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ICF course introduction

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ICF course introduction

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ICF course introduction

  1. 1. Sentrum vir Gesondheidsberoepe Onderwys  Centre for Health Professions Education Fakulteit Gesondheidswetenskappe  Faculty of Health Sciences International Classification of Functioning, Disability & Health --- Interprofessional Care Framework for the biopsychosocialspiritual approach to patients, communities and systems --- Stefanus Snyman DAY 1: The ICF? What?
  2. 2. What on earth are you doing here? • Name • Your role in College • What is your role in health professions education? • Expectations of the ICF course?
  3. 3. Outcomes of ICF series of workshops • Apply the World Health Organisation’s International Classification of Functioning, Disability and Heath (ICF) as a framework for interprofessional team work to improve patient outcomes and strengthen health systems. • Argue why the ICF framework may be a catalyst to improve patient-centred and community-centred care, as well as the morale and motivation of staff.
  4. 4. Overview of ICF series (1) • Day 1: • Introduction to Health Professions Education for 21st century: • Overview of the ICF framework in the context of ethics and human • Interprofessional teams work out and present a case study • After Day 1 • Structured reflection (1h) (within 1 week) • Each interprofessional team prepare 1 case study to present at next workshop (3h)
  5. 5. Overview of ICF series (2) • Day 2 • Presentation by interprofessional teams on their real case study (Summative and formative assessment by peers (including ethics / human rights) • After Day 2 • Structured reflection on interprofessional case study that your team presented (1hour) • Interprofessional team prepare a draft document to submit to the Department of Health motivating the ICF framework as an approach to encourage patient-centred and community-centred care (4 hours)
  6. 6. Overview of ICF series (3) • Day 3: • Interprofessional teams conduct a ward round in hospital (1 patient for a group) based on the ICF framework, including team discussion, management plan and feedback to patient • Feedback by interprofessional teams regarding their proposed approach to present to the Department of Health a motivation to promote the use of the ICF framework to improve patient- and community- centred care • Summative and formative assessment of presentation • After Day 3: • Structured reflection & evaluation of course
  7. 7. Learning Resources • Taking notes during this contact session • ICF eLearning tooI: http://icf.ideaday.de/en/page26086.html • ICF Beginners Guide • ICF Checklist (email) • ICF Draft User Guide (email) • ICF Book (email) • ICF online: http://www.who.int/classifications/icf/en/ Your common sense !!!
  8. 8. The future of HPE in 1910 • Introduction of basic sciences in medical curricula • Doubling of human lifespan1910
  9. 9. November 2010
  10. 10. Lancet December 2010 Health professionals have made huge contributions to health and socio-ecomonic development over the past century, but we cannot carry out 21st century health reforms with outdated or inadequate competencies…. That is why we call for a new round of more agile and rapid adaption of core competencies based on transnational, multi-professional, and long-term perspectives to serve the needs of individuals and populations What we need, more than just disciplinary knowledge and skills, is a well-rounded health professional acting as change agent to address the health needs of the 21st century
  11. 11. Transformative Learning Interdependence in Education Health Equity Patient-centred Population- based Locally responsive Globally connected Open educational resources Competency-based Responsive to rapidly changing needs Creative use of IT VISION Adapted from: J Frenk, L Chen, ZA Bhutta et al: Health Professionals for a new century: transforming education to strengthen health systems in an inderdependent world. www.thelancet.com, 2010;376:1923-1958 The Lancet et al. challenge
  12. 12. Adapted with the permission of CanMEDS © 2005
  13. 13. In search of an Interprofessional Care/Collaboration Framework: a common language and approach A statistical, research, clinical, social policy and educational tool to: • Provide scientific basis • Interprofessional teamwork • Common language • Permit comparison • Systematic coding scheme
  14. 14. Interdependence • Appreciate community workers role • Commit to teamwork Transformative learning • Ownership for holistic patient care • Question biomedical model used in tertiary hospitals • Integrate ethics and human rights in patient care • Initiate IPE community projects in response to gaps indentified using ICF Health system strengthening • Preceptors apply ICF in teaching and practice • Adopt ICF as approach to patient care in PHC and district hospital settings • Service providers request capacity building in ICF • Influence patient outcomes Results from study
  15. 15. International importance • Play important role to write WHO’s ICF User Guide • 1 of 4 projects worldwide selected by Institute of Medicine’s Global Forum of Innovation in Health professions Education
  16. 16. ICF @ the individual level • For the assessment of individuals: What is the person's level of functioning within their particular context? • For individual treatment planning: What treatments or interventions can maximize functioning? • For the evaluation of treatment and other interventions: What are the outcomes of the treatment? How useful were the interventions? • For communication among physicians, nurses, physiotherapists, occupational therapists and other health works, social service works and community agencies • For self-evaluation by patients: How would I rate my capacity in mobility or communication?
