Patient / Carer Empowerment in Rehabilitation: Challenges and Success Factors

Transcription

1 東 華 三 院 黃 大 仙 醫 院 Tung Wah Group of Hospitals Wong Tai Sin Hospital Patient / Carer Empowerment in Rehabilitation: Challenges and Success Factors HA Convention 2015 Li KY, Tang IFK, Kwong MWY, Chan RWH, Ko CSH, Wong YN Department of Rehabilitation and Extended Care 1

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4 Learning new skills Chronic disease Dependent & passive Lack of support Hospitalized Patient Unresolved emotional problems Poor adaptation Knowledge deficits Poor control 4

5 Living with Chronic Illness or Diseases Patient / Carer Empowerment in Rehabilitation Quality Of Life 5

6 Rehabilitation 6

7 Key Features of Empowerment Acceptance Affection Autonomy Alliance Active participation Skinner TC; Cradock S,

8 Patient / Carer Empowerment Patient-centered Collaborative Approach Autonomy & Self-control the effects of disease, through knowledge skills sense of control over life QoL Active patient participation and influence is vital in rehabilitation process (Wikman and Faltholm, 2006) 8

9 Bloom's Taxonomy of Learning Domains The Three Domains of educational activities or learning (Bloom, et al. 1956) Cognitive: mental skills (knowledge) Affective: growth in feelings or emotional areas (attitude or self) Psychomotor: manual or physical skills (skills) 9

10 Cognitive Carer Patient / Carer Empowerment Domains Strengthening Psychomotor Affective 10

11 Patient Challenges Nurse System & Environment 11

12 Vision Hearing Emotion Illness Limitation Cognitive Readiness Physical Capabilities Attributed Values Carer Patient type Culture Attitudes & motivation Aged Literacy Quality 12

13 Challenges Nurses: Attitude & personal values Knowledge Skills Confidence System & Environment: Routine Manpower Limited resources Service gap Invest in Education and Training System & Environmental Review 13

14 Communication Assessment Counselling Nurse Roles in Patient / Carer Empowerment Information and knowledge Coordination Understanding 14

15 Focus Area Advanced Early community Discharge linkage Plan Patient / Carer Positive Early Engagement Sense of Control and Affective Empowerment Domain Strengthening Cognitive // Psychomotor Knowledge Mobility Training Domain Strengthening / Skills Reinforcement 15

16 Objectives to increase health literacy of patient and carer to improve patient s physical mobility and psychomotor skills to assist patients with disability and chronic illness to attain maximized function to increase awareness of their personal strength to relieve carer stress by increasing their sense of control 16

17 Methodology 840 patients were recruited in rehabilitation programmes (Apr Mar 2014) Pulmonary Rehabilitation (PR) Neurological Rehabilitation (NR) Musculoskeletal Rehabilitation (MSR) Geriatric Rehabilitation (GR) 17

18 NR Empowerment Programme Domains Cognitive (Knowledge Education) CVA Parkinson's disease Dementia DM Cholesterol Fall prevention Continence care Drug compliance Warfarin information Healthy life style Smoking cessation Discharge planning Community resources Hypertension Constipation Psychomotor (Skill Training) Turning Transfer Grooming Dressing Swallowing Continence care Walking Bathing H'stix checking Insulin injection Fine motor exercise Passive limb ex Affective Education and Counseling Group therapy Cognitive training Reality orientation Reminiscence therapy 18

19 PR Empowerment Programme Domains Cognitive (Knowledge Education) COPD Congestive heart disease Exercise regimen Follow-up matter Smoking cessation Fall prevention Drug compliance Healthy life style Discharge planning Community resources Psychomotor (Skill Training) Breathing control Pacing technique Energy conservation technique Puff technique Use of breathing device Transfer Walking Bathing Affective Education and Counseling Group therapy 19

20 GR Empowerment Programme Domains Cognitive (Knowledge Education) Hypertension Constipation DM Fall prevention Continence care Drug compliance Healthy life style Discharge planning Community resources Urethral Catheter care Psychomotor (Skill Training) Stoma care Transfer Continence care Walking Bathing H'stix checking Insulin injection Affective Education and Counseling Group therapy Cognitive training Reality orientation Reminiscence therapy 20

21 MSR Empowerment Programme Domains Cognitive (Knowledge Education) Fracture of Hip Osteoporosis Gouty arthritis Osteoarthritis Pain control Low back pain Fall prevention Continence care Drug compliance Healthy life style Discharge planning Community resources Psychomotor (Skill Training) Transfer Walking Continence care Affective Education and Counseling Group therapy 21

22 Journey of Patient / Carer Empowerment Out-patient Phase In-patient Phase Cognitive / Psychomotor / Affective Domain strengthening Pre-discharge Phase Admission Phase 22

