Within the social work profession, there is a lack of understanding about self-care practices of social workers working with older adults. This lack of knowledge is a concern for the profession because as the older adult population continues to grow, so will the need for social workers to address their needs. Using action research, a focus group of 7 female social workers working with older adults in the Pacific Northwest discussed the research questions related to their use of self-care practices and identifying strategies to increase the use of self-care. Self-compassion theory enhanced understanding the relationship between social workers' experiences with older adult clients and self-care. Coding protocols were used to analyze the data. Key findings provided a further understanding of the self-care practices of these social workers including the use of appropriate boundaries, effective communication, education about responsibilities and expectations, and advocacy regarding the need for self-care. Additional strategies to increase self-care involved mindfulness about job roles, primarily related to team and system barriers. Recommendations from this project included adding self-care to education and training in social work courses required for degrees, licensure renewal, and employment-based continuing education courses. By exploring self-care practices of social workers working with older adults, the findings of this study may bring about social change by increasing the awareness of current and future social workers about the importance of self-care and providing strategies that enable social workers to implement self-care.

Background: Heart failure (HF) is a leading cause of hospitalization, readmissions, and death in the United States. Patients hospitalized for HF are at risk for readmission, in- hospital mortality, and early post-discharge death. In the United States, inpatient care has been estimated to cost $83,980 over the lifetime of each patient with HF. The majority of patients with HF depend on caregiver support for successful HF self-care, which is essential for optimal patient outcomes. Support from caregivers is thought to be important for better self-care, and lower readmission and mortality rates. Yet, there are few studies considering the influence of caregivers on HF patient self-care, readmission, and mortality. Objective: The purpose of my dissertation was to determine the influence of HF caregivers on patient self-care, readmission, and mortality. The specific aims of this dissertation were to: (1) to determine if caregiver depressive symptoms mediate the relationship between family functioning and caregiver quality of life, (2) to determine if there is an association between living arrangements (living with someone vs. living alone) and all-cause readmission and death in patients with HF, and (3) to determine the efficacy of an in-hospital, multi-session, educational intervention for caregivers on heart failure patients’ self-care and 30 day readmission rate, and to evaluate the efficacy of the intervention on caregivers’ knowledge, self-efficacy and perceived control. Methods: Specific aim one was addressed by a secondary analysis of data from one- hundred and forty-three HF caregivers recruited from an outpatient clinic. Multiple regression with mediation analysis was used to determine whether depressive symptoms mediated the relationship between family functioning as measured using the three scales of the Family Assessment Device (i.e., general, problem-solving, communication) and caregiver quality of life. Specific aim two was addressed by a retrospective chart review of all 398 patients with a primary diagnosis of HF admitted to an academic medical center in one year. We collected data on patient sociodemographic, clinical characteristics, and patient living condition. The independent association of living alone with all-cause readmission or all-cause death was evaluated using Cox proportional hazards modeling adjusting for covariates. Specific aim three was addressed using a two-group (educational intervention for caregivers of patients with heart failure vs. usual educational care), prospective, repeated measures randomized controlled trial of 37 patient and caregiver dyads in which caregivers only received in-hospital HF education. Outcome measures included patient self-care, and patient all-cause readmission or all- cause death, as well as caregiver self-efficacy, knowledge, and perceived control. Patient self-care, and caregiver self-efficacy, knowledge, and perceived control were assessed at baseline (in hospital), at discharge, 7 and 30-days after patient discharge. Patient readmissions and death were assessed by a phone call at 30-days follow-up. The intervention directed only at caregivers consisted of three in-hospital, educational sessions with telephone follow-up. The educational sessions were designed to deliver HF information and skills to caregivers, thereby providing them with the resources needed to improve their self-efficacy, perceived control and HF knowledge thus improving patient self-care and readmission rates. Results: Specific aim one: The three subscales of the Family Assessment Device predicted depressive symptoms (p < 0.001) and caregiver quality of life (p < 0.001). Depressive symptoms also predicting caregiver quality of life (p < 0.001). The inclusion of depressive symptoms in the final model with each subscale of the Family Assessment Device (i.e., general family functioning, problem-solving, communication) decreased the significance of family functioning as a predictor of caregiver quality of life indicating mediation by depressive symptoms. Specific aim two: Heart failure patients living with someone experienced a significantly longer time to rehospitalization than those living alone (290 vs. 201 days, p=0.005). In a Cox regression hazard regression model, adjusting for covariates, patients who lived alone were 1.42 times more likely to be rehospitalized one year after discharge than those who lived with someone (p=0.013). The relationship between living alone and all-cause death was not significant after adjustment for covariates. Specific aim three: A linear mixed-model analysis revealed that patients whose caregiver was in the intervention group had significantly better self- care maintenance (p < 0.001) and self-care management (p < 0.001) across time. Cox survival analysis demonstrated that patients whose caregiver did not receive the educational intervention were 11 times more likely (p=0.002) to experience cardiac readmission than patients whose caregiver did receive the educational intervention. Caregivers who received the educational intervention had higher perceived control (p < 0.001) for up to 30-days post-intervention versus the control group, however, there were no differences between caregiver groups in self-efficacy and HF knowledge. Conclusion: In this dissertation, we found caregivers to play an important part in improving patient outcomes of self-care and readmission after discharge from a hospitalization for HF. Future large-scale studies are needed to develop and test interventions focused on caregivers to improve both patient and caregiver outcomes. Such studies will assist clinicians in understanding how better to support caregivers in their ability to positively influence HF self-care and readmission rates in patients with HF.

The purpose of this study was to examine trends in MSW graduate student's self-reported levels of healthy habits, family support and relationships during education, self-care, personal standards, as well as time management, and what the implications of those things are related to student burnout. The hypothesis was that students are burned out before they enter the social work field professionally. This poses a problem because the social work field has an already high level of burnout, turnover, and compassion fatigue. This study examines the trends in both the online pathways program and the on-the- ground ground program.

Self-care is necessary for psychotherapists to prevent burnout and to provide ethical services for clients. Counselling students often recognize the need for self-care, but neglect to implement it, preventing them from building the necessary practices to endure hardships related to practicing psychotherapy. Previous research, such as Butler and colleague’s work (2017), has examined the importance of self-care in counselling education, but has not examined how it is applied in practice. Therefore, this project’s research questions included: 1) How do novice therapists engage in professional self-care? 2) How do novice therapists bridge the gap between conceptual knowledge and practice of professional self-care? 3) What are the barriers to self-care? Thematic Analysis (TA) was used to distil meaning from common experiences of participants. Four psychotherapists with an average of 1.5 years of experience were interviewed using an in-depth semi-structured interview protocol. Eighteen subthemes were generated from the data, further categorized under four themes: (1) obstacles to self-care; (2) work-life balance; (3) pathways to self-care; and (4) effects of self-care. Implications of this research include structured self-reflection in counsellor training programs, integration of flexibility and self-care provisions in workplace cultures, and a strong policy emphasis on the need for counsellor self-care and improving professional guidelines to allow for counsellor self-care practices.

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.