1. Self Management Goal Setting Orientation for HRCH Staff

2. These slides were adapted from a program offered by Connie Davis,FNP-from one of the Learning Sessions. Additional slide programs on SMG setting are available on our Intranet site for a variety of conditions..

3. Chronic Care Model YOU ARE HERE

4. Self-Management Tasks Take care of the condition Adjust daily life Manage emotions, including future concerns Based on work by Clark, Corbin, Strauss and Glaser

5. Starting the conversation Is there anything you have thought of that you might do to improve your health? Can you think of what you would like to work on first? What first step might you be able to take in helping to improve your health?

6. Three things to keep in mind Importance Readiness Confidence Other barriers which might exist in the patient’s life

7. Importance Prioritize goals Use an importance ruler

8. Importance Ruler 1 2 3 4 5 6 7 8 9 10 Not Unsure Somewhat Very Important Important Important

9. Readiness: Stages of Change Pre-contemplation Contemplation Preparation Action Maintenance Termination Prochaska and DiClemente

10. Readiness Ruler 1 2 3 4 5 6 7 8 9 10 Not Unsure Somewhat Very Ready Ready Ready & Trying

11. Matching Intervention to Stage NOT READY: Pre-contemplation Contemplation Raise awareness Provide personalized information Indicate readiness to help Identify benefits of change Praise previous efforts

12. Matching Intervention to Stage READY Preparation Action Increase confidence Develop action plan Problem-solve barriers Identify small steps taken Reward small changes made Encourage support networks

13. Self-efficacy One’s belief that he/she can accomplish a specific behavior or cognitive state. Bandura

14. Self-efficacy is enhanced through Skills mastery Modeling Reinterpreting symptoms Persuasion

15. Confidence Ruler 1 2 3 4 5 6 7 8 9 10 Not Unsure Somewhat Very ConfidentConfident Confident

16. Principles of Motivational Interviewing Express Empathy Develop Discrepancy Avoid Argumentation Roll with Resistance Support Self-Efficacy Miller and Rolnick

17. Express Empathy Acceptance facilitates change Skillful reflective listening is fundamental Ambivalence is normal

18. Avoid Argumentation Resistance is a signal to change strategies Labeling is unnecessary Arguing is counterproductive Client’s attitudes are shaped by their words, not yours

19. Roll with Resistance Use momentum to your advantage Shift perceptions Invite new perspectives, do not impose them Clients are a valuable resource for finding solutions to problems

20. Support Self-efficacy Belief that change is possible is an important motivator Client is responsible for choosing and carrying out actions to change Hope lies in range of alternative approaches available

21. Making an action plan Something you WANT to do Reasonable Describes what, where, when, how, how much Confidence level greater than 7 Follow-up Plan Lorig, Chronic Disease Self-Management Program

22. Problem-solving Identify the problem List all possible solutions Pick one and try it If it doesn’t work, try another If that doesn’t work, contact resources If that doesn’t work, problem may not be solvable now. Lorig, Chronic Disease Self-Management Program

23. Four Step Self-Management Explore the Problem or Issue “What is your concern about ____?” Clarify Feeling and Meaning “Are you feeling (angry, sad, frustrated) because of _____?” Develop a Goal and Start a Plan “Where would you like to be regarding ___ (3 months, 1 year) from now? What are options? What are barriers? Who could help?” Commit to Action “What are you going to do? When? How will you know you’ve succeeded? How confident are you?” Anderson and Funnel

24. Some background for Diabetes SMG Setting Hemoglobin A1C-the average glucose level for the last three months. It should be 7 or lower. If a patient begins at 12-their first goal may be 10..It takes around three months to impact this #.

25. More Background…. Before people take aspirin, they need to check with their provider

26. More background

27. Process for completing the forms Complete the form by checking the appropriate section on the form Sign the form and give a copy to the patient and one is inserted in the chart in the progress notes. There may be a future change in where the form is placed but for now, it is kept in the chart with the date it was done. Remind the patient that each time they come in for a visit, they will be asked by the provider how they are doing on their goal/s.

28. Using the forms Schedule a separate time for patients to complete this form with either the Health Educator; CDE; Nurse or AMERICORP Review the guidelines with the patient/family members. Be mindful of patients who have poor/no reading ability Keep in mind that some of the terms on the form need to be explained to the patients. Emphasize that these are not the only choices, there are blank spaces for patients to fill in anything which they may want to work on. It may not be something on the list.. Remember that you, the counselor, are only acting as a facilitator-let the patient determine what they focus on!

29. Practice the new skill Learning how to work with patients on developing SMGs takes some practice..Do not be discouraged if this takes some time…You may find that some patients are more challenging than others…Don’t give up, it will get easier as you do more of these sessions… Now, let’s practice your skills…Each person will need to pair up with a partner..One will be a patient and the other one will be the counselor…Afterward, we will switch and let you try to be the other person. Patients need to get clearance from their provider before engaging in exercise. Building up slowly is very important. Provide the appropriate resource lists for anything the patient is working on (ie. Smoking cessation program) The plan for Glucose testing is determined with the provider and patient. There may be specific needs at different times. If you are not sure about a clinical question, please ask the CDE or e mail Kathy Brieger. Let the patient know that you will get back to them…and do it as soon as possible.. Quitting smoking is extremely important. It can impact all major organ systems. Lipid tests need to be done annually A foot exam needs to be done annually An eye exam needs to be done annually Nutrition goals can be done with the RD and patient