Sixteen out of 112 patients were eligible for HBPT. The mean age was 71 years-old; 54% males; 55% females. Stroke types included 67% ischemic and 33% hemorrhagic. A significant change (improvement) in BP was noted from: admission to discharge (P = 0.007) and admission to 30-days post-discharge (P < 0.001). All patients achieved target BP at discharge and 30-day post-discharge. All patients reported a positive HBPT experience. Conclusion: An HBPT program can be beneficial in promoting secondary stroke risk reduction and enhancing patient self-care management skills.

Psychological Insulin Resistance and Low Self-efficacy as Barriers to Diabetes Self-care Management in Patients with Type 2 Diabetes

Psychological Insulin Resistance and Low Self-efficacy as Barriers to Diabetes Self-care Management in Patients with Type 2 Diabetes

Health-Related Quality of Life and Self-Care Management Among People With Diabetic Foot Ulcers in Northern Thailand.

Diabetic foot ulcers (DFUs) are a common complication of diabetes that impacts on the health-related quality of life (HRQOL). Foot care is an important factor in the self-care management of patients with DFUs. The objective of this study was to investigate the HRQOL and foot care management of people with DFUs. A cross-sectional study involving 41 people with DFUs was conducted at a large tertiary hospital in Northern Thailand. The Diabetic Foot Ulcer Scale-Short Form and the VA-Diabetes Foot Care Survey were used to assess the HRQOL and foot care management among people with DFUs. The majority of the participants were female (n = 24, 58.5%), and the mean age was 62.13 years. The scores for HRQOL in the six domains were as follows: leisure (66.95 ± 28.03), physical health (68.93 ± 28.51), dependence or daily life (80.08 ± 25.23), negative emotions (71.23 ± 29.48), worried about ulcers (62.20 ± 31.97), and bothered by ulcer care (69.36 ± 25.20). High scores indicate a high (good) HRQOL. Less than a third of the participants reported that they had received education about foot care management. Almost all participants reported that they washed their feet daily; however, a large proportion did not test the water temperature or use lubricants on their feet. Most of the participants did not have a mirror for checking under their feet (48.8%), and there was a lack of knowledge about how to use a mirror for foot inspections (51.2%). This study provides guidance for clinicians on the content and delivery of diabetes education programs for people with diabetes (and DFUs) in Northern Thailand. The findings provide guidance on existing knowledge and the need for programs to address barriers to foot self-care management both in terms of skills and attitudes.

Self Care Management Pasien Hemodialisa Ditinjau Dari Dukungan Keluarga Di Rsud Dr.Soetomo Surabaya

Self care management in patients with chronic renal failure who undergoing hemodialysis is a positive effort of patients to find and participate in their health services to optimize health, prevent complications, control symptoms, develop medical resources, minimize disturbance in diseases that can interfere with life. Family support is very important in the care of hemodialysis patients. The purpose of this study is to analyze the relationship of family support with self-care management of hemodialysis patients. The research method used analytic description with cross sectional approach. The population involved in this study were patients in the hemodialysis room of RSUD Dr.Soetomo Surabaya, with a sample size of 52 respondents, using consecutive sampling. Independent variable in this research is family support and dependent variable is self care management. Data collection using a family support questionnaire and modified hemodialysis patient self care measurement scale. Data were analyzed using spearman rho, with significant level p less than 0,05. The results showed that family support affects the self-care management of hemodialysis patients (p = 0.01). Family support affects the self-care management of hemodialysis patients in the hemodialysis chamber of Dr.Soetomo Hospital Surabaya. The importance of family support is necessary in treating hemodialysis patients for self-care management including monitoring of diet, stress management, safe diet, exercise, good habits, shunt care, diet therapy and observation of care instructions.

A 3-State Analysis of Black-White Disparities in Diabetes Hospitalizations Among Medicaid Beneficiaries.

