Trata-se de um estudo descritivo correlacional com abordagem quantitativa, que teve como objetivos: caracterizar pacientes com Insuficiência Cardíaca (IC) atendidos em clínica especializada (grupo A) e em pronto-socorro (grupo B), conforme perfil sócio-demográfico, perfil clínico, tempo de conhecimento da doença e internações no último ano; Identificar ações de autocuidado específicas nos grupos A e B; Verificar a diferença entre o autocuidado dos grupos A e B e Identificar os possíveis fatores precipitantes de descompensação no grupo B. A amostra foi constituída por 120 pacientes de um hospital especializado em cardiologia, localizado no município de São Paulo, sendo 60 em cada grupo. A coleta de dados foi realizada de julho a novembro de 2011, por meio da aplicação de instrumento elaborado para o estudo (1) e instrumento de adesão validado em estudo prévio (2). A análise estatística foi descritiva e inferencial, sendo utilizado o Alpha de Cronbach para avaliar a consistência interna do instrumento 2, Teste Exato de Fisher para variáveis categóricas, Teste t-student para comparação entre as médias das variáveis contínuas, teste não paramétrico de Mann-Whitney quando se rejeitou a hipótese de normalidade da variável. Predominou o sexo masculino 78(65%). Não houve diferença no tempo de conhecimento da doença entre os grupos. Observou-se que o grupo B teve mais internações no último ano. Não houve diferença estatisticamente significativa no escore de adesão do Instrumento 2, com média 46,09(±8,03) entre os grupos, para um escore máximo=60. Observou-se pior resultado nas ações de autocuidado referentes à percepção de piora clínica e comunicação com a equipe de saúde; controle de peso e vacinação contra influenza, sem diferença significativa entre os grupos. Identificou-se maior número de idosos, aposentados, sem renda e residindo sozinhos; chagásicos, com piores níveis de uréia, creatinina e hemoglobina e em uso de marcapasso no grupo B. No perfil hemodinâmico do grupo B, verificou-se que 44 (73,4%) pacientes apresentaram sinais de congestão e 37 (61,7%) sinais de baixo débito cardíaco, o que contribuiu para internação prolongada e alta letalidade. Conclui-se que os pacientes realizam parcialmente as ações de autocuidado, devido à dificuldade na percepção e comunicação da piora clínica; controle de peso e vacinação contra influenza, sem diferença significativa entre os grupos. Os possíveis fatores precipitantes de descompensação no grupo B relacionam-se à idade avançada, condições sócio-econômicas e pior perfil clínico. A continuidade deste estudo, com seguimento em seis meses, permitirá identificar os principais desfechos a curto prazo. Sugere-se o acompanhamento de pacientes em ambiente familiar para avaliar a real situação dos cuidados e o desenvolvimento de estudos voltados ao autocuidado de pessoas com IC avançada e/ou de etiologia chagásica, incluindo a criação de programas de cuidados paliativos. / This is a descriptive and correlational study with a quantitative approach, that aimed to characterize patients with heart failure (HF) treated in a Specialty Clinic (Group A) and Emergency Room (Group B), according to socio-demographic and clinical profiles, knowledge time of the disease and hospitalizations in the previous year; Identify specific actions of self-care specifically in Groups A and B; Check the difference between self-care in Groups A and B and identify the possible precipitating factors of decompensation in Group B. The sample consisted of 120 patients in a São Paulo, hospital specialized in cardiology, with 60 patients in each group. Data collection was conducted from July to November 2011, by applying an instrument developed for this study (1) and an instrument of accession validated in a previous study (2). Statistical analysis was descriptive and inferential, by using Cronbach\'s alpha to assess internal consistency of instrument 2, Fisher\'s Exact Test for categorical variables, Student\'s t-test for comparison between means of continuous variables, and non-parametric Mann-Whitney when it rejected the hypothesis of normality of the variable. Seventy-eight (78) males or 65% predominated in this study. There was no difference in the knowledge time of the disease between the groups however it was observed that Group B had more hospitalizations in the past year. There was no statistically significant difference in adherence score of Instrument 2, averaging 46.09 (± 8.03) between the groups, for a maximum