Patient Self-care Management Research Articles

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.

Efficacy of a home-based educational strategy involving community health volunteers in improving self-care in patients with chronic heart failure in western Iran: A randomized controlled trial.

This study aimed to evaluate the effectiveness of a home-based educational strategy using community health volunteers (CHVs) in improving self-care of patients with chronic heart failure (CHF) in comparison with an educational strategy using formal health professionals (FHPs) at hospital, and also with a control group receiving usual care in western Iran. A three-arm controlled trial randomly allocated 231 patients with CHF into a control group and two intervention groups undertaking two different educational approaches - a face-to-face education program by CHVs at the patients' homes and a formal education program using paid FHPs at hospital. Data obtained through interviewing patients before and two months after interventions were analyzed. Self-care components significantly increased after the intervention in both interventional groups compared to the control group (p<0.001). Differences between the two strategies were not significant, except for self-care confidence being greater in the groups exposed to the health professionals (p=0.004). The mean and standard deviation (SD) of the changes in self-maintenance, self-management and self- confidence score (each with a maximum score of 100) for the CHVs group were 26.2±12.7, 29.4±11 9.5±17; for the health professional group were 29.5±12, 31.3±12, 18.1±17; and for the control group were 2.7±9, 10.2±10, -0.30±11 respectively. The home-based face-to-face education by CHVs improved self-care maintenance and self-care management in patients with CHF as effectively as the education provided by health professionals in a formal health education program, and much better than the usual care.

Disability Related to Self - care management among patients with Chronic Lymphatic filariasis in Kerala, India

Background Disability in self-care is a part of physical domain and is described as the inability to withstand bodily disruptions in normal functional performance. This study was conducted to determine the pattern of self-care management in patients with chronic lymphatic filariasis and to determine the disability in self-care on the basis of gender, duration of disease and stage of the disease in Kerala. Materials and Methods This cross-sectional study was conducted from 2008 to 2009 among individuals suffering from chronic lymphatic filariasis in Kannur District, Kerala State, India. 200 individuals with chronic lymphatic filariasis participated in this research. An interviewer-administered questionnaire, which had structured closed-ended questions and semi-structured open-ended questions, was used for data collection. A door-to-door survey was conducted to recruit the required sample size. Data analysed using SPSS version 21. Results In the present study 200 individuals (151 females and 49 males) with chronic lymphatic filariasis were participated. The mean age observed was 58.8 years with a minimum of 25 years and a maximum of 85 years. The factors included under self-care were bathing, grooming, dressing, and bowel and bladder management. The severity of self-care management shows that more than 60% had no difficulty in any of the self-care activities. 40% reported having at least some problem in toileting. Among the total participants, 3.5% reported extreme difficulty in bathing, followed by 1% in grooming, 1% in dressing and 1% in toileting. Some degree of bowel management problems was reported by 61.5% participants, and 67.5% had bladder management problems. Though males and females experienced bladder problems, former experienced them more. In both the groups the median score observed for bathing, grooming, dressing and toileting was ‘none’. There was no statistically significant difference in the median score observed between males and females. The leading difficulties related to self-care experienced by participants with duration of disease greater than 40 years were toileting (72.7%), bathing 39.4%, grooming 9.1%, and dressing (3.0%). Both bowel and bladder management problems were experienced by 85% of the participants having duration of disease greater than 40 years whereas 2.6% each experienced extremely severe bladder and bowel management problems. Statistically significant difference in median score was observed in bathing (p&lt;0.05), grooming (p&lt;0.05), Toileting (p&lt;0.05) and bowel management (p&lt;0.05), which shows as the duration of the disease increases; the difficulty for self-care management also increases. Maximum respondents with difficulty in toileting were in stage seven, the intensity ranged from a little to a lot. All distributions were statistically not different except for self-care related to toileting (p&lt;0.05). Conclusion: The prevalence of difficulty in self-care management showed variations between the genders, duration of the disease and stage of the disease. DOI: http://dx.doi.org/10.3126/nje.v5i1.12375

