Postoperativt illamående och kräkning (Postoperative nausea and vomiting, PONV) är en vanligt förekommande komplikation som drabbar 20 -30 % av patienterna, vilket kan leda till starkt obehag, aspirationspneumoni, sårruptur och förlängd vårdtid. Risken att drabbas av PONV orsakas av flertal faktorer såsom bl.a. kön, ålder, fetma, preoperativ oro, långvarig fasta, användning av opioider och operationsställe. Anestesisjuksköterskans icke-farmakologiska åtgärder i samband med detta tillstånd är av stor betydelse för att kunna tillgodose patientens fysiska och psykiska behov, men är inte evidensbaserade i samma utsträckning som vid farmakologisk behandling. Syftet med denna litteraturstudie, med analys av kvalitativ och kvantitativ forskning, är att studera vilka omvårdnadsåtgärder som kan förebygga/ lindra PONV, och vilka omvårdnadsåtgärder som sjuksköterskan utför, samt belysa patienters upplevelser och möjligheter till egenvård vid detta tillstånd. Analysen av artiklarna baseras på Evans (2002) innehållsanalysmodell där resultatet presenteras i kategorier – subkategorier. De mest frekventa omvårdnadsåtgärder som sjuksköterskan utförde var att uppmana patienten till djupandning, placera en sval tvättlapp på pannan samt utföra munvård. Dokumentationen av dessa omvårdnadshandlingar utfördes inte rutinmässigt och ansågs som ”naturliga”. God information har stor betydelse för att minska oro och därmed risken för PONV. Några av de egenvårdhandlingar som patienterna utförde var att avskärma sig från starka ljud, ljus och lukter. Akupressur har även visat god effekt vid förebyggande och lindring av PONV, vilket både sjuksköterskan och patienten själv kan utföra. Denna litteraturstudie ger oss uppfattningen att icke-farmakologiska metoder är effektiva för att öka patientens välbefinnande och bör därmed användas i allt större utsträckning. Vi anser även, att det är av stor betydelse att komplettera de redan använda omvårdnadsåtgärderna med patienternas egenvårdsaktiviteter. / <p>Program: Specialistsjuksköterskeutbildning med inriktning mot anestesisjukvård</p><p>Uppsatsnivå: D</p>

Bakgrund: Hjärtsvikt är en progressiv sjukdom och cirka 2% av den svenska befolkningen har diagnostiserats med hjärtsvikt. Hjärtsvikt innebär antingen att hjärtats tömningsförmåga är nedsatt, systolisk dysfunktion, eller att hjärtats kammare inte fylls på som de ska, diastolisk dysfunktion. Egenvård i form av kost och vätskerestriktion, eventuell viktnedgång och minskat alkoholintag är av stor betydelse för sjukdomens utveckling. Syfte: Syftet med studien var att undersöka personers upplevelser av att leva med hjärtsvikt.  Metod: En deskriptiv litteraturstudie baserad på tio artiklar, varav en artikel med kvantitativ ansats, åtta artiklar med kvalitativ ansats samt en artikel av mixad metod. Huvudresultatet: Det framkom att personer med hjärtsvikt upplevde depression, oro och rädsla över att ha drabbats av en obotlig sjukdom. Att utföra aktiviteter och arbete var mer påfrestande än tidigare innan sjukdomen eftersom de inte längre hade samma fysiska möjlighet. Personerna med hjärtsvikt tog hjälp av egenvård och olika hanteringsstrategier för att förbättra hälsotillståndet och undvika försämring både vad de gällde fysiska och psykiska aspekter. Slutsats: Personerna med hjärtsvikt upplevde försämrad psykisk hälsa och fysisk förmåga, vilket gav upphov till en känsla av isolation och ensamhet. Egenvård ansågs vara viktigt för att undvika försämring av sjukdomen. En ökad förståelse av personers upplevelser av hjärtsvikt bland sjuksköterskor kan förbättra stödet för personer med hjärtsvikt i deras egenvård och kan således ge en förbättrad livskvalité för den specifika patientgruppen / Background: Heart failure is a progressive disease, and in Sweden around 2% of the population have been medically diagnosed with heart failure. The condition weakens the heart, and its capacity to function normally, making it unable to supply the cells with enough oxygen-rich blood. There are different types of heart failure, where the two most common is diastolic heart failure, which hinder the heart’s ability to fill up with blood properly, and systolic heart failure, which refers to the heart's inability to pump after filling with blood. While there is usually no cure for heart failure, many lifestyle changes like regular exercise, maintaining a healthy body weight, and giving up smoking can slow down its progression. Purpose: The purpose of this study was to investigate different people’s perspective of living with CHF. Main Results: The study indicated that people with heart failure experienced depression, anxiety and worry after being diagnosed with an incurable condition. It also showed that daily activities and work became more strenuous for sufferers after developing the condition because they no longer had the same physical capacity. Many diagnosed with heart failure utilized different coping strategies to improve their general health in order to avoid physical or mental deterioration. Method:  A descriptive literature review of ten articles, one article with a quantitative approach, eight with a qualitative approach and one with a mixed method approach.  Conclusion: Those diagnosed with heart failure experienced a decline in both their mental health and physical capacity, which left them feeling isolated and lonely. Self-care was highlighted as an important aspect to avoid the condition getting worse. An improved understanding of patients experiences with heart failure among nurses can lead to improved care and quality of life for the specific patient groupBackground: Heart failure is a progressive disease, and in Sweden around 2% of the population have been medically diagnosed with heart failure. The condition weakens the heart, and its capacity to function normally, making it unable to supply the cells with enough oxygen-rich blood. There are different types of heart failure, where the two most common is diastolic heart failure, which hinder the heart’s ability to fill up with blood properly, and systolic heart failure, which refers to the heart's inability to pump after filling with blood. While there is usually no cure for heart failure, many lifestyle changes like regular exercise, maintaining a healthy body weight, and giving up smoking can slow down its progression. Purpose: The purpose of this study was to investigate different people’s perspective of living with CHF. Main Results: The study indicated that people with heart failure experienced depression, anxiety and worry after being diagnosed with an incurable condition. It also showed that daily activities and work became more strenuous for sufferers after developing the condition because they no longer had the same physical capacity. Many diagnosed with heart failure utilized different coping strategies to improve their general health in order to avoid physical or mental deterioration. Method:  A descriptive literature review of ten articles, one article with a quantitative approach, eight with a qualitative approach and one with a mixed method approach.  Conclusion: Those diagnosed with heart failure experienced a decline in both their mental health and physical capacity, which left them feeling isolated and lonely. Self-care was highlighted as an important aspect to avoid the condition getting worse. An improved understanding of patients experiences with heart failure among nurses can lead to improved care and quality of life for the specific patient group

