110614 abstract booklet

“LEADING CHANGE FOR THE FUTURE”Supporting People to Self-Manage

Tuesday 14 June 2011Centre for Health Science, Inverness, IV2 3JH

ABSTRACT BOOKLET

WORKSHOPS & POSTERS

“LEADING CHANGE FOR THE FUTURE” Supporting People to Self-Manage

WORKSHOPS


Title of abstract Let’s Get On With It Together Partnership - The Highland, Argyll And Bute Partnership For Delivering Supported Self-Management (SMC02)

Your Details: Name/s, Designation, Organisation and e-mail address

Andrew MacLean, Project Co-ordinator, Partnerships for Wellbeing – [email protected]

Key theme(must fit one of the key themes of the conference)

Partnership Working For Service And Educational Providers / Promoting Self-Management And The Need For Cultural Change

Please indicate your preferred format

Interactive workshop

Aim The term ‘Let’s Get On With It Together’ is derived from the motivation of different organisations within Highland, Argyll and Bute to work together in partnership.

The Partnership has been constituted to develop and deliver a structured and sustainable self-management strategy for the Highland and Argyll & Bute Council areas. Underpinning the Partnership vision is a commitment to improve the lives of people living with long term conditions by offering a co-ordinated and innovative approach to self-management. The Partnership is intended to take forward and extend the work of the NHS Highland Long Term Condition Collaborative.

Design Prefer workshop during which delegates will get overview of Partnership, also partner members will have display material. Audience participation to probe their views, experiences and work in self management/ also interactive presentation on self management courses – this could be designed as a separate workshop.

Method Following a session of seminars and workshops the Partnership was brought together in the summer of 2010 and has since then developed a 5 year vision which identifies its key objectives and outcomes.

Result Objectives identified to take forward the strategy.

Conclusion Multi Agency Partnership set up to take forward strategy within Highland, Argyll and Bute


Title of abstract

Carers and Telehealthcare Training Toolkit (SMC12)

Your detailsNameDesignationOrganisationEmail-address

Donna Henderson, Consultant, Joint Improvement Team, [email protected]

Anne Conlin, Development and Training Manager, Carers Scotland, [email protected]

Key theme Partnership working for service and educational providers


Interactive Workshop

Aim To present the new Carers and Telehealthcare Training Toolkit, produced by Carers Scotland and the Joint Improvement Team.

Design The Toolkit was developed in response to the University of Leeds research report “A Weight off my Mind” (2009), which highlighted the need for awareness raising / training for unpaid carers and professionals on the benefits of telehealthcare to support carers in their vital caring role.

Method The Joint Improvement Team and Carers Scotland developed a range of flexible training resources including digital stories and case studies featuring the experiences of unpaid carers, presentations about telehealthcare and information on how to identify and support unpaid carers through the carer assessment process.

Result The Toolkit has been distributed to health and social care professionals / organisations, carer and other voluntary sector organisations which provide information and support to unpaid carers. Initial feedback has been positive and an evaluation of the Toolkit’s impact will be carried out to inform its further development.

Conclusion Working together to provide better outcomes and support for unpaid carers, the Joint Improvement Team and Carers Scotland have taken positive action to increase awareness of the benefits that telehealthcare can bring to unpaid carers.

mailto:[email protected]



Title of abstract Supporting Self Management - Learning From the Self Management Fund for Scotland (SMC13)


Kevin Geddes – Director of Self ManagementJen McCole – Grants Development OfficerLong Term Conditions Alliance [email protected]


Learning about Self ManagementPractical ExamplesPartnership WorkingPromoting cultural changeResources



Aim This session will have three main aims;

Review of Self Management in Scotland Highlight examples of good practice from the Self

Management Fund for Scotland Suggest recommendations for the future

This session will discuss ‘Gaun Yersel’ - the Self Management Strategy for Scotland and the Self Management Fund supporting 81 projects based in the voluntary and community sector working in partnership to develop self management initiatives and resources. This session will explore what self management means for those living with long term conditions, or caring for someone who does. Voluntary Sector, asset-based approaches to supporting Self Management will be highlighted, as well as how these approaches can be used in practice/partnership with health and social care providers.

Method Interactive session using;

PowerPoint Case Studies Film Clips Discussion



Result Participants will leave the session with;

an increased understanding of the range of self management approaches that are happening all over Scotland

real examples of improvement and partnership projects that they can learn from and share

an opportunity to take recommendations back and also suggest recommendations for future activity

Conclusion The session will be useful for people across sectors and will equip people with knowledge, skills and tools to support their own work around self management.