Introduction:Although diabetes is one of the leading chronic disease in the country, efforts in primary care and patient self-care management could prevent most of the diabetes-related hospitalizations and produce cost savings and improvements in quality of life. We used information from Medicaid beneficiaries in 3 states to predict racial differences in diabetes hospitalizations and demonstrate how they vary across states.Methods:We conducted a cross-sectional study to examine differences between black and white patients with diabetes hospitalizations. Information was obtained from the Medicaid Analytic eXtract files. We used multiple logistic regression models to assess the significance of the differences.Results:Analysis included 10 073 adult Medicaid recipients from the states of Mississippi (51%), Georgia (35%), and Michigan (14%). Blacks were more likely to experience longer hospital stays in Georgia (odds ratio [OR] = 1.040; 95% confidence interval [CI]: 1.03-1.06) and Mississippi (OR = 1.048; 95% CI: 1.03-1.07). A majority of patients in both groups were likely to be discharged to their homes for self-care. Black patients had lower odds of repeated stays in Georgia (OR = 0.670; 95% CI: 0.54-0.84), but higher odds in Michigan (OR = 1.580; 95% CI: 1.12-2.24). Similar differences occurred when patients were matched by age and sex. Blacks had lower odds of qualifying for dual Medicare–Medicaid enrollment benefit in Georgia and Mississippi.Conclusion:Racial differences in diabetes-related hospitalizations reflect possible inefficiencies in the process of care. Identification of race-specific factors for hospitalizations and implementation of primary care strategies that support effective self-management skills would aid in reducing diabetes hospitalizations and related disparities.

Relationship Between Proactive Coping and Self-Care Management in Patient with Pulmonary Tuberculosis

Introduction: Patient with pulmonary tuberculosis not only experience physical problems but also face psychosocial problems and it can get worse during the treatment phase that gives impact on patients’ self-care. In order to prevent further impacts on patients, proactive coping is needed. This study was aimed to identify the relationship between proactive coping and self-care management in pulmonary tuberculosis patients.Methods: This study was a cross-sectional research. As many as 105 respondents taken with consecutive sampling technique. The inclusion criteria of respondent were pulmonary tuberculosis patients both in intensive and continuous phase. This research was conducted in three primary public health care center in Surabaya, East Java, Indonesia. The variables were proactive coping that was measured by Proactive Coping Inventory (PCI) and self-care management that was measured by Self-care Management questionnaire. The data was analyzed using Spearman test.Results: This study showed that proactive coping had a positive correlation with self-care management in patients with pulmonary tuberculosis (p= 0.000; r= 0,848).Conclusion: This study shows a strong correlation between the variables, whereas the higher the level of proactive coping, the better the self-care management in pulmonary tuberculosis patients. Further research can find out the factors that influence the proactive coping in pulmonary tuberculosis patients thus can improve the self-care behavior.

Caregiver determinants of patient clinical event risk in heart failure.

Preventing hospitalization and improving event-free survival are primary goals of heart failure (HF) treatment according to current European Society of Cardiology guidelines; however, substantial uncertainty remains in our ability to predict risk and improve outcomes. Although caregivers often assist patients to manage their HF, little is known about their influence on clinical outcomes. To quantify the influence of patient and caregiver characteristics on patient clinical event risk in HF. This was a secondary analysis of data using a sample of Italian adults with HF and their informal caregivers ( n = 183 patient-caregiver dyads). HF patients were followed over 12 months for the following clinical events: hospitalization for HF, emergency room visit for HF or all-cause mortality. Influence of baseline caregiver- and patient-level factors (patient and caregiver age; dyad relationship type; patient New York Heart Association (NYHA) Class, cognition, and comorbidities; and caregiver strain, mental health status, and contributions to HF self-care) on patient risk of death or hospitalization/emergency room use was quantified using Cox proportional hazards regression. Over the course of follow up, 32.8% of patients died, 19.7% were hospitalized for HF and 10.4% visited the emergency room. Higher caregiver strain, better caregiver mental health status and greater caregiver contributions to HF self-care maintenance were associated with significantly better event-free survival. Worse patient functional class and greater caregiver contributions to patient self-care management were associated with significantly worse patient event-free survival. Considering caregiving factors together with patient factors significantly increases our understanding of patient clinical event risk in HF.