Abstract P096: Effectiveness of a Comprehensive Care Delivery System on Readmission Rates and Self-Care in Older Adult Patients with Heart Failure

Background: Telemedicine interventions to prevent readmissions in patients with heart failure (HF) have shown inconsistent results in their effectiveness on HF-related and all-cause rehospitalization. Team-based interventions geared toward patient-centric care delivery in concert with comprehensive care coordination that enhances patient self-care may help to prevent unplanned hospitalizations in patients with HF. Objective: To evaluate the outcomes of a comprehensive care delivery system using a team-based high-touch coaching and remote patient monitoring intervention designed for older adult patients with heart failure in a community hospital setting. Design: A descriptive cross-sectional observational design was used to measure readmission rates. A one-group pretest-posttest design using the Self-care of Heart Failure Index was used to measure self-care outcomes. Correlation analysis was performed to determine relationships between the coaching and outcomes. Patients: Participants were older adult patient hospitalized with heart failure and followed for 30-days. Patients were excluded if they were unwilling to participate, non- English speaking, had end-stage renal disease, a terminal illness, debilitating neuro-psychological disorder, or lived greater than 30 miles away. Results: The 30-patients were primarily Caucasian, female with a mean age of 77.5 years. The majority of patients had medically optimized NYHA class II or III HF with an ejection fraction ≤ 40%. HF readmission rate was zero, and 6% for all cause. Patient self-care scores improved (p &lt; .0001). Team based coaching was correlated with improvement in self-care maintenance scores (p =.009). Conclusion: A comprehensive care delivery system leveraging remote patient monitoring and health coaching significantly reduced 30-day readmission and enhanced patient self-care management. Implications: Patient centric team based care models leveraging technology should continue to be developed and implemented to transform care delivery for older adults with HF. Table 1. Change in Mean Self-Care of Heart Failure Index Scores p &lt; .0001 p &lt; .0001 p &lt; .0001

The Association Between Regular Symptom Monitoring and Self-care Management in Patients With Heart Failure

Symptom monitoring is considered the first step toward self-care management (actions to manage altered symptom status) to avert worsening heart failure (HF). However, empirical evidence demonstrating that symptom monitoring leads to adequate self-care management is lacking. We examined the relationship of adherence to regular symptom monitoring with adequate self-care management in HF patients. A total of 311 HF patients (60 years, 35% women) were divided into 3 groups by adherence to 2 symptom monitoring behaviors (monitoring daily weights and lower extremity edema). Patients who were adherent to both symptom monitoring behaviors formed the adherent group (15.1%). Those adherent to either of the symptom monitoring behaviors formed the partially adherent group (28.9%). Those adherent to neither of the symptom monitoring behaviors formed the nonadherent group (56.0%). The adjusted odds of performing adequate self-care management were increased by 225% (95% confidence interval, 1.13-4.48) and 344% (95% confidence interval, 1.55-7.62) for the partially adherent and adherent symptom monitoring groups, respectively, compared with the nonadherent group. Adequacy of self-care management was predicted by adherence to symptom monitoring behaviors. This finding suggests that regular symptom monitoring facilitates performance of adequate self-care management, which may contribute to a decrease in preventable hospitalizations in HF.

Self-management for adult patients with cancer: an integrative review.

