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What is self-management? Self-care management is defined as the behaviour employed by an individual in managing and implementing the treatment regimen within the individual’s lifestyle routine and it recognizes an individual’s central role in managing chronic diseases (Costantini et al. , 2008). In sum, self-management is to help individuals collaborate with health care professionals to help themselves, by using strategies and proper interventions, to bring self-care into daily routine to help managing chronic diseases and to promote quality of life.
How will you promote self-efficacy and autonomy for your clients in your practice? Chronic kidney disease (CKD) affects almost every aspect of patient’s life, both physical and emotional.
According to Mok (2011, p12), several strategies identified in helping patients with CKD to improve nutritional adherence. These strategies fall into three categories: patient education, behaviour modification and organizational changes. These strategies also applicable in other treatment in CKD.
According to Barbra (2011,p183), when patients’ disease deteriorate or towards terminal states, strategies of ending self-management and back to medical or comfort care were also mentioned.
Nurses can apply these strategies by nursing interventions to help promote patients self-efficacy and autonomy. First, patient education strategies. Nurses should assess patients’ need and their knowledge and literacy level before providing education. These assessment should make sure patients are ready to accept the changes and the education received can be fully understood.
Usually when patients are knowledgeable in their own condition, their self-efficacy and autonomy will be greatly improved. In addition, education should also be provided to caregivers because a lot of patients with CKD depend on caregivers in ADLs.
During assessment and education process, nurses should be aware of using good communication skills, interviewing skills and make sure accurate information and related resources are provided to patients and caregivers.
Second, behaviour modification strategies. According to Mok (2011, p12), several techniques can be used in behaviour modification such as reminders, self-monitoring, and positive reinforcement. Nurses can combine effective behavioral, psychosocial strategies such as periodical reminder by using telephone, email, regular appointment or face to face interaction. Nurses should advocate patients for regular follow up to make sure patients adherence to treatment.
No patient is alone in chronic disease treatment, nurses should collaborate with patients’ family members and caregivers to help maintain compliance. In addition, nurses can assist patients in using self-monitoring techniques such as blood pressure monitoring, diaries, logs, personal health records to help track their health condition. Third, organizational changes. According to Mok (2011, p13), nurses can collaborate with other health care professionals such as dietitians and physicians to enhance compliance.
Nurses can directly help patients in developing dietary plan and improve patients’ satisfactory, in turn, promote treatment adherence. Lastly, according to Barbra (2011, p183), when patient unable to perform self-care, giving up self-management and return to professional medical care should be acknowledged. Nurses should educate and assess patients’ and caregivers’ capability of performing self-management, making sure they are knowledgeable of serious symptoms and capable of seeking help when needed.
What are indicators of successful self-management in patients with CKD? According to Mok (2011, p12), several factors may affect successful treatment such as lack of knowledge, hectic lifestyle, lack of decision making in own dietary outcomes and dissatisfactory of dietary prescription. First, knowledge deficit will make patients unable to choose proper food or make necessary adjustments, in turn, leads to failure in self-care management. Therefore, patients education, knowledge and ample resources provision are indicators of successful self-management.
Second, hectic lifestyle such as fast-paced lifestyle or elderly depend on others are often unable to adherence to the prescribed regimen. Therefore, lifestyle modification, caregivers’ capability and support are also indicators of successful self-management. Third, lack of decision making of own dietary outcome due to depend on caregivers instead of patients might influence successful self-management. Fourth, dissatisfaction of prescribed renal diet will affect patients’ adherence.
Therefore, patient readiness to change, communication skills, assessment tools and psychosocial support are also indicators of successful self-management. In sum, indicators of successful self-management involves every aspect of disease process and treatment. In nurses’ and patients’ perspective, nurses’ communication skills, interviewing skills, collaboration capability, staff training, patients’ readiness, patients’ emotional support, patients’ knowledge, problem solving techniques, etc are all indicators of successful self-management.
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