Self Management Strategies of Patients on Long Term Dialysis

7/29/2019 Self Management Strategies of Patients on Long Term Dialysis

1/57

SELF MANAGEMENT

STRATEGIES OF PATIENTS ON

CHRONIC DIALYSIS

Ma. Nisan T. Manauis, RN, MAN CRNC

Board Member, RENAP


2/57

What does the FUTURE hold?


3/57

Patient Adaptation to Disease

Seek medicalhelp

Follow courseof treatment

Do best torecover

ESRD

Patient

Alerted tomany

complications

Managefluid

restrictions

Managedietary

regulation

Managemedication

regimen

Acute Diseases Chronic Diseases

Burks, 1999; Feste & Anderson, 1995; Holman & Lorig, 2000; Singleton, 2000


4/57

Self Management / Self Care

Individual's efforts to

advance optimal health

prevent illness

recognize symptoms as early as possible cope with or manage chronic conditions

Can include:

self-monitoring and assessment

symptom perceptions and labeling

evaluation of severity

evaluation and selection of treatment alternative

Easton, 1993; Woods, 1989


5/57

Benefit of Self Management

Patients who engage in

self-management of

their disease and/or its

treatment are more likelyto enjoy improved

health-related quality of

life

QUALITY

OF LIFE

SOCIAL

& ROLE

PHYSICAL

& MENTAL

BIOLOGIC

HEALTH RELATED QOL

(Horsburgh, 1999; Meers et al., 1996)


6/57

Challenge to Self Management

One reason for the difficulty may be

connected with Parsons' (1951;

1975) conceptualization of the "sick

role. Patients are to be relieved of their usual

role responsibilities so that they can turn

their energies to recuperation

Patients are expected to seekappropriate health care and to follow the

recommendations of their health

providers to "get well" as quickly as

possible.


7/57

Challenge to Self Management

Manner in which dialysis treatment is

usually administered


8/57

HEALTH CARE MANAGEMENT

STRATEGIES OF LONG-TERM DIALYSIS

SURVIVORS

Curtin, Roberta Braun; Mapes, Donna L; Thomas-Hawkins,

Charlotte; August 2001


9/57

Purpose

Explore the process by which long-term

survivors of dialysis manage their illness,

its symptoms, and its treatment

Identify common characteristics, attitudes,

beliefs, and behaviors among long-term

survivors that may be related to their long-

term survival


10/57

Study Method

Sample

Selected based on the unique knowledge,

perceptions, and perspectives that they are presumed

to possess ESRD patients who had been treated with any

dialysis modality for a cumulative total of 15 or more

years

Recruited via a modified "snowball" technique: a fewmembers of the phenomenal group were first

identified and these members, in turn, identified

others who could also be expected to be "information-

rich"


11/57

Study Method

Sample

18 patients currently maintained on

hemodialysis

8 patients reported having received peritonealdialysis, and 3 reported having received home

hemodialysis in the past

12 patients reported receiving kidney transplants;

several receiving more than one

DM not the primary renal disease


12/57

Demographics


13/57

Demographics


14/57

Study Method

Interviews

Topical, semi-structured interviews with key

informants

2 to 6.5 hours

Broad question that introduced the general

topic

Probes and open-ended follow-up questionswere used to gently direct the discussion

Audiotaped and fully transcribed


15/57

Findings

6 Self Management Strategies

Impression Management

Selective symptom report and management

Vigilant oversight of care

Proposal of treatment by patient

Confrontation of system--active self-advocacy

Independent adoption of treatment/use of

alternative therapies


16/57


Monitoring, manipulation, and deliberate management ofself-presentation

Orchestrating interactions with health care providers in an

attempt to improve chances of receiving optimal care

Actively projecting characteristics they thought were most

valued or appreciated by providers


17/57


I am treated in a way that I would not put up

with if I was in a different context. But because

my life depends on them, I am quiet

You've got this problem where you will die if you

don't have dialysis--you have got to go to this

facility and depend on these people. Then you

have to get along with them day in and day out,

no matter what kind of people they are or what

their competency is.


18/57

Selective Symptom Report

and Management

Closely attuned to physical selves -

alert to the warnings of their bodies

and subtle signals that something is

wrong

Employing a kind of triage of their

symptoms before deciding whether toreport them to a health care

professional or manage the situation

on their own right


19/57

Selective Symptom Report

and Management ... they know if I ever have a problem, I call `em. I mean,

I don't sit around and wait for the month--the end of the

month to tell them. I call them. I put them on the spot

right away. So they pretty much always know where I am

at.

I say ... you are my doctor. You are in charge because

you are my doctor. But when I talk to you, I want you to

listen to me and give me the time, because I have beenso many years in this business that I am very much in

tune with my body.


20/57

Vigilant Oversight of Care

Attentiveness to the care that was

provided to them by all levels of providers


21/57

Vigilant Oversight of Care

I think because of my high control needs, I've never been

able to sleep on dialysis.... I think what it is, I'm afraid

that I will die if I go to sleep. You know, I'm out of control

and I am not watching what is going on and I just can't

do it.

I want to learn and I want to know. When I sit in that

chair, I'm watching. You may see me lying back, but I'm

watching, you know. I make sure there is no air comingback to the arterial line, because if they start fumbling

with the bag and air is getting introduced into the line,

you know. I'm always watching everybody.


