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Contenuto dell'articolo principale
Abstract
Introduction. Chronic illnesses care represents a challenging issue for people well-being and future health systems' sustainability. Promotion of self-care is considered a key point for chronically ill patients' care. The aim of this literature review was to explore: how self-care of chronic illness has been theoretically defined; how self-care can be assessed in clinical and research settings; what associations exist between self-care and health outcomes of chronically ill patients. Results. A wide range of definitions and terminologies related to self-care of chronic illness has been found in the literature. Although some common elements useful to explain the concept of self-care have been identified, the physical, cognitive, emotional and social processes underlying self-care remain controversial and poorly defined. Valid and reliable disease-specific assessment tools have been developed and used in a growing number of studies; however, the lack of utilization of standardized instruments in clinical practice has been referred by many authors. Significant correlations between self-care of chronic illness and outcome measures e.g. general health status, quality of life and healthcare costs, are reported by a limited number of studies. Conclusions. Supporting patient self-care is recognized as a crucial factor in chronic illness care. A deeper analysis of variables and processes influencing self-care could help for a full description of the phenomenon. A systematic evaluation of self-care in health professionals' everyday clinical practice is strongly recommended. The development of general non-disease-specific assessment tools could facilitate the evaluation of complex patients, especially those with multiple co-morbidities. Although self-care has been recognized as a vital intermediate outcome, further large-scale studies clarifying the association between self-care and patients' and health systems' outcomes are needed. Key words: self care, self management, chronic illness, health promotion, nursing assessment, nursing theories, nursing outcomes, patient outcomes
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Una revisione della letteratura sul self-care nelle malattie croniche: definizione, valutazione e outcomes associati
Introduzione. L'assistenza alle persone con malattie croniche rappresenta una sfida per il benessere della popolazione e per la futura sostenibilití dei sistemi sanitari. La promozione del self-care è considerata un aspetto chiave dell'assistenza ai malati cronici. Lo scopo di questa revisione della letteratura è stato quello di esplorare: come il self-care nelle malattie croniche è stato definito dal punto di vista teorico; come il self-care può essere valutato nella pratica clinica e nella ricerca; quali associazioni esistono tra il livello di self-care e i risultati di salute dei pazienti con malattie croniche. Risultati. In letteratura si è riscontrata un'ampia gamma di definizioni e terminologie connesse con il self-care nelle malattie croniche. Sebbene nei diversi approcci siano stati identificati alcuni elementi comuni utili a spiegare il concetto di self-care, le variabili fisiche, cognitive, emotive e socioculturali sottese al self-care nelle malattie croniche risultano controverse e scarsamente definite. Un crescente numero di studi ha sviluppato o impiegato strumenti di valutazione del self-care validi ed affidabili per una specifica malattia cronica; tuttavia molti autori riportano la mancanza di utilizzo di strumenti di valutazione nella pratica clinica standard. Un numero limitato di studi ha mostrato delle correlazioni significative tra il self-care nelle malattie croniche e alcune misure di risultato come lo stato generale di salute, la qualití di vita e i costi dell'assistenza sanitaria. Conclusioni. Favorire lo sviluppo del self-care è riconosciuto come un aspetto cruciale dell'assistenza ai malati cronici. Un'analisi più approfondita delle variabili e dei processi che influenzano il self-care potrebbe contribuire ad una più completa descrizione di questo fenomeno. La valutazione sistematica del self-care nella pratica clinica dei professionisti sanitari è fortemente raccomandata. Lo sviluppo di strumenti generali e non specifici per singola malattia potrebbe facilitare la valutazione dei malati complessi, specialmente in presenza di comorbidití multiple. Sebbene il self-care sia definito come un outcome intermedio vitale per i malati cronici, sono necessarie delle ulteriori ricerche su larga scala allo scopo di chiarire l'associazione tra il self-care e i risultati dei pazienti e dei sistemi sanitari.
Parole chiave: self-care, self-management, malattie croniche, promozione della salute, valutazione infermieristica, teorie infermieristiche, risultati infermieristici, risultati dei pazienti.
Dettagli dell'articolo
Riferimenti
- Artinian N., Magnan M., Sloan M. & Lange M.P. (2002). Self-care behaviors among patients with heart failure. Heart and Lung, 31 (3), 161-172.
- Bandura A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84, 191-215.
- Bandura A. (2004). Health promotion by social cognitive means. Health Education & Behavior,31(2),143-164.