score = 60. Worse results were observed in the actions of self-care with reference to the perception of clinical worsening and communication with the health team; weight control and influenza vaccination, without a significant difference between the groups. It was identified that the greater number of elderly, retired, no income and living alone; chagasic patients having worse levels of urea, creatine and hemoglobin and pacemaker use were all in Group B. In the hemodynamic profile of Group B, it was found that 44 (73.4%) patients showed signs of congestion and 37 (61.7%) signs of low cardiac output, contributing to prolonged hospitalization and high mortality. It was concluded that patients perform self-care actions in part because of the difficulty in perception and communication of clinical worsening, weight control and influenza vaccination, without significant difference between the groups. Possible precipitating factors of decompensation in Group B are related to advanced age, socio-economic status and worse clinical profiles. The continuity of this study, with a follow-up in six months, will identify the principal outcomes in the short term. It is suggested that the monitoring of patients be done in a family environment to assess the real situation of care and the development of studies to self-care of people with advanced HF and / or Chagas disease, including the establishment of palliative care programs.

As helping professionals, music therapists show compassion to their clients but may lack necessary self-care skills to prevent burnout and promote well-being. Due to a lack of research in this area, this study investigated reported levels of compassion for others, self-compassion, burnout, secondary traumatic stress, and compassion satisfaction among music therapists in relation to age, gender, and years of professional experience. A survey of 575 board certified music therapists in the USA revealed higher levels of compassion for others than self-compassion, low levels of burnout and secondary traumatic stress, and high levels of compassion satisfaction. Burnout strongly negatively correlated with both self-compassion and compassion satisfaction and strongly positively correlated with secondary traumatic stress. A MANCOVA revealed significant differences in compassion for others and compassion satisfaction based on gender, with female participants reporting significantly higher scores for both constructs. Additionally, there was a trend related to self-compassion and compassion levels increasing over time. There were strong associations between compassion and self-compassion with burnout and secondary traumatic stress; therefore, it would benefit music therapists to cultivate compassion practices to lower burnout risk.

Estudo correlacional que teve como objetivo analisar os fatores relacionados ao autocuidado de pessoas com diabetes tipo 2. Participaram 252 pessoas que ingressaram no Serviço de Urgência do Hospital Regional Mérida ISSSTE, em 2006. Utilizaram-se seis instrumentos de coleta de dados: um formulário e um questionário contendo as variáveis sociodemográficas, clínicas e laboratoriais; uma escala de medida de capacidade de autocuidado; três questionários, ou seja, medida de adesão ao tratamento medicamentoso, dietético e de atividade física. Os dados foram obtidos mediante consulta ao prontuário e no domicilio por meio de entrevista dirigida. Para a analise utilizou-se o programa estatistico SPSS, versão 12.0, estatística descritiva univariada, bivariada e correlação. Os resultados mostram predomínio de mulheres (51,8%), a idade média é de 62,88 ± 11,18 anos; casados (81,7%), do lar e aposentados (27,9 e 25,5%), respectivamente; escolaridade média de 9,16 ± 3,94 anos; católicos (65,7%); família nuclear (59%), apoio familiar (84,8%). O peso médio é de 71,39 ± 10,59Kg; altura de 1,51 ± 0,07m; IMC de 31,46 ± 5,41Kg/m2, circunferência abdominal de 113 ± 17,59cm. Pressão arterial sistólica de 126,95 ± 14,26mmHg e diastólica de 83,03 ± 9,35mmHg. O tempo médio de evolução da doença é de 17,53 ± 9,03 anos, com média de internação de 2,30 ± 1,05 vezes. As principais causas de internação foram a hiperglicemia, o pé diabético e a hipoglicemia; e as complicações mais freqüentes foram a hipoglicemia, neuropatia e pé diabético. Os antecedentes familiares referidos foram o diabetes e a hipertensão arterial. Quanto ao tratamento medicamentoso, a maioria utiliza antidiabéticos orais do grupo das sulfonilureas. Em relação