There is a practice gap in the self-management education of patients with chronic low back pain. Insufficient self-management leads to increased frequency of flare-ups of low back pain, disability, loss of productivity, and increased cost of health care. The guiding practice-focused question was focused on the unmet self-management support needs of the chronic low back pain patients in a Midwestern state local pain clinic. The purpose of this descriptive cross-sectional study was to ascertain the unmet needs of patients' self-management support by analyzing the results of a patient study performed by this clinic. The theoretical principles of the model for evidence-based practice change, the chronic care model, and the middle-range theory of self-care of chronic illness were used. The evidence included the analysis of the Patient Assessment of Chronic Illness Care Survey (PACIC) data from 100 patients treated in this pain clinic. The clinic used the PACIC questionnaire to collect data from its 100 chronic low back pain patients, selected by simple random sampling method. The average weighted scores of these patients' responses were below the norm on all PACIC subscales and summary scores. According to study results, this pain clinic did not meet the self-management support needs of its chronic low back pain patients. Evidence-based recommendations were made for the improvement in the medical model of patient care by including nurse-led patient education and support. The positive social change is the improvement in the health status of this growing health population by meeting their identified education and support needs. Positive results from this nurse-led intervention could lead to the dissemination and widespread implementation of these recommendations in other pain clinics.

Burnout among child welfare social workers negatively affects social workers and the social welfare system. The purpose of this action research study was to explore what child welfare social workers do to alleviate burnout. The practice-focused research questions for this study center on two elements: (a) the experiences of burnout among child welfare social workers employed by the Department of Family and Children services in the southeastern region of the United States and (b) the social work practices used to alleviate burnout. The conceptual framework for this study was the Maslach theory on burnout. Action research study procedures were used to facilitate analysis of the research problem. Data were collected using semistructured questions administered to 6 child welfare social workers in a focus group. The selection criteria for the child welfare social workers were social workers who work for the department of children and family services for at least 6 months. The data were transcribed verbatim from an audio recording. Codes were assigned to the data and reliability checks were conducted. The themes that emerged from analysis of the data included workload, lack of influence on the job, lack of rewards on the job, negative social interaction, and value differences in individuals and their jobs. The findings of this study might contribute to positive social change by enhancing awareness regarding burnout in child welfare social workers and providing an opportunity for child welfare social workers and child welfare agencies to learn how to address causes of burnout in child welfare social workers in the southeastern United States.

Most youth receiving care in residential treatment centers (RTCs) have experienced significant childhood trauma and require intensive mental health treatment to recover from their traumatic childhood experiences. Staff turnover is one factor that can negatively affect outcomes for these children and adolescents. Understanding factors that predict the turnover of professional counselors providing counseling to youth in RTCs can help counselors, supervisors, and counselor educators address barriers to staff retention. The purpose of this quantitative cross-sectional study was to explore the relationship between the turnover of professional counselors providing counseling to youth in RTCs and their perception of the work environment, burnout, vicarious trauma, and self-care. The theoretical framework for this study was constructivist self-development theory, which described the impact of working with traumatized youth in RTCs. Professional counselors working in RTCs for youth across the United States received an online survey to measure the study variables and obtain data for the study. Results of the multiple regression data analysis indicated that the combination of perception of work environment, burnout, vicarious trauma, and self-care predicted counselor turnover. Independently, perception of work environment, burnout, and self-care also predicted turnover. This information may help to increase counselor retention in residential treatment centers and improve outcomes for the vulnerable youth receiving care in those settings. This research will contribute to positive social change by improving the quality of life for this marginalized population of youth and decreasing the long-term social and financial burden placed on the community at large.