Diabetes är en vanlig sjukdom i Sverige och ungefär 800 barn och ungdomar får diagnosen varje år. Det är en sjukdom som kräver mycket planering för regelbundna måltider, insulindoser, blodsocker kontroller och motion. Svåra och hastiga komplikationer kan uppstå om sjukdomen inte behandlas korrekt. Bakom varje ungdom finns en familj som också påverkas. Mycket oro kan finnas hos föräldrar som tar ansvar för sina barn med diabetes och när barnet blir ungdom kan det vara svårt för föräldrarna att lämna över ansvaret till ungdomen. Detta är dock nödvändigt för att ungdomen ska kunna bli självständig. Syftet med denna uppsats är att utifrån ungdomars egna erfarenheter belysa vad de anser vara viktigt för att ta ansvar för sin diabetes i vardagen. En litteraturöversikt valdes som inkluderade tio kvalitativa artiklar med utgångspunkt från ungdomars egna erfarenheter och upplevelser av att ta ansvar för sin diabetes. Artiklarna analyserades utifrån Fribergs (2006) metod för analysera studier och resultatet presenteras i fem teman; stöd, kommunikation, kunskap, tillåtas ta ansvar samt stegvis ansvarstagande. Ungdomarna i artiklarna uttryckte att det var viktigt att känna föräldrarnas, sjuksköterskans, vänners och signifikanta andras stöd för att våga ta mer ansvar och bli mer självständiga. Det framkom även att relevant och anpassad information för ökad kunskap var viktigt för ungdomarna. God kommunikation med föräldrar och diabetesteam var viktigt samt att tillåtas ta mer ansvar, steg för steg. I diskussionen beskrivs de mest framträdande teman i resultatet och vi reflekterar över hur sjuksköterskor kan underlätta och bemöta ungdomar med diabetes. / Program: Sjuksköterskeutbildning

Introdução: A Doença Renal Crônica (DRC) está associada à alta morbidade e mortalidade, com aumento progressivo nas populações mundiais. A DRC e o tratamento hemodialítico podem desencadear mudanças no estilo de vida dos pacientes como alterações em seu cotidiano, na capacidade para desempenhar atividades do seu dia a dia e no autocuidado. Objetivos: Caracterizar os pacientes atendidos nos serviços de hemodiálise de uma cidade do interior paulista quanto aos aspectos sociodemográficos, econômicos e clínicos; descrever a independência funcional utilizando o instrumento de Medida de Independência Funcional (MIF); descrever a capacidade de autocuidado utilizando a escala para avaliar as capacidades de autocuidado (ASA-A); verificar a associação da independência funcional e da capacidade do autocuidado com as variáveis sociodemográficas e clínicas e verificar correlação entre a independência funcional e a capacidade de autocuidado. Material e Método: Foi realizado um estudo transversal, populacional e descritivo com abordagem quantitativa nos três serviços de diálise do município de São José do Rio Preto-SP, nos quais foram entrevistados 214 pacientes com 18 anos ou mais de idade, residentes nesse município, em tratamento por hemodiálise e que aceitaram participar do estudo. Os instrumentos utilizados para a coleta de dados foram: Miniexame do Estado Mental (MEEM) para a avaliação do estado cognitivo; instrumento para caracterização dos dados sociodemográficos, econômicos e clínicos; a MIF e a ASA-A. Os dados foram analisados por meio do programa estatístico SAS®9.0, no qual foram gerados as análises descritivas, os testes de associação e a correlação entre as variáveis do estudo. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da Faculdade de Medicina de São José do Rio Preto - FAMERP. Resultados: Dos 214 pacientes, 108 eram adultos e 106 idosos, dos quais 136 eram homens e 78 mulheres. O número médio de comorbidades para cada paciente foi de 2,3, e o número médio de complicações físicas foi de 4,7 por paciente. Foram evidenciados um nível de independência completa ou modificada nessa população (média MIF total 118,38; dp12,4) e um relativo conhecimento dos pacientes referente a sua capacidade de autocuidado (média 94,53; dp12,86). A MIF se correlacionou positivamente com a ASA-A e as duas negativamente com as variáveis idade, complicações relacionadas ao tratamento hemodialítico e comorbidades. Conclusão: Os pacientes em tratamento hemodialítico apresentaram resultados satisfatórios de independência funcional e a capacidade de autocuidado. À medida que aumentam os escores de independência funcional, aumentam também os de capacidade de autocuidado. As variáveis sexo, idade, comorbidades, complicações relacionadas ao tratamento hemodialítico constituíram fatores importantes que prejudicaram a independência funcional e a capacidade de autocuidado dessa população. Os resultados deste estudo permitiram compreender aspectos referentes a essas variáveis que poderão subsidiar intervenções para a melhoria da assistência de enfermagem prestada a essa população. / Introduction: Chronic Kidney Disease (CKD) is associated with high and progressively increasing morbidity and mortality levels around the world. CKD and hemodialysis treatment can trigger changes in patients\' lifestyles, such as changes in their daily lives, in their ability to perform daily activities and in self-care. Aims: To characterize the patients attended at hemodialysis services in an interior city in São Paulo State, Brazil regarding sociodemographic, economic and clinical aspects; to describe their functional independence using the Functional Independence Measure (FIM) scale; to describe their self-care ability using the Appraisal of Self-Care Agency Scale (ASA-A); to check the association between functional independence and self-care ability and sociodemographic and clinical variables and to check for the correlation