Self Management in Nursing Essay

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A Concept Analysis in Behavior Management: Self-Management in Psych Nursing

Introduction

In nursing, when it comes to behavior management—i.e., helping individuals to alter their behavior in order to achieve a positive aim—various strategies are available. One concept of behavior management that has been handed down over generations of nursing practice is the concept of self-management. This concept analysis paper will analyze self-management by describing a history of the concept, its defining characteristics and attributes, antecedents and consequences, various cases related to the concept, empirical measurements, and recommendations following a discussion of the analysis.

Aims and Purposes of Analysis

Aims

The aims of this analysis are:

1) to obtain better understanding of a concept;

2) to obtain clarity in terms of what the concept means and how it impacts an environment, a population, a sector, an industry or a strategy; and

3) to establish definition in terms of empirical evidence that can be used to develop evidence-based practice, which is so crucial for the improvement of quality care in nursing overall (Northington, 2018).

Purpose

The purpose of this analysis is to define the concept of behavioral self-management as it applies to psych nursing by:

a. evaluating the history of the concept—how it was identified, developed, tested and revised

b. defining its characteristics and attributes

c. analyzing model, borderline, related and contrary cases

d. obtaining empirical measurements

e. and discussing the research so as to give recommendations for practice

Definition

My definition of self-management as I understand it is that behavioral self-management is an empowering tool that appeals to the need of the patient to be more engaged with and actively participating in the patient’s own care process. Self-management occurs when patients are active participants in the care process, when they oversee the care strategy designed and developed between them and their care provider so that the patient can manage their own care and be more engaged in the process, and when the implement the care design themselves in order to manage effectively their own behavior and bring it into conformity with the target goals of the behavior management process

Using this definition will help to add to the nursing body of knowledge because it uses combines specific terms that integrate a number of theories to help support a concept of behavior self-management that be used in the psych nursing field. These theories include Maslow’s (1943) theory of human motivation and the needs hierarchy that he developed to explain the progression of motivation by having lower level needs met first as the individual grows to a level of self-actualization.

Other theories included in this definition that help to expand its meaning and give it new application are the theories of classical conditioning developed by Pavlov (1927) and Skinner (1953). These two theories helped to lead the way to cognitive behavior theory, which was then developed into one of the leading psychoanalytic therapies today—cognitive behavioral therapy (CBT). CBT plays a part in behavior self-management in that the target behavior is identified by the patient with the assistance of the psych nurse and the patient is then given the tools and empowered to self-manage his or her own behavior in order to reach the target.

Literature Review

Databases Searched

· PsycINFO

· U.S. National Library of Medicine’s MEDLINE,

· Cochrane Database of Systematic Reviews

· Cochrane Central Register of Controlled Trials

· American Psychological Association’s PsycARTICLES

· Sociology Research Database SocINDEX

· Cumulative Index to Nursing and Allied Health Literature (CIHAHL)

Keywords used to conduct the searches were “behavior self-management.”

History of Concept

How it was identified. Creer was the first to use the term (Grady & Gough, 2014), which he applied to “indicate that the patient was an active participant in their care” (Lubkin & Larsen, 2013, p. 552). For Creer, self-management referred to the practice of giving the patient more say in terms of making decisions about how the care should proceed, the goals, and so on—much of which is currently used in the practice of cognitive behavioral therapy.


How it was developed. The concept was developed over time as care providers saw a need to include patients in the process of their own care. Patients have often demonstrated a need to feel more included in their own care process, and this concept developed as a result of providers realizing they needed to meet this need more effectively (Baird, Rehm, Hinds, Baggot, Davies, 2016; Al Danaf et al., 2017). As the concept was applied in diverse ways with diverse settings under diverse conditions, outcomes have been, predictably, diverse (Lubkin & Larsen, 2013).

How it was tested. The impact of self-management has been tested in various fields using both qualitative and quantitative analysis: for example, there have been studies conducted using multivariate statistical analysis (Verchota & Sawin, 2016), self-reporting (Schilling et al., 2009a, 2009b), experiment (Lorig et al., 1999), meta-analysis testing of participants (Chodosh et al., 2005) and interviews and surveys (Lorig, Sobel, Ritter, Laurent & Hobbs, 2001).

Examples include:

· Lorig et al. (1999) in which the researchers examined 952 patients in a randomized control trial. The researchers’ intervention was a Chronic Disease Self-Management Program which took place over seven weeks, with sessions explaining how to self-manage so as to achieve self-identified goals rather than to achieve goals prescribed by a care giver. Measures consisted of health behavior, status and utility. Results showed that participants benefited by have fewer limitations six months after the intervention, less tiredness, and decreased anxiety about their health care.

