Aim
To assess what is known about the effectiveness of face‐to‐face self‐management programmes designed specifically for adolescents (10–19 years) with a chronic illness.
Design
A systematic review ...and synthesis without meta‐analysis (SWiM).
Data sources
Six international web‐based reference libraries were searched with a date range of 1946 to July 2020.
Review method
The PRISMA statement and SWiM guideline were used for reporting the methods and results. The PICO format was used to develop a focused clinical question and the eligibility criteria of our review. Quality assessment of the included studies was performed using the Cochrane Effective Practice Organisation of Care criteria.
Results
Eight studies (four randomized controlled trials and four descriptive designs) met the inclusion criteria and were published between 2003 and 2017. Results of the review: Three studies demonstrated measures of illness control which showed initial improvements in adherence as a result of the interventions but failed to demonstrate sustained adherence over time. Booster sessions were identified as an effective strategy to improve adherence, but were often omitted.
Conclusions
There is a limited body of evidence on the effectiveness of self‐management programmes specifically developed for adolescents with a chronic illness, an important but under researched area. Future research lies in the development of more rigorous studies that focus on quantitative outcome measures for evaluating the effectiveness of self‐management programmes to guide the development of future programmes.
Impact
It is crucial for adolescents with a chronic illness to develop independence and the self‐management skills required to effectively manage their chronic condition as they transition to adulthood. On current evidence, in planning future self‐management interventions should include booster sessions. Nurses with additional training and experience have a key role in supporting adolescents with a chronic illness to develop self‐management skills as they assume responsibility for their own healthcare.
IntroductionHealthcare providers usually manage medication for patients during hospitalisation, although patients are expected to self-manage their medication after discharge. A lack of ...self-management competencies is found to be associated with low adherence levels and medication errors harming patients’ health. Currently, patients seldom receive support or education in medication self-management. When self-management is allowed during hospitalisation, it is rarely provided using a structured, evidence-based format. Therefore, an in-hospital medication self-management intervention (ie, SelfMED) was developed based on current evidence. To date, empirical data demonstrating the effect of SelfMED on medication adherence are lacking. This study primarily aims to evaluate the effect of the SelfMED intervention on medication adherence 2 months postdischarge in polypharmacy patients, as compared with usual care.Methods and analysisA multicentre pre–post intervention study will be conducted. The study will start with a control phase investigating usual care (ie, medication management entirely provided by healthcare providers), followed by an intervention period, investigating the effects of the SelfMED intervention. SelfMED consists of multiple components: (1) a stepped assessment evaluating patients’ eligibility for in-hospital medication self-management, (2) a monitoring system allowing healthcare providers to follow up medication management and detect problems and (3) a supportive tool providing healthcare providers with a resource to act on observed problems with medication self-management. Polymedicated patients recruited during the control and intervention periods will be monitored for 2 months postdischarge. A total of 225 participants with polypharmacy should be included in each group. Medication adherence 2 months postdischarge, measured by pill counts, will be the primary outcome. Secondary outcomes include self-management, medication knowledge, patient and staff satisfaction, perceived workload and healthcare service utilisation.Ethics and disseminationThe ethics committee of the Antwerp University Hospital approved the study (reference no: B3002023000176). Study findings will be disseminated through peer-reviewed publications, conference presentations and summaries in layman’s terms.Trial registration number ISRCTN15132085.
Only 17% of adolescents with type 1 diabetes (T1D) are currently meeting their glycemic targets despite advances in diabetes technologies. Self-management behaviors and challenges specific to use of ...diabetes technologies are insufficiently studied in adolescents. We aimed to describe the experience of diabetes technology self-management, including facilitators and barriers, among preteens/adolescents with low and high A1C.
Youth (10-18 years of age) with T1D who use insulin pump therapy were recruited from the larger quantitative cohort of a mixed methods study for participation in semi-structured qualitative interviews. Maximum variability sampling was used to recruit youth with A1C <7.5% (n = 5) and A1C >9% (n = 5). Participants' personal insulin pump and continuous glucose monitoring data were downloaded and served as a visual reference. Interviews were analyzed using a qualitative descriptive approach.