Individuals with cancer are surviving long term, categorizing cancer as a chronic condition, and with it, numerous healthcare challenges. Symptoms, in particular, can be burdensome and occur from prediagnosis through many years after treatment. Symptom severity is inversely associated with functional status and quality of life. Management of these millions of survivors of cancer in a stressed healthcare system necessitates effective self-care strategies. The purpose of this integrative review is to evaluate intervention studies led by nurse principal investigators for self-care management in patients with cancer. PubMed, CINAHL (Cumulative Index to Nursing and Allied health Literature), and the Cochrane Database were searched from January 2000 through August 2012. Search terms included "symptom management and cancer," "self-management and cancer," and "self-care and cancer." All articles for consideration included intervention studies with a nurse as the primary principal investigator. Forty-six articles were included yielding 3 intervention areas of educational and/or counseling sessions, exercise, and complementary and alternative therapies. Outcomes were predominately symptom focused and often included functional status and quality of life. Few studies had objective measures. Overarching themes were mitigation, but not prevention or elimination of symptoms, and improved quality of life related to functional status. No one intervention was superior to another for any given outcome. Current interventions that direct patients in self-care management of symptoms and associated challenges with cancer/survivorship are helpful, but incomplete. No one intervention can be recommended over another. Guiding patients with cancer in self-care management is important for overall functional status and quality of life. Further investigation and tailored interventions are warranted.

Effect of self - care education on quality of life in patients with primary hypertension: comparing lecture and educational package.

Hypertension is a dangerous risk factor for public health. It profoundly affects the patients' quality of life. However, there is lack of agreement on the best method for self-care management in patients with hypertension. This study was conducted to compare the effect of lecture and educational pamphlets on quality of life (QOL) in patients with primary hypertension. A quasi-experimental study was performed on 90 patients with chronic primary hypertension referred to two outpatient clinics in Kashan city. Patients were randomly divided into three groups including lecture group, educational package group, and control group. The participants' quality of life was measured using the SF-36 questionnaire at the beginning of the study, and two months later. Data was analyzed using ANOVA and Chi-Square tests. No significant differences were observed between the three groups for demographics characteristics and QOL before the intervention except for marital status. Mean scores of QOL dimensions of the intervention groups were increased at the end of the study, except for the dimension of bodily pain. Tukey post-Hoc test showed that except for general health, the two intervention groups were not significantly different in other dimensions, and significant differences were observed between the control group and the two intervention groups (P < 0.05). At start and the end of the study, the mean differences in the general health dimension in three groups were 2.25 ± 0.1, 0.07 ± 0.01, and -1.70 ± 0.01 respectively. There were significant differences among groups (P = 0.04). Lecture and educational package can both improve some dimensions of the QOL in patients with hypertension. However, as pamphlets are cheap and easy to use, this method may be used as an effective method for self-care education in health care settings in Iran, where the system is faced with nursing shortage.

The long-term impact of education on diabetes for older people: a systematic review.

Background:Although enthusiasm is growing for diabetic education programs for older people, data regarding their effectiveness and their long-term impact on self-management were neglected.Purpose:To systematically review diabetes mellitus education that has long-term effects on the self-management of older diabetic people.Data Sources:The authors searched multiple sources dated through September 2012, including the Cochrane Library, MEDLINE, PsycINFO, Nursing and Allied Health databases, and the bibliographies of 50 previous reviews.Methods and Data Extraction:Electronic databases were searched for controlled studies in English, published from 1987 to 2012, assessing the effects of long-term education for older people. Reviewers extracted study data using a structured abstraction form. Aggregated information about the effects of long-term education programs on older people with diabetes was used for making adjustments in the review.Results:The pooled estimate of the long-term effects of education was a 0.5 percentage point reduction (95% confidence interval), modest but significant improvement. The evidence also supports that long-term education is beneficial for improving diabetic patient self-care management in terms of glycemic control.

Diabetes Self-Management Education (DSME) Intervention to Improve Self-Care Management of Diabetes Mellitus Patients

Self-care management is an important component in the management of Diabetes Mellitus Type 2 (DMT2). Knowledge, self-efficacy, and compliance in self-care are the main factors to improving quality of life and preventing complications. Diabetes Self-Management Education (DSME) in support groups was used in community nursing interventions to improve diabetes self-care management. This study used a one-group pre-post design with t-test analysis to determine the ability of self-management levels and blood sugar values of the group with diabetes before and after the intervention. The instrument used was the Diabetes Self Care Management Questionnaire (DSMQ). Diabetes Mellitus patients received DSME intervention for two months. The number of samplings in this study was 49 people with diabetes. The findings show that in intervention groups, self-care improves, and blood sugar levels fall. There were significant changes in the diabetics' group (n = 48) before and after the intervention on self-care and blood glucose levels (p = 0.000 and p = 0.011). We suggest that the DSME might be given to the diabetes group by nurses as one of the strategies for implementing health education in the public health care program (PERKESMAS).

