Self-care Resources Research Articles

Resilience in Ministry: Listening to the Voice of Church of Scotland Ministers

ABSTRACT The present study analyses the qualitative text written on the back page of a quantitative survey concerned with resilience in ministry among ministers serving in the Church of Scotland. Of the 505 ministers who took part in the survey, 176 wrote further (sometimes detailed) comments on the back page (35% participation rate). Three main themes emerged from these comments concerned with different aspects of resilience in ministry. The first theme concerns definitions of resilience from the perspective of ministers. The second theme concerns the challenges to resilience highlighted by ministers including workload and stress, ill health and family issues, tensions with changing theology and apathy to Christianity, conflicts with congregations, and problems with wider church structures. The third theme concerns the coping strategies and support mechanisms identified by ministers as essential for resilience including personality and self-care resources, and interrelationships with family, friends, peers, the church institution, and outside agencies.

Evolution of SmartBEAT for Heart Failure Telemonitoring.

The prevalence of Heart Failure is growing exponentially in the last decades, particularly amongst older adults. Heart Failure is a chronic cardiovascular disease that demands self-care management and substantial healthcare resources. For that reason, it is highly associated with hospital readmissions and mortality. Due to increased hospitalization costs, excessive waiting times and lack of specialized healthcare professionals to follow-up this growing population, telemedicine and telemonitoring technologies have become the best solutions to support health providers in the disease management tasks. Telemonitoring technologies offer better and more comfortable care because the elderly do not have to leave the comfort of their home to interact with the doctors, giving and receiving daily feedbacks trough these new applications, wearables, and health care platforms. This paper provides a comprehensive review covering the current progress of research in telemedicine and telemonitoring and their applications to Heart Failure Management services. It presents SmartBEAT, which demonstrated during a pilot phase, a user adherence of 97% for three months. Furthermore, SmartBEAT plus, an improved solution, is described, and the system usability a technology acceptance will be evaluated through a pilot with 40 Heart Failure Patients, involving nurses and cardiologists.

A single educational intervention on heart failure self-care: Extended follow-up from a multisite randomized controlled trial.

Heart failure outcomes remain poor, and little is known about the causes and predictors of these outcomes in Lebanon. The purpose of this article is to report the causes and predictors of the 6- and 12-month readmission and mortality of previously recruited patients to the Family focused Approach to iMprove Heart Failure care In LebanonQualitY intervention (FAMILY) study. A multi-site block randomized controlled trial in three tertiary medical centers in Beirut. Initially, participants were randomized to either the control or the intervention group. The latter group, with their family caregivers, received heart failure self-care resources and an educational intervention on self-care and symptom management during their index admission. Participants from the FAMILY study were followed up with through phone calls for readmission and mortality at 6 and 12 months following their hospital discharge. A total of 218 (85%) patients were followed up with for this evaluation. There was a significant difference between the intervention group and the control group in terms of mortality at 6 months (n=18 (16%) versus n=36 (33%); p<0.05) and 12 months (n=29 (26%) versus n=45 (42%); p<0.05) post the index discharge. Mortality at 6 and 12 months was associated with aging, lower body mass index scores and readmission at 30 days post the index admission. Results of a logistic regression for mortality at 6 months showed hypertensive etiology of heart failure and 30-day readmission to be the only significant predictors. A single session intervention was associated with lower mortality, even after an extended period of time, possibly mediated by other variables. Future studies should be powered for such outcomes while also addressing the cultural needs and literacy levels of the patients using multi-session trials and more frequent follow-ups.

Development and psychometric testing of the self-care scale for patients with chronic atrial fibrillation (AF-SCS-10).

