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Chronic disease self-management: A hybrid concept analysis

BACKGROUND Chronic diseases require chronic disease self-management (CDSM). Existing CDSM interventions, while improving outcomes, often do not lead to long-lasting effects. To render existing and new CDSM interventions more effective, an exploration of the concept of CDSM from both the literature and patient perspectives is needed. The purpose of this study was to describe the current conceptualization of CDSM in the literature, identify potential inadequacies in this conceptualization based on a comparison of literature- and patient-based CDSM descriptions, and to offer a more comprehensive definition of CDSM. METHODS A hybrid concept analysis was completed. DISCUSSION In the literature, CDSM is defined as behaviors influenced by individual characteristics. Patients in the fieldwork phase discussed aspects of CDSM not well represented in the literature. CONCLUSIONS CDSM is a complex process involving behaviors at multiple levels of a persons environment. Pilot work to develop and test CDSM interventions based on both individual and external characteristics is needed.

Oncology nurses' narratives about ethical dilemmas and prognosis-related communication in advanced cancer patients.

Background: Oncology nurses routinely encounter ethical dilemmas when caring for advanced cancer patients, particularly concerning prognosis-related communications. Nurses experience uncertainty and barriers to providing quality end-of-life care; thus, more information is needed about recognizing and managing these dilemmas and to clarify their role in these situations. Objective: The purposes of this study were to (1) describe the frequency and types of ethical dilemmas experienced by oncology nurses caring for advanced cancer patients and (2) to summarize their written comments about prognosis-related communications. Methods: This was a content analysis of narrative comments provided by 137 oncology nurses who completed a mailed national survey of members of the Oncology Nursing Society. Results: The most frequently reported ethical dilemmas encompassed uncertainties and barriers to truth telling, familial and cultural conflict, and futility. Physician-nurse teams were considered optimal for delivering prognosis-related information. Nurses offered strategies for facilitating these communications. They also expressed the need for more education about how to engage in prognosis-related discussions and for better methods for relaying this information among team members to avoid “working in the dark.” Conclusions: Oncology nurses routinely experience ethical dilemmas, and there is a need for clarification of their role in these circumstances. Healthcare providers would benefit from interdisciplinary education about prognosis-related discussions. Attention to managing familial conflict and understanding cultural variations associated with illness, death, and dying is also needed. Implications for Practice: Findings reveal new information about ethical dilemmas encountered by nurses and strategies for improving end-of-life communications with advanced cancer patients.

CE: critical care recovery center: an innovative collaborative care model for ICU survivors.

OverviewFive million Americans require admission to ICUs annually owing to life-threatening illnesses. Recent medical advances have resulted in higher survival rates for critically ill patients, who often have significant cognitive, physical, and psychological sequelae, known as postintensive care syndrome (PICS). This growing population threatens to overwhelm the current U.S. health care system, which lacks established clinical models for managing their care. Novel innovative models are urgently needed. To this end, the pulmonary/critical care and geriatrics divisions at the Indiana University School of Medicine joined forces to develop and implement a collaborative care model, the Critical Care Recovery Center (CCRC). Its mission is to maximize the cognitive, physical, and psychological recovery of ICU survivors. Developed around the principles of implementation and complexity science, the CCRC opened in 2011 as a clinical center with a secondary research focus. Care is provided through a pre-CCRC patient and caregiver needs assessment, an initial diagnostic workup visit, and a follow-up visit that includes a family conference. With its sole focus on the prevention and treatment of PICS, the CCRC represents an innovative prototype aimed at modifying post–critical illness morbidities and improving the ICU survivors quality of life.

Our depression is different: Experiences and perceptions of depression in young Black men with a history of incarceration.

One in three Black men in the US faces difficulties obtaining employment, housing and maintaining self-sufficiency post incarceration. Felony records result in considerable social and economic vulnerability, placing many young Black men at risk for depression. Little is known about depression in Black men with felony records. Twenty Black men with a history of incarceration were interviewed to explore perceptions and experiences of depression. Emergent themes were anger and negativity, depression is weakness, invisible depression, being strong and going on, and our depression is different. Findings have implications for clinicians who initiate ongoing therapeutic relationships with young Black men.

Critical Care Follow-up Clinics: A Scoping Review of Interventions and Outcomes

Objective: The purpose of this scoping review is to identify evidence describing benefits of interventions provided in intensive care unit (ICU) survivor follow-up clinics. Background: Advances in ICU treatments have increased the number of survivors who require specialized care for ICU-related sequelae. Intensive care unit survivor follow-up clinics exist, yet little is known about the nature and impact of interventions provided in such clinics. A scoping review of publications about in-person post-ICU follow-up care was undertaken. Method: Ten databases were searched yielding 111 relevant unique publication titles and abstracts. Sample heterogeneity supported using a scoping review method. After excluding nonrelated publications, 33 reports were fully reviewed. Twenty international publications were included that described ICU follow-up clinic interventions and/or outcomes. Results: Authors discussed very diverse interventions in 15 publications, and 9 reported some level of intervention effectiveness. Evidence was strongest that supported the use of prospective diaries as an intervention to prevent or improve psychological symptoms, whereas evidence to support implementation of other interventions was weak. Conclusions: Although ICU follow-up clinics exist, evidence for interventions and effectiveness of treatments in these clinics remains underexplored. Implications: Intensive care unit survivor follow-up clinics provide a venue for further interdisciplinary intervention research that could lead to better health outcomes for ICU survivors.

