Current evidence indicates that individuals and families who engage in self-management (SM) behaviors improve their health outcomes. While the results of these studies are promising, there is little agreement as to the critical components of SM or directions for future study. This paper offers an organized perspective of similar and divergent ideas related to SM. Unique contributions of prior work are highlighted and findings from studies are summarized. A new descriptive midrange theory, Individual and Family Self-management Theory, is presented; assumptions identified, concepts defined, and proposed relationships outlined. This theory adds to the literature on self-management by focusing on individual, dyads within the family, or the family unit as a whole; explicating process components of self-management; and proposing use of proximal and distal outcomes.The need to manage chronic conditions and to actively engage in a lifestyle that fosters health is increasingly recognized as the responsibility of the individual and their family. Health problems have shifted from acute to chronic and personal behaviors are linked to over half of chronic health problems. 1,2 Health care delivery has shifted to non-hospital venues with hospitalizations often eliminated or shortened. Criteria for hospital discharge are related to outcomes of conditions or procedures rather than the ability of patients or families to manage care. 1 It is estimated that half of all Americans are managing a serious chronic health condition at home. Over 12% of children have special health care needs and 23% of these children are significantly impacted by their condition. 3 In adults, 7% of persons between the ages of 45 and 54 and 37% of person over the age of 75 are managing three chronic conditions. 1 While the values of health promotion are increasingly realized for individuals and families, few health-promoting strategies are routinely incorporated into the delivery of health care in many settings. Individuals and families are expected to sort through the myriad of contradictory health information of varying quality and engage in behaviors promoting their health. Personal efforts to engage in healthy behaviors are often Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptNurs Outlook. Author manuscript; available in PMC 2010 July 23. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript derailed by social factors incongruent with health, 1, 4 such as neighborhoods unsafe for exercise, peer-group norms related to food choices and alcohol, and ...

An essential characteristic of advanced practice nurses is the use of theory in practice. Clinical nurse specialists apply theory in providing or directing patient care, in their work as consultants to staff nurses, and as leaders influencing and facilitating system change. Knowledge of technology and pharmacology has far outpaced knowledge of how to facilitate health behavior change, and new theories are needed to better understand how practitioners can facilitate health behavior change. In this article, the Integrated Theory of Health Behavior Change is described, and an example of its use as foundation to intervention development is presented. The Integrated Theory of Health Behavior Change suggests that health behavior change can be enhanced by fostering knowledge and beliefs, increasing self-regulation skills and abilities, and enhancing social facilitation. Engagement in selfmanagement behaviors is seen as the proximal outcome influencing the long-term distal outcome of improved health status. Person-centered interventions are directed to increasing knowledge and beliefs, self-regulation skills and abilities, and social facilitation. Using a theoretical framework improves clinical nurse specialist practice by focusing assessments, directing the use of best-practice interventions, and improving patient outcomes. Using theory fosters improved communication with other disciplines and enhances the management of complex clinical conditions by providing holistic, comprehensive care. Keywordsclinical nurse specialists; health behavior change; Integrated Theory of Health Behavior Change; self-management Personal behavior influences one's health. 1,2 Many people can improve their health by managing their chronic condition or engaging in health promotion behaviors. Persons with chronic conditions improve their health by managing specific health behaviors, a process that requires behavior change. Healthy people, as well as persons with chronic conditions, have opportunities to improve their health by regularly engaging in health promotion activities, a behavior change process similar or identical to the process used to manage chronic conditions.

Tailored interventions could be improved by (a) identifying the most salient characteristics to be tailored, (b) further delineating essential components of TIs, (c) determining the efficacy of different delivery channels, (d) determining factors that moderate effects of TIs, and (e) clarifying whether the efficacy of TIs changes over time.

Background Self-management of complex medication regimens for chronic illness is challenging for many older adults. Objectives The purpose of this study was to evaluate health status outcomes of frail older adults receiving a home-based support program that emphasized self-management of medications using both care coordination and technology. Design Randomized controlled trial with three arms and longitudinal outcome measurement. Setting Older adults having difficulty self-managing medications (N = 414) were recruited at discharge from three Medicare-certified home health care agencies in a Midwestern urban area. Methods All participants received baseline pharmacy screens. The control group received no further intervention. A team of advanced practice nurses and registered nurses coordinated care for 12 months to two intervention groups who also received either an MD.2 medication-dispensing machine or a medplanner. Health status outcomes (Geriatric Depression Scale, Mini-Mental Status Examination, Physical Performance Test, and the SF-36 Physical Component Summary and Mental Component Summary) were measured at baseline, 3, 6, 9, and 12 months. Results After covariate and baseline health status adjustment, time by group interactions for the MD.2 and medplanner groups on health status outcomes were not significant; time by group interactions were significant for medplanner and control group comparisons. Discussion Participants with care coordination had significantly better health status outcomes over time than those in the control group, but addition of the MD.2 machine to nurse care coordination did not result in better health status outcomes.

