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Fredens M, Palmhøj Nielsen C, Grønkjær M, Kjærside Nielsen B, Konstantin Nissen N, Benthien KS, Toft U, Rasmussen K, Kidholm K, Deleuran Terkildsen M. Nurses' perspectives on challenges and facilitators when implementing a self-management support intervention as an everyday healthcare practice: A qualitative study. J Adv Nurs 2024; 80:2475-2486. [PMID: 38012863 DOI: 10.1111/jan.15988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/07/2023] [Accepted: 11/13/2023] [Indexed: 11/29/2023]
Abstract
AIM To explore registered nurses' perspectives on challenges and facilitators to implementing a telephone-based self-management support (SMS) intervention (Proactive Health Support) as an everyday healthcare practice, during the early stages of implementation. DESIGN Data were collected using a qualitative research design involving focus-group interviews and participant observations. METHODS We conducted participant observation following nine nurses and four focus group interviews with 14 nurses. Data were analysed using thematic analyses. RESULTS Proactive Health Support was implemented in units organized independently of the existing organizational units within healthcare services. This independent organization, along with the intervention's generic (non-disease specific) design, empowered nurses to become autonomous practitioners capable of prioritizing the operationalization of SMS as an everyday healthcare practice. However, unlearning already embedded medical practices and establishing new nursing roles necessary to accommodate the intervention in practice was experienced a challenge. Education and supervision were identified as valuable tools for successful implementation. CONCLUSION Our study highlights the significance of organizational context and autonomy in successful SMS implementation. Balancing external factors like organizational context, priority and time is vital, but navigating the internal shift in professional practice is equally crucial. Role transition processes can constitute challenges demanding accommodation. IMPLICATIONS FOR THE PROFESSION From a nursing perspective, this study highlights that practising SMS requires substantial training and education. Generic SMS interventions can introduce higher levels of contingency due to their versatile nature. Thus, equipping nurses with competencies that enable them to navigate this unpredictability flexibly is crucial. IMPACT Policymakers and administrators should allocate resources and support implementation processes in ways that accommodate both internal and external conditions to facilitate nurses in delivering effective SMS. REPORTING METHOD This study adheres to the SRQR guideline. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Mia Fredens
- DEFACTUM - Public Health Research, Central Denmark Region, Aarhus, Denmark
| | - Camilla Palmhøj Nielsen
- DEFACTUM - Public Health Research, Central Denmark Region, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Mette Grønkjær
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | | | - Kirstine Skov Benthien
- Palliative Care Unit, Copenhagen University Hospital, Hvidovre, Denmark
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Ulla Toft
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Knud Rasmussen
- Department of Data and Development Research, Zealand Region, Sorø, Denmark
| | - Kristian Kidholm
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - Morten Deleuran Terkildsen
- DEFACTUM - Public Health Research, Central Denmark Region, Aarhus, Denmark
- Department of Forensic Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Brunner K, Weisschuh L, Jobst S, Kugler C, Rebafka A. Defining Self-Management for Solid Organ Transplantation Recipients: A Mixed Method Study. NURSING REPORTS 2024; 14:961-987. [PMID: 38651485 PMCID: PMC11036239 DOI: 10.3390/nursrep14020073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/15/2024] [Accepted: 03/29/2024] [Indexed: 04/25/2024] Open
Abstract
Patients with Solid Organ Transplantations (SOTx) face long-term lifestyle adaptations, psychological and social adjustments, and complex self-care regimes to maintain health post-transplant. Self-management (SM) skills represent important aspects of nursing communication with SOTx patients; however, there is potential for SM to be defined narrowly in terms of medication adherence. The study presented here collated the existing definitions in a mixed method review in order to identify SM attributes for this group (including those unique to this population). Secondary analysis of a dataset and bibliographic analysis and an expert panel were used to develop a comprehensive working definition of SOTx patients. The analysis comprised critical interpretation of the evolving definition content, concepts, and contexts of application in current usages and over time. We identified eight definitions and 63 cited definition sources from bibliographic analysis. Findings identified limitations of the existing definitions. Population-specific attributes included optimisation of transplant outcomes, active engagement in healthy behaviours, control, structure, and discipline characteristics, and moderating factors of patient motivation, self-efficacy, and cognitive function. A critical appraisal of definitions indicated inadequately defined aspects such as setting, temporal dimension, concept interaction, interventions, and measurable outcomes. The bibliographic analysis highlighted the influence of broader chronic illness constructions of SM, underpinning the generalisable SM attributes in current definitions. Further research may advance the development of a definition in exploring the relevance of SOTx-specific attributes of the definition.
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Affiliation(s)
| | | | | | | | - Anne Rebafka
- Institute of Nursing Science, University Medical Centre, Albert-Ludwigs University Freiburg, Breisacher Straße 153, 79110 Freiburg, Germany (S.J.); (C.K.)
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Otter CEM, de Man-van Ginkel JM, Keers JC, Smit J, Schoonhoven L. 'Towards a conceptualization of nurses' support of hospitalised patients' self-management-A modified Delphi study'. J Clin Nurs 2024. [PMID: 38433362 DOI: 10.1111/jocn.17066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/29/2023] [Accepted: 01/10/2024] [Indexed: 03/05/2024]
Abstract
AIM To determine patients', nurses' and researchers' opinions on the appropriateness and completeness of the proposed conceptualization of nurses' support of hospitalised patients' self-management. DESIGN A modified Delphi study. METHODS We conducted a two-round Delphi survey. The panel group consisted of patients, nurses and researchers. The conceptualization of nurses' support of hospitalised patients' self-management presented in the first Delphi round was based on previous research, including a scoping review of the literature. Data was analysed between both rounds and after the second round. Results are reported in accordance with the guidance on Conducting and Reporting Delphi Studies (CREDES). RESULTS In the first round all activities of the proposed conceptualization were considered appropriate to support the patients' self-management. Panel members' comments led to the textual adjustment of 19 activities, the development of 15 new activities, and three general questions related to self-management support during hospitalisation. In the second round the modified and the newly added activities were also deemed appropriate. The clarification statements raised in the first Delphi round were accepted, although questions remained about the wording of the activities and about what is and what is not self-management support. CONCLUSION After textual adjustments and the addition of some activities, the proposed conceptualization of nurses' support in patients' self-management while hospitalised have been considered appropriate and complete. Nevertheless, questions about the scope of this concept still remains. The results provide a starting point for further discussion and the development of self-management programs aimed at the hospitalised patient. IMPLICATION FOR THE PROFESSION AND/OR PATIENT CARE The results can be considered as a starting point for practice to discuss the concept of nurses' support for hospitalised patients' self-management and develop, implement and research self-management programs specific for their patient population. REPORTING METHOD Results are reported in accordance with the guidance on Conducting and Reporting Delphi Studies (CREDES). PATIENT OR PUBLIC CONTRIBUTION Patients were involved as expert panellist in this Delphi study. Impact statement What problem did the study address? Self-management support during hospitalisation is understudied, which undermines the development of evidence-based interventions. What were the main findings? A panel, consisting of patients, nurses and researchers, agreed on the appropriateness of a conceptualization of nurses' support of inpatients' self-management, and identified some points for discussion, mainly related to the boundaries of the concept self-management. Where and on whom will the research have an impact? This study is crucial for generating conceptual understanding of how nurses support patients' self-management during hospitalisation. This is necessary for policy, clinical practice, education, and research on this topic.
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Affiliation(s)
| | - Janneke M de Man-van Ginkel
- Julius Centre for Health Sciences and Primary Care, Nursing Science, University Medical Centre Utrecht, University Utrecht, Utrecht, The Netherlands
- Academic Nursing, Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Joost C Keers
- Regional Public Health Services, Utrecht, The Netherlands
| | - Jakobus Smit
- University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Lisette Schoonhoven
- Julius Centre for Health Sciences and Primary Care, Nursing Science, University Medical Centre Utrecht, University Utrecht, Utrecht, The Netherlands
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
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Magon A, Arrigoni C, Durante A, Falchi C, Dellafiore F, Stievano A, Caruso R. Barriers to self-monitoring implementation in the oral anticoagulated population: A qualitative study. Int J Nurs Pract 2023; 29:e13095. [PMID: 35971277 DOI: 10.1111/ijn.13095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/31/2022] [Accepted: 07/25/2022] [Indexed: 02/04/2023]
Abstract
AIM This study aimed to explore and understand the barriers perceived by Italian nurses to adopting self-monitoring for managing oral anticoagulation in real-life settings. BACKGROUND Barriers to self-monitoring implementation for managing oral anticoagulation have been poorly described. DESIGN The study had a qualitative descriptive and exploratory design with a hybrid approach. METHODS A literature review was conducted to identify a priori barriers (deductive approach), while a small and semi-structured focus group discussion was performed to explore the contextual barriers experienced by Italian nurses (inductive approach). A classic content analysis technique was adopted. Data were collected in 2019. FINDINGS Two main categories were identified. Organizational barriers referred to the lack of inter-professional collaboration and health-care system strategies to provide clinical pathways for self-monitoring. Individual barriers encompassed professional characteristics (e.g. university background, professional knowledge, continuum education and accountability/responsibility) and patient characteristics (e.g. patient health literacy and knowledge, engagement/empowerment and educational programmes). Finally, unwarranted clinical variation in oral anticoagulation management arose as a barrier determined by organizational and individual elements. CONCLUSIONS The results of this study pointed out an urgent public health issue in addressing barriers influencing self-monitoring practice and in sustaining care models that might enhance the quality improvement of self-monitoring for managing oral anticoagulation.
