NUR 352: self management & adherence

what does self management and adherence involve

- client education, but we need to be aware if the patient is ready to learn, do they see barriers in maintaining their health, will it be beneficial to change poor health behaviors

what needs to happen to help individuals/families achieve optimal health

- in order to help individuals and families to achieve optimal states of health, it needs to be through their own actions and initiative
- remember: therapeutic communication mutuality, working in partnership with the client (you need to give the facts needed and allow clients to have a say in their treatment)

what are learning needs

- you need to determine your patient’s learning needs: age, developmental stage, level of education, health beliefs, motivation, readiness to learn, health risks, current knowledge and skills, barriers and facilitators to learning (consider cognitive learning)

what are ways to facilitate learning for learning needs

- partnership, readiness of learner, information relevant to learner, positive encounter, start with what your patient knows, use language learner will understand, be culturally sensitive (never assume)

what is self-management

- ability of an individual/caregiver to engage in daily tasks necessary to maintain health and well-being OR manage the holistic needs of chronic disease
- based on knowledge of condition, consequences and plan of care developed with the health care team (disease promotion is key)

what is scope of concept

- level or degree of self care varies in people, in different situations across the lifespan
- characterized in terms of approaches to enhance confidence (like starting with small tasks and short teaching time), knowledge, and skills of patients and their caregivers

where can self management education be provided

- self management education can be provided in different group settings and is collaborative. Examples include
→ causes and consequences of common chronic diseases
→ medication or symptom management
→ lifestyle and health promotion behaviors
→ social support

what are core expectations and skills

- clients and caregivers have sufficient knowledge of chronic conditions and treatment
- they must monitor conditions and respond to information about current disease state with appropriate cognitive and behavioral responses, in context with fluctuating circumstances
- clients and caregivers must be able to accurately convey important information and management to provider (like contacting provider with struggles or issues)

what is self-efficacy and patient engagement

- self-efficacy: having the confidence in one’s knowledge and abilities to reach a desired outcome
- patient engagement: linked to self-efficacy and refers to having the knowledge, skills, ability, and willingness to be an active participant in one’s health and health care

what is health education

- health education: any combination of learning experience designed to help patients and their caregivers improve health (or chronic conditions) by enhancing their knowledge, skills, and confidence or influencing their attitudes

what is patient-provider relationship

- patient-provider relationship: patient take responsibility for their health (or chronic condition) and the provider which represents members of the health care team as well as health system in which care is being provided, serves as the vehicle through which optimal self-management occurs

how is self-management essential across lifespan

- parents primarily responsible for infants, toddlers, school age years
- adolescents with parents often share tasks
- provider’s role in assisting patient with self-management depends on life stage, effectively transitioning roles and responsibilities

describe social context in terms of self management

- social context is where skills are used to determine level of support patient’s need to successfully manage health
→ poverty: paying for health care, nutrition, medications
→ neighborhood violence (safety)
→ transportation to HCP

what is cognitive behavioral theory

- thoughts affect behavior (internal process)
- assumes an active, involved, responsible patient engaged in specific actions as part of a plan the patient develops
- ex: child failed test and has internal belief that they are smart and but didnt study and can do better → no depression

what is social cognitive theory

- based on idea that an individual's expectations influence their behaviors
→ high self efficacy and in good health remain confident can maintain health with positive health behaviors
- personal factors = behavior = environmental factors
- ex: if a child watch an individual be aggressive towards a doll → the child will also be aggressive towards the doll

what are areas regarding self management

- health enhancement and wellness: wellness visits and screening appointments; lifestyle behaviors that promote health
- pre-disease/disease prevention: risk of developing full disease based on current health status and risk
- disease/new diagnosis: must make significant lifestyle changes
- chronic disease managment

what do you educate patients when doing nursing care

- education: preventative and supportive health measures
- patient-centered plan of care: respect the patient’s wishes and desires, they are a partner in their care → SMART goals

what are interrelated concepts of self-management

- patient education
- adherence
- health promotion
- care coordination
- collaboration
- health disparities

what is adherence

- patient focused and is the extent to which a person’s actions or behaviors coincide with advice or instruction from a HCP intended to prevent, monitor, or ameliorate a disorder

how do you measure adherence

- persistence in the practice and maintenance of desired health behaviors and is a result of active participation and agreement

what is compliance vs adherence

- compliance is more commonly used and it described patient behavior and patient’s obedience to treatment
- adherence is more positive connotation

what is scope of adherence

- the action or behavior of adherence is in part the patient’s degree of willingness and motivation to accept all or part of health recommendations
→ non-adherence: complete omission/not doing anything
→ intention partial adherence: adjusting dose/frequency (increase or decrease)
→ non-intentional partial adherence: non-purposefully forgets/misses neglects
→ total adherence

what are consequences of non-adherence

- falls into 3 areas:
→ patient related: increase mortality and morbidity, conflict, embarrassment, changes in quality of life
→ health: professional related - ambivalence, misinterpretation, avoidance, lack of empathy
→ health care system related: increase costs for health care services

what are barriers to adherence

- patient specific barriers
- illness specific barriers
- medication specific barriers
- healthcare and system specific barriers
- social and cultural barriers
- logistical and financial barriers

what is the theory of planned behavior

- individual behavior is driven by behavioral intentions, which are shaped by 3 core components: attitudes toward the behavior, subjective norms (social pressure), and perceived behavioral control

what is the health belief model

- explains how people believe that they are susceptible to a disease or severity based on key components of perceived susceptibility, perceived severity, perceived benefits, and perceived barriers

what are interrelated concepts of adherence

- culture, functional ability, development, cognition, family dynamics, spirituality