ao seguimento da doença, de 78% das pessoas com diabetes tipo 2 que comparecem ao serviço de saúde, 48% o faz a cada 2 meses. Os valores da glicemia capilar foram de 197,29 ± 52,35mg/dl, glicemia plasmática de 209,35 ± 119,02mg/dl; colesterol total de 333,19 ± 69,47mg/dl, LDL de 110,82 ± 25,49mg/dl, HDL de 37,55 ± 5,53mg/dl e triglicerídeos de 184,81 ± 61,40 mg/dl. No que se refere à capacidade de autocuidado obteve-se média de 35,72 ± 3,69 pontos, o que evidenciou capacidade de autocuidado regular dos sujeitos estudados. Quanto à adesão ao tratamento medicamentoso obteve-se a média de 30,08 ± 3,13 pontos, com taxa de adesão de 8,8%; adesão ao tratamento dietético, média de 12,67 ± 1,32 pontos, com taxa de adesão de 8%; e atividade física, média de 2,73 ± 1,53, com taxa de adesão de 5,2%. Houve correlação direta entre capacidade de autocuidado e anos de estudo, controle do diabetes e adesão à atividade física; e correlação inversa entre capacidade de autocuidado e IMC, colesterol total, LDL, religião, tratamento medicamentoso, tempo de evolução da doença e fatores de risco. Conclui-se que face aos resultados obtidos torna-se urgente a implementação das diretrizes propostas pelo Modelo Integrado de Atenção à Saúde (MIDAS) e da Norma Oficial Mexicana 015-SSA2-1994 para a prevenção, tratamento e controle do diabetes com vistas ao desenvolvimento de habilidades de autocuidado das pessoas com diabetes tipo 2 para o manejo da doença. / This is a correlational study; the purpose was to analyze the factors related to selfcare of people with type 2 Diabetes. Participants 252 people with diabetes type 2 who entered the Emergency Department of the Regional Hospital of Merida ISSSTE, 2006. Six instruments were used: a registration form, a questionnaire concerning the sociodemographic, clinical and laboratory variables, a self-care capacity scale, a questionnaire measuring adherence to medical, dietary and physical activity treatment. The information was collected through the review of clinical records and interviews. They were analyzed through the program SPSS Version 12,0, univariate and bivariate descriptive statistics, and correlation. The sample was characteristic by having dominance in women (51.8%), with an average age of 62.88 ± 11.18 years; married (81.7%); predominantly housewives and retirees (27.9 and 25.5%), average schooling of 9.16 ± 3.94 years; catholics (65.7%); with nuclear family (59%), family support (84.8%). The average weight was 71.39 ± 10.59kg, height of 1.51 ± 0.07m, with an IMC of 31,46 ± 5,41Kg/m2, abdominal circumference of 113 ± 17.59cm; the systolic blood pressure of 126.95 ± 14.26mmHg and diastolic of 83.03 ± 9.35mmHg. The average time of evolution was 17.53 ± 9.03 years, until 6 internments with an average of 2.30 ± 1.05, the leading causes of admission were hyperglycemia, diabetic foot and hypoglycemia. They have hypoglycemia, neuropathy and diabetic foot as major complications with a history of diabetes and hypertension, risk factors present in the majority; they use oral antidiabetic agents, mainly sulfonylureas, and 78% of people who go to the doctor, 48% it does every two months. The average values monitoring of blood glucose was 197.29 ± 52.35 mg/dl, plasma glycemic 209.35 ± 119.02 mg/dl; total cholesterol from 333,19 ± 69,47mg/dl, LDL from 110.82 ± 25.49 mg/dl, HDL of 37.55 ± 5.53mg/dl and triglyceride 184.81 ± 61.40mg/dl, respectively. When investigating capacity for self-care they presented an average of 35.72 ± 3.69 points, with regular ability for self-care. With regard to the treatment adherence it was found an average in the drug treatment of 30.08 ± 3.13 points, with 8.8% of adherence; for membership in the dietary treatment, 12.67 ± 1.32 points, 8% adherence and in treatment of physical activity 2.73 ± 1.53, with adherence of 5.2%. It was showed a direct correlation between the ability of self-care and years of study, disease control and adherence to physical activity, an inverse correlation between the ability of self-care and IMC, total cholesterol and LDL, religion, drug treatment, time evolution of the disease and risk factors. It is concluded that, based on the results obtained, it becomes urgent the implementation of the guidelines proposed by the Model Integrated Health Care (MIDAS) and the Norma Oficial Mexicana 015-SSA2- 1994 for the prevention, treatment and control diabetes with the aim of developing the skills of self-care for people with type 2 diabetes to manage the disease.

