Maria Grazia De Marinis

The experiences of self-care in community-dwelling older people: A meta-synthesis

OBJECTIVES To identify, critically appraise and synthesize qualitative evidence of self-care experiences in health promotion for home-dwelling elders. DESIGN A meta-synthesis was conducted following the Joanna Briggs Institute guidelines and using Qualitative Assessment and Review Instrument Software. DATA SOURCES The literature search was conducted on PubMed, CINHAL, Embase, PsycInfo, Eric and ILISI databases from inception up until March 2015. Other articles were searched on Scopus and Web of Knowledge. The reference list of all the identified articles was also searched for additional studies. Studies published in English, Italian, French, Portuguese, and Spanish were considered for inclusion in the review. REVIEW METHODS Data from the selected qualitative articles were extracted independently by two reviewers using the data extraction tool of the Joanna Briggs Institute-Qualitative Assessment and Review Instrument. The meta-synthesis involved the following three steps: the production of a set of statements representing the aggregated data obtained by assembling the findings of qualitative studies; the categorization of findings on the basis of similarity in meaning; and the aggregation of these categories to produce a comprehensive set of synthesized findings. No studies were excluded due to methodological quality. RESULTS Of the 4001 records identified, 11 articles met the inclusion criteria. Most articles were conducted in Scandinavian countries and used a phenomenological design. Most elders in the sample were middle-class, cognitively intact, independent, and in good health. The meta-synthesis revealed that older people living at home make decisions about their self-care activities on the basis of their attitudes toward their life and future. These self-care activities are directed toward holistic wellness, prevention and treatment of aging effects, obtaining a sense of satisfaction, and self-realization. Furthermore, self-care activities are settled in a social and relational network that allows old people to take care of themselves and of others or to be cared for by others. CONCLUSIONS This meta-synthesis presents the perspectives of home-dwelling old people on health-promoting self-care experiences. Such information can help healthcare professionals to maintain long-term autonomy of elders in self-care and to promote healthy aging. Further qualitative research describing self-care experiences of home-dwelling elders from different cultures, education levels, and social backgrounds is needed.

Self-Care of People with Chronic Obstructive Pulmonary Disease: A Meta-Synthesis

BackgroundSelf-care in people with chronic obstructive pulmonary disease (COPD) can improve health-related quality of life, reduce hospital admissions and decrease dyspnoea.ObjectiveThis review aimed to systematically identify, evaluate and synthesise the qualitative literature on the self-care behaviours and strategies used by people with COPD.MethodsThe Joanna Briggs Institute (JBI) meta-aggregative method was followed. An electronic search of six relevant databases was conducted. The search was limited to articles published from January 1996 to January 2016. Reference lists of all identified articles were searched to find additional literature. Two independent reviewers analysed the studies against the inclusion criteria, extracted the data and assessed the methodological quality of the 14 identified papers using the JBI qualitative assessment and review critical appraisal instrument. Findings were synthesised using a meta-aggregation process.ResultsFour synthesised findings emerged from the aggregation of 114 findings: self-care is directed towards the prevention, control and management of the physical consequences of COPD; self-care focuses on the management of the psychological effects of COPD; self-care is aimed at reducing the impact of COPD on social life; and self-care is influenced by contact with healthcare services and requires the acquisition of knowledge and skills.ConclusionsThis meta-synthesis provides evidence on the self-care behaviours and strategies that people with COPD perform to prevent, control and manage the physical, psychological and social consequences of the disease. The findings of this meta-synthesis could help healthcare professionals to tailor self-care educational programmes to the experiences, preferences and priorities of people with COPD.

