ICF framework and goal setting Flashcards
what does ICF stand for?
- international classification of function
what are on the different levels of the ICF model?
- health condition at the top
- three domains from impairments, limitations and restrictions in the middle
- environmental and personal factors at the bottom
what are the six different sections of the ICF model?
- health condition
- body function & structure
- activities
- participation
- environmental factors
- personal factors
what are the five stages of the rehabilitation process?
- assessment
- generate hypothesis
- set goals
- plan treatment
- evaluate
where do you start from in the assessment part of the rehabilitation process? what should you do?
- start from the patient perspective
- you should understand patient and their problem (impact and impairments)
what does the assessment in rehabilitation include?
- subjective and objective assessment
what question should be answered in the assessment of the rehabilitation process?
- what can they do which is important to them
what is the point of generating a hypothesis?
- allows us to find reasons for the identified problems
how do we test hypotheses?
- as part of assessment or via implementation of plans to change them
what are the goals based on? what do we need to understand to set these goals?
- SMART goals based on problems identified by patient and developed collaboratively
- need understanding of the problems to set goals
how do you plan treatment? what may not work?
- look at the evidence
- what does the evidence suggest may help achieve the goals for the individual
- why might evidence- based intervention not work in this case?
what makes evidence based interventions less likely to work?
- specific context
- need to adapt
how do you evaluate in rehabilitation? what is used?
- outcome measures used to monitor progress and inform re-assessment and review hypothesis
is the rehabilitation process linear?
- no its not linear
- need to keep going back to previous steps
what does the biopsychosocial model allow?
- allows a full picture of the patient
how does assessment link to the ICF framework- what is understood?
- understanding of the history of present condition e.g., patient records and the impacts
how does the assessment process allow us to get a more in depth understanding of? - give some examples
- understanding of how impaired the body systems are and physiological impacts e.g., strength, sensation
what does the assessment process assess? how do you do this? - give some examples
- assess activities
- via movement analysis e.g., sit to stand, arm function
what are the two types of assessment you could perform on the patient regarding QoL?
- home/ community assessment e.g., getting to the shops
- personal assessment of family support and mental health
how does generating a hypothesis linked to ICF?
- can decide which section of the ICF is restricting participation
- what sections have the biggest impact
what is allowed when we identify the priority?
- goals can be targeted in the right place
how do you set goals using the ICF model?
- final goal normally relates to participation
- other goals are set underneath the main one
how can treatment link to ICF?
- can be targeted to any level
what are some examples of treatment of health condition, body function and activities?
- condition= medication
- body function= strengthening training
- activities = sit to stand
what are some examples of treatment of participation, environmental and personal?
- participation= supported meaningful social participation
- environmental= home adaptations e.g., hand rails
- personal = carer support, mental health support
how does evaluation link to ICF?
- measures success using outcome measures at each level over time
what are short term goals?
- step towards helping you achieve your long term goals
- normally 2 weeks
what are medium term goals?
- several short term goals added together
how long do long term goals take to achieve normally?
- can take months to years
what is goal- action planning?
- framework that has been developed to support person centred goal set practice
what does goal- action planning support people with?
- supports people to set, work towards, attain and if necessary adjust goals
what are the 4 factors that the goal- action planning model supports?
- supports attainment of personal goals
- supports goal adjustment, disengagement and reengagement with alternatives
- supports person to be involved
- supports a consistent approach to goal setting practice
what does goal- action planning model make the goals?
- makes the goals person centred
what does confidence affect in G-AP? how can we help this?
- affects the goal achievability
- may need to adapt the goal if not confident
what can help to increase self- efficacy?
- feedback
- motivation
what should be considered if the person is not achieving their goal? (2)
- environmental factors
- personal factors
when would you exit the G-AP process?
- may stop due to medical problems e.g., stroke
- may need palliative or nursing care
what are the two subsystems of stage 1 of the G-AP?
- goal negotiation
- goal setting
what does goal negotiation focus on?
- focuses on really understanding from the person’s perspective how things are going at the moment and what hopes & aspirations for the future
what is discussed in goal negotiation?
- main problems and potential goals are discussed
what is it important to ask in the goal negotiation stage?
- ask about what’s going well as well as what’s not going so well
what does goal negotiation involve?
- involves a staff member having a structured conversation with the person and taking time to listen to what they have to say
what is important to set aside in the goal negotiation stage? what does this allow?
- important to set aside enough time for the conversation
- it allows a foundation to build from
what is it useful to consider in the goal negotiation stage? what should you make sure?
- useful to consider the language you use
- make sure you use words the person is familiar with and understands
who may need additional support in the goal negotiation phase?
- people with cognitive or communication difficulties may need additional support to get involved in the conversation in a way that suits them
what does understanding the person’s perspective in goal negotiation allow?
- allows the G-AP process to move forward in person centred way
- ensures that goals set reflect the person’s needs, preferences and priorities
what is the outcome of goal negotiation?
- staff member will understand the person’s perspective about where they are at right now and where they would like to get
- info can be written down using the person’s own words in the coming up with the goals page of G-AP record
what is goal setting?