Patients with atrial fibrillation (AF) require continuous self-care due to possible complications and side effects from treatment. However, existing tools do not capture all of the critical factors of AF self-care and have limited evidence of reliability and validity. The aim of this study was to develop and evaluate a new Atrial Fibrillation Self-Care Scale-10 (AF-SCS-10) that assesses disease-specific, multidimensional, person-centered self-care for AF patients in South Korea. For this cross-sectional research design, 290 individuals over 20 years of age with a diagnosis of AF for at least three months were recruited. A literature review and in-depth interviews were utilized to identify the scale items. An expert panel evaluated the validity and reliability of a preliminary scale. Exploratory factor analysis and parallel analysis was performed to extract factors; confirmatory factor analysis (CFA) was performed to evaluate fit on the factor structures. Criterion validity was supported by the correlation between AF-SCS-10 and AF quality of life. The internal consistency reliability coefficient was 0.87. Three factors, "self-care knowledge," "self-care behavior," and "self-care resources" were extracted from the exploratory factory analysis, explaining 79.30% of the total variance in the data. The three-factor model was also confirmed by parallel analysis; CFA met the fitness criteria. There is preliminary evidence for internal consistency reliability, as well as content and construct validity, for the AF-SCS-10. Future research is needed to confirm the study results using a larger, more culturally diverse sample.

“Take good care of yourself” An integrative review of older widows’ self-care for health and well-being

ABSTRACT Take good care of yourself is a regard often said to older bereaved women. However, what does it mean? Though self-care is a well-known phenomenon within health, it is not well understood in the context of late life spousal bereavement and widowhood. We undertook an integrative review to synthesize knowledge of older women’s self-care challenges, resources and activities when bereaved and in a healthy transition to widowhood. Good care refers to health-promoting self-care and can be explained as the older widows’ ability to access and mobilize resources and activities that are significant for a healthy transition to widowhood.

Using digital and social media for health promotion: A social marketing approach for addressing co-morbid physical and mental health.

This study examines consumer engagement with a social marketing digital media strategy designed to support the implementation of Equally Well-a program to improve the physical health of people living with mental illness. A four-stage strategic analysis and intervention mix were used as the theoretical framework to assess stakeholder needs and to evaluate the effectiveness of the intervention. Online and digital media. Mental health consumers, carers, clinicians and service managers. A digital media, social marketing intervention to support those seeking to improve the physical health of people living with mental illness. The strategy was developed using a co-design methodology and provided links to self-care resources, access to service providers, clinical tools for health professionals and links to existing successful rural programs. The main outcome measures were the number of people from each category accessing the media, making connections and downloading resources. The program has resulted in more than 24500 website hits per annum, 3500 tweets and 14.5million Twitter impressions with good bounce and download rates. The analysis suggested the materials were mostly used by clinicians and service managers using desktop computers. Using a co-design approach, the study demonstrated the potential of a social marketing digital media strategy as a health promotion methodology. The paper has provided a framework for implementing and evaluating the effectiveness of digital social media campaigns that can help consumers, carers, clinicians and service planners address the challenges of rural health service delivery and the tyranny of distance.

When a Child Dies in the PICU: Practice Recommendations From a Qualitative Study of Bereaved Parents*

Around the world, the PICU is one of the most common sites for hospitalized children to die. Although ensuring the best possible care experience for these children and their families is important, clear recommendations for end-of-life and bereavement care, arising from the parents themselves, remain limited within current literature. This report aims to describe bereaved parents' recommendations for improvements in end-of-life care and bereavement follow-up when a child dies in intensive care. Thematic analysis of incidental data from a larger grounded theory study. Four Australian PICUs. Twenty-six bereaved parents participated in audio-recorded, semi-structured interviews in 2015-2016. Interviews explored their experiences of having a child die in intensive care and their experiences of end-of-life care and bereavement follow-up. Data pertaining to this report were analyzed via thematic analysis. None. Bereaved parents identified several areas for care delivery and improvement across three time periods: during hospitalization; during the dying phase; and during bereavement. During hospitalization, parents' recommendations focused on improved communication, changes to the physical environment, better self-care resources, and provision of family support. During the dying phase, parents suggested private, de-medicalized rooms, familiar staff members, and support to leave the hospital. Recommendations for care after death focused mainly on the provision of ongoing support from the hospital or local bereavement services, as well as improved information delivery. Findings from this study offer many concrete recommendations for improvements in care both during and after a child's death. These recommendations range from simple practice changes to larger organizational modifications, offering many potential avenues for change and improvement both on an individual healthcare provider level and within individual PICUs.

Feasibility and outcomes of a multi-function mobile health approach for the schizophrenia spectrum: App4Independence (A4i).