À medida que a população envelhece, a prevalência das doenças crônicas não transmissíveis aumenta. Dentre as doenças que acometem a população idosa, destaca-se o diabetes mellitus (DM). Por ser uma doença crônica e envolver riscos de complicações e sequelas, a realização de atividades de autocuidado pode contribuir para o controle da doença. Dessa forma, o objetivo dessa pesquisa foi estudar o perfil clínico, epidemiológico e sociodemográfico, bem como o nível de adesão ao autocuidado de idosos com DM Tipo 2 (DM2). Trata-se de um estudo observacional do tipo transversal, sendo selecionados 115 indivíduos com idade igual ou superior a 60 anos, com DM2 e cadastrados no Ambulatório do Estágio Integrado do Centro de Saúde Escola Joel Domingos Machado no município de Ribeirão Preto/SP há pelo menos um ano. Os instrumentos de coleta de dados foram o Instrumento de Caracterização dos Participantes, Critério de Classificação Econômica Brasil e o Questionário de Atividades de Autocuidado com o Diabetes. Todos os preceitos éticos foram respeitados. Quanto aos resultados obtidos, observou-se um predomínio de mulheres e de participantes com ensino fundamental incompleto (68,7%). O tempo médio de diagnóstico da doença foi de 13,6 anos para os homens e 14,4 anos para as mulheres. Em relação ao tipo de tratamento farmacológico utilizado, 50,4% dos participantes relataram utilizar apenas antidiabético oral, 37,4% antidiabético oral associado à insulina, 9,6% apenas insulina e 2,6% não faziam uso de nenhum medicamento. Cerca de 88% mencionaram a hipertensão arterial como doença associada e 11,3% apresentavam nefropatia como complicação decorrente do DM. Quanto às atividades de autocuidado, verificou-se níveis baixos de adesão tanto para adesão geral quanto para as recomendações alimentares, especialmente entre as mulheres. Por outro lado, o domínio medicação foi o que apresentou maior adesão por parte dos participantes. A avaliação dos itens \"avaliar o açúcar no sangue o número de vezes recomendado\" e \"examinar os pés\" mostrou diferença significativa quando mulheres e homens foram comparados. Em elação ao tabagismo, a maioria relatou não fumar. A análise multivariada mostrou que no domínio adesão geral, não utilizar nenhum e/ou apenas um antidiabético oral foram considerados fatores preditores para baixa adesão. Já os preditores de alta adesão foram não utilizar metformina e apresentar hemoglobina glicada alterada. No que se refere ao domínio adesão à alimentação, não utilizar nenhum antidiabético oral foi fator preditor de baixa adesão, enquanto ser negro e apresentar glicemia de jejum não controlada representaram fatores preditores de alta adesão. Aderir às recomendações gerais e alimentares se correlacionaram positivamente com o tempo de diagnóstico [(r=0,34964; p<0,001); (r=0,25947; p=0,005), respectivamente]. Conclui-se que fatores sociodemográficos, clínicos e epidemiológicos influenciam a adesão ao autocuidado. Obter informações para orientar e planejar ações que possam aumentar a adesão ao tratamento do DM é fundamental para melhorar o controle da doença, diminuir riscos de complicações e proporcionar melhor qualidade de vida aos pacientes. / As the population ages the prevalence of chronic non-communicable diseases increases. Amongst the diseases that affect the elderly population, diabetes mellitus (DM) stands out. As a chronic disease and involve risks of complications and sequelae, the performance of self-care activities may contribute to disease control. The objective of this research was to study the clinical, epidemiological and sociodemographic profile, as well as the level of adherence to self-care of the elderly with type 2 DM (DM2). This is a cross-sectional observational study, in which were selected 115 individuals aged 60 years and over with type 2 DM and registered at the School Health Center Joel Domingos Machado Ambulatory of Integrated Internship for at least one year. The data collection instruments were: Instrument of Participants Characterization, Brazilian