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 selfhealing.
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.
This research will help build a network telenursing for patients with chronic diseases in Bali,
other parts of Indonesia and the world. This study conducted in collaboration with hospitals,
where patients with chronic diseases that are ready to be discharged asked to consent to survey
respondents, given firsthand information about the self-management of disease control. After
that it will follow up with a phone and social media agreed with the patient.
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 selfmanagement, the act of 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 selfmanagement 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
This research is quasy experimental to analyze the differences in the ability of self-management
in the group of patients with chronic disease given telenursing method (treatment group) and the
group of patients with chronic diseases who are not given telenursing method (the control
group). The telenursing method that have been done is phone call and SMS to give the nursing
information needed. The population was patients with chronic diseases who were treated at
Sanglah Hospital in Denpasar. Sampling technique used is purposive sampling. The inclusion
criteria for patients suffering from chronic diseases are diagnosed and treated for at least 3 days
in Sanglah Hospital in Denpasar. The sample size is determined documentation data from 54
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.
The level of self-management with PAM scores, most respondents in the group that did not do
telenursing are at stage 1 is the patient's belief on the importance of the roles of PAM score of
47.0 or less as much as 15 respondents (27.8%). In patients with chronic disease selfmanagement level given telenursing with PAM scores, the majority of respondents are in stage 4
which then manage themselves even under stress or pressure PAM score of 67.1 or more as
many as 18 patients (33.3%). At this stage the patient remains capable of controlling the disease
is continuously consistently in various situations. Patients with hypertension remain a diet low in
salt even though her blood pressure was stable or under pressure from a variety of social
situations. This research was supported by the results of research conducted Solomon (2008)
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.
Patients with chronic diseases who were treated at Sanglah Hospital, most of them have suffered
from chronic diseases over 2 years. Knowledge about the illness is quite good. The desire to
control the disease have consistently not been so good in patients with chronic illness is not
given telenursing, where the average value of PAM is 50.81. Patients with chronic diseases are
given methods telenursing own knowledge as well as the desire to consistently control the
chronic disease experienced by the average value of PAM 73.86. Almost all patients with
chronic diseases very cooperative received a phone call and SMS answer from researchers.
Patients often ask researchers talked with other family members who are
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.
References:
Ackley, B. J., Ladwig, G. B., Swan, B. A., & Tucker, S. J. (2007). Evidence-based nursing care
guidelines: Medical-surgical interventions St. Louis: Mosby
Bulechek GM, Butcher HK, Dochterman JM, Wagner CM (2013). Nursing Intervention
Classification (NIC) 2013, MOSBY, Elsevier, 2013
Banner, L., & Olney, C. M. (2009). Automated clinical documentation. Computers, Informatics,
Nursing, 27(2), 75–81.
Barlow, J., Wright, C., Sheasby, J., Turner, A., & Hainsworth, J. (2002). Self-management
approaches for people with chronic conditions: a review. Patient Education and
Counseling, 48(2), 177–87. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12401421
Brandt, C. L. (2010). Study of older adults’ use of self-regulation for COPD self-management
informs an evidence-based patient teaching plan. Rehabilitation Nursing : The Official
Journal of the Association of Rehabilitation Nurses, 38(1), 11–23. doi:10.1002/rnj.56
Bucknall, C. E., Miller, G., Lloyd, S. M., Cleland, J., Mccluskey, S., Cotton, M., … Cotton, P.
(2012). Glasgow supported self-management trial ( GSuST ) for patients with moderate to
severe COPD : randomised controlled trial, 344(March). doi:10.1136/bmj.e1060
Burks, K. J. (1999). A nursing practice model for chronic illness. Rehabilitation Nursing : The
Official Journal of the Association of Rehabilitation Nurses, 24(5), 197–200. Retrieved
from http://www.ncbi.nlm.nih.gov/pubmed/15027663
Clark, N. M., & Gong, M. (2000). Management of chronic disease by practitioners and patients: are
we teaching the wrong things? BMJ (Clinical Research Ed.), 320(7234), 572–5.
Retrievedfrom:http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1117606&tool=
pmcentrez&re dertype=abstract
Cohen, S (2007). Critical Thinking in the Medical-Surgical Unit: Skills to Assess, Analyze, and
Act. published by HCPro, Inc.
Epping-Jordan JE, Pruitt SD, Bengoa R, Wagner EH (2004). Improving the quality of health care
for chronic conditions. Quality&Safety in Health Care, 2004; 13: 299–305.