  17. 17. ICF @ the institutional level… • For educational and training purposes • For resource planning and development: What health care and other services will be needed? • For quality improvement: How well do we serve our clients? What basic indicators for quality assurance are valid and reliable? • For management and outcome evaluation: How useful are the services we are providing? • For managed care models of health care delivery: How cost-effective are the services we provide? How can the service be improved for better outcomes at a lower cost?
  18. 18. ICF @ social level • For eligibility criteria for state entitlements such as social security benefits, disability pensions, workers’ compensation and insurance: Are the criteria for eligibility for disability benefits evidence based, appropriate to social goals and justifiable? • For social policy development, including legislative reviews, model legislation, regulations and guidelines, and definitions for anti-discrimination legislation: Will guaranteeing rights improve functioning at the societal level? Can we measure this improvement and adjust our policy and law accordingly? • For needs assessments: What are the needs of persons with various levels of disability -impairments, activity limitations and participation restrictions? • For environmental assessment for universal design, implementation of mandated accessibility, identification of environmental facilitators and barriers, and changes to social policy: How can we make the social and built environment more accessible for all person, those with and those without disabilities? Can we assess and measure improvement?
  19. 19. The qualifiers Individual / Community Functioning & Disability Body function & structure Change in body function Change in body structure Activities & Participation Capacity Performance Contextual factors Environmental factors Barriers / Facilitators Personal Factors
  20. 20. Defining concepts (1): Body function and structure Health condition / service (individual / community) Body function & structure (Impairment) Activities (Limitations) Participation (Restriction) Personal factors Environmenta l factors Contextual factors
  21. 21. Defining concepts (1): Body function and structure • Body functions Physiological functions of body systems • Body structures Anatomical parts of the body
  22. 22. Body function and structure: Impairment (2) • Mental status • Sensory functions (vision, hearing, vestibular, pain) • Voice and speech • Vascular and circulatory system • Respiratory system • Endocrine, digestive and metabolic • Genito-urinary and reproductive systems • Skin and related structures
  23. 23. Defining concepts (3): Activity and participation Health condition / service (individual / community) Body function & structure (Impairment) Activities (Limitations) Participation (Restriction) Personal factors Environmenta l factors Contextual factors
  24. 24. Defining concepts (3): Activity and participation • Activity Tasks or actions • Activity limitation Inability / difficulty to perform an activity in the manner or range considered normal for all individuals of a similar group • Participation Life roles • Participation restriction Problems related to social roles
  25. 25. Defining concepts (4): Participation • Life roles • 9 domains of participation • Participation restriction: Problems related to social roles
  26. 26. Participation domains (1) • Learning and applying knowledge • General tasks and demands • Organising and planning tasks • Multiple tasks • Using money and finance • Communication • Verbal (understanding and producing) • Nonverbal (understanding and producing)
  27. 27. Participation domains (2) • Mobility • Indoors (home) • Outdoors • Transportation
  28. 28. Participation domains (3) • Self care • Personal care • Health care • Domestic life • Domestic management and tasks
  29. 29. Participation domains (4) • Interpersonal interactions • Family • Intimate • Informal • Major life • Education • Employment
  30. 30. Participation domains (5) • Community, social and civic life • Community • Recreation and leisure • Religion and spirituality
  31. 31. Defining concepts (3): Activities • Tasks and actions related to fulfilling your social and life roles • Examples Moving in bed, transfers, walking, driving, dressing, washing, grooming, cooking, cleaning, doing laundry, ironing, taking out the garbage, performing working tasks, using the computer etc. • Activity limitation Inability / difficulty to perform an activity in the manner or within the range considered normal for all individuals or a similar group
  32. 32. International Classification of Functioning (ICF) Health condition / service (individual / community) Body function & structure (Impairment) Activities (Limitations) Participation (Restriction) Personal factors Environmenta l factors Contextual factors
  33. 33. Defining concepts (4): Contextual factors • Environmental • Personal Represent the specific context and background of an individuals life
  34. 34. Environmental factors • Products and technology • Natural environment and man made changes • Support & relationships • Attitudes • Services, systems & policies
  35. 35. Environmental factors
  36. 36. Personal factors • Positive / negative • Age • Gender • Race • Education • Experiences • Personality • Aptitude • Coping styles • Lifestyle • Fitness, etc.
