Class of 2017 Abstract / Objectives: The purpose of this systematic review was to identify the types of management strategies reported by individuals with chronic pain to manage chronic pain, the average number of strategies used, outcomes, and side effects. Methods: To be included in the systematic review, reports of population surveys of adult patients with chronic pain, as defined by the authors, had to be published in English, include chronic pain from any cause, and include information on the treatment strategies used by respondents. Search terms included “pain,” “self-care,” “self management,” “self treatment,” and “adult” and the search strategy included systematic searches of Pubmed, Embase, Cochrane Library, PsycINFO, CINAHL, Web of Science, International Pharmaceutical Abstracts, searches of reference lists, and citation searches as well as key websites such as the CDC and NIH. Results: A total of 13 study reports were identified. Sample size ranged from 103 to 4839; mean age ranged from 42 to 81 and 51 to 69% female. All reports included information on medications used to manage pain; 6 reported other medical strategies; 9 reported physical strategies; 6 reported psychological strategies; and 11 reported non- medical strategies. Only 4 studies reported some data on the number of strategies used; one study reported 23% used 6 or more medications, another reported 51% used 3 or more strategies. Six studies reported some type of outcome; including inadequate control of pain (40%) or good relief (87%), and 36% as effective in a third study. Few side effects were reported; two studies reported constipation, nausea and vomiting. Conclusions: Population-based surveys of chronic pain have identified a large number of strategies used to manage pain, however they provide little information on the average number of strategies used, the effectiveness of the strategies, or resulting side effects.

(M.Phil.) / Disposition or attitude, is the small something that can make a big difference (Haverlock, 1999:1). It is alleged that a positive attitude to life has positive results and positive results in turn lead to happiness and success. According to Jampolsky and Cirincione (1994:57,75) a negative attitude has a direct influence on a person's health and interpersonal relationships. Diseases such as migraine, diabetes, coronary disease and even cancer often relate to a person's attitude to life (Jampolsky & Cirincione, 1994:59-60). The problem investigated by this research was why people exhibit a positive or negative attitude and how a person can exercise control over his or her own life from a personal leadership perspective. The objective of the investigation was to conduct a descriptive study of the relationship between attitude or disposition and personal leadership...

Chronic pain has no cure. It is a lifelong condition presenting a growing concern due to its high occurrence and effects on every facet of life. It cost about $635 billion each year in medical treatment and lost productivity (IOM, 2011). The management of chronic pain using prescription painkiller opioids has increased drastically in the last two decades, leading to a consequential increase in deaths from chronic opioid use. This Plan-Do-Study-Act quality improvement project investigates the problem of the prevalence of opioid prescription using agent-based computational modeling method. The simulation models the interaction of 50 patient-agents with pain self-management messages in an episode of 50 patient iterations (visits) for 10 simulated years. This interaction generates health benefit and risk outcomes represented by wellness data obtained when messages are processed. As the simulation runs, data are dynamically captured and visualized using wellness charts, time series plots, and benefit and risk regression plots. The result of the project provides evidence for research and practice on the process of achieving more impact of programs based on administering pain self-management education to patients with chronic non-cancer pain who are currently on opioid therapy and on the process of customizing interventions that might take advantage of the conditions of behavior change driven by pain self-management messages. The tools and the evidences in this project are highly recommended to nurse practitioners primary care providers involve with providing care to the vulnerable groups of patient with chronic non-cancer pain. These evidences might inform the formation of self-management interventions that might lead to a decline in opioid use and prescription and accelerate the acceptance of self-management practices.