Prevalence, incidence and associated factors of pressure ulcers in home palliative care patients: A retrospective chart review:

Background: Terminally ill patients are at high risk of pressure ulcers, which have a negative impact on quality of life. Data about pressure ulcers’ prevalence, incidence and associated factors are largely insufficient. Aim: To document the point prevalence at admission and the cumulative incidence of pressure ulcers in terminally ill patients admitted to an Italian home palliative care unit, and to analyse the patients’ and caregivers’ characteristics associated with their occurrence. Design: Retrospective chart review. Setting/participants: Patients (n = 574) with a life expectancy ⩽6 months admitted to a palliative home care service were included in this study. Results: The prevalence and incidence rates were 13.1% and 13.0%, respectively. The logistic regression models showed body mass index (p < 0.001), Braden score at risk (p < 0.001), Karnofsky Performance Scale index <30 (p < 0.001), patients’ female gender, patients’ age >70 and >1 caregiver at home as the dichotomous variables predictors of presenting with a pressure ulcer at time of admission and during home palliative care. Conclusion: The notable pressure ulcers’ incidence and prevalence rates suggest the need to include this issue among the main outcomes to pursue during home palliative care. The accuracy of body mass index, Braden Scale and Karnofsky Performance Scale in predicting the pressure ulcers risk is confirmed. Therefore, they appear as essential tools, in combination with nurses’ clinical judgment, for a structured approach to pressure ulcers prevention. Further research is needed to explore the home caregivers’ characteristics and attitudes associated with the occurrence of pressure ulcers and the relations between their strategies for pressure ulcer prevention and gender-related patient’s needs.

Measurement properties of instruments evaluating self-care and related concepts in people with chronic obstructive pulmonary disease: A systematic review

The use of valid and reliable instruments for assessing self-care is crucial for the evaluation of chronic obstructive pulmonary disease (COPD) management programs. The aim of this review is to evaluate the measurement properties and theoretical foundations of instruments for assessing self-care and related concepts in people with COPD. A systematic review was conducted of articles describing the development and validation of self-care instruments. The methodological quality of the measurement properties was assessed using the COSMIN checklist. Ten studies were included evaluating five instruments: three for assessing self-care and self-management and two for assessing self-efficacy. The COPD Self-Efficacy Scale was the most studied instrument, but due to poor study methodological quality, evidence about its measurement properties is inconclusive. Evidence from the COPD Self-Management Scale is more promising, but only one study tested its properties. Due to inconclusive evidence of their measurement properties, no instrument can be recommended for clinical use.

Adherence to Oral Administration of Endocrine Treatment in Patients with Breast Cancer: A Qualitative Study

Background: Breast cancer is the most common cancer in women in the world, and it is also the leading cause of cancer deaths among women. Nevertheless, breast cancer survival has increased as a result of improvements in early diagnosis and therapy, for example, oral endocrine therapy. Despite the importance of adherence to endocrine therapy, its trend appears complex and multidimensional and therefore has many loopholes and missing information. Objective: The study aims to explore the experiences of adherence to endocrine therapy in women with breast cancer and their perceptions of the challenges they face in adhering to their medication prescribed. Methods: The study used a qualitative exploratory design, with face-to-face semistructured interviews. Data were analyzed using framework analysis in accordance with Ritchie and Spencer’s approach. Results: The sample included 27 women. Seven themes were identified: the different faces of adherence, fear of the drug, adherence stimulates the balance of the experience of illness, adherence influences the future of disease, adherence requires attention to the person, knowledge seeking, and “forgetfulness” activates the search for functional strategies. Conclusions: This study shows that adherence assumes different connotations that are mainly influenced by the type of relationship established with health professionals the attention paid to the person, the information received, and the influence that the drug has on the disease. Implications for Practice: It appears that fear has a strong influence on the behaviors involved in taking the therapy. The only way to overcome irrational fear is to improve the patient’s knowledge.

