Munce Sarah E P, Webster Fiona, Fehlings Michael G, Straus Sharon E, Jang Eunice, Jaglal Susan B
Institute of Health, Policy, Management and Evaluation, University of Toronto, Rehabilitation Sciences Building, 160-500 University Ave., Toronto, M5G 1 V7, ON, Canada.
Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
BMC Neurol. 2016 Jan 23;16:11. doi: 10.1186/s12883-016-0534-2.
The trend of decreasing length of stay in rehabilitation facilities has led to individuals with spinal cord injury (SCI) entering the community with unmet needs and fewer self-care skills to prevent secondary complications. The implementation of a self-management program for individuals with SCI for the management of these complex needs, including secondary complications, may be one option to fill these care gaps. A greater understanding of the meaning of self-management may facilitate the development of a tailored self-management program in this population. Thus, the current research aims to understand the meaning of self-management in traumatic SCI from the perspectives of individuals with traumatic SCI and their caregivers as well as acute care/trauma and rehabilitation managers.
A descriptive qualitative approach was used. Semi-structured telephone interviews were conducted with 26 individuals with traumatic SCI, their family members/caregivers, and managers from acute care/trauma and rehabilitation centres. Inductive thematic analysis was applied.
The meaning of self-management in SCI related to two overarching themes of internal and external responsibility attribution and revealed differences between the meaning of self-management in SCI among individuals with traumatic SCI and their caregivers versus managers. Overall, the meaning of self-management among the SCI and caregiver participants related principally to internal responsibility attribution. For the manager participants, the meaning of self-management was much narrower and the overarching theme of internal responsibility attribution that was observed among the SCI-caregiver dyads was not as widely expressed by this group.
Interventions that are co-created by users and health care professionals are associated with positive physical and mental health outcomes. Thus, the understanding of self-management from these varying perspectives could be applied to the development of a tailored self-management program that is relevant to individuals with traumatic SCI and their caregivers. This may involve the development of a program that uses some of the structure of traditional chronic disease self-management programs, in accordance with the beliefs held by the managers, but also incorporates elements of wellness/health promotion interventions, in accordance with the beliefs held by the SCI and caregiver participants.
康复机构住院时间缩短的趋势导致脊髓损伤（SCI）患者进入社区时存在未满足的需求，且自我护理技能较少，难以预防继发性并发症。为SCI患者实施自我管理计划以满足这些复杂需求，包括继发性并发症，可能是填补这些护理缺口的一种选择。更深入理解自我管理的含义可能有助于为该人群制定量身定制的自我管理计划。因此，当前研究旨在从创伤性SCI患者及其护理人员以及急性护理/创伤和康复管理人员的角度，了解创伤性SCI中自我管理的含义。
采用描述性定性研究方法。对26名创伤性SCI患者、其家庭成员/护理人员以及急性护理/创伤和康复中心的管理人员进行了半结构化电话访谈。应用归纳主题分析法。
SCI中自我管理的含义与内部和外部责任归因这两个总体主题相关，并揭示了创伤性SCI患者及其护理人员与管理人员对SCI中自我管理含义的差异。总体而言，SCI患者和护理人员参与者中自我管理的含义主要与内部责任归因有关。对于管理人员参与者，自我管理的含义要窄得多，SCI - 护理人员二元组中观察到的内部责任归因这一总体主题在该组中没有得到广泛体现。
由用户和医疗保健专业人员共同创建的干预措施与积极的身心健康结果相关。因此，从这些不同角度对自我管理的理解可应用于制定与创伤性SCI患者及其护理人员相关的量身定制的自我管理计划。这可能涉及根据管理人员的信念制定一个采用传统慢性病自我管理计划某些结构的计划，但也根据SCI患者和护理人员参与者的信念纳入健康促进干预措施的要素。
