Self-care Theory Research Articles

Descriptive qualitative study of breathlessness and its management of Turkish individuals with self-reported heart failure

AimsTo explore the experiences of individuals with heart failure, with a specific focus on elucidating the full spectrum of symptoms experienced and their subjective descriptions of breathlessness and self-management strategies...

Abstract 4141453: The Pandemic influenced the Self-care of African Immigrants with Diabetes and Hypertension

Background: Self-Care is essential for chronic illness management. Self-Care comprises three domains: Self-Care maintenance (daily behaviors to maintain health [e.g., medication adherence]), Self-Care monitoring (surveillance for changes), and (3) Self-Care management (prompt response to symptoms). The COVID-19 pandemic challenged self-care in some populations, but little is known about how it influenced the self-care of African immigrants living in the US with chronic illnesses such as hypertension and diabetes. Methods: Using a qualitative descriptive design, we enrolled a purposeful sample of 24 sub-Saharan African immigrant adults with self-reported symptomatic hypertension or diabetes. Participants who spoke English were enrolled between March 2020 and September 2021. Individual audio-taped interviews were transcribed and analyzed. Inductive and deductive thematic analysis was guided by the Theory of Self-Care of Chronic Illness. Results: Participants were mean=59 years (range 40-72). Most were Nigerian (n=16), male (n=16), married (n=17), living with family (n=21), highly educated (n=21), and reporting enough income to meet their needs (n=21). Five major themes were identified: (1) Being especially careful in following COVID-19 precautions (e.g., use of facemasks). (2) A focus on self-care maintenance (e.g., healthy diet, staying active while at home). Fear of COVID-19 increased medication adherence. Participants were diligent in taking medications as prescribed due to fear of COVID-19. (3) Close monitoring for symptoms. (4) Trouble reaching providers to discuss symptoms. (5) Access to resources. Participants reported loss of health insurance/jobs and lack of provider access, which impacted their ability to perform self-care. Conclusions: COVID-19 increased focused attention on self-care but also created barriers for sub-Saharan African Immigrants. Most impacted was self-care maintenance. Interventions to promote self-care in this population should leverage heightened vigilance to self-care and address challenges around access to resources.

Effectiveness of the Individualized Self-Care Program Based on Orem’s Self-Care Theory: Impact on Learning Needs and Self-Care Behaviors Following Coronary Artery Bypass Surgery – A Randomized Controlled Trial

PurposeThis study aimed to investigate the specific learning needs of patients within the experimental group after receiving the Individualized Self-Care Program (ISCP) at two key time points: Time 2 (Day 2, Week 1) and Time 3 (Day 15, Week 3). Furthermore, it aimed to compare the effectiveness of the ISCP in improving self-care behavior between the experimental group and the control group, which received standard health education. MethodsThe study utilized a Randomized Controlled Trial (RCT) design and included a consecutive sample of 128 patients who had undergone their first CABG procedure. These patients were randomly divided into two groups: the experimental group (n = 64) and the control group (n = 64). The experimental group received an ISCP at Time 2 and Time 3 after being discharged, whereas the control group received standard health education. Statistical analyses included paired t-tests to assess differences in learning needs over time and Repeated Measures Analysis of Variance (ANOVA) to evaluate the effectiveness of the ISCP on self-care behavior. ResultsA paired t-test indicated a statistically significant difference in the total number of learning needs identified within the experimental group between Time 2 and Time 3 assessments. Patients in the experimental group initially identified more learning needs at Time 2 (4.3±1.5), but their knowledge significantly improved at Time 3, leading to fewer learning needs (2.6±1.1). Furthermore, an ANOVA comparing the experimental and control groups showed that the ISCP effectively improved self-care behavior in the experimental group, with significantly greater improvements compared to the control group, which received standard health education. ConclusionISCP delivered in early recovery enhances self-care behaviors and addresses postdischarge gaps. The study also revealed that patients' learning needs change over time during home recovery, emphasizing the importance of tailored self-care programs for CABG patients after discharge.

