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.

Effect of Foot Self-Care Behavior According to Severity of Diabetic Neuropathy in Japanese Patients with Diabetes

PURPOSE: Diabetic patients with severe diabetic neuropathy often have hypoesthesia and numbness. This study evaluated foot self-care behavior according to severity of diabetic neuropathy. METHODS: We used a hand-held nerve conduction test device DPN check (HDN-1000, Omron) to evaluate severity of diabetic neuropathy. Foot self-care was evaluated using the Japanese SDSCA (the Summary of Diabetes Self-Care Activities measure). Foot self-care comprised visual inspection, washing, wiping interdigital areas, and checking shoes, and was scored according to the number of days self-care which was performed in the previous week. RESULTS: The study evaluated 103 diabetic patients (age: 65.7 years, diabetes duration: 13.9 years, HbA1c: 7.3%). Total scores (out of 28 points) for self-care behavior according to neuropathy severity were 11.8 (Normal: n = 54), 10.6 (Mild: n = 27), 13.3 (Moderate: n = 17), and 10.8 (Severe: n = 5). Foot self-care scores were low in all groups, with particularly low scores in those with severe neuropathy. However, no statistically significant differences were observed. CONCLUSIONS: Foot self-care is essential in diabetes because lesions are more likely to occur in severe neuropathy. Living alone and the presence of recurrent foot lesions are associated with poor survival prognosis. Accordingly, foot-care intervention must take neuropathy severity and lifestyle factors into account. The severity of diabetic neuropathy must be determined and foot-care intervention should take lifestyle factors into account.

Effects of health concept model-based detailed behavioral care on mood and quality of life in elderly patients with chronic heart failure

BACKGROUND With the intensification of social aging,the susceptibility of the elderly population to diseases has attracted increasing attention,especially chronic heart failure(CHF)that accounts for a large proportion of the elderly.AIM To evaluate the application value of health concept model-based detailed behavioral care in elderly patients with CHF.METHODS This study recruited 116 elderly CHF patients admitted from October 2018 to October 2020 and grouped them according to the nursing care that they received.The elderly patients who underwent health concept model-based detailed behavioral care were included in a study group(SG;n=62),and those who underwent routine detailed behavioral nursing intervention were included as a control group(CG;n=54).Patients’negative emotions(NEs),quality of life(QoL),and nutritional status were assessed using the self-rating anxiety/depression scale(SAS/SDS),the Minnesota Living with Heart Failure Questionnaire(MLHFQ),and the Modified Quantitative Subjective Global Assessment(MQSGA)of nutrition,respectively.Differences in rehabilitation efficiency,NEs,cardiac function(CF)indexes,nutritional status,QoL,and nursing satisfaction were comparatively analyzed.RESULTS A higher response rate was recorded in the SG vs the CG after intervention(P<0.05).After care,the left ventricular ejection fraction was higher while the left ventricular end-diastolic dimension and left ventricular end systolic diameter were lower in the SG compared with the CG(P<0.05).The post-intervention SAS and SDS scores,as well as MQSGA and MLHFQ scores,were also lower in the SG(P<0.05).The SG was also superior to the CG in the overall nursing satisfaction rate(P<0.05).CONCLUSION Health concept model-based detailed behavioral care has high application value in the nursing care of elderly CHF patients,and it can not only effectively enhance rehabilitation efficiency,but also mitigate patients’NEs and improve their CF and QoL.

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.

Psychological aspects of diabetes care: Effecting behavioral change in patients

Patients with diabetes mellitus(DM) need psychological support throughout their life span from the time of diagnosis. The psychological make-up of the patients with DM play a central role in self-management behaviors. Without patient's adherence to the effective therapies, there would be persistent sub-optimal contro of diseases, increase diabetes-related complications,causing deterioration in quality of life, resulting in increased healthcare utilization and burden on healthcare systems. However, provision of psychosocial support is generally inadequate due to its challenging nature of needs and demands on the healthcare systems. This review article examines patient's psychological aspects in general, elaborates in particular about emotion effects on health, and emotion in relation to other psychological domains such as cognition, self-regulation,self-efficacy and behavior. Some descriptions are also provided on willpower, resilience, illness perception and proactive coping in relating execution of new behaviors,coping with future-oriented thinking and influences of illness perception on health-related behaviors. These psychological aspects are further discussed in relationto DM and interventions for patients with DM. Equipped with the understanding of the pertinent nature of psychology in patients with DM; and knowing the links between the psychological disorders, inflammation and cardiovascular outcomes would hopefully encourages healthcare professionals in giving due attention to the psychological needs of patients with DM.

