Patient Carer Empowerment in Rehabilitation: Challenges and …€¦ · in Rehabilitation:...

Patient / Carer Empowerment

in Rehabilitation:

Challenges and Success Factors

HA Convention 2015

Li KY, Tang IFK, Kwong MWY,

Chan RWH, Ko CSH, Wong YN

Department of Rehabilitation and Extended Care

東華三院黃大仙醫院 Tung Wah Group of Hospitals

Wong Tai Sin Hospital

1

Hospitalized Patient

Chronic disease

Poor control

Unresolved emotional problems

Learning new skills

Poor adaptation

Knowledge deficits

Lack of support

Dependent & passive

4

Living with

Chronic Illness or Diseases

Quality Of Life

Patient / Carer Empowerment in

Rehabilitation

5

6

Rehabilitation

Key Features of Empowerment

Acceptance

Alliance

Affection

Active participation

Autonomy

Skinner TC; Cradock S, 2000 7


• Patient-centered Collaborative Approach

• Autonomy & Self-control

• the effects of disease, through

– knowledge

– skills

– sense of control over life

• QoL

• Active patient participation and influence is vital in

rehabilitation process

(Wikman and Faltholm, 2006) 8

Bloom's Taxonomy

of Learning Domains

The Three Domains of educational activities or

learning (Bloom, et al. 1956)

• Cognitive: mental skills (knowledge)

• Affective: growth in feelings or emotional

areas (attitude or self)

• Psychomotor: manual or physical skills

(skills)

9


Domains Strengthening

Cognitive

Psychomotor

Affective

Carer

10

Challenges

Patient

System & Environment Nurse

11

• Aged

• Literacy

• Quality

• Patient type

• Culture

• Attitudes & motivation

• Illness

• Limitation

• Vision

• Hearing

• Emotion

Cognitive Readiness

Physical Capabilities

Carer Attributed

Values

12

Challenges

Nurses:

Attitude & personal values

Knowledge

Skills

Confidence

System & Environment:

Routine

Manpower

Limited resources

Service gap

Invest in Education and

Training

System &

Environmental

Review 13

Nurse Roles in


Assessment

Communication

Coordination Counselling

Information and

knowledge

Understanding

14

Early

Discharge

Plan

Patient / Carer

Early Engagement and

Empowerment

Cognitive / Knowledge

Mobility Training / Skills Reinforcement

15

Advanced

community

linkage

Patient / Carer

Positive Sense of Control

Affective Domain Strengthening

Cognitive / Psychomotor

Domain Strengthening

Focus Area

Objectives

• to increase health literacy of patient and carer

• to improve patient’s physical mobility and

psychomotor skills

• to assist patients with disability and chronic

illness to attain maximized function

• to increase awareness of their personal strength

• to relieve carer stress by increasing their sense

of control

16

Methodology

840 patients were recruited in rehabilitation

programmes (Apr 2013 - Mar 2014)

17

Pulmonary Rehabilitation

(PR)

Neurological Rehabilitation

(NR)

Musculoskeletal Rehabilitation

(MSR)

Geriatric Rehabilitation

(GR)

NR Empowerment Programme Domains

Cognitive

(Knowledge Education)

