Self-care Problems Research Articles

Actual Nursing Practice by Proficient Nurses for Elderly Myocardial Infarction Patients and Problems with Self-Care

Purpose : The study was conducted to ascertain what was actually done for elderly myocardial infarction (hereafter MI) patients by proficient nurses and to identify problems with self-care that they encountered in their daily nursing practice. Methods : A focus-group interview was carried out on proficient nurses in two hospitals. The interview was recorded and later transcribed for inductive qualitative analysis. Results : Content-wise problems with self-care that proficient nurses encountered in their nursing care were related to the issues of a low-salt diet, medication management, and whereas method-wise problems were related to the issues of a decline in understanding and cognitive abilities, family functions, and continuity of nursing. The major place of nursing for patients was the hospital ward (treatment right after MI). Out of the features categorized into 15 extracted from my preceding study, the categories that were frequently confirmed by both groups were : Patient's anxiety about recurrence, Reduction in the level and scope of activities, and Observation of the process up to coronary angiography after leaving hospital. This study added three categories as to issues in continuous nursing. Conclusions : In order to cope with difficulties in supporting elderly patients who had self-care problems in a limited period of hospitalization, important were the continuity of nursing in the ward, the outpatient department and a hospital stay for examination, and coordination with people in other domains such as registered dieticians and pharmacists.

Advance Directive and End-of-Life Care Preferences Among Chinese Nursing Home Residents in Hong Kong

The objectives of the present study were to describe the knowledge and preferences of Hong Kong Chinese older adults regarding advance directives and end-of-life care decisions, and to investigate the predictors of preferences for advance directive and community end-of-life care in nursing homes. This was a cross-sectional survey conducted in 140 nursing homes in Hong Kong. A total of 1600 cognitively normal Chinese older adults were recruited. Information on demographics, social, medical diseases, preferences of end-of-life care decisions, and advance directives were collected by face-to-face questionnaire interviews. The mean age of the participants was 82.4 years; 94.2% of them would prefer to be informed of the diagnosis if they had terminal diseases and 88.0% preferred to have their advance directives regarding medical treatment in the future. Approximately 35% would prefer to die in their nursing homes. The significant independent predictors for the preference of advance directive included asking for relatives' advice, wishing to be informed of their terminal illness diagnoses, absence of stroke, and having no problems in self-care in European Quality of Life-5 Dimensions. For the preference for community end-of-life care and dying in nursing homes, the independent predictors included older age, not having siblings in Hong Kong, Catholic religion, nonbeliever of traditional Chinese religion, not receiving any old age allowance, lower Geriatric Depression Scale score, and being residents of government-subsidized nursing homes. Most of our cognitively normal Chinese nursing home older adults prefer having an advance directive, and one-third of them would prefer to die in nursing homes.

Development and Psychometric Properties of the 12-Item Diabetes Fatalism Scale

This study describes the development and validation of the Diabetes Fatalism Scale (DFS) in adults with type 2 diabetes. Thirty-five items were derived from focus groups, literature review, and expert opinion. The items were pilot tested on 20 adults with diabetes and then administered to 216 primary care patients with type 2 diabetes to assess the validity and reliability of the scale. Exploratory factor analysis (Principal Component Analysis with Varimax rotation) yielded a 12-item scale with three subscales. Pearson's correlation was used to test the DFS's association with diabetes self-care, HbA1c and quality of life. Multiple linear regression was used to assess association between the DFS and HbA1c controlling for demographics, comorbidity and insulin use. Cronbach's alpha for the 12-item DFS scale was 0.804 indicating internal consistency. The DFS is scored in such a way that higher scores represent greater diabetes fatalism. The DFS scores were not significantly correlated with age, years of education, or diabetes duration. Whites, men, those with government or no insurance, and those with 3+ comorbid conditions had significantly higher DFS scores. DFS was significantly correlated with self management understanding (r = -0.35, p < 0.001), control problems (r = 0.22, p = 0.002), self-care ability (r = -0.30, p < 0.001), and self-care adherence (r = -0.23, p < 0.001). The DFS was significantly correlated with HbA1c (r = 0.20, p = 0.004) and mental health component of SF-12 (r = -0.24, p = 0.001). In multivariate models, adjusting for demographics, comorbidity and insulin use, the DFS was independently associated with increased HbA1c (beta 0.21, p = 0.005). The DFS is a valid and reliable measure of diabetes fatalism. Diabetes fatalism is associated with self-care problems, poor glycemic control, and decreased quality of life.