The Nursing Minimum Data Set (NMDS) represents the first attempt to standardize the collection of essential nursing data. These minimum core data, used on a regular basis by the majority of nurses in the delivery of care across settings, can provide an accurate description of nursing diagnoses, nursing care, and nursing resources used. Collected on an ongoing basis, a standardized nursing data base will enable nurses to compare data across populations, settings, geographic areas, and time. Public health nurses will be able to evaluate and compare services. The purpose of this article is to discuss briefly the following aspects of the NMDS: background including definition, purposes, and elements; availability and reliability of the data; benefits; implications of the NMDS with emphasis on nursing research; and health policy decision making.

Readiness for Discharge After Birth Scale performed well in psychometric testing. Assessing mothers'perceptions of readiness for discharge is important for measuring outcomes of hospitalization and for identifying mothers at risk for postdischarge problems.As hospital length of stay has decreased, the need to assess readiness for discharge and transition to home following hospitalization has become increasingly important to patient safety, satisfaction, physical, emotional, psychological, and social outcomes. Length of stay for childbirth has been an emotionally and politically charged issue. Public and political reaction to the perception that mothers and babies were being sent home too early and before they were ready resulted in legislation that mandated payment for a 48-hour postpartum stay for vaginal birth mothers and 96 hours for cesarean mothers (Newborn and Mothers Health Protection Act, 1996; effective January 1, 1998). However, the legislation left the decision about discharge timing to the mother and her health care provider. clinician's assessment of a new mother's readiness for discharge may be different from the new mother's perception. Shorter length of stay has been associated with lower perceived readiness for discharge (Weiss, Ryan, Lokken, & Nelson, 2004), suggesting that the mothers' perceptions of readiness may not be taken into account in discharge timing decisions. Instruments to measure the new mother's perception of her readiness for discharge after birth have not been available for clinical assessment or research purposes. The purpose of this study was to assess the validity and reliability of a new scale to measure perceived readiness for discharge after birth. BackgroundReadiness for discharge has been described as a multifaceted concept that provides an estimate of patients' and family members' ability to leave an acute care facility (Steele & Sterling, 1992). It is a perception of being prepared or not prepared for hospital discharge (Congdon, 1994;Fenwick, 1979). Home readiness, a term used in the anesthesia and ambulatory surgery literature, describes patients in intermediate rather than later stages of recovery and indicates a sufficient level of recovery to permit safe discharge (Korttila, 1991). Concerns about adequacy of maternal preparation and safety of early neonatal discharge (Braveman, Egerter, Pearl, Marchi, & Miller, 1995;Brown, Small, Faber, Krastev, & Davis, 2002;Eaton, 2001;Grullon & Grimes, 1997) have been prominently reported in the professional and lay literature.Readiness for discharge can be assessed from the perspectives of the providers, patients, and family members. Criterion-based assessment by the provider is the most commonly reported method of determining discharge readiness, and discharge criteria have been reported for many clinical populations (Barnes, 2000;Chung, 1995;Fenwick, 1979;Korttila, 1991;Merritt & Raddish, 1998;Stephenson, 1990;Titler & Pettit, 1995;Wong & Wong, 1999).Criteria that have been included in discharge readiness assessments are ...

Length of stay after childbirth is a controversial issue that affects new mothers and babies, Weiss, Ryan, Lokken, Nelson 2 health care delivery systems, and health policy and legislation. A trend of decreasing length of postpartum hospital stay has been observed globally (1). In the United States, in response to pressures fueled by anecdotal data, public opinion, and political rhetoric, legislation (2) was enacted that mandated insurance coverage for a minimum postpartum hospital stay of 48 hours for mothers and babies after vaginal birth. However, the legislation left the ultimate decision on timing of discharge with the new mother and her caregiver.Research about early obstetrical discharge has focused on the impact on maternal-neonatal outcomes (1,3), not on factors associated with, or predictive of, who will be discharged early. Studies to evaluate the premise that a longer postpartum stay is beneficial in terms of infant morbidity and mortality have not produced consistent findings (1,(3)(4)(5)(6)(7)(8). Little emphasis has been given to other factors associated with length of postpartum hospital stay that may influence decisions about postpartum discharge timing. The purpose of this study was to compare the sociodemographic characteristics and readiness for discharge of new mothers and their newborns at 3 discharge time intervals (24, 36, and 48 hr postpartum), and to determine if any of these variables are associated with postpartum length of stay.

The purpose of this study was to describe the initial steps in the role transition of graduate to staff nurse. During the first 3 weeks of an orientation to a clinical unit in an acute care hospital, graduate nurses and their preceptors used feedback sheets to document the learning activities of the graduate nurse, communicate the need for and evaluation of learning experiences, and plan activities to meet the continued needs of graduate nurses. Daily feedback sheets from 27 orientees and preceptors were analyzed using content analysis. A model representing the process and components of role transition was developed. The model was based on five themes which emerged from the data: Real Nurse Work, Guidance, Transitional Processes, Institutional Context, and Interpersonal Dynamics. Analysis of results revealed that the initial transition of a graduate nurse to the role of a staff nurse was a dynamic and interactive process occurring between the graduate nurse and the preceptor. Guided learning led to progress in balancing increasingly complex care within a specific institution. Interpersonal dynamics among staff, preceptors, and graduate nurses affected the process of role transition.