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.

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.

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.

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.

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.

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.

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.

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.

Effect of Activities of Daily Living on Self-Care Agency in Individuals with Type 2 Diabetes

Diabetes mellitus continues to be a global health problem with increasing importance across the world by affecting the activities of daily living and self-care ability of patients due to its incidence and troubles caused by it. The present study aims at determining the effect of activities of daily living of patients with type 2 diabetes mellitus on their self-care agency. Methods: The population of this descriptive study consisted of patients with type 2 diabetes mellitus who were being treated at the internal medicine clinic of a provincial state hospital between July 2014 and November 2015 and its sample consisted of 150 diabetic patients who volunteered to take part in the study and who were open to communication. A personal information form, the Activities of Daily Living (ADL) Scale, the Instrumental Activities of Daily Living (IADL) Scale and the Self-Care Ability Scale (CAS) were used as data collecting tools. The data were analyzed using descriptive statistics (numbers, percentages, mean, standard deviation, mean rank and frequencies), the Shapiro-Wilk, Kruskal-Wallis Variance Analysis, Mann-Whitney U test and Cronbach’s alpha formula and correlation analysis. Results: Approximately 97.3% of the patients with type 2 diabetes stated that they were independent in ADL and 75.3% of them in IADL. The patients’ mean self-care ability score was found to be 83.85 ± 17.87 ADL and IADL were found to be affected by age, marital status, education, duration of disease, willingness to receive further education, and presence of another disease besides diabetes. There was a significant correlation between the self-care agency score and marital status, education, duration of disease, willingness to receive further education, presence of another disease besides diabetes, regular checking of blood sugar and compliance with diet. A significant positive correlation was found between the patients’ activities of daily living and their self-care agency. Conclusion: The patients’ activities of daily living were found to affect their self-care agency. The personal and disease-related characteristics of patients should be identified so that their self-care behaviors can be increased.

Self-care in stroke patients and the capability of primary caregivers

Stroke rehabilitation, especially for patients with sequelae, lacks practicable rehabilitation training methods. Using the convenience sampling method, self-care ability in 60 stroke patients was investigated for 6 months to 2 years post-stroke （sequelae stage）, as well as the capability of primary caregivers selected from two communities in Shanghai, China. Influential factors were analyzed. Results demonstrated that only 37% of stroke patients exhibited strong self-care ability, and 43% of primary caregivers provided high levels of care. Results also demonstrated that self-care ability in stroke patients, as well as the capability of primary caregivers, should be improved. A total of 47% of stroke patients participated in community rehabilitation training, and self-care ability was significantly better in this group than in patients who did not receive rehabilitation training. Thus it is necessary to develop systematic, individualized, and family-based rehabilitative strategies to improve community rehabilitation training modes and strengthen rehabilitation guidance for patients and caregivers.

Assessment on self-care, mobility and social function of children with spina bifida in Turkey

The aim of the study was to investigate the functional performance in children with spina bifida, using the Pediatric Evaluation of Disability Inventory （PEDI） to look into capacity of twen- ty-eight children with spina bifida with lesions at different levels in different dimensions of self- care, mobility and social function. Mean age of the patients was 3.5 ± 2.3 （1-10） years. In the muscle test carried out, 13 patients （44.8%） had no movements including pelvic elevation in lower extremity muscles and they were at level 5. Sixteen patients （54%） were non-ambulatory according to the Hoofer ambulation classification. Raw and scale scores in the self-care, mobil- ity and social function domains both in the functional skill scale and in the caregiver scale were found to be lower compared to the data of the normal population. A statistically significant correlation was observed in the self-care values of the Functional Skills Scales and the Caregiver Assistance Scale measurements, which was positive for age and negative for Functional Ambu- lation Scale and muscle test （P 〈 0.05）. A positive relation was found between the Functional Skills Scales-mobility area and age while a negative relation was observed between Functional Ambulation Scale and muscle test （P 〈 0.005）. A negative relation was also found between Care- giver Assistance Scale-mobility and Functional Ambulation Scale and muscle test （P 〈 0.005）. In our study, the functional performance of the children was found to be low. Low-level lesions, encouraging muscular strength and independence in mobility are all very important factors for functional independence.

Self-Care Practice of Patients with Mechanical Heart Valve Prosthesis Accompanied in Nursing Consultation

The objective was to evaluate the practice of self-care of patients with mechanical heart valve prosthesis. A descriptive, cross-sectional study developed in two outpatient valvopathies of teaching hospitals of Fortaleza/CE, from October 2013 to January 2014. The sample consisted of 127 patients with mechanical heart valve prosthesis. It was held an interview using instrument based on the Theory of Orem’s Self-Care and Brazilian Guidelines for Valvular Heart Diseases. The data were presented in tables and charts. Results: Universal self-care practices of larger adhesion: body hygiene (97.6% washed-haired, daily-bath 92.1%);oral hygiene (brushing teeth before sleeping, 87.4%);fluid intake (drinking-water 95.2%);food intake (salt intake ≤ 2 g/day, 92.1%, fruit and vegetable consumption 79.5%);intestinal eliminations (without blood or mucus—96%, non-parasitic 94.4%);urinary elimination (no blood nor pus-96.8%, urination 4 to 6 times a day, 96%). As self-care developmental requirements predominated: never used illegal drugs, tobacco, alcohol, or stopped at the discovery of the disease (70%). As self-care health deviation requirements we have: making use of certain medication at the right dose (95.2%);attending medical appointments (cardiologist—92.1%;nursing—84.2%);INR control (identifies signs of bleeding— 85.8%). We conclude that patients did not perform all recommended self-care practices, being necessary to establish strategies to reduce the self-care deficit.