- staff member and patient agree specific goals to work towards
what should the G-AP goals be described in? what should they be tailored to?
- described in person’s own words
- tailored to their social and/ or environment situation
what are the two ways that goals should be specific?
- should focus the effects of the person and the staff working with them
- should allow them to judge whether it has been achieved or not
what are the G-AP goals perceived as? what can they do for the patient?
- perceived as just the right challenge by the person
- should be important and motivating to the patient i.e., what’s in it for me
what should staff do when setting goals?
- staff should support the person to think about a specific goal they would like to achieve
what may be helpful in goal setting?
- helpful to have short term goals, which lead towards a more complex long term goal
what are the 4 reasons we set goals?
- motivation
- focuses the person and staff member’s efforts
- creates clear bench marks to work towards
- can judge progress against bench mark
what are the three sub- systems of stage 2?
- action plan
- coping plan
- confidence
what does action planning act as?
- acts as incremental stepping stone towards goal achievement
what does an action plan detail? (4)
- details what has to be done, how, where and when
what does action planning often become for the patient?
- often becomes homework for the person to complete out with scheduled sessions
what is good action planning? what does this stand for?
- should be SMART
- specific
- measurable
- achievable
- relevant
- timed
how is an action plan created?
- staff members and person discuss the first stepping stone together (should both agree)
what should the action plan be? why?
- should be written
- so that the person understands exactly what has to be done
what are the three reasons why we create an action plan?
- motivated to turn intention into action
- supports the person to build the skills & confidence necessary to achieve their goal
- unsuccessful action plan completion creates an important opportunity for the person to reflect & learn from setbacks
what is the coping plan designed to do?
- designed to overcome barriers that might get in the way of carrying out an action plan
when is the anticipation of barriers easier?
- easier when the person has had some experiences of trying to complete the action plan
what are the 4 factors that a good coping plan should be?
- should be described in own words
- related to specific action plans
- takes into account the patient’s social and/ or environmental context
- increase patient’s confidence in their ability to complete AP
how do you set a coping plan?
- staff members ask the person about any any barriers (staff may prompt)
- if a barrier is identified, a coping plan is agreed which will either remove/ reduce its impact (supports person to successfully follow through )
why bother setting a coping plan?
- by considering barriers ahead of time, coping plans optimise the person’s chances of successfully completing the action plan
what does the measuring confidence stage consist of?
- consists of staff member assessing the patient’s self- efficacy to complete the action plan
how do you measure confidence?
- rated on a 10- point visual analogue scale (0= not confident at all; 10= very confident)
- if the staff member fells that using the visual analogue scale will be confusing they can just ask the patient how confident they feel about completing the plan
what does the different levels of confidence show?
- more confident the patient = more likely they will follow through with the plan
- lack of confidence (less than 7)= plan should be adjusted to optimise the chances of successful completion
what is the sub- system of stage 3?
- action
how should you carry out the plan? (3)
- independently
- with supervision
- with assistance
what are the three sub- systems of stage 4?
- appraisal
- feedback
- decision making
what does appraisal involve?
- staff and patient consider the outcome of the action plan and judge whether the progress is being made (or not) towards achieving the goals
how do you implement appraisal?
- staff member should understand person’s perspective of how they got on and make own assessment of how the person got on carrying out the plan
what does appraisal create?
- creates an opportunity for the staff member and the person to review each action plan as they are completed and decide whether process is being made towards reaching the goal
what does appraisal give an opportunity for?
- opportunity to explore why the person hasn’t completed agreed plans
what is feedback?
- health professionals give the patient feedback on their action plan performance and goal progress
how if feedback given?
- if AP successfully completed then feedback focuses on praising success, highlighting progress & boosting confidence
- if AP was unsuccessful then feedback can focus on providing support, encouragement and re-framing lack of success as an important opportunity to better understand limitations
what is the two reasons that feedback is given?
- positive feedback will enhance confidence and motivation
- support and encouragement will support the person’s emotional wellbeing & help them to understand their limitations
what can be highlighted and discussed in the process of feedback?
- if a person is not engaging with the process
what feedback should you provide when there is satisfactory progress?
- praise
- success
what feedback should you provide if unsatisfactory progress?
- encourage/ reassure
- reframe failure as an opportunity for future success
what decision making should you do if there is satisfactory progress?
- agree new action and coping plans
- negotiate new goal
- exit G-AP
what decision making should you do when there is unsatisfactory progress?
- re- target action and coping plans
- revise goals (adjust to make achievable)
- goal disengagement
- exit G-AP
what are the two reasons for exiting the G-AP process?
- all goals achieved
- no further achievable goals
what should be considered following appraisal and feedback?
- consider and discuss avaliable decision making options and agree on a decision that will support ongoing progress
what does the decision making stage support the patient with?
- patients supported to decide, on the basis of experience, whether they think their goal is achievable or not
what do patients need before adjusting or letting goals go?
- need some level of understanding and acceptance of their limitations
- this can take time and people may need additional emotional support
what is the outcome of decision making?
- staff member and patient will discuss and agree on what should happen next to optimise the chances of goal achievement and ongoing progress
