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Synthesis project : cardiac clients and nurses perception of self management Pacheco, AnnaMarie; Juhn, Haeyoon; Chang, Jinny 2014

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AnnaMarie?Pacheco ??Haeyoon?Juhn?Jinny?Chang?Background??? Self?management?is?an?integral?part?of?the?continuum?of?care?for?cardiac?health?clients?as?cardiac?conditions?often?require?lifestyle?changes.?Therefore,?it?is?important?to?understand?how?patients?and?health?care?professionals?view?self?management?to?improve?communications?and?patient?health.??? We?investigated?the?literature?regarding?self?management?perspectives?and?found?that?more?research?needs?to?be?done.?We?therefore?interviewed?8?clients?and?8?nurses?at?a?cardiac?outpatient?clinic?in?Surrey,?British?Columbia?about?their?perspectives?on?self?management?and?their?own?regiments/recommendations.?Nurses?Ques?ns?and?Answers?1)?What?does?self?management?mean?to?you???? A.?Ability?to?have?tools/skills?available?to?cope?with?chronic?illness.??? B.?Being?able?to?take?care?of?your?disease.??? C.?Able?to?know?the?disease,?what?is?in?my?control,?healthy?behaviours.??? D.?Educating?clients?about?their?illness?process,?empower?them,?achieving?goals?to?increase?quality?of?life??? E.?Patient?being?able?to?control?their?disease,??entire?picture??of?health??? F.?Understanding?the?disease,?recognizing?S&S??? G.?Empowering?patients?to?look?after?their?own?health??? H.?Bringing?out?and?supporting?clients??capacity?to?manage?their?illness.??2)?Please?name?3?things?you?have,?or?would,?recommend?your?cardiac?client?to?do?at?home?in?terms?of?self?management.??? A.?Take?meds?as?prescribed;?lifestyle?changes?(exercise);?diet??? B.?For?heart?failure???taking?daily?weight,?fluid?intake?ins/outs,?sodium?intake??? C.?Goal?setting?(what?do?you?want?to?improve?);?do?2?flights?of?stairs?without?SOB;?increase?quality?of?life??? D.?For?heart?failure???disease?related?issues?(daily?weights;?education;?etc);?recognize?signs?of?decompensation;?watching?fluid?and?salt?intake??? E.?Diet?and?salt;?blood?pressure?chart;?activity?&?exercise;?low?stress??? F.?Quit?smoking,?lower?salt?intake,?watch?fluid?intake??? G.?Daily?weights,?daily?BP?checks,?and?low?sodium?diet??3)?Can?you?tell?if?a?client?has?been?doing?self?management?or?not??Please?describe,?if?possible.??? A.?Yes,?reflected?in?BP/heart?rate,?edema?etc.??? B.?Yes,?review?education?&?gaps;?bring?weight?records,?view?Na+?intake??? C.?Yes,?can?measure?(bloodwork,?symptoms,?etc).??? D.?Yes,?most?of?the?time.??? E.?Usually?yes,?depending?on?their?goals.??? F.?Yes,?when?they?have?showed?no?lifestyle?change,?don?t?want?to?move?around,?have?an?enabling?family??? G.?Yes,?in?most?cases.?Patients?are?honest?about?what?they?haven?t?been?able?to?keep?up.??? H.?Yes,?it?is?reflected?in?their?BP?and?weight.?4)?What?do?you?feel?is?the?largest?obstacle?for?clients?to?be?able?to?effectively?self?manage?their?chronic?illness??? A.?Education?&?understanding,?and?confidence,?motivation.??? B.?Language?barrier,?understanding?of?disease??? C.?Finances,?language,?dependency?on?family,?transportation??? D.?Cognitive?function,?fatigue?levels,?language?barriers,?depression,?not?enough?time.??? E.?Cognitive?decline,?denial,?poor?coping?strategies.??? F.?Not?understanding?their?disease?properly.??? G.?Being?mentally?challenged??? H.?Language?barrier?5)?What?is?the?least?challenging?self?management?action?or?skill?most?clients?have?been?able?to?do,?in?your?opinion???? A.?Taking?medications.??? B.?Daily?weights.??? C.?Exercise???can?walk?at?home?for?~10?min.??? D.?Being?patient?led?(centered?care)??? E.?Diet?modification??? F.?Taking?medications??? G.?Daily?weights??? H.?Maintaining?healthy?diet??6)?On?a?scale?of?1?10?