自我管理的概念与体用

自我管理的概念與體用伍杏修香港復康會總監(復康）聯絡：13530474291(852)97792794電郵：hs.ng@rehabsociety.org.hk報告內容下載 http://www.rehabsociety.org.hk 電郵：hs.ng@rehabsociety.org.hk 由3月7日至3月25日報告大綱熱身準備(你一定知道，但……)長期病/慢性病人口、特徵自我效能（Self-efficacy）自我管理（Self-management）定義、為甚麼要、元素、應用及實踐、成效實習--訂定行動計劃身心力行課程推行(長期病患者的自我管理課程)CDSMP朋輩帶領的發展自由發問長期健康問題/慢性病長期健康問題/慢性病包含類別非常廣泛，包括有傳染性。例如：愛滋病(HIV/AIDS)非傳染性。例如：心血管病、癌症、糖尿病等等精神健康。例如：抑鬱、精神分裂等等殘障。例如：截肢、關節問題、視障等等長期健康問題/慢性病世界趨勢一般來說，長期健康問題/慢性病都有共同趨勢病患者數目不斷上升(以程糖尿病為例，1995年有1.35億人，但估計到2025年有3億人口)病患者年齡不斷年輕化為目前醫療體系構成極大挑戰和沉重負擔目前約共60%醫療資源用於處理長期健康問題/慢性病，估計到2020年會上升至80%長期病患人口香港特區政府統計處於1999年9月至11月期間進行調查，發現有86萬人患有各式各樣長期病，即8個港人有1個長期病患56.3%的長期病患者的年齡為60歲或以上，患病者的年齡中位數為63，相對於整體市民的年齡中位數為36，長期病的病發較多在老年人口身上相對於不同的年齡組別，60歲或以上的病發率為48.8%女性病發率為14.1%；男性則為11.9%根據香港大學內科學系家庭醫學部林露娟教授於2001年公佈調查結果，全港約有180萬成年人患有一種或以上的長期病。平均每人有0.58個病，而37%的長期病患者有多於一種的長期病3使用醫療服務香港特區長期健康問題人士/慢性病患者多一般沒有長期健康問題人士/非慢性病患者3倍使用住院服務多一般沒有長期健康問題人士/非慢性病患者18倍使用藥物長期病現象病徵不斷或持續影響患者正常活動和日常生活現有藥物不能或者只有限度發揮治療功能藥物副作用或併發症足以影響患者或其家人正常生活病症對患者構成嚴重社會和心理影響2一般慢性健康問題香港特區關節痛症20%高血壓11%慢性肺病5%糖尿病5%精神健康問題8%TheKaiserPermanenteTriangle第三層非常複雜個案管理第二層高危疾病//護理管理第一層:70-80%慢性病人口可以自我管理/自我照顧促進健康RatioofSharedProfessionalCaretoSelfCareacrosstheChronicIllnessPopulationbase專業共同照顧SharedProfessional自我照顧促進健康自我照顧自我效能Self-efficacy(1)自我效能理論是從社会学習理論發展而來的。在SLT中人類行為的產生是个体因素、環境因素及行為本身相互影响的、能動的過程。一个新行為的獲得和維持决定于3个方面：行為的能力，即有執行某行為所必需的技能；效能預期值的高低，即對自己能够成功地執行某行為的自信程度；結果預期值的高低，即對執行某一行為將會出現應有的作用或后果的相信程度 傅東波，加拿大健康促進研究印象自我效能Self-efficacy(2)病患者判斷自己能力能做到的事情。這並不牽涉他有甚麼，有多少技能，反而最重要是他有信念能實踐他擁有的技能自我認知的能力能處理一特定處境 A.Bandura自我管理的定義(1)學習如何可以積極及正面去面對長期健康問題目標是令參加者採納積極和配合的態度與醫護人員合作 KateLorig,StanfordPatientEducationCenter,1993自我管理的定義(2)健康進階中心（1996）： 「讓患者（有長期病患人士）能參與一些活動，活動的目標是維持及提昇健康，監察及處理症狀，處理因病患引起功能上、情緒上及人際上的衝擊和依照醫護計劃行事。」 AccordingtotheCentreforAdvancementinHealthinWashingtonDC,SelfManagementinvolvesapartnershipbetweenclientsandtheirhealthworkers.InthisrelationshipTheclienthassomeresponsibilities.Theyinclude:engaginginactivitieswhichpromotetheirhealth.monitoringandmanagingtheirsymptomsday-to-dayadheringtotreatmentsthathavebeenagreedtowithhealthworkers.Whenaclienthasmasteredtheseskills,theyaresaidtobegoodselfmanagers.自我管理的定義(3)自我管理是任何有長期健康問題的人士可以透過自我管理設訂目標或方針去面對及處理因健康引致的處境並與它共存。這些工作應包括建立在治療管理、角色管理及情緒管理方面自信心。 NewPerspectives:InternationalConferenceon PatientSelf-Management,2005甚麼是自我管理是建基於患者現有或要面對的問題要建立及提昇自信心（自我效能）達致3個目標或方針疾病管理角色管理情緒管理目標是善用醫護服務或設施去改善生活質素 Define:SelfEfficacyisacombinationofconfidencelevelandknowledgetoachievesomethingI.e.onemayhavetheconfidencebutnottheknowledgeorvs.DiseaseManagement:monitoring,recordingandrespondingtosymptomsRoleManagement:partnershipsthatisequalbutdifferent,takinganactiveroleinplanningcareandresponsibilityinkeepingtotheplanEmotionalManagement:managingtheemotionalimpactthatthediseasehasontheirlife,family,socialandeconomical