Criterion of Economic Classification and the Summary of Diabetes Self-Care Activities Questionnaire. All ethical guidelines were respected. Regarding the results, it was observed that the women and individuals with incomplete elementary school (68.7%) were predominated. The average time of diagnosis was 13.6 years for men and 14.4 years for women. Regarding the type of pharmacological treatment, 50.4% of the participants reported only oral antidiabetic use, 37.4% oral antidiabetic associated with insulin, 9.6% only insulin and 2.6% did not use any medication. About 88% reported hypertension as an associated disease and 11.3% had nephropathy as a complication of diabetes. As for self-care activities, it was verified low adherence levels for both general adherence and dietary recommendations, especially among women. However, the medication domain has presented the highest adherence by the participants. The evaluation of the items \"assessing blood sugar the recommended number of times\" and \"examining the feet\" showed a significant difference when women and men were compared. Regarding smoking, the majority reported do not smoke. The multivariate analysis showed that in the general adhesion domain, not using any and / or only an oral antidiabetic were considered predictive factors for low adhesion. On the other hand, the predictors of high compliance were not to use metformin and to have altered glycated hemoglobin. Regarding the adherence to food domain, no oral antidiabetic agent was used as a predictor of low adherence, while being black and presenting uncontrolled fasting glucose represented predictors of high adherence. Adhering to general and dietary recommendations had a positive correlation with the time of diagnosis [(r = 0.34964; p <0.001); (R = 0.25947; p = 0.005)]. We conclude that the factors sociodemographic, clinical and epidemiological factors to influence adherence to self-care. Obtaining information to guide and plan actions that can increase adherence to DM treatment is fundamental to improve disease control, reduce risks of complications, and provide better quality of life for patients.

Trata-se de um estudo descritivo correlacional com abordagem quantitativa, que teve como objetivos: caracterizar pacientes com Insuficiência Cardíaca (IC) atendidos em clínica especializada (grupo A) e em pronto-socorro (grupo B), conforme perfil sócio-demográfico, perfil clínico, tempo de conhecimento da doença e internações no último ano; Identificar ações de autocuidado específicas nos grupos A e B; Verificar a diferença entre o autocuidado dos grupos A e B e Identificar os possíveis fatores precipitantes de descompensação no grupo B. A amostra foi constituída por 120 pacientes de um hospital especializado em cardiologia, localizado no município de São Paulo, sendo 60 em cada grupo. A coleta de dados foi realizada de julho a novembro de 2011, por meio da aplicação de instrumento elaborado para o estudo (1) e instrumento de adesão validado em estudo prévio (2). A análise estatística foi descritiva e inferencial, sendo utilizado o Alpha de Cronbach para avaliar a consistência interna do instrumento 2, Teste Exato de Fisher para variáveis categóricas, Teste t-student para comparação entre as médias das variáveis contínuas, teste não paramétrico de Mann-Whitney quando se rejeitou a hipótese de normalidade da variável. Predominou o sexo masculino 78(65%). Não houve diferença no tempo de conhecimento da doença entre os grupos. Observou-se que o grupo B teve mais internações no último ano. Não houve diferença estatisticamente significativa no escore de adesão do Instrumento 2, com média 46,09(±8,03) entre os grupos, para um escore máximo=60. Observou-se pior resultado nas ações de autocuidado referentes à percepção de piora clínica e comunicação com a equipe de saúde; controle de peso e vacinação contra influenza, sem diferença significativa entre os grupos. Identificou-se maior número de idosos, aposentados, sem renda e residindo sozinhos; chagásicos, com piores