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Self Care Training Manual

Module 7: setting goals and overcoming challenges to self care

Using effective communication to gather ideas, concerns and expectations from people will mean new types of workers learning a lot more about how the person copes day-to-day with their long term conditions. Having this information is important as it can lead to opportunities to set goals with them to improve their self care.

Module 7 introduces how to set realistic goals with people, so they can plan and work in partnership with new types of workers to learn new skills and improve their self care.

Motivating people to learn new ways to self care can be challenging, as they are used to the traditional operating system of homecare, and having care workers just ‘doing for’ them. It is crucial that new types of workers can consider the challenges people may face, as they change their own thinking towards their care and support, and attempt to build their confidence to become more involved in their self care.

Learning outcomesOn completion of this module learners will be able to: � Understand how to set goals with people to support their self care � Recognise the importance of planning, monitoring and reviewing goals to

support people to achieve positive results � Appreciate the effects of low self confidence and motivation, and support

people to overcome these challenges

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(OHP 7.1 Module 7: Outcomes) � Understand how to set goals with people to support their self care. � Recognise the importance of planning, monitoring and reviewing goals to

support people to achieve positive results. � Appreciate the effects of low self confidence and motivation, and support

people to overcome these challenges.

(OHP 7.2 What is a GOAL?) � Having goals means we want to achieve something. � It is a positive way to focus on the future. � Goals are easier to reach if they are realistic and achievable. � Reaching goals can help people feel happy, confident and in control.

Having a goal means there is something that we want to do, to work towards and to achieve in our lives.

We all have goals. They may not always be written down in a structured way, but we know what we are working towards and if we really want to achieve them then we try our hardest to do so.

Some goals will be short term, like eating a healthier diet, and are something that we could do on our own. Other goals may be longer term, like giving up smoking, and can be something that we need support with from others.

Having goals is a good way to look to the future and to not get ‘stuck in the here and now’. In the old ways of working care workers would support people with the same tasks day in and day out, meaning they would maintain them where they were, and not plan for the future, to reach new goals that would make people feel more positive about their lives and involve them in their self care.

What is important is that our goals are realistic, so if I said I wanted to climb Mount Everest, the chances are that would not be very realistic, and no matter what I did, I might never reach my goal. New types of workers should always ensure they support people to set realistic goals, so there is more chance of them being reached, so ‘I would like to watch some documentaries on Mount Everest’ would be more realistic and achievable.

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! Key point: Achieving success means we are more likely to feel good about ourselves and to be motivated to try new things in our lives, so even reaching one goal – ‘I want to dress myself in the mornings’– can make people feel happy, confident and in control of their lives.

(OHP 7.3 How to Set goals with people)New types of worker will have a responsibility to set goals with individuals so they can improve their lifestyles and learn skills that will enable them to better self care for themselves.

But where do they start?With so many individuals to support, setting goals for each of them would be a difficult task?

The solution is to use the three steps to setting goals with each person they support and log all planning in each individual’s support plan.

Step 1: find out what they want to do?

Step 2: plan how to reach the goal.

Step 3: plan when to reach the goal.

(OHP 7.4 1. Find out what they want to do?) � A good place to start is to use the ICE (ideas, concerns, expectations)

toolNew types of workers can use the ICE tool to structure their conversations with the people they support. Taking the time to understand a person’s ideas, their concerns and their expectations means the new type of worker can gather valuable information that could lead to opportunities to set new goals in self care.

‘Mrs Harris has a lot of ideas about why she is feeling low; by listening to her concerns I have built a good partnership of trust and respect, and now we are working towards what she would like to do about it!’

� Read and discuss the person’s support plan with themDiscussing the person’s support plan and the choices they have made will help to build trust, and a mutual respect between new types of workers and the people they support.

It will tell new types of workers where to focus their skills and give them insight into each person they support.