Socio-Demographics and Late Antenatal Care Seeking Behavior: A Cross Sectional Study among Pregnant Women at Kyenjojo General Hospital, Western Uganda

Background: Late antenatal care attendance among pregnant women at health facilities remains a significant public health problem. Globally, approximately 830 women die every day due to pregnancy-related complications and 99% of these deaths occur in developing countries whereby 86% of pregnant women access Antenatal Care (ANC) services at least once. Objective: The general objective of the study was to determine factors associated with late antenatal care seeking behavior among pregnant women at Kyenjojo general hospital. Methods: This was a descriptive cross sectional study design that considered quantitative data collection methods among pregnant women attending ANC. The sample size was determined using Kish and Leslie (1969) formula using a proportion of 37% (0.37) of women who sought late ANC. A systematic sampling technique was used to sample pregnant women on daily basis. Results: A total of 283 women participated in the study. Spouse’s occupation was significantly associated with late ANC attendance (p = 0.026). On the other hand, education level of respondent (Fisher’s = 8.363, p = 0.028*), religion (Fisher’s = 5.77, p = 0.048*) and parity (Fisher’s 10.312, p = 0.026*) revealed statistically significant association with late ANC attendance. In multivariate logistic regression, on occupation, women with unemployed spouses were significantly associated with 25% increase in attendance of late ANC compared to those in formal employment (AOR = 0.25, CI: 0.073 - 0.855, p = 0.027*). Conclusion: The Majority of pregnant women sought ANC at 90.1% (n = 255). There’s a need for government to strengthen health promotion targeting women in rural communities.

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.

Rehabilitative Outcomes after Hip Fracture in a Special Care Unit for Persons with Dementia and Behavioral and Psychotic Symptoms

Aim: Hip fracture implies severe problems to older people;special concerns regard persons with dementia, due either to cognitive impairment, or to behavioral and psychic symptoms. This study illustrates rehabilitative outcomes of these patients discharged by a special care unit ruled by “GentleCare” principles. Method: 54 patients [89% females, aged 82.3 years (range 66 - 94)] followed a post-surgery rehabilitative program carried out by a physiotherapist and an occupational therapist, supported by a psychologist. The multidimensional assessment consisted of cognition evaluation (Mini Mental State Examination, Clinical Dementia Rating, Global Deterioration Scale), functional evaluation (Barthel Index, Tinetti Gait and Balance, Bedford Alzheimer Nursing Severity scale), behavioral evaluation (UCLA Neuropsychiatric Inventory) and comorbidity evaluation (Cumulative Illness Rating Scale). Results: All parameters improved, including the 5 most frequent behavioral and psychic symptoms that usually preclude admission in ordinary rehabilitation units. 24% of improvement in Barthel Index total score was explained by agitation and apathy at discharge, in a multiple linear regression model: better functional levels corresponded to smoother behavioral problems. Most patients improved;70.5% of them were discharged to home. Conclusion: A prosthetic approach enables valuable results in the rehabilitation of severely demented patients with hip fracture also in presence of behavioral symptoms.

Prevalence of childhood illness and mothers’/caregivers’ care seeking behavior in Bahir Dar, Ethiopia: A descriptive community based cross sectional study

