patient carer empowerment in rehabilitation: challenges and …€¦ · in rehabilitation:...
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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
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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
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Key Features of Empowerment
Acceptance
Alliance
Affection
Active participation
Autonomy
Skinner TC; Cradock S, 2000 7
Patient / Carer Empowerment
• 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)
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• Aged
• Literacy
• Quality
• Patient type
• Culture
• Attitudes & motivation
• Illness
• Limitation
• Vision
• Hearing
• Emotion
Cognitive Readiness
Physical Capabilities
Carer Attributed
Values
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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
Patient / Carer Empowerment
Assessment
Communication
Coordination Counselling
Information and
knowledge
Understanding
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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
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Methodology
840 patients were recruited in rehabilitation
programmes (Apr 2013 - Mar 2014)
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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
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PR Empowerment Programme Domains
Cognitive
(Knowledge Education)
Psychomotor
(Skill Training) Affective
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
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GR Empowerment Programme Domains
Cognitive
(Knowledge Education)
Psychomotor
(Skill Training) Affective
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
Education and Counseling
Group therapy
Cognitive training
Reality orientation
Reminiscence therapy
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MSR Empowerment Programme Domains
Cognitive
(Knowledge Education)
Psychomotor
(Skill Training) Affective
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
Education and Counseling
Group therapy
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Journey of Patient /
Carer Empowerment
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Cognitive / Psychomotor / Affective
Domain strengthening
Admission
Phase
In-patient
Phase
Pre-discharge
Phase
Out-patient
Phase
Success Factors: Staff & System
• Team spirit & Mission alignment
• Management support
• Resources availability
• Nurses competency
• Multidisciplinary
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Success Factors: Domains
Early
Discharge
Plan
Patient / Carer
Early Engagement and
Empowerment
Cognitive / Knowledge
Mobility Training / Skills Reinforcement
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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
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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
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Result - PR
High Frequency Sessions
Cognitive Psychomotor Affective
COPD
Fall prevention
Drug compliance
Breathing control
Pacing technique
Energy
conservation
technique
Puff technique
Use of breathing
device
Education and
Counseling
Group therapy
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Result - GR
High Frequency Sessions
Cognitive Psychomotor Affective
Hypertension
DM
Fall prevention
Continence care
Urethral Catheter
care
Transfer
Continence care
Walking
Education and
Counseling
Group therapy
Cognitive training
Reality orientation
Reminiscence
therapy
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Result - MSR
High Frequency Sessions
Cognitive Psychomotor Affective
Fracture of Hip
Fall prevention
Drug compliance
Continence care
Transfer
Walking
Continence care
Education and
Counseling
Group therapy
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Conclusion
Role of Rehabilitation Nurse patient’s quality of life
Specific approaches challenge into success
Empowered Cognitive, Psychomotor & Affective domains & better carer support.
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• 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,
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• Wikman and Faltholm, 2006, Patient empowerment in Rehabilitation: “somebody told me to get rehabilitated”. Advances in Physiotherapy, 8(1): 23-32.
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• Skinner TC et al., 2000, Empowerment : what about the evidence? Practice Diabetes International (Pract Diabetes Int) May – Jun 2000 (3) 91-5
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