Clinical Leadership in SelfCare Implementing the self care philosophy across a Strategic Health Auth

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Clinical Leadership in Self-CareImplementing
the self care philosophy across a Strategic
Health Authority

• Dr Alf Collins
• Dorset and Somerset SHA
• (On behalf of project team)

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A 1 year DSSHA/DH project

• Aims
• To promote an awareness across health and social
  care communities of the fundamental importance of
  self-care
• To dispel common myths about self-care

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Process

• Initial 2 day scoping event
• Involving 45 relevant stakeholders
• Formation of
• Working party plus dedicated project lead
• User reference group
• Professional reference group
• Objective
• To develop a learning tool (handbook) for all
  staff to be disseminated across the SHA

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Outcomes

• A 70 page handbook (Promoting Optimal Self
  Care)
• Initial print run of 2,500
• PDFs downloadable from SHA (and DH) website
• A complementary 15 slide presentation kit
• A launch event
• 4 initial training seminars

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• Ensure front line staff receive appropriate
  training inprinciples of self-care
• Ensure professionals change the way that
  consultations are conducted in order to
• Develop a more equal relationship with patients
• Modify the way that people seek help by
  challenging their beliefs about their condition

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Principles of optimal self-care

• Biomedicine is a belief system that does not
  optimally support people with conditions that it
  cannot cure
• The relationship between the severity of any
  condition and HRQOL is complex
• Beliefs and expectations appear to be strong
  predictors of HRQOL
• For people with longer term conditions, lifestyle
  change is inevitable being in a degree of
  control of the process is fundamentally important

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Cellular pathology
Organ pathology (impairment)
Symptoms
Disability
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Impairment and disability
disability
Passive avoiders
Active copers
impairment
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impairment
thoughts
symptoms
context, meaning
feelings
Afferent input
beliefs
actions
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Disability Worried? Sick? Or worried sick?
Culture, development
symptom
Anxiety, fear
Worse symptoms at lower thresholds
Threatening illness beliefs
Doctors
Catastrophic thinking
Experience, conditioning
Disuse, Disability, Depression
Avoidance
The fear-avoidance loop
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Primum non-nocere Stage 1a

• Dont have potentially disabling
• conversations with patients

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Potentially disabling conversations

• are those that
• Can be misinterpreted
• Describe pathology without necessarily putting
  the description within a more helpful context

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Primum non nocereStage 1b

• Ensure all members of clinical networks provide
  information that is
• Unambiguous
• Consistent
• Supportive of self-care

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You have 3 degenerate discs in your
spine. Dont worry the pain will ease when they
fuse
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Pain microfractures of healing (fusing) discs
Avoid pain and potentially painful situations
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Stopped work a year ago
Core identity threatened, key social and family
role lost
Less money family struggling
Despair, despondency, depression
Suicide attempt
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Promoting self care..
Your pain is caused by the muscles doing more
than they want right now. Gentle, paced
activity helps most people. Shall we talk about
ways we can support you in pacing yourself into
gently doing a little more over time?
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Self-care reinforced

• Non-pathological definition supports activity and
  self-efficacy
• Unambiguous description not open to
  misinterpretation
• Facilitative style shall we discuss rather
  than you should do

becomes
Potentially passive avoider
Active coper
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Stage 2

• Have enabling conversations with people
• Put medical/surgical interventions into context
  of planned rehabilitation
• Only use evidence based interventions
• Tell people when their condition is
  medically/surgically optimised open up new ways
  of working

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Goal-directed self-care
Reasonable goals Self-adjustment
Self-management skills acquisition
Acceptance Readiness to change
Best evidence disease/ symptom management
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Stage 3

• Develop specific counselling skills (eg MI)
• Use a layered model also incorporating stages of
  change/self-efficacy/health beliefs

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Stages of change motivation to change behaviour

• Beliefs (about symptoms and treatment)
• Acceptance of symptoms

Pre-contemplation
How confident are you that you can do
this? What might hold you back?
contemplation
Self-efficacy
planning
Skills acquisition
action
relapse
maintenance
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Optimising self care is not a nice to know its
a need to know