A study on diabetes-related self-care plan and its determinants among diabetes patients in a Warangal region, Telangana, India

Abstract The prevalence of epidemiological diseases, including diabetes, has continued to increase because of the adaption of Western culture and the lack of self-care activities among patients with diabetes. Therefore, in this cross-sectional study, we aimed to assess self-care plans and determinants among diabetes outpatients in Warangal. We conducted a prospective observational study among diabetes outpatient clinic in Warangal, India over 6 months from October 2019 to March 2020. We used the expanded Summary of Diabetes Self-Care Activities (SDSCA) questionnaire. A P value of less than < 0.05 was considered statistically significant. Respondents (mean age, 52.3 (standard deviation (SD), 11.01) years) had an overall SDSCA score of 49.18 ± 3.57 (SD). Mean scores for the diet, physical activity, foot care, medication adherence, and blood sugar testing scales were 12.79 (SD, 1.61), 10.24 (SD, 1.77), 15.67 (SD, 1.5), 5.66 (SD, 1.17), and 4.80 (SD, 0.68), respectively. Patients' age, education, disease duration and hemoglobin A1C (HbA1C) levels of <7.5% (P < 0.001)) had significantly higher mean scores for blood sugar testing, diet, physical activity, and adherence (P < 0.001). The employment status is associated with all the domains of Summary of Diabetes Self-Care Activities (P < 0.001). Taken together, our results revealed that patients with diabetes in Warangal had poor self-care planning, highlighting the need for strengthening initiatives that generate awareness regarding diabetes and improving related self-care practices

Medical Education and the Ethics of Self-Care: A Survey of Medical Students Regarding Professional Challenges and Expectations for Living Healthy Lifestyles.

OBJECTIVES: Little is known about medical students' attitudes regarding the healthy lifestyle habits they are taught to recommend to patients and whether they believe they have a professional responsibility to live a healthy lifestyle. Understanding students' attitudes and practices regarding healthy lifestyles may provide insights into the personal and professional challenges that students face as they navigate the ethical tension between obligations to care for others (altruism) and for themselves (self-care). METHODS: The authors conducted a cross-sectional, anonymous, online survey of all medical students at the University of Iowa Carver College of Medicine in fall 2019, using descriptive statistics for analysis. RESULTS: A total of 351 students participated (response rate, 52.0%). Most agreed that physicians (85.5%) and medical students (77.8%) have a responsibility to try to live a healthy lifestyle; that physicians who practice healthy behaviors are more confident in counseling patients (94.0%), more likely to counsel patients (88.3%), and more likely to have their advice followed (86.9%); that as students they are more likely to counsel patients if they practice the healthy behavior (90.0%); and that their medical school workload resulted in exercise (69.7%), sleeping (69.4%), and eating (60.2%) practices that were less healthy than they should be. CONCLUSIONS: Most medical students support the professional responsibility to live a healthy lifestyle and believe doing so increases their effectiveness in counseling patients about healthy lifestyle habits. The medical school workload may limit some students' ability to live healthy lifestyles, however. Medical students need educational opportunities in ethics and professionalism to discuss challenges and expectations for living healthy lifestyles, with an eye toward practical approaches to living the life of a medical student that are professionally responsible and personally realistic.

Ethical Aspects of Personal Science for Persons with Parkinson's Disease: What Happens When Self-Tracking Goes from Selfcare to Publication?

Using Parkinson's disease as an exemplary chronic condition, this Commentary discusses ethical aspects of using self-tracking for personal science, as compared to using self-tracking in the context of conducting clinical research on groups of study participants. Conventional group-based clinical research aims to find generalisable answers to clinical or public health questions. The aim of personal science is different: to find meaningful answers that matter first and foremost to an individual with a particular health challenge. In the case of personal science, the researcher and the participant are one and the same, which means that specific ethical issues may arise, such as the need to protect the participant against self-harm. To allow patient-led research in the form of personal science in the Parkinson field to evolve further, the development of a specific ethical framework for self-tracking for personal science is needed.

Self-care as care left undone? The ethics of the self-care agenda in contemporary healthcare policy.

Self-care, or self-management, is presented in healthcare policy as a precursor to patient empowerment and improved patient outcomes. Alternatively, critiques of the self-care agenda suggest that it represents an over-reliance on individual autonomy and responsibility, without adequate support, whereby 'self-care' is potentially unachievable and becomes 'care left undone'. In this sense, self-care contributes to a blame culture where ill-health is attributed to personal behaviours or lack thereof. Furthermore, self-care may represent a covert form of rationing, as the fiscal means to enable effective self-care and supplement, or replace, self-care capacities, is not provided. This paper explores these arguments through a contemporary ethical analysis of the self-care agenda. The terms self-care and self-management are used interchangeably throughout whereby self-management is understood as a point in the wider self-care continuum.