Cross-validation of the Self-care Ability Scale for Elderly (SASE) in a sample of Italian older adults

The assessment of self-care among older adults is important as it permits the tailoring of educational interventions directed to prevent health deterioration and contrast the effects of ageing. The Self-care Ability Scale for the Elderly (SASE) was developed to assess the perceived self-care ability in older adults. Its psychometric properties were tested only in Scandinavian countries and China. This research was a cross-validation of the SASE on 402 Italian adults aged 65 and older recruited in hospitals, clinics and homes, from September 2016 to February 2017. We performed exploratory and confirmatory factor analyses on two subsamples and identified three factors, self-care ability to perform ADLs, self-care ability to achieve well-being and self-care ability to set personal goals, with a good model fit (CFI > 0.93; RMSEA = 0.07; SRMR = 0.06). We eliminated four items, however, to improve the structural validity. Internal consistency for the three factors of the Italian version of the SASE (SASE-I) ranged from 0.72 to 0.92. The test-retest reliability indicated good stability of the scale (ICC coefficient = 0.92). We assessed convergent validity by comparing the SASE-I with the Katz Index of Independence in Activities of Daily Living and the Lawton Instrumental Activities of Daily Living Scale, showing moderate-to-strong correlations. In addition, the SASE-I discriminated the self-care ability in groups with different ages, levels of education and settings. Our study produced a 13-item version of the SASE with good psychometric properties that could be recommended for use in clinical practice and research after further validation on different populations and settings.

A Systematic Review and Integration of Concept Analyses of Self‐Care and Related Concepts

PURPOSE This systematic review identified, synthesized, and integrated concept analyses on self-care and related concepts. DESIGN The guidelines for systematic literature reviews of the Joanna Briggs Institute were followed. METHODS The Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, PsycINFO, and EMBASE databases were searched for concept analyses published in the past 20 years. FINDINGS A total of 26 concept analyses were identified that had been published on self-care, self-care agency, self-monitoring, self-management, self-management support, symptom management, and self-efficacy. Differences and commonalities in the examined literature were identified, and a model was delineated, explaining the relations among the various concepts from the nursing perspective. CONCLUSIONS The healthcare literature has broadly described self-care and related concepts; however, consensus on the definitions remains beyond our reach and should not be expected, due to the different perspectives and paradigms from which the concepts are interpreted. From a nursing perspective, self-care can be considered a broad concept encompassing the other concepts, which describe more specific individual levels of activities and processes. CLINICAL RELEVANCE Nurses are actively involved in disease management and self-management support as well as in promoting self-care in healthy and sick people. Referring to a model on self-care and related concepts could avoid misinterpretations in nursing practice, research, and policy.

Psychometric testing of the modified Care Dependency Scale (Neuro-CDS)

BACKGROUND Effective measures of nursing care dependency in neurorehabilitation are warranted to plan nursing interventions to help patients avoid increasing dependency. OBJECTIVE The Care Dependency Scale (CDS) is a theory-based, comprehensive tool to evaluate functional disability. This study aimed to modify the CDS for neurological and neurorehabilitation patients (Neuro-CDS) and to test its psychometric properties in adult neurorehabilitation inpatients. METHODS Exploratory factor analysis (EFA) was performed using a Maximum Likelihood robust (MLR) estimator. The Barthel Index (BI) was used to evaluate concurrent validity. Stability was measured using the Intra-class Correlation Coefficient (ICC). RESULTS The sample included 124 patients (mean age = 69.7 years, 54% male). The EFA revealed a two-factor structure with good fit indexes, Factor 1 (Physical care dependence) loaded by 11 items and Factor 2 (Psycho-social care dependence) loaded by 4 items. The correlation between factors was 0.61. Correlations between Factor 1 and the BI and between Factor 2 and the BI were r = 0.843 and r = 0.677, respectively (p <  0.001). The Cronbachs alpha coefficients were 0.99 and 0.88 (Factor 1 and 2). The ICC was 0.98. CONCLUSIONS The Neuro-CDS is multidimensional, valid, reliable, straightforward, and able to measure care dependence in neurorehabilitation patients as a basis for individualized and holistic care.