Evolution of a conceptual model for adaptation to chronic illness

Biographical Renewal and its Facilitators in Cancer Survivorship: A Conceptual Paper

Experiencing cancer impinges life in several ways. Research on the biographical implications of cancer has focused on its disruptive nature. Biographical renewal is not given full attention despite existing literature on positive transformations after cancer. This conceptual paper presents an account of biographical renewal in the milieu of cancer survivorship. Further, we discussed some crucial facilitators that promote the biographical renewal. Caregivers may consider biographical renewal as a substantially new goal in the survivorship care plan to improve patients' quality of life. The discussion is designed to foster an understanding of biographical renewal for the psychosocial practice by professionals with cancer patients, survivors, and their caregivers - formal and informal, to provide comprehensive care during cancer survivorship. Implications for palliative care are also discussed.

Chronotype and the Big-Five personality traits as predictors of chronic fatigue among patients with sarcoidosis. A cross-sectional study

BACKGROUND

Sarcoidosis may seriously hamper patients' quality of life despite fairly good prognosis.

OBJECTIVES

To assess the relationship between the Big Five personality traits, chronotype and severity of fatigue symptoms, in the context of selected clinical variables and general mental health among patients with sarcoidosis.

METHODS

The study group comprised 60 patients with a confirmed diagnosis of sarcoidosis. They were asked to share relevant clinical data and complete a set of questionnaires: Fatigue Asessment Scale (FAS), General Health Questionnaire (GHQ-28), the NEO Five Factor Inventory and Composite Scale of Morningness.

RESULTS

In linear regression analysis, FAS score was predicted by female sex, active sarcoidosis status, Morning Affect and Conscientiousness. In principal component analysis, FAS score and all GHQ-28 subscale scores (somatic symptoms, anxiety/insomnia, social dysfunction and depressive symptoms) formed a single component explaining 60% of variance. The factor loading for each variable exceeded 0.6.

CONCLUSIONS

The psychological burden appeared to rise with the severity of the fatigue, regardless the inactive/active phase of sarcoidosis. The severity of fatigue may be linked to patient's poor morning affect. The profile of psychological burden presented by the patients may be associated with their personality and clinical presentation of sarcoidosis.

The impact of Inflammatory Bowel Disease related fatigue on Health-Related Quality of Life: a qualitative semi-structured interview study

Background

Fatigue is a frequently reported symptom of Inflammatory Bowel Disease (IBD), having a negative impact on Health-Related Quality of Life (HRQoL). Patients' experiences of this have not been researched in IBD.

Methods

Semi-structured interviews were conducted with adults with Crohn's Disease from out-patient clinics in the United Kingdom. Interviews were audio-recorded and transcribed verbatim, then analysed using thematic analysis.

Results

Fourteen participant interviews were conducted. Three key themes were identified: 1) 'The new normal' established through adaptation and acceptance; 2) 'Energy as a resource' describing attempts to better manage fatigue through planning and prioritising tasks; 3) 'Keeping healthy' encompasses participants' beliefs that 'good health' allows better management of fatigue.

Conclusion

Participants establish a 'new' normality, through maintaining the same or similar level of employment/education activities. However, this is often at the expense of social activities. Further research is required to explore patient led self-management interventions in IBD fatigue.

Equine-Assisted Activities and Therapies: State-of-the-Art Review

The purpose of this paper is to explore what is known about equine-assisted activities and therapies based on Roy's adaptation model. Quality of life for vulnerable populations who engage with equine-assisted activities and therapies is considered the main concept here. This state-of-the-art review was conducted from four databases ranging from January 2019 to February 2020. Limited studies examined the effect of equine-assisted activities and therapies on cancer survivors, although preliminary data were promising. The rural context was not extensively examined. Thus, equine-assisted activities and therapies may enhance the quality of life through four adaptation modes.

