Decision-Making and Management of Self-Care in Persons with Traumatic Spinal Cord Injuries: A Preliminary Study

Patients and physicians understand the importance of self-care following spinal cord injury (SCI), yet many individuals with SCI do not adhere to recommended self-care activities despite logistical supports. Neurobehavioral determinants of SCI self-care behavior, such as impulsivity, are not widely studied, yet understanding them could inform efforts to improve SCI self-care. We explored associations between impulsivity and self-care in an observational study of 35 US adults age 18 - 50 who had traumatic SCI with paraplegia at least six months before assessment. The primary outcome measure was self-reported self-care. In LASSO regression models that included all neurobehavioral measures and demographics as predictors of self-care, dispositional measures of greater impulsivity (negative urgency, lack of premeditation, lack of perseverance), and reduced mindfulness were associated with reduced self-care. Outcome (magnitude) sensitivity, a latent decision-making parameter derived from computationally modeling successive choices in a gambling task, was also associated with self-care behavior. These results are preliminary;more research is needed to demonstrate the utility of these findings in clinical settings. Information about associations between impulsivity and poor self-care in people with SCI could guide the development of interventions to improve SCI self-care and help patients with elevated risks related to self-care and secondary health conditions.

Information Needs and Self-Care Practices of Diabetic Patients in Mbala, Northern Province, Zambia

Introduction: Diabetes mellitus (DM) is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. It is “a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action or both” manifested by carbohydrates, fat and protein metabolism abnormality. If untreated high blood sugar can damage the nerves, eyes, kidneys, and other organs. The purpose of this study was to assess the information needs and self-care practice of Diabetic Patients in Mbala, Northern Province Zambia. Methods: This was an analytical cross-sectional study where 105 respondents aged 18 years and above participated in the study. Participants were randomly selected. A structured interview schedule and a check list were used to collect data. Statistics Package for Social Sciences computer software package version 23.0 was used to analyze data. Chi square and fisher’s exact tests were used to test the significance of the association between Knowledge of Diabetes Mellitus, attitude towards self-care practices, self-care practices among Diabetic patients and the need for information among Diabetic patients. A 95% confidence interval and P value of 0.05 were used to ascertain the degree of significance. Multi-variate binary logistic regression model to determine predictors of self-care practices and need for information was also used. Result: On analyzing the dependent variables, more than half (61.9%), had high need for information and three quarters (85.7%) of respondents had poor self-care practices. Slightly more than half (58.1%) had high knowledge levels majority (78.1%), had a negative attitude. Significant associations were found P Conclusion: Negative attitudes and lack of information among Diabetic patients were the main reasons associated with poor self-care practices. Particular attention should therefore be given to ensuring that Diabetic patients are given adequate information on Diabetes self-care in order to improve the quality of life.

医院-社区-家庭三元联动延续护理在2型糖尿病病人中的应用

目的:探讨医院-社区-家庭三元联动延续护理对2型糖尿病病人自我管理能力、自我效能感、代谢相关指标的影响。方法:选取2022年1月—7月入住我院内分泌科的108例病人,应用医院-社区-家庭三元联动延续护理模式进行为期18个月的干预。分别于干预前及干预3、6、9、12、18个月后评估病人的自我管理能力、自我效能感和代谢相关指标。结果:干预不同时间,2型糖尿病病人的自我管理能力、自我效能感、空腹血糖、糖化血红蛋白、葡萄糖在目标范围内时间均有统计学意义(P<0.05)。结论:医院-社区-家庭三元联动延续护理模式有助于提升2型糖尿病病人的自我管理能力和自我效能感,改善代谢相关指标。