- Barlow J., Wright C., Sheasby J., Turner A. & Hainsworth J. (2002). Self-management approaches for people with chronic conditions: a review. Patient Education and Counseling, 48, 177-187.
- Battersby M., Von Korff M. & Schaefer J. (2010). Twelve Evidence-Based Principles for Implementing Self-Mangement Support in Primary Care. The Joint Commission Journal on Quality and Patient Safety, 36 (12), 561-570.
- Baumann L.C. & Dang T.T.N. (2012). Helping patients with chronic conditions overcome barriers to self-care. The Nurse Practitioner, 37 (3), 33-38.
- Borsbo B., Gerdle B. & Peolsson M. (2010). Impact of the interaction between self-efficacy, symptoms and catastrophising on disability, quality of life and health in chronic pain patients. Disability and Rehabilitation, 32 (17), 1387-1396.
- Braden, C.J. (1990). A test of the self-help model: Learned response to chronic illness experience. Nursing Research, 39, 42-47.
- Braden, C.J. (1993). Research program on learned response to chronic illness experience: Self-help model. Holistic Nursing Practice, 8, 38-44.
- Brady T.J. (2011). Measures of Self-Efficacy. Arthritis Care and Research, 63 (11), 473-485.
- Burks K.J. (1999). A Nursing Practice Model for Chronic Illness. Rehabilitation Nursing, 24 (5), 197-200.
- Cameron J., Worral-Carter L., Driscoll A. & Stewart S. (2009). Measuring self-care in chronic heart failure. A review of the psychometric properties of clinical instruments. Journal of Cardiovascular Nursing, 24 (6), 10-22.
- Carlson B., Riegel B. & Moser D. (2001). Self-care abilities of patients with heart failure. Heart and Lung, 30 (5), 351-359.
- CDC - Centers for Disease Control and Prevention (2005). Chronic Disease and Health Promotion. http://www.cdc.gov/chronicdisease/overview/index.htm Ultimo accesso 12-06-2014.
- Chodosh, J., Morton, S. C., Mojica, W., Maglione, M., Suttorp, M. J., Hilton, L., Rhodes, S. & Shekelle, P. (2005). Meta-analysis: Chronic Disease Self-Management Programs for Older Adults. Annals of Internal Medicine, 143, 427-438.
- Costantini L., Beanlands H. & Horsburgh M.E. (2011). Development of the Self-Care for Adults on Dialysis Tool (SCAD). The CANNT Journal, 21 (2), 38-43.
- Cramm J.M. & Nieboer A.P. (2012). Self-management abilities, physical health and depressive symptoms among patients with cardiovascular diseases, chronic obstructive pulmonary disease, and diabetes. Patient Education and Counseling, 87, 411-415.
- Creer, T., Renne C. & Christian, W. (1976). Behavioral contributions to rehabilitation and childhood asthma. Rehabilitation Literature, 37, 226-232, 247.
- Department of Health (2005a). The expert patient: a new approach to chronic disease management for the 21st century. http://webarchive.nationalarchives.gov.uk /+/www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4006801 Ultimo accesso il 16-06-2014.
- Department of Health (2005b). Self-care: a real choice. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4101702.pdf Ultimo accesso il 16-06-2014.
- Department of Health (2005c). Public Attitudes to Self-Care: Baseline Survey. http://www.dh.gov.uk/prod _consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4111263.pdf Ultimo accesso il 16-06-2014.
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- Du S. & Yuan C. (2010). Evaluation of patient self-management outcomes in health care: a systematic review. International Nursing Review, 57, 159-167.
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- Grey M., Knafl K. & McCorkle R. (2006). A framework for the study of self- and family management of chronic conditions. Nursing Outlook, 54 (5), 278-286.
- Harris M., Wysochi T., Sadler M., Wilkinson K., Harvey L., Buckloh L., Mauras N. & White N. (2000). Validation of a Stractured Interview for the Assessment of Diabetes Self-Management. Diabetes Care, 23 (9), 1301-1304.
- Hibbard J.H., Mahoney E.R., Stockard J. & Tusler M. (2004). Development of the Patient Activation Measure (PAM): Conceptualizing and Measuring Activation in Patients and Consumers. Health Services Research, 39 (4), 1005-1026.
- Hibbard J.H., Mahoney H.R., Stockard J. & Tusler M. (2005). Development and testing of a short form of the patient activation measure. Health Services Research, 40 (6), 1918-1930.
- Hill-Briggs F. (2003) Problem Solving in Diabetes Self-Management: a Model of Chronic Illness Self-Management Behavior. Annals of Behavioral Medicine, 25 (3), 182-193.
