Thesis (M.S.)--University of Michigan, 1992.

Thesis (M.S.)--University of Michigan, 1981.

Thesis (Ph. D.)--University of Texas at Austin, 2006. / Vita. Includes bibliographical references.

Theory Stroke, a cerebrovascular disease, causes severe disability and failure of self-sufficiency for nearly of half of the patients. Nursing focuses on respecting the individuality of each patient, supports the return and consolidation of a good health, promotes self-sufficiency and searches for the needs of the patient. Conceptual model of D. E. Orem assumes the ability of each human to take care of self. Although partially, or not capable of self-care at all, it is necessary to fill up the deficit by nursing care. Objectives The first objective was to state the options to how to fill up the deficit of self-care by patienst after stroke. The second objective was to determine, whether the patient´s living environment has an impact the development of self-care. Research questions Q1: Does the home environment stimulate the acceleration of the return of self-care ability by patients after a stroke? Q2 : Does the respondent perceive the issue of own disability equaly as the surrounding? Q3 : Is it more beneficial for the patient to perform self-care with deficiency, or to receive perfect execution of it by others? Q4 : Does the patient perceive the subsequent therapy (physiotherapy, occupational therapy) as a faster way to return to sufficient self-care? The research part of the thesis was carried out by a qualitative survey, conducted as a individual semi-structured thematic interviews with respondents devided into two groups. One group consisted of patients after a stroke and a second group of caregivers. Total of 8 patients, 4 males and 4 females, were interviewed. The research was completed in three sessions, each at intervals of four to six weeks. The information received were processed by open coding method, analytical induction development of technology showdown and narrative analysis. Results Using data received from interviews with respondents it was possible to answer all the research questions. The first research question examined was, whether the home environment stimulates the acceleration of the return of self-care ability by patients after a stroke. According to interviews and objective evaluation, the domestic environment has improved overall condition and faster return to individual self-care. Although, aftercare provided enough nursing and rehabilitative care, patient very much appreciated mental stimulation given by the home environment. The second research question focused on whether the respondent perceives own disability equaly as the surrounding. The interviews showed most of the patients perceive their health and subsequent disabilities better than its surroundings. The third research question examined whether it is more beneficial for the patient to perform self-care with deficiency, or to receive perfect execution of it by others. The results indicated more benefits by performing own self-care, even with mistakes that encourage practising, thereby repeating and consolidating manners. Most of the respondents refused any help. The fourth research question focused on patient´s perception of the subsequent therapy (physiotherapy, occupational therapy) as a faster way to return to sufficient self-care. The interviews showed that the respondents did not realize the importance of aftercare, considered it to be routine and as a part of the treatment. Yet, increased physiotherapy activities results into a quicker adjustment of self-sufficiency. Conclusion The temporal evolution of self-sufficiency of patients after a stroke and the attitudes of caregivers are described in this thesis. The results are presented in a form of mental map. This might be used by the patients after stroke, nursing staff or official home caregivers and informal caregivers, as well.

