The role of the nurse manager is important in organizations and influences outcomes such as the safety and quality of care provided on a unit, satisfaction, turnover of nursing staff, and overall health of the work environment. Stressors for managing nurses can impair physical and emotional health and lead to poor patient and staff satisfaction, safety, and outcomes. The evidence-based practice project will explore nurse managers' well-being and self-care activities. The theoretical framework of the project is the Relationship-Based Care Model as well as Kotter's change theory. The literature suggests that self-care activities can reduce stress and improve well-being. A group of nurse managers who have accountability for inpatient hospital units will be recruited to participate in the project through public discussion boards and email groups of organizations that support nurse leaders. They will be educated through a self-guided learning module about stress and self-care and then will be asked to participate in self-care activities 3 times weekly for 4 weeks. Following the education, the nurse managers will complete a researcher-crafted posteducational assessment to evaluate whether the education and activities met their needs, whether they learned new information, and the helpfulness of the project. Nurse managers participating in regular self-care are able influence positive social change by role modeling healthy coping skills to nurses providing direct care to patients. Self-care promotes effective stress management and contributes a healthier work environment.

In 2012, research suggested that 21% to 67% of mental health professionals experience burnout. Burnout is described as a negative experience resulting in workplace stress that produces psychological, emotional, physical, and somatic symptoms. The purpose of this study was to examine a quantitative, correlational relationship between self-care practices and therapist beliefs in relation to burnout among home-based mental health therapists. The research question concerned whether there is a relationship between therapist beliefs, self-care, and burnout among home-based therapists. Equity theory was the base theory used for this project, indicating that reciprocity between therapist and client or therapist and supervisor may be a factor of burnout. While burnout has been researched extensively in the helping professions, this research focused specifically on those working as home-based mental health therapists (N = 80) from local community-based mental health care centers. Results of the quantitative correlational analyses showed that rigid adherence to therapeutic model, low tolerance for distress, belief in responsibility, workplace or professional balance, and balance significantly predicted burnout. Positive social change may result from this study through improved knowledge of symptoms of burnout, therapist beliefs, and self-care methods, which may allow agencies to combat early signs of burnout and promote appropriate training on burnout and approaches to self-care. The early detection and prevention of burnout would allow clinicians to be more effective in making a difference in the lives of clients. In addition, better training and awareness would lead to improvement in the lives of the clinicians and their families.

Compassion fatigue (CF) and burnout (BO) in the novice nurse population can negatively affect the organization, patient safety, patient satisfaction, and the individual. Novice nurses are susceptible to the development of CF and BO due to a lack of knowledge about the causes and the stress experienced as the novice nurse transitions to practice. The purpose of this staff education project was to fill the gap in practice by creating awareness about CF and BO during the nurse orientation process and by providing prevention strategies. The relationship-based care model and the theory of planned behavior were used to guide the project development and to discover motivational factors to encourage self-care and improve the well-being and resiliency of the novice nurse. The post-education evaluation was an anonymous, 10-question, Likert-type survey. All participants scored each question based on the course learning objectives, feasibility, and efficacy of the program, with a (5) strongly agree or (4) agree. A descriptive analysis of the data collected from the survey scores provided information that positively supported the practice-focused question that staff education on CF, BO, and prevention strategies would add value to the novice nurses' orientation program by validating the stressors of working with patients and providing tools to promote self-care as they transition from student to practicing registered nurses. Future recommendations would be to offer this education to staff nurses in all units during the annual skills day, huddles, and staff meetings. This project has the ability to create positive social change by educating novice nurses early in their career about the symptoms and self-care measures designed to promote resiliency, thus preventing CF and BO.

