Robyn Gallagher

Factors influencing self-management in chronic obstructive pulmonary disease: An integrative review

BACKGROUND Chronic obstructive pulmonary disease is a common, chronic and burdensome condition requiring the individual to engage in a range of self-management strategies. The capacity to engage in self-management is dependent on a range of internal (e.g., personal) and external (e.g., health service) factors. OBJECTIVES This paper seeks to define self-management, identify the determinants which influence the individuals ability to cope and adjust to living with chronic obstructive pulmonary disease in the community, and identify implications for clinical practice and research. DESIGN Integrative review. DATA SOURCES Medline, Embase, PubMed, CINAHL, Google Scholar. REVIEW METHODS Integrative review using prospective research questions. Papers were included in the review if they were published in peer reviewed journals and written in English between 2000 and 2010. Articles were accepted for inclusion if they discussed the determinants that influenced self-management of chronic obstructive pulmonary disease in the community. Confirmation of results and discussion themes was validated by specialists in chronic obstructive pulmonary disease and complex care. FINDINGS Self-management is less well characterised in chronic obstructive pulmonary disease compared with other chronic conditions. Functional limitation and the need to balance disease management with everyday life are the two key elements that patients face in managing their condition. Provider characteristics, socioeconomic status and health literacy are sparsely discussed yet are known to influence chronic obstructive pulmonary disease self-management. CONCLUSIONS Chronic obstructive pulmonary disease self-management must be a key focus internationally as the disease incidence increases. Collaborative care is required between patients and health providers in order facilitate patients in confident management of their condition.

Evaluation of a critical care simulation series for undergraduate nursing students

Abstract Simulation is increasingly being used to prepare and supplement clinical practice in critical care areas for undergraduate Bachelor of Nursing (BN) students, with some success. However, the effects of multiple, medium–high fidelity simulations for this purpose have not been previously assessed. The purpose of this study was to assess self-reported confidence and competence using scenario-based simulations. A pre-test post-test design was used to evaluate a series of simulations conducted over a semester. There were twenty seven scenarios, incorporating programmed mannequins, moulage and actors. The scenarios were embedded in a team-based process involving preparation and video-recordings used for debriefing. Third year BN students reported their confidence and competence before and after the simulation series and made comments on their perception of the experience. Multiple scenario simulations are effective in improving BN students’ confidence and competence related to critical care practice and are an enjoyable experience for students.

Self-management in older patients with chronic illness

Chronic illness causes the majority of disease burden and health costs in developed countries; however, this could be substantially reduced by optimal patient self-management. This study examined the levels of self-management in patients (n = 300) with chronic illness (chronic heart failure, chronic respiratory disease, Parkinsons disease and chronic schizophrenia) of moderate severity who had experienced an illness exacerbation in the last month. Patients perceptions of self-efficacy in relation to their self-management and their sense of coherence were also assessed at baseline and 1 month later. No changes occurred in self-perceptions or self-management from baseline to follow-up. Patients at risk of poor self-management included people with low self-efficacy, poor sense of coherence, older age and a primary diagnosis of chronic schizophrenia. As self-efficacy is the only predictor known to be amenable to intervention, self-efficacy enhancing support should be promoted.

Anxiety, depression and perceived control in patients having coronary artery bypass grafts

TITLE Anxiety, depression and perceived control in patients having coronary artery bypass grafts. AIM This paper is a report of a study to determine (1) the course of anxiety, depression and perceptions of control, and (2) the influence of perceptions of control, in patients undergoing coronary artery bypass grafts before surgery, after surgery in hospital and 2 weeks after discharge. BACKGROUND Anxiety and depression are common in patients undergoing coronary artery bypass graft surgery patients and predictive of worse outcomes. Few researchers have examined the influence of perceived control on these emotional states in the acute surgical period. METHODS A prospective, descriptive design was used with a convenience sample of patients having coronary grafts (n = 155). Anxiety and depression were measured by the Hospital Anxiety and Depression Scale and perceptions of control over their cardiac illness by the Control Attitudes Scale before surgery, after surgery during hospitalization and 2 weeks after hospital discharge. The data were collected in 2005. RESULTS Patients had low levels of anxiety at each timepoint; however, borderline or clinically significant levels were common before surgery (38.7%) and after discharge. (38.6%). Depression levels were low, but increased over time (F = 27.03, P < 0.001). Patients had low to moderate perceptions of control over their illness before surgery, which increased over time (F = 25.51, P < 0.001). Those with stronger perceptions of control were less anxious or depressed at all times and those who were more anxious or depressed before surgery continued to be so afterwards. CONCLUSION Routine assessment of anxiety, depression and perceptions of control are justified to identify patients at risk and to intervene to promote control perceptions.