Measure of quality of life for Taiwanese persons with early to moderate dementia and related factors

This study validates the Chinese Dementia-Quality of Life instrument (DQoL) in patients with early to moderate stages of Alzheimer's disease (AD) (Clinical Dementia Rating Scale, CDR=0.5, 1, and 2; MMSE >or= 12). A cross-sectional design was used involving 98 participants (27 controls, 35 patients with questionable dementia (QD), and 36 patients with mild to moderate AD) and 51 paired family caregivers (FCs) (20 FCs of QD patients, 31 FCs of AD patients). FCs were recruited to evaluate patients' DQoL using the parallel form. Internal consistency, construct validity and concurrent validity of the DQoL were examined. The findings indicated that the Chinese DQoL instrument has stable internal consistency but only moderate validity when used in early to moderate AD participants with MMSE greater than, or equal to 12. The DQoL and Self-esteem subscales were significantly different across the three dementia severity groups. The values of internal consistency of the DQoL and its five subscales were high for the ratings of both the patients and the FCs. The interscale correlations for the DQoL were almost all significant for patients' and FCs' ratings. Agreement of the DQoL and its subscales for patients and FCs was significant. However, two inconsistencies were found in the results of the factor analysis and the prior conceptualization of patients' DQoL, the subscales of Self-esteem and Negative Affect. Global cognitive impairment and self-care problems significantly correlated with the patients' DQoL, while the patients' depressive symptoms and self-care problems significantly correlated with the FCs' DQoL. The Chinese DQoL reported by early to moderate AD patients has good reliability, but moderate validity because the patients' depressive symptoms did not correlate with their DQoL and the major subscales. Both patients' and FCs' ratings on DQoL are important in research and treatment decision making.

DEPRESSIVE SYMPTOMS AND COGNITIVE STATUS AFFECT HEALTH‐RELATED QUALITY OF LIFE IN OLDER PATIENTS WITH PARKINSON'S DISEASE

DEPRESSIVE SYMPTOMS AND COGNITIVE STATUS AFFECT HEALTH‐RELATED QUALITY OF LIFE IN OLDER PATIENTS WITH PARKINSON'S DISEASE

The Conundrum of Self-Care

In this paper I propose a theoretical framework for the treatment of patients with self-care problems. This framework takes as its starting point the frequent countertransference “pulls” encountered with such patients toward what might be called concerned action—the impulse to intervene actively in a protective or directive way in the hope of fostering better self-care. I suggest that, rather than simply acting on these impulses, on one hand, or viewing them as projectively or intersubjectively induced impulses simply to be processed internally by the analyst for purposes of interpretation, on the other, we view such impulses as the opening of a paradoxical or dialectical potential space in the transference–countertransference relationship. I argue that self-care problems result from the breakdown of a central dialectic in the parent–child relationship between concerned action and empathic recognition and that it is this dialectic that must be reestablished and reworked in the treatment relationship.

Self-Care Problems of Adolescents With Type 1 Diabetes in Southern Taiwan

The purpose of this study was to explore problems encountered in self-care of adolescents with type 1 diabetes (type 1 + insulin-dependent diabetes mellitus) from a patient-oriented perspective in Taiwan. Thirteen girls and six boys were recruited for participation. An open-ended, in-depth interview method was used for data collection. Findings revealed that 26.3% to 42.1% of the subjects' self-care activities were administered by parents, 36.8% did not use any meal plan, 10% could not manage their hypoglycemia well, and 36.8% had difficulties following prescribed regimens and tried alternative therapies such as herbal medicines or nutrient supplements. Results indicate the importance of parents encouraging their children to take on self-care responsibilities. Professional staffs also need to help modify contents and schedules of regimens for each adolescent patient.

