Guest Editorial: Chronic disease management and self-care support for people living with long-term conditions: is the nursing workforce prepared?

Defining Self-Management for Solid Organ Transplantation Recipients: A Mixed Method Study

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.

Mental health as a prerequisite for functioning as optimally as possible in old age: A phenomenological approach

Aim

To describe the impact of mental health on the ability to function optimally among older adults experiencing mental health issues.

Design

This study had a descriptive qualitative design.

Methods

Six older females with a Hospital Anxiety and Depression Scale (HADS) score of ≥8 on either of the subscales (depression or anxiety) participated in individual interviews. All data were analysed using a phenomenological approach influenced by Giorgi.

Results

The phenomenological analysis led to a structured synthesis comprising the following three themes: (a) life situations affecting mental health, (b) consequences of mental health in everyday life and (c) strategies for maintaining mental health.

Cochrane reviews of educational and self-management interventions to guide nursing practice: A review

BACKGROUND

The burden of chronic disease on healthcare services worldwide continues to grow, and the increased development of educational interventions which help patients to better manage their own condition is evident internationally.

OBJECTIVES

This paper reports on findings of an updated review of Cochrane systematic reviews of interventions designed to improve patients' knowledge and skills to manage chronic disease, with particular reference to nursing contribution and practice.

METHODS

A broad search strategy was used to search the Cochrane Database of Systematic Reviews to identify reviews of patient education, self-management, and self-care studies. Two reviewers independently assessed eligibility for inclusion and extracted data from the reviews.

FINDINGS

From a total of 882 reviews, 63 met the inclusion criteria, and 900 studies were identified. Most (68%, n = 43) of the 63 reviews were judged by Cochrane reviewers to provide inadequate evidence of the effectiveness of the interventions reviewed. Information on the profession of the person delivering the intervention was often not available, although 78% (n = 49) of reviews mentioned that nurses were involved in a proportion of studies delivering interventions either independently or as part of a multi-professional team.

CONCLUSION

Educational programmes have definite benefits for patients suffering from asthma, chronic obstructive pulmonary disorder and stroke, and are promising in areas such as diabetes, epilepsy, cancer care, and mental health. However, it still is not clear what the active ingredients of many successful interventions are. Further research is needed to establish the impact of technology on programme delivery, and to develop programmes tailored for patients with multiple health problems.

Important, misunderstood, and challenging: a qualitative study of nurses' and allied health professionals' perceptions of implementing self-management for patients with COPD

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.

Knowledge translation in the discourse of professional practice

Clients and practitioners desire up-to-date, safe and effective healthcare. Knowledge translation, a term used to describe the interchange of knowledge between its producers and users, aims to support this desire. Knowledge, and by extension knowledge translation, is subject to varying perspectives ranging from the objective truth-tested knowledge of empiricism, associated by some with academia, to knowledge in the practitioner realm. This latter knowledge is often based on multiple users' experiences and contexts, thus constructed to meet their needs. The goal of this paper is to compare and contrast knowledge and knowledge translation from empirical and constructivist perspectives. It then relates knowledge translation to professional practice discourse and concludes with thoughts on constructivist knowledge translation strategies, including practitioner-driven strategies derived from practice. For example, knowledge translation can be woven into processes to train/integrate new graduates into the healthcare system, it can be captured in practitioner-driven provision of continuing education, and/or it can be facilitated through practitioner collaboration in research via action research approaches. Regardless of the perspective taken, delivery of up-to-date, safe and effective care requires useful, relevant knowledge available when necessary and applicable to real-life issues as perceived, critically, by the knowledge end-user.

District nurse role in end-stage COPD: a review

District Nurses (DNs) are core providers of end-stage care in the community but appear to have little contact with patients suffering from non-malignant diseases, such as chronic obstructive pulmonary disease (COPD). This review found limited literature describing the role of DNs in end-stage COPD care, and the studies that did touch on the subject restricted their discourse to the frequency of interaction. A clear bias of end-of-life services to patients with malignancy was noted, as well as a call for community services to extend care to all end-stage patients regardless of underlying disease. In addition, there was a further call for DNs to apply a more holistic approach to care, as described in the literature. Finally, it was clear that while ongoing community intervention is necessary for end-stage COPD patients, support and training is essential to equip DNs to care for these vulnerable patients.

Evolution of the concept of self-care and implications for nurses: a literature review

BACKGROUND

Worldwide, the increasing prevalence of chronic disease evokes concern on a number of levels, including quality of life, health care costs and workforce issues to meet increasing demands on services. One response has been a shift in governmental health policy to encourage greater involvement of the chronically ill individual in their health care through participation in self-management programmes. Embedded in self-management programmes is the underlying concept of self-care, a complex and multidimensional phenomenon.

