FACTORS THAT INFLUENCE A CHANGE IN BEHAVIOUR Emily MooreTO INCREASE THE HEALTH Calle Linden OF HEART FAILURE The Dinh Thi PATIENTS
FACTORS INFLUENCING SELF -CARE Motivation Knowledge Don’t know what to do Hard to change habbits Don’t know how to do See no reason Have difficulty learning Decreased memory Insufficient self-care Easily tired Fatigue No opportunities to teach patients Not sufficient knowledge to teach patientsBarriers Nurse s responsibilities
WHY SELF-CARE? Cost-ef fective way to treat patients Decreased risk for readmission Shorter stay at hospital Improve situations in everyday life Provide the patients with active decisions Gives the patient a feeling of control Improving compliance to treatments Better understanding for treatments gives an improved compliance
TOOLS FOR IMPROVING PATIENTS KNOWLEDGE Telephone-delivered education Individual with follow up The patient can be at their home Significant improved knowledge (Baker, Darren 2011). Web-based education Increases patients access to knowledge and possibility to share information Requires close to non experience using computers
TOOLS FOR IMPROVING PATIENTS KNOWLEDGE Video educations Patients are free to choose whenever they wish to learn Improved compliance to self-care (Albert, Buchsbaum & Li, 2007) Education session at hospital Ensure the patient receive information prior to discharge Reduced the risk for readmission (Krumholz et al., 2002)
MODEL OF IMPROVEMENT Helping patients change behavior is an important role for family physicians Change interventions are especially useful in addressing lifestyle modification for disease prevention, long -term disease management and addictions. The concepts of “patient noncompliance” and motivation often focus on patient failure. Understanding patient readiness to make change, appreciating barriers to change and helping patients anticipate relapse can improve patient satisfaction and lower physician frustration during the change process.
PLAN 1 . What change are we testing - what is the objective of the test? 2. Who is included in the test - who will be involved in the testing process (nurses, QI team, staf fing) and on whom will the test be conducted (patients with urinary incontinence)? 3. When are we testing (start and end date)? 4. Where are we testing?
To change behavior, the patient must understand what to do and how to do it. The patient needs enough knowledge to adjust the treatment or prevention regimen in response to changing circumstances. Learning relies heavily on the educators ability to adapt teaching strategies to the individual and on the patients ability to process information. Because poor glycemic control and cognitive dysfunction are associated, it is among the numerous factors that can af fect the ability of the patient with diabetes to process information.
DO Doing the test. Collecting data for analysis - complete the chart audits, collect whatever data is needed to help complete the quality picture. Carrying out the Change - work the plan. Documenting problems - note any problems encountered along the way. This will assist you in analyzing this cycle and in avoiding problems in the future. Collecting Data - what information are you finding as you work the plan? Beginning Analysis - make observations and begin analyzing the findings and continue to document expected and unexpected observations along the way.
STUDY In this phase an organization should study the data and determine what was learned. List out problems, successes and surprises specifically so that you can substantiate your conclusions and have the list as a resource for future QI cycles.
ACT It is important at this stage to set up a specific plan with detailed action steps that will help maintain or hold any gains and that improvements continue over time. In the ACT stage, organizations also should establish a new plan for next PDSA cycle and begin the cycle over again. (continue to explain patient motivation of techniques that have been developed for influencing patient behavior.)
CLINICAL MICROSYSTEMS CLINICAL MICROSYSTEM TOOLTen success characteristics1. LeadershipSetting and reaching collective goals, and to empower individualsautonomy and accountability• Ask -- raise the issue• Advise -- increase awareness of risk and benefits related to behaviour• Assist -- help the patient to identify a negotiated SMART(specific, measurable, achievable, realistic, timed) goal relatedto behaviour change and signpost if appropriate.2. Organizational suppor tThe larger organization looks for ways to suppor t the work of theMicrosystem3. Staf f focusExpectations of staf f are high regarding per formance, continuingeducation, professional growth, and networking
4. Education and TrainingOf fering training and education courses on the managementand proper treatment of heart failureProcesses to change lifestyle5. InterdependenceThe interaction of staf f is characterized bytrust, collaboration, willingness to help each other, appreciationof complementary roles, respect and recognition that allcontribute individually to a shared purpose .6. Patient FocusThe primary concern is to meet all patient needs –caring, listening, educating, and responding to special requests,
7. Community and Market FocusEstablish innovative relationships with the community; TheMicrosystem is a resource for the community; the communityis a resource for the MicrosystemInitiatives in the community8. Performance ResultPerformance focuses on patient outcomes, avoidablecosts, streamlining delivery, using data feedback9.Process ImprovementLearning and redesign is supported by the continuousmonitoring of care, use of benchmarking, frequent tests ofchange10. Information and Information TechnologyTechnology facilitates ef fective communication
NICE- National Institute for Health and Clinical Excellence.Lets Get Moving initiative 2007-recommendations for health professionals on interventions forpatientse.g.• learning to spot things that trigger or reinforce theunwanted behaviour• setting goals and planning how to achieve them• building confidence to make important and wanted changes• self-monitoring• creating SMART action plans• building social support through signposting• rewarding success.