Psychosocial Adaptation to Chronic Illness and Disability: An Updated and Expanded Conceptual Framework

The article revisits and updates an earlier model (Livneh, 2001) that examined the building blocks that constitute the dynamics of psychosocial adaptation to chronic illness and disability (CID). In the revised tripartite model, the author reconstructs and refines the earlier model based on recent theoretical formulations, clinical reviews and research findings. In the revised model, the author discusses three overarching components, namely, antecedents (causes of medical conditions, background variables), processes (the dynamically unfolding course of post-CID events), and outcomes (anticipated exit indicators that serve, as snapshot end products, to assess the individual’s experienced and reported quality of life following onset of CID). The article concludes with a brief review of the model’s practical and research implications.

Coping with chronic cardiovascular disease in Iran: A qualitative study

The effects of chronic cardiovascular disease can challenge the achievement of treatment goals and recovery outcomes. This study explores the ways in which patients cope with the effects of chronic cardiovascular disease, from the perspectives of patients, family caregivers, and health professionals. The qualitative study was conducted from May 2019 to September 2020 in Isfahan, Iran. Thirteen people with chronic cardiovascular disease, 6 family caregivers, and 16 healthcare professionals participated in semi-structured individual interviews. Transcripts were analysed thematically. Findings suggest that people with chronic cardiovascular disease use a range of coping strategies, both positive and negative, to adjust to their conditions. The positive strategies include managing their health-related symptoms, drawing on religious or spiritual beliefs, and accessing social and relational supports. Negative strategies can include over-reliance on family members for support, leading to reduced activity and loss of independence. Understanding the nature of the strategies used by patients provides an important means by which health service providers can support patients to further develop positive coping strategies. This, in turn, will enable patients to achieve higher levels of wellbeing.

Adapting to, integrating and self-managing HIV as a chronic illness: a scoping review protocol

INTRODUCTION

The process of adapting to a life with a chronic illness, is a well-researched phenomenon for a number of common chronic illnesses. The construct, adaptation, embeds the notions of integration of the chronic illness into identity and self-management. Integration precedes self-management and is key to living positively with a chronic illness. Adaptation is an important concept in understanding trajectory and outcomes of living with a chronic illness. Applicability of these concepts to HIV as a chronic illness; when suppressive adherence has been achieved, however, is unknown. Specifically, the adaptation process to living with HIV as a chronic illness, the integration of HIV into identity and the resulting self-management behaviours by adults living with HIV are relatively unexplored. We describe a protocol for a scoping review of adaptation to living with HIV, we structure the enquiry around integration of HIV into identity and self-management and interrogate theories, models and frameworks that have been proposed and studied and we evaluate them for relevance and usefulness in the care and management of HIV.

METHODS AND ANALYSIS

Methods proposed by the Johanna Briggs Institute will be followed. The protocol was drafted using the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews and was registered with the Open Science Framework. MEDLINE, SCOPUS, Cochrane Library, CINHAL and SocINDEX databases will be searched. A search in Social Science Research Network eLibrary and Open Access Theses and Dissertations will gather grey literature and reference lists of included sources will be screened. Study selection process will involve a title and abstract review and full text review, guided by clearly defined inclusion and exclusion criteria.

ETHICS AND DISSEMINATION

Ethical approval is not required because this is a proposed review and collection of data on publicly available materials. The results will be published in a topic relevant journal and presented at related scientific events.

Psychosocial evaluation for liver transplantation: A brief guide for gastroenterologists

Liver transplantation is a lifesaving treatment that improves survival and quality of life. The procedure requires adequate transplant candidate selection carried out by a multidisciplinary team. Psychosocial evaluation is a necessary part of recipient selection and its primary aims are to identify problems and psychosocial needs of the patient and his/her family, to improve transplantation outcomes. Different psychosocial conditions are considered risk factors for morbidity and mortality after transplantation. The presence of those factors per se is not an absolute contraindication, thus adequate evaluation promotes equal access to healthcare, improves results, and optimizes resources. The present review provides an overview of and guidelines for the most important psychosocial issues during the pretransplantation phase.