Title of abstract Chronic disease management. Tools to support a self management approach “The Flinders model” (SMC14)


Maggie ClarkLong Term Conditions Manager, Argyle and Bute CHPNHS [email protected]


PROMOTING SELF-MANAGEMENT AND THE NEED FOR CULTURAL CHANGE

RESOURCES FOR PLANNING FOR SELF-MANAGEMENT



Aim To investigate the Flinders model of self management within the Scottish culture

Design 1 year funded project

Method Train 10 staff in the use of Flinders

Evaluate the effect of the Flinders model on community services

Evaluate the patient experience of using the Flinders assessment and care planning process

Result This project is its early stages in Scotland but has been well researched in Australia. Evidence has shown increase in self efficacy and a reduction in admission to hospital

Conclusion The tools utilised as part of the Flinders approach link very well with our motivational interviewing, self management, reenablement work.



Title of abstract

Supporting Self-Management Using Technology throughEducation and Training in Telehealthcare (SMC15)

Your detailsNameDesignationOrganisationEmail-address

Nessa Barry, Service Development Manager, Scottish Centre for Telehealth/NHS [email protected]

Donna Henderson, Consultant, Joint Improvement Team, [email protected]

Ann Grodzicka, University of AbertaySchool of Social & Health SciencesUniversity of Abertay [email protected]

Key theme Partnership working for service and educational providers

Preferred format

Interactive Workshop

Aim Telehealthcare technologies are increasingly used to support self-management. Health and social care staff require both knowledge about the benefits and challenges of using telehealthcare and the skills and confidence to use in practice.

Design Working in partnership with Higher Education Institutions, such as the University of Abertay School of Social and Health Sciences, to incorporate existing telehealthcare training resources and develop new content to incorporate into the undergraduate programme for nursing students.

Method To use existing resources including digital stories, examples of telehealthcare in practice, with additional content which will be developed in partnership between the Scottish Centre for Telehealth, the Joint Improvement Team and University partners.

Result This approach will enhance existing undergraduate modules and avoid the need for new modules in an already packed curriculum. This is an example of successful partnership working.

Conclusion The growth of telehealthcare to support self-management presents both opportunities and challenges. This approach is generalisable to other HEIs educating and training undergraduates in health and social care.





Title of abstract Planning for self management – sustaining a skilled workforce through accessible resources (SMC16)


P Thomson1, J Barrie2, A Smith1, B Stoddart1, S Boulton3, A Taylor4, C Harvey4 1) School of Nursing, Midwifery & Health, University of Stirling; 2) Lanarkshire Health Board; 3) Centre for e-learning, University of Stirling; 4) NHS Education for Scotland. E-mail: [email protected]


Resources for planning for self-management



Aim To discuss the challenges of developing an interactive resource to support self management in daily practice, one that links the best available evidence and encourages reflective practice through the assessment process.

Design NES funded project on Supporting Self Management in Long Term Conditions – Guidance & Self Assessment Tool for Healthcare Providers.

Method Three focus groups were conducted. One focus group with 10 members of the Thistle Foundation (arranged via the LTCAS) and two focus groups with 15 health care practitioners (HCPs), from a range of professional backgrounds. The data were analysed and used to inform the development of the self management resource and self assessment tool.

Result Overall, similar themes emerged from the focus groups with the HCPs and people with long term conditions. The HCPs viewed self management was an ethos of care as well as a set of techniques, although supporting self management in everyday practice was seen as a real challenge, especially for generalists. The HCPs used different strategies to support self management at different times, their decisions were often context bound and role defined.

Conclusion This self management resource and self assessment tool may be used by practitioners for self directed study and as evidence for their Knowledge and Skills Framework, or by health care teams as part of planning for self management.



Title of abstract Sleep Management in Parkinson’s – a self management approach to Insomnia. (SMC18)


Anna LynallProject [email protected]


Practical examples of Self management



Aim Out of the 10,000 people in Scotland living with Parkinson’s it is estimated that 4,000 experience poor quality sleep, tiredness and fatigue. This single symptom has an enormous emotional and physical impact on all aspects of daily life. However, sleep problems feature very little in medical or other professional teaching, and people with Parkinson’s are often left to cope alone without support. When a person is able to sleep, it becomes easier for them and their families to manage the other challenges of living with Parkinson’s.

The project aims to support people with Parkinson’s to improve their quality of sleep by a non-pharmacological approach to managing sleep. By enabling people with Parkinson’s to feel in control of their sleep, the project aims to increase individual’s confidence and self belief to manage their condition effectively.