A randomized controlled trial to prevent glycemic relapse in longitudinal diabetes care: Study protocol (NCT00362193)

BackgroundDiabetes is a common disease with self-management a key aspect of care. Large prospective trials have shown that maintaining glycated hemoglobin less than 7% greatly reduces complications but translating this level of control into everyday clinical practice can be difficult. Intensive improvement programs are successful in attaining control in patients with type 2 diabetes, however, many patients experience glycemic relapse once returned to routine care. This early relapse is, in part, due to decreased adherence in self-management behaviors.ObjectiveThis paper describes the design of the Glycemic Relapse Prevention study. The purpose of this study is to determine the optimal frequency of maintenance intervention needed to prevent glycemic relapse. The primary endpoint is glycemic relapse, which is defined as glycated hemoglobin greater than 8% and an increase of 1% from baseline.MethodsThe intervention consists of telephonic contact by a nurse practitioner with a referral to a dietitian if indicated. This intervention was designed to provide early identification of self-care problems, understanding the rationale behind the self-care lapse and problem solve to find a negotiated solution. A total of 164 patients were randomized to routine care (least intensive), routine care with phone contact every three months (moderate intensity) or routine care with phone contact every month (most intensive).ConclusionThe baseline patient characteristics are similar across the treatment arms. Intervention fidelity analysis showed excellent reproducibility. This study will provide insight into the important but poorly understood area of glycemic relapse prevention.

The Effect of Self-care on the Renal Transplantation Outcomes

本文从自我护理的概念、病人的基本管理、社会支持、种族/肾移植生存率、社会经济地位、病人的爱好和信念与自我护理实施及对肾移植转归的影响等多方面进行了评述,并针对自我护理存在的问题提出了相应的建议,希望肾移植患者能在公平的前提下得到合理治疗与自我护理方面的支持。

Assessing the Occupational Performance Priorities of People Who Are Homeless

SUMMARYThis study examined retrospective data for 65 participants enrolled in an occupational therapy supportive employment program. The Canadian Occupational Performance Measure (COPM) was used to identify self-perceived occupational performance problems specific to this population. Over half of the identified problems fell in the self-care domain (59%), about one-third (31%) were in the productivity domain and the final 10% were in the leisure domain. Narrative analysis of verbatim goals suggests that these individuals identified different types of self-care and productivity problems than samples in previous studies. The results of this study indicate that the COPM can facilitate person-centered, culturally responsive assessment with individuals who are homeless.

Self-Neglect: A Proposed New NANDA Diagnosis

To propose a new NANDA diagnosis, self-neglect. Research studies and literature published from a variety of disciplines including nursing as well as primary research. This diagnosis can be used to describe a constellation of self-care problems of varying severity and impact on the health and well-being of people who self-neglect. Included are two subtypes of self-neglect based on the degree of intentionality. Clarification of self-neglect is long overdue because self-neglect presents conceptual, identification, and intervention problems for nurses, healthcare workers, and for medicolegal systems across settings and in many countries. The proposed diagnosis, self-neglect, fills a gap in current standardized terminology. This diagnosis will contribute significantly to nurses leading the way in the explication of an interdisciplinary and international health concern. PRACTICE AND POLICY IMPLICATIONS: Developing self-neglect as a recognized nursing label is vital to clinicians and policy makers within and across countries. Appreciating less serious/non-life-threatening presentations will give nurses a care perspective to improve the health and well-being of those in earlier stages of self-neglect. Definitions for this phenomenon will contribute to care planning and interventions, leading to consistency in practice and research.

Prevalence and impact of disability in north-western Ethiopia

Purpose. To assess the prevalence and impact of disability in one urban and three rural areas in north-western Ethiopia.Methods. The study design is cross-sectional and quantitative. Data was collected by using pretested and standardized structured questionnaires containing socio-demographic characteristics, type of disability, functional, and social dysfunction.Results. A total of 932 individuals with disability were found out of a total of 24,453 individuals giving the overall crude disability rate for the three towns as 3.8%. Disability in the lower locomotor was the most frequently reported type – 442 (47.0%) – followed by blindness 269 (28.6%), upper motor 152 (16.1%), mental retardation 97 (10.3%) and hearing loss 78 (8.3%) respectively. The major self-care problem experienced by the disabled is toileting in 292 (31.1%) cases, bathing in 248 (26.4%) and dressing 157 (16.7%). Other problems experienced by the respondents are parents' negative attitudes towards the disabled, evidenced by hiding them. This was observed in 340 (36.2%) cases. No care was provided by caregivers in 221 (23.6%) cases.Conclusion. The majority of disabled people have problems with activities of daily life especially toileting, bathing and dressing. Interventions to alleviate the problems of the disabled should be designed and implemented.