- Hochhalter A.K., Song J., Rush J., Sklar L. & Stevens A. (2010). Making the Most of Your Healthcare intervention for older adults with multiple chronic ilnesses. Patient Education and Counseling, 81, 207–213.
- Hoffman A.J., von Eye A., Audrey G., Given B.A., Given C.W. & Rothert M. (2011). The Development and Testing of an Instrument for Perceived Self-Efficacy for Fatigue Self-Management. Cancer Nursing, 34 (3), 167-175.
- Howard L.M. & Ceci C. (2012). Problematizing Health Coaching for Chronic Illness Self-Management. Nursing Inquiry, [Epub ahead of print] 1-9.
- Hoy B., Wagner L. & Hall E.O.C. (2006). Self-care as a health resource of elders: an integrative review of the concept. Scandinavian Journal of Caring Science, 21, 456-466.
- ISTAT – Italian Institute of Statistics (2008). Condizioni di salute e ricorso ai servizi sanitari. http://www.istat.it/it/archivio/10836 consulted on 16-06-2014.
- Jaarsma T., Stromberg A., Martensson J. & Dracup K. (2002). Development and testing of the European Heart Failure Self-Care Behaviour Scale. The European Journal of Heart Failure, 5, 363-370.
- Jaarsma T., Arestedt K.F., Martensson J., Dracup K. & Stromberg A. (2009). The European Heart Failure Self-care Behaviour scale revised into a nine-item scale (EHFScB-9). European Journal of Heart Failure, 11, 99-105.
- JBI – Joanna Briggs Institute (2011) Reviewers Manual 2011 Edition. http://joannabriggs.org/assets /docs/sumari/ ReviewersManual-2011.pdf consulted on 6-06-2014.
- Jerant, A., Moore, M., Lorig, K. & Franks, P. (2008). Perceived Control Moderated the Self-efficacy-Enhancing Effects of a Chronic Illness Self-management Intervention. Chronic Illness, 4, 173-184.
- Lee C.S., Carlson B. & Riegel B. (2007). Heart Failure Self-Care Improves Economic Outcomes, but Only When Self-Care Confidence Is High [abstract]. Journal of Cardiac Failure, 13 (6) (suppl 2), 0-11.
- LeFort S.M. (2000). A Test of Braden's Self-Help Model in Adults with Chronic Pain. Journal of Nursing Scholarship, 32 (2), 153-160.
- Lerman I. (2005) Adherence to treatment: the key for avoiding long-term complications of diabetes. Archives of medical Research 36, 300-306.
- Lev E.L. & Owen S.V. (1996). A measure of Self-Care Self-Efficacy. Research in Nursing and Health, 19, 421-429.
- Levin, L.S. & Idler, E.L. (1983). Self-care in Health. Annual Review of Public Health, 4, 181-201.
- Lorig K. & Holman H.R. (2003). Self-Management Education: History, Definition, Outcomes, and Mechanisms. Annals of Behavioral Medicine, 26 (1), 1-7.
- McAlister, F.A., Stewart, S., Ferrua, S. & McMurray, J.J.V. (2004). Multidisciplinary strategies for the management of heart failure patients at high risk for readmission: a systematic review of randomised trials. Journal of American College Cardiology,44(4), 810-9.
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- Newman, J. & Tonkens, E. (2011). Participation, responsibility and choice: Summoning the active citizen in the Western European Welfare state. Amsterdam: Amsterdam University Press.
- Nicholas M.K. (2007). The pain self-efficacy questionnaire: taking pain into account. European Journal of Pain, 11, 153-163.
- Orem D. (1971). Nursing Concepts of Practice. St. Louis: Mosby.
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Riferimenti
Artinian N., Magnan M., Sloan M. & Lange M.P. (2002). Self-care behaviors among patients with heart failure. Heart and Lung, 31 (3), 161-172.
Bandura A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84, 191-215.
Bandura A. (2004). Health promotion by social cognitive means. Health Education & Behavior,31(2),143-164.
Barlow J., Wright C., Sheasby J., Turner A. & Hainsworth J. (2002). Self-management approaches for people with chronic conditions: a review. Patient Education and Counseling, 48, 177-187.
Battersby M., Von Korff M. & Schaefer J. (2010). Twelve Evidence-Based Principles for Implementing Self-Mangement Support in Primary Care. The Joint Commission Journal on Quality and Patient Safety, 36 (12), 561-570.