Type 2 diabetes mellitus affects patients' health across the globe and is costly to manage. The chronic high blood sugar of diabetes is linked to cardiovascular and kidney damage, impaired functional status, and multiple organ failure. To lessen the complications associated with diabetes and promote self-care in those with the disease, health care professionals must be vigilant in offering diabetes education to patients with each clinic or primary care visit. Lack of diabetic educators in the clinic that provided the setting for this study indicated a need to increase clinical staff competency in teaching self-care and diabetes management to patients. The resulting project, guided by Bandura's theory of social learning, involved the creation of an educational curriculum, which was evaluated by 5 content experts with 5 or more years of experience caring for adult patients with Type 2 diabetes mellitus who provided narrative feedback. The content experts indicated satisfaction with the program and offered the following recommendations: (a) implementation of staff coaching on motivational interviewing, (b) additional help in securing medications and blood glucose testing supplies for noninsured patients, (c) translation of patient tools into Spanish at a Grade 3 or 4 reading level for better patient understanding, and (d) proceeding with full implementation after the recommendations are carried out. Improved self-care among diabetes patients could promote positive social change through the prevention of acute, long-term complications and disability.

Difficulties experienced at work can cause feelings of burnout that become prolonged and intensified without acts of self-care. The intense nature of mental health workers' jobs may make them, more vulnerable to burnout than other professionals. Because mental health professionals' mental and emotional wellness can significantly affect their work, adequate self-care is critical to both their well-being and that of their clients. Previous researchers have investigated the self-care behaviors of mental health professionals, but little was known about how gender affected the use of these behaviors in burnout prevention among mental health professionals. The purpose of this quantitative study was to examine the relationship between self-care behaviors and burnout among a sample of 325 mental health professionals working in New York. Differences in the ways male and female mental health professionals practiced self-care behaviors were also investigated. Burnout and gender role theories were used as the theoretical framework. Study instruments included the MBI-HSS and the Brief COPE. Multiple regression analysis and independent sample t tests were employed to analyze survey data. Analysis revealed levels of self-care behaviors were significantly predictive of depersonalization, emotional exhaustion, and reduced personal accomplishment. Gender differences in self-care behaviors were indicated for substance use, self-blame, depersonalization, emotional exhaustion, and reduced personal accomplishment. Since burnout is a significant problem for many mental health professionals, understanding how self-care affects burnout is critical to promoting behavioral changes among these professionals. Self-care among mental health professionals may improve their professional and personal lives.

Bakgrund: Antal personer som lever med kronisk njursvikt ökar med befolkningsökningen. Peritonealdialys är en vanlig livsuppehållande behandling för patienter som lever med kronisk njursvikt som främst sköts av patienter i hemmet. För att kunna fortsätta leva med sjukdomen under kontroll kräver peritonealdialys införande av nya livsförändringar som på olika sätt kan vara påfrestande för patienterna. Syfte: Syftet var att beskriva patienters upplevelser av att leva med peritonealdialys i sin vardag. Metod: Litteraturöversikten baserades på elva vetenskapliga artiklar med kvalitativa ansatser hämtade från databaserna CINAHL complete och PsyINFO. Sökorden som användes vid artikelsökning var patient experience, living with" och "peritoneal dialysis" som vidare utökades till "perspective", "home dialysis, qualitative study och interview'' med års begränsning 2000- 2017. Resultat: Litteraturöversikten visade att patienternas upplevelser av att leva med peritonealdialys innefattade en livsförändringsprocess med upplevelser av övergång som en besvärlig vändpunkt i livet vilket började redan vid PD- initiering. De första sex månaderna var den svåraste tiden att hitta balansen och anpassa sig till ett nytt levnadssätt, under den perioden hade patienterna stora behov av stöd både från sjukvården och det egna sociala nätverket dels för att bearbeta de olika förluster och begränsningar relaterad till PD- behandlingen, dels för att upprätthålla motivationen för att fortsätta sköta sin behandling. Med tiden ökade patienterna upplevelser av oberoende självständighet i att hantera sin egenvård och deras behov av stöd minskade, stödet från sjukvården minskade till enbart rutinkontroller. Diskussion: Patienters upplevelser av att leva med PD diskuterades och analyserades utifrån Orems teori om egenvårdsbalans och tidigare forskning. Större delen av diskussionen understryker betydelse av sjukvårdpersonalens bemötande som kan såväl positivt som negativt påverka patienters upplevelser. Hur väl en patient lyckades med sin egenvård berodde mycket på bemötandet, anpassad information, typ av stöd i patientens sociala nätverk och vilka vårdinsatser patienten fick under behandlingsprocessen.