Ferdinand. A; (2006). SEM Dalam Penelitian Manajemen, BP UNDIP, Semarang
Falvo D, (2005). Medical and Psychosocial Aspects of Chronic Illness and Disability, Copyright
© 2005 by Jones and Bartlett Publishers, Inc, USA.
Fitzner K, and Moss G (2013). Telenursing—An Effective Delivery Method for Diabetes SelfManagement Education. POPULATION HEALTH MANAGEMENT Volume 16, Number 3,
2013
Gonzales F, Iglesis R, Suarez A et al. (2001). Teleophthalmology link between a primary health
care center and a reference hospital. Med Inform Internet Med 2001;26:251-263.
Hughes EM. Communication skills for telenursing interaction, (2014). Home Health Nurse
2001;19:469-472.
Harvey, I. S. (2006). Self-management of a chronic illness: An exploratory study of spirituality
among African American women. Journal of Women and Aging, 18, 75–88.
Hibbard JH, Tusler M; (2007). Assessing activation stage and employing a ‘next steps’- approach
to supporting patient self-management. J Ambul Care Manage 2007; 30 (1): 2-8
Ijsselsteijn WA, de Ridder H, Freeman J et al; (2000). Presence: concept, determinants and
measurement. Proc SPIE 2000;3959:520-529.
Knight EP; Shea K. A (2014). Patient-Focused Framework Integrating Self-Management and
Informatics Journal of Nursing Scholarship, 2014; 46:2, 91–97. 91 C _ 2013 Sigma Theta
Tau International
Lee RG, Chen KC, Haiso C et al (2007). Mobile care system with an alert mechanism. IEEE Trans
Inf Technol Biomed 2007;11:507 517.
Lieberman MA, Golant M, Giese-Davis J, et al (2003). Electronic support groups for breast
carcinoma: a clinical trial of effectiveness. Cancer 2003; 97: 920-5 53.
Lorig KR, Holman H; (2003). Self-management education: history, definition, outcomes, and
mechanisms. Ann Behav Med 26:1–7, 2003
Lamb GS, Shea K,(2006). Nursing education in telenursing. JTT 2006;12:55-56
Locsin R C., Technological Competency As Caring in Nursing; (2005). A Model for Practice.
Sigma Theta Tau International, Indianapolis, Indiana, USA
Moscato S.R., Valanis B., Gullion C.M., Tanner C., Shapiro S.E. & Izumi S. (2007) Predictors of
patient satisfaction with telephone nursing services. Clinical Nursing Research 16(2), 119–
137.
Minden P, Gullickson C, (2005). Teaching Nursing Care of Chronic Illness. Copyright c 2005 by
Springer Publishing Company, Inc. New York.
Nilsson C; Skar L; Siv Soderberg. Swedish District Nurses’ experiences on the use of information
and communication technology for supporting people with serious chronic illness living at
home – a case study. Journal compilation _ 2009 Nordic College of Caring Science
Orga D-DumitRIU. Telenursing Skills. AMT, v. II, no. 3, 2014, p. 185
Popoola, M. M. (2005). Living with diabetes. The holistic experience of Nigerians and African
Americans. Holistic Nursing Practice, 19, 10–16.
Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth
Textbook of Medical Surgical Nursing (12th ed.). Philadelphia: Lippincott Williams &
Wilkins.
Villagra VG. Integrating disease management into the outpatient delivery system during and after
managed care. Health Aff 2004; 23 Suppl. W4: 281-3
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 selfhealing.
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.
This research will help build a network telenursing for patients with chronic diseases in Bali,
other parts of Indonesia and the world. This study conducted in collaboration with hospitals,
where patients with chronic diseases that are ready to be discharged asked to consent to survey
respondents, given firsthand information about the self-management of disease control. After
that it will follow up with a phone and social media agreed with the patient.
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 selfmanagement, the act of 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 selfmanagement 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
This research is quasy experimental to analyze the differences in the ability of self-management
in the group of patients with chronic disease given telenursing method (treatment group) and the
group of patients with chronic diseases who are not given telenursing method (the control
group). The telenursing method that have been done is phone call and SMS to give the nursing
information needed. The population was patients with chronic diseases who were treated at
Sanglah Hospital in Denpasar. Sampling technique used is purposive sampling. The inclusion
criteria for patients suffering from chronic diseases are diagnosed and treated for at least 3 days
in Sanglah Hospital in Denpasar. The sample size is determined documentation data from 54
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.