between functional independence and self-care ability. Material and Method: A cross-sectional and descriptive population study with a quantitative approach was developed at the three dialysis services in the city of São José do Rio Preto- SP, where 214 patients were interviewed, aged 18 years or older, living in this city, under hemodialysis treatment and who accepted to participate in the study. The instruments used for data collection were: Mini-Mental State Examination (MMSE) for cognitive state assessment; instrument to characterize sociodemographic, economic and clinical data; FIM and ASA-A. Data were analyzed in SAS®9.0, used to generate descriptive analyses, association tests and correlations among the study variables. Approval for the project was obtained from the Research Ethics Committee at São José do Rio Preto Medical School - FAMERP. Results: Out of 214 patients, 108 were adults and 106 elderly, with 136 men and 78 women. The average number of comorbidities for each patient was 2.3, and the mean number of physical complications was 4.7 per patients. Complete or modified independence levels were evidenced in this population (mean total FIM 118.38; sd12.4) and patients\' relative knowledge about their self-care skills (mean 94.53; sd12.86). The FIM was positively correlated with the ASA-A and both instruments were negatively correlated with age, hemodialysis treatment-related complications and comorbidities. Conclusion: Patients under hemodialysis treatment presented satisfactory functional independence and self-care ability results. Gender, age, comorbidities, hemodialysis treatment-related complications represented important factors that impaired this population\'s functional independence and self-care ability. These study results permitted understanding aspects related to these variables that can support interventions to improve nursing care delivery to this population.

This thesis concerns the use of repertory grids to examine personal and professional development (PPD) during professional training programmes. Paper one consists of a systematic review of 11 repertory grid studies of people undergoing training in human services professions. The findings suggest that professional socialisation occurred in line with the aims of training programmes but was an idiosyncratic, non-linear process which continued post-qualification. Trainees' thinking style became more abstract, less polarised and more cognitively complex. Implications for people training in human services professions and training providers are discussed and suggestions for improved future research are provided. Paper two reports a repertory grid study examining 26 third-year trainee clinical psychologists' construal of their PPD. The findings suggest that trainees' personal and professional selves were construed to be similar to each other. Trainees reported feeling anxious, stressed, unsettled and lacking an appropriate work-life balance. These difficulties were attributed to the demands of training and were expected to resolve once training was completed. Suggestions for future research with improved methodology are made and the implications of the findings for trainees, training providers and employers of newly qualified clinical psychologists are given. Paper three provides a critical reflection of the thesis; discussing the strengths and limitations of each of the papers and concluding with the author's personal reflections on the process of the research and her own PPD.

Background: Sexual abuse is a highly distressing traumatic experience that negatively affects the lives of sexual abuse survivors. The number of individuals who reported sexual abuse has increased, which makes it a public and global concern. As a result, survivors of sexual abuse turn to counselling to cope with the traumatic impacts. Counsellors, psychotherapists, and psychologists engage in deep and meaningful explorations of the sexual abuse in order to support survivors. However, very little is known about the impacts and coping strategies involved in this type of work. Objectives: The objective of this study, therefore, was to explore the experiences of UK-based counselling professionals who counsel survivors of sexual abuse. The research questions were as follows: 1. What is the impact of counselling survivors of sexual abuse? and 2. What self-care strategies and coping techniques have been beneficial when counselling survivors of sexual abuse? Method: An inductive qualitative design was used for the purposes of this study. Semi-structured interviews were conducted with twelve UK-based counselling professionals who provided counselling to individuals who had experienced sexual abuse. The collected data were then analysed using thematic analysis. Findings: The themes developed from the first research question revealed a number of ways in which counselling survivors of sexual abuse affected counselling professionals. Three main themes emerged from the data analysis: work-related impacts, impacts on personal wellbeing and relationship impacts. These themes encompassed a total of fourteen sub-themes. Another two main themes were developed when exploring participants' self-care techniques and coping strategies: holistic self-care and work environment selfcare. Both of these main themes incorporated twelve more sub-themes. These are introduced and outlined in depth in turn. Conclusions: This research has provided a unique insight into the impacts and coping strategies of UK-based counselling professionals working with survivors of sexual abuse. The findings suggest that the counsellors experienced a number of negative impacts, some of which were perceived as traumatic in nature. Further, the impacts were not limited to the counsellors themselves; partners, children, extended family, and friends were also affected by the work. Such far-reaching impacts of sexual trauma have not been sufficiently explored previously. Contrary to the negative tendencies expressed in the research literature, some of the findings indicate positive aspects, such as high job satisfaction and evolved personal growth. The findings of this study provide a rare insight into the useful self-care techniques and copings strategies specific for counselling survivors of sexual abuse. Although the strategies are similar to those used in other areas of counselling, they emphasize organisational and educational responsibilities to support counsellors' wellbeing. Suggestions are proposed for research, educational, organisational, and ethical developments.

