Self-Management Flashcards
Differentiate
Self-care vs. Self Management
self care: considered the tasks performed at home by people to prevent illness rather than managing an existing illness
* includes activities of daily living
self-management: the day to day management of chronic conditions by individuals over the course of an illness
* involves knowledge and beliefs, self-regulation, and social facilitation
similarities
*person engages in specific behaviours to achieve outcomes
Antecedents of self-care
define, list
Antecedents:
* what needs to be present for self care in chronic illness to exist
Includes:
* illness or treatment
* health systems: access, cost, relationships with providers
* environment: sociocultural, physical, access (internet)
Attributes of Self-Care
define, list
Attributes:
* what contributes to the likelihood of self-care - what does it look like?
Includes:
* readiness - for self-care
* ability - cognitive, mental health, age, sex, gender
* activity/practice - characteristics we see in self care relate to self-efficacy - having ability may result in increased confidence and individuals may be empowered to try something more difficult next time - i.e. breaking down tasks into smaller tasks
Consequences of Self-Care
- acceptance of disease
- health care cost reduction
- illness stability
- relief of stress
- quality of life
- changes in lifestyle
- enhancement of knowledge and awareness
- increase in adjustment with the disease
Self Management
set of tasks (3); core processes (5)
Set of tasks associated with living with chronic illness
1. medical management of the condition
2. behavioural management
3. emotional management
Core processes:
1. problem solving
2. decision making
3. resource utilization
4. partnership with HCPs
5. taking action
Describe
Self-Management and Family Management Framework
Risk and Protective Factors:
health status
* severity of condition
* regimen
* trajectory
* genetics
individual factors
* age
* gender
* psychosocial characteristics
* diversity/culture
family factors
* SES
* structure
* function
environmental context
* social networks
* community
* healthcare system
Outcomes:
health status
* control
* morbidity
* mortality
individual outcomes
* quality of life
* adherence
family outcomes
* function
* lifestyle
environmental context
* access
* utilization
* provider relationships
Describe
Proximal vs. Distal Outcomes
- proximal: individual and family self-management, cost of healthcare
- distal: health status, QOL, cost of health (direct and indirect)
- intervention is included as influencing context and process to influence proximal and distal outcomes
- context = risk and protective factors; process = self management
Self-Management Programs
- tailored to specific groups with a variety of delivery strategies successful at improving health outcomes
- aim to enhance ability of individual to imrpove health status, regardless of where they fall on the health-disease spectrum
- cross primary, secondary, and tertiary levels of care and prevention
Outcomes of Self Management
- condition outcomes - things to do to help improve illness
- individual, family and environmental outcomes - enhanced social support
- proximal vs. distal outcomes
- client-reported outcome measures
- population level chronic disease self-management data - promote greater health in the community
Role of Self-Efficacy
- belief in oneself to be able to do something
- self-management and efficacy are significantly correlated
Bandura on self-efficacy
4 components
- mastery experience - able to perform something successfully; able to master task
- vicarious experience - see positive outcomes in others and believe more in self - “if they can do it, so can I”
- social persuasion - can be positive or negative; positively encouraging or influencing someone to improve self-confidence
- psychological factors - self talk to promote selves and ability to be successful at meeting a goal or doing something
Assessment of COPD is based on:
- level of symptoms
- risk for exacerbatinos
- severity of spirometry abnormality
- presence of comorbid conditions
Nursing Practice Related to Self-Management
list 5 points
- coaching as a technique to enhance self-management and family management
- medication and treatment self-management
- nursing care coordination, technology, and medication self-management
- resources and supports
- interprofessional collaboration
Challenges with Self-Management Programs
4 points
- access far from guaranteed
- philosophy of client empowerment
- assumption of education - if management programs target too many interventions, can be overwhelming for patients
- potential widening between ‘haves’ and have-nots - SES can widen gap if interventions are for-profit or interventinons that require purchasing resources, transportation, etc…
List
Components of Transtheoretical Model of Behaviour Change
- precontemplation
- contemplation
- preparation
- action
- maintenance
define:
Precontemplation
- person has no intention of making any changes in the next 6 months
- may lack motivation
- may lack knowledge and skills that enable them to change behaviour
Contemplation
- person is contemplating change within the next 6 months
- aware of benefits of changing behaviour
- ambivalence occurs as the person focuses on barriers and costs that will occur during change period
Preparation
- individuals prepare to take action within the next month - generally have a plan and may have already taken some action toward the change
Action
- person has made modifications and action that is observable and measurable. it is during this stage that ongoing support is essential as relapse is high risk
Maintenance
- changes have been made and risk of relapse is decreasing