níveis de uréia, creatinina e hemoglobina e em uso de marcapasso no grupo B. No perfil hemodinâmico do grupo B, verificou-se que 44 (73,4%) pacientes apresentaram sinais de congestão e 37 (61,7%) sinais de baixo débito cardíaco, o que contribuiu para internação prolongada e alta letalidade. Conclui-se que os pacientes realizam parcialmente as ações de autocuidado, devido à dificuldade na percepção e comunicação da piora clínica; controle de peso e vacinação contra influenza, sem diferença significativa entre os grupos. Os possíveis fatores precipitantes de descompensação no grupo B relacionam-se à idade avançada, condições sócio-econômicas e pior perfil clínico. A continuidade deste estudo, com seguimento em seis meses, permitirá identificar os principais desfechos a curto prazo. Sugere-se o acompanhamento de pacientes em ambiente familiar para avaliar a real situação dos cuidados e o desenvolvimento de estudos voltados ao autocuidado de pessoas com IC avançada e/ou de etiologia chagásica, incluindo a criação de programas de cuidados paliativos. / This is a descriptive and correlational study with a quantitative approach, that aimed to characterize patients with heart failure (HF) treated in a Specialty Clinic (Group A) and Emergency Room (Group B), according to socio-demographic and clinical profiles, knowledge time of the disease and hospitalizations in the previous year; Identify specific actions of self-care specifically in Groups A and B; Check the difference between self-care in Groups A and B and identify the possible precipitating factors of decompensation in Group B. The sample consisted of 120 patients in a São Paulo, hospital specialized in cardiology, with 60 patients in each group. Data collection was conducted from July to November 2011, by applying an instrument developed for this study (1) and an instrument of accession validated in a previous study (2). Statistical analysis was descriptive and inferential, by using Cronbach\'s alpha to assess internal consistency of instrument 2, Fisher\'s Exact Test for categorical variables, Student\'s t-test for comparison between means of continuous variables, and non-parametric Mann-Whitney when it rejected the hypothesis of normality of the variable. Seventy-eight (78) males or 65% predominated in this study. There was no difference in the knowledge time of the disease between the groups however it was observed that Group B had more hospitalizations in the past year. There was no statistically significant difference in adherence score of Instrument 2, averaging 46.09 (± 8.03) between the groups, for a maximum score = 60. Worse results were observed in the actions of self-care with reference to the perception of clinical worsening and communication with the health team; weight control and influenza vaccination, without a significant difference between the groups. It was identified that the greater number of elderly, retired, no income and living alone; chagasic patients having worse levels of urea, creatine and hemoglobin and pacemaker use were all in Group B. In the hemodynamic profile of Group B, it was found that 44 (73.4%) patients showed signs of congestion and 37 (61.7%) signs of low cardiac output, contributing to prolonged hospitalization and high mortality. It was concluded that patients perform self-care actions in part because of the difficulty in perception and communication of clinical worsening, weight control and influenza vaccination, without significant difference between the groups. Possible precipitating factors of decompensation in Group B are related to advanced age, socio-economic status and worse clinical profiles. The continuity of this study, with a follow-up in six months, will identify the principal outcomes in the short term. It is suggested that the monitoring of patients be done in a family environment to assess the real situation of care and the development of studies to self-care of people with advanced HF and / or Chagas disease, including the establishment of palliative care programs.