Pathways to psychological wellbeing for patients with bladder cancer and their partners-in-care

PURPOSE

The goal of the current analyses was to describe pathways through which Psychological Wellbeing might be better understood for clinical participants with bladder cancer and their partners. This was achieved by applying Roy's Adaptation Model that provides a framework with which to understand responses to challenging circumstances that has proved useful in the study of a range of chronic conditions.

METHODS

The sample comprised 119 patients with a diagnosis of bladder cancer, and 103 supportive partners. Participants completed a self-report questionnaire comprising the Bladder Cancer Index, Mini-Mental Adjustment to Cancer Scale, Psychosocial Adjustment to Illness Scale, and sociodemographic details. For each sample, structural equation modelling was used to determine goodness of fit, guided by Roy's Adaptation Model.

RESULTS

For patients, increasing age and disease duration, the negative appraisal of health care, perceived poor functioning and elevated burden of disease provided pathways to Psychological Wellbeing. For partners, increasing age, being male, a negative health care experience, and perceived burden of disease were significant. However, for both groups a positive evaluation of family and social support was the key indicator of lower Psychological Wellbeing.

CONCLUSIONS

The models presented describe a suite of issues that could inform a nursing model of care to enhance the experience of living with bladder cancer for both patients and their supportive partners.

Impacts of Fatigue, Stress, and Perceived Health Status on Women With Rheumatic Diseases: A Comparison Study

BACKGROUND

Rheumatic conditions, which increase in prevalence as populations age, are a growing public health problem that disproportionately affects women. Understanding the influences of rheumatic diseases (RDs) on fatigue, stress, and perceived health status is deemed important to the improvement of physical and mental health for women with RDs.

PURPOSE

This study was designed to compare the fatigue, stress, and perceived physical and mental health status of women with RDs (RD group) with those of peers who did not have chronic illnesses (comparison group).

METHODS

A cross-sectional, purposive sample and comparative design was used. Four hundred forty-three women with a mean age of 46.2 years participated in this study. Those with physician-diagnosed RDs (n = 212) were enrolled in the RD group, and those without chronic disease were enrolled in the comparison group (n = 231). Measures used included a demographic datasheet, Fatigue Severity Scale, Perceived Stress Scale, and Short Form-12 Items Health Survey. Analysis of covariance was used to examine the intergroup differences for major variables based on demographic covariates.

RESULTS

The RD group reported significantly more fatigue and stress than the comparison group. Moreover, the RD group reported significantly poorer perceived physical health status, significantly poorer physical functioning and general health, and greater bodily pain compared with the comparison group. Conversely, the RD group reported significantly better perceived mental health status, significantly lower vitality, and better role emotional status than the comparison group.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The findings support the theory that RDs have a negative impact on perceived stress and fatigue in women. Physical function, bodily pain, and general health may be the most significantly affected domains of perceived physical health in women with RDs. Of note, with the exception of the vitality subscale, RDs did not adversely affect the perceived mental health of participants with RD in this study. Healthcare professionals should cooperate with clinical rheumatologists, psychologists, and physiotherapists to provide comprehensive care that includes long-term education to help patients with RD self-manage stress, restore vitality, relieve pain, and increase physical function.

Exploring the Experiences of West African Immigrants Living with Type 2 Diabetes in the UK

The increasing prevalence and poorer management of Type 2 diabetes among West African immigrants in the UK is a public health concern. This research explored the experiences of West African immigrants in the management of Type 2 diabetes in the UK using a constructivist grounded theory approach. In-depth individual interviews were conducted with thirty-four West African immigrants living with Type 2 diabetes in the London area. Fifteen male and nineteen female adult West African immigrants with age range from 33-82 years participated in the study. Participants were recruited from five diabetes support groups and community settings. Initial, focused and theoretical coding, constant comparison and memos were used to analyse collected data. Three concepts emerged: Changing dietary habits composed of participants' experiences in meeting dietary recommendations, improving physical activity concerned with the experience of reduced physical activity since moving to the UK and striving to adapt which focus on the impact of migration changes in living with Type 2 diabetes in the UK. These address challenges that West African immigrants experience in the management of Type 2 diabetes in the UK. The findings of this research provide a better understanding of the influencing factors and can be used to improve the support provided for West Africans living with Type 2 diabetes in the UK, presenting a deeper understanding of socio-cultural factors that contribute to supporting individuals from this population.