‘I know from reading the individual support plan that Mrs Harris has chosen to focus on her personal care and mobility for the next six months’

� Get to know people’s likes and dislikes and their interestsWe are all very different and some people will be able to communicate quite easily the goals they wish to work towards. For others it will take the skills of a new type of worker to get to know them, their likes and dislikes and make suggestions to set goals they may work towards (remember the ICE tool).

‘I know from spending time with Mrs Harris that she likes history. I have suggested visiting the local museum to follow up on her interest, or to think of joining the mobile library service.’

� Take time to get to know people’s routinesRoutines should always be respected, as they are our own choices and help us to feel in control of what we do. However this does not mean that we can’t change them!

Observing people and how they interact in their own homes can give a new type of worker clues to new ways of supporting them.

‘I noticed that Mrs Harris always struggles to get around her room in the mornings. I suggested that we could work together and clear some of her possessions, so she could move around easier. She liked the idea and it is now a goal!’

� Ask them directly – What would you like to do?Just because a person has set an individual support plan does not mean they want it to stay the same forever! New types of workers can ask people what they would like to do.

‘I have been supporting Mrs Harris for a few months now. She is happy with the choices she has made in her individual support plan, but I asked her one day ‘Is there anything else you would like to do?’ and I was surprised at her response. She has asked to start going back to church again and would like me to support her to paint her hallway.’

Asking ‘what would you like to do?’ for some will bring a lengthy response and there will be many new ideas that people have about how they want to receive their support. For others, they may be happy to remain with their choices in their individual support plan; but this does not mean that a new type of worker should never ask if they want to do new things again.

(OHP 7.5 Group discussion)What goals might people set to improve their self care?

Please refer to discussion 7.1 in how to present module 7 in the Self Care Training Manual.

(OHP 7.6 Examples of goals)As people start to use their individual budgets to purchase the types of support they want and begin to take control of their services by planning for themselves or with the help of others, they will be able to update their support plans and set new goals with their new types of workers.

Setting goals gives people an opportunity to achieve something which is meaningful to them and will give them the chance to learn new self care skills and become more independent in their own lives. There could be any number of choices that people make when deciding on setting goals, so it is important that new types of workers are aware of the key areas where people may set goals.

Physical goalsThese are goals that relate to the person’s ability to do things on their own and may include: � being able to wash and dress independently � being able to get in and out of bed unaided � being able to walk unaided with walking frame � being able to transfer in and out of the bath independently � being able to make own breakfast, lunch or dinner � being able to make a cup of tea � being able to take own medications � being able to carry out household chores.

Social goalsThese are goals that relate to the person’s ability to get out of their home and spend time with other people, and may include: � being able to join a local support group � being able to meet up with friends and family � being able to start to do exercise – walking/swimming/keep fit class � being able to collect their own pension � being able to go to the theatre � being able to do shopping in the local community � being able to go to the park, and feed the birds.

Emotional goalsThese are goals that relate to the person’s ability to feel better about themselves and more positive for the future, and may include: � being able to do their own paperwork and household bills � being able to paint their bedroom a nice bright colour � being able to have a pet � being able to talk to someone about how they feel � being able to join a support group to help them feel better � being able to talk to family and friends more on the telephone � being able to use the internet to keep in contact more.

Health goalsThese are goals that relate to the person’s ability to start better looking after their own health, and may include: � being able to learn more about ‘my Parkinson’s’ � being able to stop drinking as much alcohol � being able to learn more about ‘my’ stroke and arthritis � being able to eat a healthier diet � being able to do more exercise � being able to drink more water during the day � being able to manage medications better.

! Key point:In many ways choosing a goal to work towards can be the easy bit. Being able to achieve it may be more difficult for people as they will all have varying strengths, abilities and motivations. Planning effectively is really important if people are going to remain focused and positive about working towards their goals. New types of workers should take the time to plan how goals will be reached with each person they support.