Guided Care护理对接受体外受精-胚胎移植的肥胖型多囊卵巢综合征不孕患者的干预效果

目的 评价Guided Care护理方案对接受体外受精-胚胎移植(IVF-ET)助孕的肥胖型多囊卵巢综合征(PCOS)患者的干预效果。方法 选择2022年1—12月在河南省人民医院生殖中心接受IVF-ET助孕的74例肥胖型PCOS患者作为研究对象,按随机数表法分为观察组(37例)和对照组(37例)。对照组患者接受常规护理,观察组在常规护理基础上接受Guided Care护理。比较两组患者治疗依从性、生活方式及焦虑程度。结果 Guided Care护理可提高患者的就医及服药依从性,改善其生活方式,降低患者的焦虑程度(P<0.05)。结论 Guided Care护理方案可以改善肥胖型PCOS患者的治疗依从性及其生活方式,降低患者的焦虑程度。

Application of self-care based on full-course individualized health education in patients with chronic heart failure and its influencing factors

BACKGROUND The treatment of heart failure not only needs to relieve the clinical symptoms and improve the quality of life for patients but also needs to select scientific and reasonable ways to prevent or delay the progression of the disease,thus reducing the mortality and hospitalization rate.Although the previous regimen can effectively relieve symptoms in the early stage of treatment,long-term use may cause adverse events,such as arrhythmia,and even increase mortality.Therefore,conventional treatment cannot meet the actual health needs of patients,and scientific nursing intervention is very necessary.AIM To investigate the application of self-care based on full-course individualized health education (FCIHE) and its influencing factors in patients with chronic heart failure (CHF).METHODS We enrolled CHF patients who were admitted to our center between September 2015 and June 2016 and divided them into an intervention group (n = 50) and control group (n = 50) using a random number table.Routine nursing care was applied to the control group,and FCIHE was offered to the intervention group.The self-care behavior,6-min walking distance (6MWD),and 36-item short form health survey (SF-36) scores were compared between the two groups.The influencing factors of the self-care were also analyzed.RESULTS The 6MWD was not significantly different between the two groups at admission (P > 0.05);however,at 3 and 6 mo after discharge,6MWD was significantly increased,and it was significantly longer in the intervention group (P < 0.05).The scores for self-care behavior showed no significant difference at admission between the two groups (P > 0.05);however,at 3 and 6 mo after discharge,the total scores for self-care maintenance,management,confidence,and behavior of the intervention group were significantly higher than those of the control group (P < 0.05).There were no significant differences in the SF-36 scores at admission (P > 0.05);however,at 3 mo and 6 mo after discharge,the scores for all eight subscales,including physical functioning,role limitations due to physical problems,bodily pain,general health perceptions,vitality,social functioning,role-limitations due to emotional problems,and mental health,were significantly higher in the intervention group (P < 0.05).As shown by logistic regression analysis,the influencing factors of self-care mainly included age,cardiac function class,and education background (odds ratio > 1;all P < 0.05).CONCLUSION FCIHE improved self-care behavior and cardiac function in CHF patients.Age,cardiac function,and education level affected the implementation of self-care among CHF patients.

Diabetes self-care in primary health facilities in India-challenges and the way forward

India has approximately 73 million people living with diabetes and another 37 million with prediabetes while nearly 47% of the diabetes cases are undiagnosed. The high burden of poor glycemic control and early onset of complications with associated economic costs indicates a high prevalence of poor self-management practices. It is well-established that achieving patient-centered primary care consistent with a chronic care model ensures optimum diabetes self-management support and improves long-term clinical and health outcomes in diabetes patients. The public sector primary care system in India provides services free of cost to beneficiaries but lacks patient-centered care that undermines diabetes selfmanagement education and support. Furthermore, factors like poor patient knowledge of diabetes, suboptimal medication adherence, persistent clinical inertia, lack of data for monitoring and evaluation through clinical audit worsens the standards of diabetes care in primary care settings of India. There is a need for government initiatives to be directed towards the provision of comprehensive outpatient care that is inclusive of uninterrupted supply of drugs, provision of essential laboratory investigators, training and availability of qualified diabetes educators and availability of specialist support when required. Furthermore, the integration of depression screening and smoking cessation services at the primary care level is warranted.