The THRIVE model: A framework and review of internal and external predictors of coping with chronic illness

This article explores the ways in which people cope with social and clinical dimensions of their chronic conditions. Existing literature was reviewed to categorize factors identified as being key. They were sorted into six groupings which are reflected by the acronym THRIVE: therapeutic interventions, habit and routine, relational-social, individual differences, values and beliefs, and emotional factors. We found little evidence to suggest different conditions prompt unique coping responses; rather, a range of common factors were observed across diverse conditions. The THRIVE framework not only summarizes current literature but provides a starting point for further research and development of future interventions.

More than a job: Career development of individuals with cystic fibrosis

BACKGROUND

Cystic fibrosis and its employment corollaries have received little attention despite the fact that complications of CF represent numerous theorized barriers to optimal career outcomes.

OBJECTIVES

The objective of the study was to conduct grounded theory research that results in an understanding of the employment experiences of people with CF and ultimately a substantive grounded theory of career development applicable to individuals with this disease.

METHODS

This study utilized the grounded theory method of qualitative inquiry. A purposive sample of ten young adults with CF participated in in-depth semi-structured qualitative interviews. Analysis of the interview transcripts followed the constant comparative approach to coding, which identified core themes and sub-themes and culminated in a conceptual framework of variables influencing employment and career development.

RESULTS

An ecologically-based grounded theory of career development was developed. Major themes that influenced employment and career development were illness appraisal, occupational compromise, persistence, and altruism. Two patterns of career development outcomes emerged - the uninterrupted and the interrupted.

CONCLUSIONS

A complicated interaction of numerous ecological variables (individual characteristics, personal contextual factors, mediating factors, and the environment) collectively influenced career development. The presence of CF alone did not guarantee negative effects on career development.

Factors associated with healthcare-related frustrations among adults with chronic conditions

OBJECTIVE

Healthcare-related frustrations (HRFs) are common occurrences in patient-provider interactions. Little is known about HRFs experienced by individuals with chronic conditions. The purposes of this study were to: 1) identify the frequency of six HRFs among adults with chronic conditions; 2) assess factors associated with these HRFs; and 3) examine factors associated with multiple HRFs.

METHODS

Data were analyzed from 589 middle-aged and older adults with 1+ chronic conditions. A series of logistic regression models were fitted to identify factors associated with each frustration, and an ordinal regression model was fitted to identify factors associated with increasing frustrations.

RESULTS

Participants reported at least two of the six HRFs. The most commonly reported HRFs included feeling tired of describing the same condition (46%) and wishing their doctor had more time to speak with them during visits (44%). Having functional limitations (Beta=0.58, P=0.004), reporting more self-care barriers (Beta=0.41, P<0.001), visiting a physician more frequently (P<0.05), and having less support (Beta=-0.64, P=0.013) were associated with increasing HRFs.

CONCLUSION

Reducing HRFs may improve patient-provider interactions, chronic disease management, and patients' overall quality of life.

PRACTICE IMPLICATIONS

Care coordination, communication and cultural competency training, and a review of materials may help address these frustrations.

