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      Effect of an education program on knowledge, self-care behavior and handwashing competence on prevention of febrile neutropenia among breast cancer patients receiving Doxorubicin and Cyclophosphamide in Chemotherapy Day Centre

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          Abstract

          Objective:

          To evaluate the efficacy of an education program on the prevention of febrile neutropenia (FN) among breast cancer patients receiving AC regimen.

          Methods:

          Randomized controlled trial with the repeated-measures design was conducted in a Chemotherapy Day Centre of an acute hospital in Hong Kong. Twenty-five subjects in the intervention group received an individual education session followed by three follow-up sessions and routine care. Twenty-four subjects in the control group received routine care. Primary outcomes included the incidence of admission due to FN, the self-care behavior adherence, the knowledge level on prevention of FN and the self-efficacy in self-management, handwashing competence were assessed by self-designed questionnaires, Chinese version of patient activation measure, and handwashing competence checklist.

          Results:

          No statistically significant difference between the intervention group and the control group on the incidence of admission due to FN, the self-efficacy in self-management, and the knowledge on prevention of FN. The self-care behavior adherence was significant at cycle 4 of AC regimen in favor of the intervention group ( P = 0.036). Handwashing competence improved more significantly among subjects in the intervention group than the control group ( P = 0.009).

          Conclusions:

          The education program on the prevention of FN had significantly favorable effects on self-care behavior adherence and handwashing competence across time. However, the intervention did not lead to statistically significant improvement on the incidence of admission due to FN, the self-efficacy in self-management and the knowledge level on prevention of FN.

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          Most cited references34

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          Development and testing of a short form of the patient activation measure.

          The Patient Activation Measure (PAM) is a 22-item measure that assesses patient knowledge, skill, and confidence for self-management. The measure was developed using Rasch analyses and is an interval level, unidimensional, Guttman-like measure. The current analysis is aimed at reducing the number of items in the measure while maintaining adequate precision. We relied on an iterative use of Rasch analysis to identify items that could be eliminated without loss of significant precision and reliability. With each item deletion, the item scale locations were recalibrated and the person reliability evaluated to check if and how much of a decline in precision of measurement resulted from the deletion of the item. The data used in the analysis were the same data used in the development of the original 22-item measure. These data were collected in 2003 via a telephone survey of 1,515 randomly selected adults. Principal Findings. The analysis yielded a 13-item measure that has psychometric properties similar to the original 22-item version. The scores for the 13-item measure range in value from 38.6 to 53.0 (on a theoretical 0-100 point scale). The range of values is essentially unchanged from the original 22-item version. Subgroup analysis suggests that there is a slight loss of precision with some subgroups. The results of the analysis indicate that the shortened 13-item version is both reliable and valid.
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            The process of empowerment: a model for use in research and practice.

            In this article, we propose a model of the process of empowerment. The notion of empowerment is compelling and much employed across many subfields inside and outside of psychology, but the lack of consistency in the ways prior literature has defined it is an obstacle to meaningful synthesis of findings and consistent application in practice. Our empowerment process model builds on prior work in taking the following steps: articulating empowerment as an iterative process, identifying core elements of that process, and defining the process in a way that is practically useful to both researchers and practitioners with terms that are easily communicated and applied. The components of the model are personally meaningful and power-oriented goals, self-efficacy, knowledge, competence, action, and impact. Individuals move through the process with respect to particular goals, doubling back repeatedly as experience promotes reflection. We make specific recommendations for research and practice and discuss applications to social justice. (c) 2010 APA, all rights reserved
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              Patient empowerment: The need to consider it as a measurable patient-reported outcome for chronic conditions

              Background Health policy in the UK and elsewhere is prioritising patient empowerment and patient evaluations of healthcare. Patient reported outcome measures now take centre-stage in implementing strategies to increase patient empowerment. This article argues for consideration of patient empowerment itself as a directly measurable patient reported outcome for chronic conditions, highlights some issues in adopting this approach, and outlines a research agenda to enable healthcare evaluation on the basis of patient empowerment. Discussion Patient empowerment is not a well-defined construct. A range of condition-specific and generic patient empowerment questionnaires have been developed; each captures a different construct e.g. personal control, self-efficacy/self-mastery, and each is informed by a different implicit or explicit theoretical framework. This makes it currently problematic to conduct comparative evaluations of healthcare services on the basis of patient empowerment. A case study (clinical genetics) is used to (1) illustrate that patient empowerment can be a valued healthcare outcome, even if patients do not obtain health status benefits, (2) provide a rationale for conducting work necessary to tighten up the patient empowerment construct (3) provide an exemplar to inform design of interventions to increase patient empowerment in chronic disease. Such initiatives could be evaluated on the basis of measurable changes in patient empowerment, if the construct were properly operationalised as a patient reported outcome measure. To facilitate this, research is needed to develop an appropriate and widely applicable generic theoretical framework of patient empowerment to inform (re)development of a generic measure. This research should include developing consensus between patients, clinicians and policymakers about the content and boundaries of the construct before operationalisation. This article also considers a number of issues for society and for healthcare providers raised by adopting the patient empowerment paradigm. Summary Healthcare policy is driving the need to consider patient empowerment as a measurable patient outcome from healthcare services. Research is needed to (1) tighten up the construct (2) develop consensus about what is important to include (3) (re)develop a generic measure of patient empowerment for use in evaluating healthcare (4) understand if/how people make trade-offs between empowerment and gain in health status.
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                Author and article information

                Journal
                Asia Pac J Oncol Nurs
                Asia Pac J Oncol Nurs
                APJON
                Asia-Pacific Journal of Oncology Nursing
                Medknow Publications & Media Pvt Ltd (India )
                2347-5625
                2349-6673
                Oct-Dec 2015
                : 2
                : 4
                : 276-288
                Affiliations
                [1 ]Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong, SAR, China
                [2 ]School of Nursing, The Hong Kong Polytechnic University, Hong Kong, SAR, China
                Author notes
                Corresponding author: Wai Chi Mak E-mail: mwc419@ 123456yahoo.com.hk
                Article
                APJON-2-276
                10.4103/2347-5625.167232
                5123502
                27981125
                ea52a063-6cfa-45f9-9f7c-b98cc6368867
                Copyright: © 2016 Ann & Joshua Medical Publishing Co. Ltd

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                : 26 June 2015
                : 16 August 2015
                Categories
                Original Article

                chemotherapy,education,febrile neutropenia,neutropenia
                chemotherapy, education, febrile neutropenia, neutropenia

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