The purpose of this study was to better understand the self-care practices of female peer support specialists (PSS) with co-occurring mood and substance use disorders. The researcher took a qualitative grounded theory approach conducting in-depth semi-structured interviews with ten women employed at peer-run agencies in Maricopa County, Arizona. Data from these interviews were transcribed, then analyzed manually, as well as with NVivo 10.0 software, to identify the key terms, nodes, categories and emergent themes of the participants' experiences. Self-care practices of peer support specialists included accessing personal and professional support networks; maintaining a daily routine to balance the demands of recovery, parenting, and working; taking medications; sleeping; practicing spirituality; participating in service work; eating nutritiously; exercising, and building a sense of coherence. Although a variety of practices were being used and identified as helpful, spirituality was identified as the most important self-care practice to achieve overall wellness. Employment improved the ability for PSSs to practice self-care because they valued the support of their supervisors and coworkers, were reminded of the consequences of not practicing self-care by working with individuals who were unstable, gained knowledge from teaching others, found healing in telling their stories, and reported higher self-esteems from working and helping others. However, participants did identify ways that employment as a PSS could interfere with practicing self-care, such as staff turnover, limited access to supervisors, or being unprepared to work in the field. Several recommendations were suggested as a result of this study, such as the importance of understanding and using effective self-care practices, building personal and professional support networks, and establishing daily routines to balance recovery with personal and professional demands.

Background: Foot ulceration and subsequent lower extremity amputation are common, serious, and expensive chronic complications for patients with diabetes. Foot-care education, provided to patients with diabetes at low-risk for ulcers, prevents minor foot problems that may lead to ulceration. Little evidence is available to support the effectiveness of educational intervention in low-risk diabetic patients. Objectives: The objectives of the pilot study were to examine the feasibility and acceptability of the foot care educational intervention, and to explore its effects on patients’ foot self-care knowledge, efficacy, and behaviors, and the occurrence of minor foot problems in adult patients with diabetes at low risk for foot ulceration. Methods: A one group repeated measures design was used. The intervention was given over a 3-week period. The first intervention session consisted of a 1-hour one-on-one, provider-patient interaction to discuss foot self-care strategies; the second session involved a 1-hour hands-on practice training. The third and fourth sessions entailed two 10-minute telephone contact booster sessions. Seventy eligible participants with type 2 diabetes at low risk for foot ulcerations were enrolled in the study, and 56 participants (30 women and 26 men; mean age: 55.8±13.2 years) completed the study. The outcomes of foot self-care knowledge, efficacy, behavior, and foot and footwear conditions were assessed at pre-test, following the first two sessions, and 3-month follow-up. Repeated measures analysis of variance, and paired-t test were used to examine changes in outcomes over time. Results: The findings provided initial evidence suggesting the foot self-care educational intervention is feasible and acceptable to adult patients with type 2 diabetes. It was effective in improving patients’ foot self-care knowledge (F (2, 54) = 230.444, p < 0.01), self-efficacy (F (2, 54) = 94.668, p < 0.01), and foot self-care behaviors (t (55)=117.228, p < 0.01), in reducing the occurrence of minor foot skin and toenails problems (all p<0.05), and in improving wearing proper shoes and proper socks (all p<0.05 ) at 3-month follow-up. Conclusions: The findings from this pilot study support the effects of the intervention. Future research should evaluate its efficacy using a randomized clinical trial design, and a large sample of patients with diabetes at low risk for foot ulcerations.

