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JOURANAL CLUB PRESENTATION:

JOURANAL CLUB PRESENTATION By Dr. Larissa Martha

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EFFECTS OF OREM-BASED NURSING INTERVENTION ON NUTRITIONAL SELF-CARE OF MYOCARDIAL PATIENTS

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The purpose of this study was to investigate the effect of a nursing intervention based on Orem’s (1985, 199 1) theory of nursing on the nutritional self-care of myocardial infarction (MI) patients.

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Orem’s (1985, 1991) self-care deficit theory of nursing conceptualizes self-care as the personal care that people require each day. The theory states that human beings have self-care agency (SCA) which is the capability for self care. human structure and function. One of these, the need for food, is the focus of this study.

Method:

Method Sample-Patients hospitalized with a myocardial infarction (the first within the past 5 years) were asked to consent to participate in the study. The sample included 62 men and 42 women who ranged in age from 34 to 83 years (M = 62, SD = 11 years). Ninety-eight of the subjects had just experienced their first MI, while the remaining eight had experienced a previous MI more than 5 years ago. Twenty of the subjects were diabetic, and 39 were classified as overweight based on body mass index of greater than 27.3 for females or greater that 27.8 for males (Whitney et al., 1990).

Measures:

Measures Nutritional self-care was measured two ways, with a diet record and with a questionnaire on dietary patterns. (1)For the diet record, patients were asked to write down everything they ate each day for three 24 hrs period. The West Diet Analysis program (Whitney et al., 1990) was used to computer analyze a 3-day food record for average daily nutrients.

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(2)The second measure of nutritional self-care was the food habits questionnaire (FHQ) which was developed which was developed to measure dietary patterns related to selecting low-fat diets (Kristal et al., 1990). There are 20 items answered on a scale of 1 (usually) to 4 (never) or a ‘not applicable’ response. The dimensions of dietary behavior assessed include: modifying meat; avoiding high-fat foods; substituting specially manufactured low-fat foods for their higher fat counterparts; replacing high-fat foods with low-fat alternatives; and increasing intake of fruit and vegetables. A lower score suggests healthy eating, while a higher score suggests unhealthy eating patterns. (3)Self-care agency (SCA) was measured with the appraisal of self-care agency (ASA) scale. The scale contains 24 items rated on five-point Likert scales. Total scores can range from 24 (low SCA) to 120 (high SCA).

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(4)Self-efficacy for health eating was measured with the Eating Habits Confidence Scale (EHCS; Sallis et al., 1988). The EHCS contains 20 items which address four factors: (1) resisting relapse; (2) reducing calories; (3) reducing salt; and (4) reducing fat. Subjects are asked to rate how confident they are that they could really motivate themselves to do things like these consistently, for at least 6 months. Ratings are on a five-point Likert -like scale from (1) “I know I cannot” to (5) “I know I can”.

Procedure :

Procedure Subjects who had experienced a myocardial infarction were contacted in one of two community, general hospitals used for the study. Nursing intervention protocol- During the nursing intervention home visit to the treatment group, data from the hospital interview on food habits and from the 3-day diet record (before analysis) were used, along with observation and questioning, to determine dietary behavior related to food selection, meal preparation, and eating out with friends. All patients received a booklet about how to modify life style following MI before leaving hospital. Patients were asked if they had any questions about this written material as it related to their diets. kGuidelines for lowering animal fat and all fat in the diet were emphasized and the fiber content of various foods was discussed. Examples from their own diet records were used to illustrate positive and negative habits. Analysis of the 3-day diet record provided information about daily total fat and saturated fat intakes as percent of caloric intake and on daily intake of cholesterol and fiber.

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Healthy self-care behavior related to diet was recognized and encouraged in the initial home visit and in three follow-up telephone calls ver the next 6 weeks. The importance of home visit and in three follow-up telephone calls over the next 6 weeks.

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