Disability-free life expectancy of elderly people in a population undergoing demographic and epidemiologic transition.

the major purpose of health and social policy in old age is to increase quality of life of elderly people. In many demographically developing countries, life expectancy is increasing very rapidly, but little information is available on survival free of disability. to determine prevalence and severity of disability among the elderly population and to compare disability-free life expectancy and self-care life expectancy among different age groups and between men and women. a cross-sectional multi-stage random sample survey and routine life tables for Thailand. national population of Thailand. 4,048 elderly subjects aged 60+ years. prevalence rates (95% CI) of long-term disability and dependency in self-care activities of daily living were 19% (95% CI 17.8, 20.2) and 6.9% (6.1, 7.7) respectively. Rates of disabilities increased with age and women were more disabled than men. The life expectancy and disability-free life expectancy at age 60 for men were 20.3 years and 16.4 years, and for women were 23.9 years and 18.2 years respectively. Self-care life expectancies at age 60, calculated from the prevalence of needing help with basic self-care activities, were 18.6 years and 21.3 years for men and women respectively. Women spent proportionately more of their longer life expectancy in a disabled state than men. Men and women can, respectively, expect that 19% and 24% of their life expectancy at age 60 will be spent in a disabled state, but may expect only about 10% of their life expectancy to be spent unable to manage basic self-care activities of daily living. long-term disability is common in old age, affecting a quarter of people over 60 years. However, self-care problems are much less common and suggest that the social and health care consequences of demographic transitions are over-estimated by use of simple questions about limiting long-standing disability. Self-care life expectancy provides a useful monitoring tool for censuses and national disability surveys.

Patient-Centered Outcomes of Diabetes Self-Care

Despite the recognition of strategies for diabetes care management, information systems that screen patient diabetes self-care problems are not commonplace, especially among low-income patients. This study examined correlates of three patient-centered outcomes of diabetes self-care (awareness of self-care components, difficulties in diabetes self-care, and adherence to self-care) among low-income diabetic patients. Clinical and patient survey data were obtained on 249 participants from 11 primary care community health clinics serving low-income populations in North Carolina in Project IDEAL (Improving Diabetes Education, Access to Care and Living). Measures of patient-centered outcomes of self-care were obtained from the Diabetes Quality Improvement Project (DQIP) Patient-Reported Measures set. A substantial proportion of patients reported difficulty achieving standard self-care treatment goals. The study identified distinct patient characteristics associated with poor self-care outcomes. Increased understanding of self-care components and adherence to them were associated with increased perception of quality of care and, in turn, better general health perceptions in these patients (p < 0.01). This study identified an unmet need for diabetes self-care knowledge and skills associated with patient outcomes in low-income patients. Routine monitoring of patient-centered self-care outcomes could help improve long-term outcomes of diabetes care in this population.

Occupational performance in older stroke wheelchair users living at home

AbstractThis research aimed to identify problems in occupational performance experienced by survivors of stroke who used a wheelchair, both from their perspective and from the perspective of their caregivers. Sixteen stroke survivors over the age of 65 years who had used a prescribed wheelchair for at least one year, who lived in their own home, who were able to participate in a conversational interview and who had a caregiver willing to participate comprised the sample. The Canadian Occupational Performance Measure (COPM) was used to identify occupational performance problems and to measure stroke survivors' and caregivers' perceptions of performance. The Functional Autonomy Measurement System (SMAF) was also used to evaluate the functional performance of stroke survivors from the caregivers' perspective. The frequency and type of problems identified by the COPM were descriptively analysed and compared for both groups. The results of Mann‐Whitney U tests showed no differences in the frequency of self‐care, productivity and leisure problems reported between the two groups. Within‐group comparisons using the Wilcoxon Signed Ranks Test showed that stroke survivors identified significantly more self‐care problems than productivity‐type problems (p=0.001), and more leisure problems than productivity problems (p=0.013). Caregivers identified significantly more self‐care problems than productivity problems (p=0.001). The most common self‐care problems reported by both stroke survivors and caregivers were dressing and bathing. Results suggest a high level of functional disability among the stroke survivors. There was a significant correlation between the score on the SMAF Instrumental Activities of Daily Living subscale and the frequency of caregiver assistance (r=0.747, p=0.001). Addressing the perspectives of both stroke survivors who are wheelchair users and their caregivers in identifying occupational performance problems at home is important for occupational therapists for planning home‐based intervention. Copyright © 2001 Whurr Publishers Ltd.