- individuals feel confident that they can continue the new behaviour
5A Model of Behaviour Change
Name the 5As
Assess
Advise
Agree
Assist
Arrange
Elaborate on the 5As
- Assess - beliefs, behaviour and knowledge
- Advise - provide specific information about health risks and benefits of change
- Agree - collaboratively set goals based on patient’s interests and confidence in their ability to change the behaviour
- Assist - identify personal barriers, strategies, problem-solving techniques, and social/environmental support
- Arrange - specify plan for followup - ex. vitals, phone calls, mailed reminders
Personal Action Plan for 5A model
- list specific goals in behavioural terms
- list barriers to strategies and address them
- specify followup plan
- share plan with practice team and client’s social support
Define
Motivational Interviewing
- Skillful clinical style for eliciting from patinets their own good motivations for making behaviour changes in the interest of their health
- involves guiding more than directing; dancing rather than wrestling; listening as much as telling
- overall ‘spirit’ of MI is collaborative, evocative, and honoring of patient autonomy
MI Assumptions
3
- clients have an inherent drive towards health and wholeness
- client is an expert about how to change their circumstances
- client’s experience of choosing and investing in their intended change is critical to success
Process of MI
Grant, 2016 - 4 points
- engaging: understanding the patient’s POV as a way to develop a working alliance with them
- focusing: the process of developing one or more clear goals for change
- evoking: calling forth the patient’s own motivation for, and ideas about change
- planning: the collaborative development of the next steps that the individual is willing to take
Phases in MI
list 4
- engaging / expressing empathy
- guiding / developing discrepancy
- evoking / role with resistance
- planning / support self-efficacy
Clinicians Role and Responsibility:
Engaging / expressing empathy
build rapport with person using OARS
* Open-ended questions
* Affirmation
* Reflective listening
* Summarizing
assess individual’s stage of change
Clinician Role and Responsibility:
Guiding/Developing discrepancy
- explore values and attitudes held by the individual
- identify goals and break into small achieveable and measurable steps
- encourage the individual to identify the benefits adn costs to changing behaviour
- allow individual to form their own argument concerning changing behaviour
Clinician Role and Responsibility:
Evoking - role with resistance
- the individual has identified a goal aimed at changing behaviour and is motivated to make the change
- use selective eliciting: elicit and selectively reinforce the individual’s motivational statements, intention to change, and ability to change
- do not argue
- use reflection
- summarize
- affirm statementss made
Clinician Role and Responsibility:
Planning - support self-efficacy
identify and set goals using SMART criteria
* specific, measurable, achieveable, realistic, timely
Self management as a process, program and outcome
- process - use of self-regulation skills to manage chronic conditions or risk factors
- program - designed by HCPs with the intent of preparing persons to assume responsibility for managing illness or engaging in health promotion activities
- outcomes: achieved by engaging in SM process -ex. stabilization of A1C
Self regulation includes:
- goal setting
- self monitoring
- reflective thinking
- decision making
- planning and action
- self-evaluation
- management of physical, emotional, and cognitive responses associated with behaviour change
Tasks Common Across Chronic Conditions
- symptom management
- taking medications
- recognizing acute episodes
- nutrition
- exercising
- smoking
- stress reduction
- interaction with health providers
- need for information
- adapting to work
- managing relations
- managing emotions
Engagement in SM leads to…
enhanced self efficacy and engagement in SM behaviours
Consequences of Self-Care
intended outcomes, unintended outcomes, additional outcomes
Intended outcome
* health status improvement and wellbeing - promotion of QOL, change in lifestyle or healthier behaviour
* increased stability of illness
* immune system rejuvenation
* lower mortality
Additional consequences:
* symptom management related - relief of stress, increase in adjustment, decreased anxiety related to chronic illness
* cost reduction related - healthcare cost, decreased hospitalization, better planned, coordinated, and convenient care
* personal development related - improved relationships, reconnecting with self- enhanced knowledge and awareness, acceptance of disease, increase in perceived control over illness, reduced use of health services, better work-life balance, increased compassion
Unintended conseqiences
* delay in treatment seeking if a person is overly reliant on their efforts
* costs such as time and effort to patients
List
The 5R’s to increase motivation
- relevance
- risk
- rewards
- roadblocks
- repitition
Elaborate on 4 Rs
define using example of tobacco use
- relevance - encouraging patient to indicate how quitting / behaviour change is personally relevant to them
- risk - encourage patient to identify potential negative consequences of tobacco use that are relevant to them
- rewards - ask patient to identify potential relevant benefits of stopping tobacco use
- roadblocks - ask patient to identify barriers or impediments to quitting and provide treatment (problem-solving counselling, medication) that could address barriers
- repetition - repeat assessment of readiness to quit. if still not ready to quit, repeat intervention at a later date