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Affiliation(s)
- Arianna Magon
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Cristina Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
| | - Angela Durante
- Nursing department, GRUPAC, Universidad de la Rioja, Logroño, Spain
| | - Chiara Falchi
- Medical Ward, Humanitas Clinical and Research Center - IRCCS, Milan, Italy
| | - Federica Dellafiore
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
| | | | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Otter CEM, Keers JC, Reker C, Smit J, Schoonhoven L, de Man-van Ginkel JM. How nurses support self-management of hospitalized patients through verbal communication: a qualitative study. BMC Nurs 2022; 21:329. [PMID: 36443771 PMCID: PMC9703649 DOI: 10.1186/s12912-022-01099-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/10/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Patients' self-management of the implications of their disease(s) is becoming increasingly important. Research shows that hospitalization disrupts established self-management routines. Nurses can play an important role in supporting patients' self-management. The aim of this study is to describe how nurses support the self-management of hospitalized patients through verbal communication during routine nursing care. METHODS A qualitative descriptive study, using overt, non-participant observations was conducted on three wards of a general teaching hospital in the Netherlands. A total of 215 hours of nursing work during 49 shifts was observed. Data was analyzed using thematic analysis based on the six phases of Braun and Clarke. RESULTS Our observations showed that nurses discuss patients' self-management mainly in short conversations during the care provision. Nurses ask patients about their self-management at home and stimulate patients to express their opinions and to be involved in the care process. Three themes reflect how nurses support self-management: 'Discussing patient's self-management', 'Enhancing patient's involvement in care' and 'Focusing on patient's perspective'. CONCLUSION Hospital nurses have methods to support hospitalized patients' self-management but it does not seem to be an integral part of daily practice. Given current developments in healthcare, it is reasonable to argue that self-management should be given greater emphasis within the hospital setting, requiring a collaborative approach with patients and other healthcare professionals across the care continuum.
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Affiliation(s)
- Caroline E. M. Otter
- grid.416468.90000 0004 0631 9063Martini Hospital, Van Swietenlaan 1, Groningen, 9728 NT The Netherlands
| | - Joost C. Keers
- grid.416468.90000 0004 0631 9063Martini Hospital, Van Swietenlaan 1, Groningen, 9728 NT The Netherlands
| | - Celeste Reker
- grid.416468.90000 0004 0631 9063Martini Hospital, Van Swietenlaan 1, Groningen, 9728 NT The Netherlands
| | - Jakobus Smit
- grid.438049.20000 0001 0824 9343University of Applied Sciences Utrecht, Heidelberglaan 7, Utrecht, 3584 CS The Netherlands
| | - Lisette Schoonhoven
- grid.7692.a0000000090126352Julius Centre for Health Sciences and Primary Care, Nursing Science, University Medical Centre Utrecht, University Utrecht, HP Str. 6.131, Heidelberglaan 100, Utrecht, 3584 CX The Netherlands ,grid.5491.90000 0004 1936 9297School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, University Road, Southampton, S017 1BJ UK
| | - Janneke M. de Man-van Ginkel
- grid.7692.a0000000090126352Julius Centre for Health Sciences and Primary Care, Nursing Science, University Medical Centre Utrecht, University Utrecht, HP Str. 6.131, Heidelberglaan 100, Utrecht, 3584 CX The Netherlands ,grid.10419.3d0000000089452978Academic Nursing, Department of Gerontology and Geriatrics, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA The Netherlands
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Otter CEM, Keers JC, Smit J, Schoonhoven L, de Man-van Ginkel JM. 'Nurses' self-management support to hospitalised patients: A scoping review. J Clin Nurs 2022; 32:2270-2281. [PMID: 35118738 DOI: 10.1111/jocn.16242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/10/2021] [Accepted: 01/12/2022] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To review the current literature to map and explore the interventions that have been considered or used by nurses to support adult patients' self-management during hospitalisation. BACKGROUND Nurses can play an important role in supporting patients' self-management. Currently, however, it is unclear how nurses perform this task during a patient's stay in hospital. Traditionally, nurses take the primary role in managing patients' care during hospitalisation. Ideally, patients should have the opportunity to continue applying strategies to manage their health conditions as much as possible while in the hospital. This can increase patients' self-efficacy and decrease unnecessary readmissions. DESIGN Scoping review informed by the Joanna Briggs Institute methodology. METHODS A database search was undertaken using Pubmed, CINAHL, PsycInfo, Cochrane, Embase and grey literature sources. Data from the included studies were mapped and summarised in a narrative summary. To synthesise the information that was given about each intervention, we conducted a qualitative inductive content analysis. Results are reported in accordance with the guidelines for reporting Items for systematic review and meta-analyses extension for scoping review (PRISMA-ScR) (Supplementary File 1). RESULTS 83 documents were included in this review. Based on the information about the interventions, three themes were identified: 'self-management support activities', 'focus of self-management support' and the 'intervention procedure'. Five self-management support activities can be distinguished: 'giving education', 'counselling and coaching', 'enhancing responsibility', 'engaging family-caregivers' and 'supporting transition from hospital to home'. The interventions focused on improving disease-related knowledge and on strengthening several self-management skills. Information about the procedure, development and the theoretical underpinning of the intervention was often limited. CONCLUSIONS Most activities within the nursing interventions to support adult patients' self-management during hospitalisation are the part of regular nursing care. However, the transfer of responsibility for care task to the patient is relatively new. Further research could focus on developing interventions addressing all aspects of self-management and that are embedded in the patient's care pathway across settings. RELEVANCE TO CLINICAL PRACTICE Clinical nurses may improve nursing care by supporting all aspects of patients' self-management and facilitate patients as much as possible for taking responsibility for self-management tasks during hospitalisation.
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Affiliation(s)
| | | | - Jakobus Smit
- University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Lisette Schoonhoven
- Nursing Science, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, University Utrecht, Utrecht, The Netherlands.,School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Janneke M de Man-van Ginkel
- Nursing Science, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, University Utrecht, Utrecht, The Netherlands
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Azar NS, Radfar M, Baghaei R. Spiritual Self-care in Stroke Survivors: A Qualitative Study. JOURNAL OF RELIGION AND HEALTH 2022; 61:493-506. [PMID: 32445043 DOI: 10.1007/s10943-020-01030-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Self-care and quality of life challenges significantly affect post-stroke life. Stroke patients look for strategies to improve their performance and cope with their new situation. The aim of this study was to explore spirituality in self-care from the perspective of stroke survivors in the northwest of Iran. Purposive sampling is done on 15 participants through Semi-structured interviews of obtained data through conventional content analysis approach. Two categories of "spiritual self-care" as the main theme included "supplication" comprising subcategories of "worship and prayer", "resort" and "trust" and "religious beliefs" with subcategories of "divine providence" and "divine blessing". Based on results of this study, Spirituality increases motivation for self-care and adaptation, reduces stress and helps patiently manage diseases as realities.
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Affiliation(s)
- Nooshin Salmany Azar
- School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Moloud Radfar
- Department of Psychiatric Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran.
| | - Rahim Baghaei
- Patient Safety Research Center, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
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Fischer H, Grønning K. Are We Transitioning Toward Person-centered Practice on Self-management Support? An Explorative Case Study Among Rheumatology Outpatient Clinic Nurses in Norway. SAGE Open Nurs 2021; 7:23779608211037494. [PMID: 34869855 PMCID: PMC8642106 DOI: 10.1177/23779608211037494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 07/18/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction There are only a few studies investigating nurses’ views on self-management
in the care of patients with rheumatic diseases. Objective The aim of this study is to explore how Norwegian rheumatology outpatient
nurses describe their ways of supporting patients’ self-management focusing
on the core dimensions of person-centered self-management support. Methods Ten individual semistructured interviews with rheumatology outpatient nurses
were conducted in Norway from March to September 2017. The interviews were
audiorecorded and transcribed verbatim. NVIVO was used to support a
systematic analysis of themes and patterns. Results Nurses’ views on self-management support fell into three approaches; (1)
narrowly biomedically orientated, (2) biomedically and holistic, and (3)
person-centered. The nurse's views of self-management support varied and did
not fully align with the core dimensions of person-centered practice. Conclusion The findings indicate that the biomedical paradigm continues to influence
Norwegian rheumatology outpatient clinic nurses’ approach to self-management
support. If person-centered principles of self-management support are to be
translated into standard nursing practice, including identifying and
supporting patient-defined self-management goals and processes, there is a
need to challenge established structures in health care systems.
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Affiliation(s)
| | - Kjersti Grønning
- Department of Public Health and Nursing, Norwegian University of Science and
Technology (NTNU), Trondheim, Norway
- Department of Rheumatology, St. Olavs hospital, Trondheim University
Hospital, Trondheim, Norway
- Kjersti Grønning, Department of Public
Health and Nursing, Norwegian University of Science and Technology (NTNU),
Postboks 8905, N-7491 Trondheim, Norway.
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Heumann M, Röhnsch G, Hämel K. Primary healthcare nurses' involvement in patient and community participation in the context of chronic diseases: An integrative review. J Adv Nurs 2021; 78:26-47. [PMID: 34288041 DOI: 10.1111/jan.14955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 05/23/2021] [Accepted: 06/15/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Primary healthcare nurses' potential to enable patient and community participation has been increasingly acknowledged. A conceptual understanding of their contributions within a broad range of participation processes is still lacking. AIMS The aims of this study were to develop a conceptual framework that provides information on the role of primary healthcare nurses in shaping participation processes with patients and communities in the context of chronic diseases and to identify conditions that enable or hinder the promotion of patient and community participation by nurses. DESIGN An integrative review was conducted. DATA SOURCES Twenty-three articles published from 2000 to 2019 were included in the analysis: 19 retrieved from PubMed and CHINAL and 4 added through other sources. REVIEW METHODS An inductive data analysis and quality appraisal of studies were conducted. RESULTS The analysis reveals four areas where nurses are involved in facilitating patient and community participation: (1) sharing understanding of health problems and needs, (2) developing resources and facilitating patient education for self-management, (3) raising patients' voices as an advocate in service development and (4) supporting individual and community networks. The conditions affecting nurses' engagement in fostering participation processes are as follows: (1) care priorities and overall workload, (2) nurses' attitudes towards participation and (3) users' acceptance of nurses as partners. CONCLUSIONS Future research can use the framework as a basis for empirical studies investigating nurses' involvement in pursuing patient and community participation. Interventions should focus less on indirect forms of participation, like patient education or advocacy, but should also focus on active forms of participation. Research is needed on nurses' involvement in community participation processes. IMPACT This framework can be used and adapted in future research on patient and community participation in primary healthcare. It describes areas of participation and the facilitators and barriers within the broad range of activities of primary healthcare nurses.