The button: initiating the patient-nurse interaction.

Patient–nurse interactions are foundational to care that is desired by patients. Evidence about patient-initiated interactions with nurses is scant and little focus has been placed on the meaning to patients of ways to call for help when needed. The purpose of this secondary analysis was to provide a more intensive focus on initiative, one of four categories identified in a grounded theory study related to the perception of feeling safe in intensive care. Of 10 participants, a subset of 9 participant interviews was included in this analysis. Participants perceived “the button” was a way to initiate interaction with a nurse and to get the help they might need “right now.” This report emphasizes the importance of nurse call lights to patients and contributes to evidence focused on the meaning for patients of initiating interaction with nurses. Findings have important implications for care quality and nurse education.

Older adults' perceptions of feeling safe in urban and rural acute care.

OBJECTIVE: The purposes of this study were to identify factors that influenced hospitalized older adults’ perceptions of feeling safe and to identify differences in perceptions between rural and urban contexts. BACKGROUND: Efforts are underway to ensure patient physical safety and improve care quality in acute-care environments. Perception of care is a unique and independent dimension of quality that includes patients’ views of care and how these perceptions might affect responses to illness. METHOD: Grounded theory method was used to identify the basic social process of feeling safe in acute care. RESULTS: Older adults felt safe when nurses provided oversight, were predictable, provided personalized care, and were willing to advocate for them. CONCLUSIONS: Findings are consistent with professional models that center on the human relational components of care. Nurse leaders can facilitate practice environments where relational aspects of nurse work, including patients’ perceptions of feeling safe, are the norm, thereby creating exceptional patient care delivery systems.

Critical Care Recovery Center: Making the Case for an Innovative Collaborative Care Model for ICU Survivors

OverviewFive million Americans require admission to ICUs annually owing to life-threatening illnesses. Recent medical advances have resulted in higher survival rates for critically ill patients, who often have significant cognitive, physical, and psychological sequelae, known as postintensive care syndrome (PICS). This growing population threatens to overwhelm the current U.S. health care system, which lacks established clinical models for managing their care. Novel innovative models are urgently needed. To this end, the pulmonary/critical care and geriatrics divisions at the Indiana University School of Medicine joined forces to develop and implement a collaborative care model, the Critical Care Recovery Center (CCRC). Its mission is to maximize the cognitive, physical, and psychological recovery of ICU survivors. Developed around the principles of implementation and complexity science, the CCRC opened in 2011 as a clinical center with a secondary research focus. Care is provided through a pre-CCRC patient and caregiver needs assessment, an initial diagnostic workup visit, and a follow-up visit that includes a family conference. With its sole focus on the prevention and treatment of PICS, the CCRC represents an innovative prototype aimed at modifying post–critical illness morbidities and improving the ICU survivors quality of life.

Reducing my risk of intrusion: an intention of old homebound women who live alone.

Background: In assessing home safety for older persons, nurses have checked home security or assessed fear of crime but neglected to explore intentions to reduce the risk of intrusion. Objectives: To describe the intentions of old homebound women relative to reducing the risk of intrusion. Methods: A descriptive phenomenological method was used. The 40 participants (aged 85-98 years, M = 89.6) met criteria for age, living alone, and homebound status. Over 18 months, a series of tape-recorded interviews was completed, focusing on perceptions about changes in feeling safe at home and precautions to prevent the need to reaching help quickly. Data analyzed were drawn from interviews with the 32 women who reported intentions to reduce intrusion risk. Findings: Feeling safe in-place was contextual to recognizing intrusion risk and intentions to reduce the risk. Most women denied a recent change in feeling safe but reported intentions to reduce intrusion risk. The nine women who reported feeling less safe referred to various personal-social situations as explanatory. The five components of the phenomenon were keeping watch here, keeping out of harms way here, preventing theft and vandalism here, discouraging people who might want to get in here, and keeping intruders out of here. Each component phenomenon was the umbrella for a variety of specific intentions to reduce intrusion risk. Conclusions: Each woman was intending to reduce intrusion risk in unique ways. When conducting home safety assessments, nurses should explore intentions to reduce intrusion risk and use that information as a basis for individualized interventions to promote safety, rather than relying on generic suggestions such as locking the door.

Markers of older widows' trust of nonprofessional home-care helpers.

There is little literature about the relationships of older women who live alone and the paid, nonprofessional helpers who assist them. Studies of interpersonal trust have focused on the vulnerability of the trusting person and actions of the trusted person. The actions of the trusting person, or empirical indicators of trust, have had little attention. Our purpose was to describe the actions of older women that were indicative of their trust in nonprofessional home-care helpers. In a descriptive phenomenological study of 25 older widows, a subsample of 11 women who had hired nonprofessional helpers reported actions toward the helpers that we deemed markers of trust. The overarching marker of trust was keeping my eyes off of the helper, with five subsidiary markers, including allowing the helper to enter my house at will. Findings extend empirical knowledge about trust, raise new questions about interpersonal theories of trust, and suggest further areas of study.