Computer Intervention: Illness Self-Management/Quality of Life of Rural Women

The Women To Women project, a computer-based support and educational research intervention, was designed to help rural women better understand and manage their chronic illnesses. Its impact on psychosocial adaptation has been reported elsewhere. This article reports on the effect of a computer intervention on chronic illness self-management skills and quality of life. Using a parallel 2-group study design, the researchers randomized 309 middle-aged rural women with chronic conditions to either a computer-based intervention or a control group. They collected data on self-management of chronic illness and quality of life indicators at baseline and at the end of the intervention. Women in the intervention group reported significantly more self-efficacy in managing their chronic disease than those in the control group and the observed effect was of moderate size. Women in the intervention group also reported statistically significant gains in quality of life; effect sizes were small but consistent. Select chronic illness self-management skills and quality of life can be positively influenced by a well-designed computer intervention.

Perception towards Regular Health Check-ups

The aim of this case study is to explore the perception of the rural people for regular health check-ups. A survey was conducted in 500 households in a village in Telangana in March 2012 to get an overview about the inhabitants’ health and their willingness to go for regular check-ups. Since majority of the respondents reported not visiting doctors or hospitals regularly, the key determinants for avoidance of such health check-ups was examined. The objective was to discover factors that may be addressed in future when healthcare facilities would be made available to these villages. The major determinants for avoidance of regular health check-ups were estimated through a logit model. The health locus of control index was constructed using five questions related to attitude and perception on regular health check-up. The results indicate that demographic factors like gender and age, economic factors such as family income and family health expenditure, distance, cost of availing a doctor and health locus of control are the key determinants for avoiding regular health check-up in rural India. However, due to increasing awareness among the rural population over the years, majority of the respondents are willing to pay a minimal amount of money and ready to use the electronic device which can monitor their health.

Selected factors affecting adherence in the pharmacological treatment of arterial hypertension

BACKGROUND

Low adherence to hypertension (HT) management is one of the major contributors to poor blood pressure (BP) control. Approximately 40%-60% of patients with HT do not follow the prescribed treatment. The aim of the study was to analyze the relationship between selected variables and adherence to hypotensive pharmacological treatment. Besides socioclinical variables, the study focused on the role of illness acceptance.

PARTICIPANTS AND METHODS

The study included 602 patients with HT. Adherence and acceptance of illness were assessed using the following validated instruments: the Acceptance of Illness Scale (AIS) and the Morisky Medication Adherence Scale (MMAS).

RESULTS

The high-adherence group comprised a significantly higher percentage of patients with high illness acceptance scale scores than that of patients with low-to-moderate scores (42.4 vs 31.8%; P=0.008<0.01). The odds ratio (OR) showed that high adherence to pharmacological treatment was >1.5 times as likely to occur in the high acceptance group as in the low-to-moderate acceptance group (OR =1.58, 95% CI 1.14-2.19). Spearman's rank correlation coefficients showed statistically significant correlations between adherence and sex (men ρ=-0.101; P=0.012), age >45-66 years (ρ=0.098; P=0.015), higher education level (ρ=0.132; P=0.001), grade ESC of HT (ρ=-0.037; P=0.057), receiving one-tablet polytherapy (ρ=0.131; P=0.015), and illness acceptance (ρ=0.090; P=0.024).

CONCLUSION

Acceptance of illness is correlated with adherence to pharmacological treatment, and consideration should be given to more widespread assessment of illness acceptance in daily practice. Male sex, age >45-66 years, duration of illness grade ESC of HT, and receiving one-tablet polytherapy are significant determinants of adherence to pharmacological treatment in HT.

Quality of life in patients with metastatic breast cancer treated with metronomic chemotherapy

AIM

The objective of the study was to detect changes in quality of life (QoL) in metastatic breast cancer patients treated with metronomic chemotherapy with daily low doses of cyclophosphamide and celecoxib.

MATERIAL & METHODS

Patients included in a Phase II trial, treated with metronomic cyclophosphamide and celecoxib were included in the QoL study. Assessment of QoL was carried out every 2 months by the Functional Assessment of Cancer Therapy Breast (FACT-B) questionnaire, Brief Pain Inventory and Eastern Cooperative Oncologic Group scale. Data were analyzed at three time points: baseline (BL); middle of treatment (MT); and end of treatment (ET).

