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Chronic > Self-Management > Flashcards

Self-Management Flashcards

1
Q

Differentiate

Self-care vs. Self Management

A

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

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2
Q

Antecedents of self-care

define, list

A

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)

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3
Q

Attributes of Self-Care

define, list

A

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

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4
Q

Consequences of Self-Care

A
  • 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
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5
Q

Self Management

set of tasks (3); core processes (5)

A

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

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6
Q

Describe

Self-Management and Family Management Framework

A

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

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7
Q

Describe

Proximal vs. Distal Outcomes

A
  • 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
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8
Q

Self-Management Programs

A
  • 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
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9
Q

Outcomes of Self Management

A
  • 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
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10
Q

Role of Self-Efficacy

A
  • belief in oneself to be able to do something
  • self-management and efficacy are significantly correlated
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11
Q

Bandura on self-efficacy

4 components

A
  • 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
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12
Q

Assessment of COPD is based on:

A
  • level of symptoms
  • risk for exacerbatinos
  • severity of spirometry abnormality
  • presence of comorbid conditions
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13
Q

Nursing Practice Related to Self-Management

list 5 points

A
  • 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
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14
Q

Challenges with Self-Management Programs

4 points

A
  • 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…
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15
Q

List

Components of Transtheoretical Model of Behaviour Change

A
  1. precontemplation
  2. contemplation
  3. preparation
  4. action
  5. maintenance
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16
Q

define:

Precontemplation

A
  • 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
17
Q

Contemplation

A
  • 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
18
Q

Preparation

A
  • individuals prepare to take action within the next month - generally have a plan and may have already taken some action toward the change
19
Q

Action

A
  • 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
20
Q

Maintenance

A
  • changes have been made and risk of relapse is decreasing
  • individuals feel confident that they can continue the new behaviour
21
Q

5A Model of Behaviour Change

Name the 5As

A

Assess
Advise
Agree
Assist
Arrange

22
Q

Elaborate on the 5As

A
  1. Assess - beliefs, behaviour and knowledge
  2. Advise - provide specific information about health risks and benefits of change
  3. Agree - collaboratively set goals based on patient’s interests and confidence in their ability to change the behaviour
  4. Assist - identify personal barriers, strategies, problem-solving techniques, and social/environmental support
  5. Arrange - specify plan for followup - ex. vitals, phone calls, mailed reminders
23
Q

Personal Action Plan for 5A model

A
  1. list specific goals in behavioural terms
  2. list barriers to strategies and address them
  3. specify followup plan
  4. share plan with practice team and client’s social support
24
Q

Define

Motivational Interviewing

A
  • 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
25
Q

MI Assumptions

3

A
  • 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
26
Q

Process of MI

Grant, 2016 - 4 points

A
  • 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
27
Q

Phases in MI

list 4

A
  1. engaging / expressing empathy
  2. guiding / developing discrepancy
  3. evoking / role with resistance
  4. planning / support self-efficacy
28
Q

Clinicians Role and Responsibility:

Engaging / expressing empathy

A

build rapport with person using OARS
* Open-ended questions
* Affirmation
* Reflective listening
* Summarizing

assess individual’s stage of change

29
Q

Clinician Role and Responsibility:

Guiding/Developing discrepancy

A
  • 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
30
Q

Clinician Role and Responsibility:

Evoking - role with resistance

A
  • 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
31
Q

Clinician Role and Responsibility:

Planning - support self-efficacy

A

identify and set goals using SMART criteria
* specific, measurable, achieveable, realistic, timely

32
Q

Self management as a process, program and outcome

A
  1. process - use of self-regulation skills to manage chronic conditions or risk factors
  2. program - designed by HCPs with the intent of preparing persons to assume responsibility for managing illness or engaging in health promotion activities
  3. outcomes: achieved by engaging in SM process -ex. stabilization of A1C
33
Q

Self regulation includes:

A
  • goal setting
  • self monitoring
  • reflective thinking
  • decision making
  • planning and action
  • self-evaluation
  • management of physical, emotional, and cognitive responses associated with behaviour change
34
Q

Tasks Common Across Chronic Conditions

A
  1. symptom management
  2. taking medications
  3. recognizing acute episodes
  4. nutrition
  5. exercising
  6. smoking
  7. stress reduction
  8. interaction with health providers
  9. need for information
  10. adapting to work
  11. managing relations
  12. managing emotions
35
Q

Engagement in SM leads to…

A

enhanced self efficacy and engagement in SM behaviours

36
Q

Consequences of Self-Care

intended outcomes, unintended outcomes, additional outcomes

A

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

37
Q

List

The 5R’s to increase motivation

A
  1. relevance
  2. risk
  3. rewards
  4. roadblocks
  5. repitition
38
Q

Elaborate on 4 Rs

define using example of tobacco use

A
  1. relevance - encouraging patient to indicate how quitting / behaviour change is personally relevant to them
  2. risk - encourage patient to identify potential negative consequences of tobacco use that are relevant to them
  3. rewards - ask patient to identify potential relevant benefits of stopping tobacco use
  4. roadblocks - ask patient to identify barriers or impediments to quitting and provide treatment (problem-solving counselling, medication) that could address barriers
  5. repetition - repeat assessment of readiness to quit. if still not ready to quit, repeat intervention at a later date

Chronic (3 decks)

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