由於慢性疾病的流行程度有著全球性上升的趨勢，它經已成為一個公共衛生的問題，為醫療系統帶來沉重的負擔。慢性疾病的發病率以老年人為最高，慢性疾病對老年人的生理、心理、社交及經濟等，構成尤其嚴重的後果。由於香港的人口持續老化，所以預計患有慢性疾病的人口數目在將來幾十年會不斷增加。但是，現時對患有慢性疾病的老年人所提供的照顧不足，再加上本地老年人擁有的多種特徵，例如社會經濟地位較低，健康讀寫能力較弱，及同時患有多重疾病，都有可能對醫護人員提供的護理造成障礙。提升慢性病患者掌管健康的能力，例如提供自我管理的支援，增強他們的信心，及協助他們作出有關健康的判斷及決策，有機會能解決慢性疾病所引起的問題。雖然過往的研究已經發現自我管理教育課程能夠改善慢性病患者的生理、心理及社交健康，及提升患者的健康行為，可是這類課程對老年人的成效，依然缺乏足夠科研證據的支持。 / 作者在這論文中進行了兩項研究，去探討自我管理教育課程對患有慢性疾病的長者的健康行為、生理、心理、社交、生活質素及醫療服務的使用的影響。甲項研究是一個半實驗性研究，探討¬「慢性疾病自我管理課程」對患有不同種類慢性疾病的長者的效果。乙項研究是一個隨機控制實驗，研究「糖尿病自我管理課程」對患有非胰島素依賴的長者的效果。 / 甲項研究招募了患有一種或以上慢性疾病，及居住在社區的長者進行研究。三百零二名治療組的參加者接受了一個為期六星期的「慢性疾病自我管理課程」，當中包括六課以小組模式進行的課堂，每堂為兩小時三十分。課程由專業人員或非專業的長者義工組長帶領。二百九十八名對照組的參加者則繼續接受六個月慣常的護理。每位參加者都會在基線及六個月後接受測試，測試包括自我管理行為、自我效能感、健康狀況及醫療服務的使用。 / 利用單向共變數分析法，結果顯示治療組的所有的自我管理行為和自我效能感測試都有顯著改善 (p < .05)。在十項健康狀況測試中，有五項有明顯改善 (p < .05)。另外，醫療服務的使用則沒有明顯改變。 / 乙項研究是利用隨機方法，分別把九十位及八十七位患有非胰島素依賴的長者分配到治療組及對照組。治療組的參加者參與了為期八堂，每星期一堂，每堂兩小時的「糖尿病自我管理課程」。對照組參加者則在八星期內繼續接受慣常的護理。所有參加者都會在基線及八星期後接受測試，測試包括身高體重指數、腰臀比例、血糖及血壓水平、糖尿病相關的認識、糖尿病指定及總稱的生活質素、及營養攝取。 / 利用單向共變數分析法，結果顯示治療組的糖尿病相關的認識 (p < .0005)，糖尿病指定生活質素的滿意分類 (p = .045)，及總稱生活質素的精神健康分類 (p = .003)皆有明顯的改善。治療組的總能量 (p = .018)及飽和脂肪攝取 (p = .03)都有明顯減少。在各生理及人體測量指標及其他生活質素測試，則沒有明顯改變。 / 此研究增加對疾病指定及非疾病指定的自我管理教育課程於社區上患有慢性疾病的長者的成效的認識。研究結果發現針對長者而設計的課程有機會改善長者的行為、心理及社交狀況，長者亦可以通過課程學習自我管理技巧及改變健康行為，從而改善健康。由長者義工組長帶領的課程有可能跟由專業人員帶領的課程的效果相近。研究結果象徵著自我管理課程需要融入醫療系統的慣常服務當中，以達致最大的成效。本論文亦為如何於各個護理層面及本地環境推行自我管理課程作出詳細討論。對於將來的研究發展，本論文建議加長跟進測試的時間及利用更大的實驗樣本探討自我管理課程於長者身上的成效，疾病指定及非疾病指定課程的效果亦需要作出比較，個別自我管理課程的特徵對課程成效的影響亦需要詳盡地探討。 / The global epidemic of chronic disease has become a public health issue and created a huge burden on health care systems and societies. Older population is highly susceptible to chronic disease. The high prevalence of chronic disease among older adults results in a series of physical, psychosocial and financial consequences in this patient group. In Hong Kong, as the population continues to age, the number of people having chronic disease is expected to increase rapidly in next few decades. The care for older adults with chronic disease is yet suboptimal. Local older people are predisposed to a number of characteristics, such as low socioeconomic status, poor health literacy and multiple morbidities, which may hinder professionals to provide effective care. Empowering patients through supporting self-management, increasing confidence and assisting decision-making of people with chronic disease has been found to be a solution to the problem. Although literature has suggested that self-management education programmes may improve physical and psychosocial outcomes, and promote health-related behaviours among people with chronic disease, the evidence of the effects of such programmes in older adults is still lacking. / Two studies have been conducted to examine the effects of self-management education programmes in improving health behaviours, physical and psychological status, quality of life and health care utilization in older people with chronic disease. Study One is a quasi-experimental trial exploring the effects of the Chronic Disease Self-Management Programme (CDSMP) in older adults with a wide range of chronic diseases. Study Two is a randomized controlled trial evaluating the effects of the Diabetes Mellitus Self-Management Programme (DMSMP) in older adults with non-insulin-dependent diabetes mellitus. / In Study One, community-dwelling older people with one or more chronic disease were recruited. The intervention group (n = 302) received the 6-week CDSMP, which consisted of 6 group sessions with each session lasting for 2.5 hours. The programme was facilitated either by professional and older lay leaders. The control group (n = 298) continued their usual care for 6 months. Self-management behaviours, self-efficacy, health status, and health care utilization of participants were assessed at baseline and 6 months. / The one-way analysis of covariance showed that the intervention group has significant improvements in all self-management behaviours and self-efficacy outcomes, and 5 out of 10 health status measures (all p < .05). No significant change was detected in the use of health care services. / In Study Two, older people with non-insulin-dependent diabetes mellitus were randomly assigned to either the intervention (n = 90) or control (n = 87) group. The intervention group attended the DMSMP comprising 8 weekly 2-hour sessions. The control group received usual care for 8 weeks. Body mass index, waist-to-hip ratio, blood glucose and blood pressure levels, diabetes-related knowledge, disease-specific and generic quality of life, and nutritional intakes were measured at baseline and 8 weeks. / Using the one-way analysis of covariance, the intervention group found significant improvements in diabetes-related knowledge (p < .0005), the satisfaction subscale score in the diabetes-specific quality of life measure (p = .045), and the mental health score in the generic quality of life measure (p = .003). Significant reductions of total energy (p = .018) and saturated fat intakes (p = .03) were also demonstrated in the intervention group. No significant change was detected in the physiological outcomes, anthropometric indices and other quality of life and nutritional measures. / The present studies enrich the knowledge of the effects of disease-specific and generic self-management education programmes for older adults with chronic disease living in the community. It demonstrated