Hospital readmissions related to chronic heart failure (CHF) are costly, widespread, and often avoidable. Patient education that includes diagnosis, causes, medications, diet, exercise, and exacerbation warning signs has been shown to reduce the number of CHF readmissions. The purpose of this study was to use risk stratification to identify CHF patients at high risk for 30-day readmission. Once a high-risk CHF patient was identified, nursing interventions would be triggered to reduce readmissions and close the gaps in the continuum of care following acute care admission. Transitions of care theory was used as the framework for this project. The methodology had a quality improvement focus. The patient population consisted of high-risk CHF patients (n = 25) with NYHA classification of II-IV using the risk identification tool. Patients were identified using the tool, were followed for 30 days, and received nursing interventions to reduce the possibility of readmission. Only one of the identified patients was readmitted within 30 days for a diagnosis unrelated to CHF, resulting in no readmissions within this sub group. This study suggests that risk stratification can identify and direct resources to CHF patients, decreasing their likelihood for readmission. Nurse leaders can use standardized tools such as the risk identification tool, thereby reducing readmissions along with associated costs for readmissions.

The definition of a successful discharge is a discharge that results in patients successfully managing a chronic disease for at least 30 days without requiring an acute inpatient hospitalization. Many chronic disease readmissions are preventable. Successful discharge planning takes a multidisciplinary team that includes nurses who assess the discharge plan and provide additional education where needed. The purpose of this project was to determine staff nurses' understanding of their role in discharge education. Dorothea Orem's self-care deficit theory guided the project and root cause analysis was used in the development of the problem statements. Staff nurses (n=12) from evening and day shift of a rural hospital were interviewed using questions developed from the content from the literature review. Individual interviews were conducted with the volunteer participants and data from the interviews were examined using content analysis. Results included barriers to discharge education were related to inadequate nursing education, poor patient compliance, and inadequate discharge planning. Recommendations from the nurses' interviewed included the need for staff nurse education regarding their role in the educational needs of the patient and their family prior to discharge. The findings from this project may benefit nurses' practice by providing them with an understanding of the need for effective discharge education for patients. When patients are appropriately educated prior to discharge, their ability to self-manage their disease may improve, which can result in a decrease in health care costs and preventable readmissions. Educating nurses about their role in discharge planning promotes positive social change by improving the quality of the discharge education and patient outcomes.