El camino de desarrollo personal a través del cuidado de San Juan de Dios / The path of personal development through the care of Saint John of God

FUNDAMENTO: La enfermería, por su vocación de servicio y al estar en contacto diario con el mundo del sufrimiento y la muerte, puede padecer una fatiga por compasión o un burn-out. Por ello es necesario la mejora de ciertas habilidades psico-espirituales para seguir desarrollándose como personas y profesionalmente, de manera que a través del autocuidado puedan llegar a alcanzar una mayor eficacia e integralidad en sus cuidados, a la vez que mejore su salud y autorrealización. OBJETIVO: describir las habilidades psico-espirituales en la enfermería propuestas por San Juan de Dios, influido por su guía espiritual San Juan de Ávila. METODOLOGÍA: realizamos un estudio historiográfico siguiendo la corriente de la historia de las mentalidades. Resultados principales: desde su juventud, Juan de Dios supo que su vocación era cuidar todo tipo de injusticias, especialmente de aquellos más vulnerables como son los pobres y enfermos. Sin embargo, presentaba ciertas dificultades para mantenerse con salud, siendo su guía espiritual quien fue marcando el desarrollo de las habilidades psico-espirituales para que, a través del autocuidado, pudiese cuidar al otro sin sufrir en su cuerpo o en su espíritu. Estas habilidades fueron las que le dieron su calidad humana y asistencial, cuidando de manera integral al otro sin abandonarse a sí mismo, convirtiendo la profesión en un camino de desarrollo personal. CONCLUSIONES: el padre de la enfermería moderna desarrolló tres habilidades psicológicas y tres habilidades espirituales por diadas, las cuales hoy en día son descritas como empatía-compasión, aceptación incondicional-hospitalidad, y autenticidad-presencia. Con ello, a través del autocuidado llegó a crear un modelo de enfermería que aún hoy se mantiene en el tiempo

INTRODUCTION: Nursing, due to its vocation of service and being in daily contact with the world of suffering and death, can suffer from compassion fatigue or burn-out. Therefore, it is necessary to develop certain psycho-spiritual skills to continue developing as individuals and professionally, so that through self-care they can achieve greater efficiency and comprehensiveness in their care, while improving their health and self-realization. OBJECTIVE: describing the psycho-spiritual abilities in Nursing proposed by San Juan de Dios, influenced by his spiritual guide San Juan de Ávila. METHODOLOGY: we carried out a historiographic study following the current of the history of mentalities. Documentary analysis: from his youth, Juan de Dios knew that his vocation was to take care of all kinds of injustices, especially those most vulnerable such as the poor and the sick. However, he had certain difficulties to stay healthy, being his spiritual guide who was marking the development of psycho-spiritual abilities so that, through self-care, he could take care of the other without suffering in his body or in his spirit. These skills were what gave him his human and caring quality, taking care of the other in an integral way without abandoning himself, turning the profession into a path of personal development. CONCLUSIONS: the father of modern nursing developed 3 psychological abilities and 3 spiritual abilities per dyad, which today are described as empathy-compassion, unconditional acceptance-hospitality, and authenticity-presence. With this, through self-care he came to create a Nursing that even today is maintained over time

Duties to Self: The Nurse as a Person of Dignity and Worth.

There is a historical emphasis on duties to self, or self-regarding duties, in nursing's ethics heritage literature from the 1860s to 1965. Yet, as nursing education shifted to university settings and society and nursing moved away from a virtue-based ethics to a duty-based ethics, the emphasis on self-regarding duties was lost. In the 2001 revision of the American Nurses Association's Code of Ethics for Nurses with Interpretive Statements, that emphasis is reclaimed and restored. The 2015 version of the Code further develops and expands the ethical obligation of duties to self. The aggregate duty or principle of "duties to self" includes attention to personal health, safety, and well-being, preserving one's wholeness of character and integrity, maintaining competence, and continuing personal and professional growth.

Machine learning in medicine: Addressing ethical challenges.

Effy Vayena and colleagues argue that machine learning in medicine must offer data protection, algorithmic transparency, and accountability to earn the trust of patients and clinicians.

A mobile revolution for healthcare? Setting the agenda for bioethics.

Mobile health (mHealth) is rapidly being implemented and changing our ways of doing, understanding and organising healthcare. mHealth includes wearable devices as well as apps that track fitness, offer wellness programmes or provide tools to manage chronic conditions. According to industry and policy makers, these systems offer efficient and cost-effective solutions for disease prevention and self-management. While this development raises many ethically relevant questions, so far mHealth has received only little attention in medical ethics. This paper provides an overview of bioethical issues raised by mHealth and aims to draw scholarly attention to the ethical significance of its promises and challenges. We show that the overly positive promises of mHealth need to be nuanced and their desirability critically assessed. Finally, we offer suggestions to bioethicists to engage with this emerging trend in healthcare to develop mHealth to its best potential in a morally sound way.