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Affiliation(s)
- Marcus Heumann
- Department of Health Services Research and Nursing Science, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Gundula Röhnsch
- Department of Health Services Research and Nursing Science, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Kerstin Hämel
- Department of Health Services Research and Nursing Science, School of Public Health, Bielefeld University, Bielefeld, Germany
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Killingback C, Thompson M, Chipperfield S, Clark C, Williams J. Physiotherapists' views on their role in self-management approaches: A qualitative systematic review. Physiother Theory Pract 2021; 38:2134-2148. [PMID: 33813990 DOI: 10.1080/09593985.2021.1911011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Self-management has been an increasingly important aspect of helping people manage their long-term conditions. The aim of this qualitative review was to synthesize the views of physiotherapists concerning their delivery of a self-management approach.Method: A systematic search was conducted on six electronic bibliographic databases to identify relevant primary studies. Studies were assessed for quality and data extracted. Qualitative data were analyzed using thematic synthesis. A total of 1189 studies were identified and screened. Eleven studies met the inclusion criteria.Results: Findings suggest that for self-management approaches to work, physio-therapists believe that patients need to actively participate. Boundaries on who is the expert were blurred at times with some physiotherapists struggling to relinquish control. High-quality patient-therapist relationships are required to build trust in order to support patients in the self-management of their long-term conditions. It is also important to consider the competing paradigms in which a service is delivered as this may facilitate or hinder self-management. Seeing patients as people is integral to supporting self-management approaches.Conclusion: Physiotherapists are well placed to support self-management but there is still a need for a cultural and paradigmatic shift in the physiotherapy profession and in some environments, this shift as yet is to be realized.
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Affiliation(s)
| | - Mark Thompson
- Faculty of Health Sciences, University of Hull, Hull, UK
| | | | - Carol Clark
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Jonathan Williams
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
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Lee EH, Lee YW, Chae D, Lee KW, Chung JO, Hong S, Kim SH, Kang EH. A New Self-management Scale with a Hierarchical Structure for Patients with Type 2 Diabetes. Asian Nurs Res (Korean Soc Nurs Sci) 2020; 14:249-256. [PMID: 32861873 DOI: 10.1016/j.anr.2020.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/10/2020] [Accepted: 08/03/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The aims of this study were to develop a new instrument for measuring self-management with a hierarchical structure [the Diabetes Self-Management Scale (DSMS)] in patients with type 2 diabetes, and evaluate its psychometric properties. METHOD The DSMS instrument was developed in three phases: (1) conceptualization and item generation; (2) content validity and pilot testing; and (3) field testing of its psychometric properties. A convenience sample of 473 participants was recruited in three university hospitals and one regional health center, South Korea. RESULTS Exploratory and confirmatory factor analyses yielded two second-order component models explaining the common variance among six first-order factors. Principal axis factoring with a varimax rotation accounted for 60.88% of the variance. Confirmatory factor analysis of the hierarchical structure revealed the following fit indices: χ2/df = 1.373, standardized root-mean-square residual = .050, goodness-of-fit index = .935, incremental fit index = .975, comparative fit index = .974, and root-mean-square error of approximation = .039. All Cronbach' α values for internal consistency exceeded the criterion of .70. All of the intraclass correlation coefficients for test-retest reliability exceeded .70 except that for the taking-medication subscale. The components of the DSMS were moderately correlated with the comparator measures of self-efficacy and health literacy administered for convergent validity. CONCLUSION The DSMS is a new instrument for measuring the complex nature of self-management in patients with type 2 diabetes, comprising 17 items scored on a five-point Likert scale. The DSMS exhibits satisfactory psychometric properties for five reliability and validity metrics, and so is a suitable instrument to apply in both research and clinical practices.
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Affiliation(s)
- Eun-Hyun Lee
- Graduate School of Public Health, Ajou University, Suwon, Republic of Korea.
| | - Young Whee Lee
- Department of Nursing, Inha University, Incheon, Republic of Korea.
| | - Duckhee Chae
- College of Nursing, Chonnam National University, Gwangju, Republic of Korea.
| | - Kwan-Woo Lee
- Department of Endocrinology and Metabolism, School of Medicine, Ajou University, Suwon, Republic of Korea.
| | - Jin Ook Chung
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.
| | - Seongbin Hong
- Department of Internal Medicine, School of Medicine, Inha University, Incheon, Republic of Korea.
| | - So Hun Kim
- Department of Internal Medicine, School of Medicine, Inha University, Incheon, Republic of Korea.
| | - Eun Hee Kang
- Graduate School of Public Health, Ajou University, Suwon, Republic of Korea.
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Ravn IM, Beedholm K, Frederiksen K, Kvangarsnes M, Foss IC, Knutsen IR. In search of the changeable: An analysis of visual representations of nursing in Norwegian and Danish professional nursing journals, 1965–2016. Nurs Inq 2020; 27:e12340. [DOI: 10.1111/nin.12340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/10/2019] [Accepted: 12/14/2019] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | - Marit Kvangarsnes
- Norwegian University of Science and Technology, NTNU Ålesund Ålesund Norway
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Drury A, Payne S, Brady AM. Colorectal cancer survivors' quality of life: a qualitative study of unmet need. BMJ Support Palliat Care 2020:bmjspcare-2020-002190. [PMID: 32601151 DOI: 10.1136/bmjspcare-2020-002190] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/10/2020] [Accepted: 06/02/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Cancer survivors' perceptions of healthcare have been identified as a predictor of quality of life (QoL) outcomes. This study aims to explore colorectal cancer (CRC) survivors' perceptions of how cancer-related healthcare affects their QoL. METHODS Semistructured interviews were conducted with 22 CRC survivors receiving follow-up care between 1 and 5 years post diagnosis. Interviews were recorded, transcribed and analysed thematically. RESULTS Five themes described the impact of healthcare experiences on CRC survivors' QoL. While cancer survivors spoke positively of their relationships with healthcare professionals, many experienced a range of unmet information and supportive care needs. Participants described a range of positive and negative experiences, as power dynamics and navigation of healthcare systems had implications for their QoL. Where negative healthcare events aligned, survivors' autonomy, dignity and confidence were undermined, and survivorship issues could be inadequately addressed. To address persistent unmet needs, survivors developed a safety net(work) of supports to bridge the gap of unmet needs in healthcare with varying outcomes. CONCLUSIONS Cancer survivors' experience of follow-up and healthcare can positively or negatively affect their QoL. Preparation for cancer survivorship must be incorporated into the acute phase of diagnosis and treatment and interlinked with clear pathways of survivorship care and accessible supportive care, which support survivors to be equal partners in their healthcare. Understanding cancer survivors' knowledge, expertise and mastery of their condition is essential to ensure delivery of person-centred supportive care that adequately addresses the survivor's unmet needs.
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Affiliation(s)
- Amanda Drury
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, D04 V1W8, Ireland
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Dublin 2, Ireland
| | - Sheila Payne
- School of Health and Medicine, University of Lancaster, Lancaster, Lancashire, UK
| | - Anne-Marie Brady
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Dublin 2, Ireland
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Abstract
Purpose
Describe the design of a health information and technology educational intervention that promotes health information sharing and technology use for older adult African Americans to support access to health information. The paper aims to discuss this issue.
Design/methodology/approach
The study team developed a novel method to design the intervention. It drew upon three approaches: intergenerational technology transfer, participatory design and community-based participatory research.
Findings
Older adult African Americans (55+) with diabetes and young adults (18–54) connected to them via familial or naturally occurring social networks designed the intervention, which was conducted in the two study sites in Michigan, USA. In total, 29 participants helped design the intervention. Four themes emerged concerning factors that promote intergenerational information exchange in the context of technology and health. First, focus on one technology skill. Second, working together in small groups is preferred. Third, patience is essential. Last, physical capabilities (i.e., eyesight, operating on relatively small screens) and literacy levels should be considered.
Originality/value
This novel method of having participants from the sample population select the health information materials and technology exercises serves as a guide for implementing health information and education interventions aimed at technology use to support self-management for vulnerable patient populations.
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Variabilidad en la exploración motora de la enfermedad de Parkinson entre el neurólogo experto en trastornos del movimiento y la enfermera especializada. Neurologia 2019; 34:520-526. [DOI: 10.1016/j.nrl.2017.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 03/06/2017] [Accepted: 03/16/2017] [Indexed: 11/20/2022] Open
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de Deus Fonticoba T, Santos García D, Macías Arribí M. Inter-rater variability in motor function assessment in Parkinson's disease between experts in movement disorders and nurses specialising in PD management. NEUROLOGÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.nrleng.2017.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
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17
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Theys S, Lust E, Heinen M, Verhaeghe S, Beeckman D, Eeckloo K, Malfait S, Van Hecke A. Barriers and enablers for the implementation of a hospital communication tool for patient participation: A qualitative study. J Clin Nurs 2019; 29:1945-1956. [DOI: 10.1111/jocn.15055] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 08/23/2019] [Accepted: 08/24/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Sofie Theys
- Faculty of Medicine and Health Sciences Department of Public Health and Primary Care – University Centre for Nursing and Midwifery Ghent University Ghent Belgium
| | - Elisa Lust
- Dienstverleningscentrum voor personen met verstandelijke beperkingen vzw Heilig Hart Deinze Belgium
| | - Maud Heinen
- Nursing Science and Allied Healthcare Radboud Institute for Health Sciences IQ Healthcare Radboud University Medical Center Nijmegen The Netherlands
| | - Sofie Verhaeghe
- Faculty of Medicine and Health Sciences Department of Public Health and Primary Care – University Centre for Nursing and Midwifery Ghent University Ghent Belgium
- Department Health Care VIVES University College Roeselare Belgium
| | - Dimitri Beeckman
- Faculty of Medicine and Health Sciences Department of Public Health and Primary Care – University Centre for Nursing and Midwifery Ghent University Ghent Belgium
- Skin Integrity Research Group (SKINT) Department of Public Health and Primary Care– University Centre for Nursing and Midwifery Ghent University Ghent Belgium
- School of Health Sciences Örebro University Örebro Sweden
- School of Nursing and Midwifery Royal College of Surgeons in Ireland Dublin Ireland
| | - Kristof Eeckloo
- Faculty of Medicine and Health Sciences Department of Public Health and Primary Care Ghent University Hospital Ghent Belgium
| | | | - Ann Van Hecke
- Faculty of Medicine and Health Sciences Department of Public Health and Primary Care – University Centre for Nursing and Midwifery Ghent University Ghent Belgium
- Nursing Department Ghent University Hospital Ghent Belgium
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Senteio CR. Investigating the Enduring Impact of a Community-Based Health Education Program to Promote African American Elders' Use of Technology Designed to Support Chronic Disease Self-Management. Geriatrics (Basel) 2018; 3:E70. [PMID: 31011105 PMCID: PMC6371165 DOI: 10.3390/geriatrics3040070] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 10/09/2018] [Accepted: 10/12/2018] [Indexed: 01/07/2023] Open
Abstract
Elders experience chronic disease disparities and barriers to access technology designed to support recommended self-management behaviors. Elders from racial minority groups are among those who experience particular disparities in chronic disease incidence, outcomes, and barriers to technology use. In order to investigate strategies to address barriers, the study team recruited elder African Americans with diabetes and young adults connected to the elders through naturally occurring familial or social networks. Participants attended a community-based health education session focused on enhancing self-efficacy for recommended self-management and using consumer-oriented technology accessible on their smartphones for self-management support. To assess enduring impact, the study team conducted a pilot study to investigate perceptions and use one month following the health education session. Both elders and young adults offered perspectives on what was effective in teaching elders how to use technology. Both age groups stressed that having patience was crucial, as is providing encouragement for the elders to try tasks on their own. Both elders and young adults also showed a statistically significant increase in aspirations to work together for additional intergenerational health and technology knowledge exchange. Several elder participants continued using technology that they first used during the session. This novel, pilot study describes how to promote self-management and technology use for individuals plagued by persistent chronic disease and technology use disparities.
