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 (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

Previous research has shown that excessive levels of stress can have a significant, negative effect on one’s overall cognitive efficiency and that stress levels are negatively correlated with various self-care practices. The present research was designed to build upon this body of knowledge by gathering data from an undergraduate sample (N = 200) with 44 males and 156 females (MAge = 21.22). Participants’ stress levels and self-care practices were measured at weeks 3, 6, 9, 12, and 15 of a standard semester using the Depression Anxiety Stress Scale and the Mindful Self-Care Scale. We hypothesized that increased stress would result in decreased self-care practices and that predisposed levels of self-care at time 1 could be used to predict stress levels at times 3 and 5. A cross-lagged panel analysis supported this hypothesis, indicating simultaneously that self-care was significantly correlated with stress and that the two factors were significantly predictive of one another at later time points.

Approximately half a million people in Canada suffer from heart failure (HF), a leading cause of hospital admission. HF outcomes can be improved by self-care behaviors, to which patients often show low adherence. This study focuses on the co-design of an online self-care application and community intervention, called HFApp, which patients with HF and their informal caregivers could use to potentially improve HF outcomes. The intended users for HFApp are older adults with HF and their informal caregivers. The primary objective of this study is to identify themes for the development of HFApp. The secondary objective is to apply these findings to identify user needs and preferences for HFApp. Persona-scenario discussion sessions were conducted with 4 older patients with HF (≥ 60 years) and 4 informal caregivers from the Hamilton Health Sciences Heart Function Clinic. One persona-scenario discussion session was held for each participant type (i.e. patients with HF or informal caregivers). Participants were divided into pairs and participant pairs created personas and scenarios together. Scenarios included: (1) how they learn about HFApp, (2) how they might access HFApp, (3) where they are when they use HFApp, (4) who might help them with HFApp, and (5) how often they use HFApp. All discussions were audio recorded. Data analysis, using NVivo 10 , provided six categories of design themes which were used to develop a list of user requirements for HFApp. Some of these requirements help users perceive HFApp to be more useful and give a sense of self-care confidence. However, some requirements may be excluded due to low feasibility. It is recommended that a larger persona-scenario group session be conducted in the future to support the requirements gathered in this study as well as identify any new requirements. / Thesis / Master of Science (MSc) / Approximately half a million Canadians suffer from heart failure (HF), a leading cause of hospitalization. This study focuses on the involvement of potential users in the design of HFApp, an online HF self-care application (“app”). These users include older patients with HF and their family and close friends. One of HFApp’s objectives is to potentially decrease hospital visits for older patients with HF. A design based on patient preferences called persona-scenarios was used to conduct this study. Participants were asked to create pretend individuals that were similar to themselves and describe scenarios in which these individuals would interact with HFApp. These could include: (1) how they learn about HFApp, (2) how they might access HFApp, (3) where they are when using HFApp, (4) who might help them with HFApp, and (5) how often they use HFApp. These interactions will be used to identify user requirements and preferences for HFApp’s design.

Thesis (Ph. D.)--University of Missouri--Columbia, 2001. / Typescript. Vita. Includes bibliographical references (leaves 111-120). Also available on the Internet.

This thesis describes a three year study which explored perceptions and experiences of being involved in self care and perceptions of control and self-efficacy over time amongst patients receiving a six month course of chemotherapy treatment for colorectal cancer. The study was underpinned by Leventhal’s Self Regulation Model and aimed to explore how patients undergoing chemotherapy for colorectal cancer perceived the meaning of self care, what they did as part of their self care in managing the effects of their treatment and whether this changed between the beginning and end of their six month course of chemotherapy. The study also set out to explore the relationship between patients’ perceptions of control and self efficacy and their involvement in self care. The study adopted a patient focussed, mixed method, longitudinal approach for complementarity and expansion purposes in which the qualitative findings formed the focus of the investigation, supplemented by the quantitative findings. This was important to provide a greater breadth and range to the study and to obtain a realistic understanding of patients’ perceptions and experiences of being involved in self care during their six month course of chemotherapy treatment and the influence of their perceptions of control and self efficacy on their involvement in self care. Thirty one patients participated in the study and data were collected using qualitative semi structured interviews (with a subsample of patients who participated in the study) and quantitative questionnaires (Illness Perception Questionnaire-revised and the Strategies Used by People to Promote Health) and prospective self care diaries with the full study sample. Data were collected at several time points over the course of patients’ chemotherapy treatment (beginning, middle and end of treatment) and were analysed and integrated in accordance with Tashakkori and Teddlie (1998)’s guidance for integrating qualitative and quantitative findings in a mixed methods study. The study findings revealed that the use of a mixed method, longitudinal study design was a valuable approach for understanding patients’ involvement in self care during chemotherapy for colorectal cancer and the influence of factors, such as their perceptions of control, on their subsequent involvement in their self care. In particular, the principal findings suggested that self care held a range of meanings to the patients in this study. Principally, patients’ self care consisted of two components; physical self care, carried out to manage the physical impact of undergoing treatment, and emotional self care, carried out to manage their emotional response to being diagnosed with, and undergoing treatment for, cancer. The findings suggested that there was no association between patients’ perceptions of control and the degree of self care that they carried out identified in the quantitative analysis. However, in the qualitative analysis, it was revealed that patients’ perceptions of control were likely to influence their attitudes towards their active involvement in self care and the importance with which they viewed this role. In particular, patients who considered themselves to have a high degree of control during their treatment were more likely to believe that they could limit the impact of the treatment through their own actions, that being actively involved in their self care was important and were interested in taking on this role, and that they would use a greater range of self care strategies in helping to manage the impact of their treatment. Conversely patients who considered themselves to have a lower degree of control during their treatment were less likely to believe that they could limit the impact of the treatment through their own actions, that their active involvement in self care was important and were less likely to expect to take on an active role, preferring to leave the management of treatment-related effects to health professionals, whom they regarded as being the “experts”. The findings from this study have implications for nursing practice because they reinforce the importance of the listening to the patient’s experience and how this approach can contribute to a fuller and more accurate understanding of how patients become involved in their self care and the factors that influence this. This is important so that nurses can provide holistic care, tailored to meet their patients’ self care needs and preferences, and to encourage partnership working between patients, nurses, allied health professionals and other agencies in promoting involvement in self care. The findings also have implications for theories relating to self care in emphasising the importance of patient centred models of care and for Leventhal’s Self Regulation Model in adding further support for the components of the model yet also offering a greater understanding of how the model fits with patients’ emotional responses to the effects of illness and its’ treatments. Finally, the study findings have implications for future research, calling for further research to focus on the meaning of constructs such as self care and control from the patients’ perspective and to further explore the use of the mixed methodology in researching and understanding patients’ involvement in self care and the factors that influence this.