Self-Management

What is self-management in chronic illness?

Individual's ability to manage their condition through knowledge, skills, and confidence, leading to effective health outcomes.

How can self-management be enhanced in chronic illness?

Eeducation, support systems, goal-setting, and the development of coping strategies.

Why are older adults disproportionately affected by chronic illness?

Older adults have a higher prevalence of chronic illnesses due to factors like age-related physiological changes, accumulation of risk factors over their lifetime, and decreased immune function, leading to increased vulnerability.

What is the prevalence of multimorbidity in older persons?

The presence of two or more chronic health conditions in an individual. It is highly prevalent in older adults, often exceeding 50%, leading to complex health challenges and greater care needs.

How is multimorbidity related to frailty?

Multimorbidity, or the presence of multiple chronic conditions, can increase the risk of frailty in older adults by exacerbating physiological decline, reducing resilience, and leading to greater dependency in activities of daily living.

Self-care

An umbrella term that encompasses self-management of chronic illness and specific disease management approaches

Self-management

Emphasizes the client’s involvement in defining health and is condition specific

Disease management

Focuses on interventions and treatments and emphasizes prevention of complications

How to support self-management

• Links the individual support resources at the individual, health care system, and community levels

• Collaboration supports individuals in managing their health more effectively

• Effective self-management can be accomplished through peer support programs

What is the environment of self-management in chronic illness?

Contextual factors that influence an individual's ability to manage their chronic condition effectively, including social support, healthcare resources, community accessibility, and individual motivation.

Policy incentives for self-management of chronic disease

• Healthy People 2030

• Chronic Disease Self-Management Program

• Medicaid Home Care Waiver program

What is Healthy People 2030?

Set of health objectives for the nation to achieve over the next decade, aimed at improving health and well-being through data-driven benchmarks.

What is the Chronic Disease Self-Management Program?

A structured program designed to help individuals with chronic diseases learn skills to manage their symptoms, improve their quality of life, and enhance their ability to cope with the challenges of living with chronic illness.

What is the Medicaid Home Care Waiver program?

A program that allows states to provide long-term care services at home or in community settings to individuals who would otherwise require care in nursing facilities, aimed at promoting independence and quality of life.

Middle-Range Theories of Self-Management

• Theory of self-care of chronic illness

• Individual and family self-management theory

• Self-management and family management framework

What is the Theory of self-care of chronic illness?

A conceptual framework that emphasizes the role of individuals in managing their own health through informed decision-making, proactive behaviors, and maintaining a healthy lifestyle to manage chronic conditions effectively.

What is the Individual and Family Self-Management Theory?

A theoretical framework that emphasizes the roles of both individuals and families in managing chronic illness, highlighting the importance of interpersonal relationships, support systems, and shared decision-making in health management.

What is the Self-Management and Family Management Framework?

A conceptual framework that integrates self-management and family involvement in managing chronic illness, emphasizing the joint roles of individuals and families in decision-making, support, and behavioral strategies to improve health outcomes.

The Meaning of Self-Management

• Clients assimilate the process of self-management in stages

• A balancing act

• Home and on-the-go resources for self-management

• Self-determination and shifting identities

• Self-realization as self-transformation

The proactive and informed approach individuals take in managing their chronic health conditions, encompassing the development of skills, knowledge, and confidence to maintain and

What are nursing interventions that support self-management in chronic illness?

Nursing interventions to support self-management include educating patients about their condition, encouraging goal setting, providing resources for community support, facilitating communication with healthcare providers, and promoting skills for self-monitoring and self-care.

Self-management Nursing Interventions

• Coaching as a technique to enhance self-management and family management

• Medication self-management

  • A model of ehealth medication self-management

• Advanced practice nurse-led group visits

Ethical Considerations in Self-Management

• Access is not guaranteed

• Client empowerment is not possible without the assurance of resources for self-management

• There is the assumption that education is noninvasive and does not require formal informed consent

• Potential for widening the gap between “haves” and “have-nots” is very real

What are the ethical considerations in self-management of chronic illness?

Ethical considerations include respecting patient autonomy, ensuring informed consent, maintaining confidentiality, promoting equity in access to resources, and recognizing the role of social determinants in health outcomes.

Self-management outcomes

• Condition outcomes

• Individual outcomes

• Family outcomes

• Environmental outcomes

• Proximal versus distal outcomes

• Client-reported outcome measures

• National study of chronic disease self-management

• Self-management requires both critical thinking and reflection

What are Condition outcomes?

The specific results or health statuses related to managing a chronic illness, which can include changes in disease symptoms, progression of the condition, treatment effectiveness, and overall health improvement or decline.

What are individual outcomes?

The specific results or impacts on a person's health status, quality of life, and well-being as a result of managing a chronic illness, which can include emotional, psychological, and functional dimensions.

What are family outcomes?

The specific impacts and results on the health status, well-being, and functioning of the family unit as a whole as a result of managing a chronic illness, which can include improved communication, increased support, and shared coping strategies.

What are environmental outcomes?

The specific impacts and results on the broader environment as a result of managing a chronic illness, which can include community health improvements, resource availability, and the creation of supportive environments that enhance individual and family health management.

What are proximal versus distal outcomes in self-management?

Proximal outcomes are short-term results or effects that occur directly from self-management efforts, such as improved health behaviors or symptom management. Distal outcomes are long-term results that reflect broader changes in health status or quality of life, such as reduced hospitalizations or enhanced overall well-being.

What are client-reported outcome measures?

(CROMs) are tools used to assess the patient's own perspective on their health status, quality of life, and the impact of their health conditions and treatments from their viewpoint.

What is the National Study of Chronic Disease Self-Management?

A comprehensive research initiative that examines the effectiveness of self-management programs for individuals with chronic conditions, focusing on long-term outcomes, behavior changes, and overall health improvement stemming from self-management practices.

How does self-management require critical thinking and reflection?

Self-management involves analyzing personal health information, evaluating treatment options, and reflecting on past experiences to make informed decisions that improve health outcomes.