Participants were 50% female with a median age of 14.9 years and 80% used CGM. The sample was predominantly white (90.0%). Analysis produced four major themes, Bad Day, Expect the Unexpected, Nighttime Dependence, and Unpredictability, It's Really a Team and interconnecting subthemes. Youth characterized ''Bad Days'' as those requiring increased diabetes focus and self-management effort. The unpredictability (''Expect the Unexpected'') of glucose outcomes despite attention to self-management behaviors was considerable frustration.
Diabetes devices such as insulin pumps are complex machines that rely heavily on individual proficiency, surveillance, and self-management behaviors to achieve clinical benefit. Our findings highlight the dynamic nature of self-management and the multitude of factors that feed youths' self-management behaviors.
To identify the self-care capacity of cancer clients treated at the chemotherapy service of a university hospital in Minas Gerais/Brazil. This is a cross-sectional study conducted with 79 adult and ...elderly participants diagnosed with primary cancer on antineoplastic chemotherapy treatment. Two instruments were used to achieve the proposed objective, one created by the authors for sociodemographic characterization and another translated, adapted and validated to Brazilian Portuguese to assess the capacity of self-care, namely, the Appraisal of Self Care Agency Scale-Revised, the ASAS-R. Most respondents were female (50.6%), married (58.2%), had between five and nine years of schooling (43.0%), had a family income of one to three minimum wages (86.1%) and were predominantly elderly (54.4%). The mean score obtained for self-care capacity was 57.8. A dichotomy between the patients' usual chores and their diagnoses was observed, but the participants also stated that they dedicate time and were willing to take care of their health. They also stated that they looked for the best ways to take care of themselves and sought updated information whenever necessary, although no statistically significant association was found between self-care scores and sociodemographic variables. This study allowed to show that sociodemographic variables such as education, income, religion and cohabitation should be taken into account by health professionals to favor the client's engagement in self-care actions.
To identify contextual factors that affect self-management of diabetes with comorbidities, and to evaluate in what way these factors affect self-management effectiveness.
A systematic review of ...literature considered English language articles published within Medline, PsycINFO, Pubmed, CINAHL Plus, and Scopus databases that focussed on individuals’ experiences of type 2 diabetes from primary intervention or observational studies. A realist evaluation approach was used to analyse themes identified within the literature. Context-mechanism-outcome theories were constructed to identify underlying contextual factors and to construct a model illustrating diabetes self-management effectiveness.
Of 1519 articles identified, 30 met inclusion criteria. Adherence was found to be the common mechanism that (within given contexts) determined self-management effectiveness. Limited financial resources were identified as the key context. Our model makes explicit a structural weaknesses of diabetes self-management.
Coping with diabetes in the context of people’s lives requires attention to issues that are often outside the remit of the person with diabetes, the health care team, and the health system within which self-management is located. Realist evaluations illuminate programme mechanisms and fine-tune context. They aid initial understandings of how an intervention or programme is thought to work, in order to influence and (re)design (new) programmes.
After a spinal cord injury (SCI), individuals must acquire their maximum level of independence before returning to their previous social and working conditions. The education provided during ...rehabilitation is one of the basic but complex aspects that influence the health perspectives of people with SCI. Gaining the perspective of SCI survivors experienced barriers and resources to enhance the education process may assist healthcare professionals in understanding this complex aspect of their practice. Through a qualitative descriptive analysis, this study aimed to identify the perceived barriers and facilitators of education provided during the rehabilitation of individuals with SCI.
A purposive sample of 22 adults with SCI and at least six months of home experience was recruited. Participants were assigned into four mini focus groups according to their level of independence. The focus groups were audio-recorded, transcribed verbatim, and analysed using a thematic analysis.
Three themes were identified: the readiness to education, the individual characteristics, and the environmental and social characteristics influencing education. Participants perceived education to be an ongoing process made up of consecutive phases, each of which had to be overcome before participants felt ready to reappraise their health and well-being. This process was affected by individual, environmental, and social factors.