that the programmes specifically tailored for older adults may improve a wide range of behavioural and psychosocial outcomes. Older adults may be able to learn new skills for self-management and change behaviours to improve their health. The effects of using older lay persons to lead such programmes may be similar with those using professional staff. The findings imply that self-management programmes need to be integrated into the routine service of health care systems and community care in order to have maximal effects. The implementation of self-management support at different levels of care and under the local context was discussed. Further studies should be conducted to explore the effects of self-management programmes on older people using prolonged follow-ups and larger sample size. The comparative effects of disease-specific and generic self-management programme should be evaluated. The individual influences of various essential features of self-management interventions need to be determined explicitly. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Chan, Lap Sun. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 265-302). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese; some appendixes also in Chinese. / Chapter CHAPTER ONE --- INTRODUCTION / The epidemiology of chronic disease --- p.1 / Causes of the epidemiology of chronic disease --- p.3 / Risk factors of chronic disease --- p.4 / Self-management approach in managing chronic disease --- p.5 / The research problem --- p.8 / Chapter CHAPTER TWO --- LITERATURE REVIEW / Challenges in managing chronic disease --- p.10 / Specific concerns for older people --- p.12 / Chronic disease management --- p.16 / Introduction --- p.16 / Patient-centred care --- p.18 / Frameworks for improving care of chronic disease --- p.20 / Chronic Care Model --- p.20 / Innovative Care for Chronic Conditions --- p.22 / Service delivery model of chronic disease management --- p.24 / Global strategies in chronic disease management --- p.26 / Empirical evidence of the Chronic Care Model --- p.29 / Self-management --- p.34 / Definitions --- p.34 / Conceptualizing self-management --- p.37 / Patient-professional relationship --- p.37 / The goal of self-management --- p.40 / Self-management tasks and skills --- p.41 / Perspectives and barriers of self-management in older adults with chronic disease --- p.44 / Self-management education and support --- p.50 / Introduction --- p.50 / Comparison with traditional patient education --- p.51 / Characteristics of self-management education --- p.53 / Theoretical basis in self-management education --- p.53 / Self-efficacy theory --- p.56 / Teaching problem-solving skills and making action plans --- p.58 / Individualizing self-management education --- p.59 / Continuity of self-management support --- p.60 / Framework of delivering self-management support services --- p.62 / Global implementation of self-management education --- p.65 / Empirical evidence of the effects of self-management interventions --- p.70 / Effects of self-management interventions in general --- p.71 / Effects of self-management interventions for older adults with chronic disease --- p.77 / Effects of self-management interventions for patients with chronic disease in Hong Kong --- p.85 / Methodological issues in self-management studies --- p.88 / Establishing self-management interventions for older adults --- p.90 / Establishing self-management interventions under the local context --- p.93 / Summary of Literature Review --- p.94 / Chapter CHAPTER THREE --- METHODS (STUDY ONE) / Introduction --- p.97 / Methodology --- p.98 / Research objectives --- p.98 / Null hypotheses --- p.99 / Study design --- p.100 / Participants --- p.101 / Recruitment and procedure --- p.101 / Intervention --- p.103 / Adaptations of programme delivery for local older participants --- p.106 / Sample size calculation --- p.107 / Outcome measures --- p.108 / The questionnaire --- p.108 / The Abbreviated Mental Test, Hong Kong version (AMT) --- p.109 / Frailty Index (FI) --- p.109 / Statistical analysis --- p.112 / Primary analysis --- p.112 / Secondary analysis --- p.112 / Focus group --- p.114 / Chapter CHAPTER FOUR --- RESULTS (STUDY ONE) / Participants --- p.116 / Baseline --- p.118 / Comparing baseline and 6 months outcomes of intervention group --- p.123 / Comparing baseline and 6 months outcomes of control group --- p.125 / Comparing outcomes between intervention and control groups at 6 months --- p.127 / Subgroup analysis --- p.130 / Comparison among age subgroups --- p.132 / Comparison among education level subgroups --- p.133 / Comparison among frailty level subgroups --- p.133 / Comparing professional staff-led and older lay-led programmes at 6 months --- p.140 / Focus group --- p.142 / Chapter CHAPTER FIVE --- DISCUSSION (STUDY ONE) / Introduction --- p.145 / Demographics characteristics --- p.145 / Baseline outcomes --- p.147 / Effects of the CDSMP on older adults with chronic disease --- p.148 / Self-management behaviours and self-efficacy --- p.148 / Health status --- p.148 / Health care utilization --- p.149 / Comparing with existing literature --- p.150 / Effects of age, education level and frailty level on the outcomes --- p.154 / Age --- p.154 / Education level --- p.154 / Frailty level --- p.155 / Effects of leaders on the outcomes --- p.156 / Qualitative findings --- p.157 / Feasibility of training older people to be lay