Emotional distress is associated with poor self care in type 2 diabetes mellitus

The aim of the present study was to evaluate possible clinical and psychosocial variables that influence diabetes self-care management in patients with type 2 diabetes mellitus (T2DM). A total of 150 individuals with T2DM who had had diabetes for at least 6 months were recruited to this cross-sectional study. Levels of self-care and psychosocial status were determined using the Self-Care Inventory (SCI) and Problem Areas in Diabetes (PAID) scale. The PAID scores were calculated using a five-point Likert scale with options ranging from 0 (not a problem) to 4 (serious problem). Data were evaluated using non-parametric and parametric tests as appropriate. The mean age of the study participants was 69.97 ± 8.68 years. Cronbach's α for SCI and PAID scores was 0.85 and 0.98, respectively. People with poor glycemic control had significantly higher mean (±SD) total PAID scores than individuals with good glycemic control (29.5 ± 30.9 vs 16.7 ± 26.9, respectively; P = 0.012). There was a significant relationship between PAID scores and glycemic control (r = 0.2; P = 0.012). The present study demonstrates that psychosocial factors directly influence glycemic control and diabetes self-care habits. In addition, diabetes-specific distress in study population was unrelated to the duration of diabetes, the age of the patients and anthropometric indices.

Promoting and supporting self-management for adults living in the community with physical chronic illness: A systematic review of the effectiveness and meaningfulness of the patient-practitioner encounter.

Background There has been a reported rise in the number of people with chronic illness (also referred to as long-term disease) in the Western world. One hundred million people in the United States have at least one chronic condition and in the United Kingdom (UK) as many as 17.5 million adults may be living with chronic disease. New models of care have been developed which recognise the complexities of managing care where there is overlap between the wider community, the health care system and provider organisations, for example, the Chronic Care Model and the Expert Patient Programme. These new models herald a shift away from the idea of chronically ill patients as passive recipients of care towards active engagement, in partnership with health professionals, in managing their own care. Partnership, ideally, involves collaborative care and self-management education. This may support self-care alongside medical, preventative and health maintenance interventions. In this context the nature of the patient-practitioner consultation in promoting self-care takes on a new importance. Objective The overall objective of the review was to determine the best available evidence regarding the promotion and support of self-care management for adults living in the community with chronic illness during the patient-practitioner encounter. Specifically the review sought to determine: What is the effectiveness of the patientpractitioner encounter in promoting and supporting self-care management of people with chronic illness? What are the individual and organisational factors which help or hinder recognition, promotion and support of chronic disease self-care management strategies? What are the similarities and differences between how ‘effectiveness’ is defined in this context by patients and different practitioners? Inclusion Criteria Types of participants The review focussed on self-caring adults aged nineteen years and older living in the community, with a physical chronic illness, and not currently being treated as an in-patient. For example, people with diabetes, asthma, arthritis, coronary disease, lung disease, heart failure, epilepsy, kidney disease and inflammatory bowel disease. Since patients meet various professionals in a variety of community settings regarding their care, a practitioner in this review included doctors (physicians and General Practitioners), nurses, nurse specialists, dieticians, podiatrists and community health workers. Types of outcome measures A variety of outcomes measures was used to evaluate effective self-care management. These included physiological measurements such as: HbA1c, blood pressure, body weight, lipids; lifestyle measurements, for example physical activity; and self-care determinants such as knowledge, attitude; and self-care behaviours regarding, for example, diet and physical exercise, and medication. The outcome measures used to explore the meaningfulness of the patient-practitioner encounter, concerned patients’, physicians’ and nurses’ views and perceptions of selfcare management and support. Types of studies The review considered all types of quantitative and qualitative evidence regarding the patient-practitioner encounter where self-care in chronic illness was the focus. The quantitative studies reviewed included systematic reviews, randomised controlled trials (RCTs), quasi-experimental studies, and survey studies. Qualitative studies reviewed included interview designs, vignette technique, qualitative evaluation, grounded theory, and exploratory descriptive design. Search Strategy The search sought to find both published and unpublished studies between 1990 and 2005. The year 1990 was deemed appropriate since it precedes the development of the Chronic Care Model in which self-management support for people living with chronic illness is heralded as an important part of care-management. An initial search of CINAHL and MEDLINE databases was undertaken to identify appropriate search terms regarding self-care and chronic illness. A search strategy was then developed using all identified MeSH headings and key words and the following databases were searched: - Ovid CINAHL; Ovid MEDLINE (R); Ovid EMBASE; Ovid EBM Reviews (CDSR, ACP Journal Club, DARE, CCTR); ASSIA; SIGLE; TRUNCATED AT 600 WORDS.