Baumann L.C. & Dang T.T.N. (2012). Helping patients with chronic conditions overcome barriers to self-care. The Nurse Practitioner, 37 (3), 33-38.
Borsbo B., Gerdle B. & Peolsson M. (2010). Impact of the interaction between self-efficacy, symptoms and catastrophising on disability, quality of life and health in chronic pain patients. Disability and Rehabilitation, 32 (17), 1387-1396.
Braden, C.J. (1990). A test of the self-help model: Learned response to chronic illness experience. Nursing Research, 39, 42-47.
Braden, C.J. (1993). Research program on learned response to chronic illness experience: Self-help model. Holistic Nursing Practice, 8, 38-44.
Brady T.J. (2011). Measures of Self-Efficacy. Arthritis Care and Research, 63 (11), 473-485.
Burks K.J. (1999). A Nursing Practice Model for Chronic Illness. Rehabilitation Nursing, 24 (5), 197-200.
Cameron J., Worral-Carter L., Driscoll A. & Stewart S. (2009). Measuring self-care in chronic heart failure. A review of the psychometric properties of clinical instruments. Journal of Cardiovascular Nursing, 24 (6), 10-22.
Carlson B., Riegel B. & Moser D. (2001). Self-care abilities of patients with heart failure. Heart and Lung, 30 (5), 351-359.
CDC - Centers for Disease Control and Prevention (2005). Chronic Disease and Health Promotion. http://www.cdc.gov/chronicdisease/overview/index.htm Ultimo accesso 12-06-2014.
Chodosh, J., Morton, S. C., Mojica, W., Maglione, M., Suttorp, M. J., Hilton, L., Rhodes, S. & Shekelle, P. (2005). Meta-analysis: Chronic Disease Self-Management Programs for Older Adults. Annals of Internal Medicine, 143, 427-438.
Costantini L., Beanlands H. & Horsburgh M.E. (2011). Development of the Self-Care for Adults on Dialysis Tool (SCAD). The CANNT Journal, 21 (2), 38-43.
Cramm J.M. & Nieboer A.P. (2012). Self-management abilities, physical health and depressive symptoms among patients with cardiovascular diseases, chronic obstructive pulmonary disease, and diabetes. Patient Education and Counseling, 87, 411-415.
Creer, T., Renne C. & Christian, W. (1976). Behavioral contributions to rehabilitation and childhood asthma. Rehabilitation Literature, 37, 226-232, 247.
Department of Health (2005a). The expert patient: a new approach to chronic disease management for the 21st century. http://webarchive.nationalarchives.gov.uk /+/www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4006801 Ultimo accesso il 16-06-2014.
Department of Health (2005b). Self-care: a real choice. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4101702.pdf Ultimo accesso il 16-06-2014.
Department of Health (2005c). Public Attitudes to Self-Care: Baseline Survey. http://www.dh.gov.uk/prod _consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4111263.pdf Ultimo accesso il 16-06-2014.
Driscoll, A., Davidson, P., Clark, R., Huang, N., Aho, Z. (2009). Tailoring consumer resources to enhance self-care in chronic heart failure. Australian Critical Care, 22, 133-140.
Du S. & Yuan C. (2010). Evaluation of patient self-management outcomes in health care: a systematic review. International Nursing Review, 57, 159-167.
European Observatory on Health Systems and Policies (2010). Tackling Chronic Disease in Europe. http://www.euro.who.int/__data/assets/pdf_file/0008/96632/E93736.pdf Ultimo accesso il 16-06-2014.
Evangelista, L.S. & Shinnick, M.A. (2008). What Do We Know About Adherence and Self-care? Journal of Cardiovascular Nursing, 23(3), 250-257.
Gallagher R. (2010). Self management, symptom monitoring and associated factors in people with heart failure living in the community. European Journal of Cardiovascular Nursing, 9: 153-160.
Grey M., Knafl K. & McCorkle R. (2006). A framework for the study of self- and family management of chronic conditions. Nursing Outlook, 54 (5), 278-286.
Harris M., Wysochi T., Sadler M., Wilkinson K., Harvey L., Buckloh L., Mauras N. & White N. (2000). Validation of a Stractured Interview for the Assessment of Diabetes Self-Management. Diabetes Care, 23 (9), 1301-1304.
Hibbard J.H., Mahoney E.R., Stockard J. & Tusler M. (2004). Development of the Patient Activation Measure (PAM): Conceptualizing and Measuring Activation in Patients and Consumers. Health Services Research, 39 (4), 1005-1026.
