Background: Chronic Kidney Disease is a global health problem. In the United Kingdom, there is impetus for self-management of long term conditions. In 2002, the National Institute for Health and Clinical Excellence’ technology appraisal guideline on haemodialysis suggested that 10%-15% of the centre’s dialysis population should undertake home haemodialysis. The clinical community is yet to rise to this challenge. In this study, we seek to explore patient-related clinical and psychosocial predictors and provider beliefs and attitudes which determine the choice of self-care dialysis, particularly, home haemodialysis. Design and methods: The design is a combined cross-sectional and longitudinal study employing an integrated mixed methodology (convergent, parallel design). Study participants include patients and multidisciplinary staff. The three patient cohorts (n = 535) include pre-dialysis (222), hospital (213) and self-care haemodialysis patients (100) from geographically distinct NHS sites, and with variable prevalence of home haemodialysis (low <3%; medium 5-8%; high >8%). The pre-dialysis patients were followed up for a period of 12 months from study entry. Quantitative data ascertained include biomarkers, clinical, psychosocial quantitative and neuropsychometric-cognitive tests in the study cohorts. Organizational attitudes and dialysis unit practices were gathered from a survey of the participating units. Semi-structured interviews were carried out for patients and care-providers. The datasets were analysed independently and the findings mixed at the stage of interpretation. Statistical tests appropriate to the specific questions were considered for the quantitative data and qualitative data was analysed using thematic analysis. Results: Home haemodialysis has a high composite (training+home) technique survival rate of 90.2%, 87.4% & 81.5% at 1, 2 and 5-years respectively in a death and transplantation censored analysis. The key predictors of self-care dialysis, especially home haemodialysis, are self-perceived higher cognitive ability (metaconcentration), lower comorbidity score, home ownership, and white ethnicity background. There are 20% lower odds of choosing self-care dialysis over fully-assisted dialysis for every unit reduction in metaconcentration score and this is significantly associated with trails making test B, an objective test of executive brain function. Perceived inability to self-cannulate was a significant predictor of the choice of peritoneal dialysis over home haemodialysis amongst CKD-5, predialysis patients. However, approximately 1 in 3 patients from the predialysis and hospital haemodialysis groups feel able to consider self-cannulation. The centre to which the patient belonged had an impact on the choice of dialysis modality, with greater proportion opting for home haemodialysis in a centre with greater home haemodialysis prevalence. Amongst predialysis patients who made a modality choice, the experience of their interaction with healthcare teams and dialysis counselling, self-efficacy, personal fulfilment through work and social engagements, and their views of the modality’s impact on their significant others, influenced the choice of home or hospital-based haemodialysis. 45% of all respondents in a survey of healthcare practitioners felt that staff knowledge and bias influenced the offer of home haemodialysis therapy. At a policy level, the tariff for home haemodialysis was not a clear incentive for its adoption due to uncertainty about operational costs. Conclusions: There exists a perception of lack of uniformity in practice pertaining to offer of home haemodialysis across the study centres. The impact of financial incentives designed at a policy level is influenced by the understanding of cost and benefits at the local operational level. Most barriers are surmountable and patients should be able to consider self-care therapies option in all but the most limiting physical and cognitive states. There is a need locally, for units to investigate barriers to home haemodialysis therapy using a conceptual framework in order to facilitate change.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / O cuidado integral com Diabetes Mellitus e suas complicaÃÃes à um desafio para a equipe de saÃde. à imprescindÃvel a identificaÃÃo de comportamentos inadequados para poder revertÃ-los e conhecer as variÃveis que possam interferir na mudanÃa de comportamento para o autocuidado. O presente estudo teve como objetivo geral: avaliar as competÃncias de idosos diabÃticos para a prÃtica de aÃÃes de autocuidado; e como objetivos especÃficos: caracterizar a populaÃÃo idosa segundo variÃveis socioeconÃmicas e clÃnicas; analisar o conhecimento dos idosos diabÃticos assistidos na atenÃÃo primÃria sobre o tratamento e o diabetes mellitus; verificar a relaÃÃo entre as caracterÃsticas sociodemogrÃficas e individuais relacionadas ao diabetes e a competÃncia dos indivÃduos para o autocuidado. Estudo descritivo de corte transversal do tipo correlacional. A populaÃÃo do estudo foi composta por idosos acompanhados nas unidades bÃsicas de saÃde sorteadas inseridas nas seis Secretarias Executivas Regionais de Fortaleza-CE. A coleta de dados foi realizada no perÃodo de marÃo a julho de 2009 nos domicÃlios dos idosos, atravÃs da utilizaÃÃo de um formulÃrio e a Escala para IdentificaÃÃo de CompetÃncias para o Autocuidado em Diabetes (ECDAC), elaborada por NUNES (1982). Os dados foram agrupados e analisados estatisticamente, atravÃs do programa Statistical Package for the Social Sciences-SPSS versÃo 14.0. A pesquisa foi aprovada pelo Comità de Ãtica em Pesquisa da Universidade Federal do CearÃ, com protocolo n 17/09. Os resultados mostraram que a maioria dos participantes constituiu-se de mulheres (76%), com idade mÃnima de 60 anos e mÃxima de 85 anos. A amostra apresentou grau de escolaridade bastante heterogÃneo: 37% eram analfabetos O tempo de diagnÃstico variou de 4 a 46 anos, com mÃdia de 10 anos de diagnÃstico da doenÃa (DP= 6,9 anos). Na Subescala I, que avalia a Capacidade FÃsica dos idosos, obtiveram pontuaÃÃo mÃnima de 11 pontos e pontuaÃÃo mÃxima de 24 pontos, mÃdia de 23,21 e desvio padrÃo de 5,72. Na Subescala III, que avalia a Capacidade Mental, os idosos obtiveram pontuaÃÃo mÃnima de 11 pontos, pontuaÃÃo mÃxima de 39 pontos, mÃdia de 23,21 e desvio padrÃo de 5,72. Somente 38% dos idosos obtiveram pontuaÃÃo entre 25-44 pontos, considerada pontuaÃÃo satisfatÃria para competÃncia para o autocuidado em diabetes. Jà na pontuaÃÃo total da ECDAC, somente 6% dos idosos atingiram pontuaÃÃo entre 78 -108 pontos, sendo que apenas estes se classificaram como competentes para o autocuidado em diabetes. Conforme os resultados apresentados, observa-se que um nÃmero reduzido de idosos, apenas 6%, foi considerado competente para o autocuidado em diabetes, fato que enfatiza a importÃncia do desenvolvimento de aÃÃes de promoÃÃo da saÃde direcionados para esta parcela da populaÃÃo que possui limitaÃÃes fÃsicas, mentais ou motivacionais para o autocuidado em diabetes, tendo como premissas a avaliaÃÃo de competÃncias para o autocuidado em diabetes.

