Nancy S. Redeker

Processes of Self‐Management in Chronic Illness

PURPOSE Self-management is a dynamic process in which individuals actively manage a chronic illness. Self-management models are limited in their specification of the processes of self-management. The purpose of this article is to delineate processes of self-management in order to help direct interventions and improve health outcomes for individuals with a chronic illness. DESIGN Qualitative metasynthesis techniques were used to analyze 101 studies published between January 2000 and April 2011 that described processes of self-management in chronic illness. METHODS Self-management processes were extracted from each article and were coded. Similar codes were clustered into categories. The analysis continued until a final categorization was reached. FINDINGS Three categories of self-management processes were identified: focusing on illness needs; activating resources; and living with a chronic illness. Tasks and skills were delineated for each category. CONCLUSIONS This metasynthesis expands on current descriptions of self-management processes by specifying a more complete spectrum of self-management processes. CLINICAL RELEVANCE Healthcare providers can best facilitate self-management by coordinating self-management activities, by recognizing that different self-management processes vary in importance to patients over time, and by having ongoing communication with patients and providers to create appropriate self-management plans.

Reproductive decision making in mothers with HIV-1.

Eighty percent of women with human immunodeficiency virus (HIV) are of childbearing age and the incidence of HIV in women is rapidly increasing. Despite the risk of perinatal transmission and The Centers for Disease Controls (CDC) recommendation that HIV-positive women delay pregnancy, HIV-infected women continue to become pregnant and have children. To gain insight into reproductive decision-making of women with HIV, 25 mothers who participated in a natural history study of perinatal HIV transmission were interviewed using open-ended questions based on Fishbeins Theory of Reasoned Action. Three major themes emerged from the content analysis of transcripts from interviews with HIV infected women: (1) motherhood viewed as a joy and a means of meeting their own needs, (2) concerns about their childrens well-being, and (3) the minor role of HIV infection in their lives. Women reported negative reactions to providers who focused exclusively on their HIV status, and not on the need to view the womens lives as a whole.Eighty percent of women with human immunodeficiency virus (HIV) are of childbearing age and the incidence of HIV in women is rapidly increasing. Despite the risk of perinatal transmission and The Centers for Disease Controls (CDC) recommendation that HIVpositive women delay pregnancy, HIV-infected women continue to become pregnant and have children. To gain insight into reproductive decision-making of women with HIV, 25 mothers who participated in a natural history study of perinatal HIV transmission were interviewed using open-ended questions based on Fishbeins Theory of Reasoned Action. Three major themes emerged from the content analysis of transcripts from interviews with HIV infected women: (1) motherhood viewed as a joy and a means of meeting their own needs, (2) concerns about their childrens well-being, and (3) the minor role of HIV infection in their lives. Women reported negative reactions to providers who focused exclusively on their HIV status, and not on the need to view the womens lives as a whole.

Effects of Napping on Sleepiness and Sleep-Related Performance Deficits in Night-Shift Workers: A Systematic Review

Night-shift workers are prone to sleep deprivation, misalignment of circadian rhythms, and subsequent sleepiness and sleep-related performance deficits. The purpose of this narrative systematic review is to critically review and synthesize the scientific literature regarding improvements in sleepiness and sleep-related performance deficits following planned naps taken during work-shift hours by night workers and to recommend directions for future research and practice. We conducted a literature search using the Medline, PsychInfo, CINAHL, Cochrane Library, and Health and Safety Science Abstracts databases and included English-language quasi-experimental and experimental studies that evaluated the effects of a nighttime nap taken during a simulated or actual night-work shift. We identified 13 relevant studies, which consisted primarily of small samples and mixed designs. Most investigators found that, despite short periods of sleep inertia immediately following naps, night-shift napping led to decreased sleepiness and improved sleep-related performance. None of the studies examined the effects of naps on safety outcomes in the workplace. Larger-scale randomized clinical trials of night-shift napping and direct safety outcomes are needed prior to wider implementation.

Sleep and trauma: an overview.

Sleep disturbance is common after traumatic events of various types, such as combat, physical trauma, and sexual abuse, and closely intertwined with Posttraumatic Stress Disorder (PTSD), a common outcome of severe and prolonged trauma. This paper reviews the current literature on the significance and characteristics of sleep disturbance occurring in the context of trauma, examines the relationship between sleep disturbance and PTSD, identifies gaps in knowledge relative to the role of sleep disturbance in trauma and PTSD, and discusses the implications of this body of knowledge for clinical practice.

Sleep during hospitalization and recovery after cardiac surgery.