Background: Foot ulceration and subsequent lower extremity amputation are common, serious, and expensive chronic complications for patients with diabetes. Foot-care education, provided to patients with diabetes at low-risk for ulcers, prevents minor foot problems that may lead to ulceration. Little evidence is available to support the effectiveness of educational intervention in low-risk diabetic patients. Objectives: The objectives of the pilot study were to examine the feasibility and acceptability of the foot care educational intervention, and to explore its effects on patients’ foot self-care knowledge, efficacy, and behaviors, and the occurrence of minor foot problems in adult patients with diabetes at low risk for foot ulceration. Methods: A one group repeated measures design was used. The intervention was given over a 3-week period. The first intervention session consisted of a 1-hour one-on-one, provider-patient interaction to discuss foot self-care strategies; the second session involved a 1-hour hands-on practice training. The third and fourth sessions entailed two 10-minute telephone contact booster sessions. Seventy eligible participants with type 2 diabetes at low risk for foot ulcerations were enrolled in the study, and 56 participants (30 women and 26 men; mean age: 55.8±13.2 years) completed the study. The outcomes of foot self-care knowledge, efficacy, behavior, and foot and footwear conditions were assessed at pre-test, following the first two sessions, and 3-month follow-up. Repeated measures analysis of variance, and paired-t test were used to examine changes in outcomes over time. Results: The findings provided initial evidence suggesting the foot self-care educational intervention is feasible and acceptable to adult patients with type 2 diabetes. It was effective in improving patients’ foot self-care knowledge (F (2, 54) = 230.444, p < 0.01), self-efficacy (F (2, 54) = 94.668, p < 0.01), and foot self-care behaviors (t (55)=117.228, p < 0.01), in reducing the occurrence of minor foot skin and toenails problems (all p<0.05), and in improving wearing proper shoes and proper socks (all p<0.05 ) at 3-month follow-up. Conclusions: The findings from this pilot study support the effects of the intervention. Future research should evaluate its efficacy using a randomized clinical trial design, and a large sample of patients with diabetes at low risk for foot ulcerations.

Syfte:            Syftet med denna litteraturstudie var att studera hur personer med hjärtsvikt kan få en förbättrad nutrition genom egenvård. Metod:          Studien genomfördes som en litteraturöversikt. Artiklarna söktes via databaserna CINAHL och PubMed. Resultat:       Studiens resultat innehöll 10 artiklar med kvantitativ ansats. En förutsättning för att personer med hjärtsvikt ska klara sin egenvård och ges möjlighet att förbättra sin nutrition är utbildning. Utbildningsmetoder som i föreliggande litteraturstudie har visat sig fungera är att kombinera skriftlig och muntlig utbildning. Undervisningen bör innehålla information om vilken typ av mat personer med hjärtsvikt behöver äta samt varför. En god följsamhet till givna riktlinjer nås genom att ge personer med hjärtsvikt individuellt anpassad information samt att uppföljning sker och information ges kontinuerligt. Slutsats:        Det är mycket viktigt att hälso- och sjukvårdspersonal kombinerar muntlig och skriftlig information vid utbildning inom nutrition riktad till personer med hjärtsvikt för att stärka deras egenvård. Hälso- och sjukvårdspersonal bör se till att kontinuerlig uppföljning sker för att optimera följsamheten.

Thesis (M.S.)--Ball State University, 2008. / Title from PDF t.p. (viewed on Aug. 21, 2009). Research paper (M.S.), 3 hrs. Includes bibliographical references (p. 53-56).

Thesis (Ph. D.)--University of Texas at Austin, 1998. / Vita. Includes bibliographical references (leaves 190-203). Available also in a digital version from Dissertation Abstracts.

Thesis (Ph. D.)--University of Texas at Austin, 1999. / Vita. Includes bibliographical references (leaves 261-292). Available also in a digital version from Dissertation Abstracts.