leaders --- p.160 / Summary of the discussion --- p.162 / Chapter CHAPTER SIX --- METHODS (STUDY TWO) / Introduction --- p.164 / Methodology --- p.166 / Research objectives --- p.166 / Null hypothesis --- p.166 / Study design --- p.167 / Pilot study --- p.168 / Participants --- p.169 / Recruitment and procedure --- p.170 / Intervention --- p.172 / Educational talks --- p.174 / Exercise practice --- p.174 / Goal setting and problem-solving --- p.177 / Issues of designing self-management programme for local older adults --- p.177 / Sample size calculation --- p.178 / Outcome measures --- p.179 / Diabetes Knowledge scale (DKN) --- p.179 / 24-hour food recall --- p.180 / Anthropometric measurements --- p.181 / Clinical health indicators --- p.182 / Quality of life --- p.183 / Statistical analysis --- p.185 / Primary analysis --- p.185 / Secondary analysis --- p.186 / Focus group --- p.186 / Chapter CHAPTER SEVEN --- RESULTS (STUDY TWO) / Participants --- p.188 / Baseline --- p.190 / Comparing baseline and 8 weeks outcomes of intervention group --- p.193 / Comparing baseline and 8 weeks outcomes of control group --- p.195 / Comparing outcomes between intervention and control group at 8 weeks --- p.197 / Nutritional intakes --- p.200 / Comparing baseline, 8 weeks and 6 months outcomes of intervention group --- p.203 / Focus group --- p.206 / Chapter CHAPTER EIGHT --- DISCUSSION (STUDY TWO) / Introduction --- p.208 / Demographics characteristics --- p.209 / Baseline outcomes --- p.210 / Effects of the DMSMP on older adults with type 2 DM --- p.213 / Knowledge and nutritional intakes --- p.213 / Anthropometric measures and clinical health indicators --- p.214 / Quality of life --- p.217 / Long-term effects of the DMSMP on intervention group participants --- p.219 / Comparing with existing literature --- p.220 / Comparing with a local study --- p.226 / Qualitative findings --- p.227 / Summary of the discussion --- p.231 / Chapter CHAPTER NINE --- CONCLUSION / Overall effects of self-management interventions for older adults with chronic disease --- p.232 / Strengths of the study --- p.238 / Using a more stringent study design --- p.238 / Incorporated essential features of self-management interventions into current programmes --- p.239 / Demonstrated a collaborative model between health and social sectors --- p.240 / Limitations of the study --- p.241 / The integrity of study sample --- p.241 / Issues in the representativeness of study sample --- p.241 / High attrition rate in the longitudinal follow-up (The DMSMP) --- p.243 / Unknown uptake rate --- p.244 / The study design --- p.244 / Non-randomized allocation of participants (The CDSMP) --- p.244 / The lack of control for attention effect --- p.246 / The implementation of study intervention --- p.247 / Using multiple components --- p.247 / The absence of blinding (The DMSMP) --- p.248 / The evaluation and statistical analysis --- p.248 / Short duration of follow-up --- p.248 / Limitations of post-hoc analyses --- p.249 / Diffusion of self-management interventions for older adults --- p.250 / Considerations to the adoption of current self-management interventions --- p.251 / Relative advantage --- p.251 / Compatibility --- p.251 / Complexity --- p.252 / Trialability --- p.252 / Observability --- p.253 / Experience of implementing self-management interventions in the UK and the US --- p.254 / Considerations to the implementation of current self-management interventions --- p.256 / Strategies applied in promoting the adoption and implementation of current self-management interventions --- p.257 / Recommendations for local implementation of self-management interventions --- p.259 / Recommendations for future research --- p.261 / Conclusion --- p.264

Effective symptom management is essential to decrease symptom severity and improve health-related quality of life for persons living with HIV (PLWH). A mobile health (mHealth) application (app) has the potential to be an effective delivery mode of an existing paper-based symptom management manual with self-management strategies for underserved PLWH. The quality of the mHealth app requires a thorough understanding of the needs of the intended end-users and ensuring the app’s usability. The purpose of this study was to translate paper-based health information into an mHealth app for symptom self-management in underserved PLWH, entitled mVIP (mobile Video Information Provider), and assess its usability. To achieve this goal, usability was evaluated rigorously throughout the development process of mVIP. Based on a stratified view of health information technology (IT) usability evaluation framework, usability evaluation was sequentially conducted with the following three levels: 1) user-task, 2) user-task-system, and 3) user-task-system-environment. At level 1 (user-task), we applied a user-centered design method to guide the information architecture of mVIP. Using a reverse in-person card sorting technique, symptoms and self-management strategies from a paper-based HIV/AIDS symptom management manual were ranked. The rank order of the 13 symptoms and 151 self-management strategies determined the order of appearance to end-users of the mVIP app, with higher-ranked symptoms and strategies appearing first. Based on the findings, we developed a prototype of mVIP as following: 1) once users log in, they are guided by an avatar through a series of 13 symptom questions ascertaining the