(OHP 7.7 Planning how to reach goals)

1. Write down what the person says they wantMany people will be used to receiving a traditional support service where care workers follow a list of tasks on their care plan, so suddenly being asked what they want to do will be a new concept to them. It is important then that new types of workers take the appropriate time to build partnerships with people so they can begin to find out if there are other areas of their lives where they would like to set goals and achieve them.

As they do, they should write down the ideas that the person comes up with: this means everything, no matter how irrelevant some may seem.

By using the person’s support plan to log the choices they make, new types of workers will have a record of what is important to the person, and will be able to refer back to them as they begin to set goals.

New type of worker experience:“I have been supporting Mr Quinn for a month now and always approach my support by involving him as far as possible in his personal care and mobility. We are making real progress and he is doing much more for himself.

I started to read more of his individual support plan each time I visited and I know once he is doing more for himself that he would like to do other things. So yesterday I started to ask him if there was anything else he would like support with, and to my surprise he has loads of ideas! I asked him if he would like to put them in his individual support plan, and we now have a list that we can plan for.”

2. How important is the goal?Once new types of workers have an idea of the goals people would like to achieve and they have written them in their individual support plan they should spend time asking people how important they are to them.

It is crucial at this stage to find out how motivated people are to change, as much work will go into successfully supporting them towards their goals. So what does reaching the goals really mean to them? How motivated are they going to be? How will their life be better once they have achieved their goals?

An easy way is to ask people, ‘on a scale of 1–10, how important is your goal?’ with one being not very important and ten being very important.

Uncovering people’s motivations will mean new types of workers can assess how likely they are to work towards achieving them. However, all is not lost if they change their minds, as other goals may be worked towards instead.

New type of worker experience:“I have spent some time with Mr Quinn now and I have built a good partnership of respect and trust with him. From our conversations I know he would like to be able to join an exercise club and he asked me to put this down as a goal in his individual support plan.

I wanted to see how motivated Mr Quinn would be to actually follow up on his goal, so over the following days I mentioned it each time and talked more about what it may involve. To my surprise he said he would prefer to wait for a while, and instead wanted to change his Monday lunchtime support to include time to walk around his garden.

I have updated his goals and we are taking smaller steps towards him joining a club, but I still mention it to him to keep his interest.”

3. Who and what is needed to support the goal?It is crucial that if goals are going to be reached that new types of workers consider who will be needed to make them happen. In many cases the people involved in supporting people to reach their goals will include:family, friends, advocates, neighbours, voluntary organisations, support groups, health professionals, social workers, new types of workers.

It is also important that new types of workers consider what is needed to support people to reach their goals. This can be thought of as all the resources that will be needed, like: money, time, transport, equipment, information.

4. Break the goal down into small achievable stepsAs they say, ‘Rome was not built in a day’, and new types of workers should never try and support people to achieve their goals in a day either. It is important that once people have set their goals that they are broken down into small achievable steps, so they feel more confident and can think about each stage without becoming too overwhelmed with the whole goal.

By breaking goals down people are more likely to be motivated to achieve them, and often the planning stages are much easier for all involved.

New type of worker experience:“I arrived at Mr Quinn’s to find a goal had been set in his individual support plan. It said ‘I want to do my own gardening’. I have a good partnership with Mr Quinn and knew this may not be realistic for him to achieve and I worried that if his goal was not broken down and planned out, he may lose faith in doing it. So after we had worked together to complete his personal care, I spent time with Mr Quinn and we both agreed that it may be easier to break it down and this is how we did it:

1. Monday – organise all the garden equipment. 2. Wednesday – arrange with Mr Quinn’s son to buy gardening gloves, protective cushion.3. Monday – start with the small plant bed in the garden and dig out some of the weeds.4. Wednesday – plant the flowers that Mr Quinn would like to plant.5. Monday – Mr Quinn’s daughter will support him with personal care and the New Type of Worker will escort Mr Quinn to the garden centre.