focusonqualityoflifebyimprovingtheirhealthstatusandappropriateuseofresources為何需要自我管理長期病患者/慢性病人口不斷增加只有50%病患者跟從醫生治療及處方只有30%病患者能依從專業人士指導改變行為和實踐健康生活模式絕大多數的患者只停留在知識層面，知而不行絕大多數的患者能參與及學習，教育程度低也沒有影響病患者可成為導師促導課程有豐富驗証數據HowdotheySupportClient’sImproveclientknowledgeofillness-oneononeorgroupworkknowledgeoftreatmentandinterventions-educationinvolvementindecisionmaking-throughselfmanagementcourses-confidencebuild-assertivetraining-problemsolveabilitytotakeactionifsymptomsworsen-throughactionplansandrecordsabilitytoarrangeandattendappointments-useofcalendarsandproactiveplanningabilitytomanagetheimpactoftheirillnessreferraltootheragencies,relaxation/anxietymanagement,fallspreventionsupportclienttoliveahealthierlifestyleQuitSmoke,Exerciseandcookingclasses自我管理的目標減少對專業照顧及護理成本提升病患者生活質素為病患者充權自我管理與日常生活病患者或服務使用者與醫護人員互相合作家人的參與照顧身、心、靈各方向需要以積極的策略達致為服務使用者賦權或充權SelfManagementAlsoEncompassesThepatient/client,andhealthprofessionalsworkingtogetherOfteninvolvesthefamilyAnholisticapproachtocareiemedicalandpsycho-socialcomponentsofaconditionPro-activeandadaptivestrategiesthataimtoempowertheindividualTheothersideoftheselfmanagementrelationshipinvolvesthehealthworker.Theirresponsibilitiesinclude: workingwiththeclient,asdifferentbutequalpartners.TheHealthworkerislikeanexpertconsultantregardingdiseaseandtreatments.Thepatientistheexpertinhowthediseaseiseffectinghim/herpersonally,day-to-day.Healthdecisionsneedtobemadetogether,inconsiderationofthedisease,andtheday-to-dayeffectitishaving.Acknowledgingthatthereismoretotheclientthanthedisease,andthatthediseaseeffectsmorethantheclient’sbody.Listenforotherinterventionsthatmayberequired,eveniftheyarenotdirectlylinkedtothedisease,eg,socialsupports(istheircarergettinganyrespite?,doestheclienttheyhaveanysocialnetworks?),otherconditionsthatareeffectingtheclientsdailyliving(deafness,incontinence).EtcBereadytothinkoutsidethe‘episodeofcare’pathway.You’reresponsibleforsupportingthewholeperson,nota‘condition’.自我管理與病人教育的分別(1)自我管理面對與病患共存提昇技巧或自信學習解決問題及作出決定病人教育改變行為學習知識使用特定工具（護理計劃、行動計劃）目標HowSelf-ManagementDiffersfromPatientEducationSelfManagementTomanagelifewithDiseaseToincreaseskills/selfconfidenceToproblemsolveandmakedecisionsPatientEducationTochangebehavioursToincreaseknowledgeTousespecificToolsi.e.CarePlan,ActionPlansBrainstormgroupDiseasewillneverbecured-wearelookingtoimprovequalityoflife自我管理與病人教育的分別(2)自我管理患者問題/需要疾病、角色及情緒管理健康狀況/服務使用情況病人教育患者需要知道的知識疾病知識及行為知識/行為需要評估內容結果/成效HowSelf-ManagementDiffersfromPatientEducationSelfManagementTomanagelifewithDiseaseToincreaseskills/selfconfidenceToproblemsolveandmakedecisionsPatientEducationTochangebehavioursToincreaseknowledgeTousespecificToolsi.e.CarePlan,ActionPlansBrainstormgroupDiseasewillneverbecured-wearelookingtoimprovequalityoflife自我管理與病人教育的分別(3)自我管理每週多個專題促導員為參加者起示範角色有限授課形式與朋輩互相學習病人教育每週一個專題講員是專家，以專家身份教授多以授課形式進行從授課/問答中學習如何教授HowSelf-ManagementDiffersfromPatientEducationSelfManagementTomanagelifewithDiseaseToincreaseskills/selfconfidenceToproblemsolveandmakedecisionsPatientEducationTochangebehavioursToincreaseknowledgeTousespecificToolsi.e.CarePlan,ActionPlansBrainstormgroupDiseasewillneverbecured-wearelookingtoimprovequalityoflife醫護人員方面：概念或假設(1)病患者應該作出改變病患者渴望或盼望有改變病患者的健康是自己的最終推動力如果病患者未能作出改變就是自己的失敗HealthProfessional:AssumptionsThispatientSHOULDchangeThispatientWANTStochangeThispatient’shealthistheirprimemotivationIfthepatientdoesnotchangethenwehavefailedThe‘StagesofChange’modelchallengesourassumptionofwhata’successfulintervention’is.Healthworkersoftenfeelthattheirclientsshouldchange,shouldwanttochange,andiftheydonotchangethenthewholeexperiencehasbeenawasteoftime.Stagesofchangetheoryreassuresusthatpeoplelearnbyexperience,andincycles.Arelapsenowplacesusinabetterpositionto‘maintain’changedbehaviournexttimeround,withtheaddedexperiencewenowhave.Wearenotlinearcreatures.Ourlivesarecomplexandourlearningisongoing.Wedothebestwecangivenourcurrentcircumstancesandskills.Eachcycleincreasesourknowledgeandskillaboutourselvesandourcondition.Ashealthworkers,ourroleistoacknowledgeandsupporttheprocessofchange,inallitsmessiness.醫護人員方面：概念或假設(2)在鼓勵下可能有改變或無反應這一刻是改變的好時間最賦挑戰的手法便是最好的方法我是專家，他或她必須跟從我的建議HealthProfessional:AssumptionsPeopleareeithermotivatedtochangeornotNowistherighttimeforchangeAtoughapproachisalwaysthebestI’mtheexpert.Heorshemustfollowmyadvice自我管理6大原則了解自己積極地與醫護人員規劃復康計劃按照復康計劃留意任何有關的症狀管理身體上、情緒上及社交上的衝擊實踐健康生活SixprinciplesofSelfManagement1Knowyourcondition2HaveactiveinvolvementindecisionmakingwithyourGPorhealthworkers3FollowtheCareplanthatyouagreedwithyourGPandotherhealthprofessionals4Monitorsymptomsassociatedwiththecondition(s)andRespondto,andmanagethesymptoms5Managethephysical,emotionalandsocialimpactofthecondition(s)onyourlife6LiveahealthyLifestyleClientsneedto:Knowabouttheirconditions.Understandwhatcausedit,whatitmeanstotheirbody,whatwillhappeniftheydon’tmaintaintheirhealth.Whattoexpectinthefuture.Beactivelyinvolvedindecisionmakingwithhealthworkers.Theyneedtoaskquestions,clarifypointthatdon’tmakesense.FeelOKaboutverbalisingtheirconcernsorfearsaboutnewtreatmentsetc.Theyneedtounderstandwhytheyarehavingthetreatments(medications,therapies)theyarehaving.Whatdifferencewilltheymake?Followtheagreedtreatmentplan.Oncethey’veagreedtoaplanofactiontheyneedtostickwithit,orrenegotiatethingswiththeirhealthworker.