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Affiliation(s)
- Charles R Senteio
- School of Communication and Information, Rutgers University, New Brunswick, NJ 08901, USA.
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Been‐Dahmen JMJ, Grijpma JW, Ista E, Dwarswaard J, Maasdam L, Weimar W, Van Staa A, Massey EK. Self‐management challenges and support needs among kidney transplant recipients: A qualitative study. J Adv Nurs 2018; 74:2393-2405. [DOI: 10.1111/jan.13730] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 03/14/2018] [Accepted: 04/04/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Janet M. J. Been‐Dahmen
- Research Center Innovations in Care Rotterdam University of Applied Sciences Rotterdam The Netherlands
- Department of Internal Medicine Erasmus MC University Medical Center Rotterdam The Netherlands
| | - Jan Willem Grijpma
- Department of Internal Medicine Erasmus MC University Medical Center Rotterdam The Netherlands
| | - Erwin Ista
- Department of Internal Medicine Erasmus MC University Medical Center Rotterdam The Netherlands
- Intensive Care Unit Erasmus MC University Medical Center‐Sophia Children's Hospital Rotterdam The Netherlands
| | - Jolanda Dwarswaard
- Research Center Innovations in Care Rotterdam University of Applied Sciences Rotterdam The Netherlands
| | - Louise Maasdam
- Department of Internal Medicine Erasmus MC University Medical Center Rotterdam The Netherlands
| | - Willem Weimar
- Department of Internal Medicine Erasmus MC University Medical Center Rotterdam The Netherlands
| | - AnneLoes Van Staa
- Research Center Innovations in Care Rotterdam University of Applied Sciences Rotterdam The Netherlands
| | - Emma K. Massey
- Department of Internal Medicine Erasmus MC University Medical Center Rotterdam The Netherlands
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20
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LeBlanc RG, Jacelon CS. Self-care among older people living with chronic conditions. Int J Older People Nurs 2018; 13:e12191. [PMID: 29573333 DOI: 10.1111/opn.12191] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 02/01/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to clarify the concept of self-care among older people living with chronic health conditions. This concept clarification will assist nurses in addressing self-care among older people through research, policy and practice in offering an expanded conceptual model. BACKGROUND Several policy influences over the past decade directly relate to the increased importance and economic necessity to require self-directed care for older people living with chronic health conditions to maintain their care at home in the community. METHOD A selective review of literature on the concept of self-care included 31 sources. The Norris Concept Clarification method (1982) was used for clarification. The phenomenon is described historically according to its antecedents, attributes and consequences. RESULTS A proposed definition is provided based on the clarification of this concept. A conceptual model is presented through an ecological framework. Self-care among older people living with chronic conditions is multidimensional and has multilevel influences (individual, community, system levels) and is mediated by the contexts and processes of ageing. Self-care originates along one's life course and is learned. Self-care responses are based on care needs when living with chronic health conditions. CONCLUSION Self-care is an individual capacity, disposition and activity older people manifest in living with multiple chronic conditions. These features (capacity, disposition, action) influence one another and are hierarchical and continuous. Research, practice and policies that promote self-care among older people can focus on these features to improve health outcomes and promote new models of care consistent with personal development and chronic care needs in older age. IMPLICATIONS FOR PRACTICE This concept clarification can offer a model to support self-care among older people living with chronic conditions.
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Affiliation(s)
- Raeann G LeBlanc
- University of Massachusetts Amherst College of Nursing, Amherst, MA, USA
| | - Cynthia S Jacelon
- University of Massachusetts Amherst College of Nursing, Amherst, MA, USA
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21
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Lenzen SA, Daniëls R, van Bokhoven MA, van der Weijden T, Beurskens A. What makes it so difficult for nurses to coach patients in shared decision making? A process evaluation. Int J Nurs Stud 2017; 80:1-11. [PMID: 29331655 DOI: 10.1016/j.ijnurstu.2017.12.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 10/27/2017] [Accepted: 12/11/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Primary care nurses play a crucial role in coaching patients in shared decision making about goals and actions. This presents a challenge to practice nurses, who are frequently used to protocol-based working routines. Therefore, an approach was developed to support nurses to coach patients in shared decision making. OBJECTIVES To investigate how the approach was implemented and experienced by practice nurses and patients. DESIGN A process evaluation was conducted using quantitative and qualitative methods. SETTINGS/PARTICIPANTS Fifteen female practice nurses (aged between 28 and 55 years), working with people suffering from diabetes, COPD, asthma and/or cardiovascular diseases, participated. Nurses were asked to apply the approach to their chronically ill patients and to recruit patients (n = 10) willing to participate in an interview or an audio-recording of a consultation (n = 13); patients (13 women, 10 men) were aged between 41 and 88 years and suffered from diabetes, COPD or cardiovascular diseases. METHODS The approach involved a framework for shared decision making about goals and actions, a tool to explore the patient perspective, a patient profiles model and a training course. Interviews (n = 15) with nurses, a focus group with nurses (n = 9) and interviews with patients (n = 10) were conducted. Nurses filled in a questionnaire about their work routine before, during and after the training course. They were asked to deliver audiotapes of their consultations (n = 13). RESULTS Overall, nurses felt that the approach supported them to coach patients in shared decision making. Nurses had become more aware of their own attitudes and learning needs and reported to have had more in-depth discussions with patients. The on-the-job coaching was experienced as valuable. However, nurses struggled to integrate the approach in routine care. They experienced the approach as different to their protocol-based routines and expressed the importance of receiving support and the need for integration of the approach into the family physician practice. CONCLUSION This study shows that changing practice nurses' role from medical experts to coaches in shared decision making is very complex and requires paying attention to skills and attitudes, as well as to contextual factors. Our results indicate that more time and training might be needed for this role transition. Moreover, it might be worthwhile to focus on organizational learning, in order to increase an organization's capacity to change work routines in a collaborative process. Future research into the development and evaluation of health coaching approaches, focusing on shared decision making, is necessary.
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Affiliation(s)
- Stephanie Anna Lenzen
- Research Centre for Autonomy and Participation for People with a Chronic Illness, Zuyd University of Applied Sciences, Heerlen, The Netherlands; Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
| | - Ramon Daniëls
- Research Centre for Autonomy and Participation for People with a Chronic Illness, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Marloes Amantia van Bokhoven
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Anna Beurskens
- Research Centre for Autonomy and Participation for People with a Chronic Illness, Zuyd University of Applied Sciences, Heerlen, The Netherlands; Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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22
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Been-Dahmen JMJ, Walter MJ, Dwarswaard J, Hazes JMW, van Staa A, Ista E. What support is needed to self-manage a rheumatic disorder: a qualitative study. BMC Musculoskelet Disord 2017; 18:84. [PMID: 28209161 PMCID: PMC5314679 DOI: 10.1186/s12891-017-1440-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 02/02/2017] [Indexed: 11/15/2022] Open
Abstract
Background Today, patients are expected to take an active role in the form of self-management. Given the burden of a rheumatic disorder, the patients cannot be expected to self-manage on their own. In order to develop self-management interventions that fit patients’ needs and preferences, it is essential to examine patients’ perspective on how support can be optimized. This study aimed to identify support needs of outpatients with rheumatic disorders and preferences for who should provide self-management support. Methods A qualitative study was conducted using focus groups and individual interviews with outpatients with rheumatic disorders treated in a Dutch university hospital. Interview data was analysed with Directed Content Analysis and coded with predetermined codes derived from our model about support needs of chronically ill patients. This model distinguished three types of support: instrumental, psychosocial and relational support. Results Fourteen patients participated in two focus group interviews and six were interviewed individually. Most patients preferred an active role in self-management. Nonetheless, they notably needed support in developing skills for self-managing their rheumatic disorder in daily life. The extent of support needs was influenced by disease stage, presence of symptoms and changes in one’s situation. A trusted relationship and partnership were conditional for receiving any kind of professional support. Patients wanted to be seen as experienced experts of living with a rheumatic disorder. Acquiring specific disease-related knowledge, learning how to deal with symptoms and fluctuations, talking about emotional aspects, and discussing daily life issues and disease-related information were identified as important elements of self-management support. It was considered crucial that support be tailored to individual needs and expertise. Professionals and relatives were preferred as support givers. Few patients desired support from fellow patients. Conclusion Self-management was primarily seen as patient’s own task. Above all, patients wanted to be seen as the experienced experts. Professionals’ self-management support should be focused on coaching patients in developing problem-solving skills, for which practical tools and training are needed.
