2011 lec wk 3

Chronic Conditions

Physical or mental condition / functional limitation that has lasted, or expected to last 6 months or more

Self-management

An individuals engagement in activities and role in promoting and managing their health and wellbeing

• Prevent / control disease progression

• Monitoring self

Components of Self-management

Medical =

• Compliance/adherence to medical treatment

  • Medications, appointments etc.

• Coping and understanding symptoms

Social =

• Behaviour adjustments

• Acting according and being able to deal with situations (eg. roles in life, work etc.)

  • Prevent negative outcomes and exacerbation of illness

Emotional =

• Emotional responses

• Mental wellbeing

• Management of feelings

  • Eg. depression, anxiety, stress etc.

What does self-management involve?

• The individual completing tasks and skills in order to sustain and maintain health

Eg. HF patients doing daily weights, fluids restrictions, adhering to their care plans

Prerequisites to Self-management

People need:

• Self-efficacy

• Health literacy

• Awareness and capability of maintaining their health

Social Cognitive Theory

Psychological framework explaining how people learn and change their behaviour by observing others and learning from them + interactions with their environment

• Not just from direct experience (trial and error)

• Learning through observation, understanding, imitating and modelling their behaviours based on their interpretations

Self-efficacy

Person’s belief in themselves

• Motivation to manage themselves

• Determination

• Willingness

• Personal judgement of their capabilities and efforts in being able to succeed in their tasks

if someone believes in themself to be able to do it ~ They are more likely to succeed.

Social Cognitive theory in self-efficacy

Self-efficacy beliefs operate with:

• Goals

  • eg. Aim to lose 10kg

• Expectations

  • eg. After losing 10kg, they expect better health and feeling better, improved appearance etc.

• Environmental support and barriers

  • eg. Support (facilitator) = friends and family | barrier (impediments) = lack of access to gym, low SES etc.

in order to regulate motivations, behaviour and wellbeing

Self-regulation theory

An individual is motivated to self-regulate when they have a desired goal (something perceived as ideal for them - and upholds value to them)

• Medical treatment adherence and self-management is significantly influenced by both internal and external factors

• Person must believe and portray that they want to achieve it.

Social Learning Theory

That new behaviours are developed through observation, instructions and copying others

Behavioural Theory

Learning is attained through conditioning behaviours

Eg.

• Behaviour is strengthened by rewards or punishments from behaviours

  • Punishment = less likely to perform behaviour again

  • Rewarded (eg. praised, given gifts) = more likely to perform behaviour again

• Miro and “WALK??” which triggers a response of excitement because he has been conditioned to behaviours because he conditions his senses to his past experiences

Principles of Self-management

1) Problem solving

2) Decision Making

3) Effective resource utilisation

• Access to resources and services (eg. consider low SES and social situations)

4) Forming a relationship with a provider

• supportive environments, a resource that will guide them and support them through their journey

• Healthcare provider and their involvements

5) Taking action

6) Self-tailoring

• Being able to self-adjust and understand their treatment regimes and medications, and be able to act accordingly

• Self-confidence and belief in themselves

Transtheoretical model of change

Self-management benefits

• Builds confidence

  • Disease management

  • Social/role management

  • Emotional management

Why is Chronic Disease Self-Management important?

• Significantly improves health outcomes

• Traditional medical model is expensive and ineffective in cases of chronic conditions

• Focuses on PCC - managing the individual rather than the condition itself (empowering the patient)

Models of Self-management

Chronic Disease Self-management (CDSM)

• Support the individual

• Tailor towards their goals

• Actively manage their chronic condition through collaborative and active participation

• Education

• Behaviour management / Emotional management

CDSM programs

• Collaboration

• Personalised care plans

• Self-management education

• Adherence to treatment

• Follow-up appointments, consistent monitoring and support

Self-management education interventions

From individual to population:

• Face-to-face consultation

• Telephone coaching

• Internet individual courses

• Internet group courses

• Group cycles (rehab programs)

• Structured and formal group programs

• Written information

• TV, Media, campaigns

Health Change Australia (CDSM approach)

Health Coaching

Applies:

• Questioning

• Conversation

• Goal setting

Based on:

Readiness to change

Information

Confidence

Knowledge

(RICK)

Get Healthy Service (CDSM Approach)

Referred from health professional

• Patients receive 10 free health coaching phone calls over 6 months

  • Eating habits, diet advice, physical activity, goal setting etc.

Chronic Care for Aboriginal People (Model of Care)

Main difference and the mainstream model of care = TRUST + cultural safety ?

Stemming from historical oppression and history of colonisation

• Effective communication

• Building rapport

• Developing a relationship with the patient

Measures of self-management

Not based on statistics and numerical values

• involves Patient Reported Outcome Measures (PROMS)

• Patient Reported Experience Measures (PREMS)

Micro =

• Patient engagement in risk factor modification and improvement

Meso =

• Successful self-management

  • Eg. less use of hospital services (such as decreased length of stay)

Macro =

• Policies and guidelines

  • In support of health clinicians to be able to provide effective and quality care

  • Eg. Staffing

Telemonitoring in Self-management

Allow patient to self manage by:

• Measuring self BGLs

• Taking their own vitals

Nurses can be shared this information - being able to provide early intervention and management

Telemonitoring Examples

Nepean Diabetes Service

CGM (Continuous Glucose Monitoring) - subsidised by GOV

• Taking BGLs is uploaded to cloud

• Allows for health clinicians to be able to adjust insulin accordingly (eg. in T1DM patients) over the phone to achieve glycemic control

Reduced pressure on endocrinologist

+ Allows for patient to develop self-management skills and allow them to be more proactive (as opposed to staying in hosptial)

Cultural Considerations in self-management

• Culturally-safe

• Understand and accept their values and beliefs - aiming not to contradict and oppose

• Consider Ethnic diversity

• PCC

Examples:

• Food/diet

• Culture & Tradition

• Religion

• Beliefs / values

Nurses’ role in self-management

• Nurses’ consider new approaches that require collaborative interactions in care

• CDSM Programs

• Collaboration and active participation in management with multidisciplinary team + the patient, their family etc.

• Motivational Interviewing

Motivational Interviewing

• Develop empathy

• Reflective listening

• Understand any discrepancies between client’s goals and their behaviours

  • Are behaviours supportive or limiting their goals?

• Don’t argue or oppose the patient - work around it

• Optimism

• Self-efficacy!!!!

Comprehensive Care Management

Assessment of:

• Medical needs

• Psychosocial needs

• Functional needs

• Review medication adherence

• Appointments and scheduled services for the patient

• Overview of the patients’ self management skills and engagement

Nurses’ role in self-management

• Patient and health professional work together

  • Building a therapeutic relationship

• Involves parents, carers, families etc.

  • HOLISTIC APPROACH

• Proactive, adaptive strategies

• Empower Individual and support throughout their journey