Type D personality negatively associated with self-care in Chinese heart failure patients

Background Little is known about the association between type D personality and self-care behaviors in heart failure （HF） patients. We examined the effect of type D personality on self-care behaviors and self-efficacy among Chinese HF patients. Methods A cross-sectional study with a convenience sample was conducted. All participants completed the questionnaires of the self-care of HF index （V6） and type D personality scale. Demographic and clinical variables were obtained from medical records and patient interviews. The me- thods used for data analysis included descriptive analysis, independent-sample t-test, Z2 test, and multiple linear regression. Results A total of 127 HF patients were included and 61.4% of them were male. The average age for this study sample was 64.9± 12.34 years. The majority of the participants were in a New York Heart Association class III or IV （87%）, and the average length of living with HF was 38.24 ± 41.1 months. A total of 33.1% of the participants were identified as having type D personality. No significant differences were determined in the demographic and clinical variables between type D and non-type D patients, except for the mean age and the length of living with HF. Type D patients were younger and had a shorter time of living with HF than their non-type D counterparts. Multiple regression demonstrated significant associations between type D personality and self-care maintenance and self-efficacy after adjusting the demographic and clinical factors. However, type D personality was not significantly associated with self-care management behaviors. Conclusions Type D personality was negatively related to self-care maintenance and self-efficacy in Chinese HF patients. Future study is warranted to develop a tailored intervention to improve engagement in self-care behaviors in HF patients with type D personality.

Self-care actions for the maintenance of the arteriovenous fistula:An integrative review

Objective:To identify self-care actions for the maintenance of arteriovenous fistula of renal patients.Method:An integrative review study was conducted and literature were searched in Medline/PubMed,Scopus,CINAHL LILACS,BDENF and SciELO Library databases using the descriptors chronic renal insufficiency,arteriovenous fistula,self-care,and knowledge.The inclusion criteria were that the documents be written in Portuguese,English,and Spanish,full text available,published in the last five years,and that they address the research question.Reflection articles,theses,dissertations,editorials of nonscientific journals,and research studies that did not follow the necessary methodological rigor were excluded.Data were analyzed with the IRAMUJTEQ software.Results:Fifteen articles were selected and comprised the final sample.Seven classes of self-care actions emerged from the text segments analysis and grouped into three categories:(1)Self-care actions that maintain the arteriovenous fistula;(2)Self-care actions for the prevention and the monitoring of complications with arteriovenous fistula;(3)Self-care actions directed at the perioperative period of arteriovenous fistula preparation.Conclusion:The results allowed us to identify important care for the maintenance of arteriovenous fistula functionality.The self-care actions identified in this study can guide a nursing care policy for implementation with protocols that help identify problems related to self-care actions and,thus,subsidize the development of actions aimed at the renal patient.However,more studies with high levels of evidence that identify self-care actions with arteriovenous fistula and the factors involved in its implementation are needed.

基于盲道病房联合Teach-back的健康教育在眼科术后患者中的实践

目的探讨盲道病房联合Teach-back的健康教育在眼科术后患者中的应用实践。方法选取2021年1—12月医院收治的122例眼科手术患者为研究对象,按照组间基线资料均衡可比的原则分为对照组和观察组,每组61例。对照组采取常规护理流程;观察组在对照组基础上采用Teach-back的健康教育方案。比较两组患者干预前后术后视障碍期间意外事件发生率、焦虑评分、术后生活自理能力以及体验的满意程度。结果观察组患者术后视障碍期间意外事件发生率低于对照组,差异具有统计学意义(P<0.05)。观察组患者术后焦虑评分低于对照组,差异具有统计学意义(P<0.05)。观察组患者术后进餐、梳洗、穿衣、如厕、活动等日常生活自理能力评分高于对照组,观察组患者对病房设置体验的满意程度高于对照组,差异均具有统计学意义(P<0.05)。结论盲道病房联合Teach-back的健康教育有利于降低眼科术后患者意外事件发生率,缓解患者术后心理焦虑问题,提高患者术后身心状态及生活自理能力,从而提高眼科护理安全管理和服务能力,也为我国眼科防盲事业发展起了推动作用。

