Health Outcome Measure In Patient Knowledge,Beliefs and Self Management In Nursing

Nurses Educator 2

Patient Knowledge, Beliefs and Self Management  In Nursing for Health Outcome Measure

Health Outcome Measure In Patient Knowledge,Beliefs and Self Management  In Nursing

Knowledge of or Need for Information In health Care and Nursing,Beliefs of Patient In health Care and Nursing,Self-management In health Care and Nursing,Other Measures In health Care and Nursing.

Knowledge of or Need for Information In health Care and Nursing

    Knowledge or assessment of a patient's or family's felt need for information is similarly specific to a particular domain of knowledge or information. Much has been made of the truth that knowledge is essential but not sufficient to create a change in behavior, this assumes that behavior change is the only valued outcome from patient education. 

    Much evidence shows that patients or families value information for the perspective it provides and almost uniformly believe they do not receive enough from the health care system.

    Redman (2003) reviews a number of knowledge instruments including for diabetes, rheumatoid arthritis, asthma, cardiac (including stroke), cancer (including breast and colorectal), maternal serum screening and phenylketonuria tests, Crohn's disease and colitis, osteoporosis, preoperative, schizophrenia , HIV/AIDS, and discharge learning needs. 

    Information needs seem to be particularly high among persons with cancer. Misters, van den Borne, De Boer, and Pruyn (2001) describe such a measure and test it with individuals with breast cancer, Hodgkin's disease, and head and neck cancer. Greater information needs were found to relate to higher levels of state-anxiety, more depression, and more psychological complaints. Need for information about disease and treatment changes over the course of the illness.

    Knowledge assessment instruments also must be checked regularly for current content, for example, treatment patterns changed after the Diabetes Control and Complications and the United Kingdom Prospective Diabetes Study. Also important is precise definition of the domains of knowledge being tested and assurance that each domain is adequately sampled. 

    Some instruments measure knowledge specific to a particular patient education program and cannot be considered universal. Many instruments measure knowledge essential for self-management, infrequently there is clarity about how much knowledge (what score level) is enough. Although patients may have the knowledge, they still may not be able to act on it. Additional instruments to assess information needs and knowledge levels are widely available. 

Beliefs of Patient In health Care and Nursing

    Beliefs are measured for two reasons: 

(a) they represent a theoretical model that explains health behavior such as the Health Belief Model.

(b) they describe a “lay” model by which people commonly understand a health condition. Several examples from the field of pain illustrate the difference. 

    The Pain Stages of Change Questionnaire (PSOCQ) is derived from the Transtheoretical Model, which holds that intentional change requires movement through discrete motivational stages: precontemplation for considering changes, contemplation, preparation for change, taking action to change, and maintenance of change. PSOCQ is used to identify an individual's readiness to self-manage chronic pain. 

    Interventions are matched to the individual's stage (Kerns, Rosenberg, Jamison, Caudill, & Haythomthwaite, 1997). The Pain Beliefs and Perceptions Inventory measures common beliefs about pain such as whether it will be an enduring part of life, that pain is mysterious and poorly understood, or that individuals are to blame for their own pain (Williams, Robinson, & Geisser, 1994 ). 

    The Osteoporosis Health Belief Scale is based on the health belief model (susceptibility to and seriousness of osteoporosis, benefits in preventive action, and barriers to accomplishing them) and is especially designed to assess beliefs related to exercise and calcium intake in the elderly. Scores should predict taking of preventive actions to avoid osteoporosis (Kim, Horan, Gendler, & Patel, 1991). 

    The Menopause Representations Questionnaire (MRQ) is based on Leventhal's self regulation model and measures a range of cognition about menopause including identity, consequences, time frame, and perceptions of control and cure (Hunter & O'Dea, 2001). MRQ can be used in research of the theoretical model.

    Other instruments measure patient beliefs about particular illnesses and provide a target for efforts to change incorrect beliefs or those that interfere with recovery. The Back Beliefs Questionnaire was developed to identify inappropriate beliefs that foster a reluctance toward early return to activities after back pain. 

    Interventions to change those beliefs have been successful (Symonds, Burton, Tillotson, & Main, 1996). The York Angina Beliefs Questionnaire assesses for common misconceptions and maladaptive beliefs among those who have angina, which can then be targeted for change (Furze, Bull, Lewin, & Thompson, 2003). 

Self-management In health Care and Nursing

    Advances in self-management of chronic illnesses are discussed. in chapter 5. Here, we consider measurement instruments, most of which involve self-report of recommended self-management behaviors. For example, the Self-Care of Heart Failure Questionnaire asks how frequently patients carry out the behaviors, how worrisome certain symptoms would be, and if patients had them, what they did about them. 

    More experienced patients reported limiting their sodium intake and increasing their diuretic dose with a sudden weight gain, as would be expected (Carlson, Riegel, & Moser, 2001). The Epilepsy Self-Management Scale also asks patients to report how frequently they carry out particular self-management activities including safety measures such as not going swimming alone (Dilorio & Henry, 1995).

    Other instruments measure skills such as ability to solve problems in self-management. The Diabetes Problem Solving Measure for Adolescents provides critical incidents that patients are asked to solve in an interview format. Adolescence is frequently a time of deteriorating glycemic control (Cook, Aikens, Berry, & McNabb, 2001). 

    Finally, the Diabetes Self-Management Profile attempts to assess (again, through self-report) what parts of the complex regimen of exercise, management of hypoglycemia, diet, glucose testing and insulin administration, and dose adjustment individuals with type 1 diabetes are carrying out (Harris et al., 2000).

Other Measures In health Care and Nursing

A cluster of measures focuses on the decision process including conflict experienced while the decision is being made and regret afterwards. They are reviewed in Redman (2003).

    Lack of culturally competent instruments for measuring relevant predictors, as well as study outcomes for groups such as Mexican American populations, is a barrier to addressing health disparities in non English speaking individuals. The work is complicated by low literacy rates in this community.

    The norm of developing instruments in English for middle-class populations means the instruments need not only to be translated but also to be made relevant to the local culture significant investment in time and skill ( Brown, Becker, Garcia, Barton, & Hanis, 2002).

    Others have described adapting objective structured clinical exams from professional education to lay caregivers. Using simulated patients, stations are set up to assess competencies and rated by faculty. 

    For example, care for a tunneled line includes stations assessing dressing change skill, identification from photos of moisture under dressings and infected line. skill in flushing the line on a chest model, and cap change and contamination to be identified from a video. At each station, learners receive immediate feedback. 

    This is a more realistic method than many reviewed above to assess when family members are adequately prepared to assume caregiving responsibilities or patients to do self-care (Heermann, Eilers, & Carney, 2001).

    Rapid expansion of the number of measurement instruments available in-patient education is helpful. Many are in very early stages of development psychometrically, and there is little evidence that those that meet psychometric standards are being used routinely in clinical practice. 

    This means that evaluation is based entirely on clinical judgment, without evidence of the predictive validity of those judgments. Setting of outcome standards (which has not yet been accomplished) would require evidence of meeting them and would perhaps force inclusion of objective measurements in addition to clinical judgment.

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