nÃo hà / O transplante cardÃaco à uma modalidade terapÃutica de alta complexidade e exige do enfermeiro uma assistÃncia especÃfica, com qualidade, tendo como foco o autocuidado, uma vez que possibilita o envolvimento do paciente de maneira participativa no tratamento. Teve-se como objetivo geral avaliar o autocuidado de pacientes que realizaram transplante cardÃaco, baseado no Modelo do Autocuidado de Orem. E como especÃficos: identificar os fatores condicionantes que interferem na prÃtica do autocuidado de paciente transplantado cardÃaco apÃs a alta hospitalar; verificar os dÃficits de autocuidado de pacientes adultos que realizaram transplante cardÃaco; e correlacionar os fatores condicionantes com o Perfil de Engajamento do Autocuidado. Trata-se de um estudo descritivo-analÃtico, com delineamento transversal e natureza quantitativa, desenvolvido na Unidade de Transplante e InsuficiÃncia CardÃaca de um hospital pÃblico terciÃrio da cidade de Fortaleza-CearÃ-Brasil. A amostra foi composta por 63 pacientes transplantados cardÃacos, que atenderam aos critÃrios de inclusÃo. A coleta de dados foi realizada mediante uma entrevista individualizada, no perÃodo de outubro a dezembro de 2011. O projeto foi aprovado pelo Comità de Ãtica e Pesquisa, sob protocolo do CEP/HM: 109/11. Como resultados dos fatores condicionantes, obteve-se: sexo masculino (88,9%); a idade variou de 23 a 72 anos, predominando de 40 a 59 anos (68,3%); cor da pele nÃo-branca (74,6%), catÃlico (81,0%); casado (77,8%); procedentes do interior do estado (49,2%); nÃvel de escolaridade-ensino fundamental (71,4%); aposentado ou nÃo trabalha (82,5%); renda de atà um salÃrio mÃnimo (47,6%); miocardiopatia chagÃsica (28,6%); tempo pÃs-transplante entre um e trÃs anos (39,7%). Em relaÃÃo ao autocuidado do requisito universal, tÃm-se como dÃficit os seguintes dados: oxigenaÃÃo/respiraÃÃo (26,9%); higiene pessoal (31,7%); higiene do ambiente domiciliar (47,6%); ingestÃo de lÃquidos (39,6%); ingestÃo de alimentos (68,8%); eliminaÃÃes (20,6%); prÃtica de exercÃcio fÃsico (87,3%); sono e repouso (79,3%); interaÃÃo social (90,4%); comportamento emocional (58,7%); prevenÃÃo de doenÃa/promoÃÃo da saÃde (77,7%); tabagismo (1,58%); etilismo (3,17%); prÃtica sexual (61,9%); prevenÃÃo do cÃncer (60,3%). Quanto ao autocuidado do requisito desenvolvimental, apresentou os seguintes dÃficits: participaÃÃo das atividades educativas (39,6%); adaptaÃÃo Ãs mudanÃas apÃs transplante cardÃaco (34,9%). E ao requisito desvio de saÃde, tÃm-se os seguintes dÃficits: comparecimento Ãs consultas da equipe de saÃde (41,2%); imunizaÃÃo bÃsica (100%); uso de mÃscara descartÃvel (46%); contato com pessoas e animais domÃsticos (38%); e conhecimento (20,6%). O Perfil de Engajamento do Autocuidado variou de 88 a 113, constatando-se que a maioria dos pacientes apresentou algum dÃficit de autocuidado, pois 57,1% estavam na classe que âfrequentemente realizava autocuidadoâ. No entanto, embora nenhum paciente realizasse 100% das prÃticas de autocuidado recomendadas para o transplantado cardÃaco, 42,9% sempre realizavam o autocuidado. Conclui-se que os pacientes transplantados cardÃacos apresentam dÃficit de autocuidado para manutenÃÃo e promoÃÃo da saÃde. Portanto, à necessÃrio que os profissionais da equipe de transplante cardÃaco estejam atentos para os fatores condicionantes do autocuidado dos pacientes transplantados cardÃacos, visando estabelecer estratÃgias para reduÃÃo do dÃficit de autocuidado.

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.

Thesis (D.N.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / This study investigated of the capacity of self-efficiency (SE) and the Health Belief Model (HBM) to predict diabetes self care. Research questions derived from Bandura's Social Cognitive Theory asked the associations between SE, HBM, and their interaction on reported self care (SC). / 2031-01-01