An investigation of the health value and self-care capabilities of the elderly in urban-rural fringe area nursing homes and the related in？uencing factors

Objective：To investigate the health value and self-care capabilities of the elderly living in urban-rural fringe area nursing homes and the factors that influence these variables.Methods：A cluster sampling method was used to select 280 elderly individuals from seven urban-rural fringe communities in Xianning to complete a survey regarding their health value and self-care capabilities.Results：The total health value and self-care capability scores of the elderly were 7.45 ± 1.45 and100.25±22.56,respectively.Both of these scores significantly differed by age,education level,marital status,and income（P 〈 0.05,P 〈 0.01）.Self-care capability was correlated with health value（r=0.521）.A multivariate linear regression analysis showed that health value,marital status,and age predicted selfcare capability.Conclusions：Elderly people living in the urban-rural fringe area with higher health values also had higher self-care capabilities.The self-care capabilities of the elderly can be enhanced by improving their health value using the ＂knowing-trusting-acting＂ model.

Self-Care Activities among Patients with Type 2 Diabetes in Morocco: Prevalence and Determinants

Background: Self-care is an important, though often neglected, area of type 2 diabetes management in lower and middle income countries (LMICs). In Morocco, whilst the evolution of the disease is increasing rapidly, evidence documenting disease self-care patterns remains scarce. Objectives: To estimate the prevalence of self-care activities among patients with type 2 diabetes in Morocco, and to identify the factors associated with good self-care practices. Methods: We performed a secondary analysis of data of 406 patients aged 30 years old and over, diagnosed with type 2 diabetes mellitus for at least 6 months. Self-care activities were assessed using the Moroccan version of the Summary of diabetes self-care activities. Studied factors included socio-demographics, disease features and healthcare use. Unadjusted and adjusted odds ratios were calculated using logistic regression. Results: Mean age was 55.8 ± 11.6 years old. Females represented 68.7% of the respondents. Mean estimates of the frequency of self-care practices exceeded 3.5 days per week for diet, exercise and foot-care;of these, good dietary behavior was the most prevalent (63.6%). In multivariate analysis, females displayed better dietary behavior (OR = 1.81 [1.27 - 2.58]), and less frequent foot care (OR = 1.81 [1.27 - 2.58]) than males. Lower levels of exercise were associated with being female (0.42 [0.26 - 0.68]), and belonging to the higher income category (0.55 [0.34 - 0.88]). Residents in rural areas also reported better exercise practices (1.72 [1.07 - 2.78]). Conclusion: This study draws attention to self-care practices and their determinants in the Moroccan context. Such findings should help in the design, implementation, and evaluation of self-management interventions for people with type 2 diabetes.

Diabetes Self-Care Activities and Glycaemic Control among Adults with Type 2 Diabetes in Sri Lanka: A Cross-Sectional Study

The prevalence of Type 2 Diabetes Mellitus (T2DM) and its complications continue to rise across the globe including Sri Lanka. Diabetes Self-care activities (DSCA) are promising behaviors to reduce complications and to achieve good glycaemic control. There is a lack of data regarding DSCA and its association with glycaemic control among adults with T2DM in Sri Lanka. A descriptive cross-sectional study was conducted among purposively selected adults with T2DM (n = 300) in a teaching hospital, Sri Lanka to determine the association between DSCA and glycaemic control. Apre-tested interviewer-administered questionnaire which includes socio-demographic, diabetes-related information and Summary of Diabetes Self-care activities questionnaire was used to collect data. Data were analyzed by using descriptive statistics and Chi-square test. General diet (Healthy eating plan) (OR = 3.04, 95% CI = 1.04 - 8.88, p = 0.034), Physical activities (OR = 2.26, 95% CI = 1.29 - 3.97, p = 0.004), Medication adherence (OR = 2.87, 95% CI = 1.24 - 6.64, p = 0.011) were significantly associated with HbA1c. Medication adherence was significantly associated with poor fasting blood sugar (FBS) (OR = 1.90, 95% CI = 1.07 - 3.37, p = 0.028). The findings highlight the need for health professionals to implement health education programs on diabetes self-care activities for adults with T2DM to enhance their adherence to DSCA, as well as to maintain glycemic control.

Development of a Measurement Scale to Evaluate Self-Care Stability for Patients Diagnosed with Type 2 Diabetes at an Older Age

Objectives: For the medical care of older adults diagnosed with type 2 diabetes later in life, it is necessary to provide medical staff support considering their life stage and to ensure that they live a stable life without fatigue. However, there is no measure for evaluating whether older diabetic patients have a stable life at the time of diagnosis. This study aimed to develop a scale to evaluate self-care stability for diabetic patients and to verify its reliability and validity. Methods: A cross-sectional study was conducted at four hospitals in Japan. A draft scale comprising 39 items was developed to identify patients’ stability of diabetes self-care in life. A total of 69 patients diagnosed with diabetes for the first time at age 60 or older responded effectively to questionnaires. Results: As a result of item analysis and factor analysis, seven factors comprising 20 items were extracted. The cumulative contribution ratio before rotation was 70.577%. Cronbach’s α was 0.700 overall. The total score on this scale and the sum of the revised Philadelphia Geriatric Center Morale Scale scores were significantly positively correlated (r = 0.379). On comparing the total scale score based on glycated hemoglobin level, the scale score of the stable group was found to be higher. Therefore, this scale was found to be reliable and valid. Conclusions: This scale may have utility in the measurement of self-care stability in patients diagnosed with type 2 diabetes later in life.