Measuring Self-Care: A Description of the Family of Disease-Specific and Generic Instruments Based on the Theory of Self-Care of Chronic Illness.

In recent years, there has been an exponential increase in attention paid to the patient-reported outcome of self-care. Many investigators have used one of the families of self-care instruments freely available on the website www.self-care-measures.com. These self-care measures have been translated into many languages, which are also available on the website. The measures include both disease-specific and generic instruments, which are based on a common theoretical framework, the Middle Range Theory of Self-Care of Chronic Illness. The purpose of this article is to illustrate similarities among the instruments and to standardize their scoring, analysis, and use. We describe the Self-Care of Heart Failure Index, the Self-Care of Coronary Heart Disease Inventory, the Self-Care of Hypertension Inventory, the Self-Care of Diabetes Inventory, the Self-Care of Chronic Obstructive Pulmonary Disease Inventory, the Self-Care of Chronic Illness Inventory, and the Self-Care Inventory. Detailed guidance on scoring, translation, and analysis is provided. Complementary measures of self-care self-efficacy and those used to measure caregiver contributions to patient self-care are briefly described. Many of the common questions of instrument users are answered in this article. Following this guidance will facilitate consistent use of the instruments, which will enable users to compare their results to those of others worldwide and facilitate future reviews and meta-analyses.Clinical ImplicationsThis review, emphasizing standard scoring and interpretation, is useful for clinicians and researchers across various populations and settings.

The effect of educational interventions by nurses through Orem's self-care theory on the ability of self-care in myocardial Infarction patients in public sector hospital: A quasi-experimental study.

To assess the impact of educational intervention by nurses guided by Orem's theory to reinforce the self-care abilities of patients experiencing myocardial infarction. The prospective, quasi-experimental case-control study was conducted from September 2020 to April 2021 at Dr. Ruth K.M. Pfau Civil Hospital, Karachi, and comprised myocardial infarction and heart failure patients with comorbidities diabetes mellitus and hypertension. The patients were randomised into experiment group A and control group B. Group A received educational intervention one day before and one day after discharge in line with the American Heart Association guidelines. Two 30-45-minute sessions of seven modules were conducted. Group B received routine information from ward staff. Assessment was done at baseline and first month and second month post-intervention using the Heart Failure Self-Care Index version 6.2. Data was analysed using SPSS 21. Of the 80 patients, 40(50%) were in group A; 27(76.5%) males and 13(32.5%) females. The remaining 40(50%) patients were in group B; 20(50%) males and 20(50%) females. The overall age of the sample ranged 36-65 years and 48(60%) had a previous history of heart failure. The mean score of maintenance, management, confidence and overall self-care were significantly higher in group A compared to group B (p<0.05). Nursing self-care educational intervention based on Orem's theory was found to be highly effective among patients of myocardial infarction and heart failure with respect to their self-efficacy ability.

Exploring Symptom Management Experiences Among College Students With Type 1 Diabetes Mellitus Using a Theoretical Framework: A Qualitative Study.

The purpose of this study was to explore symptom management experiences among college students with type 1 diabetes mellitus (T1DM). Limited qualitative data using a theoretical framework exist that explore the self-care behavior processes for symptom management. A qualitative approach was used for this study. The middle-range theory of self care of chronic illness served as a framework for data collection and analysis procedures. Data collection included distributing a survey to collect participants' demographic and sociodemographic data and utilizing a semi-structured interview guide to conduct one-on-one interviews with 31 participants. Interviews occurred via Zoom (n = 28) and in person (n = 3). Interview transcripts were uploaded in NVivo for data management. The research team created a codebook using theoretical constructs to assist with thematic analysis. Data are representative of a sample whose characteristics include undergraduate students ages 18 to 23 living with T1DM for 2 years or more who attended large, public, 4-year universities located in the southeastern United States. Three main themes were created using theoretical constructs: symptom detection experiences, symptom interpretation experiences, and symptom response experiences. Two subthemes were identified for each theme. Participants engaged in symptom management for blood glucose regulation through detecting changes in their blood glucose physiologically and via technology. Additionally, symptom interpretation involved analyzing blood glucose trends and determining common causes of blood glucose changes. Symptom response included immediately addressing hypoglycemia but delayed responses addressing hyperglycemia. Challenges were present responding to hypoglycemia; therefore, additional research is warranted to improve symptom response skills.