Relative to the large investments in mobile health (mHealth) strategies for mental illnesses such as anxiety and depression, the development of technology to facilitate illness self-management for people with schizophrenia spectrum illnesses is limited. This situation falls out of step with the opportunity mHealth represents for providing inexpensive and accessible self-care resources and the routine use of mobile technologies by people with schizophrenia. Accordingly, the focus of this study was upon the feasibility of a schizophrenia-focused mobile application: App4Independence (A4i). A4i is a multi-feature app that uses feed, scheduling, and text-based functions co-designed with service users to enhance illness self-management. This study was completed in a large urban Canadian centre and employed pre-post assessments over a 1-month period that examined medication adherence, personal recovery, and psychiatric symptomatology. App use metrics were assessed as was qualitative feedback through semi-structured interview. Findings are reported in line with the World Health Organization mHealth Evidence and Assessment (mERA) checklist. Among the 38 individuals with a primary psychosis who participated, there was no research attrition and classic retention on the app was 52.5%. Significant improvement was observed in some psychiatric symptom domains with small-medium effects. Significant change in recovery engagement and medication adherence were not observed after controlling for multiple comparisons. Those who interacted with the app more frequently were more depressed and had higher hostility and interpersonal sensitivity at baseline. Satisfaction with the app was high and qualitative feedback provided insights regarding feature enhancements. This research suggested that A4i is feasible in terms of outcome and process indicators and is a technology that is ready to move on to clinical trial and validation testing. This study contributes to the small but emergent body of work investigating digital health approaches in severe mental illness populations.

The Uveitis Patient Passport: A Self-Care Tool

ABSTRACTPurpose: Patient self-care tools can improve patient outcomes in chronic disease. In uveitis, there is an unmet need for the innovative Uveitis Patient Passport (UPP). This study aims to evaluate the success of the passport’s introduction into a tertiary uveitis service through patient experience.Methods: The UPP, created in consultation with patients and the multidisciplinary team, was evaluated using a patient questionnaire and mixed quantitative and qualitative methodology.Results: Key themes emerged, with the passport used by participants as a self-care resource and an aid for cross-specialty communication. Patient involvement in evaluation identified key areas for passport development in line with patient needs. These included improving clinician engagement and future transference into a smartphone application.Conclusion: The introduction of the first UPP was a success, especially as a self-care tool for supporting patients in managing their uveitis with the potential to improve patient outcomes.

Using a Mindfulness-Based Intervention to Support the Resiliency of In-Patient Pediatric Respiratory Therapists.

Respiratory therapists (RTs) are care providers in highly stressful work environments with limited time and resources for self-care. Mindfulness-based interventions teach non-reactive awareness to the present situation or the ability to respond versus react in the moment, to shift away from a physical and emotional stress response. Mindfulness-based group learning was offered during 2 regularly scheduled RT staff meetings for ∼30 min each session. Each meeting began and concluded with a distress assessment and with counting and recording respirations for 30 s. This quality-improvement project revealed mindfulness-based interventions to be feasible and acceptable. Mindfulness intervention reduced RT team members' physical and emotional stress related symptoms (as measured by a 1-point median decrease in the self-administered distress assessment, with P = .001 in session 1) and increased sense of calm (as measured by participant breathing rate decrease by mean of two-points P = .001 in session 1 and session 2). Mindfulness-based interventions were noted to be feasible and acceptable additions to RT staff meetings. These interventions have the potential to introduce breathing practices and mini mindfulness techniques.

CommunityRx: A Real-World Controlled Clinical Trial of a Scalable, Low-Intensity Community Resource Referral Intervention.

To test the effect of CommunityRx, a scalable, low-intensity intervention that matches patients to community resources, on mental health-related quality of life (HRQOL) (primary outcome), physical HRQOL, and confidence in finding resources. A real-world trial assigned publicly insured residents of Chicago, Illinois, aged 45 to 74 years to an intervention (n = 209) or control (n = 202) group by alternating calendar week, December 2015 to August 2016. Intervention group participants received usual care and an electronic medical record-generated, personalized list of community resources. Surveys (baseline, 1-week, 1- and 3-months) measured HRQOL and confidence in finding community resources to manage health. At 3 months, there was no difference between groups in mental (-1.03; 95% confidence interval [CI] = -3.02, 0.96) or physical HRQOL (0.59; 95% CI = -0.98, 2.16). Confidence in finding resources was higher in the intervention group (odds ratio = 2.08; 95% CI = 1.18, 3.63); the effect increased at each successive time point. Among intervention group participants, 65% recalled receiving the intervention; 48% shared community resource information with others. CommunityRx did not increase HRQOL, but its positive effect on confidence in finding resources for self-care suggests that this low-intensity intervention may have a role in population health promotion. ClinicalTrials.gov Identifier: NCT02435511.

