Thesis (Ph.D. in Nursing) -- University of Colorado Denver, 2008. / Typescript. Includes bibliographical references (leaves 57-65). Free to UCD affiliates. Online version available via ProQuest Digital Dissertations;

Thesis (DPH.)--University of Oklahoma. / Bibliography: leaves 204-225.

<p>Typ 2 diabetes är den vanligaste diabetesformen i Sverige och har samband med vår vällevnad. Tidigare studier visar att sjukdomen är mer vanlig bland fysiskt inaktiva och bland människor med ett ökat energiintag. Syftet med studien var att kartlägga sjuksköterskans hälsofrämjande arbete i primärvården vid typ 2 diabetes. En kvalitativ intervjustudie användes för att samla data. Fem sjuksköterskor från olika vårdcentraler i gamla Skaraborgs län deltog. Analysen av intervjuerna resulterade i ett huvudtema och fem underteman. Resultatet visar på att sjuksköterskorna aktivt arbetar med att motivera patienterna till att ändra kostvanor och öka den fysiska aktiviteten i den icke- farmakologiska behandlingen. Sjuksköterskorna använde information, patientrelation, konkret arbete, patientens villkor och mål som verktyg för att få patienterna motiverade. Att förespråka kost och fysisk aktivitet anses vara mycket viktig uppgift för sjuksköterskorna och utgör en central del i deras arbete.</p> / <p>Type 2 diabetes is the most common form of diabetes in Sweden today and is related to our lifestyle. Previous studies indicate that the disease is more common among physical inactive people and in people with increased energy intake. The aim of this study was to survey how nurses´ in primary health care promote lifestyle change in patients with type 2 diabetes. A qualitative interview study was used for data collection. Five nurses from different primary health care settings in old Skaraborgs county participated. The analyses of the interviews resulted in one major theme and five sub themes. The result shows that nurses work actively to motivate patients to change dietary habits and start with daily physical activity as a part of non-drug therapy. The nurses´ used information, nurse- patient relationship, concrete work, goals and the patient terms as tools to get patients motivated. Promoting diet and physical activity is a central part of the nurses’ daily work.</p>

Etude longitudinale comparative de l’efficacité d’un programme cognitivo-comportemental de groupe pour l’autogestion de la fibromyalgie : 112 patients suivis en ambulatoire à l’hôpital, âgés entre 18 et 66 ans, répartis au hasard dans un bras traitement GTCC (8 séances, 2 heures par semaine) ou dans un bras témoin GTEM (1 séance, 2 heures d’information d’éducation thérapeutique) organisés en groupes de 5 à 9 patients. Tous ont répondu à des questionnaires avant l’intervention et ont été réévalués avec des tests cliniques 3, 6 et 12 mois après le traitement. Les résultats montrent : il n’y pas de différences significatives entre GTCC et GTEM. Pour GTCC nous constatons des changements significatifs : amélioration de la motivation au maintien des acquis, de la qualité de vie spécifique à la fibromyalgie, de l’état de santé général ; et diminution du coping dramatisation, de l’intensité de la douleur, de l’anxiété et de la dépressivité. La sévérité de la douleur, reste inchangée. La dépressivité et la douleur peuvent jouer un rôle prédictif du développement de facteurs cliniques. Un programme TCC pour l’autogestion de la fibromyalgie est efficace à court et long terme / A longitudinally comparative study assessed a group self-management CBT program efficacy for 112 fibromyalgia hospital outpatients, aged 18 to 66. They were andomized in treatment group GTCC (8 weekly 2 hours sessions) and reference group GTEM (one 2 hours therapeutic patient education session), both organized with 5 to 9 patients. All patients were submitted a socio-demographic data and clinical questionnaire before intervention and a clinical re-evaluation at 3, 6 and 12 months after treatment. No significant differences between GTCC and GTEM groups were found. GTCC results shows significant short and long-term improvement in motivation to maintain the new strategies, quality of life and health status; and in decreased catastrophizing coping strategies, pain intensity, anxiety and depression propensity. No change in pain severity was found. Depression and pain can predict the development of psychological and clinical factors. A fibromyalgia self-management CBT program is efficient at short and long term.