Exploring patients with COPD self-care behaviours and self-efficacy and their interconnections: A network analysis.

The aim of this study was to investigate self-care behaviours of patients with chronic obstructive pulmonary disease (COPD), understand their complex interconnections and identify key behaviours influencing self-care and self-efficacy. An observational, cross-sectional study design. The outpatient department of two tertiary hospital. A convenience sample of patients with a diagnosis of COPD were included (n = 222). Self-care behaviours were assessed using the Chinese version of self-care of chronic obstructive pulmonary disease inventory based on the Middle-Range Theory of Self-Care of Chronic Illness. Patient self-care efficacy was evaluated using Chinese version of Self-Care Self-Efficacy Scale in Chronic Obstructive Pulmonary Disease. Employing network analysis, associations between behaviours (nodes) and their interrelationships (edges) were deciphered. The study was reported following the STROBE checklist. Among the spectrum of self-care behaviours, patients exhibited the most pronounced deficiencies in behaviours directed to enhancing breathing, monitoring extra-respiratory symptoms and problem-solving. Within the network, the most central emerging behaviour was the modification of prescribed therapy at the worsening of symptoms, as suggested by healthcare providers, which drives all self-care behaviours. The confidence in being able to do something to relieve symptoms, despite difficulties, was a bridging activator of self-care. The network structure underscored the prominence of self-care self-efficacy in driving self-care maintenance, monitoring, and management behaviours. Education programs for COPD should prioritise enhancing breathing, symptom monitoring and problem-solving skills. The crucial self-care behaviour in COPD involves adjusting treatments in response to symptom changes. Patient confidence in symptom alleviation acts as a catalyst for self-care engagement. Targeted assessments addressing these aspects could enhance educational interventions, ultimately improving COPD patient outcomes. This study has been registered in the Chinese Clinical Trials Registry (registration number: ChiCTR2200059764; registration date: 11 May 2022).

Assessment of Stroke Patients' Muscle Strength Following a Combination of Mirror Therapy and ROM (Range of Motion) Exercises Based on Self-Care Theory

Background: When blood flow problems kill off some brain cells, the result is a neurological deficiency known as a stroke. There have been 507 reported cases of stroke in East Java, while the overall stroke prevalence in Indonesia has jumped from 7% to 10.9% (Riskesdas, 2020). The researchers at RSI Darus Syifa's Surabaya set out to determine how much of an impact self-care theory-based mirror therapy and range-of-motion exercises had on the muscular strength of stroke patients admitted to the inpatient unit. Methods: A true experimental with a pretest-posttest control group design was utilised in this type of research. One hundred and ten stroke patients made up the study's population. There were a total of 34 participants in this study, with 17 serving as control subjects and 17 as interventionists. Sampling was based on probability sampling using simple random sampling. The Medical Research Council (MRC) scale was utilised by the device to measure muscular strength. Mann-Whitney and the Wilcoxon Signet Rank Test were used to examine the collected data. Results: In the inpatient ward of the Darus Syifa Surabaya Hospital, stroke patients who undergo a combination of mirror therapy and range of motion exercises based on self-care theory show a significant improvement in muscle strength, according to the Mann-Whitney test (p &lt; 0.05). Conclusion: The study found that stroke patients' muscle strength improved with a combination of mirror therapy and range of motion exercises grounded in self-care theory.

Exploring self-care practices and health beliefs among men in the context of emerging infectious diseases: Lessons from the Mpox pandemic in Brazil.