Design The sleep self management project developed following discussions between a range of stakeholders who identified a general lack of support and information about sleep. They highlighted the need to develop a non-pharmacological self management (SM) approach to sleep problems in partnership with people with Parkinson’s. It was felt important that this support should be provided by organisations and individuals that have an understanding of and commitment to the principles of SM and by those able to reach People with Parkinson’s.

Key partners have been: Loughborough University Parkinson’s UK Alliance of Parkinson’ s Disease Nurse Specialists People affected by Parkinson’s


Method Two 3 day ‘Sleep Management in Parkinson’s Disease’ training course have run which has enabled the training of 18 Parkinson’s Disease Nurse Specialists and 9 Occupational Therapists to enable them to support people with the development of personalised SM strategies for sleep problems.

The project has also designed high quality self help material specifically aimed at Parkinson’s disease and sleep.

Result 18 PDNS and 9 OTs across Scotland have been training in sleep management and are equipped to address and support people to manage their sleep.

Conclusion This project identified a gap (as sleep problems feature very little in medical or other professional teaching, and people with Parkinson’s are often left to cope alone without support) and has been able to start to fill the gap by training professional via an evidence based self management approach to managing sleep effectively. This has been backed up with the development of self help resources support and highlight areas for consideration.

People affected by Parkinson’s are now able to gain support to manage their sleep problems and engage in a non pharmaceutical self management approach.


Title of abstract Developing Reablement Training for Health & Social Care Support Staff (SMC21)


Amanda TraffordClinical Specialist Occupational Therapist (Rheumatology)Professional Lead Occupational Therapist Mid [email protected]


A resource to support staff to make the transition from a ‘doing for’ to a ‘doing with’ approach as part of the move toward reablement.



Aim The Training & Awareness Programme in Reablement, Promoting Independence has been developed to support the introduction of a new approach to Care at Home in Highland. The Programme is aimed at Social and Health Care Assistants, Homecare staff and equivalent roles in the independent care sector.The programme involves two days of training to enable experienced care staff make the transition toward a reablement approach. The workshop will share the development of the 2 day training programme and opportunities and challenges around implementation.


Title of abstract Education Solutions for Self Management“The Legacies” (SMC22)



Wendy MaltinskyPsychology Programme [email protected]


Opportunities for learning about self-management / Practical examples for self-management / Partnership working for service and education providers / Promoting Self-Management and the need for Cultural Change


Workshop

Aim • How can health and social care teams meet the policy directives to ‘shift the responsibility of care to client groups?

• What self management training/ education and projects currently exist and how are they being received?

• What education/training will support health / social care teams to meet this agenda?

• What can the Skills for Health project provide to help meet this training / education need

Design Workshop will be an interactive opportunity to explore the legacies

Method Audit conducted of:• Exploring existing resources which would support

client self management;• Identifying educational resources to support health

practitioners• Conducting focus groups of health and social care

practitioners regarding current climate in health and social care settings, knowledge of and capacity to support self management

• Compiling and drawing on expertise of steering group from NHS; UHI; Highland Region Local Authority; LTC Alliance Scotland; NES Educational Lead for Long Term Conditions; Client’s voice




Result Focus Groups:Two key themes emerged:• Difficulties in meeting self management agenda :

Limitations in time, not part of our role, culture of practice setting not conducive to self management; clients prefer to be told what to do; complications of conditions, mental health status/ age/ type of condition all limit opportunities for self management.

• Facilitators to meeting self management agenda : Working in multi-disciplinary teams seen as advantageous in meeting SM agenda. Effective review and planning systems were operating well for assisted patients to self manage.

Resources: Wide range of resources available throughout the H&I to support self management. However provision sporadic and not strategic. Practitioners not always clear about existence and suitability of resources, and clients experienced similar ambiguity.Self management education courses: Educational resources ranged from short health behaviour change courses to modules designed to investigate long term condition policies, strategies, practices and theories.While some felt that they are meeting self management agenda well, this view was not common.Summary Many felt frustrated by issues to do with time, resources, understanding, support. Appropriate consultation skills in addition to the culture of the practice setting are critical to engendering self management. Resources do exist, but availability is sporadic and practitioners and patients are not clear about how to make judgements about their relevance. Remote and rural practitioners face additional challenges due to the paucity of resources available.