The effectiveness of Motivational Enhancement Therapy (MET), a brief four session form of Motivational Interviewing (MI), provided by diabetes health practitioners at a hospital-based clinic, in improving diabetes outcome and self-management of Type 1 and Type 2 diabetes was evaluated using quasi-experimental designs (i.e., non-random control group and multiple baseline designs). Study 1 evaluated if MET provided by Diabetes Nurse Educators (DNEs) was effective in improving diabetes outcome (i.e., blood glucose and lipids) and diabetes self-management, and compared its effectiveness to the current standard treatment which comprised Patient Education (PE). Study 2 evaluated if the results of Study 1 could be generalised to Dietitians providing the intervention. Study 3 evaluated the effects of MI training and post-training supervised practice on practitioner and patient behaviour. Specific hypotheses (Studies 1-2) were that MI would lead to improved diabetes outcome through improved diabetes self-management, and would be more effective than PE. Further, training in MI plus supervised practice was predicted to lead to Nurse Educators behaving in ways consistent with MI and as a result the participants would exhibit less resistance and increased change talk than participants receiving PE (Study 3). The results suggest that MET was well received by the participants, and contributed to improved diabetes outcome (e.g., lowered blood glucose) and diabetes self-management (e.g., self-monitoring of blood glucose and dietary compliance), and may have been more effective than PE, although high variability made conclusions uncertain. Evidence of generalisation across participants, intervention staff, and outcomes is provided. Additionally, evidence is provided that with two days training plus supervised practice the DNE were able to practice MET to at least a beginning level of competency in MI and that as a result the participants behaved in ways consistent with MI theory (i.e., showed less resistance and increased change talk).

Health care systems still focus on single disease management and ignore the complexities of multiple conditions management. Though self-management is the focus of chronic disease management, patients with comorbidities face challenges in meeting their self-management goals. The purpose of this study was to explore the perspectives of patients with comorbid conditions on the use of eHealth technology to promote self-management. The research was grounded on the technology acceptance model. I sought to explore the participants' understanding of self-management, the challenges to self-management and their perspectives on the use of eHealth for self-management. In this phenomenological study, 10 interviews were conducted from a purposeful sample of those with two or more comorbid conditions. The collected data were audio recorded and transcribed verbatim. Prolonged engagement, member checks, and triangulation were used to ensure trustworthiness. Self-reports and observation augmented the interviews. Data collection continued until saturation was reached, then analyzed iteratively and organized according to themes. The results showed that the participants managed their conditions at home by taking prescribed drugs, attending clinics, and following a special diet. However, they faced financial constraints, struggled with symptom control, and took too many drugs. The results also showed that technology could be used for people living with comorbidity as a source of information, to remind patients to take drugs or attend clinics, to increase awareness of symptoms, and to assist in the management of the disease. This study is expected to help in understanding (a) the challenges faced by patients with comorbidities, and (b) how the use of technology promotes self-management in this growing group.

Diabetes self-management has clear benefits in reducing diabetes symptoms and complications and improving the health, wellbeing and quality of life of people with diabetes. Successful intervention programs focus on the development of diabetes self-efficacy, which promotes the capacity of people with diabetes to perform diabetes self-management even in the face of difficulty. Diabetes self-management, however, presents considerable challenges for health systems that have been structured to provide acute, rather than chronic care, and health professionals who have been trained to cure illness, rather than manage behaviour. It presents further challenges for people with diabetes who live in socioeconomically disadvantaged circumstances and have limited financial resources for diabetes care and therapies, and poor access to resources for diabetes self-management, such as clean, safe exercise areas and healthy foods at low-cost. These sociostructural determinants of diabetes self-management, defined here as GP care and socioeconomic resources, have the potential to impede the uptake and effective dissemination of diabetes self-management policy and intervention. This research thesis investigated the impact of sociostructural determinants on diabetes self-management using a model developed from self-efficacy theory. The model was empirically examined using a mixed quantitative and qualitative methodology, where qualitative data were used to illuminate the findings of quantitative data. The quantitative component comprised a random cross-sectional survey of 105 people with diabetes subjected to hierarchical multiple regression with tests for moderator effects. The qualitative component comprised three group interviews of 27 English-speaking, Vietnamese-speaking and Arabic-speaking people with diabetes, analysed using the phenomenological method. Findings provided partial support for the model. Relationships between sociostructural determinants and diabetes self-management were complex. While good quality GP care facilitated diabetes self-management, it also acted as a barrier to self-monitoring of blood glucose for people with low levels of diabetes self-efficacy. Having limited access to socioeconomic resources did not impede diabetes self-management, even for people with low levels of diabetes self-efficacy, although this may have been masked by access to public health schemes and welfare support. The findings from this small-scale exploratory study suggest that self-efficacy may exert an impact on diabetes self-management, even in the face of sociostructural determinants.