Background. Mothers of children with Autism Spectrum Disorder (ASD) report high levels of stress, depression, marital strain, and divorce, with little time to devote to their own self-care due to the high demands of their child’s care. Despite their well-documented levels of stress and the relationship of stress to negative parenting, there are few observational studies of parenting in this population. Thus, it is critical to examine factors influencing maternal wellbeing and quality of parenting. Two factors to explore include 1) parental use of self-care, as self-care is related to reduced stress and better health and functioning of individuals and is easily modifiable and 2) attachment style, which, while being less modifiable, influences the degree to which an individual engages in self-care and the quality of relationships which are modifiable, including parent-child interactions. Methods. Participants were 42 mother-child dyads, with children ages 2-6 to 5-6 recruited from a preschool utilizing an Applied Behavior Analysis (ABA) approach to schooling. Children had a classification of ASD, verified by the Autism Diagnostic Observation System – Two (ADOS--2) (Lord, Rutter, DiLavore, Risi, Gotham, & Bishop, 2012). Parenting behaviors were observed across three tasks designed to mirror naturalistic mother-child interactions, which were videotaped for later coding using the Psychological Multifactor Care Scale — ASD Adapted Preschool Version (Brassard, Donnelly, Hart, & Johnson, 2016). Mothers completed questionnaires assessing demographic variables, parenting stress with the Parenting Stress Index – Fourth Edition, Short Form (Abidin, 2012), attachment style with the Experience in Close Relationships – Short Form (Wei, Russell, Mallinckrodt, & Vogel, 2007), depression with the Patient Health Questionnaire – 9 (Kroenke, Spitzer, & Williams, 2001), and self-care with items adapted from the Promise Neighborhoods RFA Indicators and the Promise Neighborhoods Research Consortium [PNRC] Measurement System; Promise Neighborhoods Research Consortium: Measures, 2001) concerning exercise, diet, smoking, overweight, and sleep. Results. Mothers in this sample engaged in high levels of positive and infrequent and mild levels of negative parenting. Those who did engage in negative parenting reported higher levels of stress and higher anxious and avoidant attachment. Multiple regression analysis using conditional process analysis (Hayes, 2018) found significant indirect effects of self-care on quality of parenting for both positive (r2=.61) and harsh (r2=.18) observed parenting, when mediated by parental stress. Individuals with a high degree of self-care demonstrated less stress which related to more positive, less harsh parenting. When depressive symptoms were included as a mediator in a casual model the impact of depression was significant. Self-care was significantly related to quality of parenting for both positive and harsh parenting in a mediational model with higher levels of self-care relating to lower levels of maternal depressive symptoms, which related to lower levels of parental stress, which related to more instances of positive parenting (r2=.64) and fewer instances of harsh parenting (r2=.24). Anxious attachment was significantly related to self-care with avoidant attachment as a moderator, explaining 56% of the variance. Anxious attachment related to both positive and harsh parenting directly and indirectly through self-care and stress. Avoidant attachment was not significantly related to quality of parenting, although it interacted significantly with anxious attachment in a model of attachment style, self-care, stress, and quality of parenting. Anxious and avoidant attachment style on self-care showed mothers who were preoccupied (high anxiety/low avoidance) demonstrated the most self-care, followed by secure (low anxiety/low avoidance), dismissing (low anxiety/high avoidance), with fearful parents (high anxiety, high avoidance) demonstrating the least self-care. Regression models controlled parental race (White, Hispanic), household income, number of children in the home, and the number of adults in the home, a proxy for caregiving support, determined by the dependent variable. Observed parenting behaviors were found to be skewed with most mothers using high levels of positive parenting behaviors and low levels of harsh parenting behaviors, Mothers in this sample reported higher levels of stress (20.5% above the cutoff) and maternal depressive symptoms (10% above the cutoff vs. 7% above the cutoff ) compared to normative samples, consistent with the literature on parents of children with ASD. Conclusions. Parent’s use of self-care is a modifiable variable related to reduced stress and depression, and better quality of parenting. Attachment is related to the amount of self-care a mother engages in as well as quality of parenting indicating that a mother’s attachment style should be considered in designing interventions.

The relational processes of sacrifice and self-care both influence every human relationship and as such, every human has to learn how to engage in them. Families are one of the many communities in which one must address sacrifice and self-care. This study provides a qualitative exploration of the relational processes of sacrifice and self-care among a sample of 198 highly religious (Abrahamic faiths) families. In-depth analyses explored motivations, types, and related family processes among family relationships. Five themes from the data about how families perceived and addressed the relational processes of sacrifice and self-care are discussed: (1) tensions between sacrifice and self-care, (2) motivations of sacrifice and/or self-care, (3) types of sacrifice, (4) types of self-care, and (5) processes in faith and family relationships. The ways that participants discussed struggling to address these processes are discussed along with why these ideas are important for marriages and families.

Despite victim advocates' missions of helping survivors of abuse, advocacy work takes a toll on workers. Advocates perform a multitude of tasks in their jobs including care work, emotional labor, and empowerment counseling which may subject them to consequences such as burnout, compassion fatigue, and compassion satisfaction. As such, this thesis details the work I conducted with the Butterfly Domestic Violence and Sexual Assault agency shelter advocates. The purpose of my thesis was to (1) document and review advocates' self-identified work-related needs and to (2) co-construct an educational intervention with the advocates using feminist participatory action research that would help them manage these aspects of their work. I argue that advocacy work impacts the Butterfly advocates across relational and wellness dimensions which inspired advocates' need to implement individual and organizational self-care practices. Furthermore, I contend that the process of feminist participatory action research constructed sustainable individual and organizational self-care interventions with the shelter advocates. The findings have implications for employees in advocacy work and for the larger discourse regarding the relationship between women and care work. Furthermore, findings reveal that creating a culture of self-care may serve as a way to reinforce and resist hegemonic Western notions of work culture in trauma related and non-trauma related fields.