Hibbard J.H., Mahoney H.R., Stockard J. & Tusler M. (2005). Development and testing of a short form of the patient activation measure. Health Services Research, 40 (6), 1918-1930.
Hill-Briggs F. (2003) Problem Solving in Diabetes Self-Management: a Model of Chronic Illness Self-Management Behavior. Annals of Behavioral Medicine, 25 (3), 182-193.
Hochhalter A.K., Song J., Rush J., Sklar L. & Stevens A. (2010). Making the Most of Your Healthcare intervention for older adults with multiple chronic ilnesses. Patient Education and Counseling, 81, 207–213.
Hoffman A.J., von Eye A., Audrey G., Given B.A., Given C.W. & Rothert M. (2011). The Development and Testing of an Instrument for Perceived Self-Efficacy for Fatigue Self-Management. Cancer Nursing, 34 (3), 167-175.
Howard L.M. & Ceci C. (2012). Problematizing Health Coaching for Chronic Illness Self-Management. Nursing Inquiry, [Epub ahead of print] 1-9.
Hoy B., Wagner L. & Hall E.O.C. (2006). Self-care as a health resource of elders: an integrative review of the concept. Scandinavian Journal of Caring Science, 21, 456-466.
ISTAT – Italian Institute of Statistics (2008). Condizioni di salute e ricorso ai servizi sanitari. http://www.istat.it/it/archivio/10836 consulted on 16-06-2014.
Jaarsma T., Stromberg A., Martensson J. & Dracup K. (2002). Development and testing of the European Heart Failure Self-Care Behaviour Scale. The European Journal of Heart Failure, 5, 363-370.
Jaarsma T., Arestedt K.F., Martensson J., Dracup K. & Stromberg A. (2009). The European Heart Failure Self-care Behaviour scale revised into a nine-item scale (EHFScB-9). European Journal of Heart Failure, 11, 99-105.
JBI – Joanna Briggs Institute (2011) Reviewers Manual 2011 Edition. http://joannabriggs.org/assets /docs/sumari/ ReviewersManual-2011.pdf consulted on 6-06-2014.
Jerant, A., Moore, M., Lorig, K. & Franks, P. (2008). Perceived Control Moderated the Self-efficacy-Enhancing Effects of a Chronic Illness Self-management Intervention. Chronic Illness, 4, 173-184.
Lee C.S., Carlson B. & Riegel B. (2007). Heart Failure Self-Care Improves Economic Outcomes, but Only When Self-Care Confidence Is High [abstract]. Journal of Cardiac Failure, 13 (6) (suppl 2), 0-11.
LeFort S.M. (2000). A Test of Braden's Self-Help Model in Adults with Chronic Pain. Journal of Nursing Scholarship, 32 (2), 153-160.
Lerman I. (2005) Adherence to treatment: the key for avoiding long-term complications of diabetes. Archives of medical Research 36, 300-306.
Lev E.L. & Owen S.V. (1996). A measure of Self-Care Self-Efficacy. Research in Nursing and Health, 19, 421-429.
Levin, L.S. & Idler, E.L. (1983). Self-care in Health. Annual Review of Public Health, 4, 181-201.
Lorig K. & Holman H.R. (2003). Self-Management Education: History, Definition, Outcomes, and Mechanisms. Annals of Behavioral Medicine, 26 (1), 1-7.
McAlister, F.A., Stewart, S., Ferrua, S. & McMurray, J.J.V. (2004). Multidisciplinary strategies for the management of heart failure patients at high risk for readmission: a systematic review of randomised trials. Journal of American College Cardiology,44(4), 810-9.
Ministero della Salute (2011b). Relazione sullo stato del Paese 2009-2010. http://www.rssp.salute.gov.it/ rssp/paginaMenuSezioneRssp.jsp?sezione=risposte&lingua=italiano consulted on 16-06-2014.
Mosen D.M., Schmittdiel J., Hibbard j., Sobel D., Remmers C. & Bellows J. (2007). Is Patient Activation Associated With Outcomes of Care for Adults With Chronic Conditions? Journal of Ambulatory Care Management, 30 (1), 21-29.
Newman, J. & Tonkens, E. (2011). Participation, responsibility and choice: Summoning the active citizen in the Western European Welfare state. Amsterdam: Amsterdam University Press.
Nicholas M.K. (2007). The pain self-efficacy questionnaire: taking pain into account. European Journal of Pain, 11, 153-163.
Orem D. (1971). Nursing Concepts of Practice. St. Louis: Mosby.
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