Four commonly used methods to increase physical activity Brief interventions – advice delivered by GPs and other non -hospital-based health professionals. Exercise referral schemes – referral to a tailored physical activity programme. Pedometers – use of a device to measure how far you have walked. Walking and cycling schemes
REFERENCES Strömberg, A . (2005). The crucial role of patient education in hear t failure. The Europea n Journal of Hear t Failure, 7, 363–369 Koelling, T., Johnson, M., Cody, R. & Aaronson, K. (2005). Discharge education improves clinical outcomes in patients with chronic hear t failure. Journal of the Americ an assoc iation, 18 , 179-1 85. Krumholz , H., Amatruda, J., Smith, G., Mattera, J., Roumani s, S., Radford, M. et al. (2002). Randomized Trial of an Educati on and Suppor t Inter ventions to prevent Readmissi on of Patients With Hear t Failure. Journal of the Americ a n College of Cardiology, 39, 83-89. Kwok , T., Lee, J., Woo, J., Lee, D. & Grif fith, S. (2008). A randomized controlled trial of a community nur se -suppor ted hospital discharge programme in older patients with chronic hear t failure. The author journal compilation, 17, 109-117 Ricard, Camarda, R., Foley, L., Giver tz, M., & Cahalin, L. (2011). Case repor t: exerc ise in a patient with acute decompe nsated hear t failure receivin g positive inotropic therapy. Cardiopulmonar y Physic al Therapy Journal, 22(2) , 13-1 8. Mår tensson, J., Strömberg, A ., Fridlund, B. & Dahlström U. (2001). Nur se - led hear t failure clinics in Sweden. Europe an Journal of Hear t Failure, 3, 139-144 .
REFERENCES Shearer, N., Cisar, N., Greenberg, E. ( 2007). A telephone -delivered empowerment inter vention with patients diagnosed with hear t failure. Hear t & Lung, 36, 159-169. Baker, D., Dewalt, D., Schillinger, D., Hawk , V., Ruo, B., Bibbins- Domingo, K. et al. ( 2011). The ef fect of Progressive, Reinforcing Telephone Education and Hear t Failure Symptoms. Journal of Cardiac Failure, 17, 789- 796.Domingues, F., Clausell, N., Aliti, G., Dominguez, D., Rabelo, E. (2011). Arq Bras Caridol. Brasilien Lindén, C. et al. (2011). Web-based patient education for patients with hear t failure. Alber t, N., Buchsbaum, R., Li, J. (2007). Randomized study of the ef fect of video education on hear t failure healthcare utilization, symptoms, and self -care behavior s. Patient Education and Counseling 69, 1 29- 139. Krumholz, H., Amatruda, J., Smith, G., Mattera, J., Roumanis, S., Ra dford M., Crombie, P., Vaccarino, V. (2002). Journal of the American
REFERENCES Carole Lannon, MD MPH. Jacqueline Dunbar-Jacob, PhD, RN, FAAN. Models for Changing Patient Behavior: Creating successful self -care plans Eraker SA , Kirscht JP, Becker MH. (1984)Understanding and improving patient compliance. Ann Intern Med, 100:258-268 Michelle A . Dart. ( 2011). Motivational Interviewing in Nursing Practice: Empowering the Patient
REFERENCESNICE. (2006). Four commonly used methods to increase physicalactivity. Retrieved from http:// publications.nice.org.uk/four-commonly -used-methods-to-increase-physical-activity -ph2Huber, T.P., Kurtin, P., & Seid, M. (2006). Clinical microsystemassessment diagnostic.Retrieved fromhttp://www.dhcs.ca.gov/provgovpart/initiatives/nqi/Documents/MSAssessmentFinal.pdfHayes, S. (2010). Brief interventions to change behaviour.Practice Nurse, 39 (6). Retrieved fromhttp://web.ebscohost.com.dbgw.lis.curtin.edu.au/ehost/detail?vid=5&hid=17&sid=8517c172-8956-48cb-b335-ed8caca8b5dd%40sessionmgr13&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=rzh&AN=2010612148
SEARCH PROCESS Looked at the problems in our previous presentation-nursing knowledge-patient knowledge-lifestyle behaviours Chose lifestyle behaviours as the main focus as the other two factors also tied into this problem Used university library data bases and government websites
COLLABORATION PROCESS We each were allocated a tool and applied it to behavioural changes Calle and The both presented in previous presentations, Emily will present today Each member did their own powerpoint slides, Emily produced the final product