Sleep disturbance is common in patients undergoing cardiac surgery and has been recognized for more than 30 years. Research findings suggest that sleep disturbance is a multifactorial process that has many correlates in these patients and persists from the presurgical period throughout recovery. A growing body of literature suggests the importance of sleep for function and well-being of these patients. The research literature is synthesized and implications for future research and practice are discussed.

Sleep Patterns in Women After Coronary Artery Bypass Surgery

Sleep patterns were examined over a 6-month time period after coronary artery bypass graft surgery (CABG) using a wrist-worn actigraph and the Sleep-Rest subscale of the Sickness Impact Profile. The sample included 22 women during the first postoperative week (T1), and 13 of these women during the first posthospitalization week (T2) and the sixth (T3) and twenty-fourth postoperative weeks (T4). Nighttime sleep became less fragmented and, over time, total sleep became more consolidated during nighttime hours, as shown by significant decreases in day, evening, and total sleep and increases in the percentage of total sleep occurring at night during T1. There were also increases in nighttime sleep and percentages of total sleep and the mean sleep interval and decreases in day sleep and evening sleep and nighttime awakenings during T1 through T4. Decreases in the Sleep-Rest subscale indicated perceived improvement in sleep consistent with changes in objective sleep measures over 6 months. These data can be used to help women anticipate changes in sleep patterns over the course of recovery. They suggest the importance of interventions to improve sleep during hospitalization and posthospitalization recovery.

Measurement of activity.

Activity is a phenomenon of concern to nursing. Although a wide variety of instruments have been used to measure activity, researchers have confronted barriers to its measurement in reliable, valid, and practical ways. Technological advances have stimulated theoretical and empirical developments in the study of activity by improving the physical instrumentation. This article presents an overview of methods used to measure human activity, with an emphasis on technological advances and the methods relevant to nursing. Self-report, behavioral observation, and mechanical and electronic activity measures are reviewed and critiqued.

Symptoms Reported by Older and Middle-Aged Adults after Coronary Bypass Surgery

Knowledge of the most prevalent symptoms after coronary artery bypass surgery (CABS) can be used to assist patients to anticipate recovery. The purposes of this study were to describe the prevalence of symptoms during the first 6 weeks after CABS, to assess changes in the number and types of symptoms, and to compare symptoms in older and middle-aged adults. The most prevalent symptoms during hospitalization (rime 1) were pain, edema, wound drainage, fever, and fatigue. In the third through fifth postoperative weeks (Time 2), the most prevalent symptoms were pain, edema. sleep problems, fatigue, and wound drainage. At 6 weeks (Time 3), sleep problems, edema. pain, fatigue, and shortness of breath were the most common. Number of symptoms decreased significantly between Times 1 and 3. AU symptoms were more prevalent at Time 2 than at Time 1 and less prevalent at Time 3, with the exception of sleep problems, which were reported more frequently at Time 3 than at Time 1. The most persistent symptoms were edema, fatigue, sleep problems, pain, and shortness of breath. Significantly more middle-aged adults than older adults reported anxiety at Time 2. No other age-related differences were found. Implications for nursing practice and research are discussed.

Sleep disturbance in people with heart failure: implications for self-care.

Heart failure (HF) is associated with high levels of sleep disturbance and sleep disorders, including insomnia, periodic limb movements during sleep, and sleep disordered breathing. Recent studies underscore the importance of disturbances in sleep, a multidimensional biobehavioral phenomenon, to the pathophysiological processes associated with the development of HF, excess morbidity and mortality, and decrements in quality of life and functional performance. Managing disturbed sleep requires specific self-care strategies that must be incorporated into other self-care tasks associated with HF. Decrements in functioning associated with disturbed sleep may also have a negative impact on the self-care capacity and self-care behaviors of people with HF. The purposes of this article are to evaluate the state of the science relative to the nature of sleep disturbance experienced by people with HF and to discuss the implications of sleep, sleep disorders, and sleep-promoting interventions for self-care of people with HF.

First postoperative week activity patterns and recovery in women after coronary artery bypass surgery

The purpose of this study was to examine the relationship between activity-rest patterns and recovery in women during the first week after coronary artery bypass surgery (CABS). Twenty-five women wore wrist actigraphs to measure activity objectively throughout the first postoperative week. The Sickness Impact Profile (SIP) and length of postoperative hospital stay (LOS) were used as measures of recovery. Analysis of the activity data indicated that 21 (84%) of the participants had statistically significant positive linear trends in activity. Spectrum analysis indicated that 18 participants had periods that could be defined as circadian, 1 had a shorter period, and 6 had longer periods. After controlling for the effect of preoperative functional status, the period and linear trend of activity explained 28% of the variance in the SIP score at 1 week and 33% of the variance in length of stay. Positive linear trends in activity and circadian activity periods were related to better functioning and shorter length of stay.