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Affiliation(s)
- Janet M J Been-Dahmen
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rochussenstraat 198, P.O. Box 25035, 3001, HA, Rotterdam, The Netherlands. .,Rheumatology Department, Erasmus MC University Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.
| | - Margot J Walter
- Rheumatology Department, Erasmus MC University Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Jolanda Dwarswaard
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rochussenstraat 198, P.O. Box 25035, 3001, HA, Rotterdam, The Netherlands
| | - Johanna M W Hazes
- Rheumatology Department, Erasmus MC University Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - AnneLoes van Staa
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rochussenstraat 198, P.O. Box 25035, 3001, HA, Rotterdam, The Netherlands.,Institute of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
| | - Erwin Ista
- Intensive Care Unit, Erasmus MC University Medical Center-Sophia Children's Hospital, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
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Cox K, Macleod SC, Sim CJ, Jones AW, Trueman J. Avoiding hospital admission in COPD: impact of a specialist nursing team. ACTA ACUST UNITED AC 2017; 26:152-158. [DOI: 10.12968/bjon.2017.26.3.152] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Karen Cox
- Senior Clinical Nurse Specialist – Respiratory, Lincolnshire Community Health Services NHS Trust, Lincoln
| | - Susan C Macleod
- Respiratory Nurse Specialist, Lincolnshire Community Health Services NHS Trust, Lincoln
| | - Caroline J Sim
- Respiratory Nurse Specialist, Lincolnshire Community Health Services NHS Trust, Lincoln
| | - Arwel W Jones
- Research Fellow, Lincoln Institute for Health, University of Lincoln, Lincoln
| | - Jacqui Trueman
- Respiratory Complex Case Manager Lincolnshire Community Health Services NHS Trust, Lincoln
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Bunn F, Goodman C, Manthorpe J, Durand MA, Hodkinson I, Rait G, Millac P, Davies SL, Russell B, Wilson P. Supporting shared decision-making for older people with multiple health and social care needs: a protocol for a realist synthesis to inform integrated care models. BMJ Open 2017; 7:e014026. [PMID: 28174225 PMCID: PMC5306514 DOI: 10.1136/bmjopen-2016-014026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Including the patient or user perspective is a central organising principle of integrated care. Moreover, there is increasing recognition of the importance of strengthening relationships among patients, carers and practitioners, particularly for individuals receiving substantial health and care support, such as those with long-term or multiple conditions. The overall aims of this synthesis are to provide a context-relevant understanding of how models to facilitate shared decision-making (SDM) might work for older people with multiple health and care needs, and how they might be applied to integrated care models. METHODS AND ANALYSIS The synthesis draws on the principles of realist inquiry, to explain how, in what contexts and for whom, interventions that aim to strengthen SDM among older patients, carers and practitioners are effective. We will use an iterative, stakeholder-driven, three-phase approach. Phase 1: development of programme theory/theories that will be tested through a first scoping of the literature and consultation with key stakeholder groups; phase 2: systematic searches of the evidence to test and develop the theories identified in phase 1; phase 3: validation of programme theory/theories with a purposive sample of participants from phase 1. The synthesis will draw on prevailing theories such as candidacy, self-efficacy, personalisation and coproduction. ETHICS AND DISSEMINATION Ethics approval for the stakeholder interviews was obtained from the University of Hertfordshire ECDA (Ethics Committee with Delegated Authority), reference number HSK/SF/UH/02387. The propositions arising from this review will be used to develop recommendations about how to tailor SDM interventions to older people with complex health and social care needs in an integrated care setting.
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Affiliation(s)
- Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London, London, UK
| | - Marie-Anne Durand
- The Preference Laboratory, The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire, USA
| | - Isabel Hodkinson
- Tower Hamlets Clinical Commissioning Group, The Tredegar Practice, London, UK
| | - Greta Rait
- Research Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), London, UK
| | | | - Sue L Davies
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Bridget Russell
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Patricia Wilson
- Centre for Health Service Studies, University of Kent, Canterbury, UK
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Pétré B, Gagnayre R, De Andrade V, Ziegler O, Guillaume M. From therapeutic patient education principles to educative attitude: the perceptions of health care professionals - a pragmatic approach for defining competencies and resources. Patient Prefer Adherence 2017; 11:603-617. [PMID: 28356722 PMCID: PMC5367491 DOI: 10.2147/ppa.s121892] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Educative attitude is an essential, if implicit, aspect of training to acquire competency in therapeutic patient education (TPE). With multiple (or nonexistent) definitions in the literature, however, the concept needs clarification. The primary aim of this study was to analyze the representations and transformations experienced by health care professionals in the course of TPE training in order to characterize educative attitude. We conducted an exploratory qualitative study using several narrative research-based tools with participants of two TPE continuing education courses. We then performed an inductive thematic analysis. Thirty-three people participated in the study; the majority were women (n=29), nurses (n=17) working in a hospital setting (n=28). Seven categories of statements were identified: time-related ("the right moment, how much time it takes"), the benefits of TPE (to health care professionals' personal well-being), emotions and feelings (quality of exchanges, sharing), the professional nature of TPE (educational competencies required), the holistic, interdisciplinary approach (complexity of the person and value of teamwork), the educational nature of the care relationship (education an integral part of care) and the ethical dimension (introspection essential). The first three components appear fairly innovative, at least in formulation. The study's originality rests primarily in its choice of participants - highly motivated novices who expressed themselves in a completely nontheoretical way. Health models see attitude as critical for adopting a behavior. Best TPE practices should encourage personal work on this, opening professionals to the social, experiential and emotional aspects of managing chronic illness.
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Affiliation(s)
- Benoit Pétré
- Department of Public Health, University of Liège, Liège, Belgium
- Correspondence: Benoit Pétré, Department of Public Health, University of Liège, Quartier Hôpital, Avenue Hippocrate 13 (B23), 4000 Liège, Belgium, Tel +32 4 366 2505, Fax +32 4 366 2596, Email
| | - Remi Gagnayre
- Educations and Health Practices Laboratory (LEPS), (EA 3412), UFR SMBH, Paris 13 University, Sorbonne Paris Cite, Bobigny
| | - Vincent De Andrade
- Educations and Health Practices Laboratory (LEPS), (EA 3412), UFR SMBH, Paris 13 University, Sorbonne Paris Cite, Bobigny
| | - Olivier Ziegler
- Department of Diabetes, Metabolic diseases and Nutrition, Nancy University Hospital, Nancy, France
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Roets-Merken LM, Vernooij-Dassen MJFJ, Zuidema SU, Dees MK, Hermsen PGJM, Kempen GIJM, Graff MJL. Evaluation of nurses' changing perceptions when trained to implement a self-management programme for dual sensory impaired older adults in long-term care: a qualitative study. BMJ Open 2016; 6:e013122. [PMID: 27856482 PMCID: PMC5129041 DOI: 10.1136/bmjopen-2016-013122] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To gain insights into the process of nurses' changing perceptions when trained to implement a self-management programme for dual sensory impaired older adults in long-term care, and into the factors that contributed to these changes in their perceptions. DESIGN Qualitative study alongside a cluster randomised controlled trial. SETTING 17 long-term care homes spread across the Netherlands. PARTICIPANTS 34 licensed practical nurses supporting 54 dual sensory impaired older adults. INTERVENTION A 5-month training programme designed to enable nurses to support the self-management of dual sensory impaired older adults in long-term care. PRIMARY OUTCOMES Nurses' perceptions on relevance and feasibility of the self-management programme collected from nurses' semistructured coaching diaries over the 5-month training and intervention period, as well as from trainers' reports. RESULTS Nurses' initial negative perceptions on relevance and feasibility of the intervention changed to positive as nurses better understood the concept of autonomy. Through interactions with older adults and by self-evaluations of the effect of their behaviour, nurses discovered that their usual care conflicted with client autonomy. From that moment, nurses felt encouraged to adapt their behaviour to the older adults' autonomy needs. However, nurses' initial unfamiliarity with conversation techniques required a longer exploration period than planned. Once client autonomy was understood, nurses recommended expanding the intervention as a generic approach to all their clients, whether dual sensory impaired or not. CONCLUSIONS Longitudinal data collection enabled exploration of nurses' changes in perceptions when moving towards self-management support. The training programme stimulated nurses to go beyond 'protocol thinking', discovering client autonomy and exploring the need for their own behavioural adaptations. Educational programmes for practical nurses should offer more longitudinal coaching of autonomy supportive conversational skills. Intervention programming should acknowledge that change is a process rather than an event, and should include self-evaluations of professional behaviours over a period of time. TRIAL REGISTRATION NUMBER NCT01217502, Post-results.
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Affiliation(s)
- Lieve M Roets-Merken
- Radboud University Medical Center, Donders Center for Cognition, Brain & Behavior, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
- Kalorama Foundation, Beek-Ubbergen, The Netherlands
| | - Myrra J F J Vernooij-Dassen
- Radboud University Medical Center, Donders Center for Cognition, Brain & Behavior, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
| | - Sytse U Zuidema
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, Groningen, The Netherlands
| | - Marianne K Dees
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | | | - Gertrudis I J M Kempen
- Maastricht University, Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands
| | - Maud J L Graff
- Radboud University Medical Center, Donders Center for Cognition, Brain & Behavior, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
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Foss C, Knutsen I, Kennedy A, Todorova E, Wensing M, Lionis C, Portillo MC, Serrano-Gil M, Koetsenruijter J, Mujika A, Rogers A. Connectivity, contest and the ties of self-management support for type 2 diabetes: a meta-synthesis of qualitative literature. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:672-686. [PMID: 26429546 DOI: 10.1111/hsc.12272] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/13/2015] [Indexed: 06/05/2023]
Abstract
This paper presents a meta-synthesis of the literature on community-based self-management to support experiences of people diagnosed with type 2 diabetes. The aim was to synthesise findings on both formal and informal self-management support with particular reference to the relevance and influence of the social context operating at different levels. The review forms part of EU-WISE, a project financed through EU's 7th Framework Programme. The review was performed by systematically searching MEDLINE, PubMed, EMBASE, CINAHL, PsycINFO and Web of Science for English language publications between 2005 and 2014 presenting research conducted in Europe on the experiences and perspectives of self-management concerns of patients diagnosed with type 2 diabetes. The search yielded 587 abstracts, which were reduced through search strategy refinement and eligibility and quality criteria to 29 papers that were included in the review. This review highlights the relevance of contextual factors operating at micro- and macro-levels. The synthesis yielded six second-order thematic constructs relating to self-management: sense of agency and identity, the significance and meaning of social networks, minimal disruption of everyday life, economic hardship, the problem of assigning patients' responsibility and structural influences of primary care. Using a line of argument synthesis, these themes were revisited, and a third-order construct, connectivity emerged which refers to how links in daily life are interwoven with peoples' social networks, local communities, economic and ideological conditions in society in a way which support self-management activities. This meta-synthesis indicates a need to heed the notion of connectivity as a means of mobilising and supporting the self-management strategies of people with type 2 diabetes in everyday life.
