Patient Self Management
This discussion post will critically reflect on the care of Mrs Smith, a patient who had been admitted to an acute respiratory ward due to exacerbation of chronic obstructive pulmonary disease (COPD). Ways in which the nurse can facilitate patient self management will be explored initially; following this, barriers to the promotion of patient self management will be considered. Including
Evidence strongly suggests that empowering patients to self manage their long term health conditions is associated with positive outcomes. This includes delayed disease progression and improved health-related quality of life (e.g. The Scottish Executive, 2006; 2009; Barnet, 2009; Fraser et al., 2011).
In many respects, the concept of patient empowerment is the cornerstone of self management. Before an individual can effectively manage their condition they need to accept and understand it. For this reason it is important that the nurse understands the patient’s perception of their disease – their needs, priorities, goals and expectations. Only then can the nurse most effectively act as the educator, offering information about the pathogenesis of the condition, therapeutic options, available support etc. This involves taking a patient centred approach to practice and establishing a professional relationship in which nurse and patient are equal partners (Forbes & While, 2009). The ultimate aim would be to empower the patient; to develop their confidence in making informed decisions that have a positive impact on their ability to live with the day-to-day symptoms of their condition. Mrs Smith, for example, avoided dyspnoea at all costs, and as a result led a very sedentary lifestyle. However, when the nurse took time to explain that breathlessness per se is not to be avoided and that moderate exercise has benefits in terms of improved cardiovascular fitness and delayed progression of COPD, Mrs Smith was obviously reassured. This increased Mrs Smith understands of her
Evidence strongly suggests that empowering patients to self manage their long term health conditions is associated with positive outcomes. This includes delayed disease progression and improved health-related quality of life (e.g. The Scottish Executive, 2006; 2009; Barnet, 2009; Fraser et al., 2011).
In many respects, the concept of patient empowerment is the cornerstone of self management. Before an individual can effectively manage their condition they need to accept and understand it. For this reason it is important that the nurse understands the patient’s perception of their disease – their needs, priorities, goals and expectations. Only then can the nurse most effectively act as the educator, offering information about the pathogenesis of the condition, therapeutic options, available support etc. This involves taking a patient centred approach to practice and establishing a professional relationship in which nurse and patient are equal partners (Forbes & While, 2009). The ultimate aim would be to empower the patient; to develop their confidence in making informed decisions that have a positive impact on their ability to live with the day-to-day symptoms of their condition. Mrs Smith, for example, avoided dyspnoea at all costs, and as a result led a very sedentary lifestyle. However, when the nurse took time to explain that breathlessness per se is not to be avoided and that moderate exercise has benefits in terms of improved cardiovascular fitness and delayed progression of COPD, Mrs Smith was obviously reassured. This increased Mrs Smith understands of her
References: Barnett, M., (2009). Promoting self-management for patients with COPD. Journal of Community Nursing 23 (9): 4-6. Forbes, A., While, A., (2009). The nursing contribution to chronic disease management: A discussion paper. International Journal of Nursing Studies 46 (1): 120-13. Fraser, J., Page, S., Skingley, A.,(2011). Drawing a breath: promoting meaning and self-management in COPD. British Journal of Community Nursing 16 (2): 58-6 The Scottish Executive (2008). "Gaun Yersel" The Self-Management Strategy for Long Term Conditions in Scotland. Available from: http://www.scotland.gov.uk/Publications/2008/10/GaunYersel [Accessed 13 February 2012] The Scottish Executive (2009). Improving the Health and Wellbeing of People with Long Term Conditions in Scotland: A National Action Plan. Available from: http://www.sehd.scot.nhs.uk/mels/CEL2009_23.pdf [Accessed 13 February 2012] Wilkinson , A ., Whitehead , A., (2009). Evolution of the concept of self-care and implications for nurses: A literature review. International Journal of Nursing Studies 46 (8): 1143-1147. Wilson, P.M., Kendall, S., Brooks, F., (2006). Nurses’ responses to expert patient: The rhetoric and reality of self-management in long-term conditions: A grounded theory study. International Journal of Nursing Studies 43 (7): 803-818.