Introduction: In Ethiopia, even though there are great achievements in decreasing infant and child mortality from year 2000 to 2011, still children are suffering from diarrheal diseases, respiratory problems and malnutrition. This study was done to determine the prevalence of illnesses among under-five children and mothers’/caregivers’ care seeking behavior for childhood illnesses in Bahir Dar, Ethiopia. Methods: A community based cross-sectional study was done on a sample of 415 mothers/caregivers from April 15 to May 15, 2011. Three kebeles (the smallest administrative unit) from Bahir Dar were selected randomly. The sample was proportionally distributed to the selected kebeles according to their population size. To be eligible to participate in the study, mothers had to live in households that had children under five years of age. These households were selected by systematic sampling method. Mothers/caregivers were interviewed in their homes using a structured questionnaire that had been pre-tested. The collected data were analyzed using a computer program of SPSS version 20.0. Result and Conclusions: The overall two weeks prevalence of childhood illness that had one or more symptoms of disease was 110 (26.5%). The prevalence of the most commonly reported symptoms were diarrhea, fever, acute respiratory infection (ARI) and others 11.3%, 10%, 6.3% and 4.6% among children of under five years respectively. Eighty (72.7%) of mothers sought treatment from health care facilities for sick children. The main reasons for not seeking treatment from health care facilities as reported by mothers/caregivers were, 53.3% Illness was not serious, 26.7% lack of money and 13.3% did not see any benefit for such childhood illness. Hence there is a need for designing a tailored health message for mother/ caregivers about preventable childhood illness and treatment seeking by the local health extension workers and program planners.

Rational-emotive behavioral intervention helped patients with cancer and their caregivers to manage psychological distress and anxiety symptoms

There is a dearth of evidence-based data on how psychological distress and death anxiety symptoms experienced by cancer patients and caregivers are treated in developing regions. This article sheds light on the report of the findings from a 2016 study that revealed a rational-emotive behavioral intervention helped a select group of cancer patients and their family caregivers to manage problematic assumptions, psychological distress, and death anxiety symptoms in Nigeria.Based on my experience as a co-investigator and corresponding author of this previous study, I addressed the challenges of conducting such a study and the implications for future research in this article. This article encourages future researchers to replicate the study and endeavor to overcome the limitations of the previous study. Funders were also encouraged to ensure increased access to funds for conducting similar studies with cancer patients and their family caregivers in developing countries and other parts of the world.

医护人员的临终关怀态度和安宁疗护行为调查

目的 了解临床医护人员临终关怀态度与安宁疗护行为现况,探讨安宁疗护行为的影响因素。方法 采用临终关怀态度调查量表和安宁疗护行为测量量表对425名临床医护人员进行调查。结果 临床医护人员安宁疗护行为得分为(48.00±10.14)分,显著低于安宁疗护机构医护人员(P<0.05);临终关怀态度得分为(103.72±10.70)分。临终关怀态度与安宁疗护行为呈正相关(P<0.05)。分层回归分析结果显示,男性、已婚以及接受过临终关怀教育的医护人员安宁疗护行为水平较高;临终关怀态度中以患者及其家属为中心的照顾意识维度能独立解释安宁疗护行为总变异的11.6%。结论 临床医护人员临终关怀态度总体偏正向,安宁疗护行为有待进一步提升,临终关怀态度对安宁疗护行为具有重要的促进作用。医院应通过开展专业培训,提升医护人员安宁疗护行为能力。

合理信念替代疗法对冠心病患者心理弹性和自护能力的影响

目的:分析合理信念替代疗法对冠心病患者心理弹性和自护能力的影响。方法:按照入院顺序将某院2021年8月-2022年8月收治的102例冠心病患者分为对照组(n=51,常规干预)和干预组(n=51,常规干预+合理信念替代疗法);对比两组患者干预前后心理弹性[心理弹性量表(CD-RISC)]、自护能力[自我护理能力量表(ESCA)]、健康行为[健康促进生活方式量表Ⅱ(HPLP-II)]、生活质量[西雅图心绞痛量表(SAQ)]及满意度。结果:干预后,两组CD-RISC量表坚韧、乐观、自强各维度得分及总分均升高(P<0.05),且干预组均高于对照组(t=4.371,5.404,3.883,6.574;P<0.05);干预后,两组ESCA量表中自我概念、健康知识水平、自我护理技能、自我护理责任感各维度得分及ESCA量表总分均高于干预前(P<0.05),且干预组均高于对照组(t=7.252,3.908,5.848,5.643,10.496;P<0.05);干预后,两组HPLP-Ⅱ量表人际关系、运动锻炼、自我实现、压力管理、健康责任、营养各维度得分及总分均高于干预前(P<0.05),且干预组均高于对照组(t=2.624,3.883,3.378,3.642,3.610,2.828;P<0.05);干预后,两组SAQ各维度评分均升高(P<0.05),且干预组心绞痛稳定状况、疾病认知程度、治疗满意度、心绞痛发作频率、躯体受限程度五大维度评分较对照组高(t=2.122,2.340,3.699,2.976,2.766;P<0.05);两组满意度比较,干预组为96.08%,高于对照组的84.31%(χ^(2)=3.991,P<0.05)。结论:对冠心病患者采用合理信念替代疗法效果显著,可增强患者心理弹性,提高自护能力、健康行为水平和生活质量,获得较高的满意度。