A ética do cuidado de si como criação de possíveis no trabalho em Saúde / The ethics of self-care as a way of creating potential tools for work in Health / La ética del cuidado de sí como creación de posibles instrumentos en el trabajo en Salud

O objetivo deste artigo é contribuir para a discussão das práticas de produção do cuidado pautadas pelo desafio de se deslocarem da hegemonia dos referenciais prescritivos e homogeneizantes no campo da Saúde, isto é, daqueles que submetem os processos de experimentação de uma vida a uma ideia geral e abstrata de vida, buscando enquadrar a experiência dos sujeitos em verdades que ditam maneiras de viver baseadas em concepções moralizantes e despotencializadoras. Nosso esforço será o de pensar, a partir da filosofia de Michael Foucault, um modo de estar em meio aos processos de produção do cuidado calcados por uma perspectiva ética em favor da vida em seu sentido mais amplo, norteados por aquilo que o filósofo denominou de uma "ética do cuidado de si".(AU)

The objective of this paper is to contribute to the discussion about practices in the offer of care, guided by the challenge of escaping from the hegemony of prescriptive and homogenizing references in the field of Health, specifically those references that subsume processes of experimentation of a life in to a general and abstract notion of life. This is done with the aim of fitting subjects' experiences into truths that prescribe ways of living that are based on moralizing and undermining conceptions. Based on the work of the philosopher Michael Foucault, the focus of the paper will be on thinking about a way of being in the midst of health care work, grounded in an ethical viewpoint that supports the notion of life in its broadest sense, guided by what Foucault called the "ethics of self-care".(AU)

El objetivo de este artículo es contribuir con la discusión de las prácticas de producción del cuidado, regidas por el desafío de su desplazamiento de la hegemonía de los factores referenciales prescriptivos homogenizados en el campo de la Salud, es decir, de aquellos que someten los procesos de experimentación de una vida a una idea general y abstracta de la vida, buscando encuadrar la experiencia de los sujetos en verdades que dictan formas de vivir basadas en concepciones moralizantes y despotencializadoras. Nuestro esfuerzo será el de pensar, a partir de la filosofía de Michael Foucault, un modo de estar en el medio de los procesos de producción del cuidado basados en una perspectiva ética a favor de la vida en su sentido más amplio, norteados por aquello que el filósofo denominó de una "ética del cuidado de sí".(AU)

Commercial speech in the realm of direct-to- consumer genetic testing. Are the current bans in the Spanish legal framework necessary and proportionate?

This paper explores the right to commercial speech of the companies that offer Direct To Consumer (DTC) genetic tests in the market. The paper discusses whether the bans to commercial speech currently in force in Spain are necessary and proportional or not, attending to the rights and public interests they try to protect, and balancing them with the communicative rights of the companies and the customers

El presente artículo analiza el derecho a la comunicación publicitaria de las empresas que ofrecen test directos al consumidor. Tras un análisis de la normativa vigente en España, se plantea la necesidad y proporcionalidad de las restricciones que el ordenamiento español impone a este tipo de publicidad, ponderando los intereses en conflicto: de un lado, el derecho a la comunicación de las empresas y los potenciales clientes de otro, la protección de la salud pública y de los consumidores y usuarios

Managing Professional and Nurse-Patient Relationship Boundaries in Mental Health.

Caring nurse-patient relationships in mental health settings are key components in helping patients recover. These professional relationships provide a safe, trustworthy, reliable, and secure foundation for therapeutic interactions; however, nurses face challenges in setting and maintaining relationship boundaries. Although patients ask for special privileges, romantic interactions, and social media befriending, or offer expensive gifts, nurses must recognize that these boundary violations may erode trust and harm patients. These violations may also trigger discipline for nurses. Professional relationship guidelines must be applied with thoughtful consideration, and nurses must monitor their emotions and reactions in these relationships. The current article is a sharing of personal experiences about boundaries augmented by evidence in the literature, and focuses on managing potential boundary violations (i.e., social media, sexuality, over-involvement, and gift giving) in mental health settings. [Journal of Psychosocial Nursing and Mental Health Services, 55(1), 45-51.].

Ethical implications of HIV self-testing: the game is far from being over.

The use of combined Anti-Retroviral Therapy (cART) has been revolutionary in the history of the fight against HIV-AIDS, with remarkable reductions in HIV associated morbidity and mortality. Knowing one's HIV status early, not only increases chances of early initiation of effective, affordable and available treatment, but has lately been associated with an important potential to reduce disease transmission. A public health priority lately has been to lay emphasis on early and wide spread HIV screening. With many countries having already in the market over the counter self-testing kits, the ethical question whether self-testing in HIV with such kits is acceptable remains unanswered. Many Western authors have been firm on the fact that this approach enhances patient autonomy and is ethically grounded. We argue that the notion of patient autonomy as proposed by most ethicists assumes perfect understanding of information around HIV, neglects HIV associated stigma as well as proper identification of risky situations that warrant an HIV test. Putting traditional clinic based HIV screening practice into the shadows might be too early, especially for developing countries and potentially very dangerous. Encouraging self-testing as a measure to accompany clinic based testing in our opinion stands as main precondition for public health to invest in HIV self-testing. We agree with most authors that hard to reach risky groups like men and Men Who Have Sex with Men (MSM) are easily reached with the self-testing approach. However, linking self-testers to the medical services they need remains a key challenge, and an understudied indispensable obstacle in making this approach to obtain its desired goals.