Almost half the population of Scotland have at least one long term condition (Scottish Health Survey 2014) and we know that the older people become, the more long term conditions they will develop.
It has been suggested that on average, the length of time someone with a long term condition spends with a healthcare professional is roughly 4 hours per year (NHS England 2006). For the rest of the time, they or their families are managing the condition and their circumstances at home.
For a more detailed background and more information check out the IFIC Scotland Webinar Integrated Care Matters, Series 4: Self Management and Co production https://vimeo.com/368784654
There are a number of techniques nurses can use to help people to self manage. By embedding these skills in our practice we can support people at every interaction to engage in the behaviours necessary to facilitate self management to the point where it becomes second nature.
1. Health promoting behaviours
2. Signposting to easy to read information and educational materials
3. Facilitate the person to set small achievable goals and plan actions to achieve these.
4. Peer Support
5. Provide a coaching role
6. Support unpaid carers and recognise the very important role they have.
As nurses we have a vital role to play in ensuring people have the right knowledge, skills and support when they need it. This will enable people to develop the skills and confidence to live as independently as possible and to live well despite their long term conditions. During the development of Scotland’s Self Management Strategy, the Health and Social Care Alliance (THE ALLIANCE), together with people living with long term conditions identified key stages when people said they needed more support to continue to self manage. The key stages are:
1. On diagnosis of a long term condition
2. Living for today
5. End of Life
Please go and take a look at the Scotland’s Self Management Strategy entitled ‘Gaun Yersel’ which can be found at www.alliance-scotland.org.uk/wp-content/uploads/2017/11/ALLIANCE-SM-Gaun-Yersel-Strategy-2008.pdf
Most people will say they self manage to varying degrees. For some this may be in the form of managing complex medication regimens, for others this may involve using highly technical skills and equipment. As a result people need different levels of support at different times to help them to self-manage their own conditions.
There are some excellent resources on Self Management and Co Production available at: https://www.alliance-scotland.org.uk/self-management-and-co-production-hub/ Take a look and watch some of the very helpful videos.
In 2011, The Health Foundation published “Helping People help themselves” which looks at the evidence around self management.
The Key Points from this document are:
Evidence suggests that supporting self-management works. Supporting people to look after themselves can improve their motivation, the extent to which they eat well and exercise, as well as improving their symptoms and clinical outcomes.
Although many initiatives and different types of support are available, some are more useful than others. To encourage people to engage in self management activities the provision of information alone is unlikely to be enough to motivate behaviour change – more self-management approaches are necessary.
So, how do we know that people understand the health related information or instruction of techniques we provide to facilitate self management? There is an approach called Teach-Back. Its very simple and quick. After providing information about their condition or demonstrating a technique, all you have to do is ask the person to explain back in their own words what they have just heard or seen in order to demonstrate their understanding. If the person is unable to explain or describe the technique or information, then we should re-educate the person using different words until the person can show they understand. This is not a test for the patient, so asking the person to explain back what they have just heard should be done in a relaxed and friendly manner, avoiding technical jargon. Teach-Back has been shown to be a very useful technique to promote understanding and facilitate self management. It is a technique related to health literacy – for more about health literacy, look at the previous post on this blog site on Sensory Changes and Frailty.
For more information about teach-back go to http://teachbacktraining.org/home