Two hundred non-insulin dependent diabetic patients, predominantly from three health facilities in Lahore, Pakistan were assessed for metabolic control, weight status, diabetes knowledge, and six areas of diabetes self-care activities as well as dietary intake. A questionnaire was administered in an interview format followed by a 24-hour recall of dietary intake. Glycosylated haemoglobin status were determined on ninety subjects. The care levels appear to be inadequate for satisfactory diabetes control. Only 5 subjects had HbA1c levels within the normal range, while 21 showed extremely high levels. Complications and associated medical conditions were present in more than half of the sample. Diabetes knowledge averaged 4 correct responses out of a total of 11. Considerable variation was noted in the reported care regimens including the dietary regimen. Analysis revealed a number of areas of concern including high fat intake and a low intake of leafy vegetables, pulses and fruit which along with nutrient analysis results suggests a low fibre intake. The data points towards the need for improved diabetes education at all levels and identifies several areas of concern to be address / Master of Science (Hons)

<p><em>Bakgrund</em>: Primär dysmenorré, svår menstruationssmärta utan sjukdomsrelaterad bakomliggande orsak, är det vanligaste gynekologiska besväret för unga kvinnor. Idag fokuseras behandlingen av menstruationssmärta på läkemedel. Det har dock visats att kvinnor även använder sig av ickefarmakologiska metoder för att lindra sin smärta. Syftet med denna litteraturöversikt var att undersöka om det finns evidens för att följande ickefarmakologiska behandlingsmetoder kan lindra primär dysmenorré: akupunktur, akupressur, kostvanor och kostterapi, massage, transkutan elektrisk nervstimulering (TENS), värme samt örtterapi.</p><p><em>Metod</em>: Sökningar genomfördes i databaserna AMED, CINAHL, Cochrane Library samt Pubmed. På grund av få artikelträffar och låg kvalitet hos artiklarna exkluderades massage och värme. Totalt inkluderades 18 engelskspråkiga artiklar, publicerade mellan år 1999-2009, vilka redovisade resultat från sammanlagt 92 studier. Sammanlagt 23 studier undersökte akupunktur, 11 undersökte akupressur, 46 undersökte örtterapi, 3 undersökte kostterapi och kostvanor samt 9 undersökte TENS. Kvalitetsgranskning genomfördes enligt en mall från Forsberg & Wengström (2008).</p><p><em>Resultat</em>: Det finns evidens för att akupressur, TENS och örtterapi lindrar primär dysmenorré. Vilka specifika akupunkter och örter som har en smärtlindande effekt är dock oklart. Sjuksköterskan kan ge råd till patienter med primär dysmenorré att prova TENS för att lindra sina menstruationssmärtor.</p> / <p><em>Background</em>: Primary dysmenorrhea, menstrual pain without disease-related underlying reason, is the most common gynaecological discomfort for young women. Today the treatment regime for menstrual pain is focused on pharmacologic treatments. However, it has been observed that women also use non-pharmacologic methods to ease their pain. The objective for this literature review was to determine if there is evidence for the following non- pharmacologic treatment-methods to ease primary dysmenorrhea: acupuncture, acupressure, dietary habits and dietary therapies, massage, transcutaneous electrical nerve stimulation (TENS), heat and herbal therapy.</p><p><em>Method</em>: Searches were performed in databases AMED, CINAHL, Cochrane Library and PubMed. Because of a small number of search-results and low quality of the articles massage and heat was excluded. A total of 18 English-speaking articles published between 1999-2009 were identified. They reviewed results from 92 studies. Altogether 23 studies reviewed acupuncture, 11 acupressure, 46 herbal therapy, 3 dietary therapies and dietary habits and 9 TENS. Quality assessment was performed according to a template from Forsberg & Wengström (2008).</p><p><em>Results</em>: There is evidence that acupressure, TENS and herbal therapy ease primary dysmenorrhea. Which specific acupoints and herbs that are pain relieving could not be concluded. The nurse can give advice to patients with primary dysmenorrhea to test TENS to ease their menstrual pain.</p>