Peer-led education for adolescents with asthma in Jordan: A cluster-randomized controlled trial

Objectives: To determine the impact of a peer-led education program, developed in Australia, on health-related outcomes in high school students with asthma in Jordan. Methods: In this cluster-randomized controlled trial, 4 high schools in Irbid, Jordan, were randomly assigned to receive the Adolescent Asthma Action program or standard practice. Bilingual health workers trained 24 peer leaders from Year 11 to deliver asthma education to younger peers from Year 10 (n = 92), who in turn presented brief asthma skits to students in Years 8 and 9 (n = 148) and to other members of the school community in the intervention schools. Students with asthma (N = 261) in Years 8, 9, and 10 completed baseline surveys in December 2006 and 3 months after the intervention. Results: Students from the intervention group reported clinically significant improvements in health-related quality of life (mean difference: 1.35 [95% confidence interval: 1.04–1.76]), self-efficacy to resist smoking (mean difference: 4.63 [95% confidence interval: 2.93–6.35]), and knowledge of asthma self- management (mean difference: 1.62 [95% confidence interval: 1.15–2.19]) compared with the control group. Conclusions: This trial demonstrated that the Adolescent Asthma Action program can be readily adapted to suit different cultures and contexts. Adolescents in Jordan were successful in teaching their peers about asthma self-management and motivating them to avoid smoking. The findings revealed that peer education can be a useful strategy for health promotion programs in Jordanian schools when students are given the opportunity and training.

Post discharge problems in women recovering from coronary artery bypass graft surgery

This study was conducted to describe the types and frequency of problems Australian women experience when recovering at home in the first 6 weeks following coronary artery bypass graft (CABG) surgery and the relationship between symptom experience and psychological distress. A convenience sample of 52 women (mean age 66.31 years, range 53-79 years) who had uncomplicated CABG surgery was selected from two tertiary hospitals in Sydney. A descriptive design was used with information related to post-operative problems collected by telephone interview at 1, 3 and 6 weeks post discharge using a semistructured questionnaire. Psychological distress was assessed at 12 weeks post discharge using the Hospital Anxiety and Depression Scale (HADS). Responses were categorised, collapsed and described using frequencies and percentages. Relationships were assessed by Spearmans r. The most common problems in the first and third weeks post discharge were sleeplessness and nausea or poor appetite and chest incision pain. Although problems improved over the first 6 weeks post-operatively, approximately one-quarter of the women still reported chest incision pain and almost 40% reported problems with leg wounds and oedema. The number of problems experienced at 6 weeks was significantly correlated with depression at 12 weeks. These findings support the importance of a preoperative education programme that includes anticipation of physical problems in the immediate post-operative period and a follow-up of female patients in the early transition period following hospital discharge.

Validation of Fitbit-Flex as a measure of free-living physical activity in a community-based phase III cardiac rehabilitation population:

Background Accurate physical activity monitoring is important for cardiac patients. Novel activity monitoring devices may enable precise measurement of physical activity. This study aimed to validate Fitbit-Flex against Actigraph accelerometer for monitoring physical activity. Design A validation study with a comparative design. Methods Cardiac patients and family members participating in community-based exercise programs wore Fitbit-Flex and Actigraph simultaneously over four days to monitor daily step counts and minutes of moderate to vigorous physical activity (MVPA). Results Participants (N = 48) comprised 52.1% males, with a mean age of 65.6 ± 6.9 years and 58.9% had a cardiac diagnosis. Fitbit-Flex and Actigraph were significantly correlated in males, females, total participants and cardiac patients for step counts (r = .96; r = .95; r = .95; r = .95), though less so for MVPA (r = .81; r = .65, r = .74; r = .71). As step counts increased the differences between Fitbit-Flex and Actigraph also increased. Fitbit-Flex over-estimated step counts in females (556 steps/day), males (1462 steps/day) and total participants (1038 steps/day) as well as for minutes of MVPA in females (4 min/day), males (15 min/day) and total participants (10 min/day). Fitbit-Flex had high sensitivity and specificity in classifying participants who achieved the recommended physical activity guidelines. Conclusion Fitbit-Flex is accurate in assessing attainment of physical activity guideline recommendations and is useful for monitoring physical activity in cardiac patients. The device does, however, slightly over-estimate step counts and MVPA.