Street clinic: the care practices with users of alcohol and other drugs in Macapá

ABSTRACT Objective: To analyze the care practices of professionals from the Street Clinic team (SCt) about the care provided to users of alcohol and other drugs in Macapá, capital city of the state of Amapá. Method: Descriptive, qualitative study, carried out between April and June 2017. Ten SCt professionals participated. Five guiding questions were used for data collection, later analyzed through Bardin’s Thematic Content Analysis. Results: Facilitating care strategies involved harm reduction, teamwork, creating the link with users, team commitment and partnership with other members of the Psychosocial Care Network (PSCN). Of the factors that make care difficult, are the deficit of self-care, structural and human resources, and prejudice. Conclusion: Professionals are aware of the purpose and importance of SCt in strengthening PSCN. Conclusion: When conducting a practice based on public policies, care for the street population is facilitated.

Geospatial patterns of access to self-care resources for obesity among endometrial cancer survivors in a high poverty urban community

ObjectiveTo examine endometrial cancer survivors' access to recommended obesity-related self-care resources. MethodsParticipants included women treated 2010–2015 for endometrial cancer at an academic medical center who lived in the surrounding 16 ZIP code area on Chicago's South Side. Demographic and health data were abstracted from medical records. A socioeconomic status (SES) score (SES-1 = low, SES-5 = high) was generated for each patient using census block group-level data. Self-care resources for exercise, healthy weight, and diet were obtained from a community resource census. Geospatial techniques assessed “walkable access” (~½-mile radius around a patient's home) to obesity-related resources. Multivariable logistic regression investigated associations between access to obesity-related resources and patient characteristics. ResultsOf 195 endometrial cancer survivors, 81% identified as Black/African American and 34% lived in an SES-1 census block. Two thirds (68%) had Stage I or II endometrial cancer. Nearly two thirds (62%) were obese (BMI ≥ 30 kg/m2). Obesity was inversely associated with SES (p = 0.05). Two thirds of survivors had access to at least one of all three recommended resource types. Access was lower in low SES regions and among Black/African American women. Lower SES was associated with lower odds of walkable access to recommended resources (AOR for access to two of each resource type 0.75, 95%CI 0.59, 0.97; AOR for access to three or more of each 0.44, 95%CI 0.32, 0.61). ConclusionsObesity rates were higher and access to recommended resources was lower for Black/African American endometrial cancer survivors living in high poverty areas in Chicago.

Implementing a Peer Support Network to Promote Compassion Without Fatigue.

The aims of this study were to implement a Peer Support Network (PSN) pilot project including education/training, peer support, and resiliency training and to explore how interventions impact compassion satisfaction (CS) and compassion fatigue (CF) in a community hospital. CF has been reported to negatively affect nurse retention. The PSN provides a 3-tiered team approach to enhance CS and support nurses experiencing CF symptoms. Twenty nurses participated in PSN training and completed preimplementation and 6-week postimplementation surveys: Professional Quality of Life, Compassion Practice Instrument, and self-care resource utilization. Statistically significant improvements in CS and nonstatistical improvements in CF were found. Promoting a PSN may increase CS and potentially prevent work-related physical, emotional, social, and intellectual CF sequelae.