nature and severity of their symptoms, and 2) the avatar recommends three self-management strategies for each symptom reported. At level 2 (user-task-system), we conducted a usability evaluation of the mVIP prototype in a laboratory setting through end-user usability testing and heuristic evaluation. In end-user usability testing, we used an eye-tracking and retrospective think-aloud method to examine task performance by 20 PLWH. For the heuristic evaluation, five usability experts in informatics assessed the user interface. In the two usability evaluations conducted in a laboratory setting, we found strong user acceptance of the mVIP prototype while identifying a number of usability issues with this prototype. Based on the recommendations from the end-users and heuristic evaluators, we iteratively refined the app’s content, functionality, and interface. We then inserted videos of the finalized symptom self-management strategies into the refined mVIP prototype. At level 3 (user-task-system-environment), the usability of the refined mVIP prototype was evaluated in a real-world setting. Through 10 in-depth interviews and four focus groups conducted at the conclusion of a three-month randomized controlled trial, we explored in-depth understandings of users’ experiences, perceptions, and satisfaction of mVIP use. Findings from the study showed that first, mVIP is useful for HIV-related symptom self-management and has the potential for being used as a communication tool with healthcare providers; and second, mVIP is easy to use to monitor symptom experience over time. At the same time, participants suggested mVIP be more sensitively tailored based on years from initial diagnosis of HIV, an individuals’ age, and conditions. The overall user satisfaction with the mVIP prototype was high, which reflects strong user acceptance of mVIP. Integral to the findings from the three-level usability evaluation, we assessed the quality of the mVIP prototype in use and found the prototype was highly accepted by PLWH with high user satisfaction. This study will add to the body of literature on translation of evidence-based health information into an mHealth app and its usability assessment, which highlights the importance of the use of mobile technology for PLWH, specifically racial and ethnic minorities and those from low-socioeconomic groups who have limited health literacy and low level of education.

Este trabalho enfoca a promoção da vida através de comportamentos saudáveis, tendo como objetivos: delinear o perfil sociodemográfico e institucional/profissional dos docentes de enfermagem e analisar seus hábitos de vida, segundo os modos adaptativos de Roy. Foi utilizada a Teoria de Sister Callista Roy, destacando-se os modos de adaptação: fisiológico, autoconceito e interdependência. Implementou-se o método descritivo, quantitativo, transversal através da técnica de autorelato em amostra de 101 docentes. Para investigar esses aspectos, utilizou-se dois questionários, um deles com a escala de Likert, adaptado para a pesquisa. A produção de dados transcorreu de janeiro a março de 2009, após aprovação do Comitê de Ética em Pesquisa, Protocolo 2187, e concordância das quatro instituições públicas de ensino universitário, do Estado do Rio de Janeiro-Brasil, selecionadas. Os dados obtidos foram submetidos á estatística, aplicando-se medidas de tendência central. Quanto ao perfil docente: predomina a faixa etária de 40 a 59 anos, com 69,3%, de união estável. Relacionando cor e crença religiosa, constatou-se 37,6% de católicos brancos. Dos 50 docentes, 5% têm residência própria, na zona norte. Possuem renda individual acima de 8 salários mínimos, 67,32%, a maioria com vínculo trabalhista. No tempo de serviço, 22,94% situam-se entre 11 a 15 anos, com carga horária de 20 a 40 horas. Quanto à titulação, 42,56% são doutores e 80,2% possuem um tipo de regime estatutário. Concernente aos Modos Adaptativos de Roy foi atribuído, predominantemente, o conceito A- hábitos de vida saudável, aos modos Fisiológicos e de Autoconceito, seguindo-se o de Interdependência, que apresentou quatro conceitos B- em busca de hábitos de vida saudável, sendo o mais homogêneo dos três modos. Identificou-se que o Modo Fisiológico foi heterogêneo, pois os valores das medidas de tendência central se distanciam entre si. Concluindo-se que o pressuposto formulado atendeu parcialmente às expectativas dos docentes por utilizarem, em benefício próprio, seus saberes sobre o cuidar promovendo o bem-estar com qualidade. Considerou-se que a interdependência pode ser conquistada pelos sujeitos, visto que o enfrentamento das suas atividades profissionais, paralelamente ao viver pessoal, pode ser motivo de satisfação com o trabalho docente, remuneração recebida, ambiente institucional, relações de poder/saber no trabalho, além da possibilidade de atender sua necessidade gregária promovendo o convívio com a família e amigos. Lembra-se que lidar com pessoas cujas subjetividades devem ser objetivadas, visando sua compreensão para o atendimento de saúde, exige equilíbrio e progresso das dimensões corporais física, mental e espiritual do profissional. / This work focuses the life promotion through healthy behaviors, having as objectives: delineate the nursing teachings socio-demographic and institutional/professional profile and analyze theirs life habits, according to Roy. It was utilized the Sister Callista Roys Theory, detaching the