Introdução: Sabe-se que pacientes e famílias beneficiam-se de orientações educativas no período de pós-operatório de revascularização miocárdica. Deste modo, desenvolver uma ferramenta de ensino para ser utilizado neste período contribui para o melhor conhecimento sobre o autocuidado no domicílio, otimiza a recuperação e diminui o estresse destes indivíduos comum nesta etapa. Existem diversas ferramentas de ensino utilizadas para a orientação do paciente/família antes da alta hospitalar, entretanto, no Brasil, a produção de materiais fundamentados com orientações fidedignas e significativas, com a participação da população alvo, de expertise na área de cardiologia e com rigor metodológico para a construção destas ferramentas, ainda representa uma lacuna na produção do conhecimento. Objetivos: O objetivo geral desta pesquisa foi elaborar uma ferramenta educativa que auxilie no autocuidado de paciente revascularizado e família após a alta hospitalar e os específicos foram sistematizar, identificar, estruturar o conteúdo da ferramenta educativa e validar a adequação da linguagem, conteúdo e ilustrações da mesma com a participação de paciente/familiares e peritos em cardiologia. Método: Trata-se de um estudo de abordagem metodológica que contou com a participação de 35 pacientes/famílias e oito peritos na primeira fase e na terceira fase oito pacientes/famílias e peritos. Estes foram representados por enfermeiros, cardiologista clínico, fisioterapeuta, nutricionista, farmacêutico clínico, psicólogo. A construção se deu em três diferentes fases: na primeira organizou-se o conteúdo da cartilha mediante a revisão da literatura, a coleta de informações entre o grupo de paciente/família e entre os peritos em cardiologia; na segunda se deu a construção da ferramenta educativa piloto baseada nos dados da fase anterior, tendo como base as informações coletadas e sistematizadas pelos princípios teóricos de Orem e organizadas pelo referencial metodológico de Pasquali; a terceira fase consistiu da apresentação da ferramenta educativa piloto aos pacientes/familiares e peritos em cardiologia para validação do conteúdo, linguagem e ilustrações com a utilização de um instrumento desenvolvido para este fim. Após conclusão desta etapa foram realizadas a construção da ferramenta educativa aperfeiçoada, a diagramação e a impressão da versão final. Resultados: Os itens que foram frequentemente identificados para inclusão na ferramenta se referem ao uso correto dos medicamentos e as alternativas para conter os gastos com estes, cuidados com a alimentação, com a dieta e com o uso de bebidas alcoólicas, realização de atividades físicas e atividades de vida diária, cuidados com a ferida operatória, identificação de intercorrências e direcionamento à serviços de saúdes, retorno à consulta médica e orientações sobre adaptação psicológica e enfrentamento das dificuldades no pós-operatório. Conclusão: A construção e validação da ferramenta educativa focada no autocuidado, poderá ser útil em pesquisas futuras para aumentar as estratégias de enfrentamento dos pacientes/famílias e otimizar o planejamento da alta pelos profissionais da saúde. / Introduction: It is well known that patients and families benefit from educational orientations while recovering from coronary artery bypass graft surgery (CABG). Therefore, developing a teaching tool to be used during this period contributes to a better understanding of self-care at home, optimizes recovery, and decreases stress, a symptom common to these individuals at this stage. There are several teaching tools used to guide the patient/ family prior to discharge. However, in Brazil, the production of materials based on reliable guidelines, with the participation of the target population and experts in cardiology, and adequate methodology still represents a gap in knowledge production. Objectives: The general objective of this research was to develop an educational tool to assist in the self-care of patients undergoing CABG and their families after discharge. Specific objetives were to systematize, identify, and structurize the content of an educational tool and validate the appropriateness of language, content and illustrations, with the participation of patients/families and experts in cardiology. Method: This is a study of methodological approach that included the participation of 35 patients/families and eight experts in the first phase, and eight patients/families and experts in the third phase. The experts were represented by nurses, clinical cardiologists, physiotherapist, dietician, clinical pharmacist, and a psychologist. The construction took place in three different phases: in the first phase the contents of the booklet were organized through a review of the literature and collection of information from the group of patients/families and among experts in cardiology; in the second phase an educational pilot tool was constructed based on data from the previous phase, with the information collected and systematized by the theoretical principles of Orem and organized by the methodological framework of Pasquali; the third phase consisted of the presentation of the pilot educational tool for patients/families and experts in cardiology for validation of content, language and graphics, using a tool developed for this purpose. This led to the construction of an improved educational tool with a revised layout, and the final version was printed. Results: The items that were frequently identified for inclusion in the tool refer to the correct use of medications and alternatives to contain spending on these, nutritional care, use of alcohol, physical activities and activities of daily living, wound care, identifying and targeting the complications of home health services, return to medical consultation, and guidance on psychological adjustment and coping difficulties postoperatively. Conclusions: The construction and validation of an educational tool focused on self-care may be useful in future research to increase the coping strategies of patients/ families and optimize discharge planning by health professionals.