  37. 37. The ICF • Function & Disability is… Result of a complex relationship between health condition, participation and contextual factors • Contextual factors • May hinder / cause barriers • May facilitate • No linear relationship between impairment / activity / contextual factors
  38. 38. Examples: Disabilities that may be associated with the 3 levels of functioning linked to a health condition.
  39. 39. Different levels of disability are linked to three different levels of intervention.
  40. 40. Example of patient presentation
  41. 41. Rumours • Time • Complex • Impossible
  42. 42. Barriers • Professional tribalism • Biomedical model • Tradition • Individual stars • Against transformative learning – a threat
  43. 43. ICF within ethical, human rights and legal framework Health condition / disorder / disease Body function & structure (Impairment) Activities (Limitations) Participation (Restriction) Personal factors Environmenta l factors Contextual factors In context of ethics, human rights and legal framework Bio-psycho-social-spiritual approach
  44. 44. BATHO PELE Access Openness and Transparency Consultation Redress Courtesy Service standards Information Value for Money PATIENT CHARTER Healthy and Safe environment Participation in Decision-Making Access to Health Care Knowledge of one’s health insurance/medical aid scheme Choices in health services Treated by a named health care provider Confidentiality and privacy Informed consent Refusal of treatment A second opinion Continuity of care Complaints about health services Better patient outcomes and Improvement of health system
  45. 45. Questions
  46. 46. (1) Assess (2) Compile interprofessional management plan Health condition / disorder / disease Body function & structure (Impairment) Activities (Limitations) Participation (Restriction) Personal factors Environmenta l factors Contextual factors In context of ethics, human rights and legal framework Bio-psycho-social-spiritual approach
  47. 47. Case study example • Mr X, 45-year old male • with below-knee amp R side, three days ago. Eager for prosthesis. • Medical history: Type I diabetes • Social history: weekend alcohol abuse and smokes 15 cigarettes per day. • Permanently employed as skilled labourer (bricklayer) by builing contractor for RDP housing. • Lives in Parow. Own home, accessible.Uses public transport. Plays darts recreationally. • Married. Supporting family. Wife does not work. Three dependent school-going children.
  48. 48. Let’s apply it… Health condition / disorder / disease Body function & structure (Impairment) Activities (Limitations) Participation (Restriction) Personal factors Environmenta l factors Contextual factors In context of ethics, human rights and legal framework
  49. 49. What’s the patient’s condition? Patient (Health condition disorder / disease) Body function & structure (Impairment) Activities (Limitations) Participation (Restriction) Personal factors Environmental factors • R below knee amputation – wound present • DM pathology (eyes, kidneys, CVS, sensation) • ? Lungs • ? Liver • ? Mental health •Limited walking ability (affects walking to taxi/station/work environment) •Unsafe when bathing and using the toilet •Cannot use train •Work •Family (economic & social support) •Domestic tasks •Leisure time •Health care access Negative •Alcohol •Smoking •Life style - nutrition •Self worth •? Stress / Coping skills •Grade 8 education Positive •Economically active age •Physically fit and strong •Positive about receiving prosthesis Barriers •Social •Employer attitude •Inaccessible public transport •Delayed prosthetic rehabilitation Individual •Nil Facilitators Social •EEA •Employment benefits Individual •Access to home, etc. •Supporting family Diabetis Type 1
