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  • 1. PTHA 1301:The Profession of Physical Therapy FALL 2011: WEEK 10, LECTURE 1
  • 2. Today’s Theme SongSURPRISE!!!• “Are those the people who do those HORRIBLE gyrations???” • - from my sweet mother, HUGE fan of Elvis 
  • 3. Goals for Today: Motivation & The Interdisciplinary Team Discuss the role of health care professionals in promoting motivation and adherence Describe how the role of the PT/PTA can differ depending on the therapy setting Differentiate between the role of the PTA/PT and other health care professionals Differentiate between various health care professionals Recognize the multi-disciplinary team approach to health care
  • 4. Research Paper Due Dates Rough Draft of Visual Presentation  due Tuesday 11/01/11 at 2:30pm via Blackboard or in person Printed Draft w/your edits & at least 1 peer edit  show Elaine 11/03/11 by 3:30pm Printed Final Paper (7-10 pages)  due Tuesday 11/08/11 by 2:30pm FINAL Visual Presentation & Handout  due Tuesday 11/08/11 by 2:30pm via Blackboard and/or hard copy
  • 5. Research Paper Requirements APA Format – writing style guidelines published by The American Psychological Association 7-10 pages (Introduction, Body, Conclusion)  PLUS: Title Page & Works Cited (Reference Page)  Double Spaced  1” margins on all sides  12 point, Times New Roman font (per APA recommendations) At least 5 sources cited in your paper  One of the 5 sources must be a personal interview
  • 6. Research Presentation Requirements 8-10 minutes in length Utilize a visual aide during your presentation  Power Point  Flip Chart  Prezi Prepare & issue a written handout for the class  AT LEAST 1 page  Be creative!
  • 7. Test #3 is THIS Friday 11/04 at 10am Disability – Psych Aspects book – Ch 10 Chronic Conditions – Psych Aspects book – Ch 11 Personality – MBTI + Lecture notes after MBTI Motivation – Psych Aspects book – Ch 6 The Interdisciplinary Team  Intro book – pgs 27-38  Intro book – pgs 45-47 Jackie’s information – Abbreviations O-symbols (?)
  • 8. Promoting Motivation and Adherence Clients tend to be motivated to strive towards goals  That are important and relevant to them  That they believe/hope are possible Clients tend to adhere to programs that are  Not too difficult  Not too costly  Not too time consuming  Are consistent with their health belief system
  • 9. Concepts to Enhance Motivation and Adherence Education and empowerment Client-centered care  Ask clients to identify questions and problems in their own words  Facilitate open dialogue  Educate clients about how to be active participants Goal setting Feedback and follow-up Peer support groups Functional programs Collaboration
  • 10. Client-Related Barriers to Collaboration Non-adherence Impairments and disabilities Lack of interest in collaboration Perception that clinician has lack of time Uncertainty regarding success of treatment
  • 11. Clinician-Related Barriers to Collaboration Inadequate knowledge about how to collaborate Unwillingness to relinquish/share power Paternalistic perspective Failure to consider pre-morbid lifestyle and history
  • 12. Strategies to Enhance Motivation and Adherence Health Belief Model Transtheoretical Model for Health Behavior Change (Stages of Change) Motivational Interviewing The Five A’s Behavioral Intervention Protocol There are MANY more strategies/behavioral techniques
  • 13. Strategy 1 to Enhance Motivation/Adherence  Health Belief Model  Focuses on psychological theories of decision making  Health behaviors & choices are influenced by the value people place on a potential outcome & their belief that a certain course of action will result in a desired outcome  In order to change behavior, must first be ready to make a change  Believes that the value of making the change is stronger than the consequences of not making the change  To motivate patients to make the suggested changes, patients’ beliefs must align with our view that Western medicine provides solutions
  • 14. Strategy 2 to Enhance Motivation/Adherence Transtheoretical Model for Health Behavior Change (Stages of Change)  Focuses on motivation  Change in health behavior is a process that takes time  People move through various stages of readiness to change  Pre-Contemplation (No plans to begin change)  Contemplation (Aware of need to change/plan to in next 6 mos)  Preparation (Plan to take action in near future)  Action (Implementing the change) – appears “Motivated”  Maintenance (Change is kept) – 6 mos to 5 yrs – relapse is  Termination (Change is integrated) – Goals reached! Confident they will not return to previous unhealthy behavior  Relapse appears to be a necessary element in the process. It must be addressed to allow the patient to begin anew
  • 15. Strategy 3 to Enhance Motivation/Adherence Motivational Interviewing  Based on the belief that patients are responsible for their own actions and health AND for changing their health behaviors  Client-Centered, evidence based, directive counseling approach  Based on the transtheoretical model for health behavior change, follows 4 key counseling principles  Express empathy (Readiness to change comes from w/in patient)  Develop a discrepancy (between current unhealthy behaviors and goals/values they might strive to achieve) – (Self-determination & commitment to change rests within the patient)  Roll with resistance (PTA does not directly interfere w/client resistance. Coercion, persuasion, & confrontation are counterproductive)  Support self-efficacy (PTA supports & communicates the belief that the patient IS ABLE to effect change through a partnership rather than paternalistic relationship)  Reflective listening, open ended ?’s, affirming, & summarizing are key  “Tell me what you already know about diabetes and how it is treated?”  PTA affirms and supports all facets of the conversation to change!
  • 16. Strategy 4 to Enhance Motivation/Adherence The Five A’s Behavioral Intervention Protocol  Taken from other models  This strategy has been shown to be more successful in promoting patient motivation/adherence than information and advice alone  Address the issue (get patient’s attention, name the problem, & present the need for intervention)  Assess the patient (determine where patient is in the stages of change & identify potential barriers)  Advise the patient (include traditional medical role of giving info & educating the patient to make change/explain pros & cons of change)  Assist the patient to make change (negotiate an agreeable plan of care)  Arrange for follow-up (schedule another appointment to review progress, address barriers, and renegotiate the protocol)
  • 17. Variety of Physical Therapy SettingsAcute Care Facilities Primary Care FacilitiesSubacute Care Facilities Outpatient Care FacilitiesRehabilitation Hospitals Long Term Care Facilities(ChronicCare)Hospice Care Facilities Home Health CareSchool System Private Practice Facilities
  • 18. The Health Care Team Intradisciplinary  Members work together within same discipline (PT/PTA)  Other disciplines are not involved Multidisciplinary  Members work separately and independently in their different disciplines, without collaboration Interdisciplinary  Members work TOGETHER within ALL disciplines to set goals  ALL members collaborate but interventions may be done separately  *** This type of team is the most efficient and successful to patient outcomes.
  • 19. Possible Team Members PTA • Recreational Therapist PT • Chiropractor COTA • Pet Therapist • Therapy Aide OTR • Clinic Office Manager SLP • CNA RN • Orthotist/Prosthetist LVN • LSW MD • ATC PA • Physical Therapy Volunteers CNP • SPTs/SPTAs • Home Health Aides
  • 20. Behavior Change Small Group Activity: Background Information Ted is a 45 year old construction worker who has come to you for treatment of low back pain. This is not his first time receiving treatment. You find that he has been to PT, a nutritionist, and a back school in the past. He admits that he had trouble following through with the home programs. Ted continues to be 50 pounds overweight and smokes a pack of cigarettes per day. He is divorced and at the end of the day, he likes to sit in front of the TV and “have a few beers.”
  • 21. Small Group Activity: Instructions Divide into 3 groups of 5 Use the assigned method to attempt to change the patient’s behavior Consider the pros and cons of your assigned method Problem solve in your group and prepare to present in class