(1=very?little;?10=very?much),?how?supportive?do?you?think?health?care?staff?are?towards?self?management?clients???? A.?Depends?on?area:?Acute???3?5?due?to?no?time;?Outpatient???8?10??? B.?9?10??? C.?9??? D.?6?(not?all?nurses?are?equal?in?expertise)??? E.?10??? F.?8??? G.?8??? H.?7?7)?On?a?scale?of?1?10,?how?well?do?you?believe?a?client?understands?self?management?when?you?explain?it?to?them???? A.?Depends?on?client,?language,?reception,?motivation,?age,?fear???5?7?(6?)??? B.?6?7??? C.?6?7??? D.?6?7??? E.?They?try?their?best?(no?#)??? F.?5??? G.?7??? H.?6?8)?On?a?scale?of?1?10?how?well?do?you?think?your?client?self?manage?at?home???? A.?Depends?on?diagnosis.?Cardiac?rehab???7.5;?heart?failure???6??? B.?6?7??? C.?7?(but?better?with?each?visit)??? D.?Heart?failure???5?7;?cardiac?rehab???7?8??? E.?They?have?good?intentions?(no?#)??? F.?5??? G.?6??? H.?4??1. What does the term self management mean to you? A. Taking care of myself, managing my own affairs. B. Having my wife to help me with my health and diet. C. Being on top of the disease, getting a healthy picture in my lifestyle. D. Dealing with time management. E. Managing, doing things by myself, doing exercises at home. F. Looking after myself, listening to my own body. G. Doing my homework H. Taking care of myself outside of the hospital 2. What does your illness mean for your day to day life? A. Being slower, but keeping positive.  B. Changing habits: no smoking, decreasing salt & sugar, exercise. A wake up call to make lifestyle changes. C. Because of the severity, always being on alert. Education of signs and symptoms, always having a phone by my side. D. Taking it easy, watching the food I eat, daily routines affected. E. Not being able to do what I used to do (i.e. sports) because of the pain. F. Being aware of my body at all times (ex. being careful when walking) G. Carefully monitoring my condition H. Something that limits what I enjoy doing. 3. How long have you been doing self management and please name 3 things you did, or currently do, in terms of self management. A. 7 years since operation; Diet, watching fluid and salt intake, no sweets B. 4 months; Quitting smoking, quitting alcohol intake, maintaining health. C. Taking walks, watching cholesterol & sodium intake, taking rest. D. Since October 2013; Maintaining good sleep hygiene, watching what I eat, exercising with my kids E. Since after surgery; Exercise, exercise, exercise. F. ?long time?; Having a personal trainer at the gym, physiotherapy, going to the gym sessions at the heart clinics. G. Since 10 years ago. BP checks, fluid restriction, exercise H. Since two years ago. low salt intake, limiting sweets, and BP checks 4. Do you feel as though you self manage your chronic condition well and why do you feel this way? A. Yes with help of course. B. Starting to manage well now, except for weight. C. Yes as well as I can. D. Not sure, but I think I?m doing fine. E. Yes F. Yes. G. Yes, have been keeping well for ten years. H. Yes. Although not sure if the outcome is congruent with the amount effort I put in. 5. What is the least challenging self management action or skill, for you? A. Contacting health services. B. Not drinking and smoking, with good support from friends. C. Promoting my own independence and gaining control of disease. D. None (everything is difficult) E. Doing things for my family (cooking) F. Being aware of my surroundings (ex. being more careful in wet/icy weather) G. Taking medications H. Fluid restriction 6. What is the most challenging self management action or skill, for you? A. Staying away from water. B. Social aspect (friends smoke and drink); saying no. C. Letting things go and seeing what happens. D. Watching what I eat. E. Feeling stressed when I?m left alone, needing moral support with me all the time. F. Getting enough exercise. G. None, they?re all easy H. Cutting back on chocolate 7. On a scale of 1-10 (1=very little; 10=very much), how supportive are the health care staff of your self management regimen? A. 9  B. 10 C. 9  D. 10 E. 7-8  F. 10 G. 10  H. 9 8. On a scale of 1-10 (1=very poorly; 10=very well), how well do you believe you understand self management? A. 9  B. 6 C. 8  D. 7 E. 8  F. 10 G. 10  H. 7 9.?On?a?scale?of?1?10?