Conclusion What we produced:Two Modules: Two Masters level modules developed to deliver to lead practitioners to act as champions for self management in practice settingsModule 1: Enabling Self Management : DevelopingModule 2: Enabling Self Management : Leading Change—Health Action Planning Tool: an online tool which supports practitioners and clients in identifying and working on health behaviour goals (to be discussed at workshop)Self Management Competencies Framework; a set of competencies developed from Skills for Health competencies and mapped to LTCAS principles of self management, the framework is a self assessment tool designed to assist practitioners to support people to self manage their condition (to be discussed at workshop)Self Management Champions: students who have completed the 2 modules will be supported through a network approach to continue to facilitate change in their workplace



Title of abstract Supporting Behaviour Change using Motivational Interviewing: The Highland Learning Programme (SMC25)

Your details:Name, designation, organisation and email address

Jane Groves, Public Health Network Coordinator,NHS HighlandAssynt HouseBeechwood [email protected]


Opportunities for learning about self-management

Promoting self-management and the need for cultural change



Aims The aim of the Health Behaviour Change (HBC) learning & development programme delivered in NHS Highland has been to support practitioners to take a person-centred, collaborative and empowering approach to behaviour change, and to let go of the expert role through taking a Motivational Interviewing (MI) approach.

To provide a stepped model of training incorporating elearning elements and post-course support.

To provide a stepped model of training which incorporates generic training in brief interventions and ‘raising the issue’

To complement topic specific training provided by NHS Health Scotland

To develop practitioner capacity to underpin the use of specific LTC’s case management tools such as the Flinders model.

To provide HBC/ MI training specifically for LTC’s Case Managers in one NHSH Community Health Partnership.

To provide face to face training which complements the UHI MSC in Self-Management elearning modules

To identify and train a cohort of locally based HBC trainers in NHSH, and to shift a culture of practice in behaviour change through supporting them to provide local training and coaching. A Behaviour Change Training for Trainers course has recently been provided in Highland.



Design Redesign of existing Motivational Interviewing based health behaviour change training and development of HBC Training for Trainers course. Supported by NHS Education Scotland.

MethodMulti-agency behaviour change courses provided for health and social care professionals in Highland for a number of years.Course materials have been recently redesigned to include blended learning option and post-course support.Stepped course design developed to also provide generic training in brief interventions and ‘raising the issue’, and to complement NHS Health Scotland suite of courses.Education plan for case managers in Mid Highland CHP established HBC training as essential.Training for Trainers course designed and delivered

Result This piece of work is still in progress. The existing practitioner level courses have evaluated very well, and there is evidence of the case-management process leading to increased self-management and reduced hospital admissions. The redesigned model will be delivered during 2011, and new trainers will be supported to deliver. Practitioner adoption of the spirit and application of the skills of Motivational Interviewing takes time and provision of post-course support. The delivery of generic behaviour change training for health and social care professionals allows them to gain skills which are transferable and useful in a range of settings.

Conclusion The principles and practice of the person-centred approach of Motivational Interviewing can underpin both brief and longer interventions to support behaviour change, and including self-management of long-term conditions.


Title of abstract Exploring the beliefs about self-management and discrepancies between professionals and patients (SMC28)


Sara JoiceHealth PsychologistNHS [email protected]





Aim To highlight the beliefs professionals hold about their role in self management and the possible implications for patients and evidenced based practice

Design Interactive workshop

Method 1. Discuss the definition of self-management, creating an opportunity for participants to share their beliefs about what they think self- management is.

2. Present the theoretical background to self management including example models by Bandura 1997; Azjen 1991 Leventhal 2003

3. Explore if the theory relates to their current professional practice

4. Illustrate differences in beliefs using data from health professionals and stroke survivors

5. How do the participants think we can minimise discrepancies between patient and health professional’s beliefs e.g. stroke workbook intervention?

Result To dispel myths about self-management by encouraging participants be aware of their own beliefs and to be open to ways of incorporating self-management strategies safely in to their practice.

Conclusion Promoting self-management awareness by increasing understanding and considering the potential barriers that may exist to preventing a cultural change in practice.



POSTERS


Title of abstract Promoting self management and sustaining behavioural change in patients with COPD using Telehealth (SMC01)

Your Details:Name/s,Designation,Organisation ande-mail address

Amanda StearsSpecialist Physiotherapist Pulmonary rehabilitationNHS [email protected]

Key theme(must fit one of thekey themes of theconference)

Promoting self management and the need for cultural change.

Please indicateyour preferredformat

Poster

Aim The project aim is to provide equal access toself management support in rural and remoteareas and to keep those with COPD betterinformed about self management techniques.

Design 5 centre trial of Telehealth Technology to deliver pulmonary rehabilitation in remote areas using digital technologies.

