Photo by Alan Magayne-Roshak

Self Management Science Center (SMSC) researchers focus on looking at ways to help people better manage health conditions ranging from chronic health failure to post-partum depression. America’s aging population makes such self-management a vital part of controlling healthcare costs. Pictured here (left to right) with areas of research noted are: Sandra Plach (chronic heart failure), Beth Rodgers (obstructive sleep apnea), Jennifer Doering (post-partum depression research) and Sarah Morgan (community dwelling elders with dementia and their family caregivers).

The solution to this country’s looming health care cost crisis is to find better ways to provide health care, particularly for those with chronic health conditions, says Karen Marek, professor of nursing at the University of Wisconsin–Milwaukee.

Jennifer Doering’s work focuses on helping mothers manage the symptoms of post-partum depression, a condition that can affect quality of life for the whole family.

Marek directs the UWM College of Nursing’s Self Management Science Center (SMSC), which explores, develops and tests ways to help people with chronic health problems better manage their own care. This work is vital because such chronic conditions as heart disease, diabetes, arthritis and asthma currently account for more than 75 percent of medical expenditures, says Marek. With an aging population those numbers are likely to increase.

The SMSC, a federally funded exploratory research center, provides an umbrella for current research as well as helping foster and support new research and collaborations.

Finding the best ways to help patients and families manage care isn’t simple or easy, says Marek. Numerous factors—the health condition itself, family and community support, health beliefs, the cost of medications—impact people’s ability to manage their own care.

“Day-to-day life can be complex for people who are chronically ill,” says Marek. “They’re managing many medications, multiple providers, often dealing with technology and navigating the health care system.”

Still, such self-management is vitally important to both control health care costs and improve long-term quality of life. “If you catch a problem early, you often can prevent expensive care such as emergency room visits and hospital visits,” says Marek. Cutting down on hospitalizations and emergency room visits also lessens exposure to disease-causing germs, she adds.

Managing the symptoms of chronic heart disease

A number of current SMSC research projects are looking at ways to improve self-management of chronic conditions as well as exploring barriers to self-care.

Karen Marek (at right), professor of nursing and director of the SMSC, chats with Crystal Evans, the student assistant who supports researchers at the Center.

Sandra Plach, associate professor of nursing, is studying ways of helping older people with chronic heart failure manage their symptoms, avoiding trips to the ER and/or hospitalization.

Allowing people to have some control of their own care is critical, says Plach. “This intervention is patient-centered. They pick out the symptom they want to work on first, work with a nurse to design a symptom-management plan, and then they manage it. It’s a common-sense model.” Nurses check in with the patients at regular intervals to see how they’re doing.

For example, if shortness of breath is the symptom that’s bothering a heart patient the most, the nurse can suggest ways to control or lessen that symptom—going up the stairs more slowly, taking a daily nap or starting a mild exercise program. “They need to do something that works for them and works on a daily basis,” says Plach.

Her research, being done in collaboration with Susan Heidrich, professor in the University of Wisconsin–Madison School of Nursing, will test the intervention over a 16-week period, using experimental and control groups, to see if it helps patients better manage their symptoms and improve quality of life.   

Helping the elderly with dementia

Assistant Professor Sarah Morgan’s research focuses on helping family members caring for relatives with moderate to severe Alzheimer’s or senile dementia. Working in collaboration with the Milwaukee Community Care Program, she’s exploring ways to help family members learn to reduce the patient’s discomfort and agitation through better pain management. At the same time, her research will look at how better pain management for these elderly patients can help reduce the caregivers’ stress. Morgan is testing a technique based on Nursing Professor Christine Kovach’s Serial Trial Intervention (STI). Kovach, who has done extensive research on the issue of pain management in elderly dementia patients, designed the STI to help nursing-home staff figure out the most appropriate treatment to relieve patients’ physical or psychological pain. While Kovach’s work has focused on patients in nursing homes, Morgan is now expanding the research to test how nurses could train home caregivers to use the technique. Building on existing research is a key part of what the Self Management Science Center is about, says Marek. “All of the pieces come together to generate more research.”

Other Center research

Other current SMSC researchers are looking at conditions as diverse as sleep apnea and postpartum depression.

Jennifer Doering, assistant professor of nursing, is studying the impact of postpartum depression, particularly among low-income women. Since both depression and related fatigue can have serious impacts on the family, figuring out ways to better manage them is vital for the long-term health of both mothers and their children.

Beth Rodgers, professor of nursing, is studying why people with obstructive sleep apnea often find it hard to follow recommended treatment. This condition, which affects an estimated 18 million people, is linked to such serious conditions as stroke, heart failure, hypertension, metabolic syndrome, depression and gastrointestinal disturbances.

While the condition can be treated, many patients don’t follow recommendations and may face serious complications. “A lot of people say, ’I didn’t know this could kill me,’” says Rodgers. Rodgers’ research is focused on finding out from patients themselves why they don’t follow treatment recommendations, what barriers they face and what strategies they’re using to manage the condition now. 

The role of nurses in self-care management

Nurses already play a major role in coordinating patient care and educating those with chronic conditions. With increasing and ongoing pressures on health care costs, nursing’s role in helping patients manage their own care will become even more important, says Marek.

“We have to rethink the way we provide care. Expensive interventions without follow-through to support adherence and self care is inefficient and often dangerous” she says. “Helping people avoid hospitalization by close monitoring and supporting them in the self-management of their health is where we think health systems should be headed.”