(continuedonnextslide…)成功自我管理要素提供自我管理的訓練及支援服務讓病患者可以： 接受未能即時解決的問題處理壓力自我推動力主動及持續有醫護人員的跟進CharacteristicsofsuccessfulSelfManagementProvidearangeofself-managementtrainingandsupportservicestoassist: ClienttocopewithcircumstancesthatcannotchangeClienttomanagestressSelf-motivationActiveandsubstantialfollow-upbyhealthcareprofessionalsWagneridentifiedthatsuccessfulprogramsalsoprovidearangeofselfmanagementtrainingandsupportservicestoassistclientstocopewithcircumstancestheycannotchange,tomanagestress,toassistselfmotivationofclients,andtoensureactivefollowupbyhealthcareprofessionals.REFERENCEWagner,EH.Austin,BT.VonKorff,M.OrganisingCareforPatientswithChronicIllness,TheMilbankQuartely,Vol.74,No.4,1996.自我管理的支援由醫護人員有系統地提供教育及關顧來增強或完備病患的技巧及自信心去處理因健康引致的處境包括定期評估進程及所面對的問題及提供確立目標及解決問題等支援有提供支援自我管理的單位有長期健康問題的人士（有自信去認知及確立自己有關醫護管理，角色管理及情緒管理）家庭醫生醫務衞生署醫管局僱主傳媒研究人員非政府管轄團體醫護人員自助組織社會福利署大學或專上學院自我管理能支援病患者改善及增強下列各方面：服務使用者對所患的疾病之認知對可行的治療及方法的認知在決策過程的參與當病患惡化時有動力去面對可以安排覆診及應診可以處理因病患帶來的衝擊鼓勵實踐健康生活HowdotheySupportClient’sImproveclientknowledgeofillness-oneononeorgroupworkknowledgeoftreatmentandinterventions-educationinvolvementindecisionmaking-throughselfmanagementcourses-confidencebuild-assertivetraining-problemsolveabilitytotakeactionifsymptomsworsen-throughactionplansandrecordsabilitytoarrangeandattendappointments-useofcalendarsandproactiveplanningabilitytomanagetheimpactoftheirillnessreferraltootheragencies,relaxation/anxietymanagement,fallspreventionsupportclienttoliveahealthierlifestyleQuitSmoke,Exerciseandcookingclasses自我管理成效世界趨勢參加者6個月後在以下健康指標有改善：自我評核健康量 表 关于同志近三年现实表现材料材料类招标技术评分表图表与交易pdf视力表打印pdf用图表说话 pdf Self-RatedHealth自我評核殘障Disability社交及活動限制SocialandRoleActivitiesLimitations體能/疲勞程度Energy/Fatigue心理健康情況DistresswithHealthState EvaluationsofCDSMP,GlobalStudies自我管理成效在美國、英國、加拿大、澳洲、香港及中國的不同研究均証實自我管理課程能有效：↑自我效能self-efficacy↑自我管理方面的知識及行為↑體能及動力↑克服困難技巧↓使用醫療服務及資源↑自我感覺的健康狀況perceivedhealth自我管理成效世界趨勢改善醫療服務使用情況 在6個月內平均減少0.8日住院(p=.02) 門診服務及急症亦有減少趨勢(p=.14) USStudies香港復康會曾進行之有關研究(1)香港復康會曾進行之有關研究(2)香港復康會曾進行之有關研究(3)自我管理解決問題步驟認清問題所在列出可以解決問題的方法選擇一個方法去試行評估成效改行另一個方法利用其他資源接受問題未能即時解決的可能自我管理行動計劃要素你自己想做的事情(不是別人認為你應該做，也不是你認為自己應該做的事情)可完成的(你預計本週能夠完成)具體的行為必須回答以下的問題做甚麼?做多少?何時做?每週做多少次?有7成或以上信心「身心力行」課程香港復康會社區復康網絡2006課程簡介本課程由美國史丹福大學病人教育研究中心創辦，ChronicDiseaseSelf-ManagementProgram香港復康會社區復康網絡在2000年正式把課程引進，並採用「身心力行」課程為其譯名主要讓參加者透過不同環節，讓他們了解及認知自身的情況，並以自管理概念去發揮和提昇其潛能，藉此更有效掌控因身體帶來的各種健康問題和處境課程重點目標：採納系統化的解決問題步驟掌握痛楚及情緒的處境認知及確立自我管理的行為及態度身心力行課程是透過標準化的小組模式，每節為時2小時30分、共6節每組的人數為12-16人身心力行課程特色所有組長都是接受統一訓練 （不論專職或朋輩組長）組長亦配備一本詳盡的組長手冊主題：行動計劃，解決問題步驟及症狀循環〝工具箱〞的概念自我管理的模式及態度組員的得著↑自信心↑開心↑同醫護人員溝通↑與家人／朋友溝通↑生活趣味↓疲累、乏力↓發脾氣↓使用醫療服務，從而↓醫療開支參考 材料 关于××同志的政审材料调查表环保先进个人材料国家普通话测试材料农民专业合作社注销四查四问剖析材料 Lorig,K.(1999).TheChronicDiseaseSelf-ManagementWorkshop:LeadersManual.PaloAlto,CA:LelandStanfordJuniorUniversity.Lorig,K.,Stewart,A.,Ritter,P.,Gonzalez,V.,Laurent,D.,Lynch,J.