TRANSITIONING TO THE COMMUNITY: BRIDGING GAPS IN PATIENT CARE

The problem of transitioning heart failure patients back to the community is assessed through a review of relevant literature and a set of qualitative studies. Based on the results, information flow and temporal models of patient management are developed. Gaps in existing discharge planning and post-discharge are noted, and opportunities for facilitating patient self-care management through education and telemonitoring are identified.

Continuing Education Needs of Currently Practicing Nurses Toward the Self-Care Management of Patients With Type 2 Diabetes

Today, self-management education is a critical part of the medical plan for people with diabetes. The purpose of this study was to examine the five domains of continuing education needs of currently practicing nurses toward the self-care management of patients with type 2 diabetes. The author identified significant differences between direct care practitioners and educators in four domains: assessment skills, knowledge area, attitudes and values, and barriers. It is important for educators to understand the learning needs of direct care practitioners in order to provide appropriate education.

CHRONIC DISEASE SELF-MANAGEMENT: Improving Health Outcomes

Information such as cognitive facts, epidemiologic data, and other pieces of information generally taught in patient education classes may not be the most effective way to help patients change toward healthier behavior. This pilot clearly supported Lorig's findings that enhanced self-efficacy promotes and strengthens attitude changes and increases patients' beliefs in their ability to cope with the challenges of chronic disease. The program focused on the patient's confidence in his or her own ability to learn or perform skills rather than the actual skills involved. Self-efficacy was situational in that some individuals had a high level of self-efficacy for certain behaviors and a low level of self-efficacy for others. Self-efficacy was enhanced by successful performance, watching others succeed in similar circumstances, setting and attaining goals with clear and observable outcomes, and as an adjunct to other strategies (verbal persuasion and reinterpretation of symptoms). Self-efficacy supported the active participation of the veterans in the setting of treatment goals as well as in family support. The pilot intervention was successful for patients with multiple and mixed chronic disease such as arthritis, COPD, heart disease, diabetes, and hypertension. The cornerstone for effective behavior change lay with the patients' confidence levels in performing new health behaviors; thus the specific chronic disease took on a less significant part of this intervention. The generic approach worked on patients with mixed and multiple diseases, because it was educating them on life skills rather than disease-specific knowledge. This intervention confronted VA demand to provide cost-effective health care in a managed care environment. The VA needs models of patient responsibility and self-care management that assist the veterans in taking responsibility for maximizing of their health potential. The costs of managing veterans with chronic disease with comorbidity are astronomical. The pilot of this model has shown potential for revolutionizing the way chronic disease patient education is implemented throughout the VA and for making a significant impact on improving chronic care and reducing expenditures.