The level of self-management with PAM scores, most respondents in the group that did not do
telenursing are at stage 1 is the patient's belief on the importance of the roles of PAM score of
47.0 or less as much as 15 respondents (27.8%). In patients with chronic disease selfmanagement level given telenursing with PAM scores, the majority of respondents are in stage 4
which then manage themselves even under stress or pressure PAM score of 67.1 or more as
many as 18 patients (33.3%). At this stage the patient remains capable of controlling the disease
is continuously consistently in various situations. Patients with hypertension remain a diet low in
salt even though her blood pressure was stable or under pressure from a variety of social
situations. This research was supported by the results of research conducted Solomon (2008)
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.
Patients with chronic diseases who were treated at Sanglah Hospital, most of them have suffered
from chronic diseases over 2 years. Knowledge about the illness is quite good. The desire to
control the disease have consistently not been so good in patients with chronic illness is not
given telenursing, where the average value of PAM is 50.81. Patients with chronic diseases are
given methods telenursing own knowledge as well as the desire to consistently control the
chronic disease experienced by the average value of PAM 73.86. Almost all patients with
chronic diseases very cooperative received a phone call and SMS answer from researchers.
Patients often ask researchers talked with other family members who are
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.
References:
Ackley, B. J., Ladwig, G. B., Swan, B. A., & Tucker, S. J. (2007). Evidence-based nursing care
guidelines: Medical-surgical interventions St. Louis: Mosby
Bulechek GM, Butcher HK, Dochterman JM, Wagner CM (2013). Nursing Intervention
Classification (NIC) 2013, MOSBY, Elsevier, 2013
Banner, L., & Olney, C. M. (2009). Automated clinical documentation. Computers, Informatics,
Nursing, 27(2), 75–81.
Barlow, J., Wright, C., Sheasby, J., Turner, A., & Hainsworth, J. (2002). Self-management
approaches for people with chronic conditions: a review. Patient Education and
Counseling, 48(2), 177–87. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12401421
Brandt, C. L. (2010). Study of older adults’ use of self-regulation for COPD self-management
informs an evidence-based patient teaching plan. Rehabilitation Nursing : The Official
Journal of the Association of Rehabilitation Nurses, 38(1), 11–23. doi:10.1002/rnj.56
Bucknall, C. E., Miller, G., Lloyd, S. M., Cleland, J., Mccluskey, S., Cotton, M., … Cotton, P.
(2012). Glasgow supported self-management trial ( GSuST ) for patients with moderate to
severe COPD : randomised controlled trial, 344(March). doi:10.1136/bmj.e1060
Burks, K. J. (1999). A nursing practice model for chronic illness. Rehabilitation Nursing : The
Official Journal of the Association of Rehabilitation Nurses, 24(5), 197–200. Retrieved
from http://www.ncbi.nlm.nih.gov/pubmed/15027663
Clark, N. M., & Gong, M. (2000). Management of chronic disease by practitioners and patients: are
we teaching the wrong things? BMJ (Clinical Research Ed.), 320(7234), 572–5.
Retrievedfrom:http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1117606&tool=
pmcentrez&re dertype=abstract
Cohen, S (2007). Critical Thinking in the Medical-Surgical Unit: Skills to Assess, Analyze, and
Act. published by HCPro, Inc.
Epping-Jordan JE, Pruitt SD, Bengoa R, Wagner EH (2004). Improving the quality of health care
for chronic conditions. Quality&Safety in Health Care, 2004; 13: 299–305.
Ferdinand. A; (2006). SEM Dalam Penelitian Manajemen, BP UNDIP, Semarang
Falvo D, (2005). Medical and Psychosocial Aspects of Chronic Illness and Disability, Copyright
© 2005 by Jones and Bartlett Publishers, Inc, USA.
Fitzner K, and Moss G (2013). Telenursing—An Effective Delivery Method for Diabetes SelfManagement Education. POPULATION HEALTH MANAGEMENT Volume 16, Number 3,
2013
Gonzales F, Iglesis R, Suarez A et al. (2001). Teleophthalmology link between a primary health
care center and a reference hospital. Med Inform Internet Med 2001;26:251-263.
Hughes EM. Communication skills for telenursing interaction, (2014). Home Health Nurse
2001;19:469-472.
Harvey, I. S. (2006). Self-management of a chronic illness: An exploratory study of spirituality
among African American women. Journal of Women and Aging, 18, 75–88.
Hibbard JH, Tusler M; (2007). Assessing activation stage and employing a ‘next steps’- approach
to supporting patient self-management. J Ambul Care Manage 2007; 30 (1): 2-8
Ijsselsteijn WA, de Ridder H, Freeman J et al; (2000). Presence: concept, determinants and
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