RESULTS

A total of 20 patients were included. All patients were heavily pretreated. Treatment showed a good and safe therapeutic profile. With FACT-B questionnaire, no significant differences were observed during the response period (BL-MT). However, a significant increase was observed in the Emotional well-being and Additional concerns axes, when the last time point was included in the analysis (BL-MT-ET). A significant decrease in the proportion of patients with pain was found when comparing BL with ET (p = 0.046). The assessment with Eastern Cooperative Oncologic Group scale showed that 26.7% (4/15) of the patients improved their functional status and 40% (6/15) showed no changes, while 33.3% (5/10) worsened it.

CONCLUSION

Patients treated metronomically for several months did not worsen their QoL. A high proportion of patients showed improvement or no changes and there were less patients with pain at the end of the treatment.

Perceptions of Insulin Treatment Among African Americans With Uncontrolled Type 2 Diabetes

PURPOSE

Little is known regarding perception of insulin treatment among midlife and older African American (AA) adults with type 2 diabetes, or how perception affects self-management behaviors. Using the Roy adaptation model, this qualitative descriptive study explored the perception of insulin treatment in midlife and older AAs living with uncontrolled type 2 diabetes.

METHOD

Three 1-hour focus groups were conducted with a total of 13 participants. Thematic analysis of transcribed audio recordings used the constant comparative method.

RESULTS

Themes identified include (a) insulin as instigator of negative emotions, (b) adapting to a lifestyle with insulin, and (c) becoming an insulin user: a new identity.

CONCLUSION

Adapting to insulin is a psychosocial process that commonly results in negative emotions, identity conflict, and new roles.

IMPLICATIONS FOR PRACTICE

Further research is needed to understand how AA adults perceive insulin treatment, understand the role of perception in self-management behaviors, and determine whether interventions to change perceptions may be effective in improving adaptation to diabetes.

Comparing Online with Face-to-Face HELPP Intervention in Women Experiencing Intimate Partner Violence

Intimate partner violence (IPV) is a public health problem. The purpose of this study was to compare the effectiveness of the HELPP (Health, Education on Safety, and Legal Support and Resources in IPV Participant Preferred) intervention among IPV survivors. A sequential, transformative mixed-methods design was used. Participants were randomly assigned to one of three study groups: Online (ONL), Face-to-Face (FTF), and Waitlist Control (WLC). The HELPP intervention was offered to 32 adult female participants who were 45.2% Asian, 32.3% White, and 22.5% Black. Outcome measures were anxiety, depression, anger, personal, and social support. In total, 64% (n  =  20) of the participants reported having experienced IPV before the age of 18. The anger mean score pre-test to post-test difference was significant for ONL (p < 0.001) and WLC (p  =  0.01). The personal and social support pre-test to post-test mean score differences were significant for ONL (p < 0.001; p < 0.001) and WLC (p  =  0.01; p  =  0.006), respectively. The HELPP intervention (1) decreased anxiety, depression, anger, and (2) increased personal and social support in the ONL group. The HELPP information and intervention was shown to be feasible, acceptable, and effective among IPV survivors compared with participants in the WLC group. The WLC participants displayed (1) increased levels of anxiety, depression, and anger and (2) decreased levels of personal and social support, post-intervention. Further research could be conducted to determine if e-mail alone or e-mail plus mobile devices are more useful modes of delivering interventions.

Along the way to developing a theory of the program: a re-examination of the conceptual framework as an organizing strategy

PURPOSE

Conceptual frameworks (CF) have historically been used to develop program theory. We re-examine the literature about the role of CF in this context, specifically how they can be used to create descriptive and prescriptive theories, as building blocks for a program theory. Using a case example of colorectal cancer screening intervention development, we describe the process of developing our initial CF, the methods used to explore the constructs in the framework and revise the framework for intervention development.