Effect of Self Care Management on Nursing-Sensitive Patients’ Outcomes after Permanent Pacemaker Implantation

Background: Patients undergoing permanent implantable pacemaker, challenge with multiple physical, psychological and social complications. The patients may perceive the pacemaker device as an electronic security or as a source of physical, psychosocial and emotional discomfort. So self-care management for those patients and measuring nursing sensitive patient's outcomes will lead to improve their life and overcome physical, social and psychological problems. Aim of the study: This study was aiming to evaluate the effect of self-care management on nursing sensitive patients' outcomes after permanent pacemaker implantation. Study design: A quasi experimental design was utilized to meet the aim of the study. Subject: A Purposive sample included 50 patients after permanent pacemaker implantation which divided into two equal matched groups' (study and control groups).Setting: The study was conducted at the cardiac Catheterization unit at Ain Shams University Hospital. Data collection tools:1) Patient's socio-demographic characteristics sheet, 2) Patient's clinical data sheet, 3) Self-care management level assessment sheet, 4) Patients’ self-care practice observational checklists, and 5) Nursing Sensitive patient Outcomes Measuring Scales. Results: The present study revealed that satisfactory level of self-care knowledge, practice and the different levels of Nursing Sensitive patient Outcomes of patients in the study group were improved post implementation of self-care guidelines compared to control group and to pre implementation of self-care guidelines. Conclusion: Implementation of self-care management guidelines has positive effect on improving patient's self-care management level and enhancing all dimensions of nursing sensitive patients' outcomes (physiological health outcomes, functional health outcomes, psychosocial outcomes, health knowledge and behaviors and family health outcomes. Recommendations Generalize using nursing sensitive patient's outcomes based on (NOC) to provide more comprehensive standardized information on patient, family, and community outcomes that result from nursing interventions. Self-care management guidelines for patients after permanent pacemaker implantation should be applied in all cardiac catheterization units and should be updated periodically to enhance self-care management for those patients based on NOC.

Views of patient, healthcare professionals and administrative staff on flow of information and collaboration in a regional health information exchange: a qualitative study.

Nowadays, patients can be more involved in developing healthcare services with their healthcare professionals. Patient-centred information is a key part of improving regional health information exchange (HIE), giving patients an active role in care management. The aim was to get a deeper understanding of the flow of information and collaboration in one hospital district area from the viewpoint of patients, healthcare professionals and administrative staff. The data were collected by themed interviews and analysed using both deductive and inductive content analyses. The interview themes were the flow of information and collaboration after 5 years of HIE usage in one hospital district area in Finland. Health information exchange usage had changed the regional flow of information after the 5-year period. The patients were satisfied that their primary care physician was able to access their special care information. The experiences of healthcare professionals and administrative staff also showed that information availability and information exchange had improved regionally. HIE usage was also found to have improved regional collaboration between different organisations in patient health care. It was recognised that patients had taken on more responsibility for transferring their follow-up treatment information. Healthcare information exchange between professionals not only improves patient care or patient involvement in their own care, but it also requires that patient self-care or self-care management is integrated into HIE systems to share information not only among professionals, but also between patients and professionals. This information will be used in the development of healthcare systems to meet more the developing of the continuity of care the patient's point of view.

Assessing integration in diabetes care: utility of the instrument IEMAC-ARCHO

Assessing integration in diabetes care: utility of the instrument IEMAC-ARCHO

Consumer Health Informatics: Promoting Patient Self-care Management of Illnesses and Health.