Education is constantly provided by all members of the rehabilitation team. These must stress the relevance of the contents presented, increase SCI survivors' motivation to set achievable goals, and consider filling the gap that the patients perceive between rehabilitation centres and available community resources. The findings of this study promote the design of structured educational programmes, increasing knowledge, and improve the health perspective of SCI survivors, their families, and providers.
ChatGPT, an advanced natural language processing model, holds significant promise in diabetes self-management and education. ChatGPT excels in providing personalized educational experiences by ...tailoring information to meet individual patient needs and preferences. It aids patients in developing self-management skills and strategies, fostering proactive disease management. Additionally, ChatGPT addresses healthcare access disparities by enabling patients to access educational resources irrespective of their geographic location or physical limitations. However, it is important to acknowledge and address the deficiencies of ChatGPT, such as its limited medical expertise, contextual understanding, and emotional support capabilities. Strategies for optimizing ChatGPT include regular training and updating, integration of healthcare professionals' expertise, improvement in contextual comprehension, and enhancing emotional support. By addressing these limitations and striking a balance between the benefits and limitations, ChatGPT can play a significant role in empowering patients to better understand and manage diabetes. Further research and development are needed to refine ChatGPT's capabilities and address ethical considerations, but its integration in patient education holds the potential to transform healthcare delivery and create a more informed and engaged patient population.
Aims
To analyse the effects of nurse‐driven self‐management (SM) programs on physical and psychosocial health variables in people with chronic obstructive pulmonary disease (COPD).
Design
A ...systematic review and meta‐analysis.
Data Sources
An exhaustive scanning of PubMed, Cochrane Controlled Register of Trials, CINAHL, ScienceDirect and Medline databases between January 2010–December 2019 was conducted for this meta‐analysis.
Review Methods
Randomized controlled trials (RCTs) related to nurse‐driven SM programs in COPD population were included. The standardized mean differences with 95% confidence intervals were determined for the main variables and heterogeneity was analysed using the I2 test. The Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) was used.
Results
Twelve studies were included. The results indicated that significant difference in physical health scores based on COPD Assessment Tool (CAT) and walking distance according to the 6‐min walk distance (6MWD) test in the intervention groups compared with the control groups. About psychosocial health findings, the quality of life increased and the Hospital Anxiety and Depression Scale (HADS) scores decreased following SM programs. All of the studies had good quality (varying from 5–8 points) according to The Modified Jadad Scale.
Conclusion
Nurse‐driven SM programs may contribute to prognosis in patients with COPD. Due to methodological weaknesses in the included trials, high‐quality RCTs are needed to better determine the effects of nurse‐driven SM programs in the management of COPD. Nurse‐driven SM programs may be employed as a useful strategy to improve health status and QOL and psychosocial health in the COPD population, as well.
Impact
Current evidence shows that nurse‐driven SM programs could be safely integrated into the clinical practice for patients with COPD. Future studies are warranted that evaluating the effects of nurse‐driven SM programs on other frequently observed COPD symptoms such as dyspnoea, fatigue and sleep disturbance.