Self-care:A concept analysis

Objectives:There is extensive literature from various disciplines on self-care,an important aspect of nursing intervention via evaluation and education,but its meaning remains unprecise due to the difficulty integrating the diverse definitions developed over time across disciplines.Therefore,it is vital to clarify the meaning of self-care and formulate the defining attributes,antecedents,and consequences to self-care.Methods:Walker and Avant’s concept analysis approach was used to analyze the concept of self-care.A search of the literature was completed using the databases CINAHL,PubMed,and EBSCOhost for years 1975e2020;literature search included peer-review articles,full-text publications,and available in English.A total of 31 articles were reviewed,and saturation was reached.Results:An extensive review of the literature revealed salient characteristics that reflected the most frequently used terms associated with the concept.Guided byWalker and Avant’s method,three defining attributes emerged as common themes:awareness,self-control,and self-reliance.Conclusions:A clarified definition was identified:the ability to care for oneself through awareness,selfcontrol,and self-reliance in order to achieve,maintain,or promote optimal health and well-being.

The Process of Compliance with Self-Care among Patients with Hypertension: A Grounded Theory Study

Introduction: Controlling hypertension across world continues to be challenging. Managing hypertension is not only concerned with lowering blood pressure by using antihypertensive medications;it also aims to minimize its consequences through adopting self-care practices. Compliance with self-care practices among patients with hypertension is considered a multidimensional phenomenon. The phenomenon of hypertension has been studied quantitatively, however;little qualitative studies were conducted to understand the compliance with self-care among patients with hypertension. Aim: To understand the process that patients with hypertension go through to comply with self-care practices. Methods: This study used a qualitative design that followed constructivist grounded theory approach;purposive sampling was used to recruit participants from cardiac clinics;semi structured, in-depth and face-to-face interview was used as a major method for data collection. Findings: Four participants with hypertension participated in this study;the phenomena of self-care was identified as the central phenomena;the start of the disease was identified as a casual condition;beliefs toward hypertension disease, beliefs toward self-care practices, knowledge and awareness regarding hypertension disease and self-care practices were identified as strategies;experiencing self-care practices was identified as consequence and being patients with hypertension in a social context. Conclusions: The process of compliance with self-care has a path of actions and interactions. The process started from the moment of diagnosis where the patients start to think about self-care. The absence of health care context leads to varying level of compliance with self-care among patients with hypertension. This indicated the need for more effective patient and health care provider relationship, education and awareness campaign.

Interaction between Locomotion and Self-Care for Patients with Stroke in Severity Classification Based on the Motor Functional Independence Measure upon Admission to the Recovery Ward

Background: A correlation between self-care and gait in stroke patients has been shown. However, there are few reports suggesting an interaction between self-care and gait. Purpose: To investigate the interaction between locomotion and improvements in self-care. Participants and Methods: We retrospectively analyzed 3034 stroke patients who were registered in the Japanese Rehabilitation Database. Using their data, patients were classified into three groups (severe, moderate, slight) based on the motor functional independence measure upon admission, and data were modified as mean-centered values. We performed a correlation analysis to evaluate the relationship among all the collected data. Subsequently, a hierarchical multiple regression analysis was performed to evaluate interaction using the self-care motor score from the Functional Independent Measure (FIM) as the dependent variable. Model 1 used two independent variables (National Institutes of Health Stroke Scale and cognitive FIM score), model 2 used two independent variables (locomotion gain and gain of an item with the strongest correlation coefficient to the de-pendent variable), and model 3 used a mean-centering value, which was added to model 2. The simple slope was used for further analysis. Results: Locomotion showed an interaction with self-care, except in the slight group. The R2 changes in models 1 and 2 were significant in the following: grooming, dressing lower body, and bladder management in the severe group (p < 0.01), and only dressing upper body in the moderate group (p < 0.01). Results of the simple slope analysis were significant for grooming, bowel management, and dressing lower body in the severe group and for dressing upper body in the moderate group. Conclusion: Locomotion demonstrated interaction with improving self-care, mainly in the severe group. Therefore, for moderate and slight cases, an intervention that not only involves locomotion training but also focuses on improving activities of daily living should be considered.