临床护士关怀行为与职业应对自我效能感的相关性

目的:了解临床护士关怀行为与职业应对自我效能感现状,并分析两者相关性,为提高临床护士关怀行为提供参考。方法:2023年3月—4月将河南省各市按东部、中部、西部分层,分别抽取2所二级及以上综合医院共260名临床护士进行调查。采用一般资料调查表、职业应对自我效能感量表和护士关怀行为量表进行调查。结果:260名临床护士关怀行为得分为(121.84±19.69)分,职业应对自我效能感得分为(35.00±6.76)分,护士职业应对自我效能感与关怀行为呈正相关(P<0.01)。多重线性回归分析结果显示,工作年限、月收入、人文专项培训次数和职业应对自我效能感是护士关怀行为的影响因素(P<0.05)。结论:临床护士关怀行为水平较高,提高临床护士职业应对自我效能感有助于提高护士的关怀行为。提示管理者应进一步加强组织支持,营造和谐工作氛围以提高护士职业应对自我效能感,从而促进护士关怀水平,提升护理质量。

“土地换社保”能改变老年人的传统养老观念和养老行为吗?——来自征地养老保险政策实验的证据

“养儿防老”和“土地是命根子”塑造了中国农村社会千百年来不变的传统观念和养老模式,也构成了现代化转型的瓶颈。着眼于破解后者的“土地换社保”政策能否“一石两鸟”,既冲击“养儿防老”的传统观念,又能改变养老行为呢?本文从征地养老保险的政策实验安排出发,使用2011—2018年CHARLS数据,考察征地养老保险对传统养老观念和养老行为的影响。研究结果表明,征地养老保险使得农村老年人“养儿防老”的概率显著降低28.7%,减少了来自子女的代际经济支持,增加了对子女的经济支持力度,促进了社交活动参与,而对居住方式、劳动参与和孙子女照料没有显著影响。而一次性征地货币补偿等替代方案均不具备类似功能。本文还进行了异质性分析和稳健性检验,发现征地养老保险对老年人养老观念和养老行为的影响在高水平的征地养老保险地区和三个以上子女的家庭的影响更大。本文的结果表明,提供高水平稳定收入流的征地养老保险不但能弥补征地对农民造成的损失,还能改变农村传统养老观念和养老行为。

基于跨理论模型护理对非小细胞肺癌化疗患者的应用效果

目的:分析基于跨理论模型护理对非小细胞肺癌(NSCLC)化疗患者自护行为、生活质量及护理满意度的影响.方法:选择2018年5月至2020年6月期间本院收治的NSCLC化疗患者75例作为研究对象,按照护理干预方式的不同分成观察组(n=40,跨理论模型护理模式干预)和对照组(n=35,常规护理干预).比较两组生活质量、自我护理行为评价及护理满意度.结果:干预后,观察组自护行为量表(SCHFI)自护维持、自护信心、自护管理评分高于对照组,差异有统计学意义(P<0.05);干预后,观察组以卡诺夫斯基健康状况量表评分(KPS)及生活质量核心问卷量表(QLQ-C30)评分低于对照组,差异有统计学意义(P<0.05);观察组满意度较对照组更高,差异有统计学意义(P<0.05).结论:NSCLC化疗患者采用跨理论模型护理模式干预可明显提升患者满意度、提高患者生活质量并坚持自我护理行为.