“When I arrived at Mr Quinn’s home on the Wednesday he had planted his own flowers and was very pleased with himself. I really have not seen him smile like that in some time! I feel confident that I used my new type of worker skills to support Mr Quinn to break down his goal, and now he is in control of his gardening and so much happier for it.”

5. Plan a date to reach the goalHaving a date in mind can help us look forward to something – ‘my birthday’, ‘our anniversary’ – we know that there are certain things we need to do in preparation for the big day.

Setting a realistic date to achieve a goal is no different. It is important then that new types of workers work with people to set a date in their individual support plans to achieve their goals.

Having this date will give the goal a sense of ‘importance’ and help to motivate everyone involved to achieve it.

Please refer to worksheet 7.2 in how to present module 7 in the Self Care Training Manual.

(OHP 7.8 Review the goals)Review your progress � Ask people how they are getting on and update their individual support plans. � Reviewing may highlight challenges to reaching goals. � Reviewing may highlight achievements. � Provide regular feedback to people to motivate them further with their goals.

Reviewing progress is one of the most important stages of supporting people to reach their goals. This means new types of workers regularly checking the progress logs made in the individual support plans and asking people how they feel they are getting on with reaching their goals.

We all like to receive a little bit of praise from time to time. It makes us feel good about ourselves and can make us feel like the hard work we are doing counts, so new type of workers should regularly give people positive feedback when reviewing their progress towards their goals.

As people succeed with each small step towards their goals it will be important to celebrate their achievements in the way they feel comfortable with. This makes the review stages a positive experience for people and makes reaching their goals more enjoyable.

(OHP 7.9 Challenges to self care)Many people using community support services will have been used to having a care worker arrive at their home and simply ‘do things for’ them, so approaching support by involving them, and setting goals for them to achieve may be unfamiliar to them and many may be reluctant to change and become involved in setting goals.

New types of workers will have the challenge of supporting people to change their behaviours towards their own care and support, and this may not always be easy.The two challenges that new type of workers may come up against are: � people’s confidence � people’s motivation.

! Key point:If new types of workers are to support people to begin to self care for their long term health conditions and to take more of an active role in their daily activities, personal care, mobility and personal interests, then they will need to know how to work in partnership with people to overcome these challenges.

(OHP 7.10 What is confidence?)Confidence is about having belief in your abilities, sureness that you can achieve something and be in control of it

We all go through ‘phases’ in our lives where we have the confidence to learn new skills, start new relationships and new jobs. Whilst we may be nervous, we tell ourselves that we can do it, and we go for it. At other times, we may lack confidence to try new things, interact with new people or learn new skills; we tell ourselves that we will never be able to do it!

People who purchase services are no different, and at times will be confident to try new things, learn new skills and be involved. Equally there are other people who will get anxious about trying new activities, involving themselves with new people and new situations, and want to stick to what they know - their usual routines.

! Key point:Confidence can swing between 10 - ‘I am very confident’ to 0 - ‘I am very unconfident’, or sit somewhere in between. New types of workers will come up against confidence as a barrier to setting new goals with people, so it is their responsibility to recognise low self confidence and support people to improve it.

(OHP 7.11 Why people may lose confidence)It is easy to become frustrated with people when they appear to ‘lack interest’ or ‘refuse’ to take steps to improve their lives and the situations they may be in, so it is important that new types of workers consider why people lose their confidence and at times lack the interest to set goals and improve themselves.

The first step to support people to gain new confidence is to find out what it is that is leading them to lack confidence. Once new types of workers understand this they can begin to support people to take control over their lack of confidence and increase their self esteem and self respect.

Reasons why people lose confidence

Lack of practice: As babies we are supported by our parents to learn the skills to be independent of others and to have self determination in the world. This gives us all varying levels of confidence to ‘go it alone’ and begin to make our own lives for ourselves. The life skills we pick up along the way support us to have confidence and feel as though we are making a worthwhile contribution to our families, friends and communities.

