Effect of Telenursing Method on Self-Management in Patients with Chonic Disease.

EFFECT OF TELENURSING METHOD ON SELF MANAGEMENT IN PATIENT WITH CHRONIC DISEASE

Prapti, N.K.G., Nurhesti, O.Y., Tirtayasa,K., Damayanti, S

Lecturer of Nursing Department, Faculty of Medicine Udayana University

BACKGROUND

Chronic disease is a condition in which individuals suffering from the disease that can be controlled but not cured. Chronic disease has a variety of impact on physical function, psychological, economic, social and spiritual. The disease is generally followed by a variety of conditions such as chronic pain, disability, and limitation of function as well as the psychosocial issues that influence the quality of life of patients (CDC, 2006). Chronic diseases require the active participation of the patient for controlling and management of the disease throughout life.

Self-management refers to the ability of the individual (patient) to work with families, communities and health care providers to manage symptoms of the disease, therapy, lifestyle changes, and the consequences of psychosocial, cultural and spiritual related disease conditions (Richard & Shea, 2011) , Self-management can help individuals with chronic disease to make lifestyle changes and shows its existence as an independent individual in taking steps to self-healing.

The use of nursing technology in the treatment of patients with chronic diseases is very important to help patients controlling the disease through self-management. Telenursing is one way to facilitate the patients to perform self management using the nursing information technology in the form of telephone, SMS and social media use. According Locsin (2005), an important nursing technology was developed to support the delivery of nursing care.

The purpose of this study is to produce an innovation by leveraging technological development of nursing and community empowerment to assist individuals and families with chronic disease to manage the disease. This study is an ongoing pilot project that will be featured by nursing study program Faculty of Medicine, University of Udayana. The form of the use of technology combined with the use of telephone, SMS, BBM, WA, email, FB and Twitter in helping individuals and with chronic disease to manage the disease in five topics; nutrition, stress management, self-care, appropriate treatment protocols, illness and social support. Forms can be audio or audiovisual communication.

Measurement of the ability of self-management of patients with chronic disease can be done with a variety of measuring instruments, including the Patient Activation Measure (PAM), which is a measurement tool to assess the knowledge, confidence levels and the basic ability of patients in self-management. This instrument consists of 22 questions grouped into three components: believe in the importance of active involvement, confidence and knowledge related action self-management, the act of self-self-management, the ability to maintain self-management under stress (Hibbard & Tusler, 2007; Lieberman, 2003) ,

According to The Picker Institute Europe, 2005, interpretation PAM scores are as follows: Stage 1: the trust of patients to the importance of the roles of PAM score of 47.0 or less Stage 2: the confidence and knowledge to take action PAM score of 47.1 - 55.1

Stage 3: take action PAM score of 55.2 - 67.0

Stage 4: then manage themselves even under stress or pressure PAM score of 67.1 or more

Self-management with telenursing method is a method that integrates the concept of self-management with the help of technology and carried out by nurses in accordance with the authority held. This method is widely used to help patients with chronic diseases to manage the disease through lifestyle changes. Chronic disease with a variety of chronic characteristics such as; not curable, require control throughout a patient's life, there is an acute period between the chronic conditions, need stress management and social support to make this disease can be controlled.

Research conducted by Nilsson (2009) on the use of SMS to the medication adherence with chronic disease in the district in Sweden, shows there is increasing confidence in nurses and patient’s adherence to therapy protocols. Research conducted by Solomon (2008), Knight & Shea (2014) showed that there was significant relationship between self-management, patient characteristics and the use of technology. Telenursing provides variety of information related to self management in patients with chronic diseases such as; nutrient management, treatment protocols, social support and stress management.

MATERIALS AND METHODS

respondents, which split form the 27 respondents to the control group and 27 respondents for the treatment group. Processing of the data in the study include the steps of: editing, coding, and cleaning. The analysis of data used Man Whitney test because of the results of Shapiro Wilk normality test indicates the data were not normally distributed. The confidence level used is 95% and the value of significance alfa = 0.05. Measurement of self-management using Patient Activation Measure (PAM).