22/57

Proposal of Treatment by Patient

Actively suggesting treatments, interventions,

medications, or other alternative approaches to

their care was reported by 15 of the 18

respondents


23/57

Proposal of Treatment by Patient

But I go, if I hear anything, you know--I

always go to them and talk to them. I don't

care what they say but I tell them if I heard

this new--I heard this. And you know, theylisten ... I don't know anything about the

heart, but if I hear anything that, you know,

that's new, I will ask the doctor too.


24/57

Confrontation of System - Active

Self-Advocacy

Confronting providers either by declining a

particular activity, treatment, intervention,

or by insisting that treatments be carried

out in what they considered the "correct"manner


25/57

Confrontation of System-Active

Self-Advocacy I watch them like a hawk. This one nurse I don't

particularly like went--I felt like she needed to

change her gloves before she came to me and

she'd emptied all the garbage cans, andgranted, all she had to do was tape me up, but I

still didn't want her around me if she'd been

emptying the garbage cans. And that takes a lot

of--"oh god, how do I say it? Do I say it? Do Isay it?" And so I say, "I don't think you should be

touching me with it."


26/57

Independent Adoption of Treatment

/ Use of Alternative Therapies

When unable to obtain the

treatments they felt they needed

from health care providers via anyof the methods already

discussed, patients chose to be

non - compliant with prescribed

therapies or go outside of thesystem to get satisfaction


27/57

Independent Adoption of Treatment

/ Use of Alternative Therapies

I started tapering off my blood pressure

meds myself and I would skip days so I

was taking it every other day instead of

every day. And my blood pressure stayedfine on the machine, so then I stopped

taking it completely and my blood pressure

behaved. So then I told my doctor about itinstead of telling him ahead of time


28/57

Discussion

HealthcareSystem

Patient

Self

Mgt

Health -care

Provider


29/57

Discussion

Nursing Tenet of

Patient Dependency

& Passivity

Strict Patient

Compliance

Clinic Atmosphere

Of Dependency

& Passivity

BARRIER


30/57

Conclusion: Nursing Implications

SELFIMPRESSION

UNMASK

THE TRUTH


31/57


SELECTIVE REPORTING

MANAGEMENTSYMPTOM TRIAGE &

BASIC SELF CARE


32/57


USE OF ALTERNATIVE

THERAPIES

OPEN COMMUNCATION

TIME & INFORMATION


33/57

SELF-MANAGEMENT KNOWLEDGE AND

FUNCTIONING AND WEIL-BEING OF

PATIENTS ON HEMODIALYSIS

Roberta Braun Curtin, Dara C. Bultman Sitter

Dorian Schatell, and Betty A, Chewning


34/57

Goal

Describe the association between

hemodialysis patient self-management

behaviors and functioning and well-being


35/57

Objectives

List self-management behaviors used by

patients on hemodialysis.

Compare and contrast protective/proactive

self-management strategies & cooperative

/ participatory self-management strategies.

Discuss the significance of patient

knowledge and physical and mentalfunctioning.


36/57

Method

Sample

372 patients from 15 facilities

At least 1 year in dialysis and 18 y/o


37/57

Self Management Strategies

Suggestion of Treatment to Provider

Adoption of Alternative Therapies to

Manage Health Issues

Selective Symptom Management

Assertive Self Advocacy

Impression Management Oversight of Care


38/57

Other Points of Interest

Sources of Information Acquisition

Participation in Self Care Activities during

Hemodialysis

Time on Dialysis


39/57

Results


40/57

Results


41/57

Results


42/57

Results


43/57

Results


44/57

Results


45/57

Results


46/57

Results


47/57

Results


48/57

Results


49/57

Results


50/57

Discussion

The ability to measure self-

management strategies among

patients on hemodialysis is an

important first step towardassessing their involvement in

their own care and treatment.

The logical next step is to designand implement effective

interventions to improve patient

outcomes.


51/57

Discussion

Cooperative/participatory type of self

management is both positively associated

with physical functioning and is among the

more often performed self-managementactivities.


52/57

Discussion

An equally important finding has to do with

the protective/proactive self-management

strategies that were less utilized.


53/57

Discussion

The five topic categories queried clearly

relevant to patients on hemodialysis.

Anemia

Diet and Medication

Kidney Function

Dialysis Treatment

Rehabilitation


54/57

Practical Nursing Implications

Self Management Activity Survey is useful in

identifying and characterizing the kinds of

strategies chronic kidney disease (CKD) patients

are currently employing in their attempts to selfmanage their care and to interact productively

with their care providers


55/57


Educational and

counseling interventions

might be initiated to help

CKD patients improve theirapproaches to self

management and to

minimize their need forprotective/proactive

strategies


56/57


The association bet.participatory strategies for self-

management & better

functioning and those between

the more protective / proactivestrategies & poorer functioning

underscore the importance of

good communication between

patients and the health careteam on self management

behaviors, physical and mental

health functioning overall.


57/57

--NISAN MANAUIS

Date post:	04-Apr-2018
Category:	Documents
Upload:	harby-ongbay-abellanosa
View:	219 times
Download:	0 times

Self Management Strategies of Patients on Long Term Dialysis

Documents