M.A. / In social work, the focus is on the care for others, but the issue of self-care is neglected. There is no internship requirements for students to learn about selfcare and the consequences that a lack of self-care behaviours will have on them personally and professionally. This research study had the dual purpose of teaching social work honours students Autogenic Training (AT) as a practical method of self-care and to measure and evaluate the personal and professional value of AT for them. Autogenic training is a deep relaxation technique with an autonomic and cognitive focus, and formed the basis of the self-care programme that was presented in 10 weekly sessions. An availability sample was used, and a combined quantitativequalitative approach adopted, by using a pre-test post-test group design. A validated self-report instrument was used to measure the impact on somatic, behavioural and cognitive anxiety symptoms, while a phenomenological enquiry was used to evaluate the personal meanings and experiences of the students as a result of engaging with this programme. The high drop-out rate reflected poorly on the overall results of the self-report instrument, however, the programme proved to be a successful psychosocial intervention, as it impacted positively on the students’ physical and emotional awareness, the awareness of the impact of their past and current traumatic stresses on their physical, mental and emotional functioning, and an awareness of self-care needs. They also learned and mastered an effective stress management skill, and participation in the group was valued by the students for the emotional support it provided to help them cope with their current stresses more effectively. An experiential self-care programme could be a beneficial component of the curriculum. Future research should involve such studies as part of the curriculum to allow sufficiently sized samples and prevent the high drop-out rate.

Introduction: COPD is a progressive disease, characterised by symptoms of dyspnoea, fatigue, exercise intolerance and reduced physical activity, resulting in impaired quality of life. Furthermore, the disease poses a significant burden on healthcare systems around the world. SPACE FOR COPD is a new self-management programme which aims to support individuals in acquiring the knowledge and skills required to optimise their emotional and medical well-being. Methods: This thesis describes a randomised controlled trial which aims to establish the effectiveness of a SPACE FOR COPD compared with usual care alone. 184 people with COPD were recruited from primary care. Individuals were randomly allocated to receive either the SPACE FOR COPD intervention or to continue with their usual care. The primary outcome was a measure of health-related quality of life (HRQoL), the Chronic Respiratory Questionnaire – Self Report (CRQ-SR) dyspnoea domain. Secondary measures included exercise performance, anxiety, depression, knowledge, self-efficacy and physical activity. Outcome measures were recorded at baseline, six weeks and six months. Results: There was no significant between-group difference in the change in dyspnoea at six months, therefore our hypothesis was rejected. In secondary outcomes, there were significant gains in HRQoL, exercise, performance, anxiety, knowledge and steps at six weeks, and at six months changes in exercise performance and anxiety remained statistically significant. Correction for multiple comparisons, however, had not been made. Conclusions: SPACE FOR COPD did not result in improved dyspnoea, over and above usual care at six months. The programme may confer significant benefits in HRQoL, exercise performance, anxiety, knowledge and physical activity over and above usual care in the short-term, and gains in anxiety and exercise performance maintained at six months. Although these patients were relatively early within the course of their disease, physical activity was low, highlighting the need for a lifestyle intervention in this group of patients. Exploration of the potential benefit of additional on-going support, and delivery within group settings may of value in order to support the maintenance of these benefits in the medium- and longer-term.

Self-care is an essential component of secondary prevention of coronary artery disease (CAD) for rural women who have undergone invasive coronary interventions (ICI). The purpose of this study was to describe self-care behavior experiences of rural women with CAD post-invasive coronary interventions defined as percutaneous coronary intervention (PCI -- balloon angioplasty with or without stent placement), and coronary artery bypass graft (CABG). Three specific aims were addressed: Specific Aim 1. To identify and describe self-care behaviors initiated by these women after the intervention. Specific Aim 2. To identify and describe barriers to and facilitators of self-care behavior change. Specific Aim 3. To compare and contrast self-care behaviors in subgroups of rural women based on type of procedure and age. Orem's self-care deficit nursing theory (SCDNT), rural health theory, and the social determinants of health framework were synthesized to guide this study. A qualitative descriptive design was used to elicit descriptions of self-care behavior experiences, barriers to and facilitators of 10 rural Arizona women with CAD post-ICI who lived in Cochise and Pinal counties. Purposeful sampling was used. Rural women were recruited at the cardiology clinics by the primary investigator, who distributed recruitment flyers among them. Data were collected using semi-structured, voice-recorded interviews, which lasted an average of 25 minutes. Atlas.ti Mac Version 1.5.2 (462) software was used for data analysis. Specific Aim 1: Self-care for this study was defined as the ability of rural women to independently and purposefully initiate and adopt the following behaviors to promote and maintain cardiovascular health: cease smoking; adhere to heart healthy diet; incorporate physical activity in their daily routines; monitor their blood pressure and blood glucose levels regularly; adhere to medical regimens; and follow up with their doctors as required or access health care in a timely manner if symptoms recur. Although participants in this study talked about these self-care behaviors, adhering to a heart healthy diet and physical activity were their main self-care behaviors. Participants did not mentioning performing self-care behaviors for their heart health, but for their overall health and happiness. They ate healthy, low-fat, low-salt diets. They walked and performed housework as their most common physical activities. Specific Aim 2: Barriers for participants in this study were residential environment, health and physical ailments, family conditions, and personal characteristics. Facilitators were relationships, available resources, and personal outcomes. Specific Aim 3: Participants who had PCI rested for few days before resuming their physical activities, whereas those who had CABG were restricted for a period of six weeks to three months. Most participants were above the age of 70 years and reported they returned home after their procedures and did what they have done to move on with their lives. The only participant who was below 60 years reported a life changing experience when she returned home after her procedure.