Method Uses a hub and spoke method and Microsoft office communicator to allow one qualified member of staff to supervise two exercise classes simultaneously and with uniform delivery.

Result Early data suggest that patients receiving pulmonary rehabilitation by this method are no worse off than those receiving pulmonary rehabilitation via the traditional method.

Conclusion The use of Telehealth technology allows real-time improved efficiencies and offers opportunities to deliver pulmonary rehabilitation to those isolated at home.


Title of abstract Let’s Get On With It Together Partnership - The Highland, Argyll And Bute Partnership For Delivering Supported Self-Management (SMC02)


Andrew MacLean, Project Co-ordinator, Partnerships for Wellbeing – [email protected]


Partnership Working For Service And Educational Providers / Promoting Self-Management And The Need For Cultural Change


Poster

Aim The term ‘Let’s Get On With It Together’ is derived from the motivation of different organisations within Highland, Argyll and Bute to work together in partnership.

The Partnership has been constituted to develop and deliver a structured and sustainable self-management strategy for the Highland and Argyll & Bute Council areas. Underpinning the Partnership vision is a commitment to improve the lives of people living with long term conditions by offering a co-ordinated and innovative approach to self-management. The Partnership is intended to take forward and extend the work of the NHS Highland Long Term Condition Collaborative.

Design Prefer workshop during which delegates will get overview of Partnership, , also partner members will have display material. Audience participation to probe their views, experiences and work in self management/ also interactive presentation on self management courses – this could be designed as a separate workshop.

Method Following a session of seminars and workshops the Partnership was brought together in the summer of 2010 and has since then developed a 5 year vision which identifies its key objectives and outcomes.

Result Objectives identified to take forward the strategy.

Conclusion Multi Agency Partnership set up to take forward strategy within Highland, Argyll and Bute


Title of abstract An innovative approach to integrating user involvement in the development of a Masters module on ‘Partnerships in Care for Managing Long Term Conditions’ (SMC06)


P Thomson1, B James1, J Barrie 2, S Menzies1, G Hubbard3 1) School of Nursing, Midwifery & Health, University of Stirling; 2) Lanarkshire Health Board; 3) Cancer Care Research Centre, University of Stirling. E-mail [email protected]


Opportunities for Learning about Self Management


Poster

Aim To facilitate the exchange of information about the development of a Masters module on ‘Partnerships in Care for Long Term Conditions’

To stimulate discussion about user-directed input into the content and design of the module and priorities for future education.

Design Descriptive, education development

Method A video-linked group discussion employing a convenience sample of 14 people with a range of long term conditions (LTCs), recruited from different locations in Scotland. The participants brainstormed ideas along with teachers and researchers about what should be incorporated into the module. Content analyses was undertaken, main themes identified, learning outcomes drafted and feedback sought from the participants prior to development of the module descriptor.

Result Data analysis revealed 7 main themes: support and empowerment; partnerships; communication; carer support; knowledge; attitudes and skills, which guided development of the learning outcomes. Our results concur with the key themes identified in ‘Gaun Yersel’ (LTCAS 2008). Our approach extends the notion of service user involvement by having people with LTCs input prior to the identification of learning outcomes, design and content of the module.



Conclusion Our approach was innovative in that people with LTCs had a significant opportunity to identify from the offset, from their own unique perspectives, the knowledge and skills that practitioners need to support them in self management. It draws on the key theme of ‘partnerships in care for managing long term conditions’, which is reflected in the blended learning approach to this module, developed for advanced health care practitioners.


Title of abstract Supporting self care as a core theme in the undergraduate degree programme (SMC07)


P Thomson, B James, A Smith, School of Nursing, Midwifery & Health, University of Stirling E-mail [email protected]




Poster

Aim To facilitate the exchange of information about development of an undergraduate degree module on supporting self care

To stimulate discussion about the challenges involved in preparing practitioners to engage people more in self care

Design Descriptive, education development

Method This module was designed in collaboration with clinical partners and others agencies involved in support for self care/ self management. The domains for self care support (DoH 2005), the healthcare pyramid (Self Care Connect 2008) and core principles for self care support (DoH 2008) were used to guide the design of the module, learning outcomes and assessment. This web-based module is delivered to NMAHPs in Stirling, Inverness and Western Isles undertaking a degree module, as part of our pre-or post-registration curriculum. A blended approach to learning is used, comprising of two face-to-face study days, web/reading/writing and reflective activities

Result To date over 180 students have completed the module. Self care is a wide and complex area. The students felt challenged in considering what is self care; why should we support self care; the general principles that help support self care; theoretical underpinnings to self care and support strategies; and whether practice needs to change to support self care.