Older adults\u2019 readiness to engage with eHealth patient education and self-care resources: a cross-sectional survey

BackgroundThis study examined access to digital technologies, skills and experience, and preferences for using web-based and other digital technologies to obtain health information and advice among older adults in a large health plan. A primary aim was to assess the extent to which digital divides by race/ethnicity and age group might affect the ability of a large percentage of seniors, and especially those in vulnerable groups, to engage with online health information and advice modalities (eHIA) and mobile health (mHealth) monitoring tools.MethodsA mailed survey was conducted with age-sex stratified random samples of English-speaking non-Hispanic white, African-American/black (black), Hispanic/Latino (Latino), Filipino-American (Filipino), and Chinese-American (Chinese) Kaiser Permanente Northern California members who were aged 65–79 years. Respondent data were weighted to the study population for the cross-sectional analyses.ResultsOlder seniors and black, Latino, and Filipino seniors have less access to digital tools, less experience performing a variety of online tasks, and are less likely to believe that they would be capable of going online for health information and advice compared to younger and white Non-Hispanic seniors. Consequently, they are also less likely to be interested in using eHIA modalities.ConclusionsThe same subgroups of seniors that have previously been shown to have higher prevalence of chronic conditions and greater difficulties with healthcare access are also less likely to adopt use of eHIA and mHealth monitoring technologies. At the patient population level, this digital divide is important to take into account when planning health information and chronic disease management programs. At the individual patient level, to provide good patient-centered care, it is important for providers to assess rather than assume digital access, eHealth skills, and preferences prior to recommending use of web-based resources and mHealth tools.

The impact of the social and physical environments on parent–healthcare provider relationships when a child dies in PICU: Findings from a grounded theory study

ObjectivesThis study explores the influences of the paediatric intensive care environment on relationships between parents and healthcare providers when children are dying. It forms part of a larger study, investigating parental experiences of the death of their child in intensive care. Research methodologyConstructivist grounded theory. SettingFour Australian paediatric intensive care units. Main outcome measuresAudio-recorded, semi-structured interviews were conducted with twenty-six bereaved parents. Data were analysed using the constant comparison and memoing techniques common to grounded theory. FindingsThe physical and social environment of the intensive care unit influenced the quality of the parent–healthcare provider relationship. When a welcoming, open environment existed, parents tended to feel respected as equal and included members of their child’s care team. In contrast, environments that restricted parental presence or lacked resources for parental self-care could leave parents feeling like ‘watchers’, excluded from their child’s care. ConclusionsThe paediatric intensive care unit environment either welcomes and includes parents of dying children into the care team, or demotes them to the status of ‘watcher’. Such environments significantly influence the relationships parents form with healthcare staff, their ability to engage in elements of their parental role, and their experiences as a whole.

An evaluation of involving family caregivers in the self-care of heart failure patients on hospital readmission: Randomised controlled trial (the FAMILY study)

BackgroundThe prevalence of heart failure is increasing in Lebanon but to date there is no systematic evaluation of a disease management intervention. ObjectiveThe aim of this study was to evaluate the effect of involving family caregivers in the self-care of patients with heart failure on the risk of hospital readmission. DesignA multi-site, block randomised controlled trial. SettingsThe study was conducted over a 13-month period in three tertiary medical centres in Beirut and Mount Lebanon, Lebanon. ParticipantsAdult patients presenting for an exacerbation of heart failure to one of the study centres were included. Patients with limited life expectancy or physical functionality, planned cardiac bypass or valve replacement surgery, living alone or in nursing homes, or aged less than 18 years were excluded. MethodsPatients allocated to the intervention group and their family caregivers were provided with a comprehensive, culturally appropriate, educational session on self-care maintenance and symptom management along with self-care resources. The usual care group received the self-care resources only. Follow-up phone calls were conducted 30days following discharge by a research assistant blinded to treatment assignment. The primary outcome was hospital readmission and the secondary outcomes were self-care, quality of life, major vascular events and healthcare utilization. ResultsThe final sample included 256 patients hospitalized for heart failure randomised into control (130 patients) and intervention (126 patients) groups. The mean age was 67 (SD=8)years, and the majority (55%) were male. Readmission at 30days was significantly lower in the intervention group compared to the control group (n=10, 9% vs. n=20, 19% respectively, OR=0.40, 95% CI=0.02, 0.10, p=0.02). Self-care scores improved in both groups at 30days, with a significantly larger improvement in the intervention group than the control group in the maintenance and confidence sub-scales, but not in the self-care management sub-scale. No differences were seen in quality of life scores or emergency department presentations between the groups. More patients in the control group than in the intervention group visited health care facilities (n=24, 23% vs. n=12, 11% respectively, OR=0.39, 95% CI=0.18, 0.83, p=0.01). ConclusionThe trial results confirmed the potential of the family-centred self-care educational intervention under evaluation to reduce the risk of readmission in Lebanese patients suffering from exacerbated heart failure. Further research is needed to validate these findings with longer periods of follow-up and to identify the intervention components and intensity required to induce sustained benefits on patients' self-care management and quality of life.