METHODS

We present seven steps that guided the development of our CF: (1) assemble the "right" research team, (2) incorporate existing literature into the emerging CF, (3) construct the conceptual framework, (4) diagram the framework, (5) operationalize the framework: develop the research design and measures, (6) conduct the research, and (7) revise the framework.

RESULTS

A revised conceptual framework depicted more complicated inter-relationships of the different predisposing, enabling, reinforcing, and system-based factors. The updated framework led us to generate program theory and serves as the basis for designing future intervention studies and outcome evaluations.

CONCLUSIONS

A CF can build a foundation for program theory. We provide a set of concrete steps and lessons learned to assist practitioners in developing a CF.

Aplikacija adaptacijskega modela Calliste Roy pri pacientu z rakom in s kronično bolečino

Uvod: Prilagajanje je ključni dejavnik za uspešno soočenje posameznika s spremembami v svojem notranjem in zunanjem okolju. Z aktivnostmi zdravstvene nege medicinske sestre pomagajo zagotoviti potrebne vire za uspešnejši proces prilagajanja. Avtorji v prispevku razpravljajo, ali bi teoretični model prilagoditve Calliste Roy ustrezal pri obravnavi in zdravstveni negi v enoti za zdravljenje bolečine.Metode: Uporabljena je triangulacija metod pregleda literature in kvalitativne metode z raziskovalno tehniko kritičnega dogodka. Pregled literature je bil narejen v vzajemni bibliografsko-kataložni bazi COBIB.SI in Cumulative Index to Nursing and Allied Health Literature (CINAHL). Pridobljenih je bilo 165 zadetkov in uporabljenih 34 znanstvenih člankov ter 7 monografij. Kriteriji izbora so bili primarni viri Calliste Roy, dostopnost, relevantnost, kritična ponazoritev teoretičnega modela. Tehnika kritičnega dogodka v treh fazah opiše incident, ga analizira ter poda možne izide. Rezultati: Adaptacijski model Calliste Roy je aplikativen, uporaben in v sedanji situaciji se dobro dopolnjuje s štirinajstimi temeljnimi življenjskimi aktivnostmi po Virginie Henderson. Model daje možnost ocene tako fizičnega kot psihosocialnega stanja. Najpomembnejše prepoznane intervencije medicinske sestre, ki pripomorejo k prilagoditvenemu procesu pacienta, so psihosocialna podpora, učenje in svetovanje. Diskusija in zaključek: Prednost obravnave pacienta z rakom in bolečino po izbranem modelu zdravstvene nege je v možnosti ocene stanja po vseh štirih ravneh prilagajanja in v prikazu načrta zdravstvene nege. Pokazalo se je kot pozitivno, da medicinska sestra lahko s psihosocialno podporo in informiranjem vpliva na kakovost življenja pacienta. Pacient in družina se soočata s kronično boleznijo, načinom življenja in pomenom poznavanja ter nadzorovanja bolečine. 

An online approach to providing chronic illness self-management information

The purpose of this article was to describe an online approach to providing chronic illness self-management information to rural women with chronic illness. To self-manage chronic illness, individuals require information about their conditions. For those in rural areas who have limited access to health services, computer-based interventions are a means of providing this information. Participants were randomly assigned either to an 11-week computer intervention in which they completed nine online self-study health teaching units related to self-management, or to a control group. The health teaching units were positively rated as being helpful in managing their chronic illnesses, with scores ranging from 4.09 to 4.84 on a six-point scale. Perceptions of computer skills increased significantly for the intervention group, with no increase in the control group. Computer-based programs can be an effective approach to providing health information to rural women with chronic conditions that will assist them in their self-management efforts.