(1996).Outcomemeasuresforhealtheducationandotherhealthcareinterventions.ThousandOaks,CA:Sage.香港復康會在自我管理方面著作Chan,S.C.C.,Siu,A.M.H.,Poon,P.K.K.,&ChanC.C.H.(inpress).Chronicdiseaseself-managementprogramforChinesepatients:apreliminarymulti-baselinestudy.InternationalJournalofRehabilitationResearch.徐英賢、蕭敏康《香港人對健康的自我管理調查報告》香港復康會社區復康網絡「身心力行計劃」，2003年。徐英賢、蕭敏康《長期病患者的肥胖問題調查報告》香港復康會適健中心，2005年。香港復康會在自我管理方面著作(2)Siu,A.M.H.,&Chui,D.Y.Y.(2004).Evaluationofacommunityrehabilitationserviceforpeoplewithrheumatoidarthritis,PatientEducation&Counseling,55,62-69.Siu,A.M.H.,Chui,D.Y.Y.,Poon,P.K.K.,&Lau,J.S.K.(2004).Self-managementofHealth&Illness-acommunitytelephonesurvey.KeystoPositiveLivingconference:self-managinghealthandchronicillness.HongKong.Lung,P.Y.,Siu,A.M.H.,&Lau,J.(2004).ValidationofaTherapeuticFactorsQuestionnaireforstudyinggroupprocessesofChronicDiseaseSelf-managementGroups.KeystoPositiveLivingconference:self-managinghealthandchronicillness.HongKong.朋輩領導身心力行Peer-ledHIA4/2002-3/2004(1)獲得獎券基金撥款成立身心力行計劃引入病人自我管理概念及服務模式，將其本地化完成5項以上研究，証明課程的適合性及成效提供了約100個課程及工作坊，服務了1,000位參加者與超過25個機構/團體合作4/2002-3/2004(2)培訓了80位組長，其中約有20位核心成員。(註：由2000年開始，累積超過200位)初步確立朋輩組長模式出版中文組長手冊、書籍、鬆弛光碟使香港復康會成為病人自我管理的先導改革社區復康網絡的病人教育服務舉辦自我管理國際研討會及工作坊新挑戰4/2004獲利希填基金撥款，資助為期3年的朋輩領導長期病自我管理計劃8/2004成立適健中心，發展一系列自負盈虧的適健及個人復康服務身心力行計劃告一段落，有關課程改由CRN統籌其它發展促進其它自我管理服務發展提供協助，促進其它機構在自我管理服務方面的發展建立跨機構的合作及分享交流平台修訂「身心力行課程」及進行其它持續改善、研究及發展工作報告內容下載 http://www.rehabsociety.org.hk 電郵：hs.ng@rehabsociety.org.hk 由3月7日至3月25日32AccordingtotheCentreforAdvancementinHealthinWashingtonDC,SelfManagementinvolvesapartnershipbetweenclientsandtheirhealthworkers.InthisrelationshipTheclienthassomeresponsibilities.Theyinclude:engaginginactivitieswhichpromotetheirhealth.monitoringandmanagingtheirsymptomsday-to-dayadheringtotreatmentsthathavebeenagreedtowithhealthworkers.Whenaclienthasmasteredtheseskills,theyaresaidtobegoodselfmanagers. Define:SelfEfficacyisacombinationofconfidencelevelandknowledgetoachievesomethingI.e.onemayhavetheconfidencebutnottheknowledgeorvs.DiseaseManagement:monitoring,recordingandrespondingtosymptomsRoleManagement:partnershipsthatisequalbutdifferent,takinganactiveroleinplanningcareandresponsibilityinkeepingtotheplanEmotionalManagement:managingtheemotionalimpactthatthediseasehasontheirlife,family,socialandeconomical