Depression and anxiety are prevalent in adults with diabetes and are associated with poorer adherence to diabetes self-care. The Common Sense Self-Regulation Model (CS-SRM) hypothesises that both illness cognitions and emotions determine adherence to health behaviours but little is known about the causal pathways through which poor emotional health impairs adherence. Using the CS-SRM as a theoretical framework this thesis aimed to identify the pathways that exist between diabetes cognitions and poor emotional health and explored their combined and independent effects on diabetes self-care. A systematic review with meta-analysis identified that all previous observational studies used cross-sectional designs to explore the relationships between diabetes cognitions and poor emotional health, excluding one. Randomised controlled trials showed that changes in diabetes cognitions were associated with changes in poor emotional health but these mechanisms of action were not confirmed by mediation analyses. Few observational studies have rigorously tested how diabetes cognitions and poor emotional health operate together to determine diabetes self-management behaviours. This thesis used a longitudinal design to test whether: i) diabetes cognitions and poor emotional health have a longitudinal bi-directional relationship and ii) diabetes cognitions and poor emotional health have a combined (mediated) and independent (direct) longitudinal effect on diabetes self-care. Outpatients with Type 2 diabetes (N=261) were recruited at baseline and completed self-report measures of poor emotional health (Well-being Questionnaire), cognitions (Revised Illness Perception Questionnaire; Beliefs about Medicines Questionnaire) and diabetes self-care (Summary of Diabetes Self-Care Activities Scale) at baseline and six months follow-up. Hypothesised pathways were tested simultaneously using structural equation modelling. Participants who were more anxious at baseline perceived diabetes to be unpredictable and were apprehensive about their medications at follow-up. These effects were not observed for depression. Baseline diabetes cognitions did not predict change in poor emotional health at follow-up. Equally, neither baseline depression or anxiety predicted change in diabetes self-care behaviours at six months (directly or indirectly via diabetes cognitions). Baseline personal control beliefs remained independent of poor emotional health: greater personal control beliefs were associated with reduced adherence to diabetes self-care. A bi-directional relationship between diabetes cognitions and poor emotional health was absent in this sample. The main direction of effect was from anxiety only to diabetes cognitions. Depression and anxiety had no relationship with diabetes self-care. Whilst personal control remained independent of poor emotional health, mastery beliefs appear to be insufficient on their own to sustain adherence behaviours over time suggesting that interventions should also provide patients with action plans whilst managing outcome expectations. The unexpected findings for the relationship between poor emotional health, cognitions, and diabetes self-care may be because the sample did not include individuals with more severe depression or anxiety. This study needs to be replicated among people experiencing clinically significant levels of depression and anxiety in diabetes.

There is a gap in the literature concerning workplace emotional distress (WED) in novice counsellors. This study explored the lived experience of this phenomenon, as well as common responses used to mitigate it. Three research questions guided this research: (a) what do novice counsellors identify as triggers and predispositions to experiencing emotional distress, (b) what are the perceived consequences of emotional distress on novice counsellors’ clinical work and their work relationships, and (c) what self-care practices do novice counsellors use as protective strategies against emotional distress? Five themes, each with several subthemes, emerged: (a) experiences and feelings associated with client work, which contained four codes; (b) clinician-specific characteristics contributing to WED, which contained three codes; (c) workplace-specific characteristics contributing to WED, which contained five codes; (d) individual actions taken to combat WED, which contained four codes; and (e) policy and training recommendations, which contained three codes. As counsellor distress may cause harm to clients, findings of this research have implications for (a) enhancing the understanding of professional accountability and concerns for public safety, (b) informing decisions of future policy makers, (c) encouraging valuable help seeking or consultation, and (d) de-stigmatize issues of clinician well-being.

Caregiver burnout is an issue for health care organizations, negatively influencing cost, engagement, and workforce stability. Nurse residency programs are intended to address the gap in practice between academia and clinical practice and provide social support during this transitional time. Self-care education can positively affect novice acute care nurses' transition into their new professional role while building connections with the health care organization during the first year of employment. The purpose of this project was to develop a staff educational module to address the nursing practice problem of evidence-based self-care education within a nurse residency curriculum at the doctoral site. The practice focus question for this project was can evidence-based staff development project be developed identifying self-care strategies for novice acute care nurses within a nurse residency program. Orem's theory of self-care, which highlights the importance of taking time to care for self as integral to human functioning, and Watson's caring theory, which emphasizes the loving care of self as a vital prerequisite for caring for others, were the theoretical frameworks. This module was developed based on existing peer-reviewed journals, national organizations' position statements, white papers, and expert opinion and was synthesized using Melynk's hierarchy of evidence for intervention studies tool. This module was developed and shared with doctoral site stakeholders. The recommendation was to integrate this educational product into the existing nurse residency program. The positive implications this project has for the nursing profession include improved well-being and job satisfaction for the novice acute care nurses and potential long-term effects on organizational cost related to turnover