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      Incentives for self-management after coronary artery bypass graft surgery

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          Abstract

          Background:

          Chronic illnesses such as coronary heart disease are among the most prevalent and costly of all global health problems. Coronary heart disease is a leading cause of death worldwide, including Iran. One aspect of living with chronic illness is self-management which can reduce the impact of illness on daily life and maintain the quality of life. A qualitative understanding of how patients perceive the necessity of self-management is important for self-management support. The current study aims to determine patients’ perception of the need for self-management following coronary artery bypass graft (CABG) surgery.

          Materials and Methods:

          We used a content analysis approach to conduct this qualitative study. Data were collected by interviews with 25 patients who underwent CABG surgery at least 1 year prior to the study. Purposeful, followed by theoretical sampling was used until data saturation. Data were analyzed by descriptive qualitative content analysis according to the Graneheim and Lundman approach.

          Results:

          Participants had different perceptions regarding the need for self-management. Three themes, “reflective thinking,” “information revision,” and “beliefs influences,” comprised the basis of forming patients’ perceptions to the need for self-management.

          Conclusions:

          Patients’ perceptions vary regarding the need for self-management. The difference in perception should be the basis for training programs to guide CABG patients for successful self-management.

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          Most cited references25

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          The influence of social support on chronic illness self-management: a review and directions for research.

          A review of the empirical literature examining the relationship between social support and chronic illness self-management identified 29 articles, of which 22 were quantitative and 7 were qualitative. The majority of research in this area concerns diabetes self-management, with a few studies examining asthma, heart disease, and epilepsy management. Taken together, these studies provide evidence for a modest positive relationship between social support and chronic illness self-management, especially for diabetes. Dietary behavior appears to be particularly susceptible to social influences. In addition, social network members have potentially important negative influences on self-management There is a need to elucidate the underlying mechanisms by which support influences self-management and to examine whether this relationship varies by illness, type of support, and behavior. There is also a need to understand how the social environment may influence self-management in ways other than the provision of social support
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            Delineation of self-care and associated concepts.

            The purpose of this paper is to delineate five concepts that are often used synonymously in the nursing and related literature: self-care, self-management, self-monitoring, symptom management, and self-efficacy for self-care. Concepts were delineated based on a review of literature, identification of relationships, and examination of commonalities and differences. More commonalities than differences exist among self-care, self-management, and self-monitoring. Symptom management extends beyond the self-care concepts to include healthcare provider activities. Self-efficacy can mediate or moderate the four other concepts. Relationships among the concepts are depicted in a model. A clearer understanding of the overlap, differences, and relationships among the five concepts can provide clarity, direction and specificity to nurse researchers, policy makers, and clinicians in addressing their goals for health delivery. Concept clarity enables nurses to use evidence that targets specific interventions to individualize care toward achieving the most relevant goals. © 2011 Sigma Theta Tau International.
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              Novel therapeutic concepts: the epidemic of cardiovascular disease in the developing world: global implications.

              The epidemic of cardiovascular disease (CVD) is a global phenomenon, and the magnitude of its increase in incidence and prevalence in low- and middle-income countries (LIMIC) has potentially major implications for those high-income countries that characterize much of the developed world. Cardiovascular disease remains the leading cause of death in the world and approximately 80% of all cardiovascular-related deaths occur in LIMIC and at a younger age in comparison to high-income countries. The economic impact in regard to loss of productive years of life and the need to divert scarce resources to tertiary care is substantial. The 'epidemiologic transition' provides a useful framework for understanding changes in the patterns of disease as a result of societal and socioeconomic developments in different countries and regions of the world. A burning but as yet unanswered question is whether gains made over the last four decades in reducing cardiovascular mortality in high-income countries will be offset by changes in risk factor profiles, and in particular obesity and diabetes. Much of the population attributable risk of myocardial infarction is accountable on the basis of nine modifiable traditional risk factors, irrespective of geography. Developing societies are faced with a hostile cardiovascular environment, characterized by changes in diet, exercise, the effects of tobacco, socioeconomic stressors, and economic constraints at both the national and personal level in addition to exposure to potential novel risk factors and perhaps a genetic or programmed foetal vulnerability to CVD in later life. There are major challenges for primary and secondary prevention including lack of data, limited national resources, and the lack of prediction models in certain populations. There are two major approaches to prevention: public health/community-based strategies and clinic-based with a targeted approach to high-risk patients and combinations of these. There are concerns that in comparison with communicable diseases, cardiovascular and chronic diseases have a relatively low priority in the global health agenda and that this requires additional emphasis. The human race has had long experience and a fine tradition in surviving adversity, but we now face a task for which we have little experience, the task of surviving prosperity Alan Gregg 1890-1957, Rockefeller Foundation.
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                Author and article information

                Journal
                Iran J Nurs Midwifery Res
                Iran J Nurs Midwifery Res
                IJNMR
                Iranian Journal of Nursing and Midwifery Research
                Medknow Publications & Media Pvt Ltd (India )
                1735-9066
                2228-5504
                February 2014
                : 19
                : 7 Suppl1 , Special Issue on Health and Wellbeing 2014
                : S64-S70
                Affiliations
                [1 ]Department of Nursing, Faculty of Nursing and Midwifery, Kerman University of Medical Sciences (International Unit), Kerman, Iran
                [2 ]Department of Nursing, Faculty of Nursing and Midwifery, Khorasgan (Isfahan) Branch, Islamic Azad University, Isfahan, Iran
                [3 ]Department of Nursing, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
                [4 ]Department of Nursing, Faculty of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
                Author notes
                Address for correspondence: Dr. Majid Kazemi, Department of Nursing, Faculty of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran. E-mail: maj_kaz@ 123456yahoo.com
                Article
                IJNMR-19-64
                4402997
                da66cb5c-6633-4445-a6da-f3f58a9faaf1
                Copyright: © Iranian Journal of Nursing and Midwifery Research

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 21 September 2014
                : 03 December 2014
                Categories
                Original Article

                Nursing
                chronic disease,self-care,self-management
                Nursing
                chronic disease, self-care, self-management

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