Long-term conditions (LTCs) such as diabetes, cardiovascular diseases, respiratory diseases and cancers are recognised as the greatest challenge facing public healthcare systems globally in the 21st century. Healthcare provision for people with LTCs is shifting towards a model that puts patients at the centre of their own care through supported self-care. Self-care support has emerged as a distinct concept in the management of LTCs and is now considered an inseparable component of high quality healthcare provided by healthcare professionals. People with LTCs are regular users of community pharmacy where dispensing and other services provide opportunities for self-care support. While self-care support as a concept has been explored extensively in health disciplines like nursing, medicine and health psychology, there is a paucity of published literature in community pharmacy. The main aim of this programme of work was to explore the place and contribution of community pharmacy in self-care support of LTCs. A preliminary scoping literature review captured and synthesised the overarching components of self-care support of LTCs into a single theoretical framework consisting of collaborative care planning, self-care information and advice, self-care skills support and training, self-care support networks and self-care technology. The research programme of work employed a mixed methods design consisting of three Work Streams. The qualitative arm of the programme consisted of semi-structured interviews with 24 patients with LTCs and 24 community pharmacists in England and Scotland; these informed the quantitative arm, which was a cross-sectional, online survey of 10,000 community pharmacists in England. The survey instrument was informed and developed from the findings of the pharmacists’ interviews in combination with existing literature. Data collection and analysis in the three work streams incorporated the theoretical framework of self-care support. The qualitative data analyses were undertaken thematically, while quantitative data were analysed using a range of descriptive and inferential statistics. Interviews with patients explored their ‘lived experience’ with LTCs and found that self-care was an integral part of daily living; patients engaged in self-care in a variety of ways to attain normality in their lives. Patients used a wide range of resources for self-care support; family/carers, friends and healthcare professionals (mainly doctors and nurses). Patients viewed and used community pharmacy mainly for the supply of prescribed medicines and suggested that community pharmacy played minimal roles in self-care support. The interviews and survey of community pharmacists showed that pharmacists recognised the broad range of activities and principles of self-care. However, in terms of pharmacists’ contributions to self-care support, their perspectives were narrower and focussed on providing information and advice on medicines-use to patients, while other activities such as lifestyle advice were provided opportunistically. They indicated that they were already providing medicines-focussed self-care support through the services available in community pharmacy. The theoretical framework allowed detailed exploration of how community pharmacists operationalised the different elements of self-care support of LTCs. Collaborative care planning was viewed as important but not within the remit of community pharmacy. Self-care information and advice was unidimensional and provided opportunistically and one-off, using the paternalistic biomedical model. Pharmacists valued the roles of patients’ personal communities but were not proactive in signposting to other support networks. Self-care skills training and support and the use of self-care technologies were limited. Barriers to providing self-care support were priority accorded to dispensing activities, the structure of the community pharmacy contract, lack of incentives to provide self-care support and patients’ expectations and lack of awareness of community pharmacy’s role in LTCs management. The theoretical framework of self-care support of LTCs provided novel insights into the perspectives of patients and community pharmacists. The findings highlighted the need for a coherent LTC strategy if community pharmacy is to align with the self-care support paradigm. Recommendations are made for a comprehensive package of care, underpinned by self-care support. A case is also made for incorporating the often ‘unheard’ patient voice into community pharmacy research and interventions.

No description available.

Bakgrund: Diabetes mellitus typ 1 är en autoimmun sjukdom och antalet som insjuknar ökar varje år. Under ungdomstiden sker mycket i människans kropp och det kan vara en utmaning att balansera blodsockernivåer när hormonerna i kroppen svajar. Ungdomar med diabetes mellitus typ 1 står därför inför stora utmaningar för att lyckas med sin behandling. Syfte: Syftet är att belysa ungdomars upplevelser av att leva med diabetes mellitus typ 1. Metod: Metoden är en litteraturstudie baserad på både kvalitiva och kvantitativa studier. Analysen är genomförd utifrån en modell av Axelsson (2012). Resultat: I resultatet framkom att ungdomarna med diabetes mellitus typ 1 växte in i rollen i att bli mer självständiga i sin behandling. Detta var inte alltid lätt. Ungdomarna påverkades av hur deras vänner bemötte diagnosen, hur de blev bemötta av vården samt hur villiga deras föräldrar var att lämna över ansvaret. Resultatet presenteras utifrån fyra huvudteman samt nio subteman. Diskussion:I diskussionen tar vi upp vikten av att jobba med målet att patienten ska få kunskap så att denne kan sköta sin behandling självständigt. Vikten av stöd för att motverka känslor av skam för sjukdomen och dess behandling belyses också.

Injury is a common and emotionally painful aspect of sport participation for female athletes. Playing through injury is normalized in sport culture; unfortunately, this practice holds short- and long-term health risks. Self-compassion has been endorsed as a resource for female athletes coping with injury and is purported to result in better health-related choices. The purpose of this study was to explore the role of self-compassion in competitive women athletes’ self-care behaviours following emotionally painful experiences of injury. Participants were 159 female athletes ranging in age from 18-49 years who completed an online survey. Five measures of emotional pain were used: negative affect, threat appraisal, badness rating, emotional difficulty, and a composite score comprised of the previous four measures. Self-compassion was negatively related to negative affect (r = -.26, p < .01), threat appraisal (r = -.19, p < .05), and the emotional pain composite score (r = -.18, p < .05) but not to badness rating or emotional difficulty rating. Self-compassion did not contribute unique variance, beyond self-esteem and athletic identity, in the emotional pain measures. The emotional pain composite score was negatively related to self-compassionate reactions (r = -.23, p < .01), positive reactions (r = -.30, p < .01), and perseverant reactions (r = -.16, p < .05) and positively related to ruminative reactions (r = .54, p < .01), passive reactions (r = .24, p < .01), and self-critical reactions (r = .48, p < .01). Unexpectedly, emotional pain was positively correlated with stopping training (r = .34, p < .01), reduced training frequency (r = .33, p < .01), reduced training intensity (r = .27, p < .01), and reduced training duration (r = .33, p < .01) and not significantly related to responsible reactions or stopping the session in which the injury was incurred. Neither self-compassion nor fear of self-compassion moderated the relationship between emotional pain and self-care behaviours. Participants also completed an open-ended question in which they described in detail everything they did to care for their injuries. A codebook was developed and used to analyze the responses. Self-care behaviours fell into the following categories: diagnostics, rest, medical devices, pharmaceuticals, treatment, and training accommodations. Athletes reported using an average of 3.38 self-care behaviours - most commonly describing obtaining a medical diagnosis and undergoing treatment. Self-compassion was not related to the number of self-care behaviours used by participants or the use of any individual behaviour. Overall, the results suggest that self-compassion plays a role in women athletes’ injury experiences; however, likely due to the complex and multifaceted nature of injury, the relationships might not manifest in perfect concordance with theoretical conceptualizations.

