Self Management Goal Setting

Orientation for HRCH Staff

These slides were adapted from a program offered by Connie Davis,FNP-from one of the Learning Sessions. Additional slide programs on SMG setting are available on our Intranet site for a variety of conditions..

Chronic Care Model

YOUAREHERE

Self-Management Tasks

Take care of the condition Adjust daily life Manage emotions, including future

concerns

Based on work by Clark, Corbin, Strauss and Glaser

Starting the conversation

Is there anything you have thought of that you might do to improve your health?

Can you think of what you would like to work on first?

What first step might you be able to take in helping to improve your health?

Three things to keep in mind

Importance Readiness Confidence Other barriers which might exist in the

patient’s life

Importance

Prioritize goals Use an importance ruler

Importance Ruler

1 2 3 4 5 6 7 8 9 10Not Unsure Somewhat VeryImportant Important Important

Readiness: Stages of Change

Pre-contemplation Contemplation Preparation Action Maintenance Termination

Prochaska and DiClemente

Readiness Ruler

1 2 3 4 5 6 7 8 9 10Not Unsure Somewhat VeryReady Ready Ready

& Trying

Matching Intervention to Stage

NOT READY:

Pre-contemplation

Contemplation

Raise awareness Provide personalized

information Indicate readiness to

help Identify benefits of

change Praise previous efforts

Matching Intervention to Stage

READY

Preparation

Action

Increase confidence Develop action plan Problem-solve barriers Identify small steps

taken Reward small changes

made Encourage support

networks

Self-efficacy

One’s belief that he/she can accomplish a specific behavior or cognitive state.

Bandura

Self-efficacy is enhanced through

Skills mastery Modeling Reinterpreting symptoms Persuasion

Confidence Ruler

1 2 3 4 5 6 7 8 9 10Not Unsure Somewhat VeryConfident Confident Confident

Principles of Motivational Interviewing

Express Empathy Develop Discrepancy Avoid Argumentation Roll with Resistance Support Self-Efficacy

Miller and Rolnick

Express Empathy

Acceptance facilitates change Skillful reflective listening is

fundamental Ambivalence is normal

Avoid Argumentation

Resistance is a signal to change strategies

Labeling is unnecessary Arguing is counterproductive Client’s attitudes are shaped by their

words, not yours

Roll with Resistance

Use momentum to your advantage Shift perceptions Invite new perspectives, do not impose

them Clients are a valuable resource for

finding solutions to problems

Support Self-efficacy

Belief that change is possible is an important motivator

Client is responsible for choosing and carrying out actions to change

Hope lies in range of alternative approaches available

Making an action plan

Something you WANT to do Reasonable Describes what, where, when, how,

how much Confidence level greater than 7 Follow-up Plan

Lorig, Chronic Disease Self-Management Program

Problem-solving

Identify the problem List all possible solutions Pick one and try it If it doesn’t work, try another If that doesn’t work, contact resources If that doesn’t work, problem may not be

solvable now.Lorig, Chronic Disease Self-Management Program

Four Step Self-Management Explore the Problem or Issue

“What is your concern about ____?” Clarify Feeling and Meaning

“Are you feeling (angry, sad, frustrated) because of _____?” Develop a Goal and Start a Plan

“Where would you like to be regarding ___ (3 months, 1 year) from now? What are options? What are barriers? Who could help?”

Commit to Action

“What are you going to do? When? How will you know you’ve succeeded? How confident are you?”

Anderson and Funnel

Some background for Diabetes SMG Setting

Hemoglobin A1C-the average glucose level for the last three months. It should be 7 or lower. If a patient begins at 12-their first goal may be 10..It takes around three months to impact this #.

More Background….

Before people take aspirin, they need to check with their provider

More background

Process for completing the forms

• Complete the form by checking the appropriate section on the form

• Sign the form and give a copy to the patient and one is inserted in the chart in the progress notes. There may be a future change in where the form is placed but for now, it is kept in the chart with the date it was done.

• Remind the patient that each time they come in for a visit, they will be asked by the provider how they are doing on their goal/s.

Using the forms• Schedule a separate time for patients to complete

this form with either the Health Educator; CDE; Nurse or AMERICORP

• Review the guidelines with the patient/family members. Be mindful of patients who have poor/no reading ability

• Keep in mind that some of the terms on the form need to be explained to the patients.

• Emphasize that these are not the only choices, there are blank spaces for patients to fill in anything which they may want to work on. It may not be something on the list..

•Remember that you, the counselor, are only acting as a facilitator-let the patient determine what they focus on!

Practice the new skill

• Learning how to work with patients on developing SMGs takes some practice..Do not be discouraged if this takes some time…You may find that some patients are more challenging than others…Don’t give up, it will get easier as you do more of these sessions…

•Now, let’s practice your skills…Each person will need to pair up with a partner..One will be a patient and the other one will be the counselor…Afterward, we will switch and let you try to be the other person.

Patients need to get clearance from their provider before engaging in exercise. Building up slowly is very important. Provide the appropriate resource lists for anything the patient is working on (ie.

Smoking cessation program) The plan for Glucose testing is determined with the provider and patient. There may

be specific needs at different times. If you are not sure about a clinical question, please ask the CDE or e mail Kathy

Brieger. Let the patient know that you will get back to them…and do it as soon as possible..

Quitting smoking is extremely important. It can impact all major organ systems.

Lipid tests need to be done annually A foot exam needs to be done annually An eye exam needs to be done annually Nutrition goals can be done with the RD and patient