Consumer health informatics (CHI) is propelling important changes for medical providers and the lives of patients through information and communications technology. Independently, medical consumers seek, collect, and use health information for decision making. However, when constructing a CHI-based medical platform, high technology must be applied in a fully understandable and usable format for both health care providers and consumers. This study examines the present status of CHI and its effect on medical consumers. For the development of CHI, we discuss the need for tailored health communications and capacity building with chronic patients at the medical center. First, empowerment is a key characteristic needed for medical consumer health care management. However, promoting patient self-care management of illnesses and health is necessary to create conjugation where cooperation with medical service providers is possible. Also, establishing a health care delivery system that will support cooperation is necessary. Second, tailored health communications can uniquely construct the health information of patients, which prevents unnecessary or excessive information from leading patients to confused and inappropriate decisions. Ultimately, through the present environment of health communication, the innovation of a consumer health care information system has become the tide of the times and the positive effect of improved health can be expected.

Mobile Technology and Promoting Health Equity for Low-Income Patients

Background/Aims: Mobile health promotion (mHealth) is health practices supported by mobile devices like smartphones and wireless technology. mHealth delivers health information to increase awareness, provides guided instructions about healthy behaviors and offers self-monitoring of health status. Approximately 58% of adults and 43% of individuals earning less than $20,000/year own smartphones; pervasiveness of mobile devices provides opportunity for patient self-care management. A majority of low-income patients access services in community health centers (CHCs), thus an opportunity exists to evaluate how mobile devices can promote continuity of care in CHCs. The objectives are as follows: 1) Assess attitudes and practices concerning mobile technology; and 2) Evaluate how mobile devices can promote equity in health care access for low-income populations.

Fluid restriction in patients with heart failure: how should we think?

Fluid restriction has long been considered one of the cornerstones in self-care management of patients with heart failure. The aim of this discussion paper is to discuss fluid restriction in heart failure and propose advice about fluid intake in heart failure patients. Although there have been seven randomised studies on fluid restriction in heart failure patients, the effect of fluid restriction on its own were only evaluated in two studies. In both studies, a stringent fluid restriction compared to a liberal fluid intake was not more beneficial with regard to clinical stability or body weight. In the other studies fluid restriction was part of a larger study intervention including, for example, individualised dietary recommendations and follow-up by telephone. Thus, the effect of fluid restriction on its own has been poorly evaluated. Fluid restriction should not be recommended to all heart failure patients. However, temporary fluid restriction can be considered in decompensated heart failure and/or patients with hyponatremia. Tailored fluid restriction based on body weight (30 ml/kg per day) seems to be most reasonable. To increase adherence to temporary fluid restriction, education, support and planned evaluations can be recommended.

Using a self-care management tool to improve self-care and quality of life in patients with congestive heart failure

Self-management is a primary goal for multiple chronic diseases and particularly for Congestive Heart Failure (CHF). Currently, treatment for CHF emphasizes relieving symptoms through teaching patients how to better care for themselves. Patients who take an active role in self-care are more independent; feel more able to manage their disease and experience better psychological outcomes. However, the research focused on self care-management intervention in heart failure patients in Egypt is very inadequate. Thus, this study aims to first explore the self-care management learning needs among patients with CHF, then secondly assess the effects of a self-care-management tool on self-care adequacy and quality of life (QOL) among this group of patients and thirdly identify patient opinions regarding the instructional developed tool. The research design encompasses the two designs of descriptive and quasi-experimental pretest-posttest study. A convenient sample of 256 patients with congestive heart disease was employed for the survey group in the assessment phase of the study. From this sample, 30% were then randomly assigned to use the developed instructional tool as the experimental group. Two tools were used for data collection. The first was the Heart Failure Self-Care Management Questionnaire (HFSCMQ) which included two parts: the Self-Care Heart Failure Index which was developed by Riegel et al., in 2009, and the Minnesota Living with Heart Failure Questionnaire (MLHFQ) that was developed by Rector T, in 1986. The second tool was a patient feedback opinionnaire which was developed by the researchers to determine patient’s feedback after using the developed tool. Results for the survey group revealed observed inadequate self-care management as perceived by patients with CHF involving self-care maintenance, self-care management and self-care confidence elements, as well as poor QOL detection. Results for the experimental group showed that the CHF patient’s perceptions about self-care management with its components were improved before and after use of the developed instructional tool in the second and third assessments. As well, the QOL was slightly improved as perceived by them. This proves that the self-care management tool may be effective as a self-learning reference among Egyptian CHF patients. In conclusion, instructional health education materials, particularly for patients with chronic illnesses such as CHF, are essential nursing interventions to improve patient self-care management literacy and the QOL. Furthermore, the planning, developing, and implementing of different health instructional materials for patient teaching has become a necessary scheme for nurses to improve their practice in exploring innovative roles in the health education field and activate these roles in different health specialties.