Our goal was to explore self-care practices among men who have sex with men in the context of Mpox in Brazil. This study used qualitative research methods, including interviews and thematic analysis, to collect and analyze data from male participants across the Brazilian territory. The narratives unveil men's perspectives on self-care, risk reduction, and health beliefs during the Mpox pandemic. Our findings highlight a multifaceted approach to self-care among men, encompassing hygiene, physical contact management, mask usage, skin lesion vigilance, and adherence to official guidelines. Men's attitudes toward sexual behaviors emphasize the importance of reducing sexual partners, practicing safe sex, and combating misinformation through accurate information dissemination. The development of these behaviors and self-care practices can be facilitated by nurses guided by Dorothea Orem's Self-Care Theory, supported by patient-centered care, with strategies to address and confront the stigma associated with the disease and provide emotional support. Thus, the study underscores the pivotal role of self-care in mitigating infection risks, especially in the context of emerging infectious diseases. It acknowledges the impact of socio-cultural factors and healthcare policies on men's preventive measures. However, it also recognizes limitations, such as potential bias due to stigma concerns and a nonrepresentative sample. Ultimately, the research advocates for tailored education, promotion of gender equity, and healthcare empowerment to effectively manage health risks in such contexts.

Self-care behaviours of first-generation Chinese immigrants living with cardiovascular disease: A qualitative study.

To identify and describe self-care behaviours performed by Chinese immigrants living with cardiovascular disease in Australia, and factors perceived as barriers and facilitators to evidence-based cardiac self-care. A qualitative descriptive design. Individual semi-structured phone interviews were conducted among participants meeting the following criteria: (1) first-generation Chinese immigrants to Australia, born in Mainland China, Hong Kong, Macao or Taiwan; (2) Australian permanent residents or citizens; (3) self-reported or medically diagnosed with coronary heart disease, stroke or heart failure; (4) able to speak English or Mandarin; (5) able to provide informed consent, excluding those with history or evidence of impaired cognition such as dementia. Participants were recruited via social media, Chinese community associations and medical centres from September 2021 to June 2022. Data were analysed using inductive and deductive thematic analysis, guided by the Middle-Range Theory of Self-Care of Chronic Illness. The study was reported in line with the COREQ checklist. Twenty participants were interviewed, 60% female, mean age 69.9 years. Most migrated to Australia at older age following their retirement in China; most had limited English proficiency. Many practiced adequate self-care for their CVD in self-care maintenance and monitoring. Variously, they adopted heart-healthy diets, developed exercise routines, attended medical services and closely monitored their body signs and symptoms. However, self-adjusting medications, taking Traditional Chinese Medicine and self-administering health supplements were prevalent practices and first-response management of acute cardiac symptoms was suboptimal. Linguistic and cultural barriers to obtaining mainstream heart health information meant most participants resorted to informal, anecdotal and mainland Chinese sources. Diverse factors were held responsible for sub-optimal self-care behaviours but lack of access to linguistically and culturally appropriate heart health information was widely blamed. Linguistically and culturally appropriate community-based heart health education programmes are urgently needed, targeting healthy lifestyle modification, medication literacy and cardiac symptom management. Study findings can be used to improve cardiac nurses' cultural sensitivity and practices targeting Chinese immigrants. Partnering with Chinese community associations offers health service providers and policymakers an innovative route to co-design and deliver targeted heart health education interventions and support for this population. Chinese community centre managers contributed to data collection by supporting participant recruitment.

Effect of Nursing Intervention Based on Orem Self-care Theory on Peripheral Neuropathy in Patients with Breast Cancer Chemotherapy

Effect of Nursing Intervention Based on Orem Self-care Theory on Peripheral Neuropathy in Patients with Breast Cancer Chemotherapy

Self-Care of Diabetes and Diabetes Distress in Non-Hispanic Black Adults With Type 2 Diabetes.