Este estudo teve como principais objetivos realizar a validação de conteúdo e a validação clínica das características definidoras do diagnóstico de enfermagem Conhecimento deficiente em relação à doença arterial coronariana e à revascularização do miocárdio. Foram utilizados os modelos de validação de conteúdo e de validação clínica focado no paciente, propostos por Fehring (1987). Validação de conteúdo (1ªetapa do estudo) - foram convidados a participar dessa etapa 50 enfermeiros expertos em diagnósticos de enfermagem, em assistência a pacientes com problemas cardiológicos e/ou na área da educação. Para essa etapa, foi utilizado instrumento, constituído das características definidoras do Conhecimento deficiente e de suas respectivas definições operacionais. As características definidoras, classificadas como principais pelos expertos foram: verbalização do problema (0,96), desempenho inadequado em teste (0,83) e expressar percepção incorreta acerca do seu estado de saúde (0,83). As características classificadas como secundárias foram: seguimento inadequado de instruções (0,71), memorização de informação deficiente (0,71), indicadores nãoverbais de baixo entendimento (0,69), questionamento repetitivo (0,68), desvalorização das informações (0,64), não seguir a terapêutica prescrita (0,56), indicadores não-verbais de falta de atenção (0,56), falta de integração do plano de tratamento às atividades diárias (0,53) e expressar alteração psicológica (ansiedade, depressão) (0,51). A característica comportamentos impróprios ou exagerados (0,34) foi considerada insuficiente para caracterizar o conhecimento deficiente. Validação clínica (2ªetapa do estudo) - participaram dessa etapa 80 pacientes adultos que se encontravam no período pré-operatório de revascularização do miocárdio. Essa etapa foi realizada no Hospital Beneficência Portuguesa do município de São Paulo. Foram utilizados seis instrumentos: Questionário para avaliação geral, Mini-exame do estado mental, Escala hospitalar de ansiedade e depressão, Questionário para avaliação do conhecimento em relação à doença e ao tratamento, Questionário para avaliação da valorização de informações e Escala de autoavaliação. Todos os instrumentos de coleta de dados, utilizados nessa etapa e preenchidos pela pesquisadora, foram entregues a um enfermeiro especialista com o objetivo de verificar a concordância entre esses dois profissionais na identificação das características definidoras. As características identificadas com freqüência superior a 50%, tanto pela pesquisadora como pelo enfermeiro especialista, foram: desempenho inadequado em teste e expressar alteração psicológica. Com exceção da característica verbalização do problema, na qual se obteve 27,5% de concordância entre os dois profissionais, em todas as outras foram obtidos índices de concordância superior a 68%. As características definidoras nas quais foram obtidos maiores coeficientes de confiabilidade foram desempenho inadequado em teste e expressar percepção incorreta acerca do seu estado de saúde (R = 0,91). As características definidoras nas quais foram obtidos menores coeficientes de confiabilidade foram: indicadores não-verbais de falta de atenção (R = 0,05) e indicadores nãoverbais de baixo entendimento (R = 0,06). Apenas quatro (5%) pacientes apresentaram desempenho adequado no questionário para medir conhecimento em relação à doença e ao tratamento. Pode-se concluir que as características definidoras desempenho inadequado em teste e expressar percepção incorreta acerca do seu estado de saúde constituem as melhores manifestações do Conhecimento deficiente visto que foram classificadas, na 1ªetapa do estudo como características principais e foram identificadas, na 2ªetapa do estudo, com grande freqüência / The main goals of this research were the content and clinical validation of the defining characteristics of the nursing diagnosis Deficient knowledge in relation to coronary artery disease and coronary artery bypass grafting. The Diagnostic Content Validation Model and the patient-focused Clinical Diagnostic Validity Model proposed by Fehring (1987) were used. Content validation (1st phase of the study) - to participate in this phase, 50 nurses were invited who were experts in nursing diagnosis, care delivery to patients with heart problems and/or education. For