IPPA, a user-centred approach to assess effectiveness of Assistive Technology provision

IPPA (Individually Prioritised Problem Assessment) is a new instrument to assess the effectiveness of assistive technology provision. It assesses the impact that problems have on daily life as perceived by the end-user. In an international trial, 248 clients of service delivery centres were interviewed using the instrument, of whom 188 also participated in a follow-up interview. Respondents had problems in mobility, hearing, speech-related communication or self-care. In addition to IPPA, SIP68 and EuroQol were administered for validation purposes. The instrument fits well into the process of service delivery (and even facilitates the actual assessment). The direction of changes measured by IPPA is consistent with the direction of changes measured by SIP68 and EuroQol, supporting construct validity. Changes measured by IPPA are considerably larger, supporting our view that solving problems is a key outcome in provision of assistive devices. Results support the ideas behind the instrument and are promising enough to continue.

Empowerment: what about the evidence?

The health care system has been very successful in meeting the first set of challenges in diabetes care. As a consequence of this success a new set of challenge, low levels of self-care, poor control and unresolved emotional problems, has emerged to challenge the health care professional. Patient empowerment has been cited as an approach to address these issues. However much of this literature does little to define empowerment, and tends to rely on philosophical rather than empirical argument. This paper defines empowerment as involving at least 5 key features; acceptance, affect, autonomy, alliance and active participation. These concepts are defined, and the pertinent diabetes literature is reviewed. Empirical studies demonstrate a clear association between aspects of empowerment and self-care behaviour. Although intervention studies have tested some aspects of the empowerment model, there is as yet no published empirical study that has tested the empowerment model in its entirety. Until such data emerges the empowerment model, although promising, can only be argued for on philosophical grounds. Copyright © 2000 John Wiley & Sons, Ltd.

Diet and diabetes (i): Assessing dietary self-care in patients with insulin dependent diabetes

Diet is an important component of the management of Insulin Dependent Diabetes Mellitus (IDDM), yet it has been difficult to obtain effective measures of dietary management. Two studies were conducted assessing the frequency and antecedents of problems in dietary self-care in IDDM. In study one the Diet Problem Setting Inventory (DPSI), a self-report inventor assessing the settings in which poor dietary management occur, was developed. One hundred and thirty-seven individuals with IDDM completed the DPSI, and a factor analysis revealed three internally consistent factors. In study two, 41, IDDM patients self-monitored, and were interviewed daily about their diet, to ascertain the frequency and antecedents of problems in dietary self-care. Subjects also completed the DPSI twice to assess its test-retest reliability. The total score on the DPSI showed high test-retest reliability, and moderate convergent validity with self-monitored dietary management. The more intensive self-monitoring assessment provided greater information on the settings in which poor dietary management occurred. It was concluded that global self-report inventories, such as the DPSI, have value as screening instruments, but that self-monitoring provides additional information of clinical utility.

Functional Consequences of Bipolar Affective Disorder: An Occupational Therapy Perspective

An investigation into the functional consequences for an outpatient group of euthymic clients with the diagnosis of bipolar disorder(N=62) was conducted at the Bipolar Clinic at the Clarke Institute of Psychiatry. Participants completed a questionnaire that was based on the Role Checklist and that measured their level of involvement, satisfaction, and functioning in various life roles. The questionnaire also included criteria for adaptive level of functioning. Approximately one third of the sample did not meet the criteria for adaptive level of functioning. Furthermore the self-care, productivity and leisure problems identified in the open-ended questions suggest that the functional consequences of bipolar affective disorder are substantial for this euthymic outpatient group of clients. The implications of these results are discussed in the context of the Occupational Therapy Guidelines for Client-Centred Mental Health Practice.

Psychotic Symptoms in Parkinson's Disease Patients with Dementia

To assess the prevalence of psychotic symptoms in a group of patients with Parkinson's disease (PD) and dementia and examine the association of psychotic symptoms with neuropsychiatric problems, the level of distress reported by caregivers, and cognitive and functional impairment. The psychotic and nonpsychotic patients with PD dementia were compared on a series of demographic, neuropsychiatric, behavioral, caregiver complaint, and cognitive measures. The database from nine university-based State of California Alzheimer's Disease Diagnostic and Treatment Centers (ADDTCs). 101 patients diagnosed with PD. A total of 36 of the 101 patients (35.6%) had either hallucinations, delusions, or both. The psychotic patients had significantly more insomnia, confusion, agitation, personality changes, and self-care problems and were noted by their caregivers to be significantly more unmanageable at home than their nonpsychotic counterparts. On cognitive scales, psychotic patients were significantly more impaired. Many patients with PD and dementia experience psychosis. Psychotic symptoms in PD dementia patients are associated with major behavioral, cognitive, and functional problems.