Effect of Token Economy on Self care Management of Patients with Schizophrenia

The study was aimed at evaluating the effect of Token economy on self care management of patients with Schizophrenia admitted at the Government Mental Health Centre, Kuthiravattom, Kozhikode. A quasi experimental approach with one group pre test post test design was selected for the study. The sample consisted of 30 patients with Schizophrenia admitted in the male and female family therapy wards of Govt. Mental Health Centre, Kuthiravattom, Kozhikode. The subjects were selected based on non probability purposive sampling. The tools used for data collection were Structured interview schedule to collect Socio-personal data and Modified Social-Adaptive Functioning Evaluation Scale to assess the self care management of patients with schizophrenia. Content validity of the tools were done with the help of experts and the reliability was checked by cronbach's alpha. Token economy method was planned and implemented as an intervention. The study was conducted among 30 patients with schizophrenia admitted in the male and female family therapy wards of Govt. Mental Health Centre, Kuthiravattom, Kozhikode. The self care management ability was assessed before and after the Token economy intervention. The data collected were organized and analyzed using descriptive and inferential statistics. The findings of the study were: Patients with Schizophrenia suffered from impairment in self care management, Token economy intervention produced a significant (p<0.001) improvement in the self care management of patents with schizophrenia. From this study, it is clear that Token economy intervention was effective in improving the self care management of patients with Schizophrenia. The findings of the study have implications in nursing practice, education, administration and research. It also justified the growing importance to psychiatric rehabilitation nursing. The study reveals that the implementation of Token economy intervention along with pharmacotherapy will definitely help patients with Schizophrenia and adds to the quality of nursing care provided.

The Feasibility of Health Trainer Improved Patient Self-Management in Patients with Low Health Literacy and Poorly Controlled Diabetes: A Pilot Randomised Controlled Trial.

Type 2 diabetes mellitus is most prevalent in deprived communities and patients with low health literacy have worse glycaemic control and higher rates of diabetic complications. However, recruitment from this patient population into intervention trials is highly challenging. We conducted a study to explore the feasibility of recruitment and to assess the effect of a lay health trainer intervention, in patients with low health literacy and poorly controlled diabetes from a socioeconomically disadvantaged population, compared with usual care. Methods. A pilot RCT comparing the LHT intervention with usual care. Patients with HbA1c > 7.5 (58 mmol/mol) were recruited. Baseline and 7-month outcome data were entered directly onto a laptop to reduce patient burden. Results. 76 patients were recruited; 60.5% had low health literacy and 75% were from the most deprived areas of England. Participants in the LHT arm had significantly improved mental health (p = 0.049) and illness perception (p = 0.040). The intervention was associated with lower resource use, better patient self-care management, and better QALY profile at 7-month follow-up. Conclusion. This study describes successful recruitment strategies for hard-to-reach populations. Further research is warranted for this cost-effective, relatively low-cost intervention for a population currently suffering a disproportionate burden of diabetes, to demonstrate its sustained impact on treatment effects, health, and health inequalities.

Patient education and follow-up as an intervention for hypertensive patients discharged from an emergency department: a randomized control trial study protocol.