Class of 2017 Abstract / Objectives: To compare the impacts of regularly scheduled education and health clinic sessions on individual’s health outcomes and self-care. Subjects: Tucson community members who are participants of Project Taking Charge and have attended more than three clinic sessions during the six-month study period. Methods: A retrospective review of a central database was used to collect baseline characteristics, blood glucose, A1c, blood cholesterol, blood pressure, BMI and weight. These clinical values were then used to assess participant clinical health outcomes. The questionnaire surveys distributed at the last clinic session were collected and used to analyze the improvement in participant understanding of self-care. Results: For weight, a 1.5% decrease from 186.1 (±50.7) to 183.3 (±50.4) pounds (p=0.012) was observed to be statistically significant. In response to the importance and the frequency of different self-care questions, participants had an improved perspective on the importance of exercise by 0.9 scale (p=0.008), a better understanding of having a balanced nutritious meals by 1.34 (p=0.0002), proper hand-washing technique by 0.54 (p=0.027), and eating at home more often by 0.31 (p=0.039) compared to baseline. Conclusions: Participant responses reflect positive changed perceptions of exercise and healthy lifestyle choices. Although post-clinical values for BMI, fasting blood glucose, A1c, systolic blood pressure, and blood cholesterol levels, did not meet p<0.05 statistical significance, the trend towards improved cholesterol levels, blood sugar levels and blood pressure levels indicate there may be some benefits attributed from participation in the clinic project.

Background: A marked increase of type 2 diabetes and associated morbidity and mortality rate over the last 10 years has been recorded in Malaysia. Ineffective diabetes management and a lack of self-care practice among type 2 diabetic patients have been identified as the major reasons for this problem. Research in other countries has highlighted a range of factors influencing effective self-care of type 2 diabetes including patients' perspectives of diabetes, sociocultural issues, religious beliefs and support from healthcare. Nevertheless, there is paucity of research conducted in Malaysia. Therefore, the exploration of self-care practice and self-care support provision in patients with type 2 diabetes in Malaysia is needed to understand the problem. Aims: To understand the self-care practice of patients with type 2 diabetes in Malaysia and the factors that influence the patients' self-care practice. To understand the type 2 diabetes’ self-care support provision in Malaysia from the perspective of patients, healthcare professionals, and healthcare system. Methods: A qualitative, single embedded case study design was utilised. Eighteen patients with type 2 diabetes and 19 healthcare professionals (physicians, diabetes educators, nurse, pharmacist and dietician), involved in self-care support provision primary- and secondary-care settings in Kuala Lumpur and Putrajaya, Malaysia, participated in in-depth semi-structured interviews between November 2012 and June 2013. In addition, data were collected through participant-observation of clinic consultations, and analysis of relevant documents used in the provision of diabetes management in the respective clinics. The framework technique supported analysis of data. Data were stored and managed using Nvivo 9 software. Findings: The findings indicate that patients with type 2 diabetes had a good understanding of diabetes and self-care, but a lack of self-care support meant that effective self-care was difficult to sustain. Healthcare professionals’ (HCPs’) provision of self-care support was restricted due to several factors, including lack of opportunity to provide self-care support, unsuitable clinic environment and a fragmented management within primary and secondary care. Additionally, barriers in patient–HCP communication, a combination of the personal, interpersonal and inter-professional HCP factors, and a traditional medical model adopted by Malaysian healthcare system, seem to have influenced the practice and quality of the service delivered. Conclusion: It is clear that the increased incidence of uncontrolled type 2 diabetes is not merely due to poor self-care practice by patients, but also due to constraints in service delivery and underdevelopment of self-care support provision. The evidence generated can assist in the development of strategies to improve the quality of care and facilitate changes in the self-care support provision in Malaysia.