Chronic pain conditions can be extremely challenging to deal with in the workplace. The implications of these conditions extend far beyond the employees themselves and can create significant organizational impacts. The Chronic Pain Self-Management Program was developed by Dr. Sandra LeFort, and was originally based on the generic Stanford model of self-management. The six-week program, delivered weekly, is designed to explore and instruct those with chronic pain on different aspects of their condition. This pilot study used a mixed method design to evaluate the effectiveness of Chronic Pain Self-Management Program in the workplace. The quantitative measures for this study were unable to demonstrate the effectiveness of the workshop due to a lack of statistical significance. Through the qualitative measures it was possible to delve into how the chronic pain condition manifests itself in the workplace and what support systems are available for those with chronic pain. There are definitely some positive implications from this pilot research, but through further research it is possible to truly understand how people live with chronic pain in the workplace and how their conditions can be made more manageable. / UOIT

The purpose of this qualitative descriptive study was to explore the socio-cultural influences and social context associated with living with type 2 diabetes among migrant Latino adults. Extensive research in diabetes care has been conducted; however, there is a significant knowledge gap related to the factors that influcence the achievement of glycemic control and self-management practices of the Latino population in general, and migrant workers specifically. Based on well-documented disparities in complications and health outcomes among Latino adults compared to Anglo-American adults, there is sufficient evidence to question whether traditional Anglo beliefs about self-management are successful or appropriate for the migrant Latino population. Traditional models view self-management as an individual responsibility. Whether this view is congruent with the collectivist cultural tradition held by many Latino adults is unclear. Equally unclear is the degree to which using traditional Anglo-American models of self-management, in teaching about managing type 2 diabetes, influences health outcomes in this population. Culturally congruent care and nursing interventions involves more than an understanding of language and dietary preferences.A qualitative descriptive study using grounded theory techniques was conducted to provide a comprehensive summary of the events in the everyday terms of those events. Data analysis was completed using conventional content analysis strategies.An over-arching meta-theme "Self Management in a Social Environment" emerged. Every aspect of the process of self-management, as described in the four major themes, (1) Family Cohesion, (2) Social Stigma of Disease, (3) Social Expectations/Perceptions of "Illness," and (4) Disease Knowledge and Understanding, was influenced by the social context.This study revealed several socio-cultural influences that impact diabetes self-management practices for the migrant Latino adult. The familist traditions, central to the Mexican culture had both positive and negative consequences on diabetes management. Social stigma, in relation to a diabetes diagnosis, is likely not exclusive to this population. However, the associated negative social expectations and perceptions might well be unique. The discovery surrounding the lack of, and approach to, diabetes management education provided to individuals, families, and community members may well be central to improving the health of this population.

The effectiveness of Motivational Enhancement Therapy (MET), a brief four session form of Motivational Interviewing (MI), provided by diabetes health practitioners at a hospital-based clinic, in improving diabetes outcome and self-management of Type 1 and Type 2 diabetes was evaluated using quasi-experimental designs (i.e., non-random control group and multiple baseline designs). Study 1 evaluated if MET provided by Diabetes Nurse Educators (DNEs) was effective in improving diabetes outcome (i.e., blood glucose and lipids) and diabetes self-management, and compared its effectiveness to the current standard treatment which comprised Patient Education (PE). Study 2 evaluated if the results of Study 1 could be generalised to Dietitians providing the intervention. Study 3 evaluated the effects of MI training and post-training supervised practice on practitioner and patient behaviour. Specific hypotheses (Studies 1-2) were that MI would lead to improved diabetes outcome through improved diabetes self-management, and would be more effective than PE. Further, training in MI plus supervised practice was predicted to lead to Nurse Educators behaving in ways consistent with MI and as a result the participants would exhibit less resistance and increased change talk than participants receiving PE (Study 3). The results suggest that MET was well received by the participants, and contributed to improved diabetes outcome (e.g., lowered blood glucose) and diabetes self-management (e.g., self-monitoring of blood glucose and dietary compliance), and may have been more effective than PE, although high variability made conclusions uncertain. Evidence of generalisation across participants, intervention staff, and outcomes is provided. Additionally, evidence is provided that with two days training plus supervised practice the DNE were able to practice MET to at least a beginning level of competency in MI and that as a result the participants behaved in ways consistent with MI theory (i.e., showed less resistance and increased change talk).

Thesis (Ph. D.)--Michigan State University. College of Nursing, 2006. / Title from PDF t.p. (viewed on Nov. 20, 2008) Includes bibliographical references (p. 163-170). Also issued in print.