BackgroundPersistently elevated blood pressure (BP) is a leading risk factor for cardiovascular disease development, making effective hypertension management an issue of considerable public health importance. Hypertension is particularly prominent among African Americans, who have higher disease prevalence and consistently lower BP control than Whites and Hispanics. Emergency departments (ED) have limited resources for chronic disease management, especially for under-served patients dependent upon the ED for primary care, and are not equipped to conduct follow-up. Kiosk-based patient education has been found to be effective in primary care settings, but little research has been done on the effectiveness of interactive patient education modules as ED enhanced discharge for an under-served urban minority population.Methods/DesignAchieving Blood Pressure Control Through Enhanced Discharge (AchieveBP) is a behavioral RCT patient education intervention for patients with a history of hypertension who have uncontrolled BP at ED discharge. The project will recruit up to 200 eligible participants at the ED, primarily African-American, who will be asked to return to a nearby clinical research center for seven, thirty and ninety day visits, with a 180 day follow-up. Consenting participants will be randomized to either an attention-control or kiosk-based interactive patient education intervention. To control for potential medication effects, all participants will be prescribed similar, evidenced-based anti-hypertensive regimens and have their prescription filled onsite at the ED and during visits to the clinic. The primary target endpoint will be success in achieving BP control assessed at 180 days follow-up post-ED discharge. The secondary aim will be to assess the relationship between patient activation and self-care management.DiscussionThe AchieveBP trial will determine whether using interactive patient education delivered through health information technology as ED enhanced discharge with subsequent education sessions at a clinic is an effective strategy for achieving short-term patient management of BP. The project is innovative in that it uses the ED as an initial point of service for kiosk-based health education designed to increase BP self-management. It is anticipated findings from this translational research could also be used as a resource for patient education and follow-up with hypertensive patients in primary care settings.Trial registrationClinicalTrials.gov Registration Number: NCT02069015. Registered February 19, 2014.

Using compression hosiery to prevent rebound swelling.

The management of chronic oedema often consists of a programme of compression bandaging to reduce swelling and improve skin changes and limb shape, followed by patient self-care management in compression hosiery. Occasionally, patients experience rebound swelling and require further episodes of bandaging. In such cases, a thorough assessment of the causes of the rebound swelling should be carried out so that they can be eliminated. By evidencing three case studies, this article demonstrates that Haddenham Custom Goldpunkt garments can be useful in preventing rebound swelling, making it a cost- and resource-effective method of managing stubborn chronic oedema and lymphoedema.

Determinants of Heart Failure Self-Care Maintenance and Management in Patients and Caregivers: A Dyadic Analysis.

Disease self-management is a critical component of maintaining clinical stability for patients with chronic illness. This is particularly evident in the context of heart failure (HF), which is the leading cause of hospitalization for older adults. HF self-management, commonly known as HF self-care, is often performed with the support of informal caregivers. However, little is known about how a HF dyad manages the patient's care together. The purpose of this study was to identify determinants of patient and caregiver contributions to HF self-care maintenance (daily adherence and symptom monitoring) and management (appropriate recognition and response to symptoms), utilizing an approach that controls for dyadic interdependence. This was a secondary analysis of cross-sectional data from 364 dyads of Italian HF patients and caregivers. Multilevel modeling was used to identify determinants of HF self-care within patient-caregiver dyads. Patients averaged 76.2 (SD = 10.7) years old, and a slight majority (56.9%) was male, whereas caregivers averaged 57.4 (SD = 14.6) years old, and about half (48.1%) were male. Most caregivers were adult children (48.4%) or spouses (32.7%) of patients. Both patients and caregivers reported low levels of HF maintenance and management behaviors. Significant individual and dyadic determinants of self-care maintenance and self-care management included gender, quality of life, comorbid burden, impaired ADLs, cognition, hospitalizations, HF duration, relationship type, relationship quality, and social support. These comprehensive dyadic models assist in elucidating the complex nature of patient-caregiver relationships and their influence on HF self-care, leading to more effective ways to intervene and optimize outcomes.