基于IMB的围术期护理对肠造口患者自我护理能力的影响

目的探讨基于信息-动机-行为技巧模型(IMB)的围手术期护理对肠造口患者自我护理能力及并发症的影响。方法选取2021年7月至2022年6月南昌大学第二附属医院胃肠外科收治的124例肠造口患者作为研究对象,按照随机数字表法分为对照组(n=62)和观察组(n=62)。对照组采用常规的围手术期护理措施,观察组在常规护理上实施基于IMB的围手术期护理,比较两组肠造口患者干预前及出院1、3个月时的造口患者自我护理能力与造口并发症的发生率。结果自我护理意愿、自我护理知识和自我护理技能评分的组间、时间、交互作用比较,差异有统计学意义(P<0.05)。两组出院后1、3个月的自我护理意愿、自我护理技能评分均高于本组干预前,且两组出院后3个月的自我护理意愿、自我护理技能评分均高于本组出院后1个月时,差异有统计学意义(P<0.05);对照组出院后3个月的自我护理知识评分高于本组干预前、出院后1个月时,观察组出院后1、3个月的自我护理知识评分高于本组干预前,观察组出院后3个月的自我护理知识评分高于本组出院后1个月时,差异有统计学意义(P<0.05)。观察组出院后1、3个月的自我护理意愿、自我护理知识和自我护理技能评分均高于对照组,差异有统计学意义(P<0.05)。两组患者干预前的并发症总发生率比较,差异无统计学意义(P>0.05)。观察组患者出院后1、3个月的并发症总发生率均低于对照组,差异有统计学意义(P<0.05)。结论基于IMB模式的围手术期护理有利于提高肠造口患者自我护理能力,降低肠造口并发症发生率。

本科护生社会责任感对亲社会行为的影响:关怀能力的中介作用

了解本科护生社会责任感、亲社会行为与关怀能力的现状并探讨三者之间的关系机制,采用大学生社会责任感调查问卷、亲社会行为量表及关怀能力量表调查内蒙古呼和浩特市某高校637名本科护生,采用层次回归模型和Bootstrap法进行结果统计描述与分析。研究结果显示,新时代“健康中国”战略背景下应加强本科护生社会责任感认知、行为的培养,并继续注重护生关怀能力的提升,关怀能力是社会责任感与亲社会行为的中介变量,可通过培养本科护生社会责任感和关怀能力促进其亲社会行为的形成与发展。

感知护士长关怀在精神科护士共情疲劳与关怀患者行为间的中介效应

目的探讨感知护士长关怀在精神科护士共情疲劳与关怀患者行为之间的中介效应,为促进临床人文关怀提供参考。方法便利抽样法选择南通市7所精神疾病专科医院的360名精神科护士,采用关怀感知量表、专业生活品质量表与关怀行为量表进行调查。结果精神科护士关怀患者行为得分(114.92±19.94)分,感知护士长关怀(53.32±11.83)分,共情疲劳(41.79±11.78)分。精神科护士感知护士长关怀在共情疲劳与关怀患者行为之间起部分中介效应,中介效应占总效应的35.01%。结论精神科护士关怀患者行为处于中等水平,护理管理者可通过强化护士长关怀护士的行为,缓解精神科护士的共情疲劳,以促进护士实施临床关怀行为。

基于认知-行为的多层次护理对卒中后抑郁的效果影响

目的探讨基于认知-行为的多层次护理干预对卒中后抑郁(post-stroke depression,PSD)的效果影响。方法选择武汉科技大学附属天佑医院神经内科2019年1月—2023年1月住院的110例PSD患者作为研究对象,对上述患者入院的前后顺序进行标号,随机分为2组,对照组(n=55)予以常规护理措施干预,在此基础上观察组(n=55)予以基于认知-行为的多层次护理干预。2组患者干预前和干预后1个月,分别采用汉密尔顿抑郁量表(Hamilton depression scale,HAMD)、汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)、简易精神状态检查量表(mini-mental state examination,MMSE)、Barthel指数(barthel index,BI)、生活质量综合评定问卷-74(generic quality of life inventory 74,GQOLI-74)评估患者的精神症状、认知状况、日常生活能力、生活质量。结果与观察组护理干预前和对照组干预后比较,观察组护理干预后HAMD(16.01±1.97)分、HAMA(14.37±1.48)分均明显降低(P<0.05);观察组护理干预后MMSE(28.74±3.16分)、BI(83.09±7.81分)及生活质量评分均明显升高(P<0.05)。结论基于认知-行为的多层次护理干预可明显改善PSD患者的精神症状、认知状况及日常生活能力,同时生活质量也得到明显地提高。