As people use support services, this feeling of ‘contribution’ can be taken away from them, as they are supported by ‘having things done for them’, this means they use their skills less and less, and are at risk of becoming dependent on others. Lacking practice in their own lives can cause people to lose their life skills and lead to lack of confidence to try new things or become involved.

Bereavement: As we get older our chances of experiencing bereavement increase, for many people this will mean they experience a range of emotions that can leave them feeling detached from others and unmotivated to want to set their own goals to improve their lives.

Recent fall: Being able to move around independently is perhaps something we all take for granted, until we experience a fall or break a bone in our bodies. For many people having a fall can cause them to lose confidence in their abilities and see them suddenly withdrawing from activities that they used to do, such as walking up the stairs and going out.

Physical changes: As we age our bodies change, we may put on more weight, or lose it, and the person looking back at us in the mirror may have changed. For some people their change in appearance can mean they lose their self-esteem and their self-confidence to interact with others. This loss of confidence can leave them de-motivated and cause them to take even less care of their appearance.

Incontinence: The ability to manage our own continence is important as it helps us feel in control of ourselves and means we can go about our daily lives not having to worry as we are in control of our toileting. For people who suffer from incontinence, their confidence may be affected, as they rely on others to support them with their most personal care and come to rely suddenly on the use of incontinence pads to manage their condition.

Isolation: Not being able to get out of the house, to have regular contact with family and friends or even to meet new people can lead to people becoming isolated. This can affect their attitudes and behaviours towards their own life and cause them to lose the confidence to try and build a network of support and become less isolated.

Long term conditions: Being diagnosed with a long term health condition can be life-changing news and for some people mean their ability to ‘do things for themselves’ will change. This can lead to a loss of control as they rely more and more on other people to care for them.

! Key point: There are any number of reasons why people may lose their confidence. It is important that new types of workers can take the time to build an understanding of why people may lack confidence, so they may empathise with them and take time to slowly build their confidence and can consider setting new goals in their self care.

(OHP 7.12 Group discussion)How would you know if a person lacks self confidence? What are the signs you would pick up on?

Please refer to discussion 7.3 in how to present module 7 in the Self Care Training Manual.

(OHP 7.13 The signs of low self-confidence)People who are not very confident can get anxious about changes and trying new ways of doing things. They may not trust their own abilities and avoid setting goals to work towards as they convince themselves that they will never be able to do it!

Some common signs of low self-confidence are: � Negative most of the time – ‘Oh I can’t cope with using technology, that’s

not me at all’. � Expect the worse to happen – ‘I can’t go out I might get stuck on the

pavement’. � Anxious – People may become anxious when they undertake new activities. � Worried all the time – Some people may not be able to keep things in a

realistic perspective. � They don’t feel in control of their lives – They may allow others to make

decisions and control their lives. � Not willing to try new things – Any suggestions to try new things are

rejected. � Have very set routines – Any thought of change can upset them. � Choose new goals but don’t see them through into action when the time

comes.

(OHP 7.14 Supporting confidence)Supporting people to take control and become more confident will not happen overnight. It is therefore important for new types of workers to always display positive attitudes and behaviours with the people they support, so they can create an environment where people feel valued and respected and more comfortable to discuss their reasons for low self confidence.

Using the ICE tool (ideas, concerns, expectations) will support new types of workers to structure their communication and may lead to more information being gathered about the reasons for the person’s low self confidence. These can then be acted on.

New types of workers can support people to increase their confidence by building a person-centred partnership based on trust, honesty and respect.

Using the ICE tool – To structure communication and find out why people lack confidence, and what are their ideas, concerns and expectations.

Taking their time – It may take people days, weeks or months to feel comfortable enough to talk about their ‘feelings’ and the challenges they face to be confident to try new things and set goals in their self care. Taking time is therefore key to making them feel they are in control of change.

