Facilitating the Self-Management of Spinal Cord Injury

Transcription

1 Facilitating the Self-Management of Spinal Cord Injury Michelle A. Meade, Ph.D. University of Michigan Department of Physical Medicine & Rehabilitation Center for Managing Chronic Disease Shawn Floyd, B.S. Spinal Cord Injury Association of Virginia

2 Disclosures The Faculty have no commercial or financial interests in this presentations. CME Staff Disclosures Professional Education Services Group staff have no financial interest or relationships to disclose.

3 Acknowledgements This presentation was adapted from the Facilitating Health Mechanics manual, written by and copyrighted to the author as a part of the project Self-Management of SCI/D funded by grant #576 from the PVA Education Foundation. PVA Research Foundation grant #2751 Evaluating the Effectiveness of Health Mechanics: A Self-Management Program for Individuals with Spinal Cord Injury which is currently in progress

4 Learning Objectives Audience members will be able to discuss the importance of a self-management perspective for individuals with SCI be able to identify three self-management skills and how they may be applied by individuals with SCI become aware of how to incorporate the development of self-management skills into their patient teaching and clinical practice

5 Self-Management An evidence-based approach to managing chronic illness Provides education and skill-building related to selfmonitoring, communication, problem-solving and relaxation. The ability of an individual with a chronic condition to manage their health and its physical and psychosocial consequences Requires Learning about and understanding their injury & care Prioritizing health concerns Active participation in the health care partnership Accepting responsibility for performing specific health behaviors

6 Existing evidence and programs Peer led Chronic Disease Self-Management Program / Arthritis Lorig and Stanford Patient Education Research Center/ Living well with a disability Provider based / professionally facilitated Lifestyle Redesign (Florence Clark and colleagues) OT intervention for various populations From Asthma Clark and colleagues Problem Solving Training (Nezu & D Zurilla) Spinal Cord Injury Kennedy & Colleagues coping effectiveness training

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8 Self-Management Goals Manage health and emotions Prevent and deal with secondary conditions Improve communications with others Optimize Environment Improve Community Integration

9 SCI-Specific Management Skin Circulation / blood pressure Respiratory Bowel management Bladder management Range of Motion

10 Additional Challenges with General Health Management Nutrition / Diet Regular Exercise Not Smoking / Smoking Cessation Taking Medication Appropriately Address Bone Health Optimize Emotional / mental health Preventative health care

11 Managing Secondary Conditions Urinary Tract Infections Spasticity Pain Autonomic Dysreflexia Sexual Dysfunction Depression / anxiety Pressure sores / skin breakdown

12 Managing the Social Environment Getting social support Communication Confronting Stereotypes Educating others Attendant management

13 Managing the Physical Environment Home accessibility Transportation Ramps, steps and elevators Advocacy Americans with Disability Act

14 Managing the Healthcare System Communication with health care professionals Pain management Insurance and what is covered Ordering supplies Durable medical equipment

15 Facilitating Health Mechanics An evidence based program Developed as results of Needs Assessment Review of Existing theories, research and programs Input from both consumer and professional advisory boards Evaluated by focus groups

16 Components Attitude Self-monitoring Problem-Solving Communication Organization Stress Management

17 Attitude Importance of accepting responsibility for your health and your future and becoming positive and proactive Expectations Assumptions Outlooks Responsibility Actions

18 Self-Monitoring To Monitor is to regularly observe or record information about what is happening Identifying signs and symptoms Collecting Information Processing Information Evaluating the effectiveness of changes

19 Problem-Solving New situations or emotions Steps State problem Outline Problem with all relevant details List possible solutions Consider possible consequences of possible solutions Rank / combine solutions Implement one possibility Evaluate effectiveness

20 Communication Ways of communicating Basics of communicating Determine what the goal of the conversation is Determine the most effective way of achieving that goal (be strategic) Accept responsibility for your own feelings Give and accept feedback with an open mind and non-defensive manner Communicating in the health care environment

21 Organization To organize is to put something in an orderly system to make it easier to use or negotiate Steps Decide on a goal Plan Take Action Maintenance

22 Stress Management Primary methods Relaxing the body Calming the mind Refocusing attention Soothing the soul Building on strengths and supports Things to avoid

23 Example: Bladder management Attitude Self-monitoring Problem solving Communication Organization Stress management

24 Peer Mentoring and Self-Management

25 Why Self Management in the Real World is Critical

26 THE MANY ROLES OF A MENTOR Guide Helper Listener Role-model Sounding board Teacher Information provider Friend Supporter Advisor Confidant Self-esteem booster Big brother/sister Coach Companion Motivator Mentors facilitate a positive attitude while promoting problem solving techniques

27 Factors Factors influencing level of self-management skills and competency: Attitude Age Education Cognitive capacity Pre-existing experience in using the skills in other contexts Level of adjustment and mental health status influence both ability and motivation to take on the responsibility of actively managing health

28 Takes One to Know One Provides Support Across the Spectrum New Injury Injury education, explanation of common terminology Sort out relevant information Assess patient understanding Answers questions and provides emotional support Demonstrates firsthand that life isn t over because of the injury Discharge to 1 st year Assists in teaching concrete problem solving techniques (i.e. returning to an apartment or house that is highly inaccessible) Provides information on community resources Helps make connections as they rebuild their lives and become interested in things beyond the basics

29 Beyond the Basics Resuming work/education Family life Adaptive sports/recreation Advocacy Research Mentoring

30 Partnering with Health Care Professionals Help individuals with SCI Understand what is going on What can be done to address challenges Explain what they are recommending and why Relate info to long or short-term goals Discuss specific behaviors Assess understanding Address questions individuals with SCI have about information they have received from other sources

31 As We Age Compare Aches and Pains Expert Patients have insight that are not to be discredited.

32 Summary Both theories and research are readily available to help understand health behavior changes Health care providers can and should use these to support their own treatment and interventions Facilitating Health Mechanics is a manualized program that is available to assist providers in collaborating with patients to support their selfmanagement skills Peer mentoring can provide important supports and role modeling for the self-management process

33 Obtaining CME Credit If you would like to receive CME credit for this activity, please visit: This information can also be found in the Summit 2011 Program on page 8.