this phase, an instrument was used, comprising the defining characteristics of Deficient knowledge and their respective operational definitions. The experts classified the following as the main defining characteristics: verbalization of the problem (0.96), inaccurate performance of test (0.83) and expressing mistaken perception about health condition (0.83). The following characteristics were classified as secondary: inaccurate follow-through of instruction (0.71), lack of information recall (0.71), non-verbal indicators of low understanding level (0.69), repetitive questioning (0.68), information devaluation (0.64), not following the prescribed treatment (0.56), non-verbal indicators of lack of attention (0.56), lack of integration of treatment plan into daily activities (0.53) and expressing psychological change (anxiety, depression) (0.51). Inappropriate or exaggerated behaviors (0.34) was considered insufficient to characterize Deficient knowledge. Clinical validation (2nd phase of the study) - study participants in this phase were 80 adult patients in the preoperative period of coronary artery bypass grafting. This phase was carried out at the Beneficência Portuguesa Hospital in São Paulo City. Six instruments were used: General assessment questionnaire, Mini mental state examination, Hospital anxiety and depression scale, Questionnaire for knowledge assessment related to the disease and treatment, Questionnaire to assess information valuation and Self-assessment scale. All data collection instruments used in this phase and filled out by the researcher were passed to a specialized nurse, with a view to verifying the agreement between these two professionals in the identification of the defining characteristics. The following characteristics were identified by the researcher as well as by the specialized nurses with frequencies of more than 50%: inaccurate performance of test and expressing psychological change. Except for the verbalization of the problem characteristic, for which 27.5% of agreement was obtained between the two professionals, agreement rates exceeded 68% on all other characteristics. The defining characteristics with the highest reliability coefficients were inaccurate performance of test and expressing mistaken perception about health condition (R = 0.91). The defining characteristics with the lowest reliability coefficients were: non-verbal indicators of lack of attention (R = 0.05) and nonverbal indicators of low understanding level (R = 0.06). Only four (5%) patients displayed adequate performance on the questionnaire for knowledge assessment related to the disease and treatment. It can be concluded that the defining characteristics inaccurate performance of test and expressing mistaken perception about health condition constitute the best manifestations of Deficient knowledge, as they were identified in the 1st phase of the study as the main characteristics and were identified with high frequency levels in the 2nd phase

The problem of this study was to compare and evaluate two methods of teaching medication compliance to an elderly population with a variety of medical problems, cultural backgrounds, and educational levels. Eighty patients over 65 years old who were attending clinic at a county health care facility participated in the study and were randomly placed into two groups. The Medication Knowledge and Compliance Scale was used to assess the patients' medication knowledge and self—reported compliance. Group I (control) received only verbal teaching. Group II (experimental) received verbal teaching as well as a Picture Schedule designed to tailor the patients' medication schedule to their daily activities. Each patient was re—evaluated two to three weeks later. Medications were also counted at each visit and prescription refill records were examined. Knowledge and compliance did increase significantly among all 80 participants. Patients in Group II demonstrated a significantly greater increase in compliance than Group I but did not show a greater increase in knowledge. Patients in Group II also improved compliance as evidenced by their prescription refill records. This study demonstrates that even though significant barriers to learning exist, knowledge and compliance can be significantly improved when proper teaching techniques are utilized.