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Affiliation(s)
- Christina Foss
- Department of Nursing Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Ingrid Knutsen
- Department of Nursing Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Anne Kennedy
- NIHR CLAHRC Wessex, Health Sciences, University of Southampton, Hampshire, UK
| | - Elka Todorova
- Department of Economic Sociology, University of National and World Economy, Sofia, Bulgaria
| | - Michel Wensing
- Stichting Katholieke Universiteit, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Christos Lionis
- Clinic of Social and Family Medicine, Medical School, University of Crete, Heraklion, Greece
| | | | | | - Jan Koetsenruijter
- Stichting Katholieke Universiteit, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Anne Rogers
- NIHR CLAHRC Wessex, Health Sciences, University of Southampton, Hampshire, UK
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Trappes-Lomax T. Self-care for people coping with long-term health conditions in the community: the views of patients and GPs. JOURNAL OF INTEGRATED CARE 2016. [DOI: 10.1108/jica-05-2015-0019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Long-term health problems put great pressures on health and social care services. Supporting ‘self-care’ has measurable benefits in helping patients cope better, but is difficult to do in practice. This review aims to help improve services by exploring existing evidence about the views of patients and GPs.
Design/methodology/approach
The search terms were identified following detailed discussion with service users. Five databases (PUBMED, CINAHL, TRIP, SCIE and PSYCINFO) were interrogated against pre-set questions and criteria. The data were managed in EndNote v6 and analysed in a series of Word tables.
Findings
37 community-based studies were identified, covering diverse chronic illnesses. Analysis of ‘barriers and enablers’ showed a very complex picture, with health systems often actively inhibiting the responsiveness and flexibility which support self-care. Directly seeking service user and practitioner views could shape more effective services
Research limitations/implications
Further research is needed into: the purpose and outcomes of user involvement, the relationship between integrated care and self-care, how patient motivation and resilience can be encouraged in primary care and the effect of current incentive schemes on self-care support
Due to organisational changes, eligible studies were reviewed by one researcher only and these were mainly qualitative studies lacking generalisability. However, the results spanned a range of settings and health conditions. They are also clearly supported by later primary research findings
Practical implications
Several evidence-based, achievable opportunities to improve self-care support in primary care settings are identified
Originality/value
This service-user study, offers detailed analysis of what helps or hinders self-care in everyday life
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29
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Duprez V, Van Hooft SM, Dwarswaard J, van Staa A, Van Hecke A, Strating MM. The development and psychometric validation of the self-efficacy and performance in self-management support (SEPSS) Instrument. J Adv Nurs 2016; 72:1381-95. [DOI: 10.1111/jan.12918] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Veerle Duprez
- University Centre for Nursing and Midwifery; Department of Public Health; Faculty of Medicine and Health Sciences; Ghent University; Ghent Belgium
| | - Susanne M. Van Hooft
- Research Centre Innovations in Care; Rotterdam University of Applied Sciences; the Netherlands
- Institute of Health Policy & Management; Erasmus University Rotterdam; Rotterdam the Netherlands
| | - Jolanda Dwarswaard
- Research Centre Innovations in Care; Rotterdam University of Applied Sciences; the Netherlands
- Institute of Health Policy & Management; Erasmus University Rotterdam; Rotterdam the Netherlands
| | - AnneLoes van Staa
- Research Centre Innovations in Care; Rotterdam University of Applied Sciences; the Netherlands
- Institute of Health Policy & Management; Erasmus University Rotterdam; Rotterdam the Netherlands
| | - Ann Van Hecke
- University Centre for Nursing and Midwifery; Department of Public Health; Faculty of Medicine and Health Sciences; Ghent University; Ghent Belgium
| | - Mathilde M.H. Strating
- Institute of Health Policy & Management; Erasmus University Rotterdam; Rotterdam the Netherlands
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30
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Snyder H, Engström J. The antecedents, forms and consequences of patient involvement: A narrative review of the literature. Int J Nurs Stud 2016; 53:351-78. [DOI: 10.1016/j.ijnurstu.2015.09.008] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 09/01/2015] [Accepted: 09/09/2015] [Indexed: 12/19/2022]
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Wilkinson M, Whitehead L, Crowe M. Nurses perspectives on long-term condition self-management: a qualitative study. J Clin Nurs 2015; 25:240-6. [DOI: 10.1111/jocn.13072] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Mandy Wilkinson
- Centre for Postgraduate Nursing Studies; University of Otago; Christchurch New Zealand
| | - Lisa Whitehead
- School of Nursing and Midwifery; Edith Cowan University; Joondalup Australia
| | - Marie Crowe
- Centre for Postgraduate Nursing Studies; University of Otago; Christchurch New Zealand
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Matthews T, Trenoweth S. Nurses' perceptions of self-management in renal care. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2015; 24:956-61. [PMID: 26500125 DOI: 10.12968/bjon.2015.24.19.956] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Self-management is vital for patients with long-term conditions in order to ensure wellbeing. It needs to be supported by a healthcare workforce who are knowledgeable and able to work in collaboration with individuals. In this study, ten nurses were selected by means of exclusion/inclusion criteria and then interviewed with a semi-structured approach. Following analysis of the data with an open, axial and selective coding process, clear themes emerged: expectation of roles, lack of confidence and concerns with risk-taking. There were a number of concerns around engaging with self-management for this group of nurses, including a lack of knowledge and skills to assess the suitability of patients for self-management and subsequently to offer support, and concerns that self-management would be too unsafe in a renal setting. This study suggests that nurses would need education in strategies to support and implement self-management. Further studies should be undertaken to explore this possibility with renal patients admitted to the ward.
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Been-Dahmen JM, Dwarswaard J, Hazes JM, van Staa A, Ista E. Nurses' views on patient self-management: a qualitative study. J Adv Nurs 2015; 71:2834-45. [DOI: 10.1111/jan.12767] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Janet M.J. Been-Dahmen
- Rotterdam University of Applied Sciences; Research Center Innovations in Care; The Netherlands
- Erasmus Medical Center; Rheumatology Department; The Netherlands
| | - Jolanda Dwarswaard
- Rotterdam University of Applied Sciences; Research Center Innovations in Care; The Netherlands
| | | | - AnneLoes van Staa
- Rotterdam University of Applied Sciences; Research Center Innovations in Care; The Netherlands
- Erasmus University Rotterdam; Institute of Health Policy & Management; The Netherlands
| | - Erwin Ista
- Erasmus Medical Center-Sophia Children's Hospital; Intensive Care Unit; Rotterdam The Netherlands
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Boger E, Ellis J, Latter S, Foster C, Kennedy A, Jones F, Fenerty V, Kellar I, Demain S. Self-Management and Self-Management Support Outcomes: A Systematic Review and Mixed Research Synthesis of Stakeholder Views. PLoS One 2015; 10:e0130990. [PMID: 26162086 PMCID: PMC4498685 DOI: 10.1371/journal.pone.0130990] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 05/27/2015] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Self-management has received growing attention as an effective approach for long-term condition management. Little is known about which outcomes of supported self-management are valued by patients, their families, health professionals and those who commission self-management services. This study systematically reviewed published empirical evidence in accordance with PRISMA guidelines to determine the outcomes of self-management valued by these key stakeholder groups, using three prominent exemplar conditions: colorectal cancer, diabetes and stroke. AIM To systematically review the literature to identify which generic outcomes of self-management have been targeted and are considered important using three exemplar conditions (colorectal cancer, diabetes and stroke), which collectively have a range of features that are likely to be representative of generic self-management issues. METHODS Systematic searching of nine electronic databases was conducted in addition to hand searches of review articles. Abstracts were identified against inclusion criteria and appraised independently by two reviewers, using a critical appraisal tool. Synthesis of findings was conducted using mixed research synthesis. RESULTS Over 20,536 abstracts were screened. 41 studies which met the review criteria were fully retrieved and appraised. The majority of evidence related to diabetes. Few studies directly focussed on stakeholders' views concerning desired self-management outcomes; the majority of evidence was derived from studies focusing upon the experience of self-management. The views of health care commissioners were absent from the literature. We identified that self-management outcomes embrace a range of indicators, from knowledge, skills, and bio-psychosocial markers of health through to positive social networks. CONCLUSIONS Patients', families', health professionals' and commissioners' views regarding which outcomes of self-management are important have not been clearly elicited. The extent to which bio-psychosocial indicators relate to successful self-management from the perspectives of all groups of stakeholders is unknown. Further investigation regarding which self-management outcomes are considered important by all stakeholders is necessary to guide the commissioning and design of future self-management services.