Conclusion Reshaping healthcare and transforming practice to better support self care will take time. This module will go some way to educating current and future practitioners to develop the knowledge and skills needed to support individuals to self care better; to make careful judgements about the balance ofprofessional and lay input to care; and to make decisions about referrals to lay groups


Title A multi-disciplinary approach to supporting self management of ME-CFS (SMC11)

Your details: Dr Gregor PurdieGP and Clinical Lead for M.E.-CFSNHS Dumfries & [email protected]

Key theme Partnership working


Poster

Aim ME-CFS is a chronic illness, characterised by persistent fluctuating fatigue, pain and loss of endurance to normal activities. It causes significant ill health and disability in over 20,000 adults, young people and children across Scotland.1

Latest reasearch2 shows current specialist treatments (where available) are only moderately effective, so patients require multi-disciplinary, multi-agency help to self manage.

NHS Dumfries & Galloway aims to develop a robust network of statutory and voluntary agencies to meet this need.

DesignUse the new Good Practice Guide on ME-CFS3 and Health Care Needs Assessment4 as a toolkit in the development of services, giving due consideration to the Nation al Action Plan for Long Term Conditions.5

Method Identify and engage with local statutory and voluntary agencies that can satisfy the criteria of the toolkit to provide integrated services we couldn’t provide on our own.

Result Still under development. The workshop will share lessons learned.

Conclusion Local barriers to and benefits from partnership working to support self management of a long-term fluctuating condition.



Title of abstract Increasing the potential for self management with the use of new technology – Changing the culture (SMC19)




Argyll and Bute’s Telehealth project went live March 2009, The project has a mixture of home telehealth units and community based multi user pods to maximise self management potential.


Poster

Aim The aims of the project were: increase in self management of long term conditions. the reduction in crisis admissions to hospital and

exacerbations earlier supported discharge from hospital ability to live in own home for longer improved quality of life

Design/Method A wide variety of partners were involved. There are 2 distinct types of Telehealth equipment used with a range of LTC’s. The evaluation, of the project has proved challenging but a large amount of learning has taken place.



Result/Conclusion

The key findings emerging from the evaluation are: Increase in confidence and ability to self manage their

conditions Change in culture with both staff groups and patients

developing less of a dependency on services Increase in confidence and skills of community staff in

managing LTCs Enthusiasm between staff and patients to embrace

new technology Quality of life of people participating in the COPD pilot

had greatly improved with many people reengaging with activities they had previously been unable to do.

Clear link with reduction of admissions and length of stay

Relationships between community teams and remote specialist services has developed.

Digital stories captured the experiences of both staff and patients and identified the real benefits to both in a very powerful way.

The increase in ability to self manage their conditions was related to the technology used but also to the increased knowledge of the teams in supporting people to self manage.

The Multi user pods have potential to be more widely used and have a key role to play in screening patients and more widely in health promotion.

The key champions of the project are now the patients who have used the equipment.

The Findings indicate high transferability potential to other areas


Title of abstract From crisis care to partners in care - developing self management in COPD (SMC20)


Michelle Duffy / Corinne Clark,Clinical Practice Educator COPD /Respiratory Nurse SpecialistBoth NHS Highland [email protected] [email protected]


How we developed the COPD self management plan. How it has worked in practice.How it has empowered the patient.Development of a common language.The benefits to the patient, family and staff.What we’ve learned.


Poster

Aim When we originally developed the COPD self management plan, we envisaged it as being a patient hand held record of their condition. There was, in our opinion, a gap which existed between patients being diagnosed and their hospital care. Their care was crisis led and it seemed to us that there was no other route for management. This led us to believe that if we could provide people with information in a simple common language, they may be better able to deal with the management of their own condition. The emphasis is on encouraging people to get to know their bodies and understand what is happening. The aim is that they are better equipped to anticipate and deal with exacerbations as they almost inevitably occur.

Method We developed the COPD self management plan during a pilot project as part of introducing clinical case management .

Result The result of that project was a reduction in hospital admissions and use of bed days.

Conclusion We would like to share our experiences and help others who are developing self management strategies in other long term conditions.




Title of abstract Education Solutions for Self Management “The Legacies” (SMC22)



Wendy MaltinskyPsychology Programme [email protected]


Opportunities for learning about self-management / Practical examples for self-management / Partnership working for service and education providers / Promoting Self-Management and the need for Cultural Change


Poster

Aim • How can health and social care teams meet the policy directives to ‘shift the responsibility of care to client groups?