Les enfants de moins de 6 ans avec asthme présentent des exacerbations fréquentes et sévères conduisant à de nombreuses consultations aux urgences et hospitalisations. Éduquer les parents à prendre en charge précocement les exacerbations d’asthme de leurs enfants pourrait permettre de réduire ces recours aux soins. Les serious games représentent un outil intéressant dans ce cadre du fait de l’apprentissage actif et expérientiel qu’ils promeuvent. L’objectif de cette thèse était de concevoir et développer un serious game permettant aux parents d’enfants de moins de 6 ans avec asthme de s’entraîner à prendre en charge une exacerbation d’asthme débutant à domicile. La revue systématique de la littérature que nous avons menée n’a identifié aucun serious game à destination des parents d’enfants avec asthme. Pourtant nous avons montré que ces parents étaient prêts à utiliser de tels outils. Les comportements des parents au cours d’une exacerbation d’asthme de leur enfant ont été observés au cours d’une étude de simulation, et analysés afin de définir les objectifs pédagogiques et le contenu du serious game. La meilleure manière d’utiliser le futur serious game en temps limité a également fait l’objet d’une étude comparant deux stratégies (répéter trois fois le même scénario d’exacerbation versus utiliser trois scénarios différents). L’ensemble de ces résultats, alliés à ceux de la littérature déjà existante, ont permis de développer le simulation game « Effic’Asthme » selon une approche fondée sur les preuves. La dernière étape correspondra à l’évaluation d’Effic’Asthme via une étude randomisée contrôlée multicentrique. / Asthma in preschool children (5 years or younger) is characterized by severe and frequent exacerbations, leading to high rates of emergency department visits and hospital admissions. Teaching parents the early management of asthma exacerbations at home might reduce healthcare use. Serious games, because they allow active and experiential learning, represent an interesting way to train parents on the management of asthma exacerbations. The objective of this PhD thesis was to design and develop a serious game to teach parents of preschool children the management of asthma exacerbations starting at home. We conducted a systematic review of serious games for asthma education which revealed that no serious game had been developed for parents. Yet, we showed using questionnaires that parents were ready to use serious games for their education. Parents’ behavior during asthma exacerbations of their children were observed during a simulation study using a pediatric high-fidelity manikin, and analyzed to establish the educational objectives and the content of the serious game. Another study compared two different strategies (repeating the same scenario three times or using three different scenarios of asthma exacerbations) to teach the management of asthma exacerbations in a short, 30-minutes training. Altogether, these results combined with those of the literature allowed the development of the simulation game “Effic’Asthme” following an evidence-based approach. The usefulness of “Effic’Asthme” will be evaluated through a multicentric randomized controlled study.