Professional nurses’facilitation of self-care in intensive care units:A concept analysis

Objective:This article aims to provide an in-depth analysis of the concept of self-care in the intensive care unit and outline its defining attributes,antecedents,consequences and empirical referents.Methods:The literature was searched electronically using databases such as CINAHL,Medline,Psych INFO,ERIC,ScienceDirect,Amed,EBSCO(Health Source:Nursing and Academic Edition),Sage,Ujoogle and Google Scholar.Articles from 2013 to 2020 were searched to target recent and up-to-date information about the definitions,attributes,antecedents and consequences of the concept of self-care.Walker and Avant’s framework was utilised to analyse the concept of self-care.Results:The results of the concept analysis identified seven attributes,namely process,activity,capability,autonomous choice,education,self-control and interaction.The seven identified antecedents are self-motivation,participation,commitment,resources,religious and cultural beliefs,social,spiritual and professional support,and the availability of time.The consequences are the maintenance of health and wellbeing,autonomy,increased self-esteem,disease prevention,empowerment,increased social support and the ability to cope with stress.

Automated Telephone Calls in the Follow-Up of Self-Care in Outpatients with Type 2 Diabetes: A Feasibility Study

Aims and objectives: To test an automated telephone service as a follow-up and support strategy for self-care in a population of adult Mexican patients with type 2 diabetes. Methods: The design was a two-group comparative design, with pre and post-intervention measurements. Patients were assigned into intervention (n = 31), or comparison (n = 33) groups. Over 12 weeks, each participant in the intervention group received automated phone calls with instructions to facilitate accomplishment of the treatment, and self-care activities. Two focus groups helped to appreciate patients’ follow-up experience. Randomized grouping was performed by selecting numbers from an urn;the final sample comprised 31 (48%) patients in the intervention group, and 33 (52%) in the comparison group;these procedures were performed by the case nurse management. The study was approved by the Ethics Committee of the Autonomous University of Nuevo Leon and the University of Michigan;all of the participants signed informed consent. Results: Of the 372 programmed phone calls made to the participants, 234 were completed, representing a 62.9% response rate. Phone calls may be associated to a 0.82% decrease in the HbA1c values and to lower depression scores. HbA1c measurements decreased 0.82% (M = 7.41 - 6.69;t = 25;4.11;p = ?0.001) from the baseline values over the 12-week study in the intervention group and 0.49% (M = 7.24 - 6.75;t = 26;2.11;p = 0.044) in the comparison group. Variables related to medication intake did not exhibit differences between the baseline and second measurements, except with respect to the scale of depression.

Diabetes self-management education:Benefits and challenges

Diabetes mellitus has spread throughout many nations of the world and is now a serious threat.A lack of patient self‑management has been linked to this drain on global health.The consequences of diabetic patients’poor self‑management have increased a variety of complications and lengthened hospital stays.Poor information and skill acquisition have been linked to poor self‑management.Participating in a co‑operative approach known as diabetes self‑management education will help diabetes patients who want to successfully self‑manage their condition and any associated conditions.Information is one of the most important components of a diabetes management strategy.In conclusion,numerous studies have shown that patients with diabetes have poor self‑management skills and knowledge in all areas,making training in diabetes self‑management necessary to minimize the complications that may result from diabetes mellitus among the patients.This review discussed the severity of diabetes mellitus,diabetes self‑management,and the benefits and challenges of diabetes self‑management,which may aid individuals in understanding the significance of diabetes self‑management and how it relates to diabetes self‑care.

Health Literacy, Self-Care Behavior and Quality of Life in Acute Coronary Syndrome Patients: An Integrative Review