Focusing on ‘abilities’ – As people talk about their lack of confidence, often it will be the negatives that are discussed – ‘I am too old now’, ‘I don’t have the brains for that’. By focusing on what they can do, new types of workers can support them to ‘balance their thinking’: ‘ Ok, but you are good at...’.

Encouraging people – “Let’s give it a go and see what happens.” This approach is key if new types of workers are to support people to begin to better monitor and manage their long term conditions. New types of workers should always adopt an empowering approach.

Supporting people to make new choices – New types of workers should support people to make choices that will increase their confidence, and their self esteem. However, people have the right to make their own choices and these should be respected at all times, even if these mean they do not want to take steps to increase their confidence.

Involve people in setting their own goals – For many people receiving homecare services being asked what they would like to do, and having the opportunity to set new goals to achieve will be a very different way of doing things, so they may find it difficult to think of ‘goals’ they want to work towards. By involving people new types of workers can slowly build up their confidence and get them used to setting goals in their self care.

Breaking the goal down – For people who lack confidence the thought of achieving new goals can be a very daunting one. Even ‘walk to the shop at the end of the road’ may be too much for a person to take in and make them worry or lack the confidence to do it when the time comes. So breaking the goals down into smaller steps may support them to feel more confident to achieve them: ‘walk to the garden gate, then to the neighbour’s house, and then – when you are ready – to the shop’.

Encouraging them to be in charge – Even though people may lack confidence, encouraging them to be ‘in charge’ and to make choices and final decisions, can slowly increase their ability to make more choices about how they want to receive their support. It is important that new types of workers always empower people to be in control, no matter how low their confidence.

Celebrating their achievements – Celebrating achievements is a way to acknowledge that people have reached their goal, no matter how small or big they may be. It is important then that new types of workers give people positive feedback when they reach any one stage of achieving their goals, so their confidence to achieve it increases.

! Key point:Understanding why people are unconfident will allow new types of workers to focus on setting goals so they may overcome their low self-confidence and begin to make choices to improve their health and well-being.

Remember, even when people have set goals in their self care, they may lack the confidence to see them through; the key is not to give up, but to support them to work through their challenges.

(OHP 7.15- What is motivation?)What is motivation?Motivation is about how people ‘want’ to do something – it is their inner drive to achieve an activity. When people are motivated they are willing to focus on an activity and put energy towards achieving the goal.

Sometimes we all lose our drive to do things and say, ‘Oh I can’t be bothered’, or we start something with lots of energy and excitement and then when we realise it is hard work, or going to take some time to achieve, we can lose our motivation and either slow down or stop all together.

This is the challenge new types of workers may face when supporting people to become more involved and active in their self care, so it is crucial that they have the skills and the right approach to continue to motivate people to achieve their goals and live happier and healthier lives.

(OHP 7. 16 Why people lose motivation)Raising expectationsAn expectation can be thought of as giving someone hope that something will happen for them, that they will achieve a positive result or get something that they want.

It can be very tempting to tell people that they will be able to set as many goals as they want to and they will all be achieved without any problems at all. If new types of workers were to do this, the likelihood is that people would immediately start to plan all the things they would need to buy or find to help them reach their goals, and would tell their families and those closest to them that they were working towards achieving something new.

They will immediately have high expectations that all their goals will be achieved!

If too many goals are set and new types of workers find it difficult to achieve them, they may not meet the expectations that the people have built up.

This can result in people losing trust in their new type of worker and losing the motivation to set new goals with them in the future.

It is important then that new types of workers approach supporting people by setting realistic expectations. This means not making promises they can’t keep or setting goals that are unrealistic and could never be achieved.

(OHP 7.17 What can affect people’s motivation?)There are a number of factors that can affect an individual’s motivations to want to be involved in their support services and become more active in their self care.Individual motivations can be affected by:

Symptoms of long term conditions – People may believe that there is nothing worth doing about the long term conditions they have. Not having more information about the challenges they face can limit their understanding about other ways they may look after themselves and leave them feeling that by simply taking medications, they are doing all they can to self care.

