Assessment of self-care agency in patients with chronic obstructive pulmonary disease
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The problem of the study was to determine if self-care agency is related to recidivism, or frequency of hospitalization. Dorothea Orem's Theory of Self-Care provided propositions upon which the study was based. The descriptive correlational research design utilized a nonprobability, purposive sampling method to assess levels of self-care agency and demographic data in 37 patients with chronic obstructive pulmonary disease (COPD). Self-care agency was operationalized by the Assessment of Self-Care Agency (AS-CA) tool, modified from Bickel and Hanson's Perception of Self-Care Agency tool. A pilot study documented initial reliability and validity of the AS-CA tool, with a coefficient alpha of.87, and with construct validity assessed by factor analysis. The four AS-CA subscale factors are cognitive skills, mobility, motivation, and psychomotor skills. Cognitive skills and mobility account for 87.9% of the variance, indicating a high degree of construct validity. Reliability and validity of the AS-CA in the COPD sample resulted in similar findings, with a coefficient alpha of.85, and with an intact four factor structure. Statistical analysis included Pearson correlation coefficients and ANOVA. Analysis of the data found no significant correlation between self-care agency and frequency of hospital admissions. However, when the sample was divided into two groups (0-1 and 2 or more admissions) using discriminant analysis, statistically significant differences between the two groups were found for the total AS-CA score, and for the mobility and psychomotor skills subscale scores. Nurses should note that no significant relationship was found between cognitive skills and frequency of admission, and that no significant difference was found between the two admission groups on the cognitive subscale, because discharge planning tends to be directed toward cognitive skills rather than toward self-care deficits which have been assessed. Nurses may be better able to affect changes in mobility and in psychomotor skills through assessment of patient ability in these two areas, followed by appropriate nursing interventions, thus preventing or decreasing readmissions.