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Affiliation(s)
- Emma Boger
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Jaimie Ellis
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Sue Latter
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Claire Foster
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Anne Kennedy
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Fiona Jones
- Department of Social Care and Education, St George’s and Kingston University of London, London United Kingdom
| | - Vicky Fenerty
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Ian Kellar
- Institute of Psychological Sciences, University of Leeds, Leeds, United Kingdom
| | - Sara Demain
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
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35
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Young HML, Apps LD, Harrison SL, Johnson-Warrington VL, Hudson N, Singh SJ. Important, misunderstood, and challenging: a qualitative study of nurses' and allied health professionals' perceptions of implementing self-management for patients with COPD. Int J Chron Obstruct Pulmon Dis 2015; 10:1043-52. [PMID: 26082628 PMCID: PMC4461084 DOI: 10.2147/copd.s78670] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background In light of the growing burden of COPD, there is increasing focus on the role of self-management for this population. Currently, self-management varies widely. Little is known either about nurses’ and allied health professionals’ (AHPs’) understanding and provision of self-management in clinical practice. This study explores nurses’ and AHPs’ understanding and implementation of supported COPD self-management within routine clinical practice. Materials and methods Nurses and AHPs participated in face-to-face semistructured interviews to explore their understanding and provision of COPD self-management, as well as their perceptions of the challenges to providing such care. Purposive sampling was used to select participants from a range of professions working within primary, community, and secondary care settings. Three researchers independently analyzed each transcript using a thematic approach. Results A total of 14 participants were interviewed. Nurses and AHPs viewed self-management as an important aspect of COPD care, but often misunderstood what it involved, leading to variation in practice. A number of challenges to supporting self-management were identified, which related to lack of time, lack of insight regarding training needs, and assumptions regarding patients’ perceived self-management abilities. Conclusion Nurses and AHPs delivering self-management require clear guidance, training in the use of effective self-management skills, and education that challenges their preconceptions regarding patients. The design of health care services also needs to consider the practical barriers to COPD self-management support for the implementation of such interventions to be successful.
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Affiliation(s)
- Hannah M L Young
- National Institute of Health Research CLAHRC-LNR Pulmonary Rehabilitation Research Group, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Lindsay D Apps
- National Institute of Health Research CLAHRC-LNR Pulmonary Rehabilitation Research Group, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Samantha L Harrison
- National Institute of Health Research CLAHRC-LNR Pulmonary Rehabilitation Research Group, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Vicki L Johnson-Warrington
- National Institute of Health Research CLAHRC-LNR Pulmonary Rehabilitation Research Group, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Nicky Hudson
- School of Applied Social Sciences, De Montfort University, Leicester, UK
| | - Sally J Singh
- National Institute of Health Research CLAHRC-LNR Pulmonary Rehabilitation Research Group, University Hospitals of Leicester NHS Trust, Leicester, UK ; Applied Research Centre in Health and Lifestyle Interventions, Coventry University, Coventry, UK
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36
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Support supplied by Parkinson's disease specialist nurses to Parkinson's disease patients and their spouses. Appl Nurs Res 2015; 28:86-91. [PMID: 25908544 DOI: 10.1016/j.apnr.2014.12.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 09/16/2014] [Accepted: 12/18/2014] [Indexed: 11/21/2022]
Abstract
AIM The purpose of the study was to identify the role of the Parkinson's disease specialist nurse in providing support both for people with Parkinson's disease (PD) and their spouses. BACKGROUND PD is a neurodegenerative disease with symptoms that affect many aspects of daily life. In Sweden, specialised nurses called Parkinson's disease specialist nurses (PD specialist nurses) have been working for over a decade to support PD patients and their families. METHOD A qualitative approach was taken using dyad interviews with each PD patient and spouse. The analysis was conducted using conventional qualitative content analysis. FINDINGS The analysis resulted in the identification of one overarching category; competent, professional practice, tailored for the individual. Four categories: professional competence, nursing practice, continuity of contact and emotional support, are distinct but related to each other and show different nuances of the same phenomenon. CONCLUSION The work of PD specialist nurses in providing support to PD patients and their relatives should be tailored to individual patients and their families as well as including skilled nursing care to relieve the impact of the disease on daily life.
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Boström E, Isaksson U, Lundman B, Sjölander AE, Hörnsten Å. Diabetes specialist nurses’ perceptions of their multifaceted role. ACTA ACUST UNITED AC 2015. [DOI: 10.1002/edn.204] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Grindrod K. Management of stable chronic obstructive pulmonary disease. Br J Community Nurs 2015; 20:58, 60-4. [PMID: 25651279 DOI: 10.12968/bjcn.2015.20.2.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a common condition. There are an estimated 3 million cases in the UK. Of these, 2 million have not got a formal diagnosis. Community nurses meet patients with COPD frequently, although COPD may not be the primary reason for the encounter, or the COPD may be present but undiagnosed. The number of patients with COPD is believed to be increasing and, with increased awareness of the condition and an emphasis on improving diagnosis, the number of cases is expected to rise. Community nurses are well placed to raise concerns that a patient in their care may have undiagnosed COPD; if the condition is subsequently diagnosed and appropriate treatment is given, outcomes will improve for that individual. Community nurses can also support patients and their families to manage the condition through all stages of the disease trajectory, from diagnosis to the end-of-life phase.
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Affiliation(s)
- Karen Grindrod
- Service Manager and Specialist Respiratory Nurse, Croydon Respiratory Team, Croydon Health Services NHS Trust
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39
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Lauvergeon S, Mettler D, Burnand B, Peytremann‐Bridevaux I. Convergences and divergences of diabetic patients' and healthcare professionals' opinions of care: a qualitative study. Health Expect 2015; 18:111-23. [PMID: 23121596 PMCID: PMC5060754 DOI: 10.1111/hex.12013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2012] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To investigate opinions' convergences and divergences of diabetic patients and health-care professionals on diabetes care and the development of a regional diabetes programme. BACKGROUND Development and implementation of a regional diabetes programme. RESEARCH DESIGN Qualitative study using focus groups to elicit diabetic patients' and health-care professionals' opinions, followed by content analysis. SETTING AND PARTICIPANTS Eight focus groups: four focus groups with diabetic patients (n = 39) and four focus groups with various health-care professionals (n = 34) residing or practicing in the canton of Vaud, Switzerland, respectively. RESULTS Perceived quality of diabetes care varied between individuals and types of participants. To improve quality, patients favoured a comprehensive follow-up while professionals suggested considering existing structures and trained professionals. All participants mentioned communication difficulties between professionals and were favouring teamwork. In addition, they described the role that patients should have in care and self-management. Financial difficulties were also mentioned by both groups of participants. Finally, they were in favour of the development of a regional diabetes programme adapted to actors' needs. For patients indeed, such a programme would represent an opportunity to improve information and to have access to comprehensive care. For professionals, it would help the development of local networks and the reinforcement of existing tools and structures. DISCUSSION AND CONCLUSIONS Acknowledging convergences and divergences of opinions of both diabetic patients and health-care professionals should help the further development of a programme adapted to users' needs, taking all stakeholders interests and priorities into consideration.
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Affiliation(s)
- Stéphanie Lauvergeon
- Institute of Social and Preventive Medicine (IUMSP)Lausanne University HospitalLausanneSwitzerland
| | - Désirée Mettler
- Institute of Social and Preventive Medicine (IUMSP)Lausanne University HospitalLausanneSwitzerland
| | - Bernard Burnand
- Institute of Social and Preventive Medicine (IUMSP)Lausanne University HospitalLausanneSwitzerland
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40
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Dwarswaard J, Bakker EJM, van Staa A, Boeije HR. Self-management support from the perspective of patients with a chronic condition: a thematic synthesis of qualitative studies. Health Expect 2015; 19:194-208. [PMID: 25619975 DOI: 10.1111/hex.12346] [Citation(s) in RCA: 163] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Receiving adequate support seems to be crucial to the success of self-management. Although different empirical studies separately examined patients' preferences for self-management support (SMS), an overview is lacking. OBJECTIVE The aim of this qualitative review was to identify patients' needs with respect to SMS and to explore by whom this support is preferably provided. SEARCH STRATEGY Qualitative studies were identified from Embase, MEDLINE OvidSP, Web of science, PubMed publisher, Cochrane central, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsycINFO. INCLUSION CRITERIA Articles needed to meet all of the following criteria: (i) focuses on self-management, (ii) concerns adult patients with rheumatic diseases (rheumatoid arthritis and fibromyalgia), a variant of cancer or chronic kidney disease, (iii) explores support needs from the patients' perspective, (iv) uses qualitative methods and (v) published in English. DATA EXTRACTION AND SYNTHESIS A thematic synthesis, developed by Thomas and Harden, was conducted of the 37 included studies. MAIN RESULTS Chronic patients need instrumental support, psychosocial support and relational support from health-care professionals, family/friends and fellow patients to manage the chronic condition. Relational support is at the centre of the support needs and fuels all other types of support. DISCUSSION AND CONCLUSIONS Patients do not self-manage on their own. Patients expect health-care professionals to fulfil a comprehensive role. Support needs can be knitted together only when patients and professionals work together on the basis of collaborative partnership. Dynamics in support needs make it important to regularly assess patient needs.
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Affiliation(s)
- Jolanda Dwarswaard
- Research Centre Innovations of Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.,Department of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Ellen J M Bakker
- Research Centre Innovations of Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - AnneLoes van Staa
- Research Centre Innovations of Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.,Department of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Hennie R Boeije
- Department of Methodology and Statistics, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
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41
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van Hooft SM, Dwarswaard J, Jedeloo S, Bal R, van Staa A. Four perspectives on self-management support by nurses for people with chronic conditions: A Q-methodological study. Int J Nurs Stud 2015; 52:157-66. [DOI: 10.1016/j.ijnurstu.2014.07.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 07/04/2014] [Accepted: 07/10/2014] [Indexed: 10/25/2022]
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Wilson PM, Reston JD, Bieraugel R, Da Silva Gane M, Wellsted D, Offredy M, Farrington K. You cannot choose your family: sociological ambivalence in the hemodialysis unit. QUALITATIVE HEALTH RESEARCH 2015; 25:27-39. [PMID: 25205792 DOI: 10.1177/1049732314549030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Living with end-stage renal disease is challenging and requires a great deal of self-management, but little is known about the experiences of patients and staff around the subject. We held six focus groups in three hemodialysis units, each unit hosting 1 staff and 1 patient focus group. A total of 15 staff members and 15 patients participated. We employed thematic analysis using a priori and emerging codes. Five key themes emerged: challenges, enablers, complex balancing acts, good patient/bad patient, and the hemodialysis unit as a family. We explored the family metaphor further through the work of Bourdieu, but concluded that relationships in the hemodialysis unit most closely fit the concept of sociological ambivalence. We present an explanatory framework around inherent tensions characterizing relationships within the hemodialysis unit and highlight implications for facilitating self-management and developing collaborative approaches to care.