modes of adaptation: physiological, self concept and interdependence. It implemented the descriptive, quantitative, transversal method through the self relate technique in sample of 101 teachers. To investigate these aspects, it was utilized two questionnaires, one of them with the Likert scale, adapted to the research. The data production transcurred from January to March of 2009, after approval of the Comitê de Ética em Pesquisa (Committee of Ethics in Research), Protocol 2187, and concordance of the four public institutions of university teaching of the Rio de Janeiro state Brazil, selected. The data obtained were submitted to the statistics, applying central trend measures. As for the teaching s profile: it predominates the age group of 40 to 59 years, with 69.3% of stable union. In relating religious color and belief, it evidenced 37.6% of the white catholic persons. Of the 50 teachers, 5% have own residence, in the north zone. They have individual income above 8 minimal wages, 67.32%, the most of persons with labor link. In the service time, 22.94% situate between 11 to 15 years, with workload of 20 to 60 hours. As for the degree, 42.56% are doctors and 80.2% have a type of statutory regime. Concerning the Roy s Adaptable Modes it was attributed, predominantly, the A concept- healthy life habits, to the Physiological and of Self concept, following the one of Interdependence, that presented four B concepts- in search of healthy life habits, being the most homogeneous of the three modes. It identified that the Physiological Mode was heterogeneous, once the central trend measures values keep away from them. Concluding that the purposes formulated attended partially the teachers expectancies for utilizing, in own benefit, their knowledge about the care promoting the well-being with quality. It considered that the interdependence can be won by the subjects, respecting the facing of theirs Professional activities, parallelly to the personal live, can be satisfaction motive with the teaching work, remuneration received, institutional environment, power/knowledge relations in the work, besides the possibility of attending their gregarious need promoting the conviviality with the family and friends. It remembers that the dealing with persons, whose subjectivities must be objectified, aiming at their comprehension for the health attendance, requires equilibrium and progress of the professional s physical, mental and spiritual dimensions.

Bakgrund: Typ 2 diabetes är en växande folksjukdom och är förenad med följdsjukdomar. Ökningen beror främst på ohälsosamma levnadsvanor. Behandlingen av typ 2 diabetes innebär att förändra livsstilen, vilket medför stora utmaningar för den enskilda personen. En bristande följsamhet till behandlings råd bidrar oftast till komplikationer och följdsjukdomar, vilket leder till ökade samhällskostnader och stora utmaningar för hälso- och sjukvården. Syfte: Syftet med denna litteraturöversikt är att beskriva patientens följsamhet till behandlingsråd hos personer med typ 2 diabetes. Metod: En litteraturöversikt baserad på 15 vetenskapliga artiklar där både kvalitativa och kvantitativa artiklar granskats. Artiklarna samlades in via databaserna Cinahl och Pubmed. Resultat: Viktiga beståndsdelar som framkom i resultatet och påverkade följsamheten av behandlings råd hos personer med typ 2-diabetes var information, kunskapsbrist, utbildning, självmedvetande, socialt stöd och personcentrering. Alla ovanstående faktorer var viktiga för att uppnå livsstilsförändring. Slutsats: Sjuksköterskan måste ha en förståelse för vilka behandlingsråd som påverkar följsamheten vid typ 2 diabetes. Sjuksköterskan måste få en bild av patientens tidigare erfarenheter, kunskap och personliga egenskaper för att sedan anpassa information och utbildning till patienten. Dessa faktorer ökar självmedvetenheten och motivation tillsammans med stöd av anhöriga vilket leder till god följsamhet till behandlingsråd vid typ 2 diabetes. / Background: Type 2 diabetes is a increasing and is associated with complications. The increase is mainly due to unhealthy living habits. The treatment of type 2 diabetes primarily involve changing of lifestyle, which poses great challenges for the individual. A lack of compliance to change lifestyle advice may contribute to complications which leads to increased cost and major challenges for healthcare. Aim: The purpose of this literature review is to describe factors that affect the adherence to treatment advice among persons with type 2 diabetes. Method: A Literature review based on 15 scientific publications with qualitative and quantitative design. Articles were collected from the databases Cinahl and Pubmed. Results: Factors that emerged that affected the adherence to treatment advice in people with type 2 diabetes were information, lack of knowledge, education, self-awareness, social support and person centred approach. All the above factors were important to achieve lifestyle changes. Conclusion: Nurses must have an understanding of the factors that affect the compliance to lifestyle advice of Type 2 diabetes. Nurses need to be aware of the patients previous experience, knowledge and personal characteristics. To make the information and education feasible to the patient these factors increase self-awareness and motivation together with support from relatives resulting in good adherence to lifestyle advice to patients with type 2 diabetes.