Sammanfattning Bakgrund: Personer som drabbats av diabetes har ökat under de senaste decennierna. Fler sjuksköterskor kommer behöva evidensbaserad kunskap om hur de vårdar dessa personer på bästa sätt. Tidigare forskning visade patienters- och anhörigas erfarenheter av diabetessjukdomen samt diabetesvården. Då återstod frågan vad sjuksköterskor hade för erfarenheter av att vårda personer med diabetes. Syfte: Att beskriva sjuksköterskors erfarenheter av att vårda personer som drabbats av diabetes. Metod: Systematisk litteraturstudie med beskrivande syntes enligt Evans (2002) med en induktiv ansats. Resultat: Sjuksköterskors erfarenheter beskrevs i två teman med fyra tillhörande subteman. Första temat var att vårda utifrån den unika människan med subteman, att stötta patienten till egenvård samt att arbeta med en komplex vård kring patienten. Andra temat var att inte ha förutsättningar för att ge god vård med subteman, att inte ha tid och kompetens samt att generalisera och inneha en maktposition. Slutsats: För att vårda den växande populationen av personer med diabetes på bästa möjliga sätt, visade detta examensarbete bland annat att sjuksköterskor bör beakta patienters självbestämmanderätt, samt att sjuksköterskor bör vårda mer personcentrerat. / Abstract Background: Number of people affected by diabetes has increased during the past decades. Numerous nurses will be needing evidence-based knowledge of how to care for these people in the best way. Previous research has shown patients 'and relatives' experiences of diabetes and diabetes care. The question of what experiences nurses had of caring for diabetics remained. Aim: To describe nurses’ experiences of caring for people who suffer from diabetes. Method: Systematic literature study with descriptive synthesis according to Evans (2002) with an inductive approach. Results: Nurses' experiences were described in two themes with four subthemes. The first theme was to care for the unique human, with subthemes, to support the patient to self-care and to work with a complex care around the patient. The second theme was not to have the conditions to provide good care with subthemes, not to have time and competence a long with to generalize and hold a power position. Conclusion: To facilitate the best care for the growing population of diabetics, this degree project showed, for instance, that nurses should both consider patients' self-determination rights and apply more person-centred care. / <p>Sjuksköterskeprogrammet</p><p>Kurs: Examensarbete i vårdvetenskap med inriktning mot omvårdnad.</p>

Bakgrund: Levercirros är slutstadiet för många olika leversjukdomar och har sitt ursprung i alkoholöverkonsumtion, hepatitvirusinfektioner samt övervikt och fetma. Forskning visar att personer med sämre hantering av levercirros drabbas av fler akuta sjukhusinläggningar, mer lidande och en lägre livskvalitet. Patientutbildning är ett sätt att bli delaktig i sin vård. Det är således av vikt att förstå hur patientutbildning påverkar patienter med levercirros i sin sjukdom och sitt dagliga liv. Syfte: Syftet var att belysa patientutbildningens betydelse för patienter med levercirros. Metod: En litteraturöversikt valdes som metod. Datainsamling skedde genom databaserna Cinahl Complete och PubMed och resulterade i elva artiklar, två var kvalitativa och nio var kvantitativa. Artiklarna har kvalitetsgranskats och analyserats i enlighet med Fribergs rekommendationer. Resultat: Tre kategorier identifierades: förbättrad kunskap och hantering av sjukdom, ökat välbefinnande samt önskan om mer utbildning. Sammanfattning: Resultatet visade att patientutbildning för patienter med levercirros kan leda till fördelar både på individ- och samhällsnivå och hade betydelse på flera plan. Kunskapen om sjukdomen och dess komplikationer ökade, även patientens livskvalitet förbättrades. Vidare ledde patientutbildning till en bättre sjukdomshantering vilket minskade sjukhusinläggningar. Det framkom även att patienterna upplevde ett behov av mer kunskap. / Background: Liver cirrhosis is the final stage of many liver diseases and derives from overconsumption of alcohol, hepatitis virus infections as well as overweight and obesity. Research shows that people with poor management of liver cirrhosis endure more acute hospitalizations, more suffering and a reduced quality of life. Patient education is a way to become more involved in their care. It is therefore important to understand how educational interventions affect patients with liver cirrhosis in their disease and daily life. Aim: The aim was to highlight the significance of patient education for patients with liver cirrhosis. Method: A literature review was the chosen method for this study. Data was collected through the databases Cinahl Complete and PubMed, resulting in eleven articles, two qualitative and nine quantitative. The articles have been quality reviewed and analyzed in accordance with Friberg’s recommendations. Results: Three categories were identified: increased knowledge and self-care ability, improved quality of life as well as patients' perceived need for more knowledge. Summary: The results showed that patient education for patients with liver cirrhosis can lead to benefits at both the individual and societal level. Knowledge about the disease and its complications increased, as well as the patient's quality of life. Furthermore, patient education led to better disease management, which reduced hospital admissions. It also emerged that patients experienced a need for more knowledge.