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Affiliation(s)
| | | | | | | | | | | | - Ken Farrington
- East & North Hertfordshire NHS Trust, Stevenage, United Kingdom
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43
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Power T, Jackson D, Carter B, Weaver R. Misunderstood as mothers: women's stories of being hospitalized for illness in the postpartum period. J Adv Nurs 2014; 71:370-80. [PMID: 25186144 DOI: 10.1111/jan.12515] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2014] [Indexed: 11/27/2022]
Abstract
AIM This paper aims to explore women's experiences with healthcare providers to ascertain ways health care may be improved for women disrupted in their mothering. BACKGROUND Women can find it difficult to relinquish care even when they are acutely unwell requiring hospitalization. Despite mothering being a priority for women, many healthcare professionals do not understand the importance of continuing to mother during maternal illness. DESIGN This research used a qualitative methodology drawing on principles of feminism and storytelling. METHODS Women's stories were collected through face-to-face interviews, email and via the telephone. The twenty-seven women who participated were from either Australia or the USA, had between one and six children and identified themselves as having been disrupted in their mothering by illness. Data were collected in 2011 and were analysed thematically. FINDINGS The majority of participants had been hospitalized at some point in time for acute illness. A subset of participants reported feeling judged by nurses and that their efforts to continue to mother their newborn children despite their illness were misunderstood and not facilitated. CONCLUSION Findings from this study suggest that women are more likely to remember times that health professionals failed to understand the primacy that mothering held for them or facilitate their efforts to continue to mother despite illness. Nurses and midwives should regularly reflect on their personal values in regard to mothering, validate women's attempts to mother to the best of their ability during illness and find ways to support and empower women in their mothering.
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Affiliation(s)
- Tamara Power
- Faculty of Health, University of Technology, Sydney, New South Wales, Australia
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Hughes HA, Granger BB. Racial disparities and the use of technology for self-management in blacks with heart failure: a literature review. Curr Heart Fail Rep 2014; 11:281-9. [PMID: 25012939 PMCID: PMC4118038 DOI: 10.1007/s11897-014-0213-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Heart failure is a debilitating illness that requires patients to be actively engaged in self-management. Self-management practices, including maintenance and management of an evidence-based medication regimen, are associated with improved outcomes. Yet, sustained engagement with self-management practices remains a challenge. Both self-management practices and clinical outcomes differ by race, with the poorest self-management and clinical outcomes reported in Blacks. Contemporary interventions to address self-management and reverse current trends in outcomes have evaluated the use of technology. Technological innovations, such as text messaging, social networking, and online learning platforms may provide a more accessible means for self-management of heart failure, yet these innovations have been understudied in the population at greatest risk - Blacks with heart failure. We conducted a review and discovered only four studies evaluating use of technology for self-management in Blacks. More studies are needed to close the gap on racial disparities and use of technology for self-management.
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Affiliation(s)
| | - Bradi B. Granger
- Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710 USA
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Arnetz JE, Zhdanova L. Patient involvement climate: views and behaviours among registered nurses in myocardial infarction care. J Clin Nurs 2014; 24:475-85. [DOI: 10.1111/jocn.12629] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Judith E Arnetz
- School of Medicine; Wayne State University; Detroit MI USA
- Department of Public Health and Caring Sciences; Uppsala University; Uppsala Sweden
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Fletcher MJ, Dahl BH. Expanding nurse practice in COPD: is it key to providing high quality, effective and safe patient care? PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2014; 22:230-3. [PMID: 23666716 PMCID: PMC6442791 DOI: 10.4104/pcrj.2013.00044] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The prevalence of chronic obstructive pulmonary disease (COPD), a common and preventable chronic disease, is on the increase, and so are the financial and social burdens associated with it. The management of COPD is particularly challenging, as patients have complex health and social needs requiring life-long monitoring and treatment. In order to address these issues and reduce the burden imposed by COPD, the development of innovative disease management models is vital. Nurses are in a key position to assume a leading role in the management of COPD since they frequently represent the first point of contact for patients and are involved in all stages of care. Although evidence is still limited, an increasing number of studies have suggested that nurse-led consultations and interventions for the management of COPD have the potential to impact positively on the health and quality of life of patients. The role of nurses in the management of COPD around the world could be significantly expanded and strengthened. Providing adequate educational opportunities and support to nurses, as well as addressing funding issues and system barriers and recognising the importance of the expanding roles of nurses, is vital to the well-being of patients with long-term medical conditions such as COPD and to society as a whole, in order to reduce the burden of this disease.
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Operationalising unscheduled care policy: a qualitative study of healthcare professionals' perspectives. Br J Gen Pract 2013; 63:e192-9. [PMID: 23561786 DOI: 10.3399/bjgp13x664243] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND UK health policy aims to reduce the use of unscheduled care, by increasing proactive and preventative management of patients with long-term conditions in primary care. AIM The study explored healthcare professionals' understanding of why patients with long-term conditions use unscheduled care, and the healthcare professionals' understanding of their role in relation to reducing the use of unscheduled care. DESIGN AND SETTING Qualitative study interviewing different types of healthcare professionals providing primary care or unscheduled care services in northwest England. METHOD Semi-structured interviews were conducted with 29 healthcare professionals (six GPs; five out-of-hours GPs; four emergency department doctors; two practice nurses; three specialist nurses; two district nurses; seven active case managers). Data were analysed using framework analysis. RESULTS Healthcare professionals viewed the use of unscheduled care as a necessary component of care for patients with long-term conditions. Those whose roles involved working to targets to reduce the use of unscheduled care described a tension between this and delivering optimum patient care. Three approaches to reducing unscheduled care were described: optimising the system; negotiating the system; and optimising the patient. CONCLUSION Current policy to reduce the use of unscheduled care does not take account of the perceptions of the healthcare professionals who are expected to implement them. Lipsky's theory of street-level bureaucrats provides a framework to understand how healthcare professionals respond to imposed policies. Healthcare professionals did not see the use of unscheduled care as a problem and there was limited commitment to the policy targets. Therefore, policy should aim for whole-system change rather than reliance on individual healthcare professionals to make changes in their practice.
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Affiliation(s)
- Mike Brady
- College of Human and Health Science, Swansea University, an associate lecturer with the Open University, and a paramedic with South Western Ambulance Service NHS Foundation Trust
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Peeters JM, Wiegers TA, Friele RD. How technology in care at home affects patient self-care and self-management: a scoping review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:5541-64. [PMID: 24173139 PMCID: PMC3863859 DOI: 10.3390/ijerph10115541] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 10/17/2013] [Accepted: 10/17/2013] [Indexed: 11/18/2022]
Abstract
The use of technology in care at home has potential benefits such as improved quality of care. This includes greater focus on the patients’ role in managing their health and increased patient involvement in the care process. The objective of this scoping review is to analyse the existing evidence for effects of technology in home-based care on patients’ self-care and self-management. Using suitable search terms we searched the databases of Pubmed, Embase, Cochrane Library, Cinahl, Picarta and NIVEL dating from 2002 to 2012. Thirty-three studies (six review studies and twenty-seven individual studies) were selected. Effects were extracted from each study and were classified. In almost all the studies, the concepts self-care and self-management are not clearly defined or operationalized. Therefore, based on a meta-analysis, we made a new classification of outcome measures, with hierarchical levels: (1) competence (2) illness-management (3) independence (social participation, autonomy). In general, patient outcomes appear to be positive or promising, but most studies were pilot studies. We did not find strong evidence that technology in care at home has (a positive) effect on patient self-care and self-management according to the above classification. Future research is needed to clarify how technology can be used to maximize its benefits.
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Affiliation(s)
- José M. Peeters
- NIVEL, Netherlands Institute for Health Services Research, Otterstraat 118-124, Utrecht 3513 CR, The Netherlands; E-Mails: (T.A.W.); (R.D.F.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +31-30-272-9628; Fax: +31-30-272-9729
| | - Therese A. Wiegers
- NIVEL, Netherlands Institute for Health Services Research, Otterstraat 118-124, Utrecht 3513 CR, The Netherlands; E-Mails: (T.A.W.); (R.D.F.)
| | - Roland D. Friele
- NIVEL, Netherlands Institute for Health Services Research, Otterstraat 118-124, Utrecht 3513 CR, The Netherlands; E-Mails: (T.A.W.); (R.D.F.)
- Faculty of Social and Behavioural Sciences, Tilburg University, Warandelaan 2, Tilburg 5037 AB, The Netherlands
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van Bekkum JE, Hilton S. The challenges of communicating research evidence in practice: perspectives from UK health visitors and practice nurses. BMC Nurs 2013; 12:17. [PMID: 23835038 PMCID: PMC3710274 DOI: 10.1186/1472-6955-12-17] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 07/01/2013] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Health practitioners play a pivotal role in providing patients with up-to-date evidence and health information. Evidence-based practice and patient-centred care are transforming the delivery of healthcare in the UK. Health practitioners are increasingly balancing the need to provide evidence-based information against that of facilitating patient choice, which may not always concur with the evidence base. There is limited research exploring how health practitioners working in the UK, and particularly those more autonomous practitioners such as health visitors and practice nurses working in community practice settings, negotiate this challenge. This research provides a descriptive account of how health visitors and practice nurses negotiate the challenges of communicating health information and research evidence in practice. METHODS A total of eighteen in-depth telephone interviews were conducted in the UK between September 2008 and May 2009. The participants comprised nine health visitors and nine practice nurses, recruited via adverts on a nursing website, posters at a practitioner conference and through recommendation. Thematic analysis, with a focus on constant comparative method, was used to analyse the data. RESULTS The data were grouped into three main themes: communicating evidence to the critically-minded patient; confidence in communicating evidence; and maintaining the integrity of the patient-practitioner relationship. These findings highlight some of the daily challenges that health visitors and practice nurses face with regard to the complex and dynamic nature of evidence and the changing attitudes and expectations of patients. The findings also highlight the tensions that exist between differing philosophies of evidence-based practice and patient-centred care, which can make communicating about evidence a daunting task. CONCLUSIONS If health practitioners are to be effective at communicating research evidence, we suggest that more research and resources need to be focused on contextual factors, such as how research evidence is negotiated, appraised and communicated within the dynamic patient-practitioner relationship.
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Affiliation(s)
| | - Shona Hilton
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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