Within the social work profession, there is a lack of understanding about self-care practices of social workers working with older adults. This lack of knowledge is a concern for the profession because as the older adult population continues to grow, so will the need for social workers to address their needs. Using action research, a focus group of 7 female social workers working with older adults in the Pacific Northwest discussed the research questions related to their use of self-care practices and identifying strategies to increase the use of self-care. Self-compassion theory enhanced understanding the relationship between social workers' experiences with older adult clients and self-care. Coding protocols were used to analyze the data. Key findings provided a further understanding of the self-care practices of these social workers including the use of appropriate boundaries, effective communication, education about responsibilities and expectations, and advocacy regarding the need for self-care. Additional strategies to increase self-care involved mindfulness about job roles, primarily related to team and system barriers. Recommendations from this project included adding self-care to education and training in social work courses required for degrees, licensure renewal, and employment-based continuing education courses. By exploring self-care practices of social workers working with older adults, the findings of this study may bring about social change by increasing the awareness of current and future social workers about the importance of self-care and providing strategies that enable social workers to implement self-care.

Background: Heart failure (HF) is a leading cause of hospitalization, readmissions, and death in the United States. Patients hospitalized for HF are at risk for readmission, in- hospital mortality, and early post-discharge death. In the United States, inpatient care has been estimated to cost $83,980 over the lifetime of each patient with HF. The majority of patients with HF depend on caregiver support for successful HF self-care, which is essential for optimal patient outcomes. Support from caregivers is thought to be important for better self-care, and lower readmission and mortality rates. Yet, there are few studies considering the influence of caregivers on HF patient self-care, readmission, and mortality. Objective: The purpose of my dissertation was to determine the influence of HF caregivers on patient self-care, readmission, and mortality. The specific aims of this dissertation were to: (1) to determine if caregiver depressive symptoms mediate the relationship between family functioning and caregiver quality of life, (2) to determine if there is an association between living arrangements (living with someone vs. living alone) and all-cause readmission and death in patients with HF, and (3) to determine the efficacy of an in-hospital, multi-session, educational intervention for caregivers on heart failure patients’ self-care and 30 day readmission rate, and to evaluate the efficacy of the intervention on caregivers’ knowledge, self-efficacy and perceived control. Methods: Specific aim one was addressed by a secondary analysis of data from one- hundred and forty-three HF caregivers recruited from an outpatient clinic. Multiple regression with mediation analysis was used to determine whether depressive symptoms mediated the relationship between family functioning as measured using the three scales of the Family Assessment Device (i.e., general, problem-solving, communication) and caregiver quality of life. Specific aim two was addressed by a retrospective chart review of all 398 patients with a primary diagnosis of HF admitted to an academic medical center in one year. We collected data on patient sociodemographic, clinical characteristics, and patient living condition. The independent association of living alone with all-cause readmission or all-cause death was evaluated using Cox proportional hazards modeling adjusting for covariates. Specific aim three was addressed using a two-group (educational intervention for caregivers of patients with heart failure vs. usual educational care), prospective, repeated measures randomized controlled trial of 37 patient and caregiver dyads in which caregivers only received in-hospital HF education. Outcome measures included patient self-care, and patient all-cause readmission or all- cause death, as well as caregiver self-efficacy, knowledge, and perceived control. Patient self-care, and caregiver self-efficacy, knowledge, and perceived control were assessed at baseline (in hospital), at discharge, 7 and 30-days after patient discharge. Patient readmissions and death were assessed by a phone call at 30-days follow-up. The intervention directed only at caregivers consisted of three in-hospital, educational sessions with telephone follow-up. The educational sessions were designed to deliver HF information and skills to caregivers, thereby providing them with the resources needed to improve their self-efficacy, perceived control and HF knowledge thus improving patient self-care and readmission rates. Results: Specific aim one: The three subscales of the Family Assessment Device predicted depressive symptoms (p < 0.001) and