(1=very?poorly;?10=very?well),?how?well?do?you?believe?you?are?keeping?to?your?self?management?regimen??A.?8 ?B.?7?8?C.?7 ?D.?7?E.?8 ?F.?10?G.?10 ?H.?7?10. Has your quality of life changed or remained the same before implementing these self management strategies? Please describe if possible. A. It has gone down with the progression of disease, but I did my best to maintain my QoL. B. It remained pretty much the same since I can?t go back to work yet. C. It has improved. D. It has changed for the better. E. Improved very much. F. Improved, I would be nowhere without self management. G. Hard to tell since I?ve been doing this for about ten years. I think the self-management prevented further deterioration and any acute episodes resulting from my illness. H. Disease-wise, it changed for the better. However, it?s challenging not being able to do what I enjoy, so it reduced my QoL in this regard. 11. Can you talk about any services you've had trouble getting? A. No, services have been excellent.  B. No C. No    D. No  E. No    F. Being on waiting lists for education, exercise programs etc. G. Can?t think of anything  H. No 12. If you could change anything about your health care what would it be? A. None.    B. None. C. No.    D. Everything is good. E. Nope.    F. Nothing, just making sure I carry on with my care. G. Nothing    H. Waiting times. Summary??? For?this?project,?we?interviewed?8?clients?and?8?nurses?at?the?Jim?Pattison?Outpatient?Care?&?Surgery?Centre?in?Surrey,?British?Columbia.?The?clients?attend?the?clinic?for?check?ups?for?heart?failure?or?for?cardiac?rehab.??The?nurses?handled?the?client?appointments,?did?follow?up?and?relayed?information?to?doctors.?The?interviews?took?place?either?before?the?client?s?appointment?in?a?private?part?of?the?waiting?room?or?after?the?client?s?appointment?in?the?examination?room.?Nurses?were?interviewed?in?their?offices?or?wherever?there?was?a?private?room.???? Clients?and?nurses?were?presented?with?a?consent?form,?and?were?read?the?questions?by?the?interviewer.?The?interviewees?answered?the?questions?orally.?The?interviews?were?approximately?10?15?minutes?each.??? We?removed?a?question?from?our?original?list?as?we?realized?it?sounds?very?similar?to?another?question?previously?asked.?The?question?removed?asked?for?the?most?challenging?self?management?skill,?which?was?difficult?to?differentiate?at?first?listen?from?the?question?asking?what?barriers?or?obstacles?do?you?encounter?with?self?management.???? We?found?that?the?answers?were?mostly?similar?from?both?parties.?Nurses?had?more?in?depth?answers?and?clients?had?more?simplified?answers.?Overall,?nurses?had?lower?ratings?of?clients??abilities?to?self?manage,?in?comparison?to?clients??own?ratings.?All?nurses?acknowledged?that?their?clients?are?doing?the?best?that?they?can,?and?all?clients?felt?very?supported?and?trusting?of?the?nurses?in?regards?to?aiding?them?with?their?self?management.?Summary?of?Experience??? Our?experience?working?on?this?project?was?rather?challenging.?We?encountered?difficulties?in?scheduling?time?to?work?collaboratively?together?due?to?group?members?having?different?timetables?and?living?far?from?one?another.?Thus,?most?communication?was?done?through?e?mail.?Workload?was?divided?between?the?three?of?us.?Unfortunately,?this?meant?more?solo?work?and?thus?the?project?felt?quite?disjointed?at?times.???? We?were?fortunate?to?have?a?great?project?facilitator?who?guided?us?and?kept?us?on?track.??

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