23 Admission Phase 23

24 Empowerment Start from Triage Early Patient / Carer Involvement 24

25 In-patient Phase 25

26 Prompt Communication / Early Discharge plan Early Patient / Carer Involvement 26

27 Individual Health Education Knowledge & Skill Attention 27

28 Individual Health Education Knowledge & Skill Technique Timely Reinforcement 28

29 Group Health Education Knowledge & Skill Attention 29

30 Health Education Materials Tailor-made for Elderly Patients and Carer 30

31 Health Education Materials Take Home Message With Early Carer Involvement 31

32 Cognitive & Psychomotor Skill Training 32

33 Cognitive Training 33

34 Reality Orientation 34

35 Reality Orientation 35

36 Reality Orientation 36

37 Reminiscence Therapy 37

38 Reminiscence Therapy 38

39 Reminiscence Therapy 39

40 Group Therapy 40

41 Pre- Discharge Phase 41

42 Pre- Discharge Education Community Services Introduction 42

43 Out-Patient Phase 43

44 Follow-up & Monitoring for Target Patient Group 44

45 Success Factors: Staff & System Team spirit & Mission alignment Management support Resources availability Nurses competency Multidisciplinary 45

46 Success Factors: Domains Advanced Early community Discharge linkage Plan Patient / Carer Positive Early Engagement Sense of Control and Affective Empowerment Domain Strengthening Cognitive // Psychomotor Knowledge Mobility Training Domain Strengthening / Skills Reinforcement 46

47 Results (Average) 5 times of knowledge and skills training were provided to each patient s carer during patient hospitalization 65% of patients were discharged home 47

48 Result - NR High Frequency Sessions Cognitive Psychomotor Affective CVA DM Fall prevention Continence care Drug compliance Hypertension Transfer Grooming Continence care Walking Education and Counseling Group therapy Cognitive training Reality orientation Reminiscence therapy 48

49 Result - PR High Frequency Sessions Cognitive Psychomotor Affective COPD Fall prevention Drug compliance Breathing control Pacing technique Energy conservation technique Puff technique Use of breathing device Education and Counseling Group therapy 49

50 Result - GR High Frequency Sessions Cognitive Psychomotor Affective Hypertension DM Fall prevention Continence care Urethral Catheter care Transfer Continence care Walking Education and Counseling Group therapy Cognitive training Reality orientation Reminiscence therapy 50

51 Result - MSR High Frequency Sessions Cognitive Psychomotor Affective Fracture of Hip Fall prevention Drug compliance Continence care Transfer Walking Continence care Education and Counseling Group therapy 51

52 Conclusion Role of Rehabilitation Nurse patient s quality of life Specific approaches challenge into success Empowered Cognitive, Psychomotor & Affective domains & better carer support. 52

53 Recommendation Patient satisfaction Qualitative & Quantitative Psychosocial empowerment 53

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55 References Vluggen et al. 2012, Multidisciplinary transmural rehabilitation for older persons with a stroke: the design of a randomised controlled trial, BMC Neurology 2012, 12:164 Palaka C. Patel et al., 2011, Journal Club An Equation for Positive Patient Outcomes and Nursing Empowerment, Evidence- Based Practice and a Nursing Journal for Nurses in Staff Development & Volume 27, Number 5, 227Y230 Mental Health Atlas 2011, China, Hong Kong Special Administrative region, Department of Mental Health and Substance Abuse, World Health Organization Nelma B. Crawford Shearer, 2009, Health Empowerment Theory as a Guide for Practice, Geriatric Nursing, Volume 30, Number 2S Anna M. Chudyk, et al., 2009, Systematic Review of Hip Fracture Rehabilitation Practices in the Elderly, Arch Phys Med Rehabil Vol 90, February 2009 Alison J. Tierney, 2008, Patient empowerment, The Author. Journal compilation, Blackwell Publishing Ltd 393, Celeste Shawler, 2006, The Empowerment of Older Mothers and Daughters: Rehabilitation Strategies Following a Hip Fracture, Geriatric Nursing, Volume 27, Number 6 Wikman and Faltholm, 2006, Patient empowerment in Rehabilitation: somebody told me to get rehabilitated. Advances in Physiotherapy, 8(1): Michigan Diabetes Research and Training Center, University of Michigan Medical School, 2004 Patient empowerment. Crit Care Nurs Q Apr-Jun;27(2): Mark Faulkner, 2001, A measure of patient empowerment in hospital environments catering for older people, METHODOLOGICAL ISSUES IN NURSING RESEARCH, Blackwell Science Ltd Skinner TC et al., 2000, Empowerment : what about the evidence? Practice Diabetes International (Pract Diabetes Int) May Jun 2000 (3)

56 Acknowledgment Dr Doris MIU Consultant in Charge DREC WTSH DREC Rehabilitation Team Doctors Nurses Physiotherapists Occupational Therapists Medical Social Workers Speech Therapist Dietitian Clinical Psychologist 56