OBJECTIVE

This paper explores the development of the concept of self-care through health related literature and reviews the factors that have shaped the concept.

DESIGN

A comprehensive search of the literature was undertaken drawing principally on key electronic databases of the health literature, augmented with reference list searching.

DATA SOURCES

English language publications indexed in CINAHL, EMBASE, AMED, MEDLINE and PsycInfo with no limit on date of publication.

REVIEW METHODS

Abstracts were reviewed against the inclusion criteria and quality appraisal undertaken. Twenty-two studies were reviewed.

RESULTS

Many definitions of self-care exist and a consensual definition has not been reached. The current concept of self-care has been shaped by many different social, economic and political factors and is embedded in diverse theoretical perspectives and paradigms.

CONCLUSION

An understanding of the underlying theoretical perspectives and paradigms embedded within acute and chronic disease management will facilitate nurses' engagement in the debate, practice within appropriate ethical boundaries and support individuals, families and communities more effectively in managing chronic disease.

Medication adherence self-report instruments: implications for practice and research

BACKGROUND

After an acute cardiac event, adhering to recommendations for pharmacologic therapy is important in achieving optimal health outcomes. Considering the impressive evidence base for cardiovascular pharmacotherapy, strategies for promoting adherence are less well developed. Furthermore, accessing reliable, valid, and cost-effective mechanisms of monitoring adherence in the research and clinical settings is challenging.

AIM

The aim of this article was to review published self-report measures assessing and monitoring medication adherence in cardiovascular disease and provide recommendations for research into medication adherence.

METHODS

The electronic databases CINAHL, Medline, and Science Direct were searched using the key search terms medication adherence and/or compliance, cardiovascular, self-report measures, and questionnaires. The World Wide Web was searched using the Google and Google Scholar search engines, and reference lists of retrieved documents were reviewed. The search strategy was verified by a health librarian. Instruments were included if they specifically addressed medication adherence as a discrete construct rather than a disease-specific or a generic health status measurement.

FINDINGS

Despite of the problems with medication adherence identified in the literature, only 7 instruments met the search criteria. There was limited use of instruments across studies and settings to enable comparison across populations and extensive psychometric evaluation.

CONCLUSIONS

Medication adherence is a complex, multifaceted construct dependent on a range of physical, social, economic, and psychological considerations. In spite of the importance of adherence in ensuring optimal cardiovascular outcomes, conceptual underpinnings and methods of assessing medication adherence require further discussion and debate.

Predictors of Successful Diabetes Management in Low-Income Hispanic People

The specific aim of this predictive, correlational study was to test a culturally sensitive diabetes-specific health protection model to determine predictors of successful diabetes management in a newly diagnosed, type 2, low-income Hispanic population. Using a research-based Hispanic Health Protection Model (HHPM) as a framework, 240 adult participants with low levels of acculturation, strong beliefs about illness attribution and control of health, and low literacy levels were interviewed in a three-phase process over 4 to 6 months. The data analysis resulted in support of the HHPM based on relationships between 11 variables in four partial structural equation models, including lifestyle profile, acculturation, health beliefs, professional and social support, self-efficacy, diabetes knowledge, quality of life (self-satisfaction and impact of diabetes), and changes in hemoglobin a1c and body mass index. The study established carefully translated measures that held up to strong psychometric criteria. There was support for the HHPM for this population, and the results suggest future intervention with strengthening enablers, such as professional support and diabetes self-efficacy, in relation to this group's health beliefs.

Cochrane reviews of educational and self-management interventions to guide nursing practice: a review

BACKGROUND

The burden of chronic disease on healthcare services worldwide is growing and the increased development of educational interventions which help patients to better manage their own conditions is evident internationally.

OBJECTIVES

This paper reports on findings of a review of Cochrane systematic reviews of interventions designed to improve patients' knowledge and skills to manage chronic disease, with particular reference to nursing contribution and practice.

METHODS

Thirty Cochrane systematic reviews were identified as meeting the inclusion criteria. Data were extracted and summarised.

FINDINGS

The majority of reviews included in this paper were judged by Cochrane reviewers to provide inadequate evidence (n=18, 60%) of the effectiveness of the interventions reviewed. Information on the professional delivering the interventions was often not available, although 77% (23) of reviews mentioned that nurses were involved in a proportion of studies.

CONCLUSION

Educational programmes have definite benefits for patients suffering from asthma and are promising for interventions in areas such as diabetes mellitus, epilepsy and mental health. However, it still is not clear what the active ingredients of many successful interventions are.