Self-Management Support in Chronic Illness Care: A Concept Analysis

2012 ◽  
Vol 26 (2) ◽  
pp. 108-125 ◽  
Author(s):  
Jennifer Kawi
Keyword(s):  
Chronic Illness ◽  
Theory Development ◽  
Concept Analysis ◽  
Self Management ◽  
Chronic Illness Care ◽  
Team Approach ◽  
Clear Understanding ◽  
Management Support ◽  
Patient Centered ◽  
Adequate Knowledge

Purpose: This article reports on the concept analysis of self-management support (SMS) to provide clarity for systematic implementation in practice. Background: SMS is a concept in its early phase of development. It is increasingly evident in literature on chronic illness care. However, the definition has been simplified or vague leading to variable SMS programs and inconsistent outcomes. Elucidation of SMS is necessary in chronic illness care to facilitate clear understanding and implementation. Method: Rodgers’ evolutionary concept analysis method was used to examine SMS. Data sources included systematic multidisciplinary searches of multiple search engines. Results: SMS refers to comprehensive sustaining approaches toward improving chronic illness outcomes consisting of patient-centered attributes (involving patients as partners; providing diverse, innovative educational modalities specific to patients’ needs; individualizing patient care), provider attributes (possessing adequate knowledge, skills, attitudes in providing care), and organizational attributes (putting an organized system of care in place, having multidisciplinary team approach, using tangible and social support). Implications: A well-clarified SMS concept is important in theory development. The attributes offer necessary components in SMS programs for systematic implementation, evaluation, and research. There is great potential that SMS can help improve outcomes of chronic illness care.

scholarly journals Modifying the PACIC to assess provision of chronic illness care: An exploratory study with primary health care nurses

2010 ◽  
Vol 2 (2) ◽  
pp. 118 ◽  
Author(s):  
Jenny Carryer ◽  
Claire Budge ◽  
Chiquita Hansen ◽  
Katherine Gibbs
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Chronic Illness ◽  
Care Delivery ◽  
Self Management ◽  
Chronic Illness Care ◽  
Management Support ◽  
Primary Health ◽  
Health Practitioners ◽  
Primary Health Care Nurses

INTRODUCTION: In line with Wagner’s Chronic Care Model, the Patient Assessment of Chronic Illness Care (PACIC) has been developed to evaluate chronic illness care delivery from the patient's perspective. Modification of the instrument to assess the same aspects of care delivery from the health practitioner’s perspective would enable individual practitioners to evaluate their own provision of self-management support, and would also enable a more direct comparison between care provided and care received within the chronic illness context. AIM: To explore the potential of a modified PACIC instrument to assess individual health practitioners’ delivery of care to chronic illness patients with a sample of primary health care nurses. METHODS: Seventy-seven primary care nurses completed the modified PACIC, reworded to ask about care provision rather than receipt of care. An additional seven cultural sensitivity items were included, as were questions about the suitability of the types of chronic illness care and who should be providing the care. RESULTS: The modified PACIC items appear to be appropriate for use with health practitioners. Agreement that the types of care described in the PACIC should be provided was almost unanimous, and the predominant view was that self-management support should be provided by both nurses and doctors. Mean scale scores were higher than those generally reported from studies using the PACIC. DISCUSSION: The results of this first evaluation of a modified PACIC suggest that the original items plus the cultural sensitivity items can be used to assess self-management support by individual health practitioners. KEYWORDS: Chronic illness; self-management; primary health care, nurses

scholarly journals Providing and receiving self-management support for chronic illness: Patients and health practitioners' assessments

2010 ◽  
Vol 2 (2) ◽  
pp. 124 ◽  
Author(s):  
Jenny Carryer ◽  
Claire Budge ◽  
Chiquita Hansen ◽  
Katherine Gibbs
Keyword(s):  
Chronic Illness ◽  
Self Report ◽  
Self Management ◽  
Health Board ◽  
Team Approach ◽  
Management Support ◽  
Primary Nursing ◽  
Primary Health ◽  
Health Practitioners ◽  
The Individual

INTRODUCTION: Providing care for people with chronic illness is a major issue for health practitioners around the world, especially as populations age. Encouraging self-management is beneficial in terms of relieving the burden on the health system and promoting better health and adherence to medication and advice amongst this group. AIM: To measure the level of self-management support being provided to and received by people living with chronic illness in a District Health Board (DHB) region. METHODS: Self-report questionnaires (PACIC) were completed by 341 people living with chronic illness to measure the self-management support they receive from general practitioners and nurses. A modified version of the PACIC was used with 12 GPs and 77 primary health nurses in the same region to assess the provision of self-management support. RESULTS: Patients’ assessments suggest that they are receiving intermittent self-management support for their chronic illness. A comparison of ratings of different health practitioners revealed that nurses were reported to be providing support more consistently than GPs. The health practitioners rated themselves as providing self-management support more often than the patients reported receiving it. Many clinicians also suggested that not all forms of support are appropriate for everyone, suggesting the need to tailor support to the individual. DISCUSSION: Chronic illness support needs to be considered within the context of the individual and to be embedded in an ongoing relationship between the person and the provider. Findings highlight the benefits of a multidisciplinary team approach to self-management support and education in chronic illness care. KEYWORDS: Chronic disease; self care; primary health care; primary nursing care; physicians, family

Patient-Centered Medicine: Who, What, and How?