Researchers have considered the principles of ethics in doing any action or intervention in this study and all activities performed on a patient using the clear informed consent. Before the study began done ethical ethics clearance through the test conducted by research ethics committees FK unud/Sanglah Hospital in Denpasar, so this study considering the ethical principles like beneficence, Respect for human dignity, Justice.

RESULTS AND DISCUSSION

The age of patients suffering from chronic diseases are above 30 years and in both groups of patients with highest number of patients is in the age range 51-60 years and 31-40 years of age. Demand Falvo, (2005); Smelthzer Bare, Hinkle, Cheever, (2010), chronic diseases can be suffered by any age group, socio-economic and cultural level. According Oeffinger, Mertens & Sklar, (2006), the epidemiological transition has changed the course of various chronic diseases, with chronic diseases appear at increasingly younger ages due to various causes including lifestyle factors. In both groups the control of chronic disease affects more men than women are respectively 15 cases (55.56%) and 14 cases (51.85%).

Types of chronic disease most suffered by patients in the case group that does not do telenursing is DM and CKD with the number of each of 4 (14.81%), while in patients who do approach telenursing types of chronic diseases most was DM with the number and frequency of 5 (18:52%). According to WHO (2010), ten most chronic disease in 2009 based on data from inpatient hospitals in Indonesia is cancer, stroke, chronic kidney disease, heart disease, and the rest is a combination of various diseases. According to Clarke & Currie, (2009), the emergence of chronic disease will be followed by the emergence of other chronic diseases in the same individual so many people not only suffer from one type of chronic disease.

where the use of nursing information technology can improve the ability of self management in patients with chronic diseases. Results of other studies that support this research which PAM score was used to assess self management in patients with chronic disease do Greene and Hibbard (2012); Hibbard et al (2005), by providing information over the telephone and audiovisual on the community who are at risk of chronic disease shows there is an increase PAM scores for screening the disease in an individual.

According to Harvey, (2006); Popoola, (2005) a few factors that influence self-management in individuals with chronic diseases have been identified, namely: Demographic factors: These factors include socioeconomic status and cultural, Clinical factors: morbidity, mortality and the degree of complexity of the clinical conditions of the patient, Factor system: factor this includes the quality of relationships and communication with health care providers. This study uses a system of factors of effective communication between patients and health tenega to provide information on patients with chronic diseases of various patients with the necessary control and social support is expected. These factors can help patients to better understand themselves and illness.

Mann Whitney test results show the value of p = 0.000 where the value is less than 0.05 so there is a significant different of (significant) in the self-management of chronic disease patients given telehalth by phone and SMS and chronic disease patients who were not given telenursing. The results of this research together with research conducted by McCabe et al (2014), where there is increased self-management knowledge, support and ability rehabilitation in patients with chronic lung disease after being given information about the management of the disease. Research Sharma and Clark (2014) showed that the delivery of services by telenursing getting positive support from nurses who provide care to patients with chronic diseases as a new method in the delivery of nursing care. Telenursing able to be a method that removes the barriers of distance and time in patients with chronic diseases. Freedom of communication between patients with a nurse over the phone is a method of providing support according to some patients.

CONCLUSIONS AND RECOMMENDATIONS

Based on the results of research and discussion telenursing influence on self-management methods in patients with chronic disease can be concluded that PAM scores of patients with chronic diseases are given telenursing higher compared to patients with chronic diseases who are not given telenursing. Mann Whitney analysis indicates the value of p = 0.000 where the value is less than 0.05 so there is a significant different of self management in patients with chronic disease given telenursing nursing information via telephone and SMS and chronic disease patients who were not given telenursing. Telenursing method by using phone and SMS is a method that can be used to improve self-management of patients with chronic diseases.

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