  50. 50. Management (1): Short-term & Medium to Longterm Patient (Health condition disorder / disease) Body function & structure (Impairment) Activities (Limitations) Participation (Restriction) Personal factors Environmental factors Diabetes • Work: • Sick leave benefits (Dr, Co) • Temp dis / UIF during rehab period (OT, Co, Dr) • Social support between sick leave & temp dis (Co, OT, SW, Ds) • Family support / counseling (SW, Ds) • If delayed rehab results in loss of employment: Alternative placement / retraining, re- employability [OT, PT, SW, Dr] • Revise temp dis 6/12 [AT, PT, Dr, Co] • Revise any social family support [SW, Ds] • Pain mgt, wound & skin care, Anti- sepsis (Sr) • Stump maturation & oedema management (PT, OT, Sr) • Control DM & target organs (Dr, Sr) • ?Angina (Dr) • Secondary prevention management & training (Dr, Sr, OT, PT) • Medication (Pharmacist) • Counselling (Ps, SW, Sr, Dr, Rev) • DM diet education (Sr, Dr, Dietician) • DM, Rook, -OH (All) • Early rehabilitation intervention – e.g. balance retraining (OT, PT) • Rehabilitation management planning with client (All) • Prosthesis [Pr Sr, PR, PT] • DM control & manage [Dr, Sr] • Smoke, Alcohol [All] • Improve standing & walking balance for gait & self-care activities (PT, OT) • Improve gait endurance & dynamic balance (PT, OT) • Assess need for temp wheelchair (PT/OT) • Optimise self care by improving safety, e.g. provision of assistive device (e.g. bath board, grab rails) [PT/OT] • Prosthetic rehab with focus on gait, domestic tasks, work activities [PT, OT] Due to inaccessible transport & potential loss in income in early phase: • Arrange for transport for medical care and rehab access • Consider need for inpatient rehab
  51. 51. Management (2): Short-term & Medium- to Long-term Patient (Health condition disorder / disease) Body function & structure (Impairment) Activities (Limitations) Participation (Restriction) Personal factors Environmental factors Diabetes • Work: • Sick leave benefits (Dr, Co) • Temp dis / UIF during rehab period (OT, Co, Dr) • Social support between sick leave & temp dis (Co, OT, SW, Ds) • Family support / counseling (SW, Ds) • If delayed rehab results in loss of employment: Alternative placement / retraining, re- employability [OT, PT, SW, Dr] • Revise temp dis 6/12 [AT, PT, Dr, Co] • Revise any social family support [SW, Ds] • Wound & skin care, Anti-sepsis (Sr) • Stump maturation & oedema management (PT, OT, Sr) • Control DM & target organs (Dr, Sr) • Secondary prevention management & training (Dr, Sr, OT, PT) • Medication (Pharmacist) • Counselling (Ps, SW, Sr, Dr, Rev) • DM diet education (Sr, Dr, Dietician) • DM, Rook, -OH (All) • Early rehabilitation intervention – e.g. balance retraining (OT, PT) • Rehabilitation management planning with client (All) • Prosthesis [Pr Sr, PR, PT] • DM control & manage [Dr, Sr] • Smoke, Alcohol [All] • Improve standing & walking balance for gait & self-care activities (PT, OT) • Improve gait endurance & dynamic balance (PT, OT) • Assess need for temp wheelchair (PT/OT) • Optimise self care by improving safety, e.g. provision of assistive device (e.g. bath board, grab rails) [PT/OT] • Prosthetic rehab with focus on gait, domestic tasks, work activities [PT, OT] Due to inaccessible transport & potential loss in income in early phase: • Arrange for transport for medical care and rehab access • Consider need for inpatient rehab
  52. 52. What now? • Structured reflection • Max 500 words (1-1½ pages). • Prepare your real case study to present on ….. • Each interprofessional team prepare 1 case study to present at next workshop on ??? • Compile your teams now! Give names to Maryke • Pitch on ….: The ICF - it works! • Diarise the last workshop: … The ICF - what are we waiting for?
  53. 53. Instructions for structured reflection • Introduce yourself (name, family, occupation, position) [2 paragraphs] • What was your understanding of the ICF before today? (Refer to the notes you made during the introductions) [1 paragraph] • What on earth were you doing here today? What was your expectations of this series of workshops? (Refer to the notes you made during the introductions) [1 paragraph] • Identify and critically analyse your positive and negative feeling about the ICF after the first session in the context of (1) health professions education and (2) patient-centred care. [½ -1 page]
  54. 54. Thank you

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