• What self management training/ education and projects currently exist and how are they being received?

• What education/training will support health / social care teams to meet this agenda?

• What can the Skills for Health project provide to help meet this training / education need

Design Poster will describe the process this project went through to identify and then develop the educational solutions which were required for Self Management in Health and Social Care.

Method Audit conducted of:• Exploring existing resources which would support

client self management;• Identifying educational resources to support health

practitioners• Conducting focus groups of health and social care

practitioners regarding current climate in health and social care settings, knowledge of and capacity to support self management

• Compiling and drawing on expertise of steering group from NHS; UHI; Highland Region Local Authority; LTC Alliance Scotland; NES Educational Lead for Long Term Conditions; Client’s voice





Result Focus Groups:Two key themes emerged:

• Difficulties in meeting self management agenda : Limitations in time, not part of our role, culture of practice setting not conducive to self management; clients prefer to be told what to do; complications of conditions, mental health status/ age/ type of condition all limit opportunities for self management.

• Facilitators to meeting self management agenda : Working in multi-disciplinary teams seen as advantageous in meeting SM agenda. Effective review and planning systems were operating well for assisted patients to self manage.

Resources: Wide range of resources available throughout the H&I to support self management. However provision sporadic and not strategic. Practitioners not always clear about existence and suitability of resources, and clients experienced similar ambiguity.Self management education courses: Educational resources ranged from short health behaviour change courses to modules designed to investigate long term condition policies, strategies, practices and theories.While some felt that they are meeting self management agenda well, this view was not common.Summary Many felt frustrated by issues to do with time, resources, understanding, support. Appropriate consultation skills in addition to the culture of the practice setting are critical to engendering self management. Resources do exist, but availability is sporadic and practitioners and patients are not clear about how to make judgements about their relevance. Remote and rural practitioners face additional challenges due to the paucity of resources available.

Conclusion What we produced:Two Modules: Two Masters level modules developed to deliver to lead practitioners to act as champions for self management in practice settingsModule 1: Enabling Self Management : DevelopingModule 2: Enabling Self Management : Leading Change—Health Action Planning Tool: an online tool which supports practitioners and clients in identifying and working on health behaviour goals (to be discussed at workshop)Self Management Competencies Framework; a set of competencies developed from Skills for Health competencies and mapped to LTCAS principles of self management, the framework is a self assessment tool designed to assist practitioners to support people to self manage their condition (to be discussed at workshop)Self Management Champions: students who have completed the 2 modules will be supported through a network approach to continue to facilitate change in their workplace



Title of abstract

Health Action Planning Tool Study:Investigating the use of an online resource to support people to create physical activity action and coping plans and build physical activity self efficacy (SMC23)


Wendy MaltinskyInverness College UHIPsychology Programme [email protected]

Key theme Resources for planning for self management


Poster

Aim The study aimed to test the efficacy of a tool that could be used to support clients directly as well as in conjunction with health practitioners to develop physical activity action and coping plans and increase levels of physical activity self efficacy

Design Independent Groups 2 x 2 Factorial DesignIndependent Variables:Social Support and Health Action Planning Tool Intervention

Method Week 0:Participants undertook a baseline measurement of their walking and completed a questionnaire on their attitudes and beliefs about physical activity.Week 1Participants were then randomly allocated to one of two modules: All modules contained information about how to complete and access physical activity action plans

Module 1:Group 1 – participants received information on the benefits of Physical activity and were guided through a process of setting action and coping plans.Group 2: as per group 1 plus received a weekly supportive messageModule 2:Group 3: received a weekly supportive message onlyGroup 4 – control group received no information nor any supportive messages.

Week 2:Groups 1 and 2 reviewed action and coping plans against their actual activity and were guided in how to adapt plans


Week 3:Reviewing progress All participants completed a questionnaire on beliefs and attitudes to physical activity. Participants who were in the Hap tool intervention groups (1 &2) also completed questions providing feedback on their views of the toolAll groups recorded their physical activity for 4 weeks – from week 0 – week 3

Result 86 participants completed the initial weekly activity diaries at base line;Of the 44 enrolled on module 1 63% completed physical activity coping and action plansEarly results suggest that by week 3, the amount of walking undertaken by groups 1 and 2 was greater than that for groups 3 and 4. The final data is still being analysed.Participants who were in groups 1 and 2 commented about the tool:recording [exercise] also reinforced the fact that sometimes I mean to exercise but don't. In my mind I often think I have exercised because I have thought about it, when in actual fact I have only thought about it and not actually done anything about it! Also giving information in manageable chunks each week is helpful and stops it being overwhelming.