AIDS is a chronic disease that seriously affects health, emotions, social relations and household economy. People living with HIV/AIDS experience great suffering, stigmatisation and discrimination from other people around them because they know that it is incurable, contagious, evokes social disgust and is a complex disease requiring life-long self-care. This researcher explored ways people with HIV/AIDS take care of their health and manage their lives in the context of stigma and discrimination. A grounded theory study was conducted with 30 participants with HIV/AIDS, in Mahasarakham Province, Thailand. Participants were recruited from an HIV/AIDS day care clinic and by snowball sampling. Data were gathered through in-depth interviews, participant observations and field notes made during home visits. Interviews were tape recorded, then transcribed verbatim. “From experiencing social disgust to passing as normal” was generated inductively from the data as the basic social psychological process of Thai people living with HIV/AIDS. From experiencing social disgust to passing as normal comprised four categories: being HIV/AIDS, making choices, keeping well and feeling empowered. The category “being HIV/AIDS”- discovering the meaning of having HIV/AIDS, comprises four concepts: being diagnosed with HIV/AIDS, being stigmatised, suffering, and learning about HIV/AIDS. The category “making choices”- to live a normal life, involves three concepts: avoiding unhappy situations, getting remarried and seeking support. The category “keeping well”- maintaining emotional and physical health, includes eight concepts: religious practices, keeping a cheerful mind, self-treatment, taking care of the body, keeping the environment clean to prevent getting germs, healthy behaviours, getting healthcare services, and attention to, and concern about, medication. The last category “feeling empowered”- personal and social acceptance of illness, includes eight concepts: being encouraged, acknowledging the disease, social acceptance, tamjai, feeling proud of self, feeling good about life, feeling lucky and having hope. In the context of northeastern Thailand, successful management of HIV/AIDS was underpinned by participants making a transition from “experiencing social disgust” to “passing as normal” within their communities. The desire to live a normal life despite having HIV/AIDS motivated participants to undertake effective self-care in order to remain symptom free (thus avoiding visible signs of the disease), and to selectively disclose their illness to avoid the ongoing risk of stigma and discrimination. The findings of this study are useful in that they will provide Thai health professionals with a clearer conceptualisation of self-care among the Thai population. An inductively derived theory of self-care among Thai with HIV/AIDS can be applied and integrated by health professionals into the self-care models for people living with HIV/AIDS including models used in nursing education, research and practice.

This naturalistic exploratory study focused on Australians living with chronic illnesses who chose to use complementary and alternative medicine (CAM). The purpose of this sociological study was to discover and illuminate the lived experience of using CAM by individuals living with chronic illnesses in an attempt to understand their reasons for choosing CAM for their health care needs within the social contexts of their lives. The research question guiding this qualitative study was: Based upon a reflection of lived experiences, why do individuals living with chronic illnesses choose to use CAM? The major finding of this study was that research participants turned to CAM to find practical solutions for coping with pain and the ongoing demands of living daily lives while suffering and living with chronic illnesses. Unlike existing research findings, participants in this study did not turn to CAM for ideological reasons, nor were they seeking a holistic approach to health and health care. As such, the findings of this study strongly suggest that individuals living with chronic illnesses initially choose to use CAM for pragmatic reasons rather than ideological dispositions. However, the findings also suggest that after their initial use of CAM, individuals appear to adopt, via enculturation processes, more holistic ideologies resulting in modifications to perceptions of self, illness and health. / Doctor of Philosophy (PhD)