Self management, symptom monitoring and associated factors in people with heart failure living in the community.

Background: Regular symptom monitoring enables early detection and treatment of heart failure exacerbations, reducing preventable hospital admissions. Aim: To determine the level of self management and frequency of symptom monitoring and factors associated in patients with moderate severity HF living in the community. Methods: A correlation study of a convenience sample of patients recently admitted or enrolled in treatment for heart failure were interviewed twice, one month apart, on self management and the frequency of monitoring five key heart failure symptoms. Results: Participants (n = 63) had an age mean of 78.38 years (SD 8.54 years), and approximately half were male (57%) and married (56%). Daily monitoring occurred in 69.8% for peripheral oedema, 65% for weight and 41.3% for fatigue, 38.9% for dyspnea during normal activity and 28.6% for dyspnea at night or at rest. At baseline, better self management was predicted by more comorbid conditions (ß = − 2.64) and stronger sense of coherence (ß = − 0.24), and one month later, by the baseline self management score (ß = .65). The only predictor of symptom monitoring at one month was the frequency of monitoring at baseline (OR = 9.18). Conclusions: Neither self management nor symptom monitoring is ideal in people with HF. As these behaviours did not change with time, interventions are needed early in the illness course.

Anxiety in patients undergoing percutaneous coronary interventions

OBJECTIVE Many patients undergoing percutaneous coronary intervention (PCI) experience symptoms of anxiety; however, it is unclear whether anxiety is an issue in the early recovery period and the types of factors and patient concerns that are associated. This study set out to determine the patterns of anxiety and concerns experienced by patients undergoing PCI and the contributing factors in the time period surrounding PCI. METHODS A convenience sample of patients undergoing PCI (n = 100) were recruited, and anxiety was measured using the Spielberger State Anxiety Inventory immediately before the PCI, the first day postprocedure, and 1 week postdischarge. Patients were also asked to identify their most important concern at each time. Independent predictors of anxiety at each time were determined by multiple regression analysis. RESULTS Anxiety scores were highest pre-procedure (35.72, standard deviation [SD] 11.75), decreasing significantly by the postprocedure time (31.8, SD 10.20) and further still by the postdischarge time (28.79, SD 9.78) (repeated-measures analysis of variance: F = 39.72, P < .001). The concerns patients identified most frequently as most important were the outcome of the PCI and the possibility of surgery pre-procedure (37%) and postdischarge (31%), and the limitations and discomfort arising from the access site wound and immobility postprocedure (25%). The predictor of anxiety at the pre-procedure time was taking medication for anxiety and depression (b = 7.12). The predictors of anxiety at the postprocedure time were undergoing first-time PCI (b = 4.44), experiencing chest pain (b = 7.63), and experiencing pre-procedural anxiety (b = .49). The predictors of anxiety at the postdischarge time were reporting their most important concern as the future progression of CAD (b = 7.51) and pre-procedural anxiety (b = .37). CONCLUSION Symptoms of anxiety were common, particularly before PCI. These symptoms are important to detect and treat because pre-procedural anxiety is predictive of anxiety on subsequent occasions. Patients who have had chest pain or their first PCI should be targeted for intervention during the early recovery period after PCI, and information on CAD should be provided postdischarge.

The effects of graduate nurse education on clinical practice and career paths: a pilot study

The recent proliferation of graduate courses in nursing has increased the need for educational administrators to evaluate the impact of such programmes on clinical practice and the career of participants. 40 registered nurses undertaking graduate studies were surveyed as a pilot for an extensive longitudinal study of their perception of the effects of study on work performance and career opportunities. Overall, positive effects were noted by respondents on their job satisfaction, self-esteem, professional thinking and career moves. Increases in professional behaviours such as mentoring, research and writing for publication were noted. Negative consequences were noted by a minority and were related to alterations to health status and increased levels of stress.