Thinking through what I could change and then seeing if I managed it.

Planning out what I was going to do and helped keep to it

Kept me motivated to follow my action plan

How it helped me to write my own action plan

Some suggestions for the development of the tool:

Some immediate analysis and feedback on pedometer readings. It should be possible to automate this so that participants see percentage increase/decrease in activity week on week. This would be useful information for self motivation.

Conclusion Support in forming action and coping plans as well as building self efficacy can help people to identify targets, consider barriers and build efficacy about the selected behavioural target. Integrating support into the process can provide additional motivational impetus.


Title of abstract Is self-management in lymphoedema just common sense? (SMC24)


Louise ShakespeareMacmillan CNSNHS [email protected]




Poster

Aim The research project investigated the experience of living with lymphoedema in a very remote and rural area in Scotland, and suggested ways of improving access to self management support.

Design Structured interviews were conducted with a small sample of people with lymphoedema, recruited from a larger sample who completed a self-administered postal questionnaire

Method Based on the results from the interviews, self-care measures and their use will be described. Some had adopted these as common sense and managed the condition well, with little support. Suggestions will be offered to improve uptake of these measures.

Result Many of the sample with mild, uncomplicated lymphoedema effectively self-managed their condition, with little support from healthcare professionals, based on their own common sense experience.

Conclusion It is suggested that raising awareness amongst health and social care workers at all levels of lymphoedema and simple measures that can reduce risk and / or alleviate symptoms would support the self management of this condition.


Title of abstract Information packs improve self efficacy to exercise among mental health patients attending an exercise group. (SMC27)

Your Details:Name/s,Designation,Organisation ande-mail address

Reejo John Paul

Senior PhysiotherapistNew Craigs [email protected]

Key theme(must fit one of thekey themes of theconference)

PROMOTING SELF-MANAGEMENT AND THE NEED FOR CULTURALCHANGE


Poster

Aim To evaluate the impact of information packs on self efficacy to exercise among patients already attending an exercise group.

Design A Formative evaluation using a PDSA model and quantitative data analysis.

Method Consenting participants who attended an exercise group in a mental health setting completed a Self efficacy to exercise tool (SEE) pre and post the introduction of an information pack. The data was analysed using Repeated measures ANOVA.

Result The information pack improved self efficacy to exercise scores in patients. The data was statistically significant (p=0.00005) for an intervention effect.

Conclusion The information pack appears to have increased self efficacy to exercise in all participants in a statistically significant manner thus improving self esteem and self management. The design of exercise groups needs to incorporate strategies to improve self efficacy which may improve adherence rates and provide long term benefits to health.


Title of abstract Remote and Rural Education and Assessment for Cardiac Health (RREACH) (SMC29)


Mandi Smith (Lead Heart Failure Nurse) and Katie Wilson (Cardiac Nurse Specialist)NHS [email protected]@nhs.net


Promoting Self management and the need for cultural change


Poster

Aim The aim is to work with the multi disciplinary teams (MDT’s) to facilitate best practice to enable people living with heart failure to self manage their condition , in some of the most isolated and deprived communities within the Highlands.

Design The heart failure nurse (HFN) service has evolved to provide an equitable and accessible service tailored to meet the people’s needs. We utilise all forms of technology to support patients and staff to manage heart failure safely and effectively. Our robust communication links is essential to the delivery of care and support for all those involved.

Method Empowering and enabling patients and their carers to manage their condition starts with a trusting relationship. This facilitates the transfer of knowledge and skills which engenders confidence, improves quality of life and a sense of wellbeing.

We are establishing a robust network with all stakeholders throughout the region.

We are engaging with the MDT to develop the skills that are central to self management, thereby ensuring equitable and accessible service provision, making better use of the limited HFN resource.




Result The creation of the educational packages tailored to patients, carers and MDT staff, focusing on early symptom recognition and titration of medication. Working together we aim to prevent the escalation of heart failure symptoms thereby reducing distress and unnecessary readmission. These benefits are borne out by patient testimonials collected through service questionnaire.

Conclusion With the new Clinical Standards for Heart Disease (QIS 2010) raising the bar, especially in the face of budgetary constraints. Utilising technology, we can make even more effective use of the limited resource of the HFN’s by building on professional relationships established within the MDT’s ensuring better service provision for patients.

Health & Medicine

110614 abstract booklet