This thesis explores the issue of men's access to chronic illness self management programs from a social constructionist perspective. A combination of research methodologies was used; a quantitative analysis to confirm gender differences in levels and patterns of service use; a qualitative analysis to gain an increased understanding of the factors affecting men's access; and a trial to test the application of the research findings. The clients and services of Arthritis Victoria were chosen as the setting for this research. The quantitative analyses were conducted on contingency tables and odds ratios and confirmed that men were under-represented as service users. The analyses also identified gender differences in patterns of service use. The qualitative analysis was based on a series of in-depth, semi-structured interviews. It was undertaken from a grounded theory approach to allow for the development of theoretical explanations grounded in the data. It was found that men's decisions to access chronic illness self management programs were strongly influenced by dominant social constructions of masculinity which constrained help-seeking and health management behaviour. However, the restrictive influence of hegemonic masculinity was progressively undermined by the increasing severity of the chronic condition until a crisis point was reached in terms of the severity of the condition or its impact on lifestyle. This resulted in a reformulation or rejection of hegemonic masculinity. The described conceptual framework was consistent for men from diverse social groupings, although it appeared less prominent in both younger and older men, suggesting that dominant social constructions of masculinity have the greatest influence on health decisions during the middle stage of adulthood when work and family obligations are greatest. The thesis findings informed the development of some guiding principles for reviewing the structure and delivery of chronic illness self management services for men. The guiding principles will have direct application in the planning of Arthritis Victoria programs, and implications for other chronic illness self management programs in Australia, and also in Western countries with a similar health and sociocultural setting to Australia.

AIDS is a chronic disease that seriously affects health, emotions, social relations and household economy. People living with HIV/AIDS experience great suffering, stigmatisation and discrimination from other people around them because they know that it is incurable, contagious, evokes social disgust and is a complex disease requiring life-long self-care. This researcher explored ways people with HIV/AIDS take care of their health and manage their lives in the context of stigma and discrimination. A grounded theory study was conducted with 30 participants with HIV/AIDS, in Mahasarakham Province, Thailand. Participants were recruited from an HIV/AIDS day care clinic and by snowball sampling. Data were gathered through in-depth interviews, participant observations and field notes made during home visits. Interviews were tape recorded, then transcribed verbatim. “From experiencing social disgust to passing as normal” was generated inductively from the data as the basic social psychological process of Thai people living with HIV/AIDS. From experiencing social disgust to passing as normal comprised four categories: being HIV/AIDS, making choices, keeping well and feeling empowered. The category “being HIV/AIDS”- discovering the meaning of having HIV/AIDS, comprises four concepts: being diagnosed with HIV/AIDS, being stigmatised, suffering, and learning about HIV/AIDS. The category “making choices”- to live a normal life, involves three concepts: avoiding unhappy situations, getting remarried and seeking support. The category “keeping well”- maintaining emotional and physical health, includes eight concepts: religious practices, keeping a cheerful mind, self-treatment, taking care of the body, keeping the environment clean to prevent getting germs, healthy behaviours, getting healthcare services, and attention to, and concern about, medication. The last category “feeling empowered”- personal and social acceptance of illness, includes eight concepts: being encouraged, acknowledging the disease, social acceptance, tamjai, feeling proud of self, feeling good about life, feeling lucky and having hope. In the context of northeastern Thailand, successful management of HIV/AIDS was underpinned by participants making a transition from “experiencing social disgust” to “passing as normal” within their communities. The desire to live a normal life despite having HIV/AIDS motivated participants to undertake effective self-care in order to remain symptom free (thus avoiding visible signs of the disease), and to selectively disclose their illness to avoid the ongoing risk of stigma and discrimination. The findings of this study are useful in that they will provide Thai health professionals with a clearer conceptualisation of self-care among the Thai population. An inductively derived theory of self-care among Thai with HIV/AIDS can be applied and integrated by health professionals into the self-care models for people living with HIV/AIDS including models used in nursing education, research and practice.