摘要
目标
分析护士驱动的自我管理计划对慢性阻塞性肺疾病(COPD)患者身心健康变量的影响。
设计
系统回顾和荟萃分析。
数据来源
对国际文献数据库(PubMed)、Cochrane 临床对照试验中心注册数据库、护理学数据库(CINAHL)、期刊全文数据库(ScienceDirect)和联机医学文献分析和检索系统(MEDLINE)数据库2010年1月至2019年12月期间的文章进行详尽的扫描。
评审方法
纳入慢性阻塞性肺病患者群体中与护士驱动的自我管理计划相关的随机对照试验(RCT)。确定主要变量的标准化平均差(95%置信区间),并用I2检验分析异质性。应用系统回顾和荟萃分析的首选报告项目(PRISMA)。
结果
纳入12篇研究。结果表明,干预组与对照组相比,慢性阻塞性肺病患者评定工具(CAT)的身体健康评分和6分钟步行距离(6MWD)测试存在显著差异。 心理社会健康调查结果显示,经过自我管理计划,生活质量提高,医院焦虑和抑郁量表(HADS)得分下降。根据改良的Jadad评分法,所有研究均质量良好(从5‐8分不等)。
结论
护士驱动的自我管理计划可能有助于慢性阻塞性肺病患者的预后。由于纳入试验的方法学的缺陷,需要高质量的随机对照试验来更好地确定护士驱动的自我管理计划在慢性阻塞性肺病管理中的效果。护士驱动的自我管理计划可以作为改善慢性阻塞性肺病群体的健康状况、生活质量和心理社会健康的有效策略。
影响
目前的证据表明,护士驱动的自我管理计划可以安全地整合到慢性阻塞性肺病患者的临床实践中。未来的研究有必要评估护士驱动的自我管理计划对其他常见慢性阻塞性肺病症状(如呼吸困难、疲劳和睡眠障碍)的影响。
Objective
Limited clinical resources create barriers to quality management of cancer‐related distress. CaringGuidance After Breast Cancer Diagnosis is a web‐based, patient‐controlled, ...psychoeducational program of cognitive‐behavioral, coping and problem‐solving strategies aimed at early post‐diagnosis distress reduction without clinical resources. This study evaluated the feasibility of recruiting and retaining newly diagnosed women to 12 weeks of CaringGuidance and program acceptance.
Methods
Women with stage 0 to II breast cancer diagnosed within the prior 3 months were recruited from clinics and communities in four states, from 2013 to 2015 and randomized to 12 weeks of CaringGuidance plus usual care (n = 57) or usual care alone (n = 43). Recruitment, retention, and program use were tracked. Using standard and study‐derived measures, demographic and psychological variables were assessed at baseline and monthly and program satisfaction at 12 weeks.
Results
Of 139 women screened, 100 enrolled, five withdrew, and 12 were lost to follow‐up (83% retention rate). Total program engagement was positively associated with greater baseline intrusive/avoidant thoughts. Intervention participants (92%) believed CaringGuidance would benefit future women and was easy to use. Sixty‐six percent believed CaringGuidance helped them cope. Women used program content to change thoughts (49%) or behaviors (40%). Stress in the previous year was positively associated with reports that CaringGuidance was reassuring and helpful.
Conclusions
Feasibility and acceptance of CaringGuidance was demonstrated pointing to the program's potential as a cancer‐distress self‐management intervention. Future research will explore program feasibility and acceptability in other regions of the United States, leading to clinical implementation trials.
Aim
The aim of this study was to examine how nurse‐led interventions that support self‐management of outpatients with chronic conditions work and in what contexts they work successfully.
Background
...Self‐management could be directed at goals such as quality of life, adherence or patients’ empowerment. Self‐management support is an increasingly important task of nurses. Many nurse‐led interventions have been developed but it is not clear how these actually help improve patients’ self‐management capabilities.
Design
Realist review.
Data sources
Primary research studies on self‐management support interventions conducted by nurses from January 2000 until March 2015 were retrieved from all relevant databases. The studies had a before–after design and used qualitative and quantitative methods.
Review methods
For each study, we described how the intervention was supposed to improve self‐management and compared this with the empirical evidence. Next, we described the context–mechanism–outcome strings for each separate study, explored patterns and integrated the findings.
Results
Thirty‐eight papers were included, evaluating 35 interventions concerning a diversity of conditions. Seven different context–mechanism–outcome strings were identified. Interventions focusing on patients’ intrinsic processes were most successful. Least successful were interventions only providing education aimed at patient behaviour change. Various contexts can influence the success of the interventions: involvement of relatives, target group (i.e. chronic condition, motivation, being recently diagnosed or not), involvement of fellow patients and intervention group homogeneity or heterogeneity.
Conclusion
Successful interventions focus on patients’ intrinsic processes (i.e. motivation or self‐efficacy). This would guide nurses to decide what self‐management support intervention they can best use in their specific setting and patient group.
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