2016 ◽  
Author(s):  
Mark D. Sullivan
Keyword(s):  
Health Care ◽  
Chronic Illness ◽  
Clinical Problem ◽  
Chronic Illness Care ◽  
Patient Centered ◽  
Patient Agency ◽  
Centered Care ◽  
Primary Means ◽  
Patient Centered Medicine ◽  
Clear Idea

We don’t have a clear idea where health comes from. Our efforts to reform health care to make it more patient-centered and more responsive to the challenges of chronic illness have been too superficial. Three lessons for chronic illness care are derived: 1) we cannot assume that death and disease are the most important targets for health care, 2) we must draw on the patient’s perspective to define the nature of the clinical problem and the criteria of success for our clinical interventions, and 3) we must always aim toward increasing the patient’s capacity for self-care. The patient-centered care of chronic disease requires that we recognize the patient as the primary perceiver and producer of health. We must move not only from the passive patient to the informed and activated patient, but to the autonomous patient. Patient agency is both the primary means and primary end of health care.

e-Patients Perceptions of Using Personal Health Records for Self-management Support of Chronic Illness

2015 ◽  
Vol 33 (6) ◽  
pp. 229-237 ◽  
Author(s):  
PERRY M. GEE ◽  
DEBORA A. PATERNITI ◽  
DEBORAH WARD ◽  
LISA M. SOEDERBERG MILLER
Keyword(s):  
Chronic Illness ◽  
Personal Health Records ◽  
Self Management ◽  
Personal Health ◽  
Management Support ◽  
Health Records

Nurse-led patient-centered self-management support improves HbA1c in patients with type 2 diabetes—A randomized study

2016 ◽  
Vol 99 (11) ◽  
pp. 1821-1829 ◽  
Author(s):  
L. Jutterström ◽  
Å. Hörnsten ◽  
H. Sandström ◽  
H. Stenlund ◽  
U. Isaksson
Keyword(s):  
Type 2 Diabetes ◽  
Randomized Study ◽  
Self Management ◽  
Management Support ◽  
Patient Centered

scholarly journals Patient cardiovascular risk self-management: results from a randomized trial of motivational interviewing delivered by practice nurses

2018 ◽  
Vol 36 (4) ◽  
pp. 460-466 ◽  
Author(s):  
Elke Huntink ◽  
Jan Koetsenruijter ◽  
Michel Wensing ◽  
Jan van Lieshout
Keyword(s):  
Risk Management ◽  
Cardiovascular Risk ◽  
Chronic Illness ◽  
Randomized Trial ◽  
Self Management ◽  
Chronic Illness Care ◽  
Cardiovascular Risk Management ◽  
Practice Nurses ◽  
Implementation Programme

Abstract Background To enhance cardiovascular risk management and patients’ self-management, a tailored programme to improve cardiovascular risk management was tested in a randomized trial. The presented study concerned secondary analysis. Objectives To explore the correlations of practice nurses’ counselling skills at baseline on chronic illness care (measured with Patient Assessment of Chronic Illness Care questionnaire) and patients’ self-management (assessed with Patient Activation Measure) at follow-up and to examine the effect of the tailored implementation programme on chronic illness care and patients’ self-management. Methods A two-arm cluster randomized trial was conducted in 34 general practices in the Netherlands. Counselling skills of practice nurses at baseline were abstracted from audio-taped consultations, which were assessed by Motivational Interviewing Treatment Integrity. Data of 2184 patients with established cardiovascular disease or at high cardiovascular risk were gathered at inclusion and at 6 months follow-up by a composite questionnaire. Multilevel regression analysis was applied, controlling for patient characteristics. Results Counselling skills of practice nurses were not associated with chronic illness care and patients’ self-management scores. At follow-up, patients in the intervention group experienced less chronic illness care and were less activated in disease management than patients in the control group. The most important predictors were patients’ age, gender and education level. Conclusions The logic model underlying the implementation programme needs to be reconsidered, because patient perceptions were neither influenced by nurses’ counselling skills nor by other components of the implementation programme.

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