focusonqualityoflifebyimprovingtheirhealthstatusandappropriateuseofresourcesHowdotheySupportClient’sImproveclientknowledgeofillness-oneononeorgroupworkknowledgeoftreatmentandinterventions-educationinvolvementindecisionmaking-throughselfmanagementcourses-confidencebuild-assertivetraining-problemsolveabilitytotakeactionifsymptomsworsen-throughactionplansandrecordsabilitytoarrangeandattendappointments-useofcalendarsandproactiveplanningabilitytomanagetheimpactoftheirillnessreferraltootheragencies,relaxation/anxietymanagement,fallspreventionsupportclienttoliveahealthierlifestyleQuitSmoke,ExerciseandcookingclassesSelfManagementAlsoEncompassesThepatient/client,andhealthprofessionalsworkingtogetherOfteninvolvesthefamilyAnholisticapproachtocareiemedicalandpsycho-socialcomponentsofaconditionPro-activeandadaptivestrategiesthataimtoempowertheindividualTheothersideoftheselfmanagementrelationshipinvolvesthehealthworker.Theirresponsibilitiesinclude: workingwiththeclient,asdifferentbutequalpartners.TheHealthworkerislikeanexpertconsultantregardingdiseaseandtreatments.Thepatientistheexpertinhowthediseaseiseffectinghim/herpersonally,day-to-day.Healthdecisionsneedtobemadetogether,inconsiderationofthedisease,andtheday-to-dayeffectitishaving.Acknowledgingthatthereismoretotheclientthanthedisease,andthatthediseaseeffectsmorethantheclient’sbody.Listenforotherinterventionsthatmayberequired,eveniftheyarenotdirectlylinkedtothedisease,eg,socialsupports(istheircarergettinganyrespite?,doestheclienttheyhaveanysocialnetworks?),otherconditionsthatareeffectingtheclientsdailyliving(deafness,incontinence).EtcBereadytothinkoutsidethe‘episodeofcare’pathway.You’reresponsibleforsupportingthewholeperson,nota‘condition’.HowSelf-ManagementDiffersfromPatientEducationSelfManagementTomanagelifewithDiseaseToincreaseskills/selfconfidenceToproblemsolveandmakedecisionsPatientEducationTochangebehavioursToincreaseknowledgeTousespecificToolsi.e.CarePlan,ActionPlansBrainstormgroupDiseasewillneverbecured-wearelookingtoimprovequalityoflifeHowSelf-ManagementDiffersfromPatientEducationSelfManagementTomanagelifewithDiseaseToincreaseskills/selfconfidenceToproblemsolveandmakedecisionsPatientEducationTochangebehavioursToincreaseknowledgeTousespecificToolsi.e.CarePlan,ActionPlansBrainstormgroupDiseasewillneverbecured-wearelookingtoimprovequalityoflifeHowSelf-ManagementDiffersfromPatientEducationSelfManagementTomanagelifewithDiseaseToincreaseskills/selfconfidenceToproblemsolveandmakedecisionsPatientEducationTochangebehavioursToincreaseknowledgeTousespecificToolsi.e.CarePlan,ActionPlansBrainstormgroupDiseasewillneverbecured-wearelookingtoimprovequalityoflifeHealthProfessional:AssumptionsThispatientSHOULDchangeThispatientWANTStochangeThispatient’shealthistheirprimemotivationIfthepatientdoesnotchangethenwehavefailedThe‘StagesofChange’modelchallengesourassumptionofwhata’successfulintervention’is.Healthworkersoftenfeelthattheirclientsshouldchange,shouldwanttochange,andiftheydonotchangethenthewholeexperiencehasbeenawasteoftime.Stagesofchangetheoryreassuresusthatpeoplelearnbyexperience,andincycles.Arelapsenowplacesusinabetterpositionto‘maintain’changedbehaviournexttimeround,withtheaddedexperiencewenowhave.Wearenotlinearcreatures.Ourlivesarecomplexandourlearningisongoing.Wedothebestwecangivenourcurrentcircumstancesandskills.Eachcycleincreasesourknowledgeandskillaboutourselvesandourcondition.Ashealthworkers,ourroleistoacknowledgeandsupporttheprocessofchange,inallitsmessiness.HealthProfessional:AssumptionsPeopleareeithermotivatedtochangeornotNowistherighttimeforchangeAtoughapproachisalwaysthebestI’mtheexpert.HeorshemustfollowmyadviceSixprinciplesofSelfManagement1Knowyourcondition2HaveactiveinvolvementindecisionmakingwithyourGPorhealthworkers3FollowtheCareplanthatyouagreedwithyourGPandotherhealthprofessionals4Monitorsymptomsassociatedwiththecondition(s)andRespondto,andmanagethesymptoms5Managethephysical,emotionalandsocialimpactofthecondition(s)onyourlife6LiveahealthyLifestyleClientsneedto:Knowabouttheirconditions.Understandwhatcausedit,whatitmeanstotheirbody,whatwillhappeniftheydon’tmaintaintheirhealth.Whattoexpectinthefuture.Beactivelyinvolvedindecisionmakingwithhealthworkers.Theyneedtoaskquestions,clarifypointthatdon’tmakesense.FeelOKaboutverbalisingtheirconcernsorfearsaboutnewtreatmentsetc.Theyneedtounderstandwhytheyarehavingthetreatments(medications,therapies)theyarehaving.Whatdifferencewilltheymake?Followtheagreedtreatmentplan.Oncethey’veagreedtoaplanofactiontheyneedtostickwithit,orrenegotiatethingswiththeirhealthworker.(continuedonnextslide…)CharacteristicsofsuccessfulSelfManagementProvidearangeofself-managementtrainingandsupportservicestoassist: ClienttocopewithcircumstancesthatcannotchangeClienttomanagestressSelf-motivationActiveandsubstantialfollow-upbyhealthcareprofessionalsWagneridentifiedthatsuccessfulprogramsalsoprovidearangeofselfmanagementtrainingandsupportservicestoassistclientstocopewithcircumstancestheycannotchange,tomanagestress,toassistselfmotivationofclients,andtoensureactivefollowupbyhealthcareprofessionals.REFERENCEWagner,EH.Austin,BT.VonKorff,M.OrganisingCareforPatientswithChronicIllness,TheMilbankQuartely,Vol.74,No.4,1996.HowdotheySupportClient’sImproveclientknowledgeofillness-oneononeorgroupworkknowledgeoftreatmentandinterventions-educationinvolvementindecisionmaking-throughselfmanagementcourses-confidencebuild-assertivetraining-problemsolveabilitytotakeactionifsymptomsworsen-throughactionplansandrecordsabilitytoarrangeandattendappointments-useofcalendarsandproactiveplanningabilitytomanagetheimpactoftheirillnessreferraltootheragencies,relaxation/anxietymanagement,fallspreventionsupportclienttoliveahealthierlifestyleQuitSmoke,Exerciseandcookingclasses