Patients with heart failure (HF) must monitor and recognize escalating symptoms to manage worsening HF in a timely manner. However, routine symptom monitoring is not commonly performed by this population. Providing a symptom diary along with an education and counseling session may help HF patients promote symptom monitoring and interpretation. The accumulated information about changes in daily symptoms will allow patients to easily compare current symptom status to the past without depending on memory and can rapidly capture worsening HF. To date, few studies have tested the effect of a daily symptom diary. The purpose of this dissertation was to develop and test a symptom diary intervention to improve outcomes in HF patients. Prior to testing the intervention, preliminary work included: (1) determining the impact of symptom clusters on cardiac event-free survival; (2) evaluating the quality of existing symptom measures designed for HF patients; (3) evaluating the effect of physical symptom items that were often included in a depressive symptom instrument on cardiac event-free survival; and (4) evaluating the association between symptom monitoring and self-care management. Based on this information, a randomized, controlled pilot study was conducted to test the effect of a symptom diary with an education and counseling intervention on prognosis, healthrelated quality of life (HRQOL), and self-care maintenance at 3 months follow-up. A total of 44 hospitalized patients with HF were randomly assigned to either usual care or intervention providing a daily symptom diary with education and counseling. There were trends toward fewer HF events and improved self-care maintenance in the intervention group compared to the usual care group. However, there was no difference in HRQOL between the two groups. The results of this dissertation suggest the importance of assessing symptom clusters and further studies to improve the quality of existing HF symptom measures. Results from this dissertation also provided the evidence of the advantages of regular symptom monitoring to facilitate early identification of worsening HF and initiation of timely responses. However, further studies are needed to provide additional evidence of the positive impact of a use of daily symptom diary in patients with HF.

The purposes of this study were: (a) to identify which of four competing theories best accounted for self help as a learned outcome of chronic illness experience, and (b) to generate a Self Help Model that could be used to explicate self help as a learned response to chronic illness. The concepts of severity of chronic illness, intimate dependency reinforcers, self induced dependency reinforcers, cue outcome independence reinforcers, enabling skill, self help and life quality were specified in a causal format that allowed a competitive test of four different theories. The theories tested were instrumental passivity theory, self induced dependency theory, an adaptation of learned helplessness theory and learned resourcefulness theory. The study utilized a causal modeling design to assess a five stage model. A judgment sample of 786 individuals having a diagnosis of arthritis or an arthritis related condition were mailed questionnaires. Two hundred seventy-eight subjects responded, a 36 percent return rate. Seven scales using a visual analogue response format indexed the theoretical concepts. Reliability and validity estimates were conducted to assess psychometric properties of the instruments. Model parameters were estimated using multiple regression statistical techniques. Residual analysis was conducted to estimate violations of the causal model and statistical assumptions. Factors from one theory, the learned resourcefulness theory, emerged as more credible than factors from any single other theory. However, the data did evidence factors from other theories that were significant. Self induced sick role reinforcers and cue outcome independence reinforcers were found to slightly reduce perception of enabling skill (B = -.31 and B = -.12, respectively; R² = .11). Intimate dependency reinforcers and cue outcome independence reinforcers were found to slightly reduce perception of self help (B = -.34 and B = -.24, respectively; R² = .19). These factors helped to identify environmental and intra-person contingencies that led to reduction in self help. The learned resourcefulness factor, enabling skill, demonstrated the mediating skills that worked to enhance self help (B = .44; R² = .29). The Self Help Model generated to explicate self help as a learned response to chronic illness explained 50 percent of the variance in perceived self help. Self help had a direct positive impact on life quality (B = .61; R² = .46). By knowing the factors influencing a patient’s self help response to chronic illness experience, the nurse is better able to plan more effective self help promoting interventions for individuals, or groups of patients. Nurses who promote a self help response in those having a chronic illness could improve their life quality.