Prevalence and patterns of use of mantra, mindfulness and spiritual meditation among adults in the United States

BackgroundDespite a growing body of scientific literature exploring the nature of meditation there is limited information on the characteristics of individuals who use it. This is particularly true of comparative studies examining prevalence and predictors of use of various forms of meditation.MethodsA secondary analysis was conducted using data from the 2012 National Health Interview Survey (n = 34,525). Three popular forms of meditation were compared—mantra, mindfulness, and spiritual—to determine lifetime and 12-month use related to key sociodemographic, health behavior, health status, and healthcare access variables.ResultsThe 12-month prevalence for meditation practice was 3.1% for spiritual meditation, 1.9% for mindfulness meditation, and 1.6% for mantra meditation. This represents approximately 7.0, 4.3, and 3.6 million adults respectively. A comparison across the three meditation practices found many similarities in user characteristics, suggesting interest in meditation may be more related to the type of person meditating than to the type of practice selected. Across meditation styles use was more prevalent among respondents who were female, non-Hispanic White, college educated, physically active; who used other complementary health practices; and who reported depression. Higher utilization of conventional healthcare services was one of the strongest predictors of use of all three styles. In addition to similarities, important distinctions were observed. For example, spiritual meditation practice was more prevalent among former drinkers. This may reflect use of spiritual meditation practices in support of alcohol treatment and sobriety. Reasons for use of meditation were examined using the sample of respondents who practiced mindfulness meditation. Wellness and prevention (74%) was a more common reason than use to treat a specific health condition (30%). Common reasons for use included stress management (92%) and emotional well-being (91%), and to support other health behaviors. Meditation was viewed positively because it was self-care oriented (81%) and focused on the whole person (79%).ConclusionMeditation appears to provide an accessible, self-care resource that has potential value for mental health, behavioral self-regulation, and integrative medical care. Considering consumer preference for distinct types of meditation practices, understanding the underlying mechanisms, benefits, and applications of practice variations is important.

Endometrial cancer survivors’ access to recommended self-care resources to target obesity in a high poverty urban community

Endometrial cancer survivors’ access to recommended self-care resources to target obesity in a high poverty urban community

A 3-Month Randomized Controlled Pilot Trial of a Patient-Centered, Computer-Based Self-Monitoring System for the Care of Type 2 Diabetes Mellitus and Hypertension

This study was performed to evaluate the effects of a patient-centered, tablet computer-based self-monitoring system for chronic disease care. A 3-month randomized controlled pilot trial was conducted to compare the use of a computer-based self-monitoring system in disease self-care (intervention group; n = 33) with a conventional self-monitoring method (control group; n = 30) in patients with type 2 diabetes mellitus and/or hypertension. The system was equipped with a 2-in-1 blood glucose and blood pressure monitor, a reminder feature, and video-based educational materials for the care of the two chronic diseases. The control patients were given only the 2-in-1 monitor for self-monitoring. The outcomes reported here included the glycated hemoglobin (HbA1c) level, fasting blood glucose level, systolic blood pressure, diastolic blood pressure, chronic disease knowledge, and frequency of self-monitoring. The data were collected at baseline and at 1-, 2-, and 3-month follow-up visits. The patients in the intervention group had a significant decrease in mean systolic blood pressure from baseline to 1 month (p < 0.001) and from baseline to 3 months (p = 0.043) compared with the control group. Significant improvements in the mean diastolic blood pressure were seen in the intervention group compared with the control group after 1 month (p < 0.001) and after 2 months (p = 0.028), but the change was not significant after 3 months. No significant differences were observed between the groups in the fasting blood glucose level, the HbA1c level, or chronic disease knowledge. The frequency of self-monitoring of blood glucose level and blood pressure was similar in both groups. The performances of the tablet computer-assisted and conventional disease self-monitoring appear to be useful to support/maintain blood pressure and diabetes control. The beneficial effects of the use of electronic self-care resources and support provided via mobile technologies require further confirmation in longer-term, larger trials.