· Chodosh et al. (2005) attempted to measure the effect of self-management on patients suffering from hypertension. The findings showed that it was unclear what exactly constituted self-management and therefore it was difficult to effectively measure whether self-management had any real impact on care, though among the participants blood pressure levels did drop.

How it was revised. The concept was revised over the years and incorporated by various care providers into various disciplines so that it took on multiple meanings, vague meanings, looser definition, and overall ceased to possess a clear definition. In short, self-management was a concept that applied to anytime a patient overtook the day to day operations of administering self-care for chronic conditions.

Defining Characteristics or Attributes

Characteristics

The defining characteristics of behavior self-management are that the patient is in control of the process of assigning targeted goals and of overseeing the process of implementation. The patient is managing the process by assuming responsibility for the process and accountability—i.e., keeping accurate records of progression of the care process. A degree of collaboration exists between the patient and the provider, but the primary decision maker in terms of setting goals is the patient.

Attributes

The defining attributes of behavior self-management are diverse and can range depending on the patient and the type of problem being addressed. Thus the attributes can include any of the following (Green, 2014):

Proactive lifestyle. This includes any type of behaviors that the patient proactively engages in to support physical and mental health. Diet, exercise, recreation all fit into this attribute category. So too does the patient’s demonstration of an ability to research the illness or health issue and discover more information that can be included into a proactive lifestyle plan to facilitate full recovery.

Proactive problem-solving management. This includes any type of management practice designed to address a health problem suffered by the patient. Such practices would be taking medication, monitoring mood, blood pressure, etc.

Proactive collaboration. This type of attribute includes any sort of support person or group that the patients utilizes and who takes a vested interest in supplying support and even assuming a degree of responsibility for the patient. Activities include checking on the patient, providing expert advice if the support person is an expert on the area of need, and so on.

Proactive mental support. This includes behaviors that the patient takes in order to facilitate the development of a healthy mental status. The patient demonstrates awareness,….....

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References

Al Danaf, J., Chang, B. H., Shaear, M., Johnson, K. M., Miller, S., Nester, L., ... & Aboumatar, H. J. (2017). Surfacing and addressing hospitalized patients’ needs: Proactive nurse rounding as a tool. Journal of Nursing Management, https://doi.org/10.1111/jonm.12580

Baird, J., Rehm, R., Hinds, P., Baggot, C., Davies, B. (2016). Do you know my child? Continuity of nursing care in the pediatric intensive care unit. Nursing Research, 65(2): 142-150.

Chodosh, J., Morton, S. C., Mojica, W., Maglione, M., Suttorp, M. J., Hilton, L., ... & Shekelle, P. (2005). Meta-analysis: chronic disease self-management programs for older adults. Annals of Internal Medicine, 143(6), 427-438.

Grady, P. A., & Gough, L. L. (2014). Self-management: a comprehensive approach to management of chronic conditions. American Journal of Public Health, 104(8), e25-e31.

Green, A. C. (2014). A Concept Analysis of Self-Management Behavior and its Implications in Research and Policy.

Lorig, K. R., Sobel, D. S., Stewart, A. L., Brown Jr, B. W., Bandura, A., Ritter, P., ... & Holman, H. R. (1999). Evidence suggesting
that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial. Medical Care, 37(1), 5-14.

Lorig, K. R., Sobel, D. S., Ritter, P. L., Laurent, D., & Hobbs, M. (2001). Effect of a self-management program on patients with chronic disease. Effective Clinical Practice: ECP, 4(6), 256-262.

Lubkin, I. & Larsen, P. (2013). Chronic illness: Impact and intervention. Jones & Bartlett Publishers.

Maslow, A. H. (1943). A theory of human motivation. Psychological Review, 50(4), 370.

Northington, L. (2018). The novel project. Journal of Intensive and Critical Care Nursing, 1(1).

Pavlov, I. P. (1927). Conditional reflexes: an investigation of the physiological activity of the cerebral cortex. Oxford, England: Oxford Univ. Press.

Schilling, L. S., Dixon, J., K., Knafl, K. A., Lynn, M. R., Murphy, K., Dumser, S., & Grey, M. (2009a). A new self-report measure of self-management of Type 1 diabetes for adolescents. Nursing Research, 58, 228-236.

Schilling, L. S., Dixon, J. K., Knafl, K. A., Lynn, M. R., Murphy, K., Dumser, S., & Grey, M. (2009b). A new self-report measure of self-management of type 1 diabetes for adolescents. Nursing Research, 37, 87-99.

Skinner, B. F. (1953). Science and human behavior (No. 92904). Simon and Schuster.

Verchota, G., & Sawin, K. J. (2016). Testing components of a self-management theory in adolescents with Type 1 Diabetes Mellitus. Nursing Research, 65(6), 487-495.

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