Role expectations and stressful work environments place nurses at high risk for burnout. Nurses at an urban hospital were experiencing unhealthy work environments and not engaging in self-care to promote health and wellbeing. The purpose of this project was to evaluate the effectiveness of an existing quality improvement (QI) initiative developed to encourage nurses to engage in self-care. Pender'€™s health promotion model supported the premise that despite barriers, nurses will engage in self-care. A survey elicited responses from 1,248 participating registered nurses on the extent of their engagement with self-care and perceived effect on their health, health knowledge, stress level, and resilience. A chi-square test of independence was used to determine the relationship between participation in unit activities and the participants'€™ health, health knowledge, stress level, and resilience. Thirty-one percent (n = 387) participated and 69% (n = 861) did not participate. No relationship existed between overall participation and the nurses'€™ health, health knowledge, stress level, and resilience. A positive relationship existed between the number of activities and the nurses'€™ health, health knowledge, and stress level. No relationship existed between the number of activities and resilience. Reasons for participation were to improve or maintain health. Barriers included activities not available on all shifts and heavy workload. Recommendations include offering lunch-and-learn educational health programs, offering educational programs to foster resiliency, and offering activities on different shifts. Nurses who engage in self-care have the potential to serve as role models for positive social change for patients, families, and colleagues.

Self-care is a central concept in heart failure management and nursing practice. Yet, the uptake of heart failure self-care has been uncritical and detached from broader contexts. Therefore, heart failure self-care was explored using Rodger’s evolutionary concept analysis approach to identify antecedents, attributes, and consequences with attention to context, time, application, and meaning. The analysis suggests that heart failure self-care tends to focus on individual behaviours to the detriment of social and structural determinants of health. It also shifts responsibility away from the healthcare system and onto the individual. Moving forward, a more robust conceptualization of heart failure self-care is needed or possibly, the development of a new concept that focuses beyond the self. / Graduate / 2022-12-15

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Heart failure (HF) affects many older Canadians with recurrent hospitalizations despite post-discharge strategies to prevent readmission. Self-care is key to the management of HF in the home setting and can potentially lead to better clinical outcomes. Proper HF self-care includes tasks such as daily weight and symptom monitoring, as well as adjusting diuretics based on weight. Patients find HF self-care challenging, with less than 50% of patients regularly weighing themselves. Mobile applications to support self-care have been shown to be effective, however, due to their lack of consideration for barriers such as literacy, numeracy and cognitive impairment within their design, these applications are not usable for many older patients. Previous work supports the use of a paper-based standardized diuretic decision support tool (SDDST) to promote self-care in older individuals with HF. The objective of this study was to use participant (HF patients, informal care-providers) input to convert the paper-based SDDST into a user-centered electronic mobile application. We recruited 12 patients (male and female, age > 60 years) with a confirmed diagnosis of HF, and 7 informal caregivers from the Heart Function Clinic at the Hamilton Health Sciences General site. HF patients were categorized into three groups, 1) adequate self-care patients (6), 2) inadequate self-care patients without a CP (2) or 3) inadequate self-care patients with a CP (4), based on their self-care abilities measured with the Self-Care Heart Failure Index (SCHFI) where a score of > 70 is considered self-care adequate. We conducted semi-structured interviews with HF patients and CPs using Persona-Scenarios. Interviews were analyzed using NVivo, version 10, for emerging themes regarding self-care. Following data analysis, we identified 6 major themes, 1) Usability of technology, 2) Communication, 3) Application customization, 4) Complexity of Self-Care, 5) Usefulness of HF Related Information and 6) Long-Term Use and Cost. Many of the challenges patients and CPs mentioned involved their unfamiliarity with technology. However, by addressing these themes, we were able to develop a series of requirements and modifications to improve the usability of our app design. / Thesis / Master of Science (MSc) / Heart failure (HF) is one of the leading causes of hospitalization and re-hospitalization in older adults. . If patients are able to take care of themselves (self-care) at home they will be less likely to be readmitted to the hospital. However, many patients find self-care difficult, so they do not manage their symptoms. To assist patients in understanding or following their treatment, various mobile health applications have been developed. Unfortunately, older patients do not commonly use these applications because of their complicated design. In this study, we interviewed patients and their informal caregivers to help design our HF self-care app. We gathered information on features they may perceive to be helpful. Our goal was to use their feedback to make the app simpler and more user-oriented, which will make self-care easier.