Use of Creative Arts as a Complementary Therapy by Rural Women Coping With Chronic Illness

Purpose: To investigate the spontaneous use of creative arts as a complementary therapy by rural women in the Western United States who are coping with chronic illness. Design: Women to Women Project was an 11-week research-based computer intervention that provided health education and support to rural women with chronic illnesses in an effort to help them better adapt to living with chronic conditions. Method: Through the use of text queries, messages posted to an unprompted, online support and health education forum were examined for references to the spontaneous use of creative arts and their influence as a complementary therapy for dealing with chronic illness. Findings: In three identified themes—coping with pain, relaxation/quality of life, and giving back to others—participants strongly suggested that creative activity was an important strategy for coping with chronic illness and that it contributed to reduced pain and increased overall well-being, regardless of whether it was the expression of a previously learned skill or a practice established after the onset of chronic illness. Conclusion: The use of creative arts and developing art-making interventions could significantly benefit rural individuals coping with chronic illness. Discovering methods of implementing creative arts interventions in rural populations warrants further study.

The experiences and feelings of Chinese children living with leukemia: a qualitative study

BACKGROUND

Leukemia is the most common pediatric malignancy. Many children with leukemia display behavioral and emotional problems. Promoting children's psychological development and quality of life during hospitalization is an important activity carried out by health professionals.

OBJECTIVE

The objective of this study was to describe the experiences and feelings of Chinese children with leukemia in the hospital.

METHOD

In-depth interviews were conducted with Chinese children with leukemia using a descriptive qualitative research method. The data were analyzed using content analysis.

RESULTS

Twenty-nine children with leukemia were interviewed. Almost all children had negative experiences and feelings during the early stage of hospitalization, and there were 3 levels of adaptation that they displayed: inability to adapt to hospitalization, a sense of being compelled to accept hospitalization, and adaptation to hospitalization.

CONCLUSIONS

Three factors are associated with children's psychological distress, including the duration of treatment, children's personality, and age. Children of a younger age, with more extrovert personalities and who were undergoing longer treatment courses, adapted to hospitalization more easily.

IMPLICATIONS FOR PRACTICE

The findings provide information for health professionals to understand children's psychological status during hospitalization and help nurses to plan individualized psychological care for children.

About a snail, a toad, and rodents: animal models for adaptation research

Neural adaptation mechanisms have many similarities throughout the animal kingdom, enabling to study fundamentals of human adaptation in selected animal models with experimental approaches that are impossible to apply in man. This will be illustrated by reviewing research on three of such animal models, viz. (1) the egg-laying behavior of a snail, Lymnaea stagnalis: how one neuron type controls behavior, (2) adaptation to the ambient light condition by a toad, Xenopus laevis: how a neuroendocrine cell integrates complex external and neural inputs, and (3) stress, feeding, and depression in rodents: how a neuronal network co-ordinates different but related complex behaviors. Special attention is being paid to the actions of neurochemical messengers, such as neuropeptide Y, urocortin 1, and brain-derived neurotrophic factor. While awaiting new technological developments to study the living human brain at the cellular and molecular levels, continuing progress in the insight in the functioning of human adaptation mechanisms may be expected from neuroendocrine research using invertebrate and vertebrate animal models.

Patients, persons or partners? Involving those with chronic disease in their care

Self-care management is essential for effective chronic disease management. Yet prevailing approaches of healthcare practitioners often undermine the efforts of those who require on-going medical attention for chronic conditions, emphasizing their status as patients, failing to consider their larger life experience as people, and most importantly, failing to consider them as people with the potential to be partners in their care. This article explores two approaches for professional-patient interaction in chronic disease management, namely, patient-centred care and empowering partnering, illuminating how professionals might better interact with chronically ill individuals who seek their care. The opportunities, challenges, theory and research evidence associated with each approach are explored. The advantages of moving beyond patient-centred care to the empowering partnering approach are elaborated. For people with chronic disease, having the opportunity to engage in the social construction of their own health as a resource for everyday living, the opportunity to experience interdependence rather than dependence/independence throughout on-going healthcare, and the opportunity to optimize their potential for self-care management of chronic disease are important justifications for being involved in an empowering partnering approach to their chronic disease management.