Depression – The Mental Health Foundation (2008) estimates that 1 in 4 people will experience some kind of mental health problem in the course of a year. When people are depressed there are a range of symptoms they may suffer from: anxiety, loss of sleep, withdrawal, poor memory, and their ability to function and look after themselves may reduce. Having depression can mean there is no space for people to think about self care, and they are unlikely to be motivated to learn new skills and set new goals.

Low self-confidence – Low self-confidence may mean a person avoiding trying anything new, as they don’t have inner belief that they are capable of learning new skills or contributing to their own self care.

The environment – Our environments may affect how we feel about ourselves. If people live in cluttered homes they may look around at their homes and just see the ‘clutter’. Having all this around them may not make them feel very positive and ‘block’ them from thinking about making any other changes in their lives. Living with relatives and main carers can also lead some people to feel they need to seek the permission of others before they can start to make changes and set new goals.

Personal beliefs – As people age, their personal beliefs may be that they are in their ‘go slow years’ and they may expect others to ‘do things for them’. This way of thinking can de-motivate people to consider learning new skills and become more involved in their self care. Religious and cultural beliefs may also affect the person’s motivation to self care for their health needs, as they believe they should not put themselves before others.

Inherent motivation – For some people a lack of motivation may be an inherent one. This means their patterns of thinking over the years have been negative, as they convince themselves that nothing they do will make a difference or last for very long!

(OHP 7.18 Motivating people to self care)All people are motivated to achieve things for their own reasons, so new types of workers will need to find the best ways to keep them motivated as they work towards their self care goals. Now this won’t be easy and requires a commitment from all new types of workers to: � Motivate people to set goals � Motivate people to plan to reach goals � Motivate people when they want to ‘give up on their goals’.

Why should I bother?I just give up.

I don’t think anything can make a difference.

I expect you to do things for me.

Supporting people to increase their motivation can be approached by:

Setting realistic expectations – New types of workers should always remember to set realistic expectations with the people they support. This will often mean starting off with small steps, working in one key area with people so they can experience success and build on their motivation to set their next realistic goal.

No matter how difficult it may seem, being honest with people about what they are likely to achieve will allow them to be realistic about their final outcomes.

Building a person-centred partnership – Taking the time to build a good working relationship with people will slowly motivate them over time, as they realise that new types of workers do not simply ‘do for’ them but rather promote a healthy partnership where their contributions are expected and become key to their own support. Once a good partnership has been set, new types of workers may feel comfortable to speak to people directly about why they lack motivation.

Setting achievable goals – Goals must be realistic or new types of workers will lose the ‘buy in’ from people at the start. So setting a goal of running for a person who has done limited exercise for years would be unrealistic and may cause the person to worry and lose motivation. This worry could begin to extend into their thinking and affect other areas of their lives. So setting achievable goals can help motivate the person and give them small, more achievable steps to look forward to.

Plan how to achieve goals with them – By involving people as far as possible in planning what actions need to be taken they will assume the control and be able to make choices that are important to them. Knowing that they can change their minds at any time, understanding who will be involved and what they will have to do, step by step, can motivate people to stay focused and achieve their self care goals.

Focus on the positives – New types of workers should ‘spread the word’, letting people know of other people’s success stories (whilst always upholding confidentiality). Discussing the benefits of reaching individual goals can be hugely motivating; they may be able to ‘picture the success in their minds’ and become even more motivated to achieve it.

For example, discussing how people can use a ‘leg protector’ to once again be able to take a bath, and showing them a picture from a catalogue, may just motivate them to take the next step in their goal of having a relaxing bath!

Team leader / supervisor support – Where it is needed, new types of workers should always seek the advice of their team leaders or supervisors. By using the experiences and knowledge of others, an answer may be found to support those people who remain unmotivated to self care.

Please refer to worksheet 7.4 in how to present module 7 in the Self Care Training Manual.

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