Psychomotor

(Skill Training) Affective

CVA

Parkinson's

disease

Dementia

DM

Cholesterol

Fall prevention

Continence care

Drug compliance

Warfarin

information

Healthy life style

Smoking cessation

Discharge planning

Community

resources

Hypertension

Constipation

Turning

Transfer

Grooming

Dressing

Swallowing

Continence care

Walking

Bathing

H'stix checking

Insulin injection

Fine motor exercise

Passive limb ex

Education and

Counseling

Group therapy

Cognitive training

Reality orientation

Reminiscence therapy

18

PR Empowerment Programme Domains

Cognitive


Psychomotor


COPD

Congestive heart disease

Exercise regimen

Follow-up matter

Smoking cessation

Fall prevention

Drug compliance

Healthy life style

Discharge planning

Community resources

Breathing control

Pacing technique

Energy conservation

technique

Puff technique

Use of breathing device

Transfer

Walking

Bathing

Education and Counseling

Group therapy

19

GR Empowerment Programme Domains

Cognitive


Psychomotor


Hypertension

Constipation

DM

Fall prevention

Continence care

Drug compliance

Healthy life style

Discharge planning

Community resources

Urethral Catheter care

Stoma care

Transfer

Continence care

Walking

Bathing

H'stix checking

Insulin injection


Group therapy

Cognitive training

Reality orientation

Reminiscence therapy

20

MSR Empowerment Programme Domains

Cognitive


Psychomotor


Fracture of Hip

Osteoporosis

Gouty arthritis

Osteoarthritis

Pain control

Low back pain

Fall prevention

Continence care

Drug compliance

Healthy life style

Discharge planning

Community resources

Transfer

Walking

Continence care


Group therapy

21

Journey of Patient /

Carer Empowerment

22

Cognitive / Psychomotor / Affective

Domain strengthening

Admission

Phase

In-patient

Phase

Pre-discharge

Phase

Out-patient

Phase

Admission

Phase

23

Empowerment Start from Triage

24

Early Patient / Carer Involvement

In-patient

Phase

25

Prompt Communication /

Early Discharge plan

26

Early Patient / Carer Involvement

Individual Health Education

27

Knowledge & Skill Attention

Individual Health Education

28

Knowledge & Skill Technique

Timely Reinforcement

Group Health Education

29 Knowledge & Skill Attention

Health Education Materials

30

Tailor-made for

Elderly Patients and Carer

Health Education Materials

31

Take Home Message

With Early Carer Involvement

Cognitive &

Psychomotor Skill Training

32

Cognitive Training

33

Reality Orientation

34

Reality Orientation

35

Reality Orientation

36

Reminiscence Therapy

37


38


39

Group Therapy

40

Pre- Discharge

Phase

41

Pre- Discharge Education

Community Services Introduction

42

Out-Patient

Phase

43

Follow-up & Monitoring for

Target Patient Group

44

Success Factors: Staff & System

• Team spirit & Mission alignment

• Management support

• Resources availability

• Nurses competency

• Multidisciplinary

45

Success Factors: Domains

Early

Discharge

Plan

Patient / Carer

Early Engagement and

Empowerment

Cognitive / Knowledge

Mobility Training / Skills Reinforcement

46

Advanced

community

linkage

Patient / Carer

Positive Sense of Control

Affective Domain Strengthening

Cognitive / Psychomotor

Domain Strengthening

Results

(Average) 5 times of knowledge and skills

training were provided to each patient’s carer

during patient hospitalization

65% of patients were discharged home

47

Result - NR

High Frequency Sessions

Cognitive Psychomotor Affective

CVA

DM

Fall prevention

Continence care

Drug compliance

Hypertension

Transfer

Grooming

Continence care

Walking

Education and

Counseling

Group therapy

Cognitive training

Reality orientation

Reminiscence

therapy

48

Result - PR



COPD

Fall prevention

Drug compliance

Breathing control

Pacing technique

Energy

conservation

technique

Puff technique

Use of breathing

device

Education and

Counseling

Group therapy

49

Result - GR



Hypertension

DM

Fall prevention

Continence care

Urethral Catheter

care

Transfer

Continence care

Walking

Education and

Counseling

Group therapy

Cognitive training

Reality orientation

Reminiscence

therapy

50

Result - MSR



Fracture of Hip

Fall prevention

Drug compliance

Continence care

Transfer

Walking

Continence care

Education and

Counseling

Group therapy

51

Conclusion

Role of Rehabilitation Nurse patient’s quality of life

Specific approaches challenge into success

Empowered Cognitive, Psychomotor & Affective domains & better carer support.

52

Recommendation

• Patient satisfaction

• Qualitative & Quantitative

• Psychosocial empowerment

53

References • Vluggen et al. 2012, Multidisciplinary transmural rehabilitation for older persons with a stroke: the design of a randomised

controlled trial, BMC Neurology 2012, 12:164

• Palaka C. Patel et al., 2011, Journal Club An Equation for Positive Patient Outcomes and Nursing Empowerment, Evidence-Based Practice and a Nursing Journal for Nurses in Staff Development & Volume 27, Number 5, 227Y230

• Mental Health Atlas 2011, China, Hong Kong Special Administrative region, Department of Mental Health and Substance Abuse, World Health Organization

• Nelma B. Crawford Shearer, 2009, Health Empowerment Theory as a Guide for Practice, Geriatric Nursing, Volume 30, Number 2S

• Anna M. Chudyk, et al., 2009, Systematic Review of Hip Fracture Rehabilitation Practices in the Elderly, Arch Phys Med Rehabil Vol 90, February 2009

• Alison J. Tierney, 2008, Patient empowerment, The Author. Journal compilation, Blackwell Publishing Ltd 393,

• Celeste Shawler, 2006, The Empowerment of Older Mothers and Daughters: Rehabilitation Strategies Following a Hip Fracture, Geriatric Nursing, Volume 27, Number 6

• Wikman and Faltholm, 2006, Patient empowerment in Rehabilitation: “somebody told me to get rehabilitated”. Advances in Physiotherapy, 8(1): 23-32.

• Michigan Diabetes Research and Training Center, University of Michigan Medical School, 2004 Patient empowerment. Crit Care Nurs Q. 2004 Apr-Jun;27(2):201-4.

• Mark Faulkner, 2001, A measure of patient empowerment in hospital environments catering for older people, METHODOLOGICAL ISSUES IN NURSING RESEARCH, Blackwell Science Ltd

• Skinner TC et al., 2000, Empowerment : what about the evidence? Practice Diabetes International (Pract Diabetes Int) May – Jun 2000 (3) 91-5

55

Acknowledgment

• Dr Doris MIU Consultant in Charge DREC WTSH

• DREC Rehabilitation Team

Doctors

Nurses

Physiotherapists

Occupational Therapists

Medical Social Workers

Speech Therapist

Dietitian

Clinical Psychologist

56

Patient Carer Empowerment in Rehabilitation: Challenges and …€¦ · in Rehabilitation:...

Documents

Transcript of Patient Carer Empowerment in Rehabilitation: Challenges and …€¦ · in Rehabilitation:...