The purpose of the study was to describe the level of self-care of diabetes and diabetes distress and examine their relationship in non-Hispanic Black adults living with type 2 diabetes. This cross-sectional, correlational study was conducted with 275 non-Hispanic Black adults with type 2 diabetes in North Carolina over 10 weeks, July 2022 to September 2022. An online survey collected sociodemographic and clinical characteristics, self-care measures of diabetes, and diabetes distress. The theory of self-care of chronic illness guided the study. Median regression examined the relationship between self-care of diabetes and diabetes distress. Of the 275 participants, over half reported a diagnosis of type 2 diabetes at younger ages than expected, with a mean age of 40. The self-reported mean A1C of 9% exceeded the recommended goal of <7%, with an average of 2 diabetes-related comorbidities. The self-care of diabetes scale scores were low, and total diabetes distress scores were high. Significant positive associations were found between total diabetes distress and self-care monitoring and self-care management. In this sample, non-Hispanic Black adults had low levels of self-care of diabetes and high levels of diabetes distress. The findings indicate a relationship between self-care of diabetes and diabetes distress; as diabetes distress increases, so do the attempted activities of self-care of diabetes. Health care professionals in diabetes care are uniquely positioned to address further the behavioral aspects of diabetes management, particularly diabetes distress, to support non-Hispanic Black adults living with type 2 diabetes.

Impact of vaccination on society's quality of life: Reflection based on the Self-Care Theory

The aim is to reflect on the ongoing impact of vaccination on society's quality of life. In the light of the third central concept of Dorothea Orem's Self-Care Theory, which deals with the nursing system, the aim is to analyze the role of the nursing team in promoting self-care through vaccination, highlighting its significant influence in promoting public health. This is a reflective, descriptive and critical study, carried out after a search of current scientific literature using as a source scientific journals indexed in Google Scholar, PubMed and databases grouped and indexed in the Virtual Health Library. The nursing team plays a vital role in promoting vaccination-related self-care. This involves empowering individuals to make informed decisions about their health, including the decision to get vaccinated, understanding the vaccination schedule and keeping up-to-date vaccination records. The nursing team is therefore recognized as a key player in ensuring the effectiveness of vaccination campaigns, especially in a scenario of rapid dissemination of information and growing challenges in the acceptance of vaccines, directly impacting on society's quality of life in the context of the immunization process.

Barriers and Facilitators Impacting Disease and Symptom Management Among College Students With Type 1 Diabetes: A Qualitative Study.

This study aimed to explore barriers and facilitators impacting disease and symptom management among college students living with Type 1 Diabetes (T1D). A qualitative, phenomenological approach using semi-structured, one-on-one interviews. Interviews conducted on Zoom (n = 28) and in-person (n = 3). Purposive sample of 31 college students living with T1D for at least 2years who attended large, 4-year public universities in the Southeastern United States. This study was theoretically informed using the Middle-Range Theory of Self-Care of Chronic Illness Integration of Symptoms to develop interview questions. Interviews were transcribed verbatim and uploaded in NVivo. Data were analyzed thematically using a codebook developed by the research team using the theory as a framework. Trustworthiness was established using an audit trail, memos, and negative case analysis. Four themes described barriers: diabetes burnout, challenges adjusting to a college lifestyle, difficulty receiving medical supplies, and insurance limitations. Five themes explained facilitators: years of experience managing T1D, tangible support with medical supplies, informational support for disease management, and emotional/technological support for disease and symptom management. Barriers and facilitators in this study should be addressed in future T1D interventions for college students. Findings can also guide healthcare professionals, health promotion practitioners, family, friends, and significant others on how to better support college students as they manage T1D.

The Influence of Smart Visual Education Based on Dorothea Orem's Self-Care Theory on Anxiety Levels