Purpose: The review aimed to find the best evidence on the relationship between health literacy, self-care behavior and perceived quality of life (QoL) among patients with acute coronary syndrome (ACS). Methods: Searching engines included Cumulative Index to Nursing Allied Health Literature (CINAHL), Pro Quest, MEDLINE, Google Scholar, SAGE Journals, Wiley on Line Library, and Science Direct electronic databases from 2010 to 2018. Fifteen research articles assessed the main variables and their associations with demographic and clinical variables. Results: Different methodologies and samples were analyzed: analytic descriptive, systematic review, a randomized control trial, retrospective cohort, a prospective Cohort, cross-sectional, and correlational designs. The fifteen studies showed that the patients with ACS have inadequate health literacy. Patients’ ability to understand basic and complex information or to accurately assess health risks was impaired and may hinder patients’ engagement in self-care. Low HL in patients having ACS is consistently associated with poor QoL. Physical domain of QoL remained the significant outcome of both self-care behavior and health literacy after adjusting for demographics and clinical variables in patients with ACS. Conclusion: The literature pointed to the importance of considering health literacy and self-care behaviors as predictors of quality of life among patients with ACS. However, there has been no previous evidence on the best process of the association between these three variables.

The Effect of Anemia on Quality of Life and Self-Care Agency in Turkey Hemodialysis Patients

Objective: Anemia is an important complication which affects quality of life and self-care agency in hemodialysis patients. The aim of this study was to determine the effects of anemia on quality of life and self-care agency in adult patients who receive chronic hemodialysis treatment. Methods: In this cross-sectional study, the Quality of Life Scale, the Self Care Agency Scale, and a data form were administered to 136 hemodialysis patients who were receiving treatment three hospital-based dialysis units in Istanbul. Results: The health perception of cases whose hemoglobin level was 12 mg/dl and above was significantly better than those whose hemoglobin level was lower than 12 mg/dl. Hemoglobin levels were significantly and positively correlated to physical role function, general health, and health from the previous year (p < 0.05). As the hemoglobin levels of the cases increased, quality of life pertaining to the mentioned domains increased. Conclusion: It was concluded that the quality of life in chronic dialysis patients was affected by anemia.

The effect of self-employment on health, access to care, and health behavior

The focus of this paper is to investigate the role self-employment conceptualized as a lifestyle factor on health, access to health care, and health behaviors. We analyze rich data on 13,435 working adults in the US, who are either selfemployed or salaried workers. Outcomes include physical and mental health perception, validated indexes of physical and mental health, and medical conditions;access-to-care measures such as a barrier to obtaining necessary health care;and health behaviors such as smoking, physical activity and body mass index. Instrumental variables methods are used to correct for selection into self-employment. We find that self-employment is positively associated with perceived physical health, and is negatively associated with having diabetes, high blood pressure, high cholesterol and arthritis. No mental health outcome is significantly associated with self-employment. There is no significant difference between self-employed and wage-earning individuals with regard to access to care. Self-employed individuals are less likely to smoke, and are more likely to participate in physical activity and have normal-weight. We conclude that despite lack of health insurance, self-employed persons in the US are as healthy as wage-earners, do not experience a greater barrier to access to care, and are more likely to engage in healthy behavior.

Research Progress on Self-Care Ability of Hemodialysis Patients

Good self-management can help hemodialysis patients improve their quality of life and survival rate. This article reviews the status quo of self-care ability of maintenance hemodialysis patients, the influencing factors of self-care ability and the intervention measures. To improve the self-care ability and quality of life of patients, coordinated nursing intervention, self-efficacy intervention, psychological intervention and health education were proposed. To provide a reference for the self-management of hemodialysis patients.

互联网平台下的Teach-back健康教育模式在胸外科优质护理中的应用效果

目的分析Teach-back健康教育和互联网平台模式在胸外科优质护理中的应用效果。方法选择2022年5月—2023年4月临沂市中心医院收治的60例胸外科手术患者为研究对象,以抽签法按序分为研究组和对照组,每组30例。对照组提供优质护理,研究组联合Teach-back健康教育和互联网平台模式。比较两组患者护理后的自护能力和生活质量、心理状态和治疗依从。结果研究组自护能力和生活质量均明显高于对照组,差异具有统计学意义(P<0.05);研究组抑郁和焦虑自评得分均明显低于对照组,差异具有统计学意义(P<0.05);研究组治疗依从明显高于对照组,差异具有统计学意义(P<0.05)。结论新型健康教育模式在胸外科优质护理中,利于提高患者自护能力和生活质量,缓解心理压力,提高治疗依从,值得临床应用。