caregiver quality of life (p < 0.001). Depressive symptoms also predicting caregiver quality of life (p < 0.001). The inclusion of depressive symptoms in the final model with each subscale of the Family Assessment Device (i.e., general family functioning, problem-solving, communication) decreased the significance of family functioning as a predictor of caregiver quality of life indicating mediation by depressive symptoms. Specific aim two: Heart failure patients living with someone experienced a significantly longer time to rehospitalization than those living alone (290 vs. 201 days, p=0.005). In a Cox regression hazard regression model, adjusting for covariates, patients who lived alone were 1.42 times more likely to be rehospitalized one year after discharge than those who lived with someone (p=0.013). The relationship between living alone and all-cause death was not significant after adjustment for covariates. Specific aim three: A linear mixed-model analysis revealed that patients whose caregiver was in the intervention group had significantly better self- care maintenance (p < 0.001) and self-care management (p < 0.001) across time. Cox survival analysis demonstrated that patients whose caregiver did not receive the educational intervention were 11 times more likely (p=0.002) to experience cardiac readmission than patients whose caregiver did receive the educational intervention. Caregivers who received the educational intervention had higher perceived control (p < 0.001) for up to 30-days post-intervention versus the control group, however, there were no differences between caregiver groups in self-efficacy and HF knowledge. Conclusion: In this dissertation, we found caregivers to play an important part in improving patient outcomes of self-care and readmission after discharge from a hospitalization for HF. Future large-scale studies are needed to develop and test interventions focused on caregivers to improve both patient and caregiver outcomes. Such studies will assist clinicians in understanding how better to support caregivers in their ability to positively influence HF self-care and readmission rates in patients with HF.

The purpose of this study was to explore self-care strategies among parents with a child diagnosed with autism spectrum disorder. The study used a survey design to detect the extent to which respondents used self-care strategies to alleviate high stress levels associated with caring for an ASD child. The study was comprised of twenty eight respondents. The study found that the higher the level of education completed by the parent the greater the likelihood that self-care strategies were utilized. The study also found that the age of the ASD child was a factor in the level of physical self-care being incorporated among parents. Psychological self-care was also found to affect other categories of self-care. Both females and males listed lack of time as the greatest obstacle in implementing self-care. The study recommends that viewing self-care as important and finding small ways to incorporate self-care strategies might well improve other areas of parent well-being.

The purpose of this study was to examine trends in MSW graduate student's self-reported levels of healthy habits, family support and relationships during education, self-care, personal standards, as well as time management, and what the implications of those things are related to student burnout. The hypothesis was that students are burned out before they enter the social work field professionally. This poses a problem because the social work field has an already high level of burnout, turnover, and compassion fatigue. This study examines the trends in both the online pathways program and the on-the- ground ground program.

Self-care is necessary for psychotherapists to prevent burnout and to provide ethical services for clients. Counselling students often recognize the need for self-care, but neglect to implement it, preventing them from building the necessary practices to endure hardships related to practicing psychotherapy. Previous research, such as Butler and colleague’s work (2017), has examined the importance of self-care in counselling education, but has not examined how it is applied in practice. Therefore, this project’s research questions included: 1) How do novice therapists engage in professional self-care? 2) How do novice therapists bridge the gap between conceptual knowledge and practice of professional self-care? 3) What are the barriers to self-care? Thematic Analysis (TA) was used to distil meaning from common experiences of participants. Four psychotherapists with an average of 1.5 years of experience were interviewed using an in-depth semi-structured interview protocol. Eighteen subthemes were generated from the data, further categorized under four themes: (1) obstacles to self-care; (2) work-life balance; (3) pathways to self-care; and (4) effects of self-care. Implications of this research include structured self-reflection in counsellor training programs, integration of flexibility and self-care provisions in workplace cultures, and a strong policy emphasis on the need for counsellor self-care and improving professional guidelines to allow for counsellor self-care practices.