Anxiety is a feeling of discomfort, worry, fear, and tension. This response is a physiological response to external or internal stimuli that can cause behavioral, emotional, cognitive, and physical symptoms. Anxiety in patients starts from the moment the patient receives a surgery schedule. If the patient continues to feel anxious while the operation is in progress, this can disrupt the operation process because a tense patient can increase the heart rate which can affect the patient's blood pressure and breathing. This study aims to determine the effect of educational videos on anxiety in surgical patients. The research uses a quantitative research design with a quasi-experimental research design (pretest-posttest with control group design). There were 66 street children as respondents consisting of 33 control group respondents and 33 treatment group respondents. Respondents were determined using affordable population techniques. The independent variable is smart visual education based on Dorothea Orem's self-care theory and the dependent variable is anxiety level. Data was collected using a questionnaire and analyzed using the independent t-test with a significance level of p&lt;0.05. The instrument used was the Amsterdam Preoperative Anxiety and Information Scale (APAIS) Questionnaire. There is a significant relationship between respondents' anxiety levels in the pretest and posttest results (p=0.000) in both the control group and the treatment group. However, there was no significant difference in the delta of respondents' anxiety levels in both the control and treatment groups. Smart visual education based on Dorothea Orem's self-care theory influences reducing the anxiety level of patients who will undergo surgery with SAB regional anesthesia.

Caregivers' Contributions to Heart Failure Self-care: An Updated Systematic Review.

A previous systematic review reporting the contributions of informal, unpaid caregivers to patient heart failure (HF) self-care requires updating to better inform research, practice, and policy. The aim of this study was to provide an updated review answering the questions: (1) What specific activities do informal caregivers of adults with HF take part in related to HF self-care? (2) Have the activities that informal caregivers of adults with HF take part in related to HF self-care changed over time? (3) What are the gaps in the science? This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, CINAHL, EMBASE, and Cochrane CENTRAL databases were searched. Eligible studies involved an informal, unpaid caregiver of an adult with HF as a study variable or participant. Caregiving activities were benchmarked using the theory of self-care in chronic illness. Two thousand one hundred fifty-four research reports were identified, of which 64 met criteria. Caregivers' contributions occurred in self-care maintenance (91%), monitoring (54%), and management (46%). Activities performed directly on or to the patient were reported more frequently than activities performed for the patient. Change over time involved the 3 domains differentially. Gaps include ambiguous self-care activity descriptions, inadequate caregiving time quantification, and underrepresented self-care monitoring, supportive, and communication activities. Newly identified caregiver-reported activities support updating the theory of self-care in chronic illness to include activities currently considered ancillary to HF self-care. Identified gaps highlight the need to define specific caregiving activities, determine task difficulty and burden, and identify caregiver self-care strategy and education needs. Exposing the hidden work of caregiving is essential to inform policy and practice.

Interplay of self-care, self-efficacy, and health deviation self-care requisites: a study on type 2 diabetes patients through the lens of Orem’s self-care theory

BackgroundThis study aimed to examine the relationship between Self-Care, Self-Efficacy, and Health Deviation Self-Care Requisites in patients with type 2 diabetes based on Orem’s Self-Care Theory.MethodsThe research involved 341 patients with type 2 diabetes in Rasht, Iran, using a descriptive-analytical cross-sectional design. The data collection included questionnaires assessing Self-Care Behaviors, Self-Efficacy, and Health Deviation Self-Care Requisites based on Orem’s model.ResultsDemographic factors such as gender, marital status, employment, education, age, duration of disease, and oral treatment and insulin had no consistent effect on self-care behaviors. Self-efficacy was a key factor influencing Self-Care Behaviors in diabetic patients. There was a strong and direct correlation between Self-Care Behaviors and Self-Efficacy, indicating the role of individuals’ confidence in managing diabetes. Health Deviation Self-Care Requisites had both positive and negative correlations with different domains of Self-Care Behaviors.The physical exercise construct of self-efficacy was the most significant predictor of Self-Care Behaviors.ConclusionsThis study provides valuable insights into the complex relationship between Self-Care, Self-Efficacy, and Health Deviation Self-Care Requisites in patients with type 2 diabetes. The findings underscore the importance of addressing Self-Efficacy and specific self-care domains, such as physical activity and foot care, in diabetes management strategies. This research contributes to the existing knowledge base and may inform healthcare professionals and policymakers in developing targeted interventions to improve self-care practices in diabetic patients.

Development and validation of the self-volume management behaviour questionnaire for patients with chronic heart failure.

We aim to develop and validate a questionnaire on the behaviour of self-volume management of patients with chronic heart failure. Based on the specific situation theory of heart failure self-care, the items of this questionnaire were formed through literature review and expert consultation. Content validity is judged by expert consultation. Item analysis was used for further filter entries. Cronbach's alpha and retest were used for reliability. Exploratory factor analysis and confirmatory factor analysis were used to test the structural validity. The questionnaire finally contained 3 subscales and 22 items. The Cronbach's α was between 0.732 and 0.797. The reliability of the retest was between 0.983 and 0.998. In expert consultation, the I-CVI of each item was 0.92-1, and the S-CVI of each subscale was 0.99, 1.00, and 0.99. In exploratory factor analysis, each subscale has two factors. In confirmatory factor analysis, the model fits of the three subscales were good: χ2/df<3, RMSEA<0.08, CFI>0.9, TLI>0.9, and SRMR<0.05. The study has shown that the questionnaire on the behaviour of self-volume management of patients with chronic heart failure has good reliability and validity. It can be used as an evaluation tool for evaluating the self-volume management behaviour of patients with chronic heart failure.

Improvement of Pain-Free Walking Distance with Implementation of Treadmill Protocol

Peripheral arterial disease (PAD) may cause lower extremity pain that can impair activities of daily living. At a vascular clinic in rural New Mexico, peripheral arterial disease patients are managed but their symptoms continue to worsen so an evidence- based solution was sought. The purpose of this quantitative, quasi-experimental project was to determine if or to what degree the translation of McDermott et al.’s published research on the Gardner-Skinner Protocol will impact the pain-free walking distance when compared to current practice among peripheral arterial disease patients with intermittent claudication in a university activity center in rural New Mexico over four weeks. Dorothea Orem's self-care theory and Kurt Lewin's change theory provided the project's theoretical foundations. Data on walking distance was measured using the Six-Minute Walk Test in PAD patients (n = 12) and were compared at baseline and four weeks post-implementation of the intervention. A paired t-test showed no statistically significant difference in pain-free walking distance from baseline (M = 267.85, SD = 244.05) to post-intervention (M= 339.58, SD= 191.42), t (11) = -1.27, p= .23. Despite the lack of statistical significance, there was clinical significance in that the mean increase in pain-free walking distance increased by 70.83 feet. Therefore, the implementation of the Gardner-Skinner Protocol may improve walking distance in this population of patients. Recommendations are to continue the implementation and continue to analyze data for six months prior to dissemination.

Predictive influence of disease knowledge and hope on self-care behavior among adults with heart failure.

Self-care, disease knowledge, and hope are critical concepts in health-related studies. Therefore, all three are considered solutions for controlling heart failure (HF) and reducing its complications. This study aimed to identify the predictive influence of disease knowledge and hope on self-care behavior among adults with HF. This descriptive-analytical and cross-sectional study examined the data of 113 HF patients referred to the Imam Reza Clinic in Shiraz, Iran, in 2021. This study used HF patients' self-care instruments based on Orem's self-care theory, the HF Knowledge Scale-Persian version, and the Heart Hope Index-Persian version. The data were analyzed using the general linear model (GLM) and Pearson's correlation coefficients. Of the 113 HF patients, 54.90% (n = 62) were male, and 45.10% (n = 51) were female. The analysis of the Pearson correlation coefficient indicated the presence of a positive and significant correlation between "self-care and hope" (r = 0.532, P = 0.0001), "HF knowledge and hope" (r = 0.432, P = 0.0001), and "self-care and HF knowledge" (r = 0.410, P = 0.0001). GLM showed that HF knowledge symptoms (P = 0.0001), hope (P = 0.0001), unemployed patients (P = 0.042), and housewife patients (P = 0.0001) predicted self-care behavior of HF patients. Considering the positive and significant correlation between "self-care and HF knowledge," "self-care and hope," and "